ORCID

0000-0001-9008-4751 (Leader)

Document Type

Article

Publication Date

2025

DOI

10.1186/s40621-025-00599-5

Publication Title

Injury Epidemiology

Volume

12

Issue

1

Pages

52

Abstract

Background

Access to lethal means contributes significantly to suicide completion. Lethal means safety counseling (LMSC) is an injury prevention strategy to limit access to firearms, medications, and other means of injury. Not previously evaluated in the trauma setting, this study aims to design and implement a standardized LMSC protocol for pediatric patient discharge education in emergency (ED), trauma, and inpatient psychiatry settings.

Methods

A single-center quality improvement study at an academic pediatric urban tertiary Level-one trauma center was performed from July 2023 to February 2024. Protocol was implemented for pediatric patients discharged from three departments: ED, surgery trauma service, and psychiatry. Interventions included electronic medical record (EMR) based LMSC screening questions, training with Counseling on Access to Lethal Means (CALM) module, a de novo educational training video, and providing families free cable gun locks and medicine lock boxes. Healthcare collaborators completed pre- and post-training surveys. Data was recorded in Redcap and analyzed as descriptive and parametric data. Primary outcome was incorporation of LMSC and intervention into social worker's workflow. Secondary outcomes included project barriers and outcomes, familial impression of counseling, and healthcare provider impression of intervention.

Results

Out of forty-eight persons, 29 providers completed the pre-training survey and 17 completed the post-training survey. Results indicated increased discussions with caregivers about safe medicine storage comparing averages of pre and post-test results (mean difference 0.44, 95% CI 0.05-0.83, p = 0.029), but no differences in discussions about safe firearm storage (mean difference 0.50, 95% CI - 0.05-1.05, p = 0.07) or knives (mean difference 0.56, 95% CI 0.05-1.18 p = 0.07). Provider behavior changes occurred with increased clinical frequency of cable gun lock distribution.

Conclusions

This study describes implementing a standardized LMSC protocol in three pediatric hospital departments with self-reported provider improvements in LMSC. Barriers identified to protocol implementation are an opportunity to improve future preventative patient care.

Rights

© The Authors 2025.

This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if you modified the licensed material. You do not have permission under this license to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Data Availability

Article states: "No datasets were generated or analysed during the current study."

Original Publication Citation

Stegall, C. L., Carnell, B., Golden, J. M., Kapoor, R., Fanton, J. H., Mullan, P. C., & Leader, A. P. (2025). Multidisciplinary lethal means safety counseling design and implementation: Training and identifying barriers in a children's hospital. Injury Epidemiology 12(1), Article 52. https://doi.org/10.1186/s40621-025-00599-5

Additional Files
40621_2025_599_MOESM1_ESM.pdf (52 kB)
Supplementary Material 1: Guardian baseline data survey
40621_2025_599_MOESM2_ESM.pdf (82 kB)
Supplementary Material 2: Healthcare provider pre and posttest survey
40621_2025_599_MOESM3_ESM.pdf (432 kB)
Supplementary Material 3: Calm module
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