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MaineHealth d/b/a Healthy Community Coalition (HCC) will implement this Rural Emergency Medical Services Training Project to recruit and train emergency medical services (EMS) personnel in the federally designated rural catchment area of Franklin County (FC), Maine. HCC will partner with NorthStar, the sole EMS provider in FC to accomplish project goals. NorthStar is part of Franklin Memorial Hospital, which is part of MaineHealth, an integrated not-for-profit health system. Population served is 40,000 and includes EMS personnel, those who could be recruited and trained to serve as EMS personnel, and FC residents. The population like many other rural communities is older, sicker, and poorer. Over 50% of the aging population have more than 3 coexisting chronic illnesses, with 11.8% living below the poverty level. The majority of the population face multiple socioeconomic vulnerabilities. Goals and Objectives include: Goal 1: Increase recruitment, training and retention of EMS personnel in FC, ME by implementing recruitment and training programs. Objectives 1.1: By 9/1/2026, program staff will recruit and orient 30 new EMS personnel. Objective 1.2: By 9/1/ 2026, program staff and partners will provide EMS career exploration or recruitment information to 1000 individuals at 8 career fairs at state-wide middle/high-schools and career centers using both face-to-face, virtual, and social media platforms. Objective 1.3: By 9/1/ 2026, program staff and partners will provide EMS career information and job-shadowing experiences to 30 high-school or college level students. Objective 1.4: By 6/30/ 2026, NorthStar will offer Emergency Medical Response training to 20 local fire department and law enforcement officers and potential volunteer first responders. Objective 1.5: By 9/1/ 2026, NorthStar will strengthen retention strategies to engage 80% of EMS personnel in career expansion programs (i.e., providing training to expand trainees’ competence, skills, certifications, and credentials). Objective 1.6: By 9/1/ 2026, train 10 EMS providers to the Instructor Level to support EMS professional development. Goal 2: Provide EMS personnel with trauma-informed, recovery-based training to understand and provide safe, stigma free treatment for mental health and substance use disorders (SUD), co-occurring disorders (COD) in emergency situations, and provide appropriate follow-up care. This goal and objectives directly align with the need to increase EMS personnel’s knowledge of mental health disorders, SUD, and COD, and how to care for these individuals in emergency situations. Objective 2.1: By 9/1/ 2026, 100 EMS personnel will have received mental health and substance use disorder training via SAMHSA’s Technology Transfer Centers, or alternate platform. Objective 2.2: By 9/1/ 2026, 100% of NorthStar EMS personnel will have received training for best practices in harm reduction, including Naloxone administration. Objective 2.3: By 9/1/ 2026, Stigma prevention, trauma-informed, recovery-based care and motivational interviewing trainings will be provided to reach 75 EMS personnel, including 911 dispatch operators. Goal 3: To ensure EMS personnel have the equipment and training tools needed to provide high quality care. This goal and related objectives align with the need for frequent training and refresher courses to maintain complex skills. Objective 3.1: By 9/1/ 2026, NorthStar staff will have purchased and put into service the appropriate SAMHSA approved EMS medical equipment and supplies needed to complete project goals.

We propose a program that consists of EMS Training in Substance Use Disorder and Mental Health Crises in Rural New York. This proposal focuses on the two counties which are the main service areas for our Corning Hospital and its EMS services: Steuben County, the home of Corning Hospital and the primary location of patients within the service area, and Chemung County, where remaining patients stem from. The primary objectives of this proposal are: training for EMS staff in technical procedures, such as Naloxone and buprenorphine administration; training for EMS staff in possible complicating co-occurrences, such as mental health crises, through psychological first aid and de-escalation training; and providing EMS staff with firsthand experience in the field of administration of Naloxone and buprenorphine. (This program will be implemented after personnel have completed education training courses and test administration through courses. Buprenorphine administration in the field is dependent on approval by NY legislation.) We expect to train 60 EMT and BSL personnel per year, for a total of 120 trained by the end of the program. Some demographics of the program service area are categorized here: populations of 95,796 (Steuben) and 84,254 (Chemung); unemployment rates for both of these two counties are around 5.5%; the New York County Health Rankings are 37 (Steuben) and 53 (Chemung) (out of 62 total NY counties); 6.5% of residents have English as a second language; the race distribution is 75% white non-Hispanic, 10% black non-Hispanic, 7% Hispanic, and 8% other; the percentage of the population in poverty is 9% for white residents, 32% for back residents, and 30% for Hispanic residents; 26-28% of individuals in both counties have depressive disorder. Through this program, we hope to enable EMS personnel to provide more effective care to substance users in the field through ensuring adequate training in multiple aspects of patient wellbeing. We will evaluate our goals through the following measurable objectives: 1. Through the first project, year a minimum of 30 new BLS personnel will be trained to increase the number of EMS staff in the area. 2. Through the second project year, an additional 30 new BLS will be trained. 3. In each project year, we will host a hands-on training exercise day for at least 20 EMS personnel to simulate a field response. The scenario will focus on substance use disorder and mental health crises, ending with education and awareness for these conditions. 4. Through the first project year, at least 30 EMS personnel will have been educated on opioid overdoses and trained in the use of Naloxone and buprenorphine. 5. Through the second project year, an additional 30 EMS personnel will be educated in opioid overdoses and trained in reversal agents. 6. In each project year, at least 30 EMS personnel will be trained in strategies to treat patients with substance use disorders and mental health concerns. 7. Throughout each project year, the credentials of 30 EMS personnel will be maintained through training involving education and simulation practice. 8. In each project year, a total of 30 unduplicated EMS personnel will be trained to serve or continue serving in an EMS agency by obtaining initial certification or maintaining their current certification through continuing medical education classes. Through these objectives, we hope to be able to cover a wide range of SUD patients that present to the ED or to EMS staff pre-hospital and assist them for many years to come due to increased EMS capabilities.

