Community and System Advocate Perspectives on Extreme Risk Protection Order Implementation: Qualitative Lessons on Client Context,Professionalization,and Equity

Abstract

Community and system-based (eg, civil legal) advocates can play a critical role in the implementation of extreme risk protection orders (ERPO); however, the novelty of ERPO laws impedes understanding of their implementation in these settings. As most ERPO laws are based on Domestic Violence Protection Orders (DVPO), we explored how the implementation of DVPOs by system and community advocates can inform recommendations for advocate involvement in ERPO implementation. We conducted semi-structured interviews with 9 community and system-based advocates involved in DVPO implementation in the 1970s-1990s. We used narrative inquiry to identify strengths and concerns with DVPO implementation, then applied lessons learned to potential implications for ERPOs. Three lessons arose, with corresponding ERPO implications. First, advocates evaluated individual context before offering options, including protection orders. Participants suggested ERPO advocates should be prepared to offer wraparound services in addition to or instead of an ERPO, if contraindicated. Second, the “professionalization” of the role of advocates affected how they served clients. Participants recommended professional development opportunities for those with lived experience of firearm-related harm. Third, advocates were well-positioned to anticipate and identify inequities in DVPO implementation. Participants suggested an evaluation system be developed to monitor for any potential inequities in ERPO implementation. The insights from participants in this study, situated in historical context, offer ERPO researchers, implementers, and policymakers a unique opportunity to ensure that ERPO implementation aligns with its legislative intent of preventing firearm tragedies and proactively address and prevent potential unintended consequences of ERPOs.

Highlights

● Community and system-based advocates can play a critical role in the implementation of extreme risk protection orders (ERPOs).

● Offering professional development opportunities to individuals with lived experience of firearm-related harm and centering perspectives of individuals with intersectional identities may improve equitable ERPO implementation.

● An evaluation and monitoring system for equity issues in ERPOs should be developed.

Introduction

Extreme risk protection orders (ERPO) are a civil legal mechanism designed to temporarily reduce firearm access for individuals (respondents) at imminent risk of harming themselves and/or others with a firearm. These orders, initiated by petitioners such as law enforcement officers or family members prevent harm by intervening before a firearm tragedy occurs. Research supports ERPOs’ effectiveness in reducing suicides,^{1 -3} and they have been filed to prevent mass shootings ⁴ and other forms of interpersonal violence, including intimate partner violence. ⁵ As of March 2025, 21 states and Washington D.C. have implemented ERPO laws. Because early indicators show ERPOs are a promising intervention tool, additional investigation is needed to evaluate their implementation—particularly with regard to the roles of those who are not direct petitioners but operate in proximity to the process and may influence its uptake and outcomes.

Among those who work with individuals in crisis, system and community advocates are often called on to help clients navigate difficult decisions about seeking help, including whether legal interventions such as ERPOs are appropriate. System advocates typically include social workers in healthcare or social service agencies and civil legal advocates based in court settings, while community advocates often work through nonprofit organizations. Despite differences in setting, both groups help individuals at risk of harming themselves or others navigate complex medical, legal, and social service systems. ⁶ Their roles often involve clarifying available services, offering empathetic crisis support, and facilitating referrals—actions shown to improve service connection and overall well-being.^7,8 Although advocates generally cannot file ERPO petitions themselves, they are often well-placed to recognize when an ERPO may be appropriate and to help clients navigate the process.

Although a small number of states, including Connecticut (1999), Indiana (2005), California and Washington (2016), implemented ERPO laws prior to the most recent wave of state ERPO law adoption in 2018, ⁹ awareness and use of ERPOs among the general public and professionals involved in or responsible for implementing the policy (eg, social workers, law enforcement) has been slow, uneven across jurisdictions, and remains limited in some cases.^10,11 This lack of familiarity with ERPOs presents challenges for evaluating their implementation in real-world settings, particularly in community and civil legal contexts where uptake often depends on proactive engagement by trusted intermediaries. In light of these limitations, this study turns to Domestic Violence Protection Orders (DVPOs)—a longer-standing civil legal mechanism that shares structural and procedural similarities with ERPOs. DVPOs offer a well-established policy and practice landscape through which to explore the complex dynamics of protection order implementation by community and system advocates over time. They enable a victim-survivor (petitioner) of domestic violence to request court-ordered protections from their abuser (respondent), which may include firearm relinquishment, no-contact orders, removal from a shared home, stay-away provisions, and temporary custody or visitation agreements. Like ERPO petitioners, DVPO petitioners similarly benefit from advocates who help facilitate informed decision making, navigate legal systems, assess risk, and connect individuals to necessary resources, ¹² making DVPOs a useful framework for understanding advocates’ roles in ERPO implementation. Examining lessons learned from DVPO implementation provides a rare opportunity to examine how protection orders have been integrated into community-based practice over time and identify mechanisms to better equip systems and those who work to implement ERPOs to consider and address their distinct needs for professional development and training to minimize possible unintended consequences with this tool.^13,14

