Send to

Choose Destination
West J Emerg Med. 2016 Jan;17(1):8-14. doi: 10.5811/westjem.2015.11.28590. Epub 2016 Jan 12.

Lethal Means Counseling for Parents of Youth Seeking Emergency Care for Suicidality.

Author information

Colorado School of Public Health, Departments of Epidemiology and of Community and Behavioral Health, Program for Injury Prevention, Education and Research, Aurora, Colorado.
University of Colorado School of Medicine, Department of Psychiatry, Aurora, Colorado.
Colorado School of Public Health, Program for Injury Prevention, Education and Research, Aurora, Colorado.
Harvard University, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Colorado Department of Public Health, Denver, Colorado.



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).


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.


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.


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.

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Emergency Medicine department, University of California Irvine Icon for PubMed Central
Loading ...
Support Center