Margaretville Hospital will partner with Delaware County, NY Department of Emergency Services and SUNY Cobleskill. Our goal is to provide all levels of EMS training as appropriate to maintain licenses and certifications relevant to serve in an EMS agency; conduct courses that qualify graduates to serve in an EMS agency; and fund specific training to meet New York State licensing/certification requirements. There will be a significant emphasis on behavioral health and substance use disorder training. Margaretville Hospital is a rural Critical Access Hospital, located in Delaware County, whose mission is to provide immediate access to high quality medical care and services to medically underserved areas in the Catskill Mountains. The Margaretville Hospital EMS Training Program will serve the geographic catchment area of Delaware County, NY, which is a HRSA-designated rural county, and parts of Greene and Ulster counties that are also HRSA-designated rural areas that border Delaware County and are serviced by Margaretville Hospital. The fourth largest county in the state with a population of 44,740, Delaware County’s unemployment rate exceeds New York State averages, and according to the 2023 NYS Community Action report, 25.6% of youth under 18 are living in poverty in Delaware County. Delaware County is home to 20 transporting agencies dispatched by Delaware 911 and six basic life support first response agencies. Of the 20 transporting agencies, only six have paid staff, while the remaining 14 are operated by volunteers. To provide 24/7 coverage, each volunteer would need to commit 28 hours a week, the equivalent of an unpaid part-time job. Our objectives are to offer Certified First Responder (CFR), Advanced Emergency Medical Technician (AEMT), Emergency Medical Technician (EMT), and Community Paramedicine trainings. Over a two-year period, the CFR class will train 20 people, the AEMT and EMT classes will train 48 students each for a total of 116 people. In addition, six paramedics will be sponsored and trained by SUNY Cobleskill for a grand total of 122 unique individuals. If we are able to increase the number of EMS workers in our catchment area, this will reduce the number of volunteer hours necessary for each EMS worker to perform to provide 24/7 service. With the high rates of unemployment and low levels of income in this rural area, the program will provide educational opportunities that individuals might not otherwise be able to afford and will provide some paid career prospects.

Project Title: Citizens Memorial Hospital EMS Training Program Funding Request: $200,000 Funding Source: SAMHSA TI-23-011 Grant Project Director: Brice Flynn Applicant: Citizens Memorial Hospital Program Details: The CMH EMS training program will enhance didactic and hands-on training opportunities for EMTs, Paramedics, and Community Paramedics who are located within rural service areas and serve rural populations. Funding will cover training expenses and training equipment that can be utilized by internal EMS trainees and be available to other rural EMS organizations who may not have access to advanced training resources including simulation manikins. Training will include a particular focus on addressing substance use disorders and co-occurring mental health conditions through trauma-informed, recovery-based care and treatment. Approximately 70 EMS department employees who serve approximately 10,000 individuals annually through pre-hospital services will be trained through SAMHSA funding. The following goals and objectives will expand recruitment efforts and educational/training resources, and achieve funding purposes to effectively serve rural populations who encounter EMS personnel. Goal 1: Expand recruitment and training of EMS personnel who will qualify for licensure/certification standards and sufficiently meet service delivery needs. Objective 1-1: Recruit and train 18 EMS workers including EMTs, Paramedics, and Community Paramedics through each year of funding through in-house training and online resources. Objective 1-2: Assist all trained EMS personnel to meet state licensure requirements and standards in order to qualify for certification by the end of training. Goal 2: Expand training and knowledge of all EMS personnel on substance use disorder and co-occurring mental health disorders through in-house and online resources within two years of funding. Objective 2-1: Provide 4 hours of continued training to all EMS department personnel (projected unduplicated 70 individuals) EMTs, Paramedics, and Community Paramedics through online and in-person resources to expand knowledge of substance use disorder and mental health disorders within 24 months of funding. Objective 2-2: Within 24 months of funding, train all 70 EMS personnel to provide coordinated care services and warm referrals (including SBIRT training) to other hospital stakeholders and specialties for historically underserved individuals (i.e., home health, social work, SUD, mental/behavioral health, OBGYN, etc.)