Since most ERPO laws were modeled after DVPOs,^15,16 the history of DVPO implementation offers lessons for aligning legal interventions with client-defined safety. In both DVPO and ERPO contexts, advocates and institutions must weigh a range of factors when considering who their primary clients are and how best to support them. For example, assessing the appropriateness of legal interventions seeking to promote safety for both society at large and ERPO respondents must explore the unique circumstances and conditions that prompt the use of ERPOs.^{13,17 -19} This study explores how the original development and implementation of DVPOs over four decades ago can better inform recommendations for effective ERPO implementation in diverse circumstances and settings today.

Methods

We used narrative inquiry to capture the complex experiences of domestic violence system-based and community advocates involved in DVPO implementation in their settings. This qualitative study was conducted between January and August, 2023 and focused on retrospective accounts of advocates who were active during the early years of DVPO implementation in the U.S (1975-1995). We conducted interviews with key informants (n = 9), who spoke about their lived experience and analysis of the evolution of DVPOs and its implementation over decades. Participants were recruited via snowball sampling beginning with the professional networks of two members of the research team (KMC and VKK). Study criteria for participants included those who self-identified as system or community-based advocates with experience serving individuals affected by domestic violence during the early years of DVPO implementation. Although formal demographic data were not collected given the small sample size to protect participants’ privacy, participants were primarily from Midwestern and Western states and held diverse roles, including shelter advocates without professional degrees, civil legal advocates, and social workers, counselors or service providers, of whom many transitioned between these roles over the period they were actively involved in DVPO advocacy. All study procedures were approved by the University of Washington Institutional Review Board. Before interviews began, participants received an overview of the study, assurances of confidentiality, and an opportunity for questions about the study prior to providing verbal informed consent. All interviews were conducted by the lead author (KMC), who has experience conducting more than 200 qualitative interviews across a range of topics related to injury and violence. The research team was comprised of members with diverse professional and lived expertise across domestic violence, firearm injury prevention, clinical practice, ERPOs, DVPOs, and community violence.

Narrative inquiry is “grounded in the study of the particular”; ²⁰ therefore, the semi-structured interview guide was developed to encourage participants to focus on the details of their stories while allowing for natural divergence from the main question topics. Questions focused on successes and challenges in their roles as advocates, how they approached conversations with clients about available services, and their DVPO advocacy. Two participants with ERPO expertise were asked about its implementation and to provide comparisons with DVPOs. Others, who were not aware of ERPOs, were provided with a brief explanation and then asked to suggest advice for system and community advocates discussing ERPOs with clients. The semi-structured interview guide was piloted with a member of the research team whose professional background closely aligned with that of the study participants. Interviews were conducted and recorded via videoconference, lasting 45 to 90 min. Recordings were transcribed verbatim, and interviews continued until saturation was reached, meaning no new themes emerged with subsequent inquiry. ²¹

To understand each participant’s story of DVPO implementation, a single coder (KMC) first worked within each interview, ordering each story chronologically compared to others. Each story—defined as the individual account of an event—was then tagged with 1 or more codes representing a significant component. ²² Once all interviews were ordered and all accounts tagged, 2 coders (KMC and MM) collaboratively organized them into a codebook, which was iteratively revised to group related codes into categories, and then into themes. Peer debriefing and memoing were used to increase trustworthiness of the findings. ²³

Results

Themes are presented as 3 “lessons” from DVPO implementation and related “implications” for ERPO implementation (Table 1).

Table 1.

Lessons Learned From DVPO Implementation and Corresponding ERPO Implications.

