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Virginia Youth Suicide Prevention Program

CO Connecting Youth Networks of Care

Youth Suicide Prevention Program

The Wichita Tribal Youth Suicide Prevention and Surveillance Program will identify, refer, follow-up and serve American Indian youth ages 10-24 with the intent to promote protective factors and reduce the risk of suicide in the community. The Wichita and Affiliated Tribes will utilize current programs that heavily serve youth and existing relationships with service providers to accomplish the goals set forth below: Goal 1: Increase awareness and understanding of suicide while concurrently reducing stigma associated with suicide through advisory board development and public education. Goal 2: Engage the tribal community and partnering entities while developing support for the Wichita Tribal Youth Suicide Prevention and Surveillance program through coalition development, training, and outreach. Goal 3: Develop the workforce to ensure the effective assessment and treatment of youth at-risk of suicide through expert training. Goal 4: Implement community-based surveillance programming to identify at-risk youth and connect youth with Wichita Tribal Youth Suicide Prevention and Surveillance project. Goal 5: Ensure effective treatment and coordination of care through comprehensive case management and follow up services. Goal 6: Conduct surveillance and quality improvement on suicide attempts and completions.

The Sister Nations Empowerment Project (SNEP) will support the youth of the Fort Peck Assiniboine and Sioux Tribes and the agencies that serve them in their journey toward a suicide-safer community. A collaboration of the Tribes and the National Native Children's Trauma Center (NNCTC), SNEP is a reservation-wide, multi-intervention program rooted in local wisdom, cultural practices, and evidence-based practices. The project will build upon work successfully completed during SNEP's initial GLS funding period of 2011-14. The five-year grant proposed will target American Indian youth aged 10-24, including those identifying as LGBTQ or two-spirit, those with lived experience of suicide, and survivors. SNEP will be guided by four primary goals: 1) to increase the number of youth, school staff, juvenile-justice workers, elders, tribal leaders, and community members trained to identify youth at risk of suicide, refer them to clinicians, mitigate risk factors associated with youth suicide, and promote protective factors; 2) to increase the capacity of the reservation's healthcare system to provide evidence-based screening, treatment, and follow-up services for youth at risk of suicide, including those who receive treatment for substance-use and mental-health disorders; 3) to promote cross-system collaboration among the reservation's youth-serving stakeholders, ensure community input and buy-in, and enhance ongoing cross-system data collection efforts; and 4) to enhance public awareness of suicidal risk and behaviors and make suicide prevention a core priority of the reservation's youth-serving system. An estimated 1,062 community members will be served per year, for a five-year total of 5,310.

The SC Department of Mental Health (SCDMH) will implement the Young Lives Matter Project to reduce deaths by suicide and nonfatal suicide attempts among SC youth and young adults age 10-24. The project will focus on increasing access to screening and mental health services, raising awareness through social media marketing, increasing protective factors through training across community domains, supporting clinicians and educators in implementing evidence-based interventions, utilizing safety plans in emergency departments, and strengthening statewide infrastructure. The program goals for the South Carolina Garrett Lee Smith grant are as follows: 1. Strengthen statewide infrastructure that will support improved behavioral health services delivery to potentially suicidal youth and young adults, including formation of a statewide Suicide Prevention Coalition and regional youth suicide prevention task forces. 2. Raise awareness and knowledge of youth and young adults and those who care about them (e.g., teachers, parents, counselors) regarding how to get help for depression and other mental health issues that may lead to suicidal ideation and suicide attempts. 3. Educate parents, teachers, and other caring adults on the risk and resiliency factors that impact youth and young adult mental health, suicidal ideation, and attempted suicide; on how to respond when they believe youth and young adults to be suicidal; and on how to access services. 4. Increase screening of youth and young adults for suicide risk and their access to services. 5. Implement evidence-based practices and successful intervention strategies to reduce suicide attempts and deaths by suicide. 6. Develop an interagency response protocol to use in the event that a youth or young adult is determined to be at risk of suicide.

The goals of the Ohio Suicide Prevention grant are: 1) Serving gatekeepers throughout Ohio schools, medical schools, and hospitals to be empowered and equipped to identify and refer at-risk youth. 2) Substance abuse, mental health, and juvenile justice-involved personnel will be provided with capacity expansion training that will improve their confidence and ability to meet the needs of those in crisis and at risk for suicide. 3) Individuals who have attempted suicide will be provided with post-discharge services that enhance their stability and prevent future suicide attempts. 4) Comprehensively implement the 2012 National Strategy for Suicide Prevention.

