When a teenager arrives at the emergency department after suicidal thoughts or an attempt, this program does more than offer advice: it puts a firearm lockbox into the family’s hands at that moment. Since 2014, suicide has been the second most common cause of death in children and adolescents from 10 to 24 years of age in the United States.

Self-harm deaths among adolescents in Wisconsin increased by thirty-four percent since 2006. Firearms play a significant role in these deaths: over forty percent of suicides are caused by firearms. Average gun ownership per Wisconsin household was forty-three percent between 2007 and 2016, and adolescents with suicidal ideation were just as likely to have an accessible firearm at home as adolescents without a firearm.

Firearms are a predominant method for suicides nationally and in Wisconsin, while the Children’s Wisconsin Emergency Department and Trauma Center sees over eleven hundred patient visits per year for suicidal ideation or attempt. The program’s goal was to provide safe firearm storage in the homes of adolescent patients with suicidal ideation or attempt.

Every patient and family presenting to the emergency department for suicidal ideation or attempt receives a social work consult twenty-four hours a day, seven days a week. Licensed social workers evaluate the patient using the Columbia Suicide Severity Rating Scale, assess safety, provide mental health resources, and help identify inpatient or outpatient mental and behavioral health treatment options.

Hospital social workers, injury prevention specialists, pediatric residents, and a pediatric emergency medicine physician collaborated on developing the program. Social workers already discussed lethal means restriction with families of at-risk patients, but they wanted a bundle for use in the emergency department and at discharge.

That bundle included a patient and family education sheet, recommendations for safe firearm removal or storage, and provision of firearm lockboxes. Social workers use a behavioral health template in the electronic health record to document lethal means restriction family education.

The patient and family education sheet was tailored for emergency department and trauma center use and included information about behavioral health emergencies, safe storage of medications and firearms, and telephone numbers for local and national suicide prevention resources.

The patient and family education sheet was reviewed by the health literacy team. Creating the firearm lockbox program led to increased education and awareness among social workers about the importance of firearm prevention and safe storage.

Because the lockboxes are provided promptly, families can put them into use immediately after a traumatizing event. If families received only education about safe storage, they would have to find the time and funds to purchase lockboxes themselves. By supplying high-quality lockboxes at the child’s emergency department visit, the program eliminates the burden of research, time, and funding for families.

One potential consequence of providing the lockbox is improper usage: families may not use it, leave it unlocked, give it to someone else, or lose it. Education about the firearm lockbox and safe storage is given when the item is distributed to mitigate this consequence.

The lockbox stores only one handgun at a time, so a larger firearm safe is recommended for families with more or larger firearms. Social workers provide education about general firearm safe storage so families can better select an appropriate storage device. Some community-based temporary firearm-storage locations may not be immediately accessible to families, and the program also faces a potential barrier of having enough emergency-department storage space for the lockboxes.

Next steps include providing medication lockboxes, formally assessing social worker satisfaction, and following up with families who received lockboxes to assess lockbox use and satisfaction. The program plans to offer lockboxes for homicidal patients and in emergency-department cases where safe firearm storage is needed.

Lethal means restriction counseling during an emergency-department visit gives caregivers an opportunity to prevent a tragic event. Providing a firearm lockbox during the visit, together with education on its use, provides a concrete safety device and reminder to reduce lethal means in the home.

Families are in crisis after learning that their child has considered or attempted suicide, and emergency-department health providers have a crucial responsibility to assist with medical care and injury prevention strategies. The program combined lethal-means counseling, a tailored education sheet, and firearm lockboxes during pediatric emergency visits.

Its promise is immediate access to safer storage, while follow-up is still needed to measure use and satisfaction.