Inter City Fire Protection District (ICFPD) will increase EMS capabilities for the rural population with as defined in a Behavioral Health Disparity Impact Statement. ICFD plans to hold training to bolster the number of EMTs and paramedics certified to provide care under the EMS division. Training will include initial EMT classes, continuing education for certification maintenance, inservice skills training using technology based methods, and training on trauma informed care and social determinants of health. Due to current staffing levels, many ALS level calls receive only a BLS response. By recruiting, training, and retaining more ALS providers, the department will be able to offer more advanced care to the district. ICFD will provide free Narcan kits to the public that will benefit populations at risk for Substance Use Disorder. Additionally, community CPR and Narcan training will be a focus area for the project timeline. The target population to be served is a rural district of Blue Springs, MO. The demographic statistics indicate that the area is low income, low education, and has a high concentration of substance abusers. With a low socio-economic index most inhabitants cannot afford to seek medical care and other resources such as counseling, therapy, and Narcan to solve the problem. The major goal of this program is to provide free access to resources such as Narcan and ALS level EMS response for overdose emergencies and directly save lives. Community training will be implemented to address the root causes of the issue as well as equip lay people with the skills and medications needed to handle emergencies in the absence of EMS. The project goals are to recruit and retain more ALS personnel to improve patient care abilities and provide ALS level response 24/7, implement Narcan and CPR training to community to save lives in substance abuse related emergencies, maintain stock of free Narcan in a "public vending machine", improve training capabilities with classroom supplies, equipment, and instructors to ensure competent initial and continuing education during our initial EMT classes and continuing education, introduce agency provided continuing education to alleviate personnel from having to seek outside education to maintain credential and avoid skill atrophy, and improve EMS provider knowledge on handling mental health patients which constitute a majority of our interfacility transfers. The measurable objectives are to hire new/train existing EMTs and maintain at least 4 paramedics by December 2025, provide ALS level response to at least 70% of patients with a (complaint of cardiac arrest, chest pain, trauma, seizure, overdose, unresponsiveness, breathing problems, altered mental status, burns, diabetic problems, stroke/CVA, and nausea vomiting) from January 2026 through September 2026, hold at least 4 community Narcan training and distribution events annually from January 2025 to September 2026, establish a Narcan vending machine and keep at least 5 kits in stock at all times by December 2024, setup a dedicated training space and hold monthly continuing education opportunities by February 2025, fund 100% of personnel continuing education either in house or through online courses by January 2025, train at least 50% of EMS providers on mental and substance use disorders and trauma informed by May 2025, conduct at least 2 initial EMT classes per annual year starting in 2025, conduct at least 1 AHA class (ACLS, PALS, and BLS) by December 2025 for providers.

