Welcome. My name is Rebecca Williams and I'm the Director of Academic Innovation and Outreach at the Johns Hopkins Center for Gun Policy and Research. For the next hour, will we be having a live discussion on how extreme risk protection order or ERPO laws can save lives as part of the online learning event happening right now. ERPO as a civil approach to gun violence prevention Teach-out. For those who are just joining us today, maybe you haven't yet had a chance to log on to Coursera and enrolling our teach-out, I'll begin with a bit of background to orient our discussion. ERPO laws, as I mentioned, the extreme risk protection order laws, are civil orders that enable the temporary removal of firearms or a person who is behaving dangerously and at risk of committing violence against themselves or others. This innovative lifesaving policy was first developed by the Consortium for Risk-Based Firearm Policy that convened back in 2013 after the horrific shooting in Newtown, Connecticut. Today we now have extreme risk laws in 19 states plus the District of Columbia. These policies have shown promise as a tool to prevent suicides as well as mass shootings and interpersonal violence. I'm joined here today by the three instructors that are leading our ERPO civil approach to gun violence prevention teach-out. They will be responding directly to questions that we received from the general public, as well as those that have come up in the conversations learners are having right now in the teach-out. If you haven't already, please join the discussion and enroll in our teach-out by going to Coursera.org/learn/ERPO, if you'd like to enroll for free. We will also be sure to share this link later on and have a recording of this live discussion up there for you to view. I'd like to begin introducing our instructors. First, we have Shannon Frattaroli. She is Associate Professor at the Johns Hopkins Bloomberg School of Public Health, and she's also one of our core faculty members in the Center for Gun Policy and Research. I'm also joined by Josh Horowitz, who is the Executive Director of the Coalition to stop gun violence, as well as the educational funder to stop gun violence, and he's also an associate faculty member with the Johns Hopkins Bloomberg School of Public Health. Lastly, we're joined by Dr. Katherine Hoopes, who is an assistant professor of pediatric critical care medicine at the Johns Hopkins University School of Medicine. She's also a core faculty member in our Center for Gun Policy and Research. For those of you who are just joining us those are just as a refresher, the teach-out brings together these instructors, as well as a broader team of public health policy and medical experts. Who provide educational information about ERPO laws, what they are, what states have them, how they work. We hear from the voices of clinicians, law enforcement and community members about why ERPOs are important tool within the civil justice system. First, I'd like to just jump right in and begin with our first question, and I'd like to begin about why this topic is important right now. We intentionally decided to launch this teach-out and schedule this Webinar today on October 30th, 2020, to spark conversation and spread awareness around ERPOs to coincide with the legislative session. That states with ERPO laws already on the books could further develop and improve their policies. Also, so that new states might adopt ERPOs who didn't have them before. I think Josh and Shannon, if you could both maybe address this question, I was hoping you could share a little bit more with us, why, Josh in particular, is this so important for advocacy and collective action right now this current time? And then Shannon perhaps some follow up on the implementation process, and why this time is so important. Well, thanks for having me. It's great to be here. I appreciate it, and as you mentioned, it's October 30th, it's right before a national elections, also right before lots of state elections. Right after the elections in November is when really the policy making discussion gets going and state legislatures, and at the federal government. The committee's started to take shape. They'll be people who newly elected and the committees and the leadership will all take shape and advocates will come and start having those preliminary discussions about what we'd like to see in the next term, what didn't get to last year or how can this law be improved? It's the time a lot of state legislative sessions open up in January. It's too late if you're just starting to introduce an idea in January, or when it starts in February. Now's the time to introduce an idea. Now's the time to think about needed policy change. Now's the time to think about how our public health remedies impact the legislative process and policymakers. Also, before the legislative session start is a really good time to have the opportunity to sit down with a policymaker and say, "I'd like to see this. Here's why." It's a good time to get a coalition together to be able to come and sit with a lawmaker before they get right in the middle of the legislation session. For those who have never lobbied a state legislature, I highly recommend it, it is really participatory. You get to really talk to people, you get to really get involved. But state legislators unlike Congress are not highly staffed, they do a lot of work themselves. So you want to make sure that when the windows open, which is November and December, that you're there talking to the legislators. Extreme risk protection orders are policies and laws that have been spreading around the country, everybody is taking notice. I think it's a really good opportunity to take what you've learned in this class, sit down with a legislator and see what you can do to influence policy for the better. Thanks Josh. Then just a little bit Shannon, if you could share on the implementation process of RPOs and what does this time window we have right now in anticipation of the legislative session offer as far as implementation. Yeah, sure. Thanks Rebecca. Just listening to Josh reminded me of how critical and timely and really on the ground useful his advocacy section of this teach-out really are. For more advice and skill building around that, the teach-out really has