Developing an Intervention to Promote Lethal Means Safety in Suicidal Adolescents

Suicide in adolescents has become an epidemic with limited understanding of the most effective interventions to reduce suicidal ideation, attempts, and deaths. Despite this uncertainty, research points to lethal means counseling with the parent of the suicidal teen as crucial and potentially the single-most powerful intervention a clinician can conduct. However, there is limited literature on how to conduct lethal means counseling and few interventions to support in lethal means safety adherence. As such, this study focused on 1) establishing an understanding of current lethal means counseling and practices through conducting semi-structured qualitative interviews with parents (N = 6) and clinicians (N = 12) and 2) developing a text-based intervention to promote adherence to means safety (named the Safe Home intervention) and 3) examining the acceptability, feasibility, and perceived effect of this intervention. The Safe Home intervention utilizes nudges, a behavioral economics approach, to prompt parents to adhere to lethal means safety practices through twice-a-week texts consisting of brief reminders as well as a questionnaire we developed to aid parents in assessing their teen's access to lethal means. Results from this mixed-methods study indicate that our text-based intervention meets a significant need identified by parents and clinicians: it provides consistency, structure, and support specific to lethal means adherence. On the Client Satisfaction Questionnaire-8, parents (N = 9) reported overwhelming satisfaction with the intervention (M = 28, SD = 3.46) and stated the texts aided them in maintaining a safe home for their teen. In addition, parents overwhelmingly reported (88.9%) that they would continue utilizing the intervention past the study window. All parents reported that the intervention prompted them to adhere to lethal means safety practices, including buying a lockbox, searching their child's room, and securing medications. The Safe Home intervention was found to be both acceptable and feasible in a pilot setting. This study increases the literature on lethal means safety and the experiences of both clinicians and parents regarding lethal means counseling. Finally, this research indicates that this intervention is a promising tool to support parents and clinicians in keeping dangerous items out of the hands of suicidal teens.