Native Youth Wellness Initiative II's (NYWI II) purpose is to develop and implement a statewide suicide prevention and intervention strategy inclusive of collaboration among youth service institutions and agencies for American Indian/ Alaska Native (AIAN) youth ages 10 - 24. NYWI II's goal is to increase the protective/ risk factors and trauma informed approaches to reduce suicide, suicidal ideation, and attempts among urban American Indian/ Alaska Native youth ages 10 - 24 throughout California while addressing behavioral health disparities. NYWI II project components are as follows: 1) Provide statewide youth suicide prevention and early intervention training; 2) Provide statewide youth suicide prevention and early intervention outreach and engagement; 3) Provide behavioral health prevention and early intervention youth services; and 4) Provide culturally-competent prevention and early intervention services. NYWI II will partner with urban AIAN serving agencies through California to provide culturally competent prevention and early intervention services and implement direct intervention services at NAHC sites in Oakland, Richmond, and San Francisco utilizing a care team consisting of peer specialists and counselors at each site. NYWII will address youth suicide prevention from the lens of integrated, holistic, traditionally based prevention and treatment services. NAHC will use the Holistic System of Care for Native Americans in an Urban Environment (HSOC) with the ZERO Suicide approach; coupled with Wrap-Around Process, Honoring Children- mending the circle, GONA principles, Children's Mental Health First Aid, and Question, Persuade, Refer (QPR) Gatekeeper Training.

Key interventions and strategies of the suicide prevention program are: (1) a coordinated System of Care consisting of outreach, prevention activities, clinical treatment and recovery services/supports; (2) a Statewide Youth Suicide Prevention Training Institute; (3) a full-time Outreach Specialist with ties to hospital emergency departments, Lines for Life suicide prevention helpline, and social media; (4) Project Venture evidence-based outdoor camps; (5) Oregon's Tribal Best Practices; (6) incorporation of "connectedness" in all activities; (7) alignment with Oregon's Suicide Prevention Plan and the Suicide Prevention Plan for the Northwest Portland Area Indian Health Board; and (8) partnerships with eight Oregon Tribes, higher education, Coordinated Care Organizations, hospital emergency departments, Title VII Indian Education, Native American Youth and Family Center, Northwest Portland Area Indian Health Board, and the Chemawa Indian School. This Project is adopting the Zero Suicide approach to reduce rates of suicidal ideation, suicide attempts and suicide deaths and incorporating Goals 8 and 9 of the NSSP into its system transformation, which includes linkages with health, mental health, addictions and recovery for at-risk Native youth and their families.

The population of focus is all youth and young adults age 10-24 throughout Minnesota; while prioritizing American Indian youth and tribal communities. Having our program provide supports for the entire state, while targeting communities of increased risk, allows for the grant- funded coordinators and liaisons to address emerging issues over the course of the five year funding and beyond. The project goals are: 1) Make suicide prevention a core component of behavioral/health care services that will decrease suicide by 10% in 5 years, 20% in 10 years working towards zero deaths. 2) Implement effective programs to increase communities' capacity to identify youth at-risk and connect them to the coordinated and competent behavioral/health care system to decrease the number of medically-treated suicide attempts. 3) Support healthy and empowered individuals, families, and communities to increase protection from suicide risk. We will be working closely with schools and youth- serving organizations to prioritize building protective factors in our youth.

The Show Me Zero Youth Suicide Initiative aims to reduce youth suicide through an integrated systems-level approach, which includes establishing a continuity of care model for youth at risk of suicide and promoting the adoption of suicide prevention as a core priority of youth-serving institutions, such as hospitals and schools. Through collaboration with these organizations, this initiative will effectively identify youth ages 10-24 who are at risk for suicide and provide immediate linkage to intensive services and follow-up care. An innovative data-driven surveillance system will document whether services reduce suicidal behaviors. Services will be focused on a five-county region in western Missouri, centered on Jackson County, which includes Kansas City, as well as surrounding counties with more rural areas. The region has higher rates of youth suicide, suicidal ideation, and intentional self-injury than Missouri averages. A multi-pronged approach will promote and support sustainable systems level change while employing strategies from the 2012 National Strategy for Suicide Prevention that focus on treatment and support services. The initiative will place special emphasis on those at higher risk for suicide, including youth who have previously attempted suicide, 18-24 year old youth, and lesbian, gay, bisexual, transgender and questioning youth. The overall aim of the Show Me Zero Youth Suicide Initiative is to reduce suicides and suicide attempts by accomplishing three major goals: 1) Improve the system of care for suicidal youth who use hospital emergency departments, in-patient psychiatric facilities, and/or crisis hotlines. 2) Improve the capacity of school systems to identify, respond, and refer youth at risk of suicide. 3) Strengthen overall prevention efforts for at-risk youth populations in other settings. This initiative will provide direct services to 2,000 individuals in year one and increase annually, serving 15,000 over the grant period, with

