Abstract
Twenty-one states, the District of Columbia, and the U.S. Virgin Islands have Extreme Risk Protection Orders (ERPOs), with most states enacting them after the preventable mass shooting in Parkland, Florida in 2018. ERPO laws are an evidence-informed policy to curb the public health crisis of gun violence in the United States as they provide a legal mechanism to temporarily restrict access to firearms when an individual is exhibiting dangerous behaviors. This paper utilizes a well-known implementation science framework proposed by Proctor et al to evaluate implementation outcomes for ERPO laws. The framework identifies 8 components of implementation—adoption, acceptability, appropriateness, cost, feasibility, fidelity, penetration, and sustainability—which are examined in the context of ERPO implementation. By viewing the implementation process through this framework, we highlight both the successes and the gaps in ERPO implementation, with the aim of improving implementation moving forward. Each of the 8 steps in Proctor’s evaluation framework are critical to the success of ERPO laws. First, a law that has not been adopted cannot be implemented; therefore, passing ERPO laws are critical. Typically, only laws deemed “acceptable” by most lawmakers, and ideally the public, are passed. ERPO is an appropriate tool for addressing gun violence, satisfying the third prong of the framework. Costs can be mitigated to improve feasibility. Most ERPO laws have fidelity to its original mission. ERPO programs have penetrated many state entities’ infrastructure. Promising practices from around the country demonstrate how the law can be sustained through dedicated funding and support. A law that is not implemented cannot be successful. By focusing on robust implementation of ERPO based on promising practices across the country, implementers can increase the likelihood of success and save lives.
Keywords
Introduction
Gun violence is a public health crisis in the United States. 1 In 2023, 46 728 people died by firearms in the U.S., including more than 27 000 firearm suicides—the highest number ever recorded. 2 Similar to many public health crises, gun violence is complex, and effectively addressing and mitigating it requires a myriad of solutions. The passage and implementation of evidence-based solutions can prevent firearm suicides, unintentional gun deaths, and gun homicides—including mass shootings, domestic violence, community violence, and police violence. Research shows that firearm purchaser licensing, safe and secure gun storage, and firearm removal laws are associated with reductions in gun-related injuries and deaths. 3 However, this study focuses on extreme risk protection orders (ERPOs).
Extreme risk protection orders, commonly referred to as ERPOs or red flag laws, are civil court orders that temporarily prohibit an individual at risk of harm to self and/or others from accessing firearms. 4 ERPO laws exist in 21 states, the District of Columbia, and the U.S. Virgin Islands, providing a prevention tool to more than half of the country’s population. Several studies demonstrate the impact of ERPOs on gun violence. Swanson et al studied Connecticut (2017) and Indiana’s (2019) ERPO-style laws and found that their laws prevented suicides in both states.5,6 A 2024 study of 4 ERPO states estimated that for every 17 ERPOs issued, 1 suicide was prevented. 7 A 2019 study also examined the role of California’s ERPO law, called a gun violence restraining order, in preventing mass shootings. From 2016 to 2018, respondents in at least 21 cases indicated their intent to commit a mass shooting and, after the order was issued, no such shooting (or associated injuries) occurred. 8
Framework
Implementation measurement can be a challenging task; the implementation science field has various frameworks to evaluate intervention success. 9 To measure success of ERPO implementation—which requires legal change, multi-system coordination and collaboration, funding, and often a philosophical change on how to approach individuals threatening violence—the authors identified Proctor et al’s paper, “Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda” as an evaluation instrument. 10 This framework identifies 8 components of implementation which are discussed here to assess ERPO implementation: adoption, acceptability, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. By viewing the implementation process through this framework, we can both reflect on successes and identify gaps in ERPO implementation, with the overall goal being to improve future implementation.
Adoption
Proctor et al’s paper describes adoption as “the intention, initial decision, or action to try or employ an innovation or evidence-based practice.” 10 To understand the adoption of ERPO laws, it is necessary to follow a policy from the time it is first socialized, through its passage as law, and, ultimately, its implementation. Specifically, we need to understand the public and lawmakers’ perceptions of the policy and what led the idea—temporarily preventing access to firearms when a person is behaving dangerously—to become law. Ideally, the stakeholders engaged in implementing a policy are involved in its passage. Additionally, understanding the decision-making process behind using ERPO is important, as other tools may be available to accomplish a similar goal.
