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Abstract and Figures

This study assessed college counselors' anticipatory guidance on firearms for student clients. The membership of the Association for University and College Counseling Center Directors was used to identify a national random sample of counseling centers (n = 361). One counselor from each center was selected to survey. In the winter of 2008, a 3-wave mailing procedure was used to maximize the response rate. Completed surveys served as consent (as approved by the University Human Subjects Committee). A total of 213 counselors (59%) responded. They were unlikely to provide anticipatory guidance (6%), chart/keep records on client ownership/access to firearms (17%), or to counsel the majority of clients from various diagnostic categories on firearms. University personnel are likely to refer students with suspected mental health problems to university counseling centers. The findings indicate that few counseling centers will address firearm issues with students.
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JOURNAL
OF
AMERICAN
COLLEGE
HEALTH,
VOL.
58,
NO.
2
College
Counselors'
Perceptions
and
Practices
Regarding Anticipatory
Guidance
on
Firearms
James
Price,
PhD,
MPH;
Adam
J.
Mrdjenovich,
PhD;
Amy
Thompson,
PhD;
Joseph
A.
Dake,
PhD,
MPH
Abstract.
Objectives:
This study
assessed college counselors' an-
ticipatory guidance on
firearms
for
student
clients.
Participants:
The membership
of
the
Association for
University
and
College
Counseling
Center
Directors
was
used
to
identify
a
national
ran-
dom sample
of
counseling
centers
(n
=
361).
One
counselor
from
each
center
was
selected
to survey.
Methods:
In
the
winter
of
2008,
a
3-wave
mailing procedure
was
used
to
maximize
the
response rate.
Completed
surveys
served
as
consent
(as
approved
by
the
University
Human
Subjects
Committee).
Results:
A
total
of
213
counselors
(59%)
responded. They
were
unlikely
to
provide anticipatory guid-
ance
(6%),
chart/keep records
on
client
ownership/access
to
firearms
(17%),
or
to
counsel
the
majority
of
clients
from
various
diagnos-
tic categories
on firearms.
Conclusions:
University
personnel
are
likely
to
refer
students
with
suspected mental
health problems
to
university counseling
centers.
The
findings
indicate
that
few
coun-
seling
centers
will
address firearm
issues with
students.
Keywords:
counseling,
firearms,
homicide,
suicide
ollege campuses
have
recently
seen
a
series
of
high
profile firearm
traumatic
events.
On February
14,
2008,
Steven
Kazmerczak walked
into
a
Northern
Illinois
University
classroom
and shot
5
students, wounded
16
others,
and
then
shot
himself.'
He
had
previously
been
treated
for
a
mental
health problem.
On
April
16,
2007,
Sun
Hui
Cho,
a
student
at
Virginia Technological Univer-
sity killed
32
students
and faculty
and
wounded
15
more
before
he
killed
himself.2
He
too
had
been
treated
for
a
seri-
ous
mental
health problem.
It
has
been
estimated
that
90%
of
all
homicides
are
committed
by
offenders
with
a
psychiatric
diagnosis,
3
and
possibly
as
many
as
80%
of
individuals re-
Dr
Price
is
a
professor
of
Public
Health
at
The
University
of
Toledo,
Toledo,
Ohio.
Dr
Mrdjenovich
is
an
instructor
of
Health
Education
at
The
University
of
Toledo,
Toledo,
Ohio.
Dr
Thompson
is
an
assistant
professor
of
Health
Education
at
The
University
of
Toledo, Toledo,
Ohio.
Dr
Dake
is
an
associate
professor
of
Health
Education,
at
The
University
of
Toledo,
Toledo,
Ohio.
Copyright
©
2009
Heldref Publications
porting suicide-related
behaviors would
meet
the
criteria
for
a
mental illness.
4
In
the
wake
of
the multiple
campus
shoot-
ings
that
have
occurred, college
mental health
providers
are
often
criticized
for
not
being more proactive
hi
preventing
such
tragedies.
College
age
students,
many
for
the first
time,
have the
responsibility
of
existing
on
their
own
for
extended
periods
of
time.
This new-found
freedom
often
results
in
stressful
experiences
and
dubious decisions
for
many
of
them.
For
example,
the
highest
rate
of
binge
drinking
is
among those
18
to
24 years
of
age
5
and
alcohol
is
involved
in
95%
of
violent
crimes
on
college
campuses.
6
Additionally,
this
is
a
time
when
mental illnesses
start
to
manifest
themselves,
resulting
in
the
highest
rate
of
mental
illness
of
any age
group
(18
to
25
years
of
age).
7
Thus,
it
is
not
surprising
that
24,000
college
students
annually
attempt suicide
and
another
1,100
of
them
end their
lives
by
suicide.
8
'9
If
a firearm
is
used
as
a
weapon
of
opportunity
in
anger
or
as
a
maladaptive
response
in
stress,
the consequences
are
far
more
likely
to
be
fatal
than
if
any
other
type
of
weapon
was
used.1
0
A
national
study
of
119
4-year
colleges
found
that
4%
of
college
students reported
having
a
firearm at
college, approximately 700,000
firearms
based
on the size
of
the
current
college
population in the
United
States.11
There
have
been
increased
efforts
by
the
gun
lobby
to
make
firearms
more
accessible
to
college students.
For
ex-
ample, the gun lobby
has
pushed
a
bill
in
Utah that
prohibits
state
institutions
of
higher
education
from barring
firearms
on
campus. Now
similar
bills
to
permit
guns
on
college
cam-
puses
are
pending in
15
state
legislatures."
2
The
potential
for
increased
firearm
trauma (homicides,
suicides,
and
uninten-
tional
injuries)
seems
to
be
much
greater
if
more
firearms
make
it
onto
college
campuses.
Where
there
are
higher rates
of
firearm
possession,
there
are
more
acts
of
violence,
and
higher
rates
of
homicide
and
suicide.
