Lethal Means Counseling in Pediatric Emergency Care

Background:  Youth suicide is a major public health issue in the Rocky Mountain region and the emergency department (ED) is a potentially important point of intervention.

Methods: Using an online adaptation of the Counseling on Access to Lethal Means (CALM) model, we trained behavioral health providers in a large pediatric emergency department to counsel parents of suicidal youth at discharge and to provided lockboxes.  We queried providers about implementation issues and interviewed parents after the visit.

Results: Sixteen clinicians completed training and, during the study period, saw 236 patients with suicidal ideation or behaviors; 114 parents participated in follow-up interviews.   Chart reviews indicated 89% of 236 eligible families received the counseling and most accepted the free lockbox. Among the 114 parents we interviewed, 93% remembered the clinician talking about medication storage and 79% of the 33 families who reported having guns remembered counseling about gun storage. Both parents and clinicians found the intervention helpful. At follow-up, parents reported unlocked medication storage had dropped from 86% to 23%; all 33 parents who reported having guns indicated that, after means restriction counseling, their guns were either no longer stored at home or were locked.

Discussion: This intervention proved viable for implementation in this ED and appeared to favorably influence parent behavior. Wider testing in more facilities is important.