In 2013, an interdisciplinary group of experts convened to discuss the intersection—or lack thereof—between mental illness and gun violence. 11 This expert consortium, called the Consortium for Risk-Based Firearm Policy, discussed the risk factors for violence (toward self and/or others), and how to develop policies influenced by data. Consequently, the modern-day ERPO law was introduced with an increased focus on behaviors, and not mental health diagnoses. A few months after the Consortium’s meeting, the California legislature passed an ERPO law, called a Gun Violence Restraining Order (GVRO).
ERPO laws are often passed in response to mass shootings. Mass shootings in Connecticut, 12 Indiana, 13 California, 14 Florida, 15 Nevada, 16 and Michigan, 17 among others, are cited as the reason for passing an ERPO law in those states (See Table 1). Seizing on this “critical opportunity,” 18 advocates and lawmakers took a concrete step to ensure that a similar tragedy did not destroy their community—or other communities—again. 19 The act of adopting an ERPO law after a mass shooting is both one of response and prevention.
Enactment of ERPO Laws Across the United States.
However, such adoption cannot occur without political viability and support. In Virginia and Michigan, for example, ERPO laws only appeared on the governor’s desk after changes in the political make-up of the state legislatures. In both states, the law was rejected in several legislative sessions before it was finally passed. To date, only 1 state, Washington, has passed an ERPO law by ballot initiative, with 32 of its 39 counties voting in favor of the law 20 ; however, ERPO will be on the Maine ballot in November 2025. 21 In this rare instance, voters will directly decide whether they want such a law in their state. Although passing legislation through ballot initiative is rare, and certainly so for ERPO laws, it is perhaps not surprising that Washington state managed to do so given the popularity of the law. Johns Hopkins has tracked public opinion polling on several gun violence prevention policies every other year since 2013. The most recent survey, from 2025, found that 77% of Americans support ERPO laws, including 70% of Republicans, and 71% of gun owners. 22
Despite widespread support for ERPO laws, several states have tried—and failed—to pass them. For example, after a mass shooting at a Christian school in Nashville in 2023, Tennessee Governor Bill Lee indicated support for a red flag-style law. 23 Not only did the bill die during the 2023 special session, but, during the 2024 legislative sessions, Governor Lee signed a bill preventing local entities from enacting ERPO laws. 24
ERPO users may choose to adopt an ERPO after the law is enacted but before it is actively used. For instance, a law enforcement officer might encounter a situation, such as a domestic violence situation, wherein multiple remedies are available. The domestic violence survivor may have multiple forms of relief available, including an ERPO and a domestic violence protection order (DVPO). Which gets used (or, in some instances, if both get used) may depend on the knowledge of these laws among responding parties, including the survivors and victim advocates and law enforcement. The decision to adopt an ERPO law may ultimately come down to education and awareness regarding its purpose.
Acceptability
The second of the 8 implementation outcomes outlined in Proctor et al’s paper is acceptability. Acceptability is a key facet of the implementation process, described in their framework as “the perception among implementation stakeholders that a given treatment, service, practice, or innovation is agreeable, palatable, or satisfactory.” As written above, we know from public opinion polling that ERPOs are popular. 22 However, it is not uncommon for implementers to initially resist the law and then eventually get on board. Just weeks before Governor Whitmer signed Michigan’s ERPO bill into law, Livingston County Sheriff Mike Murphy declared it unconstitutional. 25 However, 1 year later and several months after the law went into effect, data showed that his office used the law. Speaking on the matter, Sheriff Murphy said, “If there’s a tool that we can use in law enforcement to accomplish a goal, then why would we not use it?” 26 No one wants to be responsible for not averting an attack when a law exists to prevent it.