13
One
of
the units
on
most
college campuses
that
needs
to
be
especially
diligent
regarding
potential
firearm
violence
is
133
Price
et
aL.
college
counseling
centers.
Thus,
the
purpose
of
this
study
was
to
assess
what
college
counseling
centers
are
doing
with
regard
to
anticipatory
guidance
on
firearms
for
their
college
student
clients.
More
specifically,
the following
questions
were
explored:
(1)
What
portion
of
university
counselors are
discussing
firearm safety
issues
with
their
clients?
(2)
Do
uni-
versity
counselors
perceive
firearm
safety
issues
as
a
greater
problem
for
clients
with
mental
health
problems than
for
the
general college
population?
(3)
How
confident
are
counselors
in
their
ability
to
communicate key components
of
firearm
safety?
(4)
Do
counselors believe
if
they
discuss
firearm
safety
issues
with clients
that
it
will
reduce
firearm
trauma?
(5)
What
do
counselors
perceive
as
their most
common
barri-
ers
to
discussing
firearm safety
issues?
(6)
Where
have coun-
selors received
their information
on
firearms
safety? and
(7)
What
factors characterize counselors
who
report
being
in-
volved
in
firearm
anticipatory guidance
versus
those
who
are
not
involved?
METHODS
Sample
This study
was
delimited
to
college
and
university
counsel-
ing
centers in
the
United
States.
In
the
interest
of
controlling
for self-presentation
bias,
the
sample
was
further
delimited
to
counseling professionals
that
did not
serve
as
directors
of
the counseling
centers
in
which
they
practiced.
The
membership
list
of
the
Association
for
University
and
College
Counseling
Center
Directors
(AUCCD)
was
used
to
identify
a
national cross-section
of
counseling
centers
for
this
study.1
4
The
AUCCD
list
provides
contact
infor-
mation
for
university and
college
counseling
centers
in
the
United
States,
Canada,
Australia,
the Bahamas,
Spain,
and
the
United
Kingdom.
The AUCCD
list
was
cross-referenced
with
the
Carnegie
Foundation's
list
of
Colleges
and Univer-
sities
in
the
United
States.15
Of
the 745 counseling
centers
on the
AUCCD
list,
94
(12%)
were eliminated
because
they
were
located
in
countries
other
than the
United
States. This
yielded
an
initial sampling
frame
of
651
counseling
cen-
ters.
An
additional
29
centers
were
eliminated because
the
staff
consisted
of
professionals
from
noncounseling
disci-
plines
(n
=
13),
or
because
the
director
was
the
one
and
only
staff
member
(n
=
16).
This
yielded
a
final
sampling
frame
of
622
counseling
centers,
from
which
the names
of
622
counseling
professionals
(i.e.,
one
practitioner per
cen-
ter) were
acquired
via
Internet
(77%)
or
telephone
(23%).
The
names
of
doctoral-level
counseling
professionals
(PhD
or
PsyD)
were obtained
except
in cases
where the
direc-
tor
was
the only
doctoral-level
staff
member
(n
=
19),
or
when
the
center
did
not
employ
doctoral-level
practition-
ers
(n
=
109,
17%).
For
these centers,
the names
of
mas-
ter's
level
practitioners
were
obtained
(MA,
MS,
MSW).
In
cases
where
more
than
one
practitioner
at a given
counseling
center
met
the selection
criteria,
one
name
was
chosen
at
random.
An
a
priori
power
analysis
was
conducted
for
this
study.
Based
on
a
total
population
of
651
college counseling
centers
in
the
United States
and an 80/20
split
with
regard
to the
prac-
tice
of
interest
(i.e.,
it
was
assumed that
no
more
than
20%
of
centers
would report that
they
are
regularly
involved
in
dis-
cussing
firearm
safety issues with clients),
it
was
determined
that a
sample
of
185
counseling
centers
would
be needed
to
make inferences
to
the total
population with
a
sampling
error
of
:L5%
at the
95%
confidence
level.
16
Factoring
in
a
potential
nonresponse rate
of
50%,
370
counseling
centers
were
randomly selected
to
receive surveys.
Procedure
Following protocol clearance
from
the
researcher's
univer-
sity
Human Subjects
Institutional
Review
Board,
potential
respondents were contacted by
US
mail.
A
3-wave
mailing
procedure
was
used
to
maximize
the
response
rate..
The
first
mailing
included
(1)
a
personalized, hand-signed
cover
letter
that introduced
the study,
requested
the
recipient's
confiden-
tial
participation, and provided
directions
for
returning
the
survey
(i.e.,
recipients
were
asked
to
disregard the
survey
and return
only the
cover
letter
in
the
event
that
they
did
not
currently
see
clients
in
a
college
or
university
counseling
cen-
ter):
(2) a
copy
of
the
survey
instrument printed
on
colored
paper;
(3)
a
SI1.00
bill
as
an
incentive
for
participation;
and
(4)
a
return
envelope
addressed
to
the
principal
investigator
with a first-class
postage
stamp.1
7
For
the purpose
of
tracking
nonrespondents,
return
envelopes
were coded
with
an
iden-
tification
number.
A
second mailing
consisting
of
a revised
cover
letter,
another
copy
of
the
survey, and
a
self-addressed
stamped
envelope
was
sent
to
potential
participants
that
did
not respond
to
our
initial
request
after
2
weeks.
A
third
mail-
ing
consisting
of
a
reminder letter,
another
copy
of
the survey,
and a
self-addressed stamped
envelope was
sent after
an
ad-
ditional
2
weeks. Return
of
the completed
survey served
as
consent
for use
of
the
answers
supplied.
Instrument
The
questionnaire
used
for
this investigation
was a
slightly
modified version
of
a
valid
and
reliable
instrument from
a
recently
published
study
regarding
psychiatrists'
anticipa-
tory
guidance
for
firearm
safety.'
8
Minimal
wording
changes
(e.g..