Funding Opportunity Number: TI-23-011 CFDA(s): 93.243 Applicant Name: South Lincoln Hospital District Descriptive Title of Applicant's Project: SLHD EMS Training Grant Project Abstract: Summary: The South Lincoln Hospital District (SLHD) Emergency Medical Services (EMS) Training Program will provide training leading to certification as an advanced emergency medical technician (AEMT) or emergency medical responder (EMR) for up to 40 students. SLHD EMS will increase the number of hours of training that EMS students receive on the treatment of patients with behavioral health conditions and/or substance use disorders. Guest speakers will highlight the behavioral health needs of LGBTQI+ individuals and of military personnel, returning military personnel, and veterans. Population: The population of focus for this project is area residents over the age of 21 with a desire to become an EMS employee, as well as medical professionals in need of continuing education credits. This program will serve residents of Lincoln, Uinta, and Sublette Counties, which have a total population of 48,759 and a population density of 4.42. Strategies: SLHD EMS will bring in guest speakers who are subject matter experts in behavioral health topics such as "Question, Persuade, Refer" (QPR), motivational interviewing, and peer support. One-on-one support will be offered each class for those studying for certification examinations. A variety of simulation equipment is being requested or is on hand for realistic classroom simulation of situation seen in the field. Goals: (1) Maintain or increase our roster of EMTs. (2) Increase the number of hours of training offered on working with patients with mental health conditions. (3) Increase the amount and types of training on connecting patients who experience an overdose to treatment and to referral to ongoing peer recovery support. Objectives: (a) Offer 2 courses leading to certification and counting as continuing education between 9/30/23 and 9/29/24. Train up to 40 students between 9/30/23 and 9/29/24. (b) Offer 4 hours of instruction on motivational interviewing to up to 40 students between 9/30/23 and 9/29/24. (c) Offer 1 hour of instruction on "Question, Persuade, Refer" (QPR, an intervention that can be used by anyone who encounters a suicidal individual) to up to 40 students between 1/1/24 and 9/29/24. (d) Offer 1-2 hours of instruction on the behavioral health needs of LGBTQI+ individuals to up to 40 students between 1/1/24 and 9/29/24. (e) Offer 1-2 hours of instruction on the behavioral health needs of active-duty military personnel, returning veterans, and military families by having a guest speaker who is a subject matter expert between 1/1/24 and 9/29/24. (f) Increase the number of hours of training offered on working with patients with mental health conditions from 2 hours per year (or 5 hours per year for students enrolled in an EMT class) to 20 hours per year between 9/30/23 and 9/29/24. (g) Purchase 50 Naloxone nasal spray kits and train all EMS staff, all EMS students, and up to 30 local first responders on their use between 9/30/23 and 9/29/24. (h) Offer 1-2 hours of instruction on peer support resources available locally to up to 40 students between 1/1/24 and 9/29/24, including a presentation by the nearest active Alcoholics Anonymous group if possible. (i) Develop procedures to ensure all overdoses are reported to the state and/or local public health department if those entities begin collection of that information during the project period. (Wyoming does not participate in SUDORS.) The total anticipated unduplicated individuals SLHD EMS proposes to train in a year is 50.

Improving the continuity of care and follow up of youth identified to be at risk for suicide. Increase capacity and accessibility to clinical services and Lakota healing ceremonies. Coordinate community and youth serving programs to work closely in prevention, intervention, and postvention with the Lakota values as the foundation.

ABSTRACT: The Pascua Yaqui Tribe Health Services Division, through its Sewa Uusim Community Partnership program as lead agency, submits this application for a cooperative agreement under the Garrett Lee Smith tribal youth suicide prevention and early intervention program. Our request is $735,000 per year over a five-year fiscal cycle. The New Pascua Reservation is 50 miles from the Mexican Border south of Tucson, AZ. We share the same focus as SAMHSA on the need for services for youth up to 24. Goal: To enhance and improve the tribal network of care for children, youth, young adults, and their families at risk for or experiencing issues related to suicide and suicidal ideation. Objective 1: Increase the number of youth focused organizations and staffs trained to enhance their ability to identify and work with youth at risk for suicide behaviors, this includes the need to increase in the capacity of clinical services. Measure: The evaluator will track the training of 50 professional staff in EB interventions annually (250). Engage 4 new agencies whose staff participate in EB Trainings by 9/30/ 2029. Measure: Track from baseline by the local evaluator. Objective 2: Enhance and coordinate the infrastructure of a tribal-wide continuity of care and postvention network for prevention, early intervention, and treatment services. Measure: As measured by the local evaluator, review the existing tribal agreement for postvention and inject new interventions and long-term coordination of community resources to assure ongoing services. Create a policy on behalf of clients utilizing high-level suicide services with a need for a model for crisis response services for community agencies' traumas. Objective 3: Enhance clinical support services related to suicide prevention early intervention services to ensure they are trauma-focused, utilizing EB Cognitive Behavioral therapy services, using evidence-based prevention models of care such as ASISIT, QPR, and Sources of Strength. Measure: 50 annually/250 total. Paraprofessional/ professional therapists will take part in evidence-based suicide prevention services. Objective 4: Create outreach services utilizing a youth technology model to reach GLBTQ, isolative, and foster youth. Measure: Bring an EB Sources of Strengths curriculum model into the community to help understand how to create a state of hope for youth. Create a technology approach to PSAs and streaming shows to reach GLBTQ and isolative youth in the community. Measure: At least 35 youth per year (175) will participate in the curriculum program, and up to 15 (75) youth will participate in the technology outreach production project over the 5 years of the project.

