Hawaii's Community Systems Initiative for Youth Suicide Prevention - The purpose of the Hawaii's Community Systems Initiative (HCSI) for Youth Suicide Prevention is to strengthen the capacity of key community-embedded youth-serving systems in the areas of primary prevention (Hope), early intervention (Help), and postvention (Heal). About 30% of Hawaii’s population is 24 years old or younger, and reflects Hawaii’s unique cultural and geographic context including Native Hawaiian, Pacific Islander, Asian American, and multiracial youth. Despite the romanticized picture frequently painted by tourist-targeted media, Hawaii’s youth face very real challenges. Suicide remains a leading cause of death among individuals ages 24 and younger in Hawaiʻi, reflecting a broader continuum of behavioral health need. For every youth suicide death, six more youth are hospitalized for suicide attempts, and another 15 are treated in emergency departments for nonfatal self-inflicted injuries, highlighting a system that is often reactive rather than preventative. Rates of suicide planning (past 12 months) among Hawaii’s high school students are substantial, ranging from 13% to 16% across islands; suicide planning rates among middle school students (lifetime) soar even higher, at an overall average of 20%. In addition, Census trends over the past several decades show shifts from dense urban areas like Honolulu (Hawaii’s capitol) to rural and neighbor island communities. Thus, more families are residing farther away from larger healthcare facilities, specialty care, and essential government services based in Oʻahu’s urban core. Taken together, these data highlight a high lifetime burden of suicide ideation and planning among Hawaiʻi youth, and underscore the need for early, sustained, and coordinated prevention efforts that begin before high school. In response, Hawaii’s suicide prevention movement has grown over time, with notable strengths in outreach/education, building partnerships, and adapting activities to community and cultural context. However, gaps remain in system coordination, workforce capacity, and sustainability. Thus, HCSI will emphasize growing and strengthening systems embedded within Hawaii’s communities. This will be accomplished through three complementary goals: 1) Develop comprehensive and community-embedded systems for continuity of care (i.e., from screening, to identification, referral, access, and follow-up); 2) Coordinate training and skill development opportunities and supports; and 3) Facilitate dialog and sharing of supportive resources to reduce stigma, while ensuring safe messaging. HCSI follows a public health approach to advancing a comprehensive system of youth suicide prevention, and aligns with the State Strategic Plan’s emphasis on connection, caring, and collaboration. Public health’s levels of prevention are reflected by the interconnected pillars of Hope, Help, and Heal. This framework is grounded in culturally embedded models developed in Hawaiʻi that integrate prevention, intervention, and postvention. HCSI’s approach and strategies also reflect a social ecological approach, addressing risk across individual, relational, community, and system levels. This work builds upon successes from two previous SAMHSA-funded youth suicide prevention initiatives, as well as over two decades of community-engaged suicide prevention scholarship and practice led by our team. Our primary beneficiaries are youth up to age 24, though we will also serve parents and families, community members, and professionals who work with youth. Our programming will reach at least 60,000 (unduplicated) people per year across the State. Ultimately, this Initiative's innovative approaches will enhance capacity among youth-serving systems, and in parallel, coalesce a collaborative system of care that reconnects youth through a strengths-based approach and bolsters Hawaii’s promotion of Hope, Help, and Healing for our communities.
