Integration Key Area 1:


Combining Multiple, Evidence-Informed Approaches

There are embedded links provided throughout this key area. Some direct you to important steps or areas elsewhere on the site, and are indicated by telling you to “go to” those places. Others are for additional information only.

After your strategic planning group has set goals and objectives by looking at data and community context, you will choose specific approaches and action steps to reach those goals and objectives. (If you have not yet set data-based goals and objectives, go to Planning Key Area 2: Using Data to Choose Goals and Objectives and then return here.) In selecting approaches, focus on the needs of the different groups that may be at increased risk for suicide. As you will see, the Integration element is closely tied to the Planning and Data elements, and there are several places where you will go back and forth between them.

Since suicide is a complex problem, it is most effective to use multiple, integrated approaches that address the most significant risk and protective factors for a particular group. For more on risk and protective factors, see the Data Key Area 1: Accessing Systems Data for Planning.

Make sure the suicide prevention programs, policies, and practices you put in your strategic plan have evidence of decreasing risk factors or increasing protective factors in the groups you are trying to reach. Many of the activities that prevent suicide also improve other behaviors with the same risk and protective factors, such as community violence and substance abuse.

A Comprehensive Approach in Action

Following are two programs that take a comprehensive approach to suicide prevention:

  • The Model Adolescent Suicide Prevention Program found that in order to prevent suicide among Indigenous youth, they also needed to address underlying issues such as alcohol dependence, domestic violence, child abuse, and unemployment.
  • The U.S. Air Force Suicide Prevention Program has 11 different initiatives that include community preventive services, trauma stress response, and suicide event surveillance system. The program is aimed at strengthening social support, promoting development of social skills, and changing policies and norms to encourage effective help-seeking behaviors.

The prevention approaches that make up your comprehensive approach are the most likely to be effective if they:

  1. Adequately address identified community needs
  2. Are evidence informed
  3. Are a good fit and feasible within your community

Prevention Approach

Key Steps

Identify strategic goals

As you select approaches, it is essential to connect them with clear goals for your community’s overall suicide prevention efforts. If you have not yet identified the hoped-for outcome of your efforts, visit Planning 2, Steps 1-3 to learn about strategic goal setting before choosing prevention approaches.

A Note about Taking Action Soon after a Suicide Loss

Healing after a suicide loss (also known as postvention) is a form of prevention. If your community recently lost someone to suicide, take time to heal before moving into other prevention planning and programming. If community members have not had enough time to grieve before formal suicide prevention efforts are launched, they may experience unresolved or undue guilt, or they may feel overlooked within the community’s suicide prevention efforts. It is helpful to focus on postvention and provide support to people impacted by suicide losses before starting formal strategic planning efforts.

For postvention information and resources, see the Centers for Disease Control and Prevention’s (CDC’s) Suicide Prevention Resource for Action, (Suicide Prevention Resource) pages 68–73, “Lessen Harms and Prevent Future Risk,” as well as Unity 1, Step 4: Address needs of the group related to suicide loss (postvention).

As you go through the following steps, note that postvention planning can be built into your overall strategic planning to better prepare for a possible future suicide loss.

Review evidence-informed approaches

When choosing approaches it is important to draw from ones that have been shown to be effective for preventing suicide (approaches that are evidence-informed). CDC’s Suicide Prevention Resource provides approaches based on the best available evidence that communities can use to reach their goals. The Suicide Prevention Resource Center’s (SPRC’s) Best Practices Registry lists particular programs and practices that support those approaches.

Communities may get better outcomes by combining clinically focused approaches (e.g., treatment for people at risk of suicide) with community-based efforts (e.g., reducing access to lethal means among people at risk for suicide, peer norm programs). Use approaches in an integrated, cohesive way, both in your own efforts and with external community programs. As you review CDC’s Suicide Prevention Resource, find where your goals and objectives overlap with its approaches.

List your approaches in the Strategic Planning Worksheet, Section 2, Column 2.

Next you will choose which programs, policies, and practices to pursue for each approach. To help you decide, look at the populations or settings that were involved in showing the approach’s impact. For example, if you are looking for a gatekeeper training to use with Latino families in churches, find out whether the trainings have been tested with this population or in this setting. If not, consider piloting a training with your Latino church community first. Or look for another training that has been shown to be effective with this community.

However, for some groups there are no evidence-informed approaches or tested interventions. In these cases, figure out either:

  • How you will adapt and test existing approaches with a new population or setting, or
  • How you will develop approaches that are based on sound suicide prevention theory, combined with input from the specific community

For additional information on cultural context and evidence-informed approaches, see Step 3 below.

When you have chosen your program(s), policy(s), or practice(s), list them in the Strategic Planning Worksheet, Section 2, Column 3.
Consider community fit and feasibility

As you choose approaches and specific programs, policies, and practices from CDC’s Suicide Prevention Resource and SPRC’s Best Practices Registry, think about which are practical, likely to succeed, and a good cultural fit for your community. (For a deeper dive on this topic, see Fit Key Area 3: Incorporating Community Context and Culture.) Also consider whether there are community partners who can take leadership in carrying out a given program, policy, or practice; whether the community is ready for it; and what the community response is likely to be to it.