Summary: The Johns Hopkins Center for Indigenous Health, with Navajo Nation authorization, will implement a tribe-wide suicide prevention and early intervention response program that works with children and youth up to 24 years old. Programming includes Applied Suicide Intervention Skills Training (ASIST) for adult practitioners and New Hope and Caring Contacts interventions for child and youth beneficiaries. Project also includes coordinating efforts. Project name: Honoring Life Suicide Prevention Program Populations to be served: This project will serve at-risk children and youth (up to age 24) residing on the Navajo Nation in Arizona, New Mexico, and Utah. Beneficiaries will be referred to the program for elevated risk of suicide. Strategies and interventions: Our project's evidence-based interventions include New Hope, Caring Contacts, and Applied Suicide Intervention Skills Training. Community mental health specialists will receive referrals from tribal and local organizations (e.g., clinics, schools) and provide suicide prevention and intervention programming to reduce the likelihood of suicide. Navajo/Diné community mental health specialists will meet with at-risk individuals, provide information to the families of those individuals, and conduct follow-up, case management and referral to support comprehensive wellbeing. All program activities will be tailored for the local Navajo/Diné population. Goals and objectives: Our goals are to: (1) increase local capacity for suicide prevention through training of the Honoring Life team and community members who interact with youth at risk of suicide; (2) support community-guided surveillance of youth suicide and self-harm behaviors and provide enhanced case management, support and brief interventions through follow-up visits with identified youth; and (3) expand access to trauma-informed, evidence based, culturally-informed preventive programming for youth, guardians, and the community. Our objectives align with each of these goals. For goal one, they include: (1-1) project staff being ASIST trained; (1-2) project staff being certified prevention specialists; (1-3) provision of annual ASIST trainings to behavioral health and related personnel on Navajo Nation; (1-4) provision of safety planning materials annually to tribal and regional organizations; and (1-5) monthly social media sharing, including Suicide Prevention Resource Center (SPRC) materials. For goal two, they include: (2-1) conducting tracking and follow-up for at least 100 youth at risk of suicide annually; (2-2) facilitating quarterly community advisory board meetings; (2-3) integration of safety planning into follow-up visits; and (2-4) monthly meetings with healthcare providers for higher-risk cases. For goal three, objectives include: (3-1) annual delivery of New Hope intervention to at least 25 at-risk youth; (3-2) selection of at least one supplemental evidence based practice; (3-3) implementation of selected supplemental evidence-based practice, including cultural adaptation; (3-4) enrollment of referred individuals into Caring Contacts supportive text messages; and (3-5) hosting annual community suicide prevention outreach event. Number of people served: We anticipate providing services to at least 400 individuals each year (2,000 during the total project period) including direct services to at least 125 children and youth 24 years of age and younger and at least 275 other members of the community through activities such as training for adult practitioners, meetings with family members, or community events.

Abstract The Nevada Office of Suicide Prevention (NOSP) Garrett Lee Smith Youth Suicide Prevention in Schools Project will enhance and expand suicide prevention efforts for youth in three school districts within Nevada. The overarching goals of this project are multifaced, focusing on enhancing suicide prevention and mental health awareness in schools, building the capacity of clinical services providers to address youth suicidality, and improving the continuity of care and follow-up for at-risk youth. The first goal aims to educate and train school personnel, youth, families, caregivers, school staff, and community members with the tools necessary to recognize and intervene effectively. to recognize and respond to signs of suicide and mental health crises by utilizing evidenced-based programs and integrating mental health education into the school curriculums with a focus on building resilience and coping skills among students. With extensive experience in managing state and federal grants, NOSP will train 1,925 participants in evidenced-based suicide prevention programs including safeTALK, QPR, ASIST, CALM, and Youth Mental Health First Aid. The second goal builds the capacity of clinical service providers to address youth suicidality effectively. This will involve bhworks for screening, assessments, and interventions in schools. This goal further aims to establish prevention and peer support groups and enhance school-based screening efforts as well as virtual suicidality interventions on an annual basis. This goal aims to reduce the emergency department overuse and provide rapid, effective treatment. Our final goal will work to improve the continuity of care and follow-up for at-risk youth. This includes conducting trainings each year on post-hospital discharge plans to ensure continuous care and safety planning. By the final year, the project aims to educate at least 80% of school administrators and staff on the suicide postvention plan to enhance community response following a suicide. Additionally, this goal will focus on developing and distributing a resource toolkit for suicide postvention to support caregivers of youth who have experienced suicidal ideation or attempts, including information on monthly support groups. NOSP will partner with key organizations such as the Nevada Department of Education’s (NDE) Office for a Safe and Respectful Learning Environment (OSRLE), NAMI Western Nevada, the Hope Institute, and local education agencies to ensure broad and effective reach and implementation. The project will utilize the bhworks platform for streamlined processes, comprehensive behavioral health management, and data-driven decision making. The American Institute of Research will be utilized to evaluate the program’s effectiveness using real-time dashboards and comprehensive reporting functionalities. Performance measures will track the number of individuals who are screened for suicidal ideation, who are referred to mental health services, and those who participate in provided trainings. Through these comprehensive and strategic efforts, this project aims to provide critical support and resources to at-risk youth, their families, schools, and the community. By enhancing early identification, intervention, and support for at-risk youth and their families, this project will work to significantly reduce youth suicides in Nevada.

