Development of an intervention to incentivize secure firearm storage among veterans at risk for suicide

Firearm injuries account for 74% of veteran suicides. During lethal means counseling (LMC), clinicians discuss with patients their access to lethal means like firearms and collaboratively develop a plan to reduce this access. However, many patients do not go on to change their firearm storage practices. While financial and social incentives motivate health behavior change, they have not been leveraged to promote secure firearm storage. We used community-engaged methods to develop an intervention offering incentives to encourage secure firearm storage among veterans at elevated risk for suicide.

We conducted qualitative interviews with 20 veteran firearm owners with recent suicidal ideation (equally split among the Philadelphia and New Orleans regions and among rural and urban-residing veterans) and 10 VA clinicians and administrators with expertise in veteran suicide prevention. We also convened an advisory board with veteran firearm owners and VA clinicians/administrators. Interviews were analyzed using rapid qualitative methods and findings were presented to the advisory board, which employed online modified Delphi procedures to reach consensus on the final intervention features.

Veterans and clinicians were enthusiastic about the potential for incentives to promote secure firearm storage. The final intervention will include two monetary and one social incentive. First, $50 will be offered to veterans who attend a follow-up session to update the clinician about their secure storage plan and a bonus $50 will be offered to veterans who provide verification of secure firearm storage (e.g., a picture or receipt from a recently purchased locking device). The social incentive will include written testimonials from veterans who chose to store their firearms more securely in the context of suicide risk. Incentives will be offered for any meaningful increase in veterans' secure storage practices using a person-centered framework (e.g., using a locking device, storing an unloaded firearm out of reach).

Using a collaborative and iterative approach, stakeholders developed an intervention leveraging financial and social incentives to encourage secure firearm storage. Study findings have implications for LMC more broadly, including development of acceptable methods of verifying secure firearm storage and identifying ongoing monitoring of firearm storage as key to improving outcomes.