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The Gun Lake Tribe (GLT) will develop a framework for suicide prevention and early intervention activities to increase program capacity, effectiveness and efficiency to identify, respond, assess and treat those identified as being at risk. The three-year We Walk Together Project will serve 160 community individuals, focusing on youth ages 10-24. GLT offers programs and services to citizens of federally recognized tribes who reside in Allegan, Barry, Kalamazoo, Kent, and Ottawa counties of Michigan. Roughly, 30% of Gun Lake Tribe Citizens who reside within the five-county service area are youth ages 10 to 24. Of that number, over 50% of GLT youth in this age range live in Allegan County, where the Tribal Government Office and Health and Human Services Department are located. The geographic catchment area where services are delivered is a rural area with limited access to hospitals and health centers. Needs Statement: GLT HHS department has basic suicide screening and intervention practices in place for individuals who access services; however, is in need of expanding services to identify, respond, assess and treat those identified as being at risk. In order to address the need, staff will accomplish two goals over the course of a three-year project: Goal 1: Develop and implement comprehensive and sustainable preventive, clinical and professional practices to enhance awareness, identification, referral and treatment strategies for American Indian Youth, ages 10-24, and household members in the GLT community focused on warning signs and risk factors for suicide, suicide and suicidal behaviors; and, Goal 2: Increase data collection and analysis to effectively address youth suicide in the Tribal community. The Zero Suicide Model was selected to develop team-based guidance and support to operationalize a suicide care plan into practice, while evidenced-based Screening, Brief Intervention and Referral to Treatment (SBIRT) was chosen to systematically screen, assist and refer people with substance abuse, suicide and suicide risk factors. The project will also incorporate staff and community training to better identify, assess and increase referrals. Over the course of the three-year project, staff will work with Cheryl Endres, evaluator, to increase data and analysis, and with Western Michigan University partner, Dee Sherwood, Ph.D. for implementation of prevention and early intervention activities. Existing relationships with Allegan County Community Mental Health Suicide Prevention Coalition will be leveraged during the project for training, strengthening resources and connections and capacity for referrals.

Saint Regis Mohawk Tribe Mental Health Services will partner with 4 youth serving programs to expand the mental health screening, referrals and treatment for youth ages ten to twenty four who are at risk for suicide in Akwesasne. We will work with the local school district where we already have 2 school based satellite mental health clinics, Akwesasne Girls and Boys club, division of Community and Family Service and the Alcohol and Chemical Dependency Programs to expand our screening and treatment capacity. Youth and parents/guardians who consent to completing a screening tool will be given results of their screening and offered services. We provide training in youth mental health issues, suicide prevention, intervention and postvention to the school staff, agency personnel, youth and their families using trainings such as Question, Persuade, Refer, Connect and Youth Mental Health First Aid. Expansion of behavioral health staff will also be a priority. We will hire an additional therapist, youth care coordinator, traditional support worker and increase psychiatric prescribing ability. Training of behavioral health staff in effective screening and treatment of youth who are at risk of suicide will increase our expertise and capacity to save lives and reduce the trauma that occurs in our small community when there is an unexpected youth suicide in Akwesasne.

The Tule River Indian Health Center, Inc. (TRIHC) will implement the Tribal Youth Suicide Prevention (TYSP) Project. The TYSP Project will provide much-needed suicide prevention, assessment, and early intervention services for Native American youth (ages 10 - 24), who reside on the Tule River Indian Reservation in Tulare County (California), as well as other Native American youth (ages 10 - 24) from throughout Tulare County. The target population reports high levels of depression related feelings -- 23.7%% in past month -- and high levels of suicidal ideation -- 17.1% in past month. The project will use three (3) evidence-based practices, including: Cognitive Behavioral Therapy (CBT); Interpersonal Psycho-therapy (IPT); and Eye Movement Desensitization and Reprocessing (EMDR). The project will also use culturally appropriate activities, including: sweat and healing lodges; smudging; teaching traditional ways; singing, dancing, and drumming; storytelling; traditional crafts; and traditional games. The goals of the project are to increase the number of educators, health care providers, emergency services personnel, and government agency personnel working with tribal youth in Tulare County who are aware of, and can identify the risk factors associated with, Native American youth suicides and provide early interventions and/or referrals as needed, as well as to increase the number of Native American who are provided with evidence-based suicide prevention, assessment, and early intervention services. At the conclusion of the five-year project period, at least 35% of educational and medical associations active in Tulare County will have incorporated suicide prevention screenings and training into their regular personnel training and patient assessments. Further, at the conclusion of the five-year project period, at least 250 youth will have completed treatment with at least 75% reporting positive long-term effects of the treatment and at least 75% of at-risk youth referred to the TYSP Project following an inpatient stay due to mental health issues will report their experience through the project as productive with a decrease in feelings of depression and ideas of self-harm.

The Cherokee Nation HERO Project aims to serve American Indian youth ages 0-23 residing within the Cherokee Nation reservation by creation of Project Sunale: Working together to build a better tomorrow. Project goals include expanding and building upon work and efforts of previous funding to improve capacity, effectiveness and efficiency of suicide prevention services for American Indian youth in Oklahoma and by providing evidenced based interventions/practices to treat suicide by working to decrease prevalence and suicidal behaviors in Cherokee Nation. Evidence based practices including community, school-wide, and individual interventions to address higher than average suicide rates among Native youth in Oklahoma will be implemented. Measurable objectives include community level evidence based practices such as creation of a social marketing plan and training project staff in Youth Mental Health First Aid to be disseminated across the Cherokee Nation reservation. Furthermore, the project will implement two school-wide interventions: Olweus Bullying Prevention Program and Lifelines Suicide Prevention Program. Olweus Bullying Prevention Program will be implemented in 3 K-8th grade schools, and Lifelines Suicide Prevention Program will be implemented in 3 high schools. Screening Brief Intervention and Referral to Treatment (SBIRT) will be implemented in identified school systems receiving a school-wide intervention. Clinical staff will be trained in Dialectical Behavioral Therapy (DBT) to address suicidality in clients. It is projected the program will serve 960 individuals the first year, increasing by 120 each year, totaling 6,000 unduplicated individuals served over the lifetime of the grant.

