PC1030: Reducing Firearm Access for Youth At-risk for Suicide in a Pediatric Emergency Department

Background: Firearm-related suicide is the second leading cause of pediatric firearm death. Lethal means counseling (LMC) can improve firearm safe-storage practices and be a critical intervention for families with youth at-risk of suicide. Study objectives are to evaluate feasibility and acceptability of pediatric emergency department (ED) behavioral health (BH) specialists providing LMC to caregivers of youth presenting with BH complaints and practice changes post-intervention.

Methods: Prospective feasibility study of caregivers (parents/legal guardians) of youth presenting with BH complaints to a pediatric ED that were evaluated by a BH specialist. Four BH specialists consented, enrolled, and provided LMC for the study. Prior to enrollment, BH specialists completed mandatory training including a nationally known online course, Counseling on Access to Lethal Means (CALM) through Zero Suicide; an online module reviewing local pediatric firearm injury/suicide data, scope of problem, and study goals; and a virtual study in-service session. At ED intake, caregivers completed a self-administered 35-question e-survey, developed and previously beta tested by the investigative team, which included self-reported demographics and firearm safe-storage knowledge/practices. All participants received LMC from BH specialist after primary BH concerns were addressed. Gun-owners were offered a free lockbox and/or trigger lock. 1-week follow-up e-surveys gathered self-reported data on firearm-safety practices and intervention acceptability. Primary outcomes include proportion of gun-owning participants, follow-up survey response, and acceptability of LMC. Secondary outcomes include reported change in firearm-safety practices. Descriptive statistics were used for univariate and paired data responses. Likert-scale acceptability responses were dichotomized to strongly agree/agree (affirmative) vs. neutral/disagree/strongly disagree.

Results: Thirty-two caregivers were approached and 22 consented. 95% of participants were female, 41% Black, mean age of 41 years (SD± 9.4). 55% had no prior gun safety counseling/education; 50% had gun at home. Among gun-owners (n=11): 36% had 3+ guns, 82% had handguns, 64% had shotguns, and majority (73%) had gun for safety/protection. 73% of gun-owners always used a safe-storage device, most commonly gun-safe or trigger lock (36%) followed by lockbox (27%). 73% of gun-owners requested safe-storage devices.
77% (n=17/22) of participants completed follow-up survey where 76% of participants asked about household guns before their child visits other homes compared to 53% pre-intervention (+23.5%). For acceptability: 82% affirmed at intake and follow-up that gun-safety education in ED was useful and 76% at follow-up affirmed ED as an appropriate place for gun safety discussion compared to 71% at intake (+5.9%). For storage practices among gun-owners that responded to follow-up (n=9): 100% stored all guns locked at 1-week compared to 78% pre-intervention (+22.2%).

Conclusion: Preliminary results show that it is feasible to provide LMC in the ED via BH specialists to families of high-risk youth. Caregivers report finding this intervention useful, acceptable, and appropriate. Additionally, LMC and device distribution led to reported changes in safe-storage practices.