DVPO lesson	ERPO implication
Lesson 1: Advocates seek understanding of survivors’ individual contexts before offering options, including protection orders
Advocates helped victim-survivors navigate the legal process, including consideration of possible unintended harms	Become familiar with local options to best utilize or circumvent medical and legal systems, as indicated
Advocates prioritized understanding survivor’s needs and goals and tailored referrals based on unique circumstances	Ensure ERPOs are not the default recommendation for firearm removal; offer wraparound services and voluntary firearm removal in addition to or instead of an ERPO
Lesson 2: The professionalization of advocacy affected service provision
Shift toward prioritization of social work degrees had substantial impacts on DVPO referral practices. Greater perception of advocacy work as a job rather than participation in a social movement; inclusion of social workers expanded pool of knowledgeable staff and therefore resources.	Offer professional development opportunities to individuals with lived experience of firearm-related harm so that they can transition to be social workers or system navigators
Theoretical underpinnings of social work influenced victim-blaming	Incorporate pedagogical methods that prioritize non-judgmental approaches
Changes in funding sources altered operational and evaluation requirements	Be prepared to navigate bureaucratic processes when relying on government funding for ERPO-related work
Lesson 3: Advocates and other providers are well-positioned to anticipate, identify, and address inequities in protection orders
Advocates were responsible for identifying how DVPO implementation helped or harmed the victim-survivors they served, and they changed their referral practices while advocating for change	Seek out potential inequities in ERPOs, then weigh potential harms and benefits while advocating for policy change to mitigate harms
There were inequities in the enforcement of DVPO and mandatory arrest laws	Design an evaluation system to monitor for inequities in filing, granting, and issuing violations of ERPOs
Efforts to collaborate with law enforcement helped promote uptake of DVPOs	Collaborate and educate law enforcement on ERPOs, given their substantial role in filing and enforcement
Women of color and Queer women foresaw unintended consequences of certain policies and were therefore hesitant to refer victim-survivors to legal system solutions	Center intersectional voices in policy development, evaluation system design, and implementation

Lesson 1: Advocates Seek Understanding of Survivors’ Individual Contexts Before Offering Options, Including Protection Orders

DVPO Lessons

Participants working in legal settings explained their role in helping victim-survivors navigate the legal process in the filing of their DVPOs, including assisting them in organizing their narratives and the description of their domestic violence situations to ensure alignment with statutes,

We really walk people through the process—help them draft their narrative, help them put into words what they experienced. Certainly, with the integrity of what they were communicating, but also knowing that we had people who are engaging in a system that has a lot of bias. And so, we would help people really craft their statement in the chronological order that the court wants to hear it in. Highlighting the things that meet the legal definition of domestic violence and trying not to have people lead with things that we know the court would take down a rabbit hole in the wrong direction.

Participants shared a common approach when interacting with victim-survivors, first listening to the survivor’s story, understanding their individual goals, then informing them about their available options, including DVPOs or other supports. One participant described their role as the following,

An advocate is like, “What do you need and what can I contribute to that?” And if I can, I will do it. If I can’t, I’ll try to find someone who can or try to coach you through it somehow.

They emphasized the importance of comprehending the complexities of each survivor’s circumstances and offering guidance accordingly, not focusing on any single or “best” resource or solution,

I think an advocate is the one whose job it is to sit down with somebody, take the time to understand all of the complexities within their circumstances, bring in the experience that they have from working with other victims or survivors in that situation, and help guide them through it.

One participant also explained that they began intentionally training other advocates to not start a conversation by offering a list of services because it prematurely shaped the interaction. Instead, this participant described the importance of advocating for “things that never would have been on the list,” such as supporting a victim-survivor in finding and enrolling in a new school for their children or obtaining new identification if they moved out of state to escape abuse.

Participants described how, in navigating conversations about DVPOs, they recognized situations where pursuing a protection order could lead to unintended consequences—particularly in the early years before widespread judicial or law enforcement understanding of domestic violence dynamics. One participant recalled a case in which she chose not to encourage a DVPO for a client facing child custody challenges. She explained that at the time, many judges lacked the training to distinguish between domestic abuse and family conflict. This inaccurate understanding often raised concerns among advocates that DVPOs could result in the mother being blamed for abuse to their children and even losing custody of them,

As an advocate, I would not necessarily “recommend” [a DVPO]—that word is a little stronger. I would say that I would offer it as a suggestion, and sometimes I would urge some people more than others to seriously consider it. But sometimes it’s a bad idea, you know, sometimes it can be more harm than good.