Target Population: American Indian youth, ages 10-24, who reside on the Flathead Indian Reservation in Montana. Strategies/Interventions: After school programming will be conducted in one of the most remote locations. With partners, they will identify a quarterly theme for the survivor activity, as a way for them to connect, heal, and be part of the prevention movement. Programming that supports interactions with elders and inclusion of cultural elements will be set up each year. Promote ongoing engagement; provide support groups and therapy to youth impacted by suicide. Support tribal/nontribal agencies in development of intervention and prevention activities. Goals: Decrease the occurrence of suicide on the Flathead Reservation by implementing evidence based trainings and providing information to expand community capacity for responding and referring at-risk youth; Raise tribal youth resiliency on the Flathead Reservation by offering culturally informed, evidence based activities that connect them to peers, elders, and the community; increase capacity on the Flathead Reservation for responding to youth at-risk for direct suicide with improved collaboration, system changes, and better use of technology and evidence based screenings; improve the emotional well-being of Flathead Reservation tribal youth with direct services by Mental Health Specialists and Case managers; cultivate better health outcomes for families and friends who have experienced a loss by delivering a battery of post suicide interventions. Numbers served annually/throughout the project: 27,235 Yr 1 3,845, Yr 2 4,750 Yr 3 6,210 Yr 4 6m,230 Yr 5 6,300.

The Tribal Health Services Department submits this proposal for implementation of a Tribal Youth Suicide Network-TYSN utilizing EB and a zero suicide approach as guides. Native American reservations nationally present with the highest level of trauma, loss with limited resources. Goal: Develop a tribal-wide zero suicide like approach utilizing seven core elements; Lead, Train, Identify, Engage, Treat, Transition and Improve to adapt the current tribal suicide care approach into a comprehensive care network designed to raise awareness of suicide factors, provide early intervention, trainings on enhanced referral processes, treatment, follow up crisis, post suicidal emergencies to improve care and outcomes for youth at risk for suicide. Objective 1 By the end of five year cooperative agreement TYSN will screen over 1,500 youth (ages 10 to 24) provided assessment, early intervention, referral EB treatment and follow up on crisis post suicidal supports to over 400 tribal youth individuals. Objective 2 TYSN will provide Suicide prevention enhancement skills training to up to 50 professional, para-professional staff annually (250 total) and up to 300 community members, parents annually (1500) key factors, awareness and resources for suicidal tribal youth. TYSN will provide services to schools, substance use, mental health foster care and group home agencies. The Sewa U'usim Community Partnership will be the lead agency, with over twelve years' experience as a tribal Medicaid provider and a SAMHSA System of Care grantee. The tribal partnership; Centered Spirit Mental Health, Community Nursing, Child Protective Services, Foster Care, YK Boys Group Home and the Health Services Division will coordinate services to implement the new cultural Tribal Suicide Network into a Tribal Network of Care. Sewa U'usim (SU) as a cultural community based behavioral health provider and program of the Tribal Health Services Division will directly work towards the implementation of the enhanced, coordinated approach to serve, treat and refer suicidal, GLBT/Bullied youth for health, behavioral health needs. Together TYSN will develop a an enhanced network for the Tribe located 50 miles from the Mexican Border a tribe with a mean age of 19.5 and heighten levels of historical trauma, risk factors for tribal youth and families on the New Pascua Reservation. TYSN will use the cultural, Honoring the Children, Mending the Circle EB model for treatment enhancement and the Wraparound in Indian Country model to engage families. The TYSP will also use social media, live youth presentation, web based training options to enhance outreach. TA support will help TYSN staff select screening and assessment interventions and components for new protocols for tribal services. TYSN will enhance our current efforts through our Native Connections program using Ben's Bells, Be Kind community awareness campaign and tribal advisory committee to build a network of sustainable consistent treatment program. The TYSN also uses expressive therapies through third party funds to providing; equine, wellness, relaxation and meditation services and an array of services with an aftercare array of cultural, substance use, violence prevention services.

MS GLS19 is a collaboration between the MS Department of Mental Health, Mississippi State University and Region 8 Mental Health aimed at reducing youth suicides by providing: a) expanded suicide awareness and gatekeeper training for families, schools, communities and youth-serving organizations statewide; b) improved identification and clinical services for at-risk youth; and c) the development of statewide rapid response postvention services. The project will: 1) increase the number of youth-serving organizations who are able to identify and refer youth at risk of suicide by providing gatekeeper training to at least 5,000 educators, childcare professionals, community care providers, and individuals in foster care and juvenile justice agencies annually; 2) increase the capacity of clinical service providers to assess, manage, and treat youth at risk of suicide by referring at-risk youth for mental health care services within 24 hours of suicide screening completion; 3) improve the continuity of care and follow-up of youth identified to be at risk for suicide, including those who have been discharged from emergency department and inpatient psychiatric units by providing statewide postvention training to at least 1,000 family members, friends, educational institutions, juvenile justice systems, substance use disorder programs, mental health programs, foster care systems, and other child and youth support organizations annually; and 4) provide postvention support services for families statewide within 24 hours of notice of suicide death or attempt. This project will build upon and integrate initiatives developed by DMH and MSU under previous Garrett Lee Smith grant-funded projects, Shatter the Silence awareness and prevention campaign (DMH), and The Alliance Project gatekeeper training (MSU). The project will serve an estimated 6,000 people annually (30,000 over five years) with suicide awareness and prevention, gatekeeper and postvention trainings to families, schools, communities and youth-serving organizations. Region 8 Mental Health expects to provide continued mental health services a total of 2,130 students over five years within its five-county catchment area through employment of school-based therapists who will conduct suicide and mental health screenings and make appropriate referrals to treatment services. An estimated 32,130 Mississippians will be served in some capacity through the grant activities over the course of five years.

