Changes in Firearm and Medication Storage Practices in Homes of Youths at Risk for Suicide: Results of the SAFETY Study, a Clustered, Emergency Department–Based, Multisite, Stepped-Wedge Trial

Miller, Matthew; Salhi, Carmel; Barber, Catherine; Azrael, Deborah; Beatriz, Elizabeth; Berrigan, John; Brandspigel, Sara; Betz, Marian E.; Runyan, Carol S. Wolf

doi:10.1016/j.annemergmed.2020.02.007

Cited by 60 publications

(35 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25 Pediatricians and other health care providers also have a role to play, given evidence that providerdelivered counseling to parents about reducing firearm access for suicidal youth may result in changes in home storage. 27,28 Firearms may also be accessible to youth outside of their own home. This may include other homes where they spend time (eg, legally owned firearms belonging to neighbors, relatives, or friends) or avenues for illegal firearm acquisition or access.…”

Section: Discussionmentioning

confidence: 99%

Perceived Access to Handguns Among Colorado High School Students

Brooks‐Russell

Brummett

et al. 2021

Pediatrics

View full text Add to dashboard Cite

OBJECTIVES: Access to firearms among youth can increase the risk of suicide or other injury. In this study, we sought to estimate the population prevalence of adolescent perception of firearm access by demographic, geographic, and other individual health characteristics. METHODS:The 2019 Healthy Kids Colorado Survey was an anonymous survey administered to a representative sample of high school students in Colorado. The survey was used to assess health behaviors and risk and protective factors. Analysis was conducted with weights to the state population of public high school students.RESULTS: In total, 46 537 high school students responded (71% student response rate; 83% school response rate). One in 5 students said it was "sort of easy" (11.1%) or "very easy" (8.8%) to access a handgun, with higher prevalence among male and older-aged youth and differences in racial and/or ethnicity groups. There were geographic differences such that students in schools in more rural areas were more likely to report perceived easy access. Students who had felt sad or hopeless, attempted suicide, or been in a fight were more likely to say they had access to a handgun. CONCLUSIONS:A relatively high proportion of youth have easy access to a firearm, with differences across age, sex, race and/or ethnicity, and geography. This highlights the need for efforts to address ways to reduce firearm access for youth, including secure storage at home, for the prevention of youth firearm suicide and other firearm injuries.WHAT'S KNOWN ON THIS SUBJECT: Suicide is a leading cause of death among adolescents, and firearms are implicated in a majority of those deaths. Safe storage of firearms can prevent adolescent suicide, homicide, and unintentional firearm injuries and deaths.WHAT THIS STUDY ADDS: In a representative sample of high school students in Colorado, 20% reported easy access to a handgun. Students with mental health concerns or who had been in a fight were more likely to say they could access a handgun.

show abstract

Section: Discussionmentioning

confidence: 99%

Perceived Access to Handguns Among Colorado High School Students

Brooks‐Russell

Brummett

et al. 2021

Pediatrics

View full text Add to dashboard Cite

show abstract

“…Prior work has shown that LMC may positively affect home storage behaviors, especially among parents of suicidal adolescents. 2 , 3 …”

Section: Introductionmentioning

confidence: 99%

“…Prior work has shown that LMC may positively affect home storage behaviors, especially among parents of suicidal adolescents. 2,3 Yet LMC in the ED does not routinely occur with suicidal adults. Even among those being discharged home, counseling is documented in only about half of these patients.…”

mentioning

confidence: 99%

Lethal Means Counseling for Suicidal Adults in the Emergency Department: A Qualitative Study

Siry-Bove¹,

Knoepke²,

Ernestus³

et al. 2021

WJEM

View full text Add to dashboard Cite

Introduction Lethal means counseling (to reduce access to firearms or other suicide methods) is a recommended critical yet challenging component of care of suicidal patients. Questions remain about communication strategies for those in acute crisis. Methods This qualitative study was an analysis of semi-structured interviews with English-speaking, community-dwelling adults with a history of lived-experience of suicidal ideation or attempts in themselves or a family member. We used a mixed inductive and deductive approach to identify descriptive themes related to communication and decision-making. Results Among 27 participants, 14 (52%) had personal and 23 (85%) had family experience with suicide ideation or attempts. Emergent themes fell into two domains: (1) communication in a state of high emotionality; and (2) specific challenges in communication: initiating, maintaining engagement, considering context. Conclusion Engaging suicidal individuals in lethal means counseling may be more effective when messaging and approaches consider their emotional state and communication challenges.

show abstract

“…Throughout the study, ED behavioural health clinicians (mostly social workers) collected contact forms from caregivers accompanying youth so as to enable the study team to do follow-up interviews. During a 2-week transition period, as hospitals prepared for the intervention phase, we asked these clinicians to complete online training in lethal means counselling and attend an in-person staff meeting in which we explained the intervention protocol and introduced the study materials (handgun safes, medication lockboxes, cable locks for other guns and educational materials), as described in more detail by Miller et al 5 and Barber et al 6…”

Section: Introductionmentioning

confidence: 99%

Lessons learned in conducting youth suicide prevention research in emergency departments

et al. 2019

Self Cite

View full text Add to dashboard Cite

IntroductionTo address youth suicide, we recruited seven emergency departments (EDs) for what we believe is the first controlled trial of an intervention to promote safer firearm and medication storage after a child was seen in an ED by a behavioural health clinician. We provided training and a common protocol that required behavioural health clinicians to counsel about reducing access to household firearms and medication and provide locking devices. This paper examines how we addressed implementation challenges and considers how lessons learnt might inform future studies and interventions.MethodsWe tracked enrolment numbers and documented, through project records, the challenges in recruiting and developing partnerships with hospitals, as well as implementing the intervention and carrying out data collection.ResultsWe encountered challenges identifying hospitals with sufficient patient volumes to meet our analytic requirements, obtaining contact information from families in the ED and providing supplies to the sites. These challenges were compounded by lack of uniformity in data systems, making it difficult to estimate total ED encounters meeting our eligibility criteria, and by differences in patterns of behavioural healthcare delivery across sites. The strategies we devised to address these challenges included creating visual materials that appealed to parents’ altruistic desire to help other families, laminated ‘cheat sheets’ and hang tags for clinician badges reminding them of the key points of the intervention and contracting with a distribution centre to coordinate shipping.DiscussionDespite the challenges noted, we found that the behavioural health clinicians in the EDs followed the protocol and found it useful in engaging families in discussions about both firearm and medication storage. Several hospitals intend to continue the intervention on their own as the new usual care, suggesting that the challenges encountered can be and are worth tackling.

show abstract

Changes in Firearm and Medication Storage Practices in Homes of Youths at Risk for Suicide: Results of the SAFETY Study, a Clustered, Emergency Department–Based, Multisite, Stepped-Wedge Trial

Cited by 60 publications

References 29 publications

Perceived Access to Handguns Among Colorado High School Students

Perceived Access to Handguns Among Colorado High School Students

Lethal Means Counseling for Suicidal Adults in the Emergency Department: A Qualitative Study

Lessons learned in conducting youth suicide prevention research in emergency departments

Contact Info

Product

Resources

About