PROJECT SUMMARY Universal firearm injury and violence prevention counseling of patients has been recommended by multiple national organizations for over a decade, yet clinicians rarely deliver this counseling. Implementation barriers must be addressed to effectively deliver firearm related injury prevention programs. The research team has demonstrated success in the implementation and sustainability of alcohol screening, brief intervention and referral to treatment protocols in two federally funded multi-site trials. The team also has expertise in clinically- based strategies for firearm injury prevention and educational program development. We will apply our implementation science and subject matter expertise to implement a universal firearm injury prevention initiative in a phased approach: first at a single, urban level 1 trauma center and second at a cohort of 4 trauma centers serving urban, suburban, and rural communities following a stepped-wedge approach. All sites have a successful history of prior collaboration through the Johns Hopkins Clinical Research Network. Our goal is to demonstrate best practices for trauma center-based firearm injury prevention strategies that promote safe storage practices and reduce firearm related injury and death. This proposal, submitted in response to PAR- 23-066, will refine a feasible, comprehensive training strategy for improving the implementation of a universal firearm injury prevention program, ACTFAST (Adopting Comprehensive Training for FireArm Safety in Trauma centers), and then study its implementation and effectiveness. In Phase 1 we will: (Primary Aim 1) demonstrate feasibility of a program for adoption, implementation, and maintenance of a universal firearm injury prevention intervention within one level 1 trauma center; and (Secondary Aim 1) evaluate trauma center clinicians’ firearm injury prevention knowledge and confidence in delivering a firearm injury prevention intervention. In Phase 2, we aim to: (Primary Aim 2) increase the adoption, implementation, and maintenance of a universal firearm injury prevention intervention within four participating trauma centers in Johns Hopkins Medicine and the Clinical Research Network, an alliance of academic and community hospitals in the mid-Atlantic states; (Primary Aim 3) assess firearm injury prevention knowledge, attitudes, and safe storage practices among trauma patients treated within participating trauma centers; and (Secondary Aim 2) evaluate trauma center clinicians’ firearm injury prevention knowledge and confidence in delivering a firearm injury prevention intervention. Using the RE-AIM methodology, we will evaluate our comprehensive strategy across the domains of adoption, implementation, and maintenance at the institutional level. We will measure clinician firearm safety knowledge and confidence in delivering firearm prevention counseling after participation in the clinician training program as measured by pre and post training surveys. ...