State Means Restriction Programs Other Means Restriction Activities
New Hampshire Alaska gun storage/safety intervention
Maine Emergency dept-based intervention
Montana VA dementia safety project
Examples of State Means Restriction Programs
Contact: Elaine Frank
Phone: 603.653.1135
Email: Elaine.M.Frank@dartmouth.edu
The Counseling on Access to Lethal Means Project (CALM) is the result of a partnership between the state Suicide Prevention Council, Injury Prevention Center (Children's Hospital at Dartmouth), and New Hampshire Department of Health and Human Services, with additional funding from the Gutin Family Foundation. Its goal is to train mental health care providers to conduct firearm safety counseling with parents of their young clients, and to reduce at-risk youth's access to firearms and medications as a preventive strategy for suicide. During the two-hour training workshop, mental health care providers are introduced to 1) the public health approach to suicide prevention; 2) the epidemiology of suicide and 3) the importance of reducing at-risk youth's access to firearms and medications as a prevention strategy. Upon completing the training, participants 1) have substantial knowledge of the association between access to lethal means and youth suicide; 2) understand the importance of and have positive attitudes toward counseling parents about reducing access to lethal means; 3) understand how counseling on reducing access to lethal means relates to state and national objectives for suicide prevention. The training includes a video depicting a reenactment of family counseling scenario. The Harvard School of Public Health has evaluated the training, and plans are currently underway to expand CALM trainings to emergency department and primary care health providers.
Contact: Lori Lovett
Phone: 317.278.0945
Email: llovet@iupui.edu
The Indiana Partnership to Prevent Violent Injury and Death (IPPVID) is located at Riley's Children's Hospital and funded formerly by the Joyce Foundation and now by the Indiana University Medical School and Clarian Health Promotion. They utilize their data surveillance system to plan their educational/prevention programs around suicide and injury prevention. The majority of their means reduction activities are firearm focused as Indiana has a high rate of gun ownership. IPPVID recently completed a two-year project to educate faith leaders about firearm suicide and violence in Marion County. This program helped provide faith leaders with resources that help them better determine who is at risk and how to intervene with those at risk for firearm suicide and injury. In addition, IPPVID has produced and conducted a medical resident training curriculum around counseling patients and their families about the risk of having a gun in the home. This is done with 4th year pediatric residents at Indiana University Medical School. It is a one-hour program that is now a mandatory part of their curriculum.
Contact: Cheryl DiCara
Phone: 207.287.5362
Email: Cheryl.m.dicara@maine.gov
http://www.mainesuicideprevention.org/
Maine's means reduction activities focus on guns, pills and rope. In 1996 7/10 suicides were the result of firearm and last year 5/10 suicides were from guns. In the early 2000's they created a video titled "Kids and Guns: Making the Right Choice" which addresses suicide prevention and means reduction. The video is geared towards 6th-8th graders, but can be used for a wider audience. The video has been widely distributed to police, schools, health educators, hospitals and child care providers. It is often distributed at health fairs, and the Suicide Prevention Coordinator often promotes the video and means reduction at health fairs. There is a brochure on means reduction (developed with the "5-minutes can save a life" model) that accompanies the video as well. They have conducted two firearm safety conferences in the past couple of years, which were well-received. In 2005 their lethal means committee met to discuss goals and activities. Members of this committee are from various backgrounds including law enforcement, doctors, child care providers, hunting & fishing officials and survivors. Their goals include the following:
- Provide education to ED staff about counseling on lethal means (guns, pills, ropes) in the house. The feedback the committee has gotten from providers is that ER doctors are reluctant to do means reduction counseling because it is not a billable service.
- Conduct grand rounds on means reduction as a form of suicide prevention.
- Develop a protocol for law enforcement to remove guns from the home if a person is suicidal or making suicidal threats.
- Develop a program similar to CALM for elderly.
Over the past year, there has been much organizational restructuring in Maine's injury prevention program, and the lethal means committee has not been meeting. Currently, Maine is planning to reconvene this committee and develop a protocol for law enforcement at local, county and state levels regarding the removal of lethal means.