Concerns were also raised about the potential risks of escalation in partner violence associated with DVPOs as a triggering event toward separation and the abusive partner’s subsequent threat of losing control of the relationship. Due to this potential risk of exacerbating violence through the filing of DVPOs, advocates stressed the need for thorough safety planning in all of their work.

ERPO Implications

Participants recommended that those working with ERPOs take an individualized approach to understand the crisis and dynamics at hand before providing specific services or resources, including that workers and advocates proactively educate themselves on all of the potential intervention options to address the underlying crisis precipitating consideration of filing ERPOs. Given law enforcement and other legal systems involvement with the ERPO, some participants expressed apprehension regarding potential biases ERPO respondents may face within the legal system, such as which respondents receive an ERPO. They saw the availability of assistance to ERPO respondents and their families as potential solutions to reduce law enforcement involvement, if indicated, in navigating this system. Additionally, they spoke of the potential for advocates to be involved in judicial and law enforcement training to ensure a trauma informed ERPO process,

I think that the ERPO advocate just needs to be somebody who has really strong advocacy skills, can do trauma informed work, has excellent knowledge of not just survivor services in the community, but also mental health and other resources to help stabilize people. Like an ERPO is great; it gets the gun away, but it doesn’t solve the other crises in the individual’s life. And so it’s always kind of the ERPO and. . .?

Relatedly, some participants expressed worries about current metrics of success in certain jurisdictions, where the focus was on the number of ERPOs obtained, rather than the appropriate use of ERPOs given certain conditions or circumstances. While they acknowledged increased ERPO use may reflect greater awareness of this safety option, they cautioned against equating volume with effectiveness. As 1 participant noted,

I think that one of the concerns I have is, [ERPO] was always designed to be of [narrow] use. We should never be measuring success based on how many have been obtained or sought.

Participants also drew parallels between the potential risks to DVPO and ERPO petitioners by ERPO respondents, where the protection order may potentially escalate the risk for retaliatory and future violence. Additionally, some advocates expressed concern for respondents at increased risk of harm from interactions with the legal system due to their social identities (eg, higher likelihood of arrest for Black respondents and petitioners). Instead, participants emphasized considering voluntary firearm removal options before referring clients to an ERPO, unless there is also a need to prohibit the individual’s ability to purchase other firearms. Overall, these insights underscored the need for a thoughtful and individualized approach to ERPO referral practices.

Lesson 2: The Professionalization of Advocacy Affected Service Provision

DVPO Lessons

Over time, services for domestic violence victim-survivors became funded primarily by the government, accompanied by more complicated rules, regulations, and reporting requirements. While some participants saw this shift as legitimizing and financially supportive of their work, others described this as shackling the domestic violence movement to governmental expectations, slowing down or complicating the movement, or as misaligned with a survivor’s needs or goals. As 1 participant shared,

And so, what happens in social movements, and what happened in our movement, is that we got a lot of stuff. And in order to preserve what we had, we had to abide by the more bureaucratic governmental requirements, and the reliance on governmental funding is still predominant in the movement today.

As funding shifted toward government sources, public agencies also assumed greater authority over defining qualifications for service providers. For example, shelters for victims and families increasingly required service and advocacy staff to hold professional degrees, such as those reimbursable by insurance. Some participants noted that these requirements expanded the number of professionally trained staff and improved service accessibility. Many early advocates began as volunteers, motivated by personal experience or a desire to support victim-survivors, and some later pursued Master of Social Work degrees. This progression broadened the pool of knowledgeable providers and further improved access to services.

These funding changes and subsequent hiring practices emphasizing formal training, particularly social work credentials, came to dominate the domestic violence movement.

We used to prioritize if you had experience with battering, that was an important thing in our hiring. And then it turned into we wanted social work degrees. So the professionalization, the power of that was very strong. And it always is in movements like that, dominant institutions just do what they do.

The de-emphasis on lived experience toward a preference for professional degrees shifted the landscape considerably, with some participants experiencing that more formally trained advocates, who may not have had their own lived experience, possessed less empathy toward victim-survivors due to a lack of knowledge about the complex interpersonal and social dynamics involved in domestic violence. One participant explained how her community-based organization discouraged hiring professionally trained social workers,

We were so nervous about who social workers were and how they thought about families and how they assigned responsibility for bad things happening to children or to women. And so, we’re like, “No, let’s just stay away from that.”

Some advocates believed this shift in preferred qualifications changed how advocates viewed their roles, seeing themselves as more in a “job” than as part of a larger social movement.

