Children's Emergency Department Provider Experiences With Lethal Means Restriction Counseling and Firearm Access.

Abstract

Objective: Assessing firearm access and providing lethal means restriction counseling (LMRC) is paramount for harm reduction, but evidence indicates that it is not commonly provided by Children's Emergency Department (ED) providers. This study aimed to explore provider perspectives and determine avenues to increase discharge safety for patients with behavioral health emergencies.

Methods: Twenty-nine Children's ED providers completed semistructured interviews which were recorded, transcribed, iteratively coded, and organized into themes.

Results: We identified the following 5 themes: (1) Children's ED providers have varying experiences with firearms which could influence their clinical practices. (2) Most providers expressed knowledge of LMRC as a necessary component of safety planning for behavioral health patients. (3) The role of medical providers is commonly assumed to be only in medical clearance, with LMRC falling to social workers and psychiatrists. (4) Many Children's ED providers seem to underestimate the gravity of risk associated with firearm access for children with behavioral health complaints. (5) Training and resources could help facilitate effective LMRC and support caregiver implementation of firearm secure storage.

Conclusions: Despite a wide range of perspectives and barriers that prevent the consistent provision of LMRC, we saw that providers are amenable to interventions to increase comfort, consistency, and efficacy of safety planning. Understanding these perspectives can inform future initiatives for comprehensive LMRC that include firearm secure storage and address this crucial gap in care.