Contact Person: Drenda Carlson
Phone: 406.444.6858
Email: dcarlson2@mt.gov
Out of 12 local sites Montana has funded, two are currently engaging in means restriction activities. These sites are focusing specifically on firearms. One site is using Project Safe Child in cooperation with law enforcement to provide gun locks at community events such as health fairs. The other site is working with law enforcement to train communities on safe storage practices through public service announcements. Both of these sub-grantees are using the QPR (Question, Persuade, Refer) Program as part of their suicide prevention activities.
Contact: Lisa Millet
Phone: 971.673.1059
Email: Lisa.M.Millet@state.or.us
http://www.oregon.gov/DHS/ph/ipe/ysp/spubs.shtml
Oregon's means reduction activities generally focus on all lethal means as opposed to just firearms. They promote means restriction on an individual level as opposed to family or school level. One activity includes promoting information for health care providers on screening for access to lethal means among their potentially suicidal patients. They are currently collaborating with Oregon Health Sciences University to produce written materials geared towards white males. They also hope to get educational information on lethal means restriction to health care providers of the elderly. Their website is extensive and includes means restriction information.
Examples of Other Means Restriction Programs
(Note: Some are state-based, but not based in a suicide prevention program)
1. The Alaska gun storage and safety intervention
This intervention was a community based program to improve firearm storage in rural Alaska. Firearm storage devices (i.e., gun safes and trigger locks) were distributed to forty randomly selected homes with two or more guns. Three months after distribution, unannounced visits were made to the homes to see if residents were using their storage and safety devices. At baseline, 85% of guns in the homes of participants were stored unlocked throughout the residence. Three months post-intervention, 86% of the gun safes were locked with guns inside. Only 30% of trigger locks were in use.
Firearm ownership is common in Norway, with greater than 30% of households owning firearms. New legislation introduced a delay of two weeks from the purchase of a gun to its actual acquisition and mandated safe storage in locked compartments in private homes. Suicide prevention education was provided to hunter organizations and included in training courses for new hunters. The Armed Forces reduced the substantial number of guns placed in the homes of members of the home guard and military reserve. Between 1987 and 2003, after the introduction of the legislation, the rate of firearm suicide in males dropped from 11.0 per 100,000 to 5.2. The overall suicide rate for males also dropped by close to a third. Females continued to have very low firearm suicide rates throughout the period.
3. Emergency department-based intervention
The goal of this intervention was to educate parents of youth at high risk for suicide about limiting access to lethal means for suicide. Education took place in emergency departments and was conducted by department staff. Lethal means covered included firearms, medications (over the counter and prescribed), and alcohol. Results found that family members of at-risk youth who received means restriction counseling were more likely than those not exposed to remove or lock up firearms and medications.
Conducted in 2001-2003, this quality improvement project focused on driving and gun safety for veterans with dementia. A questionnaire and educational pamphlets for use in VA outpatient settings were pilot-tested. The pamphlets are available online (see links above). The VA also designed pop-up reminders that appear in the electronic record when a provider enters a diagnosis in the "dementia" range. These pop-ups remind the provider to assess for firearm access and to provider lethal means counseling to family members.
5. Washington State's "Lok-It-Up" public education campaign
This campaign is the result of a partnership between the Harborview Injury Prevention Research Center, Children's Hospital & Regional Medical Center, city and county departments of Public Health, and Washington State Department of Health. Its goal is to prevent unintentional firearm deaths and injuries to young children and firearm suicides by adolescents by promoting the use of a gun lockbox that will provide the owner quick and easy access to the weapon, but prevent children from accessing it by changing community standards and norms to promote personal and community responsibility for the safe storage of guns. The target audience consists of: parents of children and adolescents, family practitioners, public health departments and the general public in Washington State. A key component of the program is the education of family practitioners on how to deliver safe gun storage messages to families. The website contains information specific to health care providers and parents, discount coupons for lockboxes, and other resources for safe storage.
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