Many participants expressed concern about the theoretical foundations of social work and how they shaped the field’s approach to domestic violence. Advocates working in child welfare, in particular, were noted for sometimes engaging in victim-blaming, such as focusing on a mother’s perceived failure to protect her child, overlooking that she was also experiencing violence beyond her control. This led to a misplaced focus on the mother’s actions rather than addressing the abusive partner’s behavior. Others criticized how their training positioned social workers as “experts,” fostering hierarchical, prescriptive approaches that sidelined victim-survivors’ lived experience with partner violence and their autonomy in decision-making for their safety and wellbeing,

This professionalization has resulted in a kind of lack of sensitivity for the resilience and the wisdom that most survivors have, which is way more than any of us who are service providers. There is a little bit of, I would call it condescension, still, towards telling survivors what to do.

Participants noted that while professionalization has had a positive impact in many aspects of the domestic violence movement, it may also undermine respect for the lived experience of both providers and survivors seeking safety and may ultimately affect the quality of interactions and care that are a necessity in dealing with this longstanding and complex social problem.

ERPO Implications

Because government funding increasingly shaped the domestic violence advocacy landscape, participants emphasized the need for training advocates and other ERPO implementers to navigate administrative burdens and systemic barriers when engaging in ERPO-related work. Participants recommended ERPO advocates and programs should anticipate and advocate to address administrative challenges to ensure that bureaucratic aspects do not hinder the program’s overall effectiveness or undermine legislative intent.

Given the lessons learned from the professionalization of the role of domestic violence advocates, participants suggested that it would be important to build a workforce with diverse lived experiences of firearm-related harm for those working with ERPOs, with specific attention to ensuring anyone working with survivors of domestic violence are well trained and grounded in understanding the dynamics of domestic violence to reduce the likelihood of retraumatizing survivors through the ERPO help-seeking process. This could be accomplished through offering professional development opportunities to individuals who have experienced or previously engaged in firearm-related harm but who have demonstrated a commitment to non-violence, to help them receive the credentials necessary for social work practice. Alternatively, establishing collaborative work environments where individuals with specific skill sets and lived experience collaborate closely with formally trained professionals to augment the effectiveness of ERPO implementation and referrals.

Among participants who perceived increased victim blaming from social workers not well-trained in the dynamics of domestic violence, many raised similar concerns about ERPOs. One participant explained a scenario where a DVPO victim-survivor may be unwilling to file a DVPO due to fears of violence escalation, but law enforcement may decide to file an ERPO without consideration for the wants or wellbeing of the victim-survivor,

The latest version of this [victim-blaming] is in the ERPO context, where it’s, if she’s not going to get a restraining order, at least we can remove the guns. Because we want to stop mass shootings. So, we’re going to go ahead and take the guns away and leave her exposed [to abuse].

This participant also explained that while in some circumstances, pursuing an ERPO may be an appropriate course of action due to potential risks to the public, it is also critical that law enforcement understand the potential collateral consequences of pursuing an ERPO under these circumstances and to ensure the survivor is working with an advocate or trained staff to engage in robust safety planning and coordination around the time an ERPO is served to a respondent, if pursued. Participants explained these concerns underscored the imperative of incorporating pedagogical methods and content that prioritize trauma-informed, non-judgmental approaches for those working with ERPOs (ie, social workers and advocates).

Lesson 3: Advocates and Other Providers Are Well-Positioned to Anticipate, Identify and Address Inequities in Protection Orders

DVPO Lessons

Because early domestic violence advocates, social service providers, legal staff, and others worked closely with the systems responsible for DVPO implementation, they were well-positioned to experience unintended consequences of this tool, particularly the carceral outcomes that could result from protection order violations. Participants highlighted the foresight of women of color in recognizing these risks, which shaped their work and referral practices for Black, Indigenous, and Queer victim-survivors. For example, some described the racist and heterosexist enforcement of mandatory arrest laws, which compelled law enforcement officers to arrest individuals when there was probable cause to believe that they had assaulted their partners, even if in self-defense. One participant noted the difficulty law enforcement and judges had in recognizing non-gendered expressions of domestic violence,

We had a lot of mixed feelings about mandatory arrest for a lot of us who were women of color. Because we saw right away what happened. First of all, men of color were disproportionately arrested. Then women started getting arrested. And that happened fairly quickly. And then in queer relationships, both of them got arrested. Because the police would get there and say, “Okay, whose fault was it? Who’s the man in the relationship? Or who’s the woman in the relationship?” And when nobody fit those roles, they said, “Well okay, then we’re gonna have to arrest both of you.”