some good elements. But one of the things that we always like to talk about with regard to our folk policy and actually with regard to policies in general, is that we need to be paying attention to the policies that we enact as Josh said, and the time is coming up in most states to be paying attention to that. But we also need to be mindful of how these laws are being implemented. Oftentimes the decisions that legislators make with regard to how those laws are written and structured, impacts the implementation efforts in important ways. If you have an RPO law now in your state, if you don't have an RPO law and are beginning those discussions, one thing that we would encourage you to do, is to be talking with the people who are going to be responsible for carrying out RPOs, so those are law enforcement, those are the courts. If you are going to have a law that includes clinicians to talk to those professional societies and really get a sense for what they are going to need from the law in order to do implementation well. Again, if you already have a law on the books, you can have those conversations and go back to your legislators and talk about improvements to the law that might need to be made, in order to facilitate implementation and assure that this good policy idea is really coming to life in your communities. Great, thank you Shannon. That gets me. I'm glad that you mentioned the different types of people in our communities that we could be talking to about RPO laws. This next question, I think that getting into the nitty-gritty of how RPO laws work, I would like to first direct it to Katherine and for a clinical response, but then also I think Shannon and Josh you can definitely chime in here. There's a lot of questions on the discussion forum in the teach-out about these RPO laws. Well, what's really the benefit of having an RPO law when you temporarily remove a firearm from someone, but there's another underlying clinical health-oriented issue happening in their lives? What's the benefit of just taking away a firearm, but then not actually addressing some other issue in this person's life? I was hoping you could tell us a little bit about clinically, what's the benefit of having the clinician petitioner that provision as part of the RPO law? Then what is the follow-up care that can be possible for those to really make sure that they get help, like learners are asking? It's not just removing the firearm, but what else can be done to make sure that this person is well and is healthy? Thanks Rebecca so much for the question. RPOs are an important means of reducing risk of suicide or violence, but they're only part of the necessary response to these crisis. An RPO removing firearms and access to the most lethal means best serves people at risk by being paired with comprehensive psycho-social support through a multi-disciplinary approach that includes not only law enforcement, but also, of course, social work, mental health, and medical professionals, all providing comprehensive care for that individual and often the entire family. As far as clinician petitioners go in Maryland, for example, eligible petitioners include any physician and a subset of mental health professionals including nurses, advanced practitioners, social workers, therapists and health officers. In DC and Hawaii, the other places with clinician petition, there'd a different cohort of medical professionals, including physicians and psychologists in DC; physicians, and advanced practitioners, and psychologists in Hawaii. Health professionals especially our primary care providers and all of our mental health colleagues have a special point of contact and a unique relationship with their patients, and all are well-poised to assess risk, but then also follow up with those patients and their families to continue to mitigate risk. Great. Thank you. And then Shannon, I think something that would be helpful, I know of the case in King County, Washington when the ERPO law was implemented. It's almost as if the implementation of the ERPO law itself sort of prompted some of this very specific discussion geared towards, how do we follow up with these individuals once an ERPO has been petitioned for? So If you could maybe share a little bit about how kind of the very implementation process itself can also lend to creating a better system of follow-up. Sure. And so what we're seeing in King County, what we're seeing in counties in Florida, here in Maryland, where we're dialing in, from at least some of us. There is our systems of implementation that are quite comprehensive and really responsive to not only that individual's needs, but as Katherine said, oftentimes they're looking at the family and the larger community to really understand why that person is in crisis and what systems of support are available to help that person get to a better, healthier place and back to a contributing member of society. One of the things that is coming out as we understand more how these ERPOs are being used, is that they are oftentimes being used when someone is at risk of self-harm or suicide. You can imagine the difficult situation that comes up, and really the importance of involving clinical care when we see that someone is at risk of suicide, and then an ERPO is used to remove lethal means from that situation. And so having those implementation infrastructures in place, where the people who are responding understand the resources that are available and have the tools and ability and training to respond in a comprehensive way that's really going to get at the root of the problem and going to point that person and their support network towards a solution. Thank you. Josh, if you could talk a little bit about what else have we learned as far as advocating on behalf of ERPOs, and advocating for the best provisions to have in ERPO laws and policies. What have we learned as far as the way that we can advocate in some places like Connecticut where this conversation started. What have we learned about throughout follow-up care with ERPO implementation? Well, I think one of the things we've learned is that ERPO can definitely be a gateway to behavioral health care. In the Connecticut study about a third of the people who were subject to an ERPO order or responding to an ERPO order, in