"psychiatrist"
to "counselor" and
"patient"
to
"client")
were made
to
orient
the
questionnaire
to
counselors rather
than
psychiatrists. The
theoretical
foundation
for
the ques-
tionnaire
included
Self-Efficacy
Theory,
the
Health Belief
Model,
and
the
5
A's
framework.
Self-Efficacy
Theory
is
comprised
of
2
main
components:
(1)
efficacy
expectations
(e.g.,
beliefs
that
one
can
perform
particular
behaviors
such
as
providing anticipatory guidance regarding
firearm
safety),
and
(2)
outcome expectations
(e.g.,
beliefs
that
particular
be-
haviors
will result
in
desired
outcomes
such
as
a
reduction
in
firearm
morbidity and
mortality).1
9
With
regard
to
The
Health
Belief
Model
(HBM), a
meta-analysis
of
its
various
constructs
found that
the
best predictors
of
health
behaviors
were
perceived
benefits
and
barriers,
20
the components
in-
cluded
in
the
questionnaire used
for
this
study.
Finally,
the
5
A's
framework
has
been identified
by
the
United
States
JOURNAL
OF
AMERICAN
COLLEGE
HEALTH
134
College
Counselors'
Perceptions
Preventive Services
Task
Force
(USPSTF)
as
a
useful tool
for
behavioral
counseling interventions.
21
The
5
A's
for
an-
ticipatory
guidance pertaining
to
firearm
safety
were:
(1)
Ask-systematically
identify
all
clients
who have
a firearm
at
every
visit;
(2)
Advise-strongly
urge
all
clients
to
rid
their
homes
of
firearms
or
to
properly
store
firearms
unloaded
and
locked;
(3)
Assess-determine
clients'
willingness
to
remove
firearms
from
their
residences;
(4)
Assist-aid
clients
in
get-
ting
rid
of
their
firearms;
and
(5)
Arrange-schedule
follow
up
contact to
confirm
successful
firearm
safety
precautions.
The
4-page
survey
consisted
of
23
items designed
to
as-
sess
college
counseling professionals' perceptions
and
prac-
tices
of
initiating discussion
about firearm
safety
issues
with
clients
that
have
received
various
mental health
diag-
noses
(e.g.,
Adjustment
Disorders,
Anxiety
Disorders, Mood
Disorders, Substance-Related Disorders,
etc.).
Respondents
rated their
level
of
agreement
with
the items
using
Likert-
type (endorsement
and
frequency)
scales
as
well
as
multiple
response
formats.
Demographic
and
background
items
were
included
for
descriptive
purposes
(e.g.,
location
of
counsel-
ing center,
level
of
education, type
of
license,
whether
or
not
the
respondent
currently owned
a
firearm
and/or had
mem-
bership in
a
firearms-related organization,
etc.).
Data Analyses
Data
were
analyzed
using
SPSS
14.0.
The dependent
vari-
ables
analyzed
using
independent
samples
t
tests or analyses
of
variance
(ANOVAs)
included
the
total
nmrnber
of
barriers
and
self-efficacy
regarding
anticipatory guidance
on
firearm
safety.
The independent
variables
included
sex,
professional
background (counselor
versus
psychologist),
level
of
educa-
tion
(masters versus doctoral),
age (less
than
50
versus
50+
years),
location
(rural, urban, and
suburban),
and
firearn
ownership
(yes
versus
no).
Level
of
significance
was
set
at
p
<.05.
RESULTS
Demographic Characteristics
of
Counselors
Questionnaires
were
mailed
to 370
college counselors.
A
total
of
9
recipients
who
indicated that
they
did
not
cur-
rently
see
clients
in
a
college or
university
counseling
center
were ineligible
to
participate
in
this
study. Responses
were
received
from
213
eligible counselors
(59%
or
213/361).
Respondents
were
predominantly
female
(68%),
Caucasian
(82%),
had
a
PhD
(57%),
were
licensed psychologists
(60%),
and did
not
personally
own a
firearm
(89%)
(Table
1).
Counselors'
Anticipatory
Guidance
on
Firearms
The
majority
(57%)
of
counselors perceived
firearm
own-
ership
safety
issues
to
be
"considerably greater"
or
"slightly
greater"
for
college
counseling center
clients
with men-
tal
health
problems
when
compared with
the general
col-
lege
population.
Yet,
only
17%
reported
that
they
routinely
charted
or
kept
records
of
whether
repeat
clients owned
or
had
access to firearms
and
6%
reported
regularly discussing
firearm
safety
issues with
their clients.
Additionally,
39%
of
TABLE
1.
Demographics
and
Background
of
Responding Counselors
*Total
(%)
Item
Sex
Male
Female
Age
(years)
20-29
30-39
40-49
50-59
60-69
Race/ethnicity
African American
Caucasian
Hispanic
Asian
Multicultural
Level
of
education
MA/MS
MSW
PsyD
PhD
Type
of
license
Licensed
psychologist
Professional counselor
Licensed
social worker
Location
of
college/counseling
center
Urban
Suburban
Rural
Currently
own
a
firearm
(yes)
Handgun
Long
Gun
Stored
gun in home
(yes)
Stored loaded
(yes)
Stored unlocked
(yes)
Purpose
of
owning
a
firearm
Target
shooting
Hunting
Personal protection
Gun
collection
69 (32)
144
(68)
18
(9)
67 (32)
54
(25)
60 (28)
13(6)
12(6)
175
(82)
12(6)
6 (3)
7
(3)
44
(21)
15(7)
30
(14)
121
(57)
127
(60)
52 (24)
16(8)
80
(38)
72 (34)
58 (27)
24(11)
10(5)
10(5)
24(11)
19(9)
16(8)
10(5)
9
(4)
8
(4)
6(3)
Note.
N
=
213.
the counselors
thought discussing
fireann
ownership would
help
reduce the
risk
of
firearm
suicides
on
campus,
but
47%
were
uncertain
of
the
effects
of
such
anticipatory guidance.