By recognizing how these practices harmed individuals in queer relationships, advocates adjusted their counseling and referral practices to better protect clients’ safety and wellbeing. In some cases, this meant not recommending a DVPO; in others, it involved careful cost-benefit analysis and safety planning with survivors. As these patterns emerged, advocates and social workers also pushed for policy changes and increased judicial and law enforcement education to address implementation gaps and misinterpretations of the law.

These concerns led many advocates to adopt a more critical view of domestic violence responses that relied solely on law enforcement or legal system responses, instead of increasing support for community-based solutions. Individuals with intersectional identities were central in identifying service gaps affecting marginalized communities. For example, one participant described a shelter’s lack of multilingual services for Asian women, underscoring the need for culturally inclusive support. To ensure these perspectives were reflected, participants emphasized the importance of embedding women of color in decision-making roles. Committees were formed with intersectional voices at the center, and policy advocacy advanced only with collective consensus. One participant explained how women of color played a key role in shifting the legal response from mandatory arrest laws toward DVPOs, viewed as a more appropriate civil mechanism,

From the earliest days of the movement we had women of color, Native women at the table, always questioning things, inputting things, framing things from their perspective. [. . .] It meant that as we considered policies, we were figuring out whether the impact of this policy meant something different for the Queer community, the Indigenous community, the Black community. [. . .] I would say that many women of color and Native women, but not all, did not want domestic violence arrest laws [criminal] to be so dominant in our strategies. In a way protection orders [civil] were much more relevant for women of color, Native women because it kept their community out of the criminal justice system, but it got them what they really needed–their housing arranged, food, money, childcare, transportation.

Some advocates noted that early in its implementation law enforcement officers did not consistently refer victim-survivors to the DVPO process. Participants attributed this to a persistent misperception of domestic violence as a “couple’s issue,” rather than a criminal matter of assault warranting system intervention. In response, advocates developed training programs to improve law enforcement’s and the court’s understanding of domestic violence and the role of DVPOs. These efforts helped bridge a critical gap in implementation by increasing appropriate referrals for victim-survivors.

ERPO Implications

Participants emphasized that identifying ERPO implementation gaps is a critical role for advocates, particularly where current practices—or their absence—may contribute to unintended consequences. They described these professionals as liaisons between policymakers and communities, advocating for reforms much like domestic violence advocates did during DVPO implementation. Participants also recommended collaborative efforts to ensure law enforcement receives adequate training and resources to make informed, constructive ERPO referrals. One participant explained their efforts,

So much of what we do [. . .] is just myth busting. This is about reducing risk in situations where it’s predictable and all the writing’s on the wall. [. . .] And in those first meetings with law enforcement, in the beginning they’re really skeptical, but when you just really connect with people about risk, we have people coming in after the [ERPO] training just saying, “You know, we’ve got this guy in our community. We always worry he is gonna be on the 5 o’clock news for doing something really scary.”

Participants noted that social workers and advocates are well-positioned to engage legal system partners around the goals, appropriateness, and processes of ERPOs. Drawing parallels to the role women of color played in identifying unintended consequences of domestic violence legal interventions, they emphasized that ERPO implementation would benefit from an intersectional approach. Social workers and advocates can help identify and mitigate potential disproportionate impacts on communities at the intersections of race, gender, and sexual orientation. Participants also stressed the importance of culturally inclusive services, including language access and cultural awareness training for advocates, law enforcement, judicial personnel, and healthcare providers.

Learning from inequitable outcomes and unintended harms within the context of DVPOs, participants stressed the importance of tracking key metrics, such as why the ERPO was originally sought, who filed the ERPOs, who ERPOs are or are not granted for, the reasons behind ERPO violations, and any disparities in violations and punishment. They explained this proactive tracking could help identify any potential trends and inform strategies to address issues promptly, ensuring more equitable and effective referral practices for ERPOs,

[For DVPOs,] we weren’t really tracking how this was happening, but we started hearing stories. And then we realized, every time somebody got arrested on a mandatory arrest, on the way to the jail, they would get beaten up by the cops in the car. [With ERPOs], you all have the benefit of tracking early on and looking for trends. The best thing you can do is look for trends. And really try to think through, “What does that mean? How do we do something about it? Is there anything to do about it?” Track, track everything you can.