fact, did go on to get care, I think in the public behavioral health system. It's an important tool not just to remove the firearm, which is important, but it often can bring attention, it can bring services. One of the things that we think is very important is to make sure that this is just a burden that's not falling on the states, because all these types of interventions can be expensive. And so, one of the things that I've been doing is really trying to convince Congress and I hope I'll be successful next year, to convince Congress to put money into the system so that when a farm is removed through a state ERPO proceeding, that there are resources there available, whether it's treatment, whether it's therapy, whether it's housing support. You think about risks of suicide. I think it's very important not just to confine that to the mental health arena. I think it's important to understand that unemployment and lack of housing, these are things that can contribute to risk and contribute to people in crisis. I think having these types of supports both in the behavioral health care system, different therapy sessions, but also for basic human needs can make a big difference here. I'm very hopeful that we'll be able to convince Congress to really put some money aside for these states so that when they issue an ERPO, the people who are subject to the order have the services and the therapies and there's the wraparound services that they need to succeed while they're on this time out. And so, I think that's something that's very important. If states can provide that, that's great. We of course encourage that. But we also want the federal government to get into a game on this and provide those types of supports. Thank you. I'm glad you brought that up, especially just thinking about ERPOs right now in the time of a pandemic. That brought me to be curious and then so as far as getting support from Congress, especially at a time when people are more isolated, we have higher rates of unemployment People are inside of their homes and we're worried about access to firearms or any lethal means. Do you think that that's an opportunity as far as states to be incentivized by Congress to get funding for RPO policies and what can Congress do to basically incentivize states to want to have more RPOs, use them as a tool, and how does that coincide with the environment we find ourselves in right now, especially with this added layer of the COVID-19 pandemic? Well, that's back to me. I'm happy to jump in there. I do think that, one is to incentivize states, is to make sure that there's the money available that I just talked about, and so if you have RPO you'll get another bucket of resources. The other thing is that there's an opportunity to provide training. In addition to the resources, there are best practices out there. There are organizations including some folks at Hopkins and Shannon and others are very involved in this, we're involved in this, but making sure that there's adequate training. It's training for law enforcement, but it's also training for courts and for other advocates within the system. It's the ability to put together multidisciplinary teams so that when someone again, is responding a RPO case that they have the ability to access services, but also for the petitioners to make sure that they feel that they're protected. I think when you're thinking about in this time of COVID, there's a lot of stress out there. I think there's an opportunity to provide resources through the states to individuals, but also to provide training for the group of what I call system actors, the people who are engaged in implementing RPO, so that they're doing it in a way that makes sense, that benefits their community, that keeps both the petitioner and the respondent safe. Great. Thank you. I don't know if Katherine or Shannon, if you have anything you'd like to add to that? I agree with everything that Josh said and maybe I'll just add that, I think that we should not underestimate the enormity of the change that the RPO process brings with it and the importance of exactly what Josh was talking about, of having the training and infrastructure support. When we talk to law enforcement who are using RPO, oftentimes the reaction is with great excitement. They've never had the opportunity to engage upstream in preventive oriented interventions, and getting law enforcement, getting the courts to think about intervening with due process protections in place before violence happens, is a new way of thinking for law enforcement. Again, from the law enforcement people that we have worked with, they're very excited about this. This is an important tool that is responsive to the evidence. It meets a lot of people who are at risk where they're at. It's also quite timely given the times we're in and the conversations we're having about law enforcement reform. RPO is moving us in a new direction for law enforcement. We need to make sure that they are adequately trained and prepared and supported, to embrace this new role. Can I jump in there on the prepared side of this? Which is, RPO gives law enforcement the opportunity to think hard about what it means to remove a firearm and how to do it safely. What are the types of services? As Shannon said this actually gives a new opportunity for law enforcement to think about what prevention looks like, to think what public health looks like. It's not just about firearm removal. It's about creating a little more of a holistic situation, saying, "okay, if we're going to remove the firearm, how do we do it safely?." What type of behavioral health specialists do we need to have with us? What does this person need to succeed in this? It's not just let's go grab a gun, right? It's turning out to be much more than that and that's where the training and the best practices really can come in, about thinking about this is a public health upstream intervention that hopefully can be used before a crime gets committed, before a criminal record, and before we see some type of tragedy. We're hopeful as we start to analyze some of these cases and analyze best practices, that there's a lot of hopeful outcomes and new outcomes that we're starting to see with this, and that's exciting for us. Great. Thank you. I think there is