For a law to pass, a majority of lawmakers must see it as an acceptable solution to the problem they are trying to solve. However, implementers—those ultimately responsible for whether a law is used—must also agree with the solution. As noted above, ERPO implementers may initially be opposed to it but eventually be convinced. After Colorado’s ERPO law passed, but before it was implemented, 37 out of Colorado’s 64 counties declared themselves second-amendment sanctuaries. However, an analysis of ERPO use in the state found that 37.3% of the ERPOs filed in Colorado between January 2020 and December 2022 were in second-amendment sanctuaries. 27 This implies that, even in counties where the ERPO was deemed “unacceptable,” implementers identified situations in which its use was warranted. A 2023 study of law enforcement officers in ERPO states found that most (81.3%) of law enforcement officers had some familiarity with ERPOs and most (56.2%) received training on ERPOs, though willingness to use the law may vary by political ideology. 28
Nonetheless, most law enforcement officers surveyed viewed ERPOs favorably. A lack of awareness about ERPOs is more common among physicians, who cannot petition in every state. Frattaroli et al’s study on Maryland physicians (who are eligible petitioners under Maryland’s ERPO law) found that 71.7% of physician respondents were not at all familiar with ERPOs, however, after reading a description of the law, over 92% noted that they were likely to encounter patients for whom they would consider filing an ERPO multiple times per year and nearly 60% noted that they would be very or somewhat likely to file an ERPO. 29
Appropriateness
Proctor et al’s third criteria for effective implementation is appropriateness, defined as “perceived fit, relevance, or compatibility of the innovation or evidence-based practice for a given practice setting, provider, or consumer; and/or perceived fit of the innovation to address a particular issue or problem.” ERPOs’ appropriateness can be viewed in several ways. As a legal framework, ERPO gives judges clear legal authority to remove firearms from individuals at a known risk—a gap in the law before the proliferation of ERPO laws around the country. The developers of the ERPO law identified circumstances and situations in which authorities recognized when possessing firearms posed a clear risk, however, they lacked the authority to limit this access, such as in Parkland, Florida, where the shooter was the subject of dozens of 911 calls and multiple reports to the Federal Bureau of Investigation. 30 The proliferation of ERPO laws demonstrates their legal compatibility in removing firearms when other legal mechanisms are not available.
In 2024, the Supreme Court of the United States issued a decision in United States v. Rahimi, its first clarifying decision after the seismic change in second amendment jurisprudence from New York State Rifle & Pistol Association, Inc. v. Bruen. 31 Rahimi held that the constitutional right to bear arms could be limited when an individual poses a known risk. The decision in Rahimi was based on second amendment jurisprudence in a domestic violence case, but the decision extends to ERPO matters: “When an individual poses a clear threat of physical violence to another, the threatening individual may be disarmed.” 31 Furthermore, ERPOs have been repeatedly found appropriate within the United States’ constitutional and legal frameworks. Scholars at the Duke Law School have broadly articulated why ERPO laws are consistent with due process protections in the United States. 32 Courts around the country have upheld ERPO laws when challenged, before and after the Rahimi decision. Three decisions from around the country in 2024 help illustrate the legality in light of the Supreme Court’s latest second amendment jurisprudence. The California Court of Appeals ruled that ERPOs are consistent with the Rahimi jurisprudence. 33 The Supreme Court of New York upheld their state’s ERPO law in response to challenges that it violated the respondent’s first, second, fourth, and sixth amendment rights. 34 In Indiana, a court found that law enforcement appropriately seized weapons using their state’s Jake Laird (ERPO) law in response to the risk of harm presented by the respondent. 35 ERPO’s legality within the United States’ legal system, as articulated by legislatures and trial and appellate courts repeatedly around the country, makes it an appropriate instrument to address gun violence.
At the individual level, ERPO users can view ERPO appropriateness in several ways. Individual ERPO users, including law enforcement and clinicians, may choose whether ERPO is an appropriate tool in their situations, especially situations that may require multiple interventions or where other tools—including involuntary commitment or domestic violence protection orders—may suffice. Individual users’ experiences with ERPOs may affect their opinions on ERPO appropriateness. For example, a law enforcement officer who felt that an ERPO prevented a mass shooting from materializing may view the law as appropriate, while a law enforcement officer who has never used the law may not see the need for it. Implementers, researchers, and the public can identify how appropriate and effective ERPO is in a variety of situations to better inform individual user’s decision-making.
Cost
Implementation cost is critical to successful implementation. In the initial implementation of ERPOs in many jurisdictions, states and localities need to make investments to stand up and sustain these programs. When resources are finite, these local actors need to justify the costs and keep them as low as possible to increase feasibility. When California passed its gun violence restraining order (GVRO) in 2014, its fiscal note listed a 1-time cost of $250 000 for development of court forms and $200 000 for the development of tracking mechanisms and training. 36 The fiscal note also documented other unknown costs when the legislation was passed, including costs to the courts to hold hearings and costs to law enforcement to serve orders and store firearms. More recently, Michigan’s legislature estimated that their new ERPO law would cost $200 000 to implement but went on to further note that should an individual be incarcerated for violation of an ERPO, the average cost of incarceration per prisoner per year is $47 900. 37 Whether ERPOs could be a cost-saving measure in the long term is an open question, such as ERPOs used to deflect individuals from the carceral justice system (which costs over $90 billion per year to run prisons 38 ) or to prevent suicide (which costs an estimated $93.5 billion in 2013 39 ).
