383 - Children's ED Provider Experiences with Lethal Means Counseling and Firearm Access for Patients with Behavioral Health Emergencies

Poster Number: 383
Publication Number: 383.1550

Background: More than a third of all children and adolescent firearm deaths in the US are by suicide. Assessing firearm access during lethal means counseling (LMC) is paramount for youth with behavioral health crises. However, there is evidence that many ED providers feel reticent to ask about firearm access during LMC. Reasons for such reticence have not been fully investigated in Children’s ED providers.

Objective: This study aimed to explore Children’s ED provider perspectives regarding firearm access during LMC and determine ways to improve discharge safety planning for pediatric patients with behavioral health emergencies.

Design/Methods: This was a qualitative study with criterion sampling of providers who evaluate patients with behavioral health emergencies in an urban Children’s ED. Providers completed semi-structured interviews that were recorded by one researcher and transcribed verbatim. The research team reviewed all interview transcripts and inductively developed descriptive codes for each transcript. Codes were iteratively revised, combined, and organized using the constant comparative method and developed into themes. Data collection ended when theoretical sufficiency was achieved.

Results: We interviewed 29 Children’s ED providers; demographic characteristics can be found in Table 1. We found the following six themes; representative quotes for each are in Table 2.
1) There are varied perspectives regarding firearm safety and access in youth with behavioral health emergencies across Children’s ED providers.
2) A safety plan must examine the patient’s unique scenario to support post-discharge safety.
3) ED providers often underestimate or inadequately examine firearm access for children with behavioral health complaints during LMC.
4) The role of medical providers is commonly assumed to be in medical clearance, with LMC falling to social workers and psychiatrists.
5) Training would be helpful to bridge gaps in knowledge about firearm safety as well as with stigmatized conversations about firearms during LMC.
6) Practitioners and patients could benefit from availability of standardized resources to assist with LMC and safety planning to support firearm safe storage.

Conclusion(s): We found six themes in our study that reveal inadequacies in LMC and assessment of firearm access for children with behavioral health emergencies in an urban Children’s ED. Education and provision of standardized resources for safe firearm storage may address these crucial gaps in the ED care of pediatric patients with behavioral health emergencies.