this idea of best practices and opportunities for training and new models is of course something we think about in public health, and we realize that ERPO, the power of the policy it has for us to learn about the whole system actors, everyone's role. But there are a lot of questions from learners getting back to this other services. I think the lethality of access to firearms and what that means in terms of people's health and the potential harm they could do to themselves or others it's important to pull out as an evidence piece. We have some questions of, why don't we think about if they have access to medications? Or access to knives? Or other types of weapons that they could still very well attempt suicide or hurt themselves or others? What is the evidence behind really this idea of lethality and the firearms? If we could just point out for learners exactly why that is this key focus that we have with ERPOs. Yeah, sure. I can jump in. It's a great question and I'm really happy that learners are curious about this because it's something that often isn't understood in our culture. When we talk about lethality, let's take suicide, and again, most gun deaths in this country are actually by suicide. When we look at how suicide occurs, when someone attempts suicide with, let's say you mentioned pills Rebecca, those attempts are likely to result in death in about two percent of the cases. When we look at suicide attempts that use a firearm more than 90 percent of the time, that attempt will result in death. It's also important to know that most of the time for most people who attempt and survive a suicide, they will go on to die by other means. I think that there's a common perception in society that if someone has made a suicide attempt, that they're going to be determined to complete that but for the majority of cases, the evidence that we have, we know that means matter. ERPO provides a way, a tool for intervening to remove the most lethal means that we know are in play when it comes to suicide. We want to remove the firearm and allow that person to live a long and healthy life. I would throw a couple of resources out there. There's a report from the Consortium for Risk-Based Firearm Policy called Breaking Through Barriers, which shows how to do lethal means counseling for health care providers and continuing the health care providers, there's a new bullet called bulletmpoints.org, I think it's dot org might be dot com. But it is a new site for putting together resources for healthcare providers in lethal means safety counseling, and that's just such an important thing to do. We know the case fatality rate for firearms is so much higher, Shannon just talked about, so given the tools out there for health care providers and others to intervene with this and provide lethal means counseling is just so important. Great. Thank you. I will make sure that where this video is saved on the recording, on our [inaudible] that we have access to those sites and resources you just mentioned Josh. Which also makes me want to bring up another great resource, which is that the Consortium Risk-Based Firearm Policy just released a new report of recommendations this past week, all about ERPOs and what has been the process of implementation and best practices right now that we know of, the latest evidence. So I was hoping that Josh, you could talk a little bit about this report and some of the key highlights that these recommendations which again, this report will also be posted to the [inaudible] , you all can look at it. It's a really great resource. Then we'll go into some of these recommendations that I'd love to hear some of the clinical side too from Katherine and a little bit more about implementation from Shannon as well. Yeah, interesting. Shannon's a founding member of the Consortium, along with me and some other colleagues, and we started in 2013. We brought people together to examine the intersection of gun violence prevention and mental health. We did it in the wake of the shooting at Sandy Hook Elementary, which was so tragic. There was a lot of, at the time people saying, "Look, we just need to keep guns away from people with mental illness." We rejected that idea because the vast majority of people with mental illness are never going to be harmful to themselves or others. Instead, we focused on behavioral risk factors, especially acts or threats of violence, and there's some other factors that we looked at, and we decided that we needed to use a well established process. If we were going to remove firearms we needed to use a process that was well established and was not criminal, within the criminal justice system. We looked at domestic violence with [inaudible] , Shannon had a lot of deep background evaluating those programs, and we built a new civil restraining order similar to domestic violence, but just focused on firearms. That is where the extreme risk protection order came from. It has due process protection the same way domestic violence restraining order does. It's a civil process. It has the rights of reviews, you can get the order lifted by showing good cause, and going back to what I said a couple times, it's a civil order. The temporary order lasts up somewhere between 2-3 weeks in the court of permanent orders just a year order and it last for a year and you can appeal that. It's really targeted, just when we talked about, to get the most lethal means of debt out of someone's hands while there's risk. We developed that in 2013. We hoped that it would take off and something would happen with it. My work at the EdFund and others helped to the advocacy once we identified this new intervention. Two-state group had a precursor to this law, Connecticut and Indiana, and we were able to add 17 new states in the District of Columbia, all within the last five years. We developed this, we had some recommendations in our original consortium report. But in many ways, those are kind of bare-bones recommendations. After we've seen how implementations work and of course it gets implemented the law is different. In each state that does this, implementation is a little bit different and so we've got questions back to the consortium. Can you help us read through a couple or work through a couple of issues that you didn't address in the