374 - Lock and Protect, Reducing Access to Adolescent Means of Suicide: A Feasibility Cohort Pilot Study

Poster Number: 374
Publication Number: 374.1382

Background: Providing lethal means counseling (LMC) to guardians in emergency departments (EDs) shows promise to prevent suicide in adolescents. Our multi-disciplinary team systematically developed Lock and Protect, a web-based LMC decision aid for guardians presenting to EDs with their adolescents.

Objective: Determine the acceptability and feasibility of implementing Lock and Protect, the feasibility of conducting a future ED trial, and the proportion change in home lethal means storage at follow-up, among guardians presenting to the ED with their adolescent for self-harm.

Design/Methods: Prospective cohort of English-speaking guardians and their adolescents, 13-17 years presenting to ED for self-harm (suicidal ideation or attempt, or non-suicidal self-injury). The first 40 guardians received Lock and Protect in the ED and the subsequent 10 received usual ED care. Lock and Protect provides LMC including: education, safe storage options, and protective monitoring. Guardians receiving Lock and Protect completed the Ottawa Acceptability Scale (OAS) and Decisional Conflict Scale after using Lock and Protect in the ED. Trial feasibility was assessed by consent and follow-up rates. Feasibility of Lock and Protect use was determined by completion rates, minutes to complete, and user feedback. We defined increased safe storage as removing a firearm and/or medications from the home and/or changing the storage to a more secure method. We used standard descriptive statistics to summarize data.

Results: Fifty of 59 eligible patients (85%) were enrolled (Figure 1). Table notes demographics and lethal means access. Figure 2 notes OAS individual outcome measures. All guardians would recommend the tool to a friend or family member in a similar situation, and 95.0% found the options presented realistic. 97.5% of guardians found Lock and Protect useful for changing home access to lethal means. Of guardians enrolled in the intervention, 37/40 (92.5%) reported a Decisional Conflict Scale score < 25 (associated with behavioral change). Guardians used the tool for a mean of 8 minutes and 100% completed the tool in the ED. Two and/or 4-week follow up procedures were completed for 76% of guardians. Of guardians who received Lock and Protect or usual care, 20/31 (64.5%; 95% CI 45.4-80.8) and 2/7 (28.6%; 95% CI 3.7%-70.9%) increased safe home storage of lethal means.

Conclusion(s): The Lock and Protect decision aid was feasible to implement in the ED and acceptable to guardians of adolescents presenting to a single, urban ED for self-harm. A future randomized trial in the ED appears feasible.