Although
22%
thought
that
discussing
firearm
ownership
with
clients
would
help
reduce
the
risk
of
firearm
homicides
on
campus,
the
majority
(55%)
were
uncertain
of
the out-
come
as
it
related
to
homicides.
An
additional
34%
reported
having never seriously
thought
about providing
anticipatory
guidance
on
firearm safety.
The
counselors were
also
asked
to
identify
the
percent
of
clients
(based
on various
diagnoses,
n
=
11)
to whom
they may
have
provided anticipatory guidance
on
firearm
safety
(Table
2).
Respondents indicated that
they
did
not
counsel
the
majority
(greater
than
50%)
of
clients
from
any
of
11
diagnostic
categories.
The
group
that
counselors
were
VOL
58,
SEPTEMBER/OCTOBER
2009
135
I
(%)
Price
et
al.
most
likely
to
discuss
firearm safety
issues
with
was
suicidal
clients; however, only
32%
counseled more than
half of
their
suicidal clients
regarding
firearms.
Three
quarters
(75%)
of
the
respondents indicated
that
a
client's
status
as
a
racial/ethnic minority
would
make
"no
difference"
in
terms
of
whether they would
counsel the
client
concerning
firearm safety
issues;
71%
indicated
that
low
socioeconomic
status
would
make
no
difference.
In
the
case
of
the client being
male,
60%
claimed
this
would
not
make
a
difference when
it
comes
to
providing
anticipatory guidance
on firearm safety.
Counselors'
Self-Efficacy
Regarding
the
5
A's
Framework
The
vast
majority
of
college counselors
had high
efficacy
expectations (scored
4
or
5
on
a
5-point
scale)
regarding
their
ability
to
use
the
5
A's
technique in
anticipatory
guid-
ance
for
firearm safety (Table
3).
However,
the
counselors
were
likely
to
have
low
outcome
expectations
(a
score
of
1
or
2
on a
5-point
scale).
The majority were most
likely
to
assess
the
outcomes
of
anticipatory
firearm
guidance
as
"unlikely"
or
"not
sure"
with respect
to
its
impact
on
firearm
suicides,
homicides,
and
accidental
firearm
injuries.
This is
not
sur-
prising because
49%
of
the respondents claimed
little
or
no
expertise
with
this
topic.
A series
of
t
tests and
ANOVAs
were calculated
to
examine
whether
segments
of
the
sample
varied
with
regard
to their
level
of
self-efficacy. No
statistically significant
differences
were
found
for
sex,
professional background,
level
of
educa-
tion,
age,
location
of
the university, or firearm
ownership.
Of
those
clients identified
as
owning
or
having
access
to
firearms
college
counselors claimed
they
"never"
or
"sel-
dom"
(25%
or
less
of
clients) counseled such clients
on the
dangers
of
firearms
(65%),
proper
storage
of
firearms
(69
%),
the dangers
of
keeping
loaded
firearms
(66%),
or
on
substi-
tutes
for
personal
safety (70%).
Counselors' Perceived
Barriers
to
Anticipatory
Guidance
on
Firearm
Safety
Issues
The
counselors
were
requested
to
select
all
that
applied
from
a
list
of
9
potential
barriers
and
an
"other"
category
where
they could
identify
other
potential
barriers.
Two
bar-
riers
were
identified
by more
than
half
of
the respondents,
"majority
of
clients
do
not
need
the
discussion"
(77%)
and
"clients
do
not
request information
on
firearm
safety"
(54%)
(Table
4).
A
series
of
t
tests and
ANOVAs
were calculated
to
examine
whether
segments
of
the
sample
varied with regard
to
their
number
of
perceived barriers
to
anticipatory guidance
for
firearm
safety.
No
statistically
significant
differences
were
found
for
sex,
professional
background,
level
of
education,
age, location
of
the
university,
or
firearm
ownership.
Source
of
Information/Training
on
Firearms
A
majority (54%)
of
college counselors had
not
received
any
information
on
firearm
safety.
Of
those
who
had
received
information,
it
was
most
likely
to have been
from mass
media
(15%)
or
training
in
graduate
school
(14%)
(Table
5).
A series
of
t
tests
and
ANOVAs
were
calculated
to
examine
whether
receiving
information/training
on firearm
safety
issues
was
significantly
associated with
self-efficacy
or perceived
bar-
riers
to
providing anticipatory
guidance
on
this
topic.
Effi-
cacy
expectations were
statistically
significantly
higher
(t
=
-4.26,
df
=
207,
p
<.001)
among
respondents
that
had
re-
ceived
information
from
any
source
(M
=
20.76,
SD
=
3.89)
versus
those
who
had not
received
any
information/training
(M
=
18.29,
SD
=
4.44).
However,
no
statistically
significant
difference
was
found
for
outcome
expectations. Concern-
ing
perceived barriers,
counselors
that
had
received
informa-
tion/training
on
firearm
safety
issues perceived
statistically
significantly
(t
=
4.17,
df
= 2
07,
p
<.001)
fewer barriers
(M
=
2.17,
SD =
1.24)
compared
to
those
who
had
not
received
information/training
(M
=
2.86,
SD =
1.17).
JOURNAL
OF
AMERICAN
COLLEGE
HEALTH
TABLE
2.
Percent
of
Clients
With
Selected
Diagnosis
Provided Anticipatory
Guidance
on
Firearm
Safety
Diagnosis
All
(100%)
Most
(99%-51%)
Some
(50%-26%)
Few
(25%-1%)
None
(0%)
Academic
problems
1% 1% 3%
16%
65%
Adjustment
disorders
1% 1% 3%
18%
63%
Sexual
and
gender
identity disorders
1%
2%
4%
17%
60%
Acculturation problems
3% 1%
4%
21%
56%
Anxiety disorders
1%
2%
4%
24%
55%
Relational
problems
1%
4%
8%
26%
49%
Personality
disorders
1% 3% 8%
24%
48%
Substance-related disorders
1%
5% 9%
27%
43%
Mood
disorders
3% 3%
12%
32%
38%
Schizophrenia
and
other psychotic
2% 5%
9%
15%
34%
disorders
Suicidal
clients
16%
16%
20%
11%
9%
Other
(e.g.,
domestic violence,
n
=
2)
Note.