The purpose of Nebraska’s proposed project is to reduce the number of suicides and attempts for youth ages 10-24 with a focus on outreach to15-24 year olds because their suicide rate is increasing in Nebraska, exceeding the US rate. Prevention activities are concentrated in southeast Nebraska because the youth suicide rate for this area is over the state and US rate. We reach the entire state by including suicide prevention in coordinated school health plans for K-12 schools and workforce development for clinicians serving youth in crisis. Nebraska will promote the zero suicide approach for health and behavioral health organizations along with evidence based strategies and practices to prevent youth suicide. The project has four goals. 1) Decrease the youth suicide rate 80% in Region 5 by 2024. 2) 100% of Nebraska public school districts will have policies and protocols in place for suicide prevention, post-suicide intervention, and transition back to school after a suicide crisis by 2024. 3) Twenty (20) Nebraska providers or healthcare systems will implement the zero suicide approach by 2024. 4) 100% of Nebraska’s child serving systems will adopt evidence-based practices to follow-up with youth after a suicide attempt or hospitalization by 2024. During the course of the grant we will reach 70,000 15to 24-year-olds in Region 5, and embed suicide prevention practices in 244 school districts reaching 187,000 public school students in grades 5-12 statewide. We will train at least 200 clinicians by introducing 30 organizations to the zero-suicide initiative, embed suicide screening with school psychologist services in 17 educational service units and 12 treatment organizations, We will implement evidence based follow-up after youth experience a suicide crisis in five child serving systems and two healthcare systems, and implement evidence based post-suicide intervention practices on five post-secondary campuses impacting lives of 40,000 college age students.

Youth suicide risk among American Indian/Alaska Native (AI/AN) populations has increased since 2003 and remains highly concentrated among AI/AN youth. The proposed program, the Mississippi Choctaw Youth Resilience Initiative (CYRI-MS), will augment and extend previous suicide prevention efforts implemented by the Mississippi Band of Choctaw Indians (MBCI). The MBCI is a self-governing vibrant Native American tribe of 11,000, but has historically faced the compounded disadvantages of cultural marginalization in one of the nation's most impoverished, racially segregated states. Many tribal members live in rural areas of Mississippi beset by significant health disparities and other challenges that accompany residing in rural underserved areas. Current data indicate that young MBCI are especially at risk of suicide. CYRI-MS will (1) increase the number of youth-serving organizations able to identify and work with youth at risk of suicide; (2) increase the capacity of clinical service providers to assess, manage, and treat youth at risk of suicide; and (3) improve the continuity of care and follow-up of youth identified to be at risk for suicide, including those discharged from emergency department and inpatient psychiatric units. The key population of focus will be MBCI citizens 10-24 years old, with the goal of2500 youth served (500 per year of project implementation). Fidelity and impact will be determined through a rigorous evaluation predicated on continuous quality improvement. Strict adherence to cultural competence standards will ensure that all services are delivered in an appropriate manner, and efforts will focus on generating a series of improvements that will provide sustainable gains in the face of this significant problem. The following nine activities are required as part of the project and will be delivered after the brief four-month preparation period: (1) Provide early intervention and assessment services for MBCI youth; (2) provide timely mental health care referrals and follow-up for MBCI youth at risk; (3) collect and analyze data on tribal youth suicide, intervention, and prevention strategies; (4) provide post-suicide intervention services, care, and information; (5) ensure that educators, childcare workers, etc. are trained in suicide risk identification; (6) ensure that child-serving professionals are trained in early intervention and prevention; (7) use SAMHSA resources including ATTCs to deliver prevention-related training and technology; (8) ensure that informed consent is obtained from parents/guardians prior to intervention; and (9) secure input from individuals with lived experience, including survivors, in all efforts. A combination of evidence­ based programs and practices (EBPs) will be used, with cultural adaptations undertaken as directed by tribal leaders: (1) QPR, (2) ASIST and AIM-SP, (3) Hazelden Lifelines, (4) EIRF, and (5) other infrastructure enhancements (e.g., policy, data, evaluation), including the design and administration of a Choctaw Youth Risk & Resilience Surveillance Survey (CYRuS). This project will improve the MBCI tribal prevention infrastructure while expanding AI/AN EBPs.

The Two Feathers Native American Family Services of Northwest California, Chekws: Hope for Tomorrow (C-HFT) Project, serves American Indian (AI) youth ages 10-18 and their families in Humboldt County. The system-wide goal for C-HFT is to build an effective, collaborative and sustainable AI-focused mental health and substance use program within two school districts to prevent suicide and improve overall well-being for AI youth and their families. The C-HFT system will operate in partnership with Klamath Trinity Joint Unified School District (KTJUSD) and Northern Humboldt School District (NH), including 24 schools and over 1,200 AI students. C-HFT will also work closely with Humboldt County Department of Mental Health and Stanford Psychiatry, Stanford Center for Youth Mental Health and Well-Being to offer trainings on suicide assessment, prevention, and intervention, as well as telemedicine psychiatric services for acute cases in the schools. C-HFT will utilize evidence-based practice (EBP) interventions and treatment approaches, as well as locally defined, culturally infused practice based programs to increase the safety net of suicide prevention and interventions for AI's living in Humboldt County. The C-HFT plans to serve 1000 youth through the following goals and objectives: Goal 1: Increase the number of culturally competent professionals able to identify and work with youth at risk for suicide. Two Feathers staff in collaboration with Humboldt County Department of Health and Human Services will provide culturally appropriate Mental Health First Aid Training to 80% of school personnel in both school districts. Goal 2: Improve prevention and early intervention for AI youth in the schools. Conduct screening with 200 AI youth annually, 1000 over the course of the 5-year project. Refer 20 parents of at risk youth per year to parent support groups. Refer 30 youth per year to local cultural groups, and 15 youth per school district annually to a trauma informed skills development group. Goal 3: Increase the engagement of youth and their families with accessible, culturally appropriate clinical service providers who can assess, manage and treat AI youth at risk for suicide. Conduct assessments with youth identified as needing a higher level of care based on screening outcomes or referrals form outside providers. Provide intensive therapeutic services to 75 youth per year. Goal 4: Increase culturally appropriate, post-suicide services for AI youth and their families. Provide direct crisis stabilization for all AI youth in the C-HFT school districts who have attempted suicide and their families through ""Family Intervention for Suicide Prevention"" services.

