Emergency Department/Trauma Center (EDTC) at Children’s Wisconsin, a free-standing, urban, pediatric hospital with a Level 1 trauma center, with approximately 70,000 visits annually, 24-h social work coverage, and an associated injury prevention program that provides home safety products to EDTC families in conjunction with the social work program.
Every patient and family who presents to the ED for SI/SA receives a social work consult, twenty-four hours a day, seven days a week. Licensed social workers evaluate the patient utilizing the Columbia Suicide Severity Rating Scale (Posner et al. 2011), assess their safety, provide mental health resources, and assist with identifying either inpatient or outpatient mental and behavioral health treatment options.
Hospital social workers, injury prevention specialists, pediatric residents, and a pediatric emergency medicine physician collaborated on the development of this program. While social workers had been counseling on lethal means restriction as part of discussions with families of at-risk patients, they were interested in developing a bundle that would include a patient/family education sheet for use in the EDTC and at discharge, and recommendations on safe firearm removal or storage, including provision of firearm lockboxes.
Social workers utilize a behavioral health template for the electronic health record where they document their lethal means restriction family education. A patient/family education sheet, specifically tailored for EDTC usage, was developed that included general information about behavioral health emergencies, considerations on lethal means restrictions (safe storage of medications, firearms), and telephone numbers for local and national suicide prevention resources. The patient/family education sheet was reviewed by our health literacy team to be at the sixth grade reading level in both English and Spanish. The patient/family education sheet is reviewed with the family at the time of the ED visit and interpreters are used for non-English speaking caregivers. In the case of caregivers who could not read, social workers review the information on the patient/family education sheet verbally.
While the social work team had previously advised families to remove all firearms completely from the home, it was noted that one barrier to safe firearm removal was the inability to find a place to move firearms out of the home, especially on short notice. Social workers noted that families were frequently reluctant to move their firearms to relatives’ homes or to a police station. Through funding from the American Academy of Pediatrics Community Access to Child Health program, we obtained firearm lockboxes for distribution to families at no cost. The lockboxes are accessible via a combination lock and can hold one handgun. We selected a small lockbox to make it feasible to keep in the home as it occupies minimal space. The lockbox does not need to be bolted to the floor or the wall, so it offers a safe storage option for families who live where housing cannot be modified.
Our injury prevention and social work teams revised a previously developed Home Safety Product Release of Liability form to include firearm lockboxes. Included on the form are checkboxes for a variety of safety products, a paragraph that notes that parents/caregivers have received the products and understand that they will not hold the hospital liable for any issues, and a place for the parents/caregivers to sign the document. A copy of the completed form is kept in the patient’s electronic health record and one is kept in the injury prevention office. The Children’s Wisconsin Risk Management Office reviewed and approved the form. Social workers were trained to ask families if they needed a firearm lockbox as part of their discussion about lethal means restrictions. They also received training to discuss the use of the firearm lockboxes, the new patient/family education sheet, and the release of liability form completed with families who received a firearm lockbox.