The Substance Abuse and Mental Health Services Administration (SAMHSA)'s May 2018 Disaster Technical Assistance Center Supplemental Research Bulletin emphasized that first responders are at greater risk of developing depression and posttraumatic stress disorder (PTSD) and struggles with substance use and suicidality/suicide due to the tremendous amount of stress, challenges, and dangers they face daily. Rural first responders' physical and mental wellness needs to be a focus and priority in public health prevention work as they are the cornerstones of their rural communities. Their mental wellbeing and support networks directly impact not only their lives also those of their patients, loved ones, and rural communities. The proposed project, Malama First Responders: Support EMS Personnel Serving Rural Hawaii Through Training, Resources, and Enhancement of Peer-to-peer Network is designed to: 1) Expand and support existing EMS trainings and wellness programs, with a focus on behavioral health needs of first responders, including culture-based activities rooted in local traditions. 2) Enhance peer-to-peer programs by purchasing equipment to provide virtual meeting spaces for connection, debriefing, and interisland support. 3) Support a statewide Critical Incidence Stress Management Network. The proposed geographic catchment area for the project is statewide, as approximately 93.9% of Hawaii's total land areas fits the United States (U.S.) Census Bureau's rural area definition. The Hawaii State Department of Health (DOH), Emergency Medical Services and Injury Prevention System Branch (EMSIPSB), and our community partners plan to establish a solid statewide support network in alliance with the public health prevention model and increase mental wellness and resiliency for EMS personnel statewide.

The purpose of the Wabash General Hospital (WGH) Emergency Medical Services (EMS) Training and Enhancement Project is to improve EMS care for the rural residents of Wabash County, Illinois (IL), by supporting trainings that will expand the EMS workforce and enhance the workforce’s responsiveness to substance use disorders (SUD) and co-occurring mental health (MH) conditions. The project catchment area is Wabash County in rural Southern IL, where WGH provides EMS. The population of focus is the current and prospective EMS workforce affiliated with WGH, including EMTs, Paramedics, and ER nurses, along with first responders who collaborate with WGH EMS. Wabash County is less diverse than IL as a whole, with small sizes of minority subpopulations underscoring the need for culturally competent, trauma-informed training and an effort to diversify EMS demographics. Amid rising statewide rates of opioid overdoes, WGH has been operating with a shortage of certified EMS personnel. WGH-EMSTEP will address the workforce shortage and the need to enhance training to include content focused on connecting individuals who experience substance use and co-occurring mental health disorders with linkages to treatment and peer support. Goal 1 is to increase the size of the EMT and Paramedic workforce in Wabash County through the implementation of the following objectives: (1) Annually recruit three cohorts of eight candidates each for eight-week EMT training courses; (2) By month 3 of year 1, recruit one cohort of 10 candidates for Paramedic training courses; (3) Annually offer eight-week EMT training courses to three cohorts of eight participants; (4) Beginning in month 4, offer the full FCC three-semester Paramedic program coursework to one cohort of 10 trainees; (5) By month 3 annually, obtain two items of equipment ($5,000+) to build EMS training capacity; and (6) By month 3 annually, obtain 100% of itemized supplies and teaching materials (less than $5,000 each) necessary for EMS training. Goal 2 is to enhance the ability of local EMT, Paramedic, ER, and first responder personnel to address substance use disorders (SUD) and co-occurring mental health (MH) conditions through the implementation of the following objectives: (1) Train 100% of EMT/Paramedic candidates and 100% of current EMS staff and associated personnel in Mental Health First Aid (MHFA); (2) Train 100% of EMT/Paramedic trainees and 100% of current EMS staff and associated personnel in Motivational Interviewing; (3) Train 100% of EMT/Paramedic trainees and 100% of current EMS staff and associated personnel in Screening, Brief Intervention, and Referral to Treatment; and (4) Train 100% of EMT/Paramedic trainees in local procedures for making referrals to treatment, harm reduction services, and peer support for individuals who experience overdose reversal or related SUD and co-occurring MH crises. Over the project’s two-year funding period, WGH will annually recruit and train 24 EMT candidates, for a total of 48 unduplicated, newly trained EMTs. In year 1, WGH will recruit 10 Paramedic candidates and offer a full three-semester Paramedic training program spanning years 1 and 2, for a total of 10 unduplicated, newly trained Paramedics. All EMT and Paramedic trainees will receive SUD/MH trainings as part of their coursework. The project will also annually include 20 existing WGH EMS staff and personnel from associated first-responder agencies in the trainings addressing SUD and co-occurring MH conditions, for a total of 40 existing/associated personnel trained throughout the grant period. The total number of unduplicated individuals to be trained to contribute to the rural EMS workforce in Wabash County over the life of the project is 98.

