319 - Reducing Firearm Access for Youth At-Risk for Suicide in a Pediatric Emergency Department

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.

Objective:

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 to investigate practice changes pre- to post-intervention.

Design/Methods:

Prospective feasibility study of caregivers of youth presenting to pediatric ED with BH complaints. Caregivers completed a self-administered electronic survey regarding 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 electronic 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:

65 subjects were approached with 49 (75%) enrolling (96% female, 49% Black, mean age 40 years (SD± 8.4)). 59% had no prior gun-safety counseling/education; 45% had at least one gun at home. Among gun-owners (n=22), 82% had handguns and 45% had shotguns. 64% always used safe-storage device. 45% used gun-safe, 27% used lock box, and 23% used trigger lock. 59% of gun-owners requested safe-storage devices.

80% (n=39/49) of enrolled participants completed follow-up, where 69% of participants asked about household guns prior to child visiting other homes compared to 46% pre-intervention (+23%). >80% affirmed at intake and follow-up that ED gun-safety education was useful and 85% affirmed at intake and follow-up that ED is appropriate place for gun safety discussions. Among gun-owners that completed follow-up (n=19), 100% stored all guns locked at 1-week compared to 74% pre-intervention (+26%). 

Conclusion(s):

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.