report. The biggest issue I think we get is health care providers. Why didn't you recommend healthcare providers at the beginning? One of the reasons we didn't, is because we didn't really have enough information. We had some conflicting thoughts about whether healthcare providers should be included. There are some healthcare providers who didn't want to be, some who did. As we've watched this over the last five years, we've come to more of a consensus among healthcare providers who have watched this, understand it as a civil order, and also understand that sometimes they are in a bit better position to intervene and for instance, law enforcement. Or they might not be family to pursue an order on behalf of someone who's at risk. Healthcare providers sometimes step into those situations. We decided after a lot of thought and a lot of consultation to add a license healthcare providers and I think it's very important, not just mental healthcare providers, but license health care providers. That includes for instance, pediatricians, emergency room doctors, and other license health professionals, because they may have opportunities to come in contact with people who need this, but it might not be part of the behavioral health system. That's something we thought was very important. Another piece that we want to add as we've seen, this is something that's come up repeatedly where the person at risk is a minor. They're living in a home with access to firearms. The question was, can a report be issued against? It can respond to a report being a minor and we looked at the evidence, we listened to our partners who said we need help with this issue. We decided after a lot of consultation that in fact, minors should be able to be responded in extremist protection order. There needs to be some special considerations and that we need to make sure that we do this thoughtfully. The ideas though is to have the parents secure their guns in their own home because there are times when a youth is at risk and the parents are not securing the gun. That's what that recommendation was all about and there's some other recommendations making sure that these orders get into the National Instant Check System so that when you do a background check, you can understand that they're there. There's also a recommendation about making sure that when law enforcement does go to retrieve a firearm, that there's trained professionals, there people with crisis intervention training, that they've thought through what they're doing that doesn't come with over too much force that people would think about it. There's a number of provisions in there that we spent the last year working through, and we believe that there well-thought out with consultation from the relevant groups. Shannon, I don't know if you want to add more. I know you've worked really hard on this report as well. I'm really proud of this report and the recommendations that we've come up with things. I know that report is now available and we'll make sure that learners have access to it through the teacher. Josh, the process that you described, I think really reflects well how important evidence is to the decisions that we make. As you said, back in 2013, when we first put together the original for [inaudible] recommendation, we didn't have information about youth involvement for instance, in recent quarters. We didn't have information about clinicians engagement in this process. The consortium and these recommendations are really based on the evidence, which has been important from the perspective of policymakers and really allowing policymakers to move forward with this recommendation with a high degree of confidence. That's great. Thank you. I love this conversation about youth. It's definitely something near and dear to my heart in my work with the Center. I also do work on some of our outreach and education programs with youth in particular. I think we see, of course, this started with Newtown, Connecticut, the Consortium forming around violence exposure among youth. Then what we've seen now up until five years into the future 2018, we have so many youth that are becoming involved in advocacy for gun violence prevention. But also we're seeing that their health is being impacted, and firearms play a role. I think that the recent trends that we've seen consistently over the past several years with the rise in youth suicide also really plays into this, and what is the access of firearms in the home, and they're not necessarily the owners of those firearms themselves. Katherine, I was hoping you could talk a little bit about this access to guns in the home and your role as a clinician. What do you see as the work that can be done, especially in regards to youth and making sure that they stay safe and using ERPOs as a tool. As a as a clinician, especially one who cares for critically ill and injured children, and the new recommendations from the report have been so important to me and to my patients, we know that clinicians are well-poised to assess risk. Like we've said, to contribute to this multi-disciplinary support for at-risk individuals moving forward. Any health professional on this call will know that scenarios like those modeled in our module in the teach-out are common. Including clinicians among eligible petitioners, as the recommendations have evolved, we think now provide a more comprehensive approach to risk reduction in the context of ERPO. As it's so well-stated in the report and by Josh and Shannon, youth are an important population that can be helped through ERPOs. We know that youth suicide, especially by young black males, is increasing. But in fact, it's been the second leading cause of death among adolescents for many years. While most young people attempt suicide by poisoning, the most fatal suicides among young people occur by firearm or by suffocation. Because young people are not usually firearm owners, the overwhelming majority of guns used in youth suicides or homicides came from their homes or those of friends or close family members. While safe storage is really effective in reducing unintentional injuries and suicide, the use of, say, a cable lock protects an adolescent from suicide maybe less well than it protects a toddler from an unintentional injury, since most adolescents, 