Connecting With Our Youth (CWOY) is a values-based initiative to reduce the rate of suicide for American Indian youth in the Paha Sapa (sacred lands of the Black Hills) catchment area. CWOY is informed by Lakota culture values of caring and compassion for all (Waú?šila) and youth are sacred (Wak?á?yeža) to strengthen connections between American Indian youth and their culture. Lakota values will be used by CWOY to develop culturally-adapted evidence-based prevention and intervention strategies designed to increase social connectedness, reduce death by suicide and suicide attempt rates, and expand knowledge of how to support American Indian youth, families and relatives. CWOY objectives include (1) deploying patient navigators entrusted to work with key stakeholders to provide early intervention and long-term support; (2) sharing the CWOY prevention curriculum with American Indian youth and their relatives, behavioral health practitioners, police officers, corrections staff, and substance abuse counselors;(3) delivering a Lakota-based mobile suicide prevention and intervention smartphone application targeted to support American Indian youth who are not active in schools, who might be waiting for follow-up care without a patient navigator, or who are not sure what to do and are looking for a private and confidential path to support and connections. The mobile app is designed to provide support and conservation of resources through peer "connectors", who hold the potential for further disseminate knowledge of how to respond productively to suicidal ideations throughout the community. Housed in the Great Plains Tribal Chairmen's Health Board in Rapid City, South Dakota, CWOY will serve American Indian youth in an eight-county catchment area characterized by high suicide rates, high proportion of American Indian population and strong cultural attachment to Paha Sapa in a collaborative effort to strengthen connections among American Indian youth and their culture, families, peers, counselors, doctors, and community members dedicated to their wellbeing.

To respond to high rates of youth suicide for its members, the Rosebud Sioux Tribe proposes a comprehensive suicide prevention program across the Rosebud Indian Reservation in South Dakota. By creating a broad coalition of youth-serving organizations, the program will employ a series of evidence-based strategies to address youth risk factors for suicide. Ongoing monitoring and assessment of programs, together with an emphasis on culturally-tailored forms of risk reduction and healing, will allow the tribe to become a best-practice example of tribal suicide prevention. Over the course of the five-year program, capacity will be developed for local youth-serving and behavioral health organizations, with the five-year period culminating in the establishment of a sustainability plan for ongoing robust efforts in the prevention of youth suicide. Objectives also will include the strengthening of three existing programs: a tribally-run suicide hotline; a smaller tribal suicide prevention program; and a school peer mentorship program designed to address risk factors for youth suicide. The program will emphasize clinical care, implementing a behavioral health aide and behavioral health specialist programs. Children who screen positive for risk factors for suicide, including substance use disorders and mood disorders, will be referred to appropriate services including these community-based behavioral health professionals as well as clinical care delivered by Rosebud Sioux Tribe health programs or the Indian Health Service Behavioral Health Department. The program will institute trainings for clinical and non-clinical youth-serving professionals in the community. Traditional healers will be contracted to join program staff in providing postvention and family support. An emphasis will be placed on vulnerable subgroups including individuals detained in correctional facilities and returning veterans. Staff affiliated with institutions of higher learning, including the tribally-affiliated Sinte Gleska University and Massachusetts General Hospital / Harvard Medical School, will provide support to the program.

Cross-Sector Coordination to Ensure Life (XSCEL) aims to decrease the rate of suicide attempts and completions among 10-24 year olds in New Mexico through a continuum of local and statewide strategies. These strategies will coordinate and align multiple intervention levels across sectors including schools, communities, and healthcare settings. This project is urgent because New Mexico’s suicide rate rose to 32.3 per 100,000 for 15-24 year olds in 2017 after already being about double the national rate for the past decade. Geographically-focused strategies will be implemented in five counties with higher rates of suicide and/or risk factors compared to the rest of the state. One focus county is urban and the rest are predominantly rural; three have a high percentage of American Indian/Alaska Native populations and four have a high concentration of military members. XSCEL’s partner organizations have experience reaching and serving Native and military populations with accessible and culturally-appropriate strategies. XSCEL’s primary goals and objectives are: Goal #1: Improve coordination and alignment of suicide prevention and treatment activities across sectors at the local and statewide levels. Objectives: Engagement of individuals with lived experience; alliance-building activities; statewide suicide prevention coalition; changes in systems, policies, and practices. Goal #2: Improve multi-level suicide prevention practices in schools. Objectives: Gatekeeper train-the-trainer; screening, referral, and follow-up by School-Based Health Centers and school nurses/counselors; school safety plans. Goal #3: Improve multi-level suicide prevention practices in communities. Objectives: Gatekeeper training with community members; media campaign; non-clinical support by Navigators for referral completion; non-clinical EBP training for suicide prevention. Goal #4: Improve multi-level suicide prevention practices in healthcare settings. Objectives: Postvention services; screening and referrals in emergency departments; clinical EBP training for suicide prevention. When all project strategies are being implemented, XSCEL will serve the following number of people annually: Gatekeeper training (560); school crisis prevention and intervention training (130); screening (10,100); referrals for those with suicide risk (2,550); Navigator services (250); behavioral health services (917). Some strategies will not be implemented all five years because they require development work, and some of the annual numbers will include some of same individuals in multiple years. Therefore, over the course of the project, we expect to serve: Gatekeeper training (2,800); school crisis prevention and intervention training (650); screening (22,000); referrals for those with suicide risk (6,000); Navigator services (1,000); behavioral health services (2,000). Thus, XSCEL will have a broad enough reach and intensity of services that we expect to positively impact rates of suicide attempts and completions in the focus communities and impact systems, policies, and practices for suicide prevention throughout the state.