The goals of the MA Youth Suicide Prevention Project are: (1) Create Suicide-Safe Centers of Care to enhance effective treatment and care management of youth at-risk; (2) develop Suicide-Safe Communities in which prevention and early identification are priorities and treatment and support are available; and (3) ensure suicide prevention is integrated into state systems to create a Suicide-Safe Commonwealth. The purpose of the MA Youth Suicide Prevention Project is to reduce the rate of suicide attempts and suicide completions among youth ages 10-24. Two regional hospitals will implement Zero Suicide standards of organizational and clinical practice. Training to enhance treatment skills of clinical and behavioral health providers in treating suicide risk in youth will result in more effective prevention, early intervention and follow-up care for youth and young adults. The high risk populations of focus in these two areas include: rural youth, youth with mental illness and substance abuse disorders, LGBT youth, young veterans, victimized youth and youth who have considered or attempted suicide. Activities in communities focus on strengthening capacities to provide prevention services and early identification, referral and treatment of youth at- risk for suicide through work with schools, colleges and community organizations. System change statewide will be effected by the creation of a Learning Collaborative with the Department of Mental Health and the Massachusetts Behavioral Health Partnership (the Medicaid payor for 1200 providers) for the implementation of Zero Suicide standards and by working with youth serving state agencies to integrate suicide prevention into their services and those of their providers.

Northwest Arctic Wellness Initiative (NAWI) is an intertribal Youth Suicide Prevention Cooperative Agreement between the Bering Strait Region and Northwest Arctic Borough of Alaska, with an aim to expand its tribal partnership statewide. NAWI primarily serves Alaska Native youth and young adults ages 10-24 in 27 villages located just above and below the Arctic Circle where the highest suicide Rates in Alaska and the nation have been reported. NAWI provides comprehensive, culturally relevant, training and intervention to create self-sufficient, sustainable, community-level suicide prevention, intervention and post-vention for Alaska Natives. The Goals of NAWI are to: 1. Expand NAWI to build a statewide collaborative partnership to advance, develop, and promote Alaska Native Suicide Prevention best practices. 2. Increase youth wellness activities, mentor supports, and youth leadership to build positive relationship with peers, role models and elders in their community and throughout the region to decrease Alaska Native youth suicide. 3. Increase youth and community dialogue to change the norms around suicide to something that can be prevented. 4. Provide appropriate suicide intervention response, care and recovery activities for Alaska Native young people in the Bering Straits Region (BSR) and Northwest Arctic Borough (NWAB). Through its multiple strategies, NAWI will reach approximately 3,600 individual school-aged children and 2,275 village adults annually. Over the length of the funding period, the project will reach 4,150 unduplicated youth (including those who are beyond school age.

Vision for the Future (Visions) is a joint suicide prevention project between the two tribal agencies serving the Doyon region of Alaska. The purpose of Visions is to develop and implement tribal-wide youth suicide prevention and early intervention strategies for the region. Fairbanks Native Association (FNA) is the lead agency for Visions, working closely with project partner Tanana Chiefs Conference (TCC). Alaska consistently reports one of the highest rates of suicide in the nation. Suicide is the number one cause of death in Alaskans aged 15-24 years of age. In 2010, Alaskans ages 15-24 had the highest suicide rate (461/100000) of any age group. This rate was significantly higher for Alaska Native females (50.3) and Alaska Native males (142). In 2014, in order to address this overwhelming need, FNA and TCC developed Saving our Youth and Young Adults (SAYA), a "Healthy Transitions" SAMHSA funded project that provides services for youth and young adults with mental disorders, including suicide and/or co-occurring substance abuse and mental health disorders. Visions will enhance SAYA by providing suicide prevention and early intervention services for ages 10-25 throughout this region. Visions will incorporate a Zero Suicide approach, per the 2012 National Strategy. Visions will extend the SAYA age range for suicide prevention services (ages 16-25) to include ages 10-15 for a total age range of 10-25 for this coordinated suicide prevention approach. It will also expand the reach of suicide prevention and early intervention services by extending the SAYA service area from the urban areas of Fairbanks and North Pole to the 42 mostly rural villages of the Doyon region. Visions will also add new prevention and intervention strategies/services including three new evidence-based practices to the service continuum. Together, these two SAMHSA projects will ensure a coordinated tribal-wide approach to suicide prevention and related behavioral health risks.

