title: Lethal Means Counseling for Parents of Youth Seeking Emergency Care for Suicidality.
abstract: BACKGROUND
  A youth's emergency department (ED) visit for suicidal behaviors or ideation provides an opportunity to counsel families about securing medications and firearms (i.e., lethal means counseling).
  
  
  METHODS
  In this quality improvement project drawing on the Counseling on Access to Lethal Means (CALM) model, we trained 16 psychiatric emergency clinicians to provide lethal means counseling with parents of patients under age 18 receiving care for suicidality and discharged home from a large children's hospital. Through chart reviews and follow-up interviews of parents who received the counseling, we examined what parents recalled, their reactions to the counseling session, and actions taken after discharge.
  
  
  RESULTS
  Between March and July 2014, staff counseled 209 of the 236 (89%) parents of eligible patients. We conducted follow-up interviews with 114 parents, or 55% of those receiving the intervention; 48% of those eligible. Parents had favorable impressions of the counseling and good recall of the main messages. Among the parents contacted at follow up, 76% reported all medications in the home were locked as compared to fewer than 10% at the time of the visit. All who had indicated there were guns in the home at the time of the visit reported at follow up that all were currently locked, compared to 67% reporting this at the time of the visit.
  
  
  CONCLUSIONS
  Though a small project in just one hospital, our findings demonstrate the feasibility of adding a counseling protocol to the discharge process within a pediatric psychiatric emergency service. Our positive findings suggest that further study, including a randomized control trial in more facilities, is warranted.
authors.affiliation: Colorado School of Public Health, Departments of Epidemiology and of Community and Behavioral Health, Program for Injury Prevention, Education and Research, Aurora, Colorado.
authors.forename: Carol W
authors.initials: CW
authors.lastname: Runyan
authors.affiliation: University of Colorado School of Medicine, Department of Psychiatry, Aurora, Colorado.
authors.forename: Amy
authors.initials: A
authors.lastname: Becker
authors.affiliation: Colorado School of Public Health, Program for Injury Prevention, Education and Research, Aurora, Colorado.
authors.forename: Sara
authors.initials: S
authors.lastname: Brandspigel
authors.affiliation: Harvard University, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Catherine
authors.initials: C
authors.lastname: Barber
authors.affiliation: Colorado Department of Public Health, Denver, Colorado.
authors.forename: Aimee
authors.initials: A
authors.lastname: Trudeau
authors.affiliation: University of Colorado School of Medicine, Department of Psychiatry, Aurora, Colorado.
authors.forename: Douglas
authors.initials: D
authors.lastname: Novins
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration; D003120:Colorado / Q000453:epidemiology; D037001:Directive Counseling / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005389:Firearms / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D010290:Parents / Q000193:education / Q000523:psychology; D010351:Patient Discharge; D055553:Prescription Drugs; D011314:Preventive Health Services / Q000458:organization & administration; D058996:Quality Improvement; D059020:Suicidal Ideation
chemical_list: D055553:Prescription Drugs
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