The White Mountain Apache (WMAT), Navajo Nation, and Johns Hopkins (JHU) are uniquely poised to respond to Grant SM-19-006. WMAT-JHU have contributed Native American data on current evidence-based interventions, adaptions of EBIs, and new culturally grounded upstream approaches to the suicide prevention field. The current proposal, Celebrating Life, will bring back this multi-tiered prevention strategy for youth and expand it to the Shiprock area of Navajo. The proposed initiative will support community-wide education to promote protective factors and reduce risks led by local Elders and community leaders; early identification and referral of high-risk youth; and infrastructure and training for similar efforts in the Navajo Nation (Shiprock site), including an intervention with youth who attempt suicide and their families.

Wabanaki Health and Wellness (WHW), in partnership with Wabanaki Public Health (WPH) recognizes that there is an ongoing need to increase infrastructure support and capacity to adequately serve Native American youth from the five tribal communities in Maine (Aroostook Band of Micmac; Houlton Band of Maliseet Indians; Passamaquoddy – Pleasant Point; Passamaquoddy – Indian Township; and Penobscot Nation, are known as the Wabanaki, the People of the First Light). Additionally, it is necessary to improve the system of care for behavioral health treatment, suicide prevention, and recovery for community members. Equally important, is the level of ongoing supports and services offered to parents, guardian’s, and caregivers; many of whom lead single-parent households, living in rural areas who need assistance with the complexities of raising a family. WHW and WPH seeks funding to improve and increase suicide prevention programming with the ultimate goal of decreasing youth suicide attempts and completions. To do this, we are proposing a project that will substantially increase the capacity of the behavioral health system, improve the suicide data surveillance system, and improve and enhance the system of behavioral health care. This will be accomplished by (1) leveraging and expanding youth prevention strategies using evidence-based strategies to increase community engagement, (2) expanding current case management and peer programs (3) increase connections between Tribal providers (i.e. health clinic, juvenile justice, foster care, etc.) for screening and referral to services providing opportunities for early identification and intervention (4) conducting community, parent, and provider trainings to raise awareness and support, (5) building crisis intervention teams to provide support for attempted and completed suicides, (6) collaborating with a higher education partner, University of Nebraska Medical School to develop a youth mental health and suicide surveillance system, and (7) ensuring all activities are grounded in culture.

Suicide prevention and early intervention is essential to support the safety and well-being of Maine young people during adolescence and into adulthood. The Maine Center for Disease Control and Prevention (MCDC) proposes to implement Project STAY (Support, Treatment, and Access for Youth) to support prevention, universal and indicated screening, evidence-based treatment, and coordination of care for youth at risk of suicide. To achieve these outcomes, MCDC will implement the following goals and objectives: Goal 1: Increase the number of schools and youth-serving organizations implementing evidence-based early intervention and suicide prevention policies and practices to identify and respond to youth with unmet mental health needs. Goal 2: Increase care management, access to mental health services, and follow-up for youth at high risk of suicide or suicide attempts. Goal 3: Increase the number of educators, care providers, and youth-serving professionals trained in evidence-based practices for screening, assessment, treatment, and follow-up of young people at risk of suicide. Goal 4: Increase help-seeking and improve youth access to care by promoting innovative outreach strategies, including crisis text services and peer-to-peer interventions. The Maine Center for Disease Control and Prevention has a long history of engaging with community partners to provide innovative suicide prevention interventions across many sectors. We believe that Project STAY will have a positive impact on the well-being of our communities by reducing Maine's rate of suicide deaths and suicide attempts.

TYSP-Mi3 will impact rates of youth/young adult suicide by establishing suicide prevention as a core priority in Michigan Child Welfare (CW) system and a growing network of Emergency Departments (EDs) TYSP-Mi3 will increase numbers of gatekeepers and clinical service providers trained in evidence-based prevention strategies and support communities in strengthening local efforts. TYSP-Mi3 capitalizes on a strong track record of public health and academic expertise and unique statewide partnerships. Building on the base established with current GLS State/Tribal Youth Suicide Prevention funding, TYSP-Mi3 program goals are: Goal 1--Build a statewide network of EDs that consider suicide prevention a core priority and consequently implement evidence-based assessment, intervention, continuity of care, and follow-up strategies for youth at risk for suicide and their families. Goal 2--Partner with Michigan's CW agency to advance and sustain suicide prevention training, screening, and referral practices, with a focus on the state's foster care system. Goal 3--Strategically embed a cadre of trained gatekeepers and clinical service providers within Michigan's youth serving workforce who consistently use evidence-based practices. Goal 4--Support local communities to implement suicide prevention best practices tailored to community needs via technical assistance, training, and educational and funding opportunities. Goal 5--Enhance the availability of resources and training for postvention services in the state. Populations of focus include 1) youth ages 10-24 seeking emergency services and 2) CW-involved youth. The University of Michigan's Psychiatric Emergency Service (PES) will serve as a Technical Assistance Center to support dissemination and implementation of suicide assessment, brief intervention , and continuity of care strategies to at least eight general medical EDs across the state. The program's current CW collaboration will continue, focusing on 1) training, policy, protocol, and referral network development to support the CW workforce as suicide prevention gatekeepers, as well as 2) expanding screening of youth entering foster care, with a goal of moving screening statewide. Via school, CMH, and community partnerships, youth serving professionals will participate in safeTALK, ASIST, and AMSR to strengthen the network of persons able and willing to help a youth/young adult in crisis. A new Postvention Work Group will be established to improve care for loss survivors. Government and non-governmental work groups will continue to advise the program and each other to enhance communication and strategic planning to ensure a ""Suicide-Safe Michigan.""