For example, you might identify two prevention approaches and associated programs that could help achieve the goal of increasing social connectedness in school-aged youth (see pages 42-47 in CDC’s Suicide Prevention Resource):

  • Engage community members in shared activities – After-school volunteer program
  • Promote healthy peer norms – Sources of Strength

However, you may determine that you do not have the funding to create an after-school volunteer program or the partners to oversee it. Given these limitations, you could table it for a future time and not include it in your current strategic plan. You would then be left with one other approach for your strategic plan—promote healthy peer norms.

Be sure to use your partners’ input when choosing goals, objectives, and specific prevention approaches. Give equal weight to partners’ feedback on what is practical, culturally appropriate, and most likely to be effective, along with whether a potential program, policy, or practice is evidence informed.

Use this information to help you fill out the Strategic Planning Worksheet, Section 2, Column 4. Note any approaches that will need adapting. Note any programs that are not a good fit even with adaptation, and ones that are not feasible.

If your coalition has subcommittees focused on different populations or settings, it may be helpful to have each group review and select appropriate approaches. This will allow each subcommittee to consider cultural fit and practicality. By having subcommittees select the activities you will also ensure there is community ownership and investment.

Once they have chosen programs, practices, and policies to put in place, the subcommittees should share this information with the larger coalition. This sharing will accomplish the following:

  • Ensure all coalition members are aware of the chosen approaches
  • Reduce duplication of efforts
  • Encourage resource sharing across activities
Connect specific approaches to goals and objectives

Now that you have selected your approaches and particular programs, policies, and practices, go to Planning 2, Step 4: Create objectives for each goal and Planning 2, Step 5: Make objectives SMARTIE to draft objectives for them. These objectives should clearly state how you will know if you have succeeded in achieving them. In addition, a logic model can help you clearly demonstrate how those successes relate to reaching your long-term goals. You can turn to Planning 2, Step 6: Map out short-term, intermediate, and long-term changes for more information on using logic models to show the relationship between approaches, objectives, and goals.

Expand prevention over time

Your community will not be able to take on every prevention approach that they want to do all at once. Instead, it is best for the coalition to identify the approaches that are the most realistic to do first and those that will need to happen later.

Start by focusing on small immediate wins and build on them over time. Prioritize approaches that you will focus on for the next two years. Keep in mind approaches that you may tackle in the longer-term. These may be equally important to your community, but your priority approaches may require less money, resources, and investment or simply be easier to launch.

For long-term approaches, focus on developing partner and audience buy-in as you create momentum and show that your short-term activities are making a difference. For example, your community may already see the value of teaching people the warning signs of suicide, but it may not yet have the time and resources to do postvention planning. In this case, your coalition can start developing postvention plans and raise awareness of their value while holding trainings on the warning signs of suicide.

List your priority approaches for the next two years in the Strategic Planning Worksheet, Section 2, Column 5.
Create action items

After you have chosen your prevention activities (i.e., specific programs, policies, and approaches), create specific action items for carrying them out. In strategic plans, action items should answer the questions “what?” “who?” “when?” and “where?”

What specific action steps need to be taken to carry out an activity?
Who will be responsible for each action item?
When will each action item need to occur?
Where will each action item need to occur?

You will likely need multiple action items and multiple partners to carry out each activity.

As you consider who to list as responsible for each item, consider which suicide prevention partners have the relevant expertise, skills, resources, and interests, including those that represent historically marginalized groups. Aligning partners with the prevention activities most relevant to their roles in the community will ensure you get strong buy-in for your strategic plan. Set up your coalition so that partners serve on subcommittees related to their relevant experiences, knowledge, and skills. Dividing up partner responsibilities for carrying out different action items will increase your ability to move your plan from paper to action.

For more guidance on aligning partners with activities, visit the Unity element.

Show how action items support activities, objectives, and goals

As you identify specific action items in your strategic plan, it is important to show how they directly align with your related activities, objectives, and goals. Often the clearest and most concise way to do this is to create tables or charts that group related goals, objectives, activities, and action items together. Table 2 is an example.

Table 2. Action Plan Example

Intermediate Goal: Increase Social Connectedness of High School Youth
Objective Approach/ Activity Action Items Groups and Individuals Involved Deadline
Objective 3: From 2022 to 2025, over half of X school district’s students will participate in weekly youth connectedness activities. Implement a peer norms program designed to reduce bullying and increase social connectedness 1.      Gather school district superintendent and school board support for peer norms program. Youth suicide prevention subcommittee 10/2023
2.      Conduct a scan of available evidence-informed peer norm programs. Youth suicide prevention subcommittee 12/2023
3.      Select an evidence-informed peer norm program that is feasible to implement in 2025. Youth suicide prevention subcommittee & X school district staff 02/2024
4.      Host a focus group on what adaptations will be needed to bring the selected program in line with community culture. X college research assistant & Y high school health classes 04/2024
5.      Coordinate with program author to approve any chosen adaptations. Youth suicide prevention subcommittee 06/2024
6.      Make approved program adaptations. Youth suicide prevention subcommittee 07/2024
7.      Train pilot school staff in peer norms program. X school district staff & Y nonprofit advocates 10/2024
8.      Pilot peer norms program in X school district middle school. X school district staff & Y nonprofit advocates 01/2025
9.      Evaluate peer norms program impact and make adjustments. Youth suicide prevention subcommittee & X college research assistant 06/2025
10.   Roll out peer norms program across 5 area school district middle and high schools. X school district staff & Y nonprofit advocates 08/2025
11.   Evaluate widespread impact. Youth suicide prevention subcommittee & X college research assistant 12/2025