Bronx Veterans Medical Research Foundation

Veterans account for one in seven suicides across New York State, with an increasing rate of suicide among New York’s youngest veterans, even as rates among older veterans have declined.

The COVID-19 pandemic is likely to exacerbate underlying behavioral health issues, substance use, and the risk of veteran suicide as a result of social isolation, financial crisis, trauma, and firearm access. The Counseling on Access to Lethal Means (CALM) training model was developed to help health care providers implement counseling strategies to assist clients who are at risk for suicide and their families in reducing access to lethal means—particularly, though not exclusively, to firearms. Although it is the gold standard for lethal means access counseling, there is a need to expand the reach of CALM and further adapt it for nonclinician communities. In 2020, NYHealth awarded the Bronx Veterans Medical Research Foundation (BVMRF) a grant to tailor and deliver CALM trainings to families and caregivers as well as increase its uptake among clinicians throughout New York State.

Under this grant, BVMRF disseminated CALM to additional clinicians and adapted the training for families and caregivers. It conducted extensive outreach and engagement among clinical networks to educate clinicians about the importance of reducing lethal means access through presentations at grand rounds and helped them integrate CALM into onboarding and training programs at their organizations. BVMRF also conducted focus groups with gun-owning veterans and their family members to obtain feedback about aspects of gun safety, storage, suicide risk, and communication. Additionally, BVMRF consulted with suicide and legal experts to develop the content for the training, including information about New York State-specific gun laws. Findings were used to inform the adaptation of the CALM training for a family and caregiver audience in both online and in-person formats. Finally, BVMRF tracked uptake and completion of the training by New York State clinicians, nonclinicians, and family members.