Through training, outreach, and implementation of evidence-based practices, the Suicide Safer Communities for Youth project will build infrastructure and increase the suicide specific continuum of care that will result in reductions in the number and rates of suicide deaths and number and rate of non-fatal suicide attempts among youth ages 10-24 in three targeted counties with suicide death rates higher than the national average. A Zero Suicide in Healthcare licensed clinical supervisor will be hired in each county to oversee development and integration of the community and clinical suicide prevention efforts. A Zero Suicide in Healthcare certified peer specialist (ZSH-CPS) in Bartow, Newton, and Oconee counties will integrate the voice of lived experience into ongoing suicide prevention efforts. Proposed evidence-based practices will include Question, Persuade, Refer Gatekeeper Training; Child and Adolescent Needs and Strengths-Mental Health; The Adult Needs and Strengths Assessment; Columbia Suicide Severity Rating Scale; Suicide Safety Plan; Collaborative Assessment and Management of Suicide; Cognitive Behavioral Therapy for Suicide Prevention; and DiDi Hirsch Youth Suicide Attempters Group. The Georgia College and University Suicide Prevention Coalition will provide 1) a yearly Suicide Prevention Conference for Colleges and Universities, 2) three additional suicide prevention training opportunities a year and 3) assessment, data collection, tracking and evaluation services for the College Coalition.

The purpose of the proposed project is to develop and implement tribal youth suicide policies and evidence-based prevention programs that enhances awareness, identification, referral and treatment strategies. Activities will focus on youth 10-24 years of age and youth- serving systems. The program has 4 identified goals. Goal 1: Strengthen our suicide community coalition Goal 2: Conduct Suicide Prevention trainings across the Yakama Reservation. Goal 3: Implement a reservation-wide EBP suicide prevention program - Sources of Strength. Goal 4: In collaboration with coalition partners increase annual screening, identification, referral and support for youth at risk for suicide.

Connecticut's Networks of Care for Suicide Prevention (NCSP) application proposes to establish a Statewide Network of Care (SNC) for suicide prevention, intervention and response, and implement an intensive community-based effort to reduce non-fatal suicide attempts and suicide deaths among at risk youth age 10-24. The SNC will be comprised of five regional, and one community network in the town of Manchester which will be the focus of an intensive community-based effort. The NCSP will embed suicide prevention as a core priority in CT and utilize interventions that are data and quality-driven, sustainable, culturally competent, formalized, uniformed, and accountable with the capacity and readiness to provide services in an organized and timely fashion. The CT Departments of Mental Health and Addiction Services, Children and Families, and Public Health, with the guidance of the CT Suicide Advisory Board (CTSAB), will co-direct the NCSP and partner with Community Health Resources; United Way of CT-National Suicide Prevention Lifeline Provider; Manchester-Public Schools, Police Department, Community College; Eastern CT Health Network; and the UConn Health Center as evaluator. The NCSP will serve an unduplicated total of 1,333 annually and 6,669 over 5-years of diverse youth and young adults age 10-24 and supportive adults representative of the CT population with emphasis on young people identified at increased risk of suicide and who have attempted suicide. NCSP goals and objectives are aligned with CT's Suicide Prevention Plan 2020 and the National Strategy for Suicide Prevention, prioritizing goals 8 and 9. The NCSP will utilize the primary EBPs of the Zero Suicide approach, Jed Foundation/Suicide Prevention Resource Center Model for Comprehensive Suicide Prevention and Mental Health Promotion, SAMHSA Strategic Prevention Framework, and other EBPs related to their implementation.

