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Walsh A, Friedman K, Morrissey BH, Godin S, Morgenstein J, Bryan CJ, Anestis MD, Foley SK, Johnson RL, Baker JC, Bryan A, Betz ME, Wright-Kelly E. Project Safe Guard: Evaluating a Lethal Means Safety Intervention to Reduce Firearm Suicide in the National Guard. Mil Med 2024; 189:510-516. [PMID: 39160836 DOI: 10.1093/milmed/usae172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/04/2024] [Accepted: 04/04/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION The purpose of this paper is to examine a scalable secure firearm storage intervention in the U.S. National Guard (NG) in preventing firearm injury and suicide. A study among firearm-owning members of the Mississippi NG testing Project Safe Guard (PSG), a 10 to 15 min lethal means counseling intervention, found that PSG increased self-reported secure firearm storage practices. Here, we sought to examine a "real world" rollout of a modified PSG program in the NG in which NG members were trained to understand the importance of lethal means safety and to deliver PSG to Guardsmen peers within their units. MATERIALS AND METHODS The PSG team collaborated with the NG to identify 4 states for the rollout; for each state, the NG was responsible for identifying key personnel ("facilitators") who would receive the training. Team members provided in-person training at 5 locations across 4 states (AZ, GA, IA, and NV) from January to April 2023. Attendees were provided with combination trigger locks or cable locks and evaluation instructions. Questionnaires were administered to training attendees via REDCap at pre-training and post-training. We conducted descriptive and comparison statistics of questionnaire data. RESULTS A total of 186 facilitators were trained at 5 in-person training locations across 4 states (AZ, GA, IA, and NV) from January to April 2023; data collection concluded in August 2023. There were 137 pre-training responses (74% pre-survey response rate) and 88 post-training responses (64% response rate from those who took the pre-training survey). Findings demonstrate increases in self-reported knowledge, attitudes, and beliefs regarding firearm injury and suicide and a reported desire to store personal firearms more securely. CONCLUSION The adapted version of PSG shows promise as a relevant and acceptable intervention among Guardsmen to enhance knowledge and attitudes regarding firearm suicide, increase secure firearm storage practices, and normalize conversations about firearm suicide prevention among peers. This intervention seeks to frame firearm suicide prevention within a culture of safety, complementary to the existing prevention methods and training within the NG.
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Affiliation(s)
- Adam Walsh
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Kaitlyn Friedman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Injury and Violence Prevention Center, Colorado School of Public Health, Aurora, CO 80045, USA
| | - Brooke Heintz Morrissey
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Shira Godin
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Joshua Morgenstein
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, Piscataway, NJ 08854, USA
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - S Kat Foley
- Injury and Violence Prevention Center, Colorado School of Public Health, Aurora, CO 80045, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO 80045, USA
| | - Justin C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - AnnaBelle Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Injury and Violence Prevention Center, Colorado School of Public Health, Aurora, CO 80045, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO 80045, USA
| | - Erin Wright-Kelly
- Injury and Violence Prevention Center, Colorado School of Public Health, Aurora, CO 80045, USA
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO 80045, USA
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Stanley IH, Anestis MD, Bryan CJ, Moceri-Brooks J, Baker JC, Buck-Atkinson J, Bryan AO, Johnson M, Hunter K, Johnson RL, Xiao M, Betz ME. Project Safe Guard: Challenges and opportunities of a universal rollout of peer-delivered lethal means safety counseling at a US military installation. Suicide Life Threat Behav 2024; 54:489-500. [PMID: 38380441 DOI: 10.1111/sltb.13050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
INTRODUCTION The US Department of Defense recommends lethal means safety counseling (LMSC) to promote firearm injury prevention via secure storage of personal firearms. We describe the rollout of a universal, peer-delivered adaptation of Project Safe Guard (PSG)-a brief, single-session LMSC discussion-at a US Space Force installation. METHOD Program evaluation data were collected via anonymous, voluntary, and online surveys. Of approximately 862 eligible active-duty service members and embedded civilians, 324 completed the preprogram survey and 68 and 37 completed the 1- and 2-month follow-ups, respectively. RESULTS At preprogram, 69.1% agreed that peer-delivered LMSC is appropriate. After rollout, 100% of the 222 firearm locking devices available to service members were requested from the on-base Violence Prevention Integrator. The effectiveness of PSG was indeterminable due to the low survey response rates. CONCLUSIONS Despite strong preprogram support for peer-delivered LMSC and behavioral indicators of secure firearm storage (e.g., firearm locking device requests), several challenges limited the uptake and evaluability of the PSG program in this naturalistic environment, including military survey fatigue and competing mission priorities. Additional work is needed to determine the effectiveness of peer-delivered LMSC in a military context. Sustained base support and military-civilian collaborations will be critical.