N
=
213.
136
College
Counselors' Perceptions
TABLE 3.
Self-Efficacy
of
Counselors
Regarding Anticipatory
Guidance
on
Firearm
Safety
Highly
Moderately
Not
confident
confident confident
at
all
Item
5
4
3
2
1
A.
Efficacy
expectations
n(%)
n
(%)
n(%)
n(%)
n(%)
How confident
are
you in
your
ability
to
do the
following actions:
Asking clients about
the
presence
of
firearms
in
their
residence
141
(66) 45
(21)
21(10)
4 (2)
1
(.5)
Advising
clients
to
remove
the
firearms
from
their
residence
124
(58)
43
(20)
35
(16) 6
(3) 3 (1)
Assess willingness
of
clients
to
remove
firearms
within
the
91
(43)
57 (27)
41
(19) 15 (7) 7
(3)
next
30
days
Assisting
clients
in what
to do
with
firearms
removed from
48
(23)
30
(14)
46 (22)
43
(20)
43
(20)
residences
Arranging
follow-up
contact within
4
weeks
to
assess
firearm
77 (36)
50 (24) 48
(23)
17
(8)
18 (9)
removal
Very
likely
Likely
Not
sure
Unlikely
Very
unlikely
B.
Outcome
expectations
n
(%) n1 (%)
n
(%)
n
(%)
n
(%)
How
likely
do
you
think that
using
the
5
A's
strategies
will result
in
the
following:
Will reduce
the
number
of
client's
homes
with
firearms
27
(13)
32
(15)
94
(44)
50 (24)
7
(3)
Will
reduce
the
number
of
firearm
suicide attempts and
10 (5) 19 (9)
76 (36) 92 (43)
13
(6)
suicides
in
clients and/or
their
families
Will
reduce
the
number
of
firearm
homicides
in
clients and/or
13
(6)
31(15) 91(43)
66
(31)
9
(4)
their
families
Will
reduce
the
number
of
accidental
firearm
injuries
or deaths
12 (6) 17
(8)
63
(30)
93
(44)
25
(12)
to
clients and/or
their
families
Note.
N
=
213.
COMMENT
Conclusions
The purpose
of
this
study
was to
assess
what
college
coun-
seling
centers
are
doing
for
their
clients with
regard
to
antici-
TABLE
4.
Counselors'
Perceived
Barriers
to
Anticipatory
Guidance
on
Firearm
Safety
Issues
Perceived
barrier
n
(%)
Majority
of
clients
do
not
need
discussion
163
(77)
Clients
do
not request
information
on
firearm
114
(54)
safety
My
lack
of
personal
expertise
on firearm
safety
104
(49)
My
job
is
addressing
mental
health problems,
46
(22)
not
firearm
safety
Lack
of
time
to
spend
on
this topic
31(15)
Clients
would
not
be
receptive
to
such
20
(9)
anticipatory
guidance
Counseling clients
would
not be
effective
in
10
(5)
reducing
firearm
injuries
Such
a
topic
might
put
ideas
in
client's
minds
5
(2)
Lack
of
financial
reimbursement
2
(1)
Other
(e.g.,
clients
don't
own
guns:
n
=
8;
43
(20)
never
thought
of
it:
n
=
6;
unrelated
to
client's
major
concern:
n
=
5;
no need
since
guns
banned
on
campus:
n
=
3)
Note.
N
=
213.
patory
guidance on
firearms.
Consistent with our
hypothesis,
only
6%
of
respondents
indicated
that
they
were
regularly
involved
in
discussing
firearm
safety
issues
with clients.
The
findings
of
this study
are
comparable
with
those
of
previous
research
involving
the perceptions and practices
of
psychia-
trists
in discussing
firearm
safety
issues
with
mental
health
patients.18
VOL
58,
SEPTEMBER/OCTOBER
2009
TABLE
5.
Counselors
Sources
of
Information/Training
Regarding
Firearm
Safety
Source
n
(%)*
Not
received
any
information
in
this
topic
115
(54)
Mass
media
31(15)
Training
in
graduate school
29
(14)
Professional
meetings
19
(9)
Workshops
17
(8)
Continuing
education
classes
16
(8)
Previous
work
experience
11(5)
Professional
journals
9
(4)
Home
study courses
4
(2)
Other
(e.g.,
peer
consultation:
n
=
4;
campus 30
(14)
police: n
=
4;
grew
up
around
guns:
n
= 3;
gun
training
course:
n
= 3)
Note.
N
=
213.
*Respondents could
select
all
that
apply.
137
Price
et
a/.
The
majority
of
counselors
in
this
study
perceived
firearm
safety
issues
to
be
"considerably
greater'
or"slightly
greater"
for
college
counseling
center
clients with
mental
health
problems
when
compared
with
the
general
population.
In-
deed,
firearm
morbidity
and
mortality
have
a
disproportion-
ate
effect
on
persons
who
experience mental health problems.
Yet,
the vast majority
of
respondents
in
this
study
claimed
they
"never"
or
"seldom"
counseled
clients who owned
or
had
access
to
guns on
the
dangers
and
proper
storage
of
firearms,
or
on
substitutes
for
personal
safety.
It
seems
un-
likely
that
this is
due to
concerns
about
ability,
given
that
the vast majority
of
counselors had
high
efficacy
expecta-
tions
regarding
their
ability
to
use
the
5
A's
technique
in
anticipatory
guidance
for
firearm
safety. Instead,
a
major-
ity
(54%)
of
counselors had not
received
any
information
on firearm
safety
issues,
and
thus
it
does
not
seem surpris-
ing
that
one
third
reported having never
seriously
thought
about
providing anticipatory guidance concerning
firearm
safety.
