"Your son needs help … and we're gonna help him": A qualitative study of the experiences of gun-owning caregivers of adolescents receiving lethal means counseling in the emergency department

Carmel Salhi; Elizabeth Beatriz; John Berrigan; Deb Azrael; Ashley Houston; Carol Runyan; Catherine Barber; Marian Betz; Matthew Miller

doi:10.1016/j.socscimed.2023.116218

"Your son needs help … and we're gonna help him": A qualitative study of the experiences of gun-owning caregivers of adolescents receiving lethal means counseling in the emergency department

Soc Sci Med. 2023 Oct:335:116218. doi: 10.1016/j.socscimed.2023.116218. Epub 2023 Sep 7.

Authors

Carmel Salhi¹, Elizabeth Beatriz², John Berrigan³, Deb Azrael⁴, Ashley Houston⁵, Carol Runyan⁶, Catherine Barber⁷, Marian Betz⁸, Matthew Miller⁹

Affiliations

¹ Department of Health Sciences, Northeastern University, Boston, MA, USA; Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA. Electronic address: c.salhi@northeastern.edu.
² Massachusetts Department of Public Health, Boston, MA, USA. Electronic address: elizabeth.beatriz@state.ma.us.
³ University of Kansas School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA; Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA. Electronic address: jberrigan2@kumc.edu.
⁴ Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA. Electronic address: azrael@hsph.harvard.edu.
⁵ Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA. Electronic address: ashley.houston@bc.edu.
⁶ Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA. Electronic address: carol.runyan@cuanschutz.edu.
⁷ Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA. Electronic address: cbarber@hsph.harvard.edu.
⁸ Injury and Violence Prevention Center, Colorado School of Public Health, Aurora, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: marian.betz@cuanschutz.edu.
⁹ Department of Health Sciences, Northeastern University, Boston, MA, USA; Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA. Electronic address: ma.miller@northeastern.edu.

PMID: 37738913
DOI: 10.1016/j.socscimed.2023.116218

Abstract

Suicide attempts in adolescents are often transient and unpredictable, making preventative approaches crucial in reducing suicide deaths. One important approach is lethal means counseling (LMC), in which clinicians counsel caregivers to reduce access to methods used in suicide, specifically firearms and medications. Research on LMC has increasingly encouraged the use of the shared decision-making (SDM) model, which emphasizes information exchange, collaborative deliberation, and joint planning between caregivers and clinicians. We examine caregivers' experiences with LMC, using the SDM model as our analytic framework. We conducted qualitative interviews with 21 firearm-owning caregivers of adolescents who came to emergency departments (EDs) in Colorado for a behavioral health complaint. The implementation of LMC at these institutions had three central components: training for clinicians, materials (e.g., lockboxes and pamphlets) to support LMC, and the protocolization of LMC at the institution. Our semi-structured, hour-long interviews examined participants' reflections on and reactions to LMC provided in the ED and how that related to changes in their understanding of their medication and gun storage practices. We analyzed interviews using a phenomenological approach, focusing on experiences with LMC and informed by the tenets of the SDM model. Our analysis revealed that caregivers were receptive to the idea of LMC in the pediatric emergency care setting. Caregivers' engagement in LMC was reinforced by experiences with clinicians who sought to understand the circumstances of their household, shared the motivation behind LMC, and facilitated conversation around a shared concern for the child's safety. In contrast, counseling delivered mechanically and without considering the household context was tied to caregivers' confusion and alienation, both for LMC and their consideration of changes to home storage practices. These findings provide insight into adolescent caregivers' experiences with LMC implemented in EDs and how LMC may best be approached.

Keywords: Adolescent; Caregiver; Emergency department; Firearm; Lethal means counseling; Medication; Parent; Qualitative; Suicide prevention.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Caregivers*
Child
Counseling
Emergency Service, Hospital
Firearms*
Humans
Male
Nuclear Family