Implementation of a Lethal Means Reduction Toolkit in Pediatric Primary Care

Pediatric suicide rates have been increasing over the last twenty years. With increased screening, assessment, and interventions, we can dramatically reduce the rates of death by suicide. Lethal means reduction counseling training, specifically the Counseling on Access to Lethal Means (CALM) training, increases provider confidence levels in talking with patients about reducing suicide risk and improving safety interventions. Suicidal ideation is often temporary; providing lethal means reduction counseling and reducing immediate access to lethal means is one way to decrease suicide deaths. Local Problem: Firearm deaths by suicide in the state of Utah are more than twice the rate in the rest of the country. Pediatric primary care providers in a local suburban clinic reported low self- rated confidence levels in providing lethal means reduction counseling to depressed patients and family members. Methods: This quality improvement project aimed to increase provider confidence levels and frequency in giving lethal means reduction counseling to patients and family members by providing training and a toolkit. Before training or intervention, the clinic held an in-person meeting to establish the project's background, problem, and goals. Based on providers' expressed needs, we created a toolkit with state and national resources, evidence-based articles, and links to the online Counseling on Access to Lethal Means (CALM) training. Before the intervention, the participants responded to a pre-questionnaire assessing self-reported confidence levels and any barriers to discussing suicide risk with patients in their practice. After two months of access to the training and toolkit, providers completed post-questionnaire reassessing self-reported confidence levels and barriers to accessing the toolkit or CALM training. In the final stage of the project, participants completed a three-question questionnaire regarding the frequency with which they are providing lethal means reduction counseling for their depressed patients and family members. Interventions: Providers received access to the toolkit through email and, later, as a PDF through email. Frequent contact with participants occurred throughout the intervention timeline via email and remote office hours. Results: Out of 42 providers contacted, 21% (n=9) completed the pre-questionnaire, 19% (n=8) completed a post-questionnaire, (n=6) completed both the pre- and at least one of the post- questionnaires. Of eleven unique participants who responded to any questionnaire, two (18%) providers had completed lethal means reduction training before the intervention, and three (27%) additional providers completed the CALM training during the intervention period. In all self- rated confidence level questions regarding suicidal ideation, suicide risk assessment, and lethal means storage, providers who completed the CALM training increased in confidence. The frequency of times a provider gave lethal means reduction counseling to depressed patients increased in all providers who completed the CALM training and the frequency response questionnaire (n=4). Conclusion: These positive results are difficult to generalize due to a limited post-questionnaire participant response rate. The intervention increased provider confidence levels and frequency in giving lethal means reduction counseling to patients and family members of those providers who participated.