TEEN LENS ED: TEen ENgaged LEthal meaNS planning for the Emergency Department

Project Summary Firearms are the leading cause of death among children and adolescents in the United States. They are also the most lethal means of suicide - more than 90% of youth who attempt suicide with a firearm will die. Limiting access to firearms for individuals at elevated risk for suicide, a component of lethal means safety counseling, is an underutilized evidence-based suicide prevention strategy. In addition to being a safety net for vulnerable youth, Emergency Departments (EDs) across the country have begun screening patients for suicide risk. Yet, lethal means counseling does not occur in most circumstances in which it’s indicated. Previous studies have developed tools, for example Lock to Live, to support adults at elevated suicide risk in the ED setting. Existing lethal means interventions for teens were developed with caregivers of teens at elevated suicide risk, and engage only caregivers in lethal means safety planning, thereby failing to address the teen voice in limiting firearm access. This proposal aims to leverage user-centered design methods to develop a user friendly teen-centered lethal means safety planning tool for teens presenting to the ED by pursuing the following aims: 1) Assess perspectives of teens at elevated risk for suicide and their caregivers around current lethal means safety planning tools using qualitative methods, 2) Adapt an intervention with teens and caregivers to co-design a tool that addresses both teen and caregiver firearm access, and 3) Test the acceptability and feasibility of the intervention in a pilot trial. As a pediatric emergency medicine physician and prior administrative leader, Dr. Maya Haasz is familiar with the benefits, challenges, and operational considerations of implementing this intervention in the Emergency Department. Her clinical experience and research expertise position her to complete the proposed K23 research and training aims. Dr. Haasz’s long- term goal is to become an independent investigator with a research program focused on reducing firearm morbidity and mortality in children and adolescents. To this end, she has developed a detailed career development plan consisting of guided literature review, coursework, workshops, and hands-on research experience to develop her skills in qualitative research, human-centered intervention development, implementation, and clinical trial design. Moreover, she has assembled a nationally renowned multi- disciplinary team with relevant expertise and extensive mentorship experience to ensure her success in achieving her research and career goals. Her innovative proposal, which involves teens in developing an intervention to decrease firearm access among teens at elevated suicide risk, will also serve as a model for teen engagement in other mechanisms of firearm injury prevention. Moreover, this proposal will prepare Dr. Haasz to transition to an independent investigator and prepare her for future R01 funding.