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

Providing lethal means counseling to caregivers is an underutilized component of emergency department (ED)-based suicide prevention. We assessed the feasibility and acceptability of Lock and Protect, a web-based lethal means counseling decision aid, among caregivers of adolescents who presented to the ED for self-injurious and/or suicidal thoughts and behaviors.

We conducted a pilot feasibility study of caregiver-adolescent dyads in a pediatric ED. Adolescents were 13-17 years old with current suicidal ideation, suicide attempt, or non-suicidal self-injury. Caregivers received the Lock and Protect intervention plus usual care while their child was in the ED. Feasibility was measured via enrollment rates, duration of time caregivers interacted with Lock and Protect, and tool completion rates. Caregiver acceptability was measured with the Ottawa Acceptability Scale. Follow-up assessments measured changes in home storage at 2- and 4-weeks after enrollment.

Of 47 caregivers screened and eligible, 40 enrolled (85.1%), of whom 39/40 and 1/40 reported home access to medications and firearms, respectively. Caregivers found Lock and Protect respectful of their family values about medications (100%) and firearms (97.5%). Almost all caregivers (95.0%) reported the length was "just right" and 92.5% reported the amount of information was "just right". All caregivers completed the tool in the ED, using it for a mean of 8 min (SD = 3.4 min). All would recommend the tool to others. Ottawa Acceptability Scale scores demonstrated that 95.0% of caregivers found the options in Lock and Protect realistic, and 97.5% found the tool useful for changing home medication access. Follow-up was completed for 77.5% of caregivers, with 20/31 (64.5%) reporting safer home storage of medications.

Lock and Protect, a web-based lethal means counseling decision aid, was feasible to administer in the pediatric ED and acceptable to caregivers of adolescents at risk for suicide.