This program is delivered to mental health clinicians, primary care providers, substance-abuse counselors, hotline responders, and crisis-intervention services and intends to impact providers and individuals who are at risk for suicide and their families. Versions of the program are available for clinicians and non-clinicians.

Counseling on Access to Lethal Means (CALM), a community-based suicide-prevention program, is designed to give mental health providers and other professionals the tools and strategies they need to counsel individuals who are suicidal and those who support these individuals regarding how to restrict access to lethal means during times of crisis.

Several single-group studies with short-term follow-ups have been conducted to test the effectiveness of CALM among various populations, including mental health providers, geriatric case managers, community-based health care providers, and college resident assistants. Results indicate increases in participants’ knowledge, beliefs, attitudes, confidence, and comfort in counseling clients; counseling intentions for the future; and the number of conversations held with clients about reducing access to lethal means.

CALM intends to inform participants about the prevalence of suicide and associated warning signs, examine different types of lethal means, discuss examples of lethal means-reduction efforts, and teach participants how to work with individuals who are in immediate crisis and have access to firearms or other lethal means. The program is not designed to discourage gun ownership or use but to encourage the temporary removal of firearms when individuals are at high risk of suicide. Objectives for participants who complete this course include the following:

• Understand that reducing access to lethal means is an evidence-based strategy for suicide prevention;
• Explain how reducing access to lethal means can prevent suicide;
• Identify clients for whom lethal-means counseling would be suitable;
• Describe methods for addressing the topic of lethal means, and feel more comfortable and competent practicing these methods with clients;
• Provide information to clients about specific off-site and in-home options for the secure storage of firearms and strategies to limit access to harmful medications, drugs, or other toxic substances; and
• Work with clients and their families to create a plan to reduce access to lethal means and follow up on this plan over time.

To receive a certificate of completion for this course, providers must complete each lesson, pass a posttest with a score of 80% or higher, and answer feedback survey questions.

In addition, CALM Conversations, a gatekeeper training for non-clinical audiences, is available, and the Lethal Means Institute, a training that helps community stakeholders develop customized suicide-prevention strategies, is available.

CALM was created by Elaine Frank and Mark Ciocca at the Injury Prevention Center of the Children’s Hospital at Dartmouth. The program has been delivered thousands of times across the country in in-person workshops. Since the COVID-19 pandemic in 2020, training has also been provided virtually. The Department of Defense is exploring opportunities to implement and evaluate CALM training throughout the military community. In addition, an adaptation of the program, CALM-ED, was designed to be implemented by non-physician personnel in the emergency department of a hospital.

CALM is delivered to clients by mental health clinicians, primary care providers, substance-abuse counselors, hotline responders, and crisis-intervention service workers. These individuals must complete training. Training is available in person and online, and options include a 3-hour certified clinical workshop or a 10-hour train-the-trainer seminar. Costs range from $750 to $1,500 plus travel costs for a workshop or $3,000 to $5,000 plus travel costs for train-the-trainer options. Please visit https://www.calmamerica.org/about-calm-trainings for more information.

Considerations for implementing this program include recruiting suitable facilitators and ensuring they complete training; acquiring buy-in from clients and their families; obtaining access to and buy-in from local services to help support clients who are suicidal; understanding course content may cover sensitive topics; and making time for providers to have a conversation about suicide and lethal means with clients and their families, create a safety plan with them, and follow up to determine if the plan was implemented.
The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email clearinghouse@psu.edu

If you are interested in implementing CALM, the Clearinghouse is interested in helping you! Please call 1-877-382-9185 or email clearinghouse@psu.edu

Time for providers to deliver lethal means counseling to clients will vary.

Information on implementation costs was not located.

To move CALM to the Promising category on the Clearinghouse Continuum of Evidence, at least one evaluation with a strong design that includes a comparison group must be conducted that demonstrates positive, sustained effects lasting at least six months from program completion.

The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email clearinghouse@psu.edu

Contact the Clearinghouse with any questions regarding this program. Phone: 1-877-382-9185 Email: clearinghouse@psu.edu

You may also contact CALM by visiting https://www.calmamerica.org/contact-us

https://www.calmamerica.org/, https://zerosuicide.edc.org/resources/trainings-courses/CALM-course, and https://sprc.org/online-library/calm-counseling-on-access-to-lethal-means/