Implications
and
Recommendations
Marked increases
have been
reported
in
the
number
of
stu-
dents
that
seek
services
at
university
counseling
centers.
22
The
2000 National Survey
of
Counseling
Center
Directors
indicated that
there
was a
growing
concern
regarding
the
number
of
students
with
severe
psychological problems
on
college campuses.
Additionally,
57%
reported
a
growing
de-
mand
for
counseling
services
while
they
had
no
increase
in
resources or,
in
some
cases,
fewer
resources.23
The
2003
Na-
tional
Survey
of
Counseling Center Directors
found
that
8
1%
of
the
directors
reported
their
centers
were
seeing
more stu-
dents
with
serious
psychological problems
than they were
5
years
earlier,
and
that
41%
of
their
clients
had
severe
psycho-
logical
problems.
24
In addition,
a
study
of
college students
at
four
midwestern universities
found that
the
most
commonly
cited campus
resource
for
helping
suicidal
students
was
per-
ceived to
be
the
university
counseling
center.25
Another
study
of
midwestern
college students over
a 13-year
period
found
significant
increases
in severity
of
mental health problems
in
clients
at
counseling
centers,
with
depression doubling
and
suicidal
patients
tripling.
26
It
has
been
claimed
that
the
client
case
loads
at
university
counseling
centers
look
more
and
more
like community mental health
centers.
27
Unfortu-
nately,
the larger the university, the
fewer
the
mental
health
counselors
who
are
available to
students. This
is
especially
disconcerting because
there
is
an
almost perfect
correlation
between
use
and
availability
of
campus
mental
health
coun-
selors.
28
Limited
access
to
campus mental
health
counselors
is
further
complicated
by
the
fact
that college students
com-
prise
the
age
group
that
is
least
likely
have
health
insurance,
further
reducing their
access
to
mental-health
professionals
outside
the university setting.
29
It
is
hypothesized that
college
counseling
professionals
could
help
reduce
firearm
morbidity
and mortality through
anticipatory guidance
of
students
regarding
firearm
safety
is-
sues.
The
findings
of
this
study
suggest that
a necessary
first
step may
be
to
raise awareness
of
college
counseling centers
in
relation
to
discussing
firearm
safety
issues with
clients.
The
fact
that perceived
barriers
were
fewer
and
efficacy ex-
pectations
were
higher
among counseling professionals
who
had
received
information and/or
training
on
firearm
safety
issues provides
support
for
this
suggestion.
In
addition
to
other sources
of
information
on
firearms
that
were
identified
by
counselors
in
this
study,
university
and
college
counseling
centers
might
consider
the
development
and implementation
of
a
firearm safety awareness
campaign
on
campus.
Similarly,
a
firearms
safety
component
could
be
included
as
standard
protocol
in
staff
training seminars,
perhaps
based
on
the
5
A's
framework. As such strategies
are
successfully implemented,
it
may be
that
college
counseling
professionals become
more
aware
of
the
potential
for
positive outcomes
(e.g.,
a
reduction
in
the
risk
of
firearm
suicides
and
homicides
on
campus).
The
National
Association
of
Student Personnel Adminis-
trators
(NASPA)
calls
for
college
counseling
centers
to
play
an
integral
role
in
the
prevention
of
campus
violence,
in-
cluding
firearm
violence.
"While
many
campuses
have
long
had
in
place
an
informal network
of
individuals
who
work
together
to
identify troubling
situations involving students,
the
time
for
informal systems
has
passed.
College
and uni-
versity
administrators
should implement
formal 'threat
as-
sessment
teams'
to
identify
and
address
situations
in
which
the
behavior
of
students
(or
other
members
of
the
campus
community) indicates
they
may
be
experiencing
difficulty
in
functioning
or
may
be
a
threat
to
self
or
others" (p.
21).10
Such
assessment could
be
made
by
counseling
professionals
who
interact
directly
with
students
at
college
and
university
counseling
centers.
Limitations
Finally,
the
limitations
of
this
study should
be
considered
when interpreting the
results.
First,
this
study
was
cross-
sectional
in
design,
which limits
the
ability
to
derive
causal
inferences. Second, although
the
response
rate
was
adequate,
if
the perceptions and practices
of
counselors
that did
not
respond were
significantly different
from those
who
did re-
spond,
this
would constitute
a
threat
to
the
external validity
of
the
findings.
Third, responses
were
self-reported
and
there-
fore
these
were
subject
to
recall bias
(not
accurately
recalling)
and
socially
desirable
responding
(over
reporting
of
appro-
priate
activities).
Fourth, responding
to a
wide
variety
of
questions
on the
same
topic
(monothematic)
may
have influ-
enced
the
respondents,
creating
a
unique
mindset
regarding
anticipatory
guidance
on firearms.
Finally,
the
closed
format
structure
of
the
questionnaire
may
not
have
included
all
of
the
important
items
that
could
have
influenced
the
depen-
dent variable.
To
the
extent
that
there may
not
have been
important perceptions listed
on the
questionnaire,
this
could
have
created
systematic
bias
to
the
internal validity
of
the
findings.
NOTE
For
comments
and
further
information,
address corre-
spondence
to
Dr
James
Price, Department
of
Health
and
JOURNAL
OF
AMERICAN
COLLEGE
HEALTH
138
College
Counselors' Perceptions
Rehabilitative Services,
The
University
of
Toledo,
2801
West
Bancroft
Street, Mail
Stop
#119,
Toledo,
OH
43606,
USA
(e-mail:
jprice@utnet.utoledo.edu).
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VOL
58,
SEPTEMBER/OCTOBER
2009
139
COPYRIGHT INFORMATION
TITLE: College Counselors’ Perceptions and Practices Regarding
Anticipatory Guidance on Firearms
SOURCE: J Am Coll Health 58 no2 S/O 2009
The magazine publisher is the copyright holder of this article and it
is reproduced with permission. Further reproduction of this article in
violation of the copyright is prohibited. To contact the publisher:
http://www.heldref.org/
... A national survey of college counseling center directors examined the use of firearm safety counseling with student clients who used college counseling centers, and 213 (59%) of the directors responded (Price et al. 2009). The majority of counselors (57%) perceived firearm ownership safety issues to be considerably or slightly greater for college counseling center clients than for the general college population . ...