In some circumstances, diverting someone from the criminal legal system using an ERPO may be appropriate, thereby potentially saving money that would be spent holding someone in jail or prison. Diversionary programs are increasingly becoming of interest to law enforcement leadership; however, ERPOs may also co-occur with arrests initially. 40
To support implementation of ERPOs, as part of a much larger legislative package and following the tragic mass shootings in Buffalo, New York, and Uvalde, Texas, Congress passed the Bipartisan Safer Communities Act (BSCA) in June 2022. 41 This landmark legislation included $750 million in funding for crisis intervention order implementation, including ERPO implementation, as part of the Byrne State Crisis Intervention Program (Byrne SCIP). 42 Every state is eligible for part of the Byrne SCIP funds, 43 and many of the jurisdictions with ERPO laws use at least some Byrne SCIP funds for ERPO implementation.44,45 By appropriating funds to implement ERPO, lawmakers make a deliberate effort to cover the costs associated with ERPO implementation and expand upon current implementation efforts by providing resources for additional staffing, training, and services for respondents.
Individual petitioners in ERPO cases typically have no filing fees. 46 Removing this barrier makes it easier for any eligible petitioner to intercede when they observe that an individual should no longer have possession of or access to firearms. In addition, respondents typically have no fees, unless they choose to hire legal representation. However, at least 1 state (Colorado) provides counsel at no cost to respondents. 47 Law enforcement store firearms at no charge to respondents for the duration of the order. The minimization of individual costs and government investment in systemic costs, particularly when balanced against the human and financial tolls of gun violence, makes funding a clearable hurdle.
Beyond the monetary costs, the indirect costs associated with ERPO should be overcome for a program to succeed. Time is finite, and prioritizing 1 area often means deprioritizing another. For example, if a police department allocates resources (financial or otherwise) to ERPO training, this may mean allocating fewer resources and less time to training in other areas. While hiring specialized officers for ERPO cases is a good practice, that itself is costly. There will often be resource issues that police and sheriff’s departments will need to overcome to help their ERPO laws succeed.
Feasibility
A law that is not feasible is doomed to fail. Described in Proctor et al’s framework as “the extent to which a new treatment, or an innovation, can be successfully used or carried out within a given agency or setting,” feasibility of implementing an ERPO law varies significantly from state to state and jurisdiction to jurisdiction. Consider 2 law enforcement agencies. One is in a rural area with only a handful of patrol officers. The other covers a major metropolitan area, sometimes spanning more than 1 county. The needs of each agency differ, as do the measures of success. What is feasible in one agency may not be feasible in another, perhaps explaining why ERPO use varies between and within states. Feasibility can also be tied to costs, as described above.
This study’s authors regularly meet with the very people responsible for making this law work across ERPO states. The law can be implemented successfully in several ways, often starting before it goes into effect. For example, states and system actors must have a plan in place before the law goes into effect. This can include the creation of court forms, law enforcement protocols, and training materials. It can also mean that law enforcement and judges handling these cases are routinely, comprehensively trained on how ERPOs work. We observe successful implementation in jurisdictions with specialized ERPO units (although this may be prohibitively costly in many jurisdictions), judges familiar with ERPOs, and coordination between key implementers (including law enforcement, judges, clerks, and prosecutors). 48 We often see ERPO’ success tied to deliberate efforts to implement the law. For example, implementers who “champion” the law can be a resource for others in a similar position either in the same state or a different state. This peer-to-peer assistance helps implementers ensure that implementing ERPO is feasible. Conversely, the absence of champions undermines ERPO uptake when there is less training and guidance across agencies and implementer groups.
It is important to note that many ERPO laws are modeled after domestic violence protection order (DVPO) laws. 48 DVPOs have existed since the 1970s, long preceding ERPO laws, and by 1989 every state and the District of Columbia had a DVPO law. 49 Although the laws are distinct and offer different protections, the processes for both are similar. 50 As such, a state does not need to completely reinvent the wheel when implementing its ERPO law and can, in some instances, look to how the state’s DVPO is implemented to create processes for the service of orders and firearm removal.