Choctaw Nation of Oklahoma proposes to implement Tomorrow's Hope, a project that will better integrate the following services: medical, behavioral health, prevention, substance abuse treatment, Jones Academy (residential educational facility), domestic violence, Eastern Oklahoma State College, and law enforcement in an effort to firmly establish new linkages and strengthen a system wide response to suicide prevention/intervention. Tomorrow's Hope proposes to annually: a) train 1,100 youth, service providers and community members in 40 QPR (Question, Persuade, Refer) trainings; b) train 100 medical providers in Emergency Department Means Restriction Education (NREPP Registry, 2014); c) train eighty Choctaw Nation Youth Advisory Board members and Jones Academy students (80) in Coping and Support Training (CAST, age 13 to 24); and d) refer/engage 240 youth and 120 family members per year in 3 to 4 month long outpatient treatment for substance use, mental health or both; offer law enforcement officers and campus police training opportunities related to suicide intervention and QPR. This means that this project will impact, minimally, 8,000 youth, health providers, college students, Jones Academy students, law enforcement and family members during its five-year duration and hopefully, throughout their lives. Services proposed will be based out of the three counties (McCurtain, Pittsburg, and Latimer) that evidence the highest suicide rates. However, because Tomorrow's Hope will build a system wide approach, all 10 1/2 counties served by the Choctaw will benefit as all counties utilize clinic and hospital services. Tomorrow's Hope, will enhance already existing linkages, build new ones, strengthen the net of protection through education, introduce and expand evidence based interventions, utilize EHR to establish a "Community Alert" (a function within the EHR system to notify both medical and behavioral health to a patient's risk for suicide), and reduce access to means.

The purpose of the Alabama Youth Suicide Prevention Program (YSPP) is to develop and implement statewide youth suicide prevention and early intervention strategies that will include collaboration among schools, educational institutions, juvenile justice systems, foster care systems, substance abuse and mental health programs, and other child and youth-supporting organizations. These activities and others will be utilized to reduce suicide deaths and non-fatal suicide attempts among adolescents in Alabama, ages 10-24, of all races and ethnicities. The Alabama Department of Public Health will partner with the Alabama Suicide Prevention and Resource Coalition, the University of Alabama at Birmingham, and five crisis centers located in North, North Central, Central, Southeast, and Southwest Alabama, that will serve as behavioral health service providers to provide services at the state level as well as the community level. The multifaceted approach will allow for multiple exposure and intervention methods as well as a larger degree of community engagement for Alabama's youth population, which suffered from 11.7 suicides per 100,000 in 2013. The goals for the YSPP that are to be achieved by 2020 are to: 1) decrease the rate of adolescents (ages 15-24) who complete suicide from 11.7 to 9.2 per 100,000; 2)decrease the percentage of high school students who seriously considered attempting suicide from 18.1 to 13.1 percent; 3) decrease the percentage of high school students who made a plan about how they would attempt suicide from 14.3 to 13.8 percent; 4) decrease the percentage of high school students who attempted suicide from 10.4 to 8.9 percent; and 5) decrease the percentage of high school students who attempted suicide that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse from 3.6 to 2.1 percent.

The purpose of the proposed project is to develop and implement tribal youth suicide policies and evidence-based prevention programs that enhances awareness, identification, referral and treatment strategies. Activities will focus on youth 10-24 years of age and youth- serving systems. The program has 4 identified goals. Goal 1: Strengthen our suicide community coalition Goal 2: Conduct Suicide Prevention trainings across the Yakama Reservation. Goal 3: Implement a reservation-wide EBP suicide prevention program - Sources of Strength. Goal 4: In collaboration with coalition partners increase annual screening, identification, referral and support for youth at risk for suicide.

The goals of the Ohio Suicide Prevention grant are: 1) Serving gatekeepers throughout Ohio schools, medical schools, and hospitals to be empowered and equipped to identify and refer at-risk youth. 2) Substance abuse, mental health, and juvenile justice-involved personnel will be provided with capacity expansion training that will improve their confidence and ability to meet the needs of those in crisis and at risk for suicide. 3) Individuals who have attempted suicide will be provided with post-discharge services that enhance their stability and prevent future suicide attempts. 4) Comprehensively implement the 2012 National Strategy for Suicide Prevention.

Through training, outreach, and implementation of evidence-based practices, the Suicide Safer Communities for Youth project will build infrastructure and increase the suicide specific continuum of care that will result in reductions in the number and rates of suicide deaths and number and rate of non-fatal suicide attempts among youth ages 10-24 in three targeted counties with suicide death rates higher than the national average. A Zero Suicide in Healthcare licensed clinical supervisor will be hired in each county to oversee development and integration of the community and clinical suicide prevention efforts. A Zero Suicide in Healthcare certified peer specialist (ZSH-CPS) in Bartow, Newton, and Oconee counties will integrate the voice of lived experience into ongoing suicide prevention efforts. Proposed evidence-based practices will include Question, Persuade, Refer Gatekeeper Training; Child and Adolescent Needs and Strengths-Mental Health; The Adult Needs and Strengths Assessment; Columbia Suicide Severity Rating Scale; Suicide Safety Plan; Collaborative Assessment and Management of Suicide; Cognitive Behavioral Therapy for Suicide Prevention; and DiDi Hirsch Youth Suicide Attempters Group. The Georgia College and University Suicide Prevention Coalition will provide 1) a yearly Suicide Prevention Conference for Colleges and Universities, 2) three additional suicide prevention training opportunities a year and 3) assessment, data collection, tracking and evaluation services for the College Coalition.

