Reducing Firearm Access for Suicide Prevention: Implementation Evaluation of the Web-Based "Lock to Live" Decision...

Area of Science:

• Public Health
• Mental Health Services
• Suicide Prevention

Background:

• Lock to Live (L2L) is a novel web-based decision aid designed to help individuals at risk of suicide reduce access to firearms.
• Previous research confirmed L2L's feasibility and patient acceptability, but its implementation within routine care settings remained underexplored.

Purpose of the Study:

• To support the implementation and evaluation of the L2L tool within routine primary care and mental health specialty encounters.
• To assess the reach, adoption, and implementation of L2L using the RE-AIM framework.

Main Methods:

• The study was conducted at Kaiser Permanente Washington (KPWA) from January 2020 to December 2021.
• Qualitative interviews with patients (n=36) and clinicians (n=30) informed implementation strategies.
• Electronic health record (EHR) data were analyzed to track L2L reach and adoption among high-risk patients.

Main Results:

• Key patient-derived recommendations for L2L introduction included open communication and validating patient experiences.
• Clinicians preferred L2L integration into EHR safety plan templates over manual addition.
• L2L adoption increased significantly, reaching 29% among primary care and 48% among mental health clinicians by the end of the study period.

Conclusions:

• Understanding user perspectives was crucial for successful L2L implementation and adoption.
• Integrating L2L into existing EHR safety plan templates proved to be a highly effective implementation strategy.
• The findings and tools developed offer valuable strategies for nationwide suicide prevention efforts in healthcare settings.