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Affiliation(s)
- Ian H Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
| | - Jayna Moceri-Brooks
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Justin C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jessica Buck-Atkinson
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - AnnaBelle O Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Megan Johnson
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Mengli Xiao
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
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Cui Y, Ahrendsen O, Mendiratta P. Mitigating firearm risks in older adults with delirium through preventive measures. J Am Geriatr Soc 2024. [PMID: 38760948 DOI: 10.1111/jgs.18960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/20/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Yuqi Cui
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, UAMS, Little Rock, Arkansas, USA
- Geriatric Evaluation and Management Center, Eugene J Towbin Veterans Affairs Healthcare Center, North Little Rock, Arkansas, USA
| | - Olivia Ahrendsen
- Geriatric Evaluation and Management Center, Eugene J Towbin Veterans Affairs Healthcare Center, North Little Rock, Arkansas, USA
| | - Priya Mendiratta
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, UAMS, Little Rock, Arkansas, USA
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Walsh A, Ghahramanlou-Holloway M, Stanley IH, Betz ME, Heintz Morrissey B, Godin S, Morgenstein J, LaCroix J, Cobb E, Grammer J, Button CJ. Firearm leadership: Development, analysis, and application of a novel concept to message secure storage of firearms in the military. MILITARY PSYCHOLOGY 2024:1-7. [PMID: 38592404 DOI: 10.1080/08995605.2024.2336641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
Suicide remains a leading cause of death in the United States (U.S.) Armed Forces. Access to firearms increases the risk of death by suicide due to the high lethality of firearm-related injuries (~90% in suicide attempts) and the highly dynamic nature of suicide which includes rapid change from low- to high-risk states. Critical gaps remain in research, programming, and communication amongst scientists, Department of Defense (DoD) programmatic leaders, front-line commanders, and service members. To enhance communication and coordination, in June 2022, the first-ever national "Firearm Suicide Prevention in the Military: Messaging and Interventions Summit" was held, with discussion of Firearm Leadership, a concept that emphasizes the importance of communication about lethal means safety (LMS) among military leaders and service members. Through a discussion of scientific literature, the points identified during the Summit, as well as presenting illustrative case examples derived from suicide death reviews, we aim to provide a conceptual model for the benefits of Firearm Leadership and how some barriers can be overcome. Following the Summit, further discussions on "Firearm Leadership" led to the development of a Firearm Leadership Factsheet.
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Affiliation(s)
- Adam Walsh
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Ian H Stanley
- Department of Emergency Medicine, Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, Colorado
| | - Marian E Betz
- Department of Emergency Medicine, Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado
| | - Brooke Heintz Morrissey
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shira Godin
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Joshua Morgenstein
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jessica LaCroix
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Erin Cobb
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Joseph Grammer
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Stanley IH, Hom MA, Wright A. Emergency medical services (EMS) clinicians' views on EMS-delivered interventions to promote secure firearm storage practices. Suicide Life Threat Behav 2024; 54:4-14. [PMID: 38243662 DOI: 10.1111/sltb.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/18/2023] [Accepted: 09/19/2023] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Lethal means safety counseling (LMSC) to promote secure firearm storage may reduce the risk of firearm-involved deaths, including suicide. We examined if emergency medical services (EMS) clinicians, including emergency medical technicians and paramedics, may be suitable LMSC messengers. METHOD We conducted a web-based survey of 229 US EMS clinicians. RESULTS While few EMS clinicians supported EMS-delivered LMSC to all patients (17.0%), most supported EMS-delivered LMSC to patients in an acute suicidal crisis (64.2%) or with a known suicide attempt history (55.9%). Barriers to EMS-delivered LMSC included lack of training (73.4%), perceptions that LMSC is outside EMS clinicians' scope of practice (58.1%), and lack of standard operating procedures (56.3%). Most reported at least some interest in receiving training on EMS-delivered LMSC (67.7%). Participants holding more accurate beliefs about the link between firearm storage practices and suicide risk, as well as the efficacy of LMSC, were more likely to support EMS-delivered LMSC across patient scenarios (ORs = 2.18-5.21, ps <0.01) and express interest in receiving LMSC training (ORs = 3.78-5.43, ps <0.001). CONCLUSION Given that many EMS clinicians interface with patients at elevated suicide risk, targeted LMSC training may be strategic; however, research is needed to determine if and how EMS clinicians might be viable LMSC messengers.
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Affiliation(s)
- Ian H Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Colorado, Aurora, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Melanie A Hom
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Angela Wright
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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