The Wichita Tribal Youth Suicide Prevention and Surveillance Program will identify, refer, follow-up and serve American Indian youth ages 10-24 with the intent to promote protective factors and reduce the risk of suicide in the community. The Wichita and Affiliated Tribes will utilize current programs that heavily serve youth and existing relationships with service providers to accomplish the goals set forth below: Goal 1: Increase awareness and understanding of suicide while concurrently reducing stigma associated with suicide through advisory board development and public education. Goal 2: Engage the tribal community and partnering entities while developing support for the Wichita Tribal Youth Suicide Prevention and Surveillance program through coalition development, training, and outreach. Goal 3: Develop the workforce to ensure the effective assessment and treatment of youth at-risk of suicide through expert training. Goal 4: Implement community-based surveillance programming to identify at-risk youth and connect youth with Wichita Tribal Youth Suicide Prevention and Surveillance project. Goal 5: Ensure effective treatment and coordination of care through comprehensive case management and follow up services. Goal 6: Conduct surveillance and quality improvement on suicide attempts and completions.

The SC Department of Mental Health (SCDMH) will implement the Young Lives Matter Project to reduce deaths by suicide and nonfatal suicide attempts among SC youth and young adults age 10-24. The project will focus on increasing access to screening and mental health services, raising awareness through social media marketing, increasing protective factors through training across community domains, supporting clinicians and educators in implementing evidence-based interventions, utilizing safety plans in emergency departments, and strengthening statewide infrastructure. The program goals for the South Carolina Garrett Lee Smith grant are as follows: 1. Strengthen statewide infrastructure that will support improved behavioral health services delivery to potentially suicidal youth and young adults, including formation of a statewide Suicide Prevention Coalition and regional youth suicide prevention task forces. 2. Raise awareness and knowledge of youth and young adults and those who care about them (e.g., teachers, parents, counselors) regarding how to get help for depression and other mental health issues that may lead to suicidal ideation and suicide attempts. 3. Educate parents, teachers, and other caring adults on the risk and resiliency factors that impact youth and young adult mental health, suicidal ideation, and attempted suicide; on how to respond when they believe youth and young adults to be suicidal; and on how to access services. 4. Increase screening of youth and young adults for suicide risk and their access to services. 5. Implement evidence-based practices and successful intervention strategies to reduce suicide attempts and deaths by suicide. 6. Develop an interagency response protocol to use in the event that a youth or young adult is determined to be at risk of suicide.

Choctaw Nation of Oklahoma proposes to implement Tomorrow's Hope, a project that will better integrate the following services: medical, behavioral health, prevention, substance abuse treatment, Jones Academy (residential educational facility), domestic violence, Eastern Oklahoma State College, and law enforcement in an effort to firmly establish new linkages and strengthen a system wide response to suicide prevention/intervention. Tomorrow's Hope proposes to annually: a) train 1,100 youth, service providers and community members in 40 QPR (Question, Persuade, Refer) trainings; b) train 100 medical providers in Emergency Department Means Restriction Education (NREPP Registry, 2014); c) train eighty Choctaw Nation Youth Advisory Board members and Jones Academy students (80) in Coping and Support Training (CAST, age 13 to 24); and d) refer/engage 240 youth and 120 family members per year in 3 to 4 month long outpatient treatment for substance use, mental health or both; offer law enforcement officers and campus police training opportunities related to suicide intervention and QPR. This means that this project will impact, minimally, 8,000 youth, health providers, college students, Jones Academy students, law enforcement and family members during its five-year duration and hopefully, throughout their lives. Services proposed will be based out of the three counties (McCurtain, Pittsburg, and Latimer) that evidence the highest suicide rates. However, because Tomorrow's Hope will build a system wide approach, all 10 1/2 counties served by the Choctaw will benefit as all counties utilize clinic and hospital services. Tomorrow's Hope, will enhance already existing linkages, build new ones, strengthen the net of protection through education, introduce and expand evidence based interventions, utilize EHR to establish a "Community Alert" (a function within the EHR system to notify both medical and behavioral health to a patient's risk for suicide), and reduce access to means.