MCNDH wishes to continue to utilize funding provided through GLS to build on previous success and to create a network throughout the entire health system to identify potential suicidal patients, to treat patients who have attempted suicide, and to continue successful community outreach and education events to build resilient and mindful communities. MCNDH will successfully create a comprehensive network within our by implementing electronic patient assessments in outpatient and inpatient facilities, expanding clinical support specific for at risk patients, and creating care coordination for discharged patients.

Billings Urban Indian Health and Wellness Center (BUIHWC) under the nonprofit status of Native American Development Corporation (NADC) will be submitting a SAMHSA Garrett Lee Smith State/Tribal Youth Suicide Prevention & Early Intervention Grant application. The purpose of this project will be to implement youth suicide prevention and early intervention strategies. The purpose of this project, submitted by the Native American Development Corporation (NADC) and the Billings Urban Indian Health and Wellness Center (BUIHWC) is to achieve measurable reductions in suicides among American Indian (AI) youth, ages 10-24 years of age, through implementation of the Zero Suicide model and culturally appropriate programming in five Montana (MT) cities served by Urban Indian Health Centers (UIHC). BUIHCW will lead and launch the project, Standing Buffalo Strong, in Billings, MT, which has the largest AI total and youth population. Billings is the largest community in MT—located nearby the Crow and Northern Cheyenne Reservations—has three major health care providers, a Veterans Administration clinic and is the largest medical/health community in the state. It is also a regional commercial center, attracting large numbers of AI families and children seeking diverse services. The following chart provides population data for Billings and the 4 other communities served by UIHC. Major Goal: To implement a culturally appropriate suicide prevention care model at the 5 Montana Urban Indian Health Centers (MUIHC) to ensure all AI youth, ages 10-24 years and their families receive immediate, safe and personalized suicidal care. To accomplish this, NADC/BUIHWC will lead and implement the Zero Suicide model and culturally appropriate treatment/services to achieve (or facilitate) a cultural shift away from fragmented suicide prevention and care toward a comprehensive approach. Working with the other 4 UIHC, along with developing a network and commitment from health care providers, community organizations and educational institutions in Billings, Helena, Missoula, Great Falls and Butte. With these partners, BIUHWC will be able to introduce AI youth suicide prevention efforts that include traditional and cultural treatments/services. This was identified by the MNYSRSP as a gap in suicide treatment. BUIHWC, as it takes on the leadership role in working on the youth, i.e. 10-24 year population, will coordinate with both the State of Montana, DPHHS Zero Suicide grant/program funded by SAMHSA (targeting AI over 25 years) and the ongoing MNYSRSP efforts. BUIHWC work will be complimentary, focusing on off-reservation youth and their families.

Native Americans for Community Action’s Reach UR Life Program, located in Flagstaff, Arizona will provide suicide prevention and intervention services to American Indian youth in Flagstaff, and reservation-based youth located within Coconino and Navajo Counties. Growing on the on the foundation that has been created, NACA will continue partnerships with schools and youth-serving agencies to grow suicide prevention activities through early identification, screening, referral and treatment services for at-risk youth. NACA will expand programming to include additional schools and youth-serving agencies every year. Additionally, NACA will continue and grow partnerships of direct care agencies for the development of a Zero Suicide framework. NACA will also grow programming by adding an emphasis of post-suicide intervention services. This project proposes to serve 1,332 unique individuals on average per year, and 5,660 over the life of the grant. The following goals will be achieved during this project; Goal 1: Provide comprehensive evidence-based identification and screening programming integrated in schools and other youth-serving organizations. Goal 2: Develop a referral to service pathway through the use of telemedicine and in collaboration with reservation-based treatment providers as appropriate. Goal 3: Provide layered training for child-serving professionals and treatment providers as appropriate based on their community role. Training will include Trauma Informed Care, safeTALK, ASIST, Motivational Interviewing, Cognitive Therapy for Suicide Prevention, and Bereavement training. Layered training efforts will be conducted on a continual basis to address the issue of personnel turnover common to this profession. Goal 4: Build upon Zero Suicide efforts at NACA and through the distribution of mini-grants to Flagstaff’s two main healthcare facilities and one of its major community-based social service agencies, in an effort to prevent suicides through early identification, screening, referral, appropriate treatment and follow up services. Goal 5: Ensure that follow up and services are provided for individuals and families who have lost someone due to suicide as identified through Flagstaff Medical Center, NACA Behavioral Health, or any other participating entity. Utilize those with lived experience as a resource in the development of these policies and procedures.

