0027 Extreme risk protection orders: understanding the role of health professionals

Statement of purpose Extreme Risk Protection Orders (ERPO) allow a petitioner to file for a civil order to temporarily reduce access to firearms among individuals (‘respondents’) at extreme risk of harming themselves, others, or both. Although unable to file ERPOs themselves in most states, social workers, and mental health and healthcare providers may play a pivotal role in the ERPO process by recommending a petitioner (e.g. family member or law enforcement) initiate the process. We describe the process of filing an ERPO when a healthcare, mental health, or social service professional contacts an ERPO petitioner in a state where they cannot file themselves. Methods/Approach Court documents of 24 ERPO respondents in Washington State between December 8th, 2016 and May 10th, 2019 were qualitatively analyzed. We constructed pen portraits from the documents and analyzed them using an inductive qualitative thematic approach informed by grounded theory and constant comparative method. Member checking with mental health professionals and law enforcement officers complemented findings. Results Respondents were deemed extreme risk of harm to themselves (n=10), others (n=5), or both (n=9). Professionals included respondents’ established mental health providers (n=11), crisis line workers (n=7), and medical staff in emergency settings (n=6). Themes included factors influencing the process by which each professional evaluated dangerous behaviors, factors considered during assessment, and factors influencing interpretation of behaviors of the respondent during a crisis. These in turn influenced the outcome of the crisis event that led to an ERPO being filed. Conclusions Each professional group differed in their approach to risk assessment of potentially dangerous behaviors. Strategies to better coordinate and align approaches may increase the effectiveness and reach of ERPO. Significance Understanding the process by which a threatening behavior reported to a health professional leads to an ERPO filing may identify process improvements crucial to ensuring reducing access to firearms.