2023 14th Annual NUBE Conference

When crisis care is inadequate, a greater financial burden is created due to an overdependence on hospital use and law enforcement, as well as the immense cost of human tragedies that occur due to a lack of access to care (Substance Abuse and Mental Health Services Administration [SAMHSA], 2020). There are specific barriers present in rural settings (e.g., lack of resources, understaffing, transportation difficulties) that exacerbate challenges in mental health crisis response (Bratina et al., 2021). Structural barriers and uncoordinated systems of care result in fragmented, inadequate care (Townsend et al., 2023). This fragmentation was apparent in Hawaii, especially in rural areas, prior to 2016. Community members and providers alike were not confident about whom to contact in a mental health crisis, and services were often unreliable. Documentation of these crisis encounters were irregular, posing ethical challenges and difficulties providing follow-up care. To address these challenges, several child-serving state agencies on Hawaii Island came together in September 2016 for a Cross-Systems Crisis Response Summit. The summit was designed to bring together professionals from various agencies and organizations to learn about crisis response plans and to collaboratively work towards a seamless crisis response system for children and youth on the island. The summit included a panel of professionals from different systems as well as several activities focusing on specific aspects of crisis response management. Action plans arose from the Cross-Systems Crisis Response Summit. One primary development was the formation of a statewide, multiagency, mental health crisis response taskforce that includes the department of education, emergency departments across the state, department of health, law enforcement, and others. Thanks to the collaborative work of this taskforce, Crisis Mobile Outreach (CMO) has become more appropriately used in multiple settings, and a feedback mechanism regarding the functioning of CMO was developed to support ongoing improvements in care. These changes, along with the release of 988 nationwide, have resulted in CMO utilization for youth being higher than ever before. Additionally, state legislation was passed in 2023 that supports longer follow-up care (i.e., six to eight weeks) for youth after mental health crisis events.  This rapid fire presentation will overview the development of youth mental health crisis response across the state of Hawaii from 2016 through present day. Presenters will explain how and why inter-agency collaboration was crucial for progress, and they will describe barriers faced working with rural communities spread across multiple islands. Presenters will share data that highlights systemic changes in crisis services and in attitude shifts about responding to mental health crises, includingpre- and post-data gathered at the Cross-Systems Crisis Response Summit. They plan to share this information in comparison with 2023 data about the same topics after seven years of work by the crisis response taskforce. Finally, presenters will incorporate SAMHSA guidelines to make suggestions regarding improvement for youth crisis response in rural settings.

Learning Objectives:

• Understand strategies used in a rural setting to improve mental health crisis services for youth.
• Illuminate importance of inter-agency collaboration.
• Provide recommendations to improve mental health crisis response for youth in rural settings.