The Social Workers Addressing Firearms Risk (SAFR) Intervention: A Pilot Randomized Controlled Trial

Background and Purpose: Firearm violence is a major public health problem in the United States: it is the number one cause of death for children, and the number one cause of death for African American males aged 15-44 (CDC, 2025). Firearms account for more than half of all suicide deaths. Social workers already interface with many individuals at risk of firearm violence. Yet, there is scant evidence regarding social workers and firearm prevention, and to our knowledge, no training programs for practitioners. The purpose of our study was to evaluate the first-ever training program, Social Workers Addressing Firearm Risk (SAFR). SAFR is a fully-online, self-paced training that provides social workers with the necessary information and skills to recognize and respond to firearm violence risks among their clients. It was developed after in-depth reviews of current literature on firearm violence prevention and in collaboration with multiple researchers and experts across the United States.

Methods: We conducted a preliminary evaluation of the efficacy of SAFR using a randomized controlled trial. We assessed prior training experiences as well as knowledge, attitudes, confidence, and behavioral interventions with clients in relation to firearms at baseline, post-test, and follow-up. We recruited practicing social workers across New York State to complete baseline measures, then randomized to either the SAFR intervention or a waitlist control group. Surveys were administered via the REDCap platform, and the SAFR course was provided as online continuing education. Analyses included descriptive statistics and a series of one-way between-subjects analyses of co-variance (ANCOVAs) to determine statistically significant differences based on randomization and intent-to-treat principles.

Results: A total of 155 social worker participants were screened between September to November 2023. After exclusions, 142 were eligible, and 112 participants consented to randomization. The overall sample was largely female (70.4%), and the majority were MSWs (78.9%). The majority were of white race/ethnicity (74.6%), followed by 11.3% Black/African American, 3.5% Asian, 3.5% mixed race, and 4.9% Hispanic. The average age was 40.5 years and the average number of years in practice was 12.7. There were statistically significant main effects of SAFR for knowledge, attitudes, and confidence either from baseline to post-test or from baseline to follow-up, and a statistically significant effect for behaviors with clients from baseline to follow-up. Qualitative feedback suggested satisfaction with SAFR with some suggestions for improvement.

Conclusions and Implications: An urgent need to develop and test trainings for social workers around firearm violence was identified in the recent Prevent Gun Violence Grand Challenge for Social Workers. The SAFR intervention fills that gap, and these results suggest it was successful in increasing knowledge, attitudes, and confidence about working with clients in relation to firearms, and somewhat successful in increasing behaviors with clients at follow-up. These results will be used to design a fully powered RCT to further establish its efficacy and to eventually design effectiveness trials. SAFR carries the potential to impact public health by improving social worker knowledge to enable them to directly address firearm violence and promote firearm safety with high-risk populations.