75 percent, know where the guns in their homes are stored and many endorse having access to guns in their homes, even when the adults in the homes think that they haven't. For me as a pediatrician, sometimes an ERPO could be used to remove guns from the home of an adolescent in crisis. Then it can also, as Josh mentioned, be used to facilitate safe storage to prevent unauthorized access by providing resources for the legal gun owner who might be included under the recommended third-party classes. Rebecca, if I could jump in there. I think one of the important things to think about ERPO is that it's something that we had been thinking about for a long time before we met, we've talked about it as groups and we all came together. While we met in the aftermath of the Sandy Hook Elementary School shooting, there was a lot of other issues that drove what we did. It wasn't just that. We know that homicide, for instance, is disproportionately born by people of color, that suicide is a really big issue and rising over the years and continues to rise. That was the time period that we were set in, what we were responding to, with the idea that it was being floated, that if we just worked on the mental illness side of things, the gun violence would go away. Our point was, it's great to spend resources in the mental health system, behavioral health system, but there's a lot more to gun violence. People with mental illness they're not the drivers and gun violence. They're not likely to be. Most people with mental illness are never going to be involved in violence. We want to make sure that we're addressing something more holistically and comprehensively. That could be used in a number of different situations. That was the conversation at the time. But ERPO was responsive, as Katherine just said, to a wide variety of situations, including suicide. That was one of the things that really drove our work, was that the rise and the continue rising suicide rate and something we think and there's mounting evidence that ERPO can reduce and prevent firearm suicide. I just want to make sure that the listeners here realize that this is a solution that was devised because of a multifaceted problem, and gun violence, is that. There's lots of components to it. There's no one solution. But we thought that the ERPO law could be affected in a couple of different scenarios there and that's why we designed it. Great. Thank you, Josh for bringing that up. I'm really happy you brought that up but I also want to touch on this idea of really incorporating and integrating equity into gun violence prevention policies. I think a lot of times we talk about something like a mass shooting or we have licensing is another policy in particular that we really see the majority of gun violence in more urban communities where there's concentrated gun violence. It's being experienced every single day. It's not so much about isolated incidents and so thinking about how do ERPOs play into also really prevent the impacts in harms of gun violence that are being experienced by those communities. Then also how do we make sure that when ERPOs are policies that states enact, how are they enforced equitably? How do we make sure that, I know in some instances we actually had one learner ask a question with law enforcement specifically, and this trust about having law enforcement be a petitioner, and some of the policies that can come in hand with the submission of an ERPO. For example, in Rhode Island, they have a provision where there can be a search warrant that's issued concurrently within ERPO. How do we deal with this? What is the best practice when we implement an ERPO versus one that we can make sure is really equitable, and the way that it's enforced and the way that it's applied? What are just some of the considerations that we've learned and we want to make sure we think about with ERPOs? I'll let anyone go. I'm sorry, I didn't direct someone's specifically. Yeah. Rebecca, you raised a great question. Equity is certainly something that we have discussed throughout our discussions, our conversations about ERPO and other recommendations that have come out of that concession. One thing that we know is that, it's important to engage diverse communities in these conversations both about policies as they're moving forward, policies as they're being implemented. We're at the stage right now, as we've alluded to, that there's research happening with regard to ERPO. Being mindful of those questions about equity and making sure that there are diverse communities in those conversations when we're looking at the evidence, when we're looking at the data on how ERPOs are being used, is going to be really important for assuring that this policy tool is one that benefits everyone and isn't something that disproportionately affects in a negative way communities that have been affected and impacted by gun violence for a very long time. Thank you, Shannon. Katherine, do you want to jump in? Should I jump? Go ahead Josh. I just want to echo what Shannon was saying that just data collection is so important. In states that are not providing data, I would highly recommend that one of the things we can do as advocates and people who are listening this course is to get access to that data, and make sure that we understand demographically what's going on, who's subject to ERPO? If there's violations of ERPO, how is that being prosecuted, and is that happening at all? Because we want to know that there's not just proportionality there. The data is going to be incredibly important. The other part of this is we want to make sure access to this is equitable as well. What are the barriers to getting an order? How do we learn about it? What does the education about this look like? What does the comfort level and the safety provided if you want to go and pursue an ERPO? Is it user-friendly? Our law enforcement professionals who will be, if there needs to be a gun removal, are they trained to bring in crisis intervention. Trained officers or other types of professionals with them. You have to look at both [inaudible] the respondent, what the access to this system itself looks like. I think those are very, very important as well. I want to make sure that we are looking at all of that and also making sure