Emergency Department Means Restriction Education


(For resources, this is the publication date. For programs, this is the date posted.)


Program with Evidence of Effectiveness
Markus J. Kruesi M.D.


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Emergency Department Means Restriction Education is an intervention for the adult caregivers of youth (aged 6 to 19 years) who are seen in an emergency department (ED) and determined through a mental health assessment to be at risk for suicide. This intervention is designed to help parents and adult caregivers of at-risk youth recognize the importance of taking immediate, new action to restrict access to firearms, alcohol, and prescription and over-the-counter drugs in the home. It also gives parents and caregivers specific, practical advice on how to dispose of or lock up firearms and substances that may be used in a suicide attempt. The intervention is designed to be delivered in a brief period consistent with the demands of busy EDs. It consists of three components or messages that can be delivered by a trained health care professional, such as a physician, nurse, social worker, or mental health specialist. The three components are (1) informing parents, when their child is not present, that the child is at increased suicide risk and why (e.g., “Adolescents who have made a suicide attempt are at risk for another attempt”); (2) telling parents they can reduce this risk by limiting their child’s access to lethal means; and (3) educating parents and problem solving with them about how to limit access to lethal means.

Designation as a “Program with Evidence of Effectiveness”

SPRC designated this intervention as a “program with evidence of effectiveness” based on its inclusion in SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP).

Outcome(s) Reviewed (Overall Quality of Research Rating-scale of 0 to 4)*

1: Access to medications that can be used in an overdose suicide attempt (2.5)
2: Access to firearms (2.7)

Read more about this program’s ratings.


* NREPP changed its review criteria in 2015. This program is a “legacy program,” meaning that it was reviewed under the post-2015 criteria. The evidence for each outcome was reviewed and scored on a scale of 0-4, with 4 indicating the highest quality of evidence and 0 indicating very poor quality of evidence. The overall rating was based on ratings of six criteria: 1) reliability of measures, 2) validity of measures, 3) intervention fidelity, 4) missing data and attrition, 5) potential confounding variables, and 6) appropriateness of analysis. When considering programs, we recommend (a) assessing whether the specific outcomes achieved by the program are a fit for your needs; and (b) examining the strength of evidence for each outcome. 

2012 NSSP Objectives Addressed: 

Objective 6.1: Encourage providers who interact with individuals at risk for suicide to routinely assess for access to lethal means.

Objective 8.4: Promote continuity of care and the safety and well-being of all patients treated for suicide risk in emergency departments or hospital inpatient units.

Objective 9.4: Adopt and implement guidelines to effectively engage families and concerned others, when appropriate, throughout entire episodes of care for persons with suicide risk.