... Mechanisms need to be in place to restore the rights to have firearms when appropriate for those who have been disqualified to purchase or possess them. Finally, we would like to add a few recommendations that specifically relate to the mental health arena (Price et al. 2007Price et al. , 2009Price et al. , 2010Price et al. , 2014 Thompson et al. 2012): ...
Article
Full-text available
Firearm violence is a significant cause of morbidity and premature mortality in the United States. The majority of suicides and homicides are committed with firearms. Considerable debate has occurred regarding firearm violence and mentally ill people. Mental health professionals can play a central role in research, practice, and advocacy regarding firearm violence prevention through a number of avenues. However, little is known about mental health professionals' perceptions and practices regarding firearm safety counseling in the mentally ill. Thus, the purposes of this investigation are to summarize the literature on firearm violence by the mentally ill and to conduct a rigorous review of the available scientific literature on mental health professionals' views and practices on firearm violence prevention. A total of nine studies were found that dealt with mental health professionals' attitudes and practices on firearm violence prevention. Findings have been summarized in the following categories: mental health professionals training, screening for the presence of firearms, engagement in firearm safety counseling, and perceptions regarding firearm violence in the United States. Mental health professionals need more training regarding firearm issues if they are going to play a role in reducing firearm trauma by the mentally ill. Their impact will be primarily on firearm suicides.
... The adjusted return rate was 306 / (623 -[56 + 40] = 527), or 58%. This is comparable to the 59% return rate in a recently published study involving the same population (Price, Mrdjenovich, Thompson, & Dake, 2009). ...
Thesis
This study assessed the perceptions and practices of mental health professionals at university counseling centers regarding their provision of guidance on the health effects of religious/spiritual involvement. The membership of the Association for University and College Counseling Center Directors was used to identify a national cross-section of university counseling centers. One licensed psychologist, professional counselor, or social worker from each counseling center was selected to survey (N = 623). A valid and reliable survey instrument was developed, and a three-wave postal mailing procedure was used to maximize the return rate. A total of 306 university counseling professionals (58%) responded. They agreed that religious/spiritual involvement has a positive influence on the health and well-being of college students (77%), but were unsure or disagreed (66%) that university counseling iii professionals should advise clients as such. Approximately one-third (31%) had never seriously thought about doing so. The respondents were predominantly (52%) “unsure” that guidance on the health effects of religious/spiritual involvement would result in lower health risks; however, nearly half (48%) indicated that such guidance would promote recovery among their clients. Although slightly more than half (54%) of the responding university counseling professionals discussed the salutary influence of religiosity/spirituality with the majority of their clients (e.g., provides a means of coping with stress, offers social support, contributes to a sense of well-being), relatively few (21%) discussed the physical health effects of religious/spiritual involvement. The most frequently endorsed perceived barrier was that discussions of religiosity/spirituality and health “should occur only with clients who indicate that religion/spirituality is important to them” (67%). A plurality (35%) of the respondents had received no formal training in this area. Respondents who had received information/training from at least one source, as well as those who indicated higher levels of personal religiosity/spirituality, were significantly more likely to be in the action or maintenance stage and to report higher efficacy expectations and more positive outcome expectations regarding the provision of guidance on the health effects of religious/spiritual involvement. Implications and recommendations for clinical training, university counseling centers, and future research are discussed.
... cide (Violence Policy Center, 2000). In addition, research shows that college counseling centers do not ask students that visit the centers about their access to firearms (Price, Mrdjenovich, Thompson, & Dake, 2009). Given the statistics, having guns available in dormitory rooms and on campuses may further increase the likelihood of collegeaged suicides. ...
... cide (Violence Policy Center, 2000). In addition, research shows that college counseling centers do not ask students that visit the centers about their access to firearms (Price, Mrdjenovich, Thompson, & Dake, 2009). Given the statistics, having guns available in dormitory rooms and on campuses may further increase the likelihood of collegeaged suicides. ...
Article
Full-text available
The purpose of this study was to identify the nature and extent of physical violence against pregnant women by male partners under the influence of alcohol and other drugs (AOD) using a sample of women who presented for prenatal care at a major hospital in Ciudad Juárez, Mexico. Of the 215 women who completed the survey, 17.7% (n = 38) self-reported being victims of physical abuse, with 89.5% (n = 34) of them reporting their male intimate partner being under the influence of AOD at the time of the act (p < 0.01). The majority of these women were poor, young housewives with less than a high school education. Substance abuse treatment centers in Juárez, Mexico may wish to incorporate physical violence screening into their history-taking protocols and offer suitable violence prevention services.
... Psychiatrists and psychologists have minimal training in assessment and management of patient violence or training in firearm anticipatory guidance345. Thus, it is not surprising that counselors, clinical psychologists and psychiatrists seldom discuss firearm issues with their patients678. Research indicates little, if any, increased risk for violence associated with serious mental illnesses unless there are comorbidity issues such as substance abuse or an early history of personality disorder91011. ...
Article
Firearms injuries place a unique burden on America in terms of lives lost (31,000/year), disability (70,000 nonfatal injuries/year), and economic costs ($174 billion in 2010). The purpose of this study was to examine psychiatric residency directors' perceptions of firearm access issues of the mentally ill. In late Fall 2012 and early Spring of 2013, a three-wave mailing was used to survey the membership of the American Association of Directors of Psychiatric Residency Training (N = 129). Due to the homogenous small sample size descriptive statistics were calculated to describe the responses. A total of 72 (56 %) directors responded. Almost 1 in 4 (23.6 %) thought that access to firearms by the seriously mentally ill should not be prohibited. The majority (91.7 %) supported closing the background check loophole. The majority (54.2 %) also believed that singling out the mentally ill as a group of "banned purchasers" adds to the stigma of the mentally ill (54.2 %) but a plurality (44.4 %) did not believe reporting the mentally ill to authorities would result in the mentally ill avoiding treatment. The current method of reducing access by the mentally ill to firearms is perceived by psychiatric residency directors as ineffective and burdensome to the mentally ill.
