Since 2020, firearms have been the leading cause of death in children aged one through 19 in the United States. Reports show significant declines in violent crime and homicides in Philadelphia since the pandemic, though gun-related incidents remain a concern. According to Chalkbeat Philadelphia’s analysis, the percentage of children who are injured by gunfire but not killed is still rising.

While some might associate gun deaths in adolescence with mass shootings and street violence, the truth is these deaths all too often occur from improper handling or storage of a firearm in the home.

“Secure storage can keep kids safe from the major ways that they are at risk from firearm injury and death,” says Dorothy Novick, primary care pediatrician at Children’s Hospital of Philadelphia (CHOP) and Director of the Center for Violence Prevention’s Gun Safety Program. Data, she says, shows that among young firearm deaths, 32 percent are from suicide and 5 percent are from unintentional shootings. “And these tragedies usually involve a family member’s gun.”

She also noted that, while mass shootings make up a very small percentage of these deaths, 80 percent of youth who commit mass shootings still obtain their firearms from a family member. That’s right on par with the rate of teen suicide, in which 79 percent is carried out with a firearm belonging to a family member.

That common thread — access to a firearm in the home or a relative’s home — sparked a question in the CHOP community: Was there a way to promote firearm safety education to both the children and their guardians, and prevent suicide or unintentional shootings?

Locked and unloaded

Gun ownership remains a hot button topic in the United States, with extreme views falling on both ends of the political spectrum. That said, Pew research does show that 58 percent of U.S. adults favor stricter gun laws, with a broader partisan agreement on restricting access for those with mental illness and increasing the minimum buying age to 21 years old.

The CHOP team knew an effective gun safety program that keeps kids safe had to come from a non-judgmental, evidence-based approach. With 6.7 million children and teens nationwide living in homes with at least one loaded, unlocked gun, it was important to fully grasp the reality of what leads to these tragic incidents — and how best to promote prevention.

“Safe firearm storage is one area where healthcare providers can make a meaningful, measurable difference, helping families take steps that protect children and save lives.”

Piloted by Joel Fein, co-director of the CHOP Center for Violence Prevention (CVP) and a physician in the emergency department, the research reviewed pediatric practices and community-based safety discussions on firearm safety. The researchers concluded that counseling alone did not yield the same uptake and interest as safety counseling combined with access to a safe storage device.

CHOP launched its Gun Safety Program within CVP in 2019, with a clear goal in mind: Keep kids safe by educating their caregivers about how to safely store firearms at home to prevent children from accessing them. The program offers participants one-on-one counseling on best practices for securing weapons in the home, as well as access to free cable locks to bring home and attach to any firearms that may already be there.

Novick joined the team in 2019: “This was a true call to action for us as pediatric healthcare providers. My role began when we adapted [the established program from] the emergency department for implementation in primary care, where I am a practicing pediatrician,” he says.

Now, when a patient comes in for a routine well visit, pediatricians and other care providers trained in firearm safety counseling educate parents and guardians on the topic, while also providing access to a locking device. It is the parents’ decision to receive the device.

In addition, physicians and nurses trained in firearm safety counseling can offer parents and guardians nonjudgmental guidance for discussing gun safety with relatives and friends. These conversations can help families ask about safe storage in homes their children visit, reducing the risk of unintentional injury or other firearm-related tragedies.

Learning and growing

Seven years in, the team feels just as passionate about the program as it did when it first started.

“CHOP’s firearm safety program is intentionally designed to reach families across the full continuum of care. While programs at other institutions may be limited to a single setting, such as the emergency department or a primary care clinic, CHOP has built a standardized, institution-wide approach grounded in evidence-based best practices,” says Novick.

“At the same time, the program is flexible enough to integrate seamlessly into workflows across a wide range of clinical settings, helping ensure that more families receive consistent, meaningful firearm-safety guidance.”

This work has received national attention as well. A team of researchers at CHOP and the University of Pennsylvania, including members of the Gun Safety Program, received a $3.2 million grant from the National Institutes of Health in 2024 to study implementation of similar programming in the inpatient setting. Since the Gun Safety Program is funded through CHOP, as well as grants and fundraising efforts, services and resources are provided to families at no cost.

This is what allows the team to both acquire and hand out the cable locks during firearm safety counseling. It also enables them to be forward-thinking in their efforts. In 2025, the program expanded to all 30 of CHOP’s primary care practices, which Novick says is a direct result of five to six years of testing and iterative improvements to how the information is relayed. Additionally, the team regularly checks in with other institutions across the country to see how they are approaching firearm safety counseling and sharing success stories along the way.

“There are many institutions across the country that are implementing similar programs, and we really are continually learning from one another, because this is a relatively new type of program that we’re integrating into healthcare,” Novick says.

“Secure storage can keep kids safe from the major ways that they are at risk from firearm injury and death.” — Dorothy Novick

While it is hard to quantify a nebulous number of tragedies avoided thanks to the counseling, the team does check in with the families that have participated in the firearm safety program in an effort to understand impact. Preliminary data from a recent CHOP internal primary care survey of about 140 families revealed that two weeks after receiving safe storage resources, 82 percent of families had shared the gun safety information they received with others; 52 percent of families were using the lock they received to secure a firearm; 32 percent had given the lock to someone else to secure a firearm; and 10 percent had removed a firearm from the home.

As another indicator of success, “We have delivered cable locks at over 23,000 clinical encounters, starting in 2021, and have educated over 1,100 healthcare providers in offering safe storage counseling and resources,” says Novick.

Further, CHOP’s program extends beyond hospital walls, connecting with the community on firearm safety through similar lock distribution programs.

“We’ve trained CHOP employees as volunteers to deliver these same resources out at community events, like block fairs, health fairs, sporting events and religious institutions’ events,” shares Novick.

These additional efforts have delivered over 3,000 locks to the community at large. The City of Philadelphia has also seen a 22 percent decrease in gun-related homicides compared to 2025, as of September 21, 2026. Although this change cannot be directly attributed to CHOP’s counseling efforts, it reflects a broader citywide shift toward firearm safety to which CHOP is contributing.

Never resting on one’s laurels

Expansion is always a key part of how CHOP thinks about its firearm safety program. Currently, it’s looking to continue growing beyond the current programming, which spans nine departments and 45 locations, starting with its Department of Rehabilitation Medicine and 11 subspecialty care centers across three states.

“This is so we can bring these resources to the places where so many children and families live and reduce the barrier to access that they might otherwise have of needing to physically come to CHOP,” Novick explains.

Looking ahead, Novick hopes to provide gun safes to families in addition to the cable locks CHOP already distributes. The program is exploring the feasibility and potential effectiveness of providing gun safes, particularly for children and adolescents at greatest risk.

“We’re hoping that by offering gun safes in addition to cable locks, we can help the children and teens who are experiencing mental health emergencies,” Novick says. The rate of teen suicide in the U.S. remains the number two cause of death in children aged 10 to 14 and number three for those in the 15 to 24 age bracket.

“Safes are probably the most preferred method of firearm storage among firearm owners. But they are far more expensive and quite a bit larger,” she adds. This potential branch of the program would prioritize youth at the highest risk.

“As pediatric healthcare providers, we are driven to prevent firearm injuries and deaths before they occur,” Novick says. “Safe firearm storage is one area where healthcare providers can make a meaningful, measurable difference, helping families take steps that protect children and save lives.”

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