New Yorkers Advancing Suicide Safer Care for Youth (NYASSC for Youth) The New Yorkers Advancing Suicide Safer Care (NYASSC) for Youth project will reduce suicide attempts and deaths among youth ages 10-24 through clinical provision of suicide safer care in multiple service settings and school- and community-based suicide prevention activities in Onondaga County and statewide. The project will provide clinical services to 34,575 youth: 5,459 in Year 1 and 7,279 each in Years 2-5. The project will also provide QPR training to 150,000 college students, 5,000 faculty and staff, 500 campus police, and 500 staff in juvenile justice, foster care, and out-of-school-time programs; these programs will identify key staff for ASIST training. College and university activities will be implemented statewide across the State University of New York (SUNY) 64-campus system. The project plans a clinical systems and community demonstration project in Onondaga County for statewide dissemination in Years 4 and 5. This demonstration project will expand an existing Zero Suicide Safety Net for adults to cover youth ages 10-24 and will incorporate non-clinical stakeholders including schools, colleges and universities, juvenile justice, foster care, an LGBT youth organization (Q Center), and the Boys and Girls Club. The Office of Mental Health will partner with the Center for Practice Innovations at Columbia University to advance implementation of Zero Suicide across the state, including screening and assessing for suicide risk, developing a prevention-oriented risk formulation and a suicide care management plan, providing suicide specific evidence-based treatment and brief interventions, and implementing protocols for transition of care and follow up when youth move to a different level of care. The four goals of the project are to 1) develop, test, and disseminate a model of suicide safer care for youth, 2) provide prevention, intervention, and treatment for school-age youth during school and out-of-school time, 3) create suicide safer college campuses through gatekeeper training, outreach, and collaboration, and 4) evaluate the project’s impact on changes in suicide risk identification, clinical service delivery, and lethal and non-lethal suicide attempts. With input and guidance from individuals with lived experience and members of the NYS Suicide Prevention Council, project goals will be accomplished through the following objectives: engaging health systems leadership; conducting learning collaboratives; training providers; developing and implementing site-specific protocols; providing gatekeeper training to schools, colleges, and community-based youth serving organizations and systems; promoting NYS Crisis Text; providing postvention support; creating a robust suicide surveillance infrastructure; and conducting an outcome evaluation to assess impact of the project on suicide attempts and deaths. In Year 4, the NYS Suicide Prevention Conference will highlight the rollout of the model tested during this project in Onondaga County, and the state’s suicide prevention website will be used to disseminate materials and best practices across the state.

Housed at the Northwest Portland Area Indian Health Board, the THRIVE project (Tribal Health: Reaching out InVolves Everyone) has worked with the NW tribes to prevent suicide since 2009. The NPAIHB is a tribal non-profit organization that represents 43 Federally-recognized American Indian tribes in Washington, Oregon, and Idaho. In collaboration with the NW Tribes, tribal clinics, and regional partners, THRIVE will build regional suicide prevention capacity and prevent suicide among American Indian and Alaska Native youth 10-24 years old. Our approach builds upon a strong tribal network and acquired expertise in culturally-relevant intervention strategies and expands the most effective activities carried out by THRIVE during our prior GLS grant (cohort 9). Our goals are to: Goal 1. Improve protective mental health knowledge, attitudes, coping skills, and help-seeking behaviors among AI/AN youth (10-24 years old) nationwide, by delivering evidence-based suicide prevention interventions. Goal 2. Promote mental health and the social acceptability of mental health services for AI/AN youth and their families. Goal 3. Enhance organizational practices in NW tribal clinics, tribal health departments, and tribal colleges to improve suicide prevention, screening, referral, treatment, and post-suicide services for AI/AN youth (10-24 years old) and their families. Goal 4. Improve and expand the delivery of suicide prevention and early intervention strategies in tribal settings, including: tribal clinics, tribal and public schools, tribal colleges, juvenile justice systems, substance use programs, health departments, foster care systems, and other community settings by focusing on youth and returning veterans. Over 353,000 AI/ANs reside in Idaho, Oregon, and Washington, representing 6.8% of the nation's AI/AN population. Over five years, our project activities will reach: 325 AI/AN youth during THRIVE’s youth conferences; 1,000 AI/AN young adults with mental health skill-building tools delivered via text message and social media; 300 AI/AN youth with caring messages; 120 AI/AN veterans with caring messages; 800,000 viewers with suicide prevention social marketing campaigns (#WeNeedYouHere); 200 AI/AN youth (10-24) with other culturally-appropriate EBIs; 5,000 AI/AN youth (10-24) with screening, assessment, treatment, and case management; and 3,500 youth-serving adults with gatekeeper training. Additionally, our monthly eNewsletters will be sent to 2,000+ contacts throughout the U.S, and our suicide prevention social media messages (delivered via We R Native) will reach 31,000 AI/AN viewers per week across the U.S. Our tribes, clinics, and partners are deeply committed to completing this scope of work, fulfilling elements of the Tribal Behavioral Health Agenda using socio-cultural-ecological approaches to improve adolescent mental health in the Pacific Northwest.

PA Resource for Continuity of Care in Youth-Serving Systems and Transitions (PRCCYSST – “PERSIST”) will implement a two-tiered approach that includes 1) sustaining and expanding prior statewide youth suicide prevention efforts in schools, colleges, and primary care (Tier 1); and 2) enhancing continuity of care in five regions through training and screening within behavioral health systems to improve care transitions for high-risk youth (Tier 2). Among the more than 2.4 million youth in Pennsylvania between ages 10-24, 51% are male and 49% are female. For youth between 10-19, 69.9% are White (non-Hispanic), 12.7% are Black or African-American (non-Hispanic), and 10.4% are Hispanic or Latino. Statewide data from the Pennsylvania Youth Survey (2017) indicates that 16.5% of PA middle and high school students reported seriously considering suicide and 9.7% reported attempting suicide one or more times within the past 12 months. The five regions that will be targeted for Tier 2 efforts through this project represent 22% of PA counties, yet they account for 55% of suicides in youth ages 10-14, 46% of suicides in youth ages 15-19, and 40% of suicides in youth ages 20-24. Nearly half of the identified counties have higher percentages of non-white and Latino populations than the state, overall. The project has four primary goals, with associated objectives and key implementation strategies. Goal 1 is to promote early identification and referral of youth at risk of suicide in schools, colleges, and primary care (Tiers 1 and 2). PRCCYSST will sustain past prevention efforts and increase the number of professionals exposed to evidence-based training and screening. Goal 2 is to increase capacity among behavioral health providers to screen, assess, manage, and treat youth at risk of suicide (Tiers 1 and 2). PRCCYSST will increase the number of providers trained in evidence-based suicide risk management and family-centered engagement and treatment practices. Goal 3 underscores a targeted approach to expand partnerships to support care transitions, reentry, and follow-up for youth admitted and discharged from hospitals and treatment centers (Tier 2). PRCCYSST will engage existing stakeholder groups in 5 regions (15 counties) to improve communication between county crisis response teams and other youth-serving systems in order to facilitate care transitions. Goal 4 aims to develop a comprehensive and sustainable statewide model for continuity of care based on lessons learned from targeted county-level efforts. PRCCYSST will engage broad stakeholder groups, including several statewide organizations with youth and family members with lived experience to develop a continuity of care toolkit that can be implemented statewide. Based on our success in our last grant and estimates based on future projects, we expect to expose 220,881 individuals to prevention messages, 19,423 to obtain gatekeeper and clinical training, and 15,474 youths to screening. Thus, we anticipate serving approximately 255,778 individuals throughout the course of this project.