Fidelity
When the Consortium first met and developed the ERPO policy, the goal was to base gun policy on evidence-based risk factors for violence (behaviors) and provide a legal mechanism to temporarily restrict access to firearms for people at risk of harm before violence occurs. Today, fidelity, “the degree to which an intervention was implemented as it was [originally] prescribed,” is still observed in ERPO laws. All ERPO laws are time-limited, with ex parte orders typically lasting up to 2 weeks and final orders up to a year. Second, ERPOs are civil in nature, though, if violated, a respondent could face criminal charges. Third, ERPOs solely address access to firearms, although an effort has been made to also connect respondents to appropriate services and thus address the underlying issues that led to the ERPO. Finally, law enforcement are always eligible petitioners, although many states have expanded their petitioning power to other groups, including family/household members and clinicians. Ten years after California passed its GVRO law, fidelity to its original mission remains, however ERPO implementation has also evolved to meet current and local needs.
For example, while ERPO laws may have originally been used mainly in efforts to prevent suicides and mass shootings, they are now used to address political violence, 51 violence by minors, 52 individuals living with dementia, 53 and domestic violence, 54 among other circumstances. ERPOs remain a tool that should evolve as circumstances where its use would be appropriate arise. States have also amended their ERPO statutes to better meet communities’ needs. For example, Illinois lawmakers extended the length of their final order so that it could be in effect for 6 months to 1 year, an increase from the 6-month final order. 55 In Connecticut, lawmakers amended their law in 2022, including adding family and household members and clinician petitioners, and expanding the law to include other deadly weapons in addition to firearms. 56 In Colorado, lawmakers expanded eligible ERPO petitioners to include healthcare providers, educators, and district attorneys. 57 Despite changes to laws through legislation and practice, the basic principles of the original ERPO law remain in place today. The authors view ERPOs as a “living policy” that can and should change over time to meet the needs of the communities where it is used, although amendments to the law and changes to implementation should not stray too far from ERPOs original mission—to temporarily remove firearms from individuals at risk of harm to self and/or others. As noted above, many ERPO laws were modeled on civil DVPO laws. While ERPO laws may be somewhat similar to DVPOs and other civil protection orders, they are still designed for specific purposes, and mission drift could affect the integrity of the law and cause further confusion among various laws. Further, ERPOs offer only 1 type of relief—temporary firearm removal—while other civil orders may offer other protections. It is important to remember how and why ERPOs were created, as well as how they are similar to, but also different from, other protections in the legal system.
Penetration
The next criterion in implementation analysis is penetration or “the integration of a practice within a service setting and its subsystems.” For ERPO implementation, this means the integration of ERPO into the work done by the federal, state, and local governments by a cross-section of system actors, including elected officials, law enforcement, social services professionals, and courts. Furthermore, ERPO penetration requires integration into the fabric of services to prevent suicides and homicides, including those clinicians and behavioral health providers specializing in mental health and addressing the underlying issues giving rise to the ERPO, professionals working with domestic violence survivors, and practitioners in the criminal legal system.
There are several indicators that ERPO has penetrated the fabric of gun violence prevention efforts in political, law enforcement, and medical contexts. In the 2022 BSCA, Senator Blumenthal spoke to the value of ERPOs, stating:
“This measure will save lives. . .This bill will increase funding for these programs, including red flag laws and programs already in place. . ..It is separating those guns from people who say they are going to kill someone or themselves. More than half of all gun deaths are suicides. Red flag laws are practical and proven and they prevent not only suicides but school mass shootings and other violent crimes.”