that when we do training for law enforcement, the law enforcement sees this in a holistic manner. That goes both for prosecutors and law enforcement to make sure that the training that we are doing is looking at not just the fire removal, but what are we doing in the system in its entirety. Are we arranging for this to happen in a way that people will be helped and that they'll have access to the services they need? Those are big questions that we want to watch as we are implementing this. That's at least two sides. The most important thing to all of this is just carefully watching. It's getting the data and doing implementation. Maybe just to reiterate what Josh just said, it's a really important point, I think oftentimes where we have conversations about equity we want to be mindful of the harms that can come to people. With ERPO we've seen so many instances anecdotally and again that data is starting to come in with great benefits associated with that access. This is a situation where we want to be mindful of any harms that are coming with it. But we also want to be very careful to make sure that the potential for benefits to people for using ERPO are also available and as Josh said, expressible. We know that with the communities color in many places, there is a historic and well founded distress of law enforcement. With that standing in the way of family members being able to use this tool and if it is, what can we do to remove those barriers and start to, perhaps this can be part of the healing process that is long overdue and very much needed. This brings me to think about something specifically Shannon, hopefully you could touch on. We had one learner specifically, this idea of access to the best possible information and how to learn [inaudible] make sure that they are advanced in communities. We had someone from Oregon post a question about how they, as a state have the ERPO law on the books, but that it's being implemented county by county, and so that has really impeded the speed of the process. Can you talk a little bit about this implementation process and then maybe Josh, you can follow up with what are some things we can do to help advocate and speed some of that implementation up? Yes, sure, happy to help the learner out to think about this in Oregon. Hopefully this will be relevant to learners in other places as well. What we are seeing, we've mentioned throughout our time together and through the teach out. There are great efforts underway in different communities around the country that have really been innovative in developing the systems and skills needed to implement ERPO in a way that's really therapeutic and helpful and very constructive when people are in crisis. What we are seeing is the real importance of local champions behind those efforts. When Josh was talking about the timing and how legislative session is coming up. Get in and meet with your legislators and find a sponsor who will take on this issue. I'd also encourage you in Oregon and other places with ERPO laws and communities where you are not seeing them being used. Reach out, find that law enforcement partners, find that advocate, find that clinician who really understand how ERPO can be used in your community. Maybe it's you. Lift up your voice and really step out and do what it takes to make ERPO happen because at the end of the day, what we are seeing with regard to these good model systems of implementation, is that there is someone behind every one. There is someone behind those systems that say, "I want this for my community because I know it can solve some of the problems that I'm seeing routinely, and I'm going to make it happen." It's a rather simplistic response, Rebecca. But really what's the first and perhaps most important step when it comes to implementation is finding that person who's going to say, "We are going to own this, we are going to make this happen in our community." Right now as we're in this time of the legislative session and we're looking at RPOs, we're hoping that states that have them, will improve those that they have, we are hoping that states that don't have them we'll get some laws on the books. What are the top three things that people can do right now for advocacy? What can we do to try and make those happen right now? Well, I would start by saying, first of all, find out who your allies are. Get some great allies, organize your allies is the most important thing. Make sure that you have people who are involved in this, people who with lived experience, people who are all the different communities that you hope to touch with this and organize them in a way that's very effective. We found that at times we can win these legislative battles if we organize our allies, we educate them and we're here to help. We'd been out in the community a lot, communities across the country helping to put the evidence, make sure that people who are working in this area, who are your allies, understand the evidence. That's really important. Understanding that we're not looking at this just from a mental health lens, but for more of a behavioral indicator lens is really important and it helps bring people together. Number 2 is, Shannon has just mentioned on the implementation, you need a legislative champion. You need to find a great sponsor and it's so important these bills to have someone who really can talk with knowledge about these bills, can be a great advocate. Picking your sponsor is something that is just, I cannot overemphasize how important it is to have a sponsor who believes in this, would put energy on this, who cares about this. That's just incredibly important. Number 3, tell great stories. Find people who might have been able to use this bill, find people who want to use an RPO, talk about their life experiences, but tell great stories. We think in stories, we think in narrative, facts are great, but we need to take a couple of facts and wrap them in great narrative. Find the people within your coalition, that's why I say organize. Organize your allies, find the people who have great stories, combine that with a strong, passionate legislature with the facts, great stories and you can really win these battles. Yeah. If I could jump in here too, I mean, I think I'm looking at Katherine and Josh, the states