The purpose of this project is to improve infrastructure for reducing suicides and ultimately prevent suicide deaths among young people up to age 24 in the Eastern Band of Cherokee Indians (EBCI). Generation Schools Network (GSN) and EBCI will work collaboratively to achieve the three goals: improve protective factors, improve infrastructure for suicide prevention, and prevent suicides among EBCI young people up to age 24. To achieve the stated objectives, GSN and EBCI partners will build a EBCI suicide prevention implementation team (IT) including the Project Director (PD), Evaluator, Cherokee Central Schools (CCS) leadership, CCS mental health staff and Multi-Tiered Systems of Support Coordinator, tribal police, behavioral health staff, public health and human services staff, tribal leadership, cultural experts, and community members, including survivors of suicide loss and suicide attempts. The IT will develop the tribal suicide prevention plan comprised of all required activities. Evidence-based suicide prevention programs will be implemented, professional development will be provided to schools staff, training and education provided to community members. An increase in screening and referrals to treatment will be a result of improvements in the coordination of efforts across the tribe. Partners from across the tribe, including residents with lived experience, will be engaged throughout the term of the grant. Evaluation will include both process and outcome measures to evaluate the achievement of goals and measurable objectives.

Keep Empowering Youth - Partners, Providers, and Lived Experience (KEY-PPLE) includes statewide (Tier 1) and targeted county (Tier 2) approaches. Through partnerships with youth, family, and community-based organizations, suicide-centered lived experience will inform statewide resource development. County-specific work will support youth at risk of suicide and their families through a pilot designed to divert youth away from psychiatric hospitalization when less restrictive treatment environments may be indicated. Among the nearly 4 million youth in Pennsylvania age 24 and below, 69% are Caucasian, 13% are Black, 3% are Asian American, 11% are LatinX, 4% are biracial, and less than 1% are American Indian Alaska Native. In 2022, suicide deaths in PA equaled the national rate of 14.2 per 100,000, whereas the suicide rate for youth in PA slightly decreased to 6.0, which is lower than that of the nation as a whole (6.9). However, within the counties in PA where targeted efforts are planned, the combined suicide rate for those under age 24 is 7.2, exceeding that of the state and country. PA Behavioral HealthChoices data shows an increasing trend in the rate of suicide ideation or attempt for individuals 24 and younger with Medical Assistance (MA) that have engaged in behavioral health services, with 49 per 1,000 individuals in 2018 and 59 per 1,000 in 2022. These increasing trends have been observed across racial/ethnic groups, with one of the county partners participating in the project's targeted efforts experiencing particularly dramatic increases for Black youth during this time (rate of 11 in 2018 to a rate of 36 in 2022). The project has three primary goals with associated objectives and key implementation strategies. Goal 1 is to promote comprehensive youth suicide prevention efforts locally and statewide through infrastructure development, cultivating partnerships, and development and dissemination of trauma-informed and culturally relevant resources. KEY-PPLE will sustain past cross-county and cross-campus collaborative efforts, promote equitable access to information and resources through alignment with other state suicide prevention initiatives, and provide technical assistance within two counties to support local youth suicide prevention infrastructure. Goal 2 is to engage youth and families with suicide-centered lived experience in community-based and statewide prevention efforts to develop culturally relevant supports and services. KEY-PPLE will connect various youth-serving organizations and obtain input from youth on grant-related efforts. Specific focus will be placed on establishing a coalition of Black youth around suicide prevention efforts to inform the project and concurrent efforts of PA’s Black Youth Suicide Prevention Workgroup. A broad range of additional upstream and targeted supports (e.g., podcasts, leadership training, family peer support groups, etc.) will be developed by and for youth and families. Goal 3 is to provide workforce development and build capacity for evidence-based and trauma-informed approaches to identify and support youth at risk of suicide and their families. This will include training efforts on evidence-based care within partner counties to increase timely and effective treatment in the least restrictive setting. It also includes statewide training opportunities on comprehensive suicide prevention and promotion of the Zero Suicide framework. Based on our success in prior grants and estimates based on available data, we expect to expose 220,881 individuals to awareness and prevention messages and 41,400 to training. We also expect 914 youth to be referred for treatment within the target counties for suicidal ideation or attempt. Overall, we anticipate serving more than 263,195 individuals throughout the course of this project.