58
The Federal Bureau of Investigation (FBI) incorporated ERPO into both the National Instant Criminal Background Check System and National Crime Information Center as separate criteria. 59 The Surgeon General’s advisory on gun violence as an epidemic identified ERPO implementation as a key “risk reduction prevention strategy.” 60 ERPO referral information is included in the national 988 suicide prevention hotlines’ training guidance for operators responding to concerned callers, and the National Alliance on Mental Illness (NAMI) identified ERPOs as valuable resources. 61 The American Foundation for Suicide Prevention (AFSP), 62 American Medical Association, 63 American Academy of Pediatrics, 64 and Doctors for America 65 have all expressed support for ERPOs. The Defense Counterintelligence and Security Agency issued ERPO guidance. 66 In some jurisdictions, such as Fairfax, Virginia, ERPOs are an integral part of their Fusion Center, which brings together 20 local state, and federal law enforcement agencies to respond to threats. 67 Even in jurisdictions without ERPO laws, journalists and editorial boards often call out the missed opportunity to use an ERPO as a life-saving measure.68 -71 Although the aforementioned entities either expressed support for ERPOs or took strides to include ERPO training in their materials, a large gap in knowledge and practice remains. For example, while many clinical organizations support ERPO, awareness of ERPO laws, and how to use them remains low among clinicians, even in states where they can petition. 29 Furthermore, there are some disagreements regarding whether ERPOs should be used in a domestic violence context. 72 As discussed above, ERPOs and DVPOs have similarities, but also key differences. Unlike ERPOs, DVPOs offer various forms of additional relief for survivors. However, ERPOs may be appropriate in a DV situation if the survivor does not want to petition for the order or if the sole relief they want is firearm removal. The authors of this paper believe that survivor autonomy is a priority, regardless of the order pursued.
Sustainability
Despite their relatively new introduction to the gun violence prevention landscape, ERPOs appear to be a sustainable tool for addressing many forms of gun violence. Sustainability is the “extent to which a newly implemented treatment is maintained or institutionalized within a service setting’s ongoing, stable operations.” The commitment by several jurisdictions around the country to invest in ERPO implementation reflects the energy and momentum toward sustainability, but the question of how ERPOs will be sustained in the long term remains open.
Several jurisdictions around the country have taken significant steps to institutionalize ERPO practice into their work, with efforts often being led by an ERPO champion. ERPO and firearm removal units are embedded into law enforcement and prosecutor practices, such as the Multnomah County, Oregon firearm removal unit; the King County, Washington Regional Domestic Violence Firearms Enforcement Unit and the Denver, Colorado ERPO unit. ERPOs were institutionalized in Connecticut through their inclusion in the State Police Officer Standards and Training Council (POST). In San Diego, California, the ERPO unit is robust and is built into the jurisdiction’s policing foundations. 73 Across Florida, ERPOs are valued by police and sheriff’s departments, as demonstrated by their usage. 74 Data show that in some states, ERPOs are used broadly across the state, such as in Maryland, where all counties have used ERPOs. 75 The development of specialized teams and the wide uptake and appreciation of ERPOs in many jurisdictions reflect how elected leaders and community members utilize ERPOs continuously. However, opportunities remain to invest in ERPO and sustain them in the long term. Jurisdictions with ERPO laws can and should provide routine training to system actors, namely law enforcement, judges, mental health and domestic violence advocates, and clinicians. The authors of this paper find that, alongside trainings on the law itself, it is beneficial to include case studies and hypotheticals in trainings to show how ERPOs have been used and where other, less restrictive, mechanisms may be more appropriate.
At a national level, ERPOs were institutionalized by the publication of the Department of Justice’s (DOJ) model ERPO policy in June 2021. 76 DOJ announced the National ERPO Resource Center in March 2024 to support ERPO states in their implementation efforts. 77 In 2019, President Trump expressed support for ERPOs, stating, “We must make sure that those judged to pose a grave risk to public safety do not have access to firearms and that if they do, those firearms can be taken through rapid due process.” 78 Attorney General Pam Bondi defended Florida’s ERPO law when she was the Florida Attorney General. 79 Given how ERPOs are passed at the state level (no national ERPO exists), federal political shifts may have less impact on state and local ERPO implementation, and sustainability appears promising.
Conclusion
Extreme Risk Protection Orders are a valuable tool for preventing gun violence. Data from around the country show how ERPOs have the power to prevent suicides, domestic violence, mass shootings, and other forms of gun violence, and news stories show how ERPOs have saved lives. However, the success of the law hinges on its implementation and requires attention to the outcomes described in Proctor et al’s framework: acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability. Promising practices for implementation are discussed throughout this article, including minimizing the costs associated with ERPO implementation, preparing court forms and other implementation documents before the law goes into effect, collaborating with a broad range of implementers, and adapting ERPO implementation to meet local needs and infrastructure. The goal of saving lives ultimately requires sustainability. However, the other 7 parts of the framework are critical for the success of ERPOs. Evidence-informed tools such as ERPO prevent violence before it occurs. This study serves as the first of its kind to review ERPO through an implementation science framework and measure its success.
Footnotes
Author Contributions
LG and SC conceived of the paper idea. LG led in the drafting of the paper. SC reviewed and edited the manuscript.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.