that we've been in to do this work, physicians, clinicians are always so important, but they're not always really quick to step up and engage in the policy process. I don't know Katherine, if you have particular advice or words of encouragement for your clinical colleagues as to how they can engage. Thank you. No, it's true. I would just echo that education is so important to all petitioners, but especially for clinicians and industrial right, clinicians often have stories of patients who've been affected or who has benefited from her opposed and they can use those stories to drive advocacy in powerful ways. I would encourage clinicians to seek out education, to tell their stories, and to feel empowered to engage as advocates because we can be pretty powerful one. Thank you. Yeah and then I guess one thing I'd love to hear this is putting you all a bit on the spot, but is there's a particular story that over this past couple of years that an RPO has really come in and really changed the situation. Something that sticks with you when you think about RPOs, and the power that it can have. Shannon is going to apply steal my spot, but you can go first. I don't know what you're thinking, Josh, which is rare, so I don't think I'm going to scoop your story. What comes to mind for me really is a story that really is one that I heard a number of times. It's just like when you see the light bulb and the renewed energy that comes from law enforcement when they find themselves engaging with their communities in a different way. The stories that I get from law enforcement about just how they looked at their jobs differently, how they look at their roles differently are so powerful. There's one example where a law enforcement officer who is just doing great work out first, related a story of when he went [inaudible] RPO, it was a case where. The man who was the respondent to the ERPO was at risk of suicide. He had in fact been threatening suicide and was very much at risk. Risk was eminent. The process of serving the order and delivering is that there was this intervention happening and that the person would be temporarily prohibited from purchasing and possessing guns. As a result of this court decision, the person was so angry and parsing up a blue streak, violent, and hostile toward the officers who were solving. As the officer related, it was really difficult service experience. They all really felt that pain, but they knew the family's perspective and they felt strongly that the actions that needed to be taken. Fast-forward six months from that really taught incident. That law enforcement officer gets a visit from that same man who says, "You saved my life. I apologize for the way that I treated you six months ago. I was in a bad place. I know that you were just trying to help me. But I didn't see that then. I see that now and I'm alive because of what you did." That's great. Thank you. Not it, different one. I'm going to tell a little bit of a different story, but one that you know well. King County District attorney's office is one of the most. They've spent a ton of effort to develop multi-disciplinary, comprehensive, holistic approach to ERPO. A lot of credit goes to that team out there for pioneering a lot of some of the best practices in ERPO. That team tells the story. I'm stealing a little bit from them. But they tell the story of a couple and the man was having a real crisis, really at risk for suicide. His partner his partner sodden ERPO on him and worked with King County, worked with the specialist is prosecutor's office. What determined that this young man really was quite at risk. They talk with him and they work within. A couple came into court hand in hand. The guy said, "This is going to save my life. I agree to this." Thanked his partner for doing this. The law enforcement removed a number of firearms and the outcomes were quite good. When we think about ERPO, we don't need to think about it always as, "Oh, yeah. This is going to be an adversary or situation." This is oftentimes people look at it as a lifeline. They look at the people who are in their lives who are helping them as caring and loving. There's many opportunities in many ways that you can use ERPO. But in this situation, that was very heartwarming was that a couple of came together and decide what the best course was for them. In this case, the respondent was incredibly grateful to be there and have this opportunity. Thank you. We have just a couple of minutes left. But I really like to end on those stories and how this actually end up panning out when we have ERPOs on the books and just how important they'd be truly a tool to save lives as we've seen. Even just one life saved is really something to be proud of and something to keep working for ERPOs. I know we just have about two minutes left. If anyone has any final words or final takeaways that you hope to share. I think I will say, "I hope that you all continue to tune into our teach-out. We will have the recording of this video and we also have lots of really wonderful resources. Also just to clarify and let you know that it's not going. Even though it ends technically on November 8th, it's still is going to live on. It will still be available on Coursera and all of the resources will still be available through our partner organizations. That is the Bloomberg American Health Initiative that has a wonderful implement ERPO site. Our Center for Gun Policy and Research as well as educational fund to soft gun violence. If anyone has any last words, I'll let you go ahead. I would just say that people taking this course. You taking this cause you're interested, learn about ERPO. But as I tell my students in my class when I get to do that in the spring is, go make it work in the world. Take the knowledge that you've learned today and go make your voice, make it effective, make it work in the world, and change the world for the better. Note the say, "Change happens with you." Thank you. Well, that puts us up at an hour. Thank you so much to our instructors, Shannon, Josh, and Katherine, I appreciate you so much for answering our learners questions. We hope to keep asking questions. We love to keep seeing the discussion going. Thank you so much for tuning in today. Thanks for having us. Thank you. Thank you.
