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. 2025 Feb;55(1):e13138.
doi: 10.1111/sltb.13138. Epub 2024 Nov 19.

Development of a peer-delivered lethal means counseling intervention for firearm owning veterans: Peer engagement and exploration of responsibility and safety (PEERS)

Claire Houtsma  1   2   3 , Melinda Hohman  4 , Michael D Anestis  5   6 , Craig J Bryan  7   8 , Gala True  1   2   3
Affiliations

Development of a peer-delivered lethal means counseling intervention for firearm owning veterans: Peer engagement and exploration of responsibility and safety (PEERS)

Claire Houtsma et al. Suicide Life Threat Behav. 2025 Feb.

Abstract

Introduction: This study aimed to adapt and expand an evidence-based lethal means counseling intervention for peer-delivery among firearm owning Veterans. We further sought to assess Veteran interventionists' fidelity to motivational interviewing (MI) in the context of the adapted intervention.

Methods: An iterative expert panel comprised of experts in suicide prevention, lethal means counseling, MI, and Veteran peer engagement (N = 9) informed intervention adaptation. Experts rated the appropriateness of the adapted intervention, named Peer Engagement and Exploration of Responsibility and Safety (PEERS), and associated interventionist training plan across six criteria. Veteran interventionists (N = 3) were trained to deliver PEERS and their fidelity to MI in the context of PEERS was evaluated.

Results: Expert panelists' average rating was 7.6 (out of 9). Ratings across all criteria (e.g., quality of the training plan; perceived ability of interventionists to engage in the intervention) were high. Interventionists' composite MI fidelity scores suggested most were client-centered, but not MI-competent in their delivery.

Conclusion: Findings suggest that PEERS is an appropriate lethal means counseling intervention for firearm owning Veterans that can be somewhat feasibly delivered by Veteran interventionists. This intervention could help expand the reach and effectiveness of lethal means counseling.

Keywords: expert panel; fidelity; motivational interviewing; secure; storage; suicide prevention.

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Conflict of interest statement

Dr. Anestis reported receiving grants from the Department of Defense, Military Suicide Research Consortium, New Jersey Department of Human Services Division of Mental Health and Addiction Services, New Jersey Office of the Secretary of Higher Education outside of the submitted work. Dr. Anestis also reported receiving royalties from Oxford University Press and speaking fees on related topics outside of the submitted work. Dr. Bryan reported receiving grants from the Department of Defense, National Institute of Mental Health, Bob Woodruff Foundation, USAA Foundation, The Boeing Company, and Navy SEAL Foundation outside of the submitted work. Dr. Bryan also reported receiving consulting fees from Oui Therapeutics and Vita Health, personal fees from Anduril LLC, and royalties from Guilford, Oxford University Press, Routledge, and Springer outside of the submitted work. No other disclosures were reported.

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