# IntERact: Preventing Risky Firearm Behaviors Among Urban Youth Seeking Emergency Department Care

> **NIH ALLCDC R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2022 · $649,997

## Abstract

Firearms are the leading cause of death for U.S. youth. National organizations have highlighted the need for
prevention programs focused on decreasing interpersonal firearm violence. Urban EDs are an underutilized
setting for such programs, as they provide access to at-risk youth engaged in risky firearm behaviors (RFBs).
Intervening early with youth in this setting may decrease subsequent firearm violence and related
consequences. Despite the importance of this problem, evidence-based interventions to decrease RFBs are
lacking. Given our prior work showing that single session ED interventions (i.e., SafERteens) integrating
motivational interviewing (MI) and cognitive behavioral therapy (CBT) are efficacious reducing violence among
lower risk youth, the application of this behavioral therapy, expanded to address greater problem severity over
multiple sessions and enhanced by adding care management (CM), represents a potentially efficacious
approach for decreasing RFBs. Our pilot of this integrated approach was found to be feasible among high-risk
youth engaged in violence. Utilizing centralized remote therapy to address identified in-person therapy barriers
(e.g., transportation) and supporting the intervention with an APP may be a promising way of enhancing
session attendance, intervention dose, and engagement, while considering future implementation issues. This
proposal addresses Objective Two (Funding Option B) of the CDC NOFO as it focuses on collecting new
data on strategies to decrease firearm violence. We propose a 2-arm randomized control trial (RCT) enrolling
ED youth (age 16-24) reporting past 3-month firearm carriage and smartphone ownership, randomizing them
to either: (1) IntERact; or, (2) an enhanced usual care + assessment (EUC+A) condition where they will receive
a resource brochure and daily assessments. The IntERact condition will receive: (1) 6 remotely delivered
behavioral therapy sessions integrating MI, CBT, and CM; and, (2) an smartphone APP supporting the therapy
by facilitating therapist contact, conducting automated daily assessments, delivering between session tailored
MI/CBT content, delivering just-in-time GPS-triggered notifications upon entry into high-risk locations, and
aiding with CM resources. Specific aims are: (1) To conduct an RCT enrolling 400 eligible youth (200/group)
to examine IntERact efficacy; and, (2) To conduct a cost evaluation, comparing resource costs for intervention
delivery to costs for outcomes averted. As a secondary aim, we will examine mediators/moderators of
efficacy. Outcomes will be assessed at 3- and 6-months. Primary outcomes include: (1) risky firearm
behaviors (RFBs); (2) firearm carriage; and, (3) violence (i.e., aggression; victimization; consequences).
Secondary Outcomes include: (1) ED visits for violent injury (e.g., firearm injuries); (2) substance use; (3)
mental health symptoms (i.e., anxiety, depression, PTSD); and, (4) criminal justice involvement (i.e., arrests).
Given el...

## Key facts

- **NIH application ID:** 10438200
- **Project number:** 5R01CE003303-03
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Patrick M. Carter
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2022
- **Award amount:** $649,997
- **Award type:** 5
- **Project period:** 2020-09-30 → 2023-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10438200

## Citation

> US National Institutes of Health, RePORTER application 10438200, IntERact: Preventing Risky Firearm Behaviors Among Urban Youth Seeking Emergency Department Care (5R01CE003303-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10438200. Licensed CC0.

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