The Oregon Garrett Lee Smith Youth Suicide Intervention and Prevention Initiative, managed by the Oregon Health Authority Injury and Violence Prevention Program (IVP), will focus on youth age 10-24 in at least 4 counties with youth suicide rates higher than the national average (Deschutes, Jackson, Josephine, Umatilla). The population of youth served is estimated at 206,545, which comprises 27.3% of the youth population in Oregon and accounted for 26.9% of deaths by suicide among youth from 2015-2017. Oregon’s rate of youth suicides almost doubled from 7.2/100,000 in 2010 to 14.1/100,000 in 2017 (OPHAT, 2019). In response, IVP will build on successes and lessons learned from three previous GLS grants to sustainably implement youth suicide prevention and early intervention strategies in schools, educational institutions, and a variety of child- and youth-serving organizations. Project goals are to (1) Increase capacity of counties with higher than average rates of youth suicide to implement sustainable, evidence-based youth suicide prevention strategies; (2) Increase the number of youth-serving organizations able to identify and refer youth at risk of suicide; (3) Increase capacity of clinical service providers to assess, manage, and treat youth at risk of suicide; and (4) Improve the continuity of care and follow-up of youth identified to be at risk for suicide. Objectives to be achieved by project conclusion in 2024 include the following: In support of Goal 1, IVP will subcontract with up to 10 direct service provider organizations to expand or establish local initiatives to undertake evidence-based youth suicide prevention, intervention and postvention. IVP and Lines for Life will develop new content pages for the Oregon Suicide Prevention website and track page views. A youth suicide prevention track will be incorporated into the annual statewide suicide prevention conference, and local prevention coordinators will have supported youth suicide coalitions in up to 10 counties. In support of Goal 2, 120 child welfare personnel will become suicide prevention gatekeeper trainers and provide training to 3,000 CW staff and foster parents. An additional 8,450 staff in youth serving organizations will receive training in QPR, ASIST, and safeTALK and ongoing training for students and staff will be established in selected middle and high schools. In support of Goal 3, 500 clinicians will receive training evidence-based suicide risk assessment, management and treatment; all 76 school-based health centers will implement evidence-based suicide risk assessment; and up to 16 health systems will participate in a Zero Suicide (ZS) Academy. In support of Goal 4, selected communities will develop and implement continuity of care and follow-up plans for youth identified to be at risk for suicide. Up to 32 healthcare systems will actively implement ZS and 100% of youth discharged from ED and inpatient psychiatric units identified in those systems will receive referrals to a mental health provider, safety planning (including lethal means counseling), and one or more caring contacts from the health system.

The Pueblo of San Felipe GLS Tribal Youth Suicide initiative KEYWAH III (Katishtya Embraces Youth Wellness And Hope III) will build on and expand the work of the previous GLS grant initiatives in the community. The purpose is to expand suicide prevention and early intervention strategies in schools, tribal courts, and the tribal behavioral health program, in order to: (1) increase the number of youth-serving organizations able to identify and work with youth at risk of suicide; (2) increase the capacity of clinical service providers to assess, manage, and treat youth at risk of suicide; (3) improve the continuity of care and follow-up of youth identified as at risk for suicide, including those who have been discharged from emergency department and inpatient psychiatric units; and (4) develop infrastructure to sustain & expand programming beyond grant funding. These goals will be accomplished through school-wide prevention programming, universal screening of all students accessing primary care at the School Based Health Center, referral to clinical services for those at risk of suicide, training of gatekeepers (e.g., school staff, teachers, tribal law enforcement) and other child-serving providers on Mental Health First Aid, training primary care providers on Zero Suicide, training clinicians on CBT-SP, and ongoing use of data for continuous quality improvement. The target population is San Felipe youth 10-24 years old at risk for suicide. Over the past 10 years, suicide prevention has become a core priority for the Pueblo of San Felipe, with efforts aimed at implementing the National Strategy for Suicide Prevention Goal 8 (promote suicide prevention as a core component of health care services) and Goal 9 (promote and implement effective clinical and professional practices for assessing and treating those identified as being at risk for suicidal behaviors). Although tribal leadership has consistently supported suicide prevention programming in the schools, loss of life due to suicide remains a significant challenge. A recent suicide of an 11- year-old boy enrolled at the San Felipe Elementary School, for instance, highlighted the gaps in collaboration between the Bureau of Indian Education (who runs the elementary school) and the Bureau of Indian Affairs (law enforcement). Developing greater collaboration through review of policies and procedures is critical, as is continuing to expand awareness and programming beyond behavioral health providers to other child-serving entities such as Family Services (child welfare/foster care), tribal law enforcement and the schools. KEYWAH III, in alignment and support of the National Tribe Behavioral Health Agenda (TBHA), will, therefore, continue to build and implement strategies where youth at risk for suicide are connected to protective factors and culturally-based supports in the San Felipe community. The unduplicated number of youth served annually will be 225, with 900 served over the life of the grant.