A recent study published in the INJEP Journal highlights the effectiveness of distributing cable locks in conjunction with lethal means counseling (LMC) to improve firearm securement among caregivers of children undergoing emergent mental health evaluations. The randomized controlled trial, conducted at a level-1 pediatric trauma center, demonstrated a significant increase in the secure storage of firearms when cable locks were provided at no cost to caregivers.
The study enrolled firearm-owning caregivers of children presenting to the pediatric emergency department (PED) for mental health evaluations. Participants were randomized into two groups: one receiving standardized LMC alone, and the other receiving LMC plus two cable-style gun locks. The primary outcome measured was self-reported securement of all firearms in the household with a locking device at 4 weeks post-PED encounter.
Key Findings
The results indicated a notable improvement in firearm securement in the intervention group. At the 4-week follow-up, a significantly higher proportion of caregivers in the LMC plus gun locks group reported securing all firearms with a locking device, compared to the LMC alone group. This finding underscores the potential of providing tangible means for safe storage to reinforce counseling efforts.
Cable locks were specifically chosen for their advantages over other types of gun locks. They are universally applicable to both handguns and long guns, are cost-effective, and pose a lower risk of unintentional discharge during the securement process. The study utilized SnapSafe Cable Padlocks, advising caregivers to store keys away from the firearm in a location inaccessible to children.
Methodology and Participants
The study population consisted of caregivers presenting to the PED with children under 18 years of age for psychiatric evaluation. Exclusion criteria included those who did not endorse firearms in the home or were unable to complete the English-based survey. Enrollment occurred between June 28, 2021, and February 10, 2022. Data was collected via tablet-based surveys using the REDCap® application.
Counseling provided by the study team was derived from the Suicide Prevention Resource Center’s “Counseling on Access to Lethal Means” training module and the “Store It Safe” campaign from the Ohio Chapter of the AAP. The guidance focused on securing dangerous items in the household, such as medications and firearms, with locking devices or removing these items from the home temporarily.
Statistical Analysis
A sample size of 200 patients was determined to detect a 30% difference in the primary outcome with 80% power and a 95% confidence interval. Statistical analysis included Wilcoxon rank sum and Fisher’s exact tests to analyze differences between primary comparison groups. Logistic regression, with adjustments for patient and caregiver age, gender, and race, was used to compare changes in proportions of caregivers reporting firearm securement between study arms.
Implications for Clinical Practice
The study's findings suggest that integrating firearm safety interventions, such as cable lock distribution, into pediatric emergency departments can be an effective strategy for promoting safe firearm storage practices. This approach may contribute to reducing the risk of suicide and unintentional firearm injuries among children and adolescents.