Participants noted close monitoring of trends and outcomes, including firearm tragedies that were potentially prevented, coupled withadvocating for changes to ERPO implementation, will ensure that the benefits of ERPOs can be accessed equitably by all communities and do not cause unintended harm.

Discussion

This study offers valuable insights into the implementation of civil protection orders into system and community settings, enriched by a historical perspective from domestic violence advocates with over 5 decades of experience in the gender violence movements beginning in the early 1970s. These experts described the underappreciated but evolving role of system and community advocates, stressing the importance of delivering tailored service and safety in crisis situations and highlighting the need to intervene to prevent firearm tragedies and ensure ERPOs center equity in referral practices and implementation. Experts additionally emphasized the significance of amplifying the voices of individuals with intersectional identities and lived experiences to guide emerging ERPO policy and practice.

Community and civil legal advocates hold discretion in option planning with survivors, including in protection order referrals, which can influence client decisions to pursue them alongside, or instead of, other resources. For example, domestic violence victim-survivors who discuss their experiences with medical professionals are 40% more likely to seek a DVPO. ¹³ However, as participants in this study noted, referrals for protection orders are not always suitable; risks such as potential violence escalation, loss of child custody, or legal system involvement require careful consideration.^{24 -26}

Participants emphasized that ERPOs should not be the only service when restricting firearm access is deemed necessary. Prior research has found that some DVPO petitioners find the process traumatic and difficult, challenging the notion that it is universally an empowering experience.^14,27,28 Petitioners often encounter barriers when filing DVPOs, including language access, costs related to child care, transportation, and lost income due to missed work due to court proceedings. ²⁴ Similarly, advocates must assess individual goals and safety concerns suggesting an ERPO. However, ERPO respondents—unlike many DVPO petitioners—may not be actively seeking help and may be resistant to intervention. This may introduce additional challenges for advocates and professionals attempting to connect ERPO respondents with voluntary supports. Community and civil legal advocates need to consider a range of factors, including the ERPO petitioner’s and respondent’s personal safety, the potential for further trauma, and practical barriers. Expanding support systems and ensuring that referrals are informed, voluntary, and contextually appropriate will be critical to equitable ERPO implementation.

The professionalization of the role of domestic violence advocates into social workers paralleled a shift from a grassroots approach, where survivors and activists led efforts, to a more structured system led by trained staff like therapists and caseworkers. ²⁴ This shift, inextricably linked to increased state involvement, expanded service availability, but also shifted the domestic violence movement. This change invisibilized and marginalized certain communities, exacerbating systemic issues including mass incarceration (eg, from mandatory arrest laws). ²⁹ Learning from the professionalization of domestic violence advocacy can guide ERPO referral practices, suggesting a need for a balanced approach that melds professional expertise with community-driven, culturally resonant solutions. To ensure that ERPO policies uphold the legislative intent of preventing firearm tragedies and do not inadvertently cause harm, it is vital to center voices with intersectional perspectives, including those based on social identities (eg, race and ethnicity, sexual orientation) and lived experiences (eg, experiences with suicidality, firearm-related harms, or the legal system). This can be achieved through professional development opportunities for those with lived experience of firearm-related harm and by formalizing the involvement of diverse voices in ERPO evaluation, monitoring, and implementation systems.

Participants emphasized the importance of learning from unintended consequences in DVPOs and mandatory arrest laws to design an evaluation system for ERPOs that will ensure the effectiveness and fairness of its implementation while continuing to prevent firearm tragedies. This system should monitor why the ERPO was sought, who receives ERPOs, their outcomes, and systemic barriers different groups may face as petitioners or those restrained by ERPOs. Advocates play a key role in ERPO implementation, as their referral practices can influence ERPO utilization. Disparities in DVPOs offer helpful insights; for example, legal representation for survivors increases the likelihood a DVPO is granted, ¹² and firearm relinquishment provisions in DVPOs reduce the state-level incidence of intimate partner homicide for white, but not Black, victim-survivors. ³⁰ Early evidence from ERPOs indicate white respondents more often have legal representation, ¹⁰ which could lead to ERPOs being disproportionately dismissed or denied when filed for these respondents, meaning they would retain access to their firearms and potentially avoid future criminal legal system consequences of the ERPO (eg, arrest for violation, although not a mandatory arrest by statute). Black women are also less likely to obtain a DVPO compared to white women, ¹³ mirroring hesitancies to petition for an ERPO among communities of color due to limited information about the availability of DVPOs and mistrust in the fairness of the system.^10,19 Considering the state-level variability in the accessibility and provisions of protection orders, ³¹ ERPO evaluation systems must collect robust data and assess for potential disparities at the state level.

