Counseling on Access to Lethal Means (CALM): An Evaluation of a Suicide Prevention Means Restriction Training Program for Mental Health Providers

Abstract

This paper evaluates the effectiveness of the Counseling on Access to Lethal Means (CALM) suicide prevention program. CALM trains mental health providers how to counsel suicidal individuals and those who support them on mean restriction during times of crisis. Pre/post/3-month follow-up assessments measured knowledge of lethal means, confidence and comfort in discussing means restriction (self-efficacy), and future intentions to counsel clients on means restriction. Change in the number of clients receiving lethal means counseling was also assessed. All constructs increased significantly at posttest. Confidence and counseling intentions were sustained at follow-up and significantly more clients received means counseling in the 3 months following the CALM training. Knowledge and comfort levels decreased at follow-up but not to pre-training levels. CALM is effective at increasing mental health professionals' comfort, knowledge, and frequency of talking about means restriction with clients. an effective means restriction training program. A template to assess clients for suicidality and lethal means access and booster sessions are recommended to further sustain effects.

Counseling on Access to Lethal Means-Emergency Department (CALM-ED): A Quality Improvement Program for Firearm Injury Prevention

“…20 However, there is a paucity of evidence on how to systematically provide this intervention across clinical settings. 21,22 Indeed, in 2018 Betz et al reported that among 800 ED patients who screened positive for suicide risk, only 18% had a documented assessment of access to lethal means, and only 8% had documentation of a specific plan to reduce access to said lethal means. 23 Leveraging the accessibility of CALM and the abundance of at-risk patients in our ED population, while cognizant of the time demands on emergency physicians, we developed the QI program CALM-ED, which was implemented by non-physician personnel.…”

Associations of Suicide Prevention Trainings with Practices and Confidence among Clinicians at Community Mental Health Centers

“…In fact, leading suicide prevention models and organizations identify training in evidence‐based practices as a gap and, thus, a primary goal in suicide prevention (Ahmedani & Vannoy, ; Goldston et al., ; Schmitz et al., ). Empirical data support the effectiveness of training as a dissemination strategy; individuals who participate in training specific to suicide care are better able to identify warning signs, report increased knowledge on the issue of suicide, indicate greater self‐efficacy and competency in providing care, and have more useful attitudes and beliefs regarding suicide (Bernert et al., ; Cross, Matthieu, Lezine, & Knox, ; DeHay, Ross, & McFaul, ; Lamis, Underwood, & D'Amore, ; Sale et al., ). These findings have been replicated using community samples, primary care providers, and behavioral health practitioners, and through online delivery of training (Cross, Matthieu, Cerel, & Knox, ; Cross et al., ; DeHay et al., ; Lamis et al., ; Sale et al., ).…”

“…Importantly, data suggest that training gains are maintained over time (Gould, Cross, Pisani, Munfakh, & Kleinman, ; Litteken & Sale, ; Sale et al., ) and ultimately impact delivery of services and outcomes (Godoy Garraza, Walrath, Goldston, Reid, & McKeon, ; Graham, Rudd, & Bryan, ). For instance, through the effects of training, increased competence has been linked to greater willingness to provide suicide care among primary care physicians (Graham et al., ).…”

Association of Firearm Ownership, Use, Accessibility, and Storage Practices With Suicide Risk Among US Army Soldiers

“… 32 More recently, work on interventions primarily focused on means restriction has increased, including motivational interviewing for means restriction and lethal means counseling training for mental health professionals. 33 We found that certain firearm-related variables were more robustly associated with suicide; thus, our results suggest areas for explicit focus within these existing interventions (eg, separate storage of guns and ammunition and limiting the carrying of firearms in public). Outside the realm of mental health research, focus on these types of firearm safety variables has been shown to significantly improve firearm storage practices.…”