‘It’s changed how we have these conversations’: emergency department clinicians’ experiences implementing firearms and other lethal suicide methods counseling for caregivers of adolescents

Abstract

Counseling parents to reduce access to firearms and other potentially lethal suicide methods is commonly known as lethal means counseling (LMC). The current study explores the experiences that emergency department-based behavioural health clinicians described having as they provided lethal means counseling to parents of adolescents at risk for suicide. Clinicians were purposively sampled from four hospital networks in Colorado after their hospitals adopted LMC protocols as part of an intervention that also included online training in LMC and provision of free medication and firearm lockboxes. Twenty-three clinicians were interviewed using semi-structured interviews. Data were analysed using a modified grounded theory-based approach. Clinicians felt more comfortable and effective in their abilities to provide LMC after the intervention. Clinicians also described how being able to offer free storage devices helped them engage in LMC. In advising parents to make guns and medications inaccessible to their at-risk child, most clinicians pointed to at least one of three research findings highlighted in the online training: (1) Suicide attempts with guns rarely afford second chances, (2) medication overdoses can kill, (3) suicidal behaviour is always unpredictable and often impulsive. All clinicians described a desire to continue LMC as currently protocolized at their hospital after the study ended.

Keywords:

• Adolescent health
• firearms
• suicide
• lethal means counseling
• emergency department
• qualitative
• interviews

Acknowledgements

We appreciate the contributions made by Marian Betz, Sara Brandspigel, Ashley Clement and Mary Vriniotis of the SAFETY study team; Sarah Brummett and Jarrod Hindman of the Colorado Department of Public Health and Environment; the staff at participating hospitals (Chery Storey, Billie Ratliff, Elizabeth Harabedian, Dawn Williams, Alyssa Stroup, Toni Sladek, Kelly Smith, Charlene Coffin), the staff in the UC legal office, HIPAA compliance office and IRB, and staff at the Community Epidemiology & Program Evaluation Group (CEPEG), particularly Arnold Levinson, Abigail Harris, Ali Billings, and Alexandra Male.

Author contributions

All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure statement

The sponsor had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the article. The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding source. No endorsement by the American Foundation for Suicide Prevention is intended or should be inferred.

Notes

1 Results from the quantitative surveys of the intervention revealed that 19% of all parents (and 29% of those in households with guns) recalled being spoken to about firearms prior to the intervention. During the intervention period counseling more than doubled: 57% of parents overall and 71% of those in households with firearms reported having been spoken to about firearms in the ED.

Additional information

Funding

This project was supported by funds from the American Foundation for Suicide Prevention [Grant ID TBT-0-013-15; Project Title: An ED-Based Randomised Controlled Trial of Lethal Means Counseling for Parents of Youth at Risk for Suicide].