... Several of these studies have surveyed physicians regarding their assessments of patient access to firearms in their homes and their practices in counseling patients regarding the potential hazards of firearm access. Anticipatory guidance is commonly used to discuss with patients how to make their home environment safer by ''means reduction'' or removing easy access to firearms in their residences [10][11][12]. ...
Article
Full-text available
The impression that college campuses are becoming more dangerous places where firearm violence is common (moral panic) is simply untrue. The result of this erroneous impression is that a contentious debate regarding whether concealed carry of firearms on college campuses makes campuses safer has been occurring on both college campuses and in state legislatures. Frequently, in such debates and policymaking, key stakeholder perceptions are not accounted for by legislators. In this article, we review the perceptions of key college stakeholders (students, faculty, administrators, staff, campus police, parents, mental health counselors, and state legislators) regarding their perceptions of campus safety and their level of support or opposition for concealed carry on college campuses. Also, we assessed the characteristics of those who supported campus carry laws and those who were opposed to such laws. Finally, we explore the effectiveness of campus carry laws. Overwhelmingly, key college stakeholders do not support concealed firearm carrying on college campuses. Those who are white, male, and conservative are more likely to support campus carry laws. Also, there is no evidence-based research to show that concealed carry campuses have less firearm violence when compared to campuses that do not have concealed carry permissions. To date, research has not found evidence that concealed carry makes campuses safer. Additional research is essential to determine the impact of concealed carry on college campuses.
Article
Purpose Firearm-involved violence and suicide in the USA, often collectively referred to as “gun violence,” has been labeled a public health problem and an epidemic, and even an endemic by some. Many lawmakers, community groups, mainstream media outlets and professional organizations regularly address gun-related issues and frequently associate firearm violence with mental health. As a result, these groups often set forth positions, engage in discussions and promote policies that are at least partially based on the widely held but incorrect assumption that medical and mental health professionals are either inherently equipped or professionally trained to intervene with their patients and reduce gun deaths. The paper aims to discuss this issue. Design/methodology/approach Furthermore, notable proportions of medical and mental health professionals self-report a level of comfort engaging in firearm-specific interventions that is often disproportionate to their actual education and training in the area. This type of overconfidence bias has been referred to as the Lake Wobegon Effect, illusory superiority, the above average effect, the better-than average effect or the false uniqueness bias. While medical and mental health professionals need to serve on the front line of firearm-involved violence and suicide prevention initiatives, the vast majority have not actually received systematic, formal training on firearm-specific issues. Findings Therefore, many lack the professional and cultural competence to meet current and potential future in regard to addressing gun violence. In this paper, the authors discuss empirical studies that illustrate this reality and a novel model (i.e. the Know, Ask, Do framework) that medical and mental health professionals can use when firearm-related issues arise. In addition, the authors set forth considerations for clinicians to develop and maintain their professional and cultural competence related to firearms and firearm-related subcultures. Originality/value This paper provides empirical and conceptual support for medical and mental health programs to develop formal education and training related to guns, gun safety and gun culture. A framework is provided that can also assist medical and mental health professionals to develop and maintain their own professional and cultural competence.
Article
Since the recent shootings in Tucson, Arizona; Aurora, Colorado; and Newtown, Connecticut, there has been an ever-increasing state and national debate regarding gun control. All 3 shootings involved an alleged shooter who attended college, and in hindsight, evidence of a mental illness was potentially present in these individuals while in school. What appears to be different about the current round of debate is that both pro-gun control and anti-gun control advocates are focusing on mentally ill individuals, early detection of mental illness during school years, and the interactions of such individuals with physicians and the mental health system as a way to solve gun violence. This raises multiple questions for our profession about the apparent increase in these types of events, dangerousness in mentally ill individuals, when to intervene (voluntary vs involuntary), and what role physicians should play in the debate and ongoing prevention. As is evident from the historic Tarasoff court case, physicians and mental health professionals often have new regulations/duties, changes in the physician-patient relationship, and increased liability resulting from high-profile events such as these. Given that in many ways the prediction of who will actually commit a violent act is difficult to determine with accuracy, physicians need to be cautious with how the current gun debate evolves not only for ourselves (eg, increased liability, becoming de facto agents of the state) but for our patients as well (eg, increased stigma, erosion of civil liberties, and changes in the physician-patient relationship). We provide examples of potential troublesome legislation and suggestions on what can be done to improve safety for our patients and for the public.
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Are perceived increases in symptom severity in college counseling center clients real or imagined? Counseling center staff, retrospectively, reported that client problems are more severe now than in the past. Yet studies examining client distress levels at intake have found no significant increases. This study examined counseling center client problems across 13 years from the perspective of the treating therapist at the time of case closure. Increases were found for 14 of 19 client problem areas, whereas other areas retained stable levels, and 2 problem areas had a quadratic trend over time. These changes directly affect counseling service practices. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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We reviewed the available data on firearm-related injuries in Canada to suggest strategies for prevention in the context of the proposed amendments to the Criminal Code (Bill C-17) currently before Parliament. The risk of death from a firearm in Canada is equivalent to the risk of death from a motor vehicle crash. We discuss the risks associated with firearms with regard to suicides, homicides and "accidents." We also discuss the accessibility of firearms. This article builds upon a recently published update on the epidemiologic basis of the public health approach for the prevention of firearm-related injuries and deaths. The key to the etiologic approach to preventing such injuries and deaths is to view the incidents, regardless of their medicolegal circumstances, as having one factor in common: the discharge of a firearm.