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Kamehameha Kapālama Athletic Well-Being Referral Form
Kingsley Ah You
Dean of Student Well-Being for Athletics
Cell: 808-292-1780
Work 808-842-8988

Student Safety Definitions 

Suspected or reported abuse (physical, emotional, sexual), or neglect, both current and/or historical 

Our Behavioral Health Specialists (BHS) are trained to assist KS employees in making reports to Child Welfare Services or the Police and can facilitate additional services for the student as needed. Notify BHS whenever a KS employee receives knowledge of potential child abuse, neglect, or sexual misconduct. For more information, please refer to: Procedure 201.1.02 — Reporting Suspected Child Abuse or Neglect

Additionally, if a student presents with any of the following behaviors (including but not limited to those below) and/or if a person reports concern to a staff member about another student in-person, via email, written assignment or through the Hi‘ikua Help Line, PLEASE IMMEDIATELY CALL FOR BHS SUPPORT: 

Danger to Self – Suicidal ideation, self-harm, increasing depressive symptoms 

Definition: A student who may verbalize, write, or post on social media about wanting to take their own life, wishing they were dead or that they would die, including any plans to commit suicide. A student who recently threatened or attempted suicide or some serious bodily injury. A student who may demonstrate dangerous or reckless behaviors through some recent act, attempt or threat of self-mutilation (i.e. cutting, scratching, burning, picking, etc.). 

Current suicidal thoughts, prior suicide attempts 

  • Recent demonstration of self-harming behaviors 

  • Presence of mental health concerns 

  1. Danger to Others – threats of violence or harm to others 

Definition: A student who may verbalize, write, or post on social media about wanting to physically hurt or harm another person, group of people, or pet. A student who states a specific or general threat of violence, including homicidal or thoughts of revenge which can appear vague or in the form of a detailed plan. 

  • Previous violent behavior (hurting animals, hurting others) 

  • Fascination with and playing with fire or dangerous objects 

  • Anti-social behaviors (very few friends), victim of abuse at home or school 

  1. A condition of being Gravely Disabled – psychotic symptoms, bizarre behaviors, sudden change in personality/social behavior, or intoxication. 

Definition: A student who may display a sudden inability to care for their basic “Activities of Daily Living” (i.e. hygiene, dressing, eating, continence, or mobility). A student who may describe hallucinations (auditory, visual) or agitation or present as catatonic (immobile or unresponsive) or intoxicated. 

  • Intoxication or ongoing substance use

  • Debilitating physical illness 

  • Current or history of high anxiety episodes, paranoia 

If the situation is not safe or the student appears to require emergent medical care: call 911, notify Campus Security, Behavioral Health Supervisor, Behavioral Health Manager, and Student Health Services Director. 


KS Kapālama BH Supervisor: 

Samantha Landry-Smith  (o) 842-8251 (c) 292-1395 

KS Kapālama BH Supervisor: Maile Mundon (o) 842-8141  (c) 349-2276 

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Email *
Student Information: Legal Name, Grade, Team
Reason for Referral: Who, What, Where, When, Why
Who have you contacted about concern? Parent, AD, Dean, School
Mahalo for your Referral!  It's been said that one coach will impact more young people in one year than the average person does in a lifetime.  The "coach" has been validated as the single greatest authoritative figure in the life of kids today.  
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