While participants highlighted the role of system and community advocates in referring individuals to ERPOs, our findings also have important implications for health professionals, including medical providers, social workers, and behavioral health providers. Healthcare settings may serve as key points of identification for individuals at risk of firearm-related harm, and health professionals may be among the few trusted actors with regular contact with these individuals.^11,32,33 In this context, the referral role may mirror that of domestic violence screening and response, where clinicians are trained to recognize risk factors and initiate appropriate support. Ensuring that health professionals have training, institutional support, and culturally resonant tools to discuss ERPOs will be essential to equitable implementation. ³⁴

This study has limitations. First, while the historical implementation of DVPOs provides a valuable lens for understanding ERPOs, the 2 policy tools emerged in distinct social and legal contexts. ERPOs were introduced decades later amid different political dynamics, media attention, and public discourse surrounding firearms, suicide, and community safety, whereas DVPOs emerged as part of a larger social movement against domestic and partner violence. Another key difference is that DVPOs are designed to address intimate partner violence, whereas ERPOs apply to multiple forms of interpersonal violence and self-harm. Additionally, the gender dynamics differ substantially: DVPOs have historically centered women as petitioners with men typically as respondents. In contrast, ERPOs can be used across a broader array of social contexts and risk scenarios because they are not limited by a specific relationship. As such, insights drawn from DVPO implementation may not fully account for the unique characteristics, challenges, or intended scope of ERPOs. Future research should examine present-day implementation and impact of ERPOs, considering the evolving attitudes and frameworks surrounding firearm-related harm. Additionally, despite the diversity in social identities of our participants, they may not have comprehensively captured the breadth of experiences in the field of domestic violence advocacy, especially as it has evolved over time. Future research should examine additional contexts and perspectives from different geographic regions.

Conclusion

The insights from this study offer ERPO researchers, implementers, and policymakers an opportunity to ensure that ERPOs fulfill their legislative intent to prevent firearm-related tragedies while proactively addressing potential unintended consequences of ERPO engagement. Drawing on the experiences of long-standing professionals in DVPO advocacy, this study underscores the critical function of advocates in the community-focused implementation of protection orders. It highlights the importance of incorporating intersectional perspectives and empowers advocates to leverage their expertise to influence policy and practice. Such informed, proactive engagement is essential to accomplish the intended firearm harm reduction and the successful and fair implementation of ERPOs, ensuring they serve as effective tools in violence prevention while being sensitive to the diverse needs of the communities they seek to protect. This approach enhances current practice while paving the way for future advancements in the field, fostering a more inclusive and responsive framework for addressing firearm-related harm.

Supplemental Material

sj-docx-1-inq-10.1177_00469580251370929 – Supplemental material for Community and System Advocate Perspectives on Extreme Risk Protection Order Implementation: Qualitative Lessons on Client Context, Professionalization, and Equity

Supplemental material, sj-docx-1-inq-10.1177_00469580251370929 for Community and System Advocate Perspectives on Extreme Risk Protection Order Implementation: Qualitative Lessons on Client Context, Professionalization, and Equity by Kelsey M. Conrick, Julie Kafka, Julia P. Schleimer, V. Kalei Kanuha, Christopher St. Vil, Ali Rowhani-Rahbar and Megan Moore in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material

sj-docx-2-inq-10.1177_00469580251370929 – Supplemental material for Community and System Advocate Perspectives on Extreme Risk Protection Order Implementation: Qualitative Lessons on Client Context, Professionalization, and Equity

Supplemental material, sj-docx-2-inq-10.1177_00469580251370929 for Community and System Advocate Perspectives on Extreme Risk Protection Order Implementation: Qualitative Lessons on Client Context, Professionalization, and Equity by Kelsey M. Conrick, Julie Kafka, Julia P. Schleimer, V. Kalei Kanuha, Christopher St. Vil, Ali Rowhani-Rahbar and Megan Moore in INQUIRY: The Journal of Health Care Organization, Provision, and Financing