Abstract GLS 2024 The Wichita and Affiliated Tribe (WAT) will implement Raising Interest in Suicide Education (RISE), a suicide prevention program for Native youth 10-24 of age in the Indian Health Service’s Lawton Service Area in Southwest Oklahoma. Natives have the highest rates of suicide of any race especially among Native male youths. Our project targets gaps in the suicide prevention system and will address unmet need for suicide prevention among Native youth. The service area is large (9039 square miles) and contains 26,422 Native persons which comprise 8.7% of the total population. Two counties, Caddo, and Comanche, contain the majority of Native Americans (76.9%) in the service area, although we will work throughout the ten counties. Native youth struggle to overcome disparities in health insurance coverage, poverty, understanding the role of mental health in suicide, and lack of mental health training among public health employees. Our project has three main goals: · Increase the number of youth-serving organizations who can identify, work with and refer Native youth to mental health services who are at risk of suicide, · Increase the capacity of clinical service providers to assess, manage, and treat youth at risk of suicide within their 10-County catchment, and · Improve the continuity of care of youth identified to be at risk for suicide, including those who have been discharged from emergency departments and inpatient psychiatric units, in their 10-County catchment. Numerous strategies will be employed to reach these goals. We will provide trauma-informed, evidence-based, and culturally and linguistically appropriate suicide prevention activities including immediate support and information for high risk Native youth. We will also implement a response system to ensure that timely referrals to a qualified treatment provider are completed. Patients will be provided safety planning as part of WAT GLS. Also central to our services is the provision of post-suicide intervention services, care, and information to families or friends. Although the area is large we will provide evidence-based training, where possible, to educators, childcare professionals, obtain input from individuals with lived experience, and collect and analyze data and report to our funder, the Substance Abuse Mental Health and Substance Abuse Services Administration (SAMHSA). Our project will compile information from youth in crisis in a Native Suicide Surveillance Database to identify risk factors to target. We will serve a minimum of 450 youth face to face during the five year grant and reach many more through our social media presence. We propose to serve at least 50 youth in the first year and 100 youth in each of succeeding four years.

The Oregon Garrett Lee Smith Youth Suicide Prevention and Early Intervention program (GLS), managed by Oregon Health Authority Injury & Violence Prevention (IVP), will focus on youth up to age 24 in counties with youth suicide rates higher than the national average. In Years 1 & 2, capacity building and activities will be provided in Deschutes, Lane, and Multnomah counties (Cohort 1) by direct service provider organizations leading suicide prevention (SP) efforts. The Cohort 1 population is estimated at 375,868 (30.7% of youth in Oregon). For Years 3-5, IVP will select Cohort 2 counties for funding via a competitive request for proposals, with the population reach for Cohort 2 to be determined. Youth in Cohort 1 are 17.9% Hispanic across races, 63.0% non-Hispanic White, 4.6% non-Hispanic Black or African American (Black), 5.8% non-Hispanic Asian, 0.6% non-Hispanic Native Hawaiian or Pacific Islander, 0.8% non-Hispanic American Indian or Alaska Native (AI/AN), with 7.4% non-Hispanic multiple races. The project goal is to implement suicide prevention & early intervention strategies and build capacity for youth in schools, educational institutions, juvenile justice systems, substance use programs, mental health programs, foster care systems, juvenile justice systems & other child- and youth-serving organizations. Objectives include the following: 1) convene a GLS team, 2) increase capacity for current GLS counties, 3) complete RFP for Years 3-5 (Cohort 2) to expand or establish local initiatives & establish evidence based (EB) youth SP, intervention & postvention strategies, 4) include youth track in annual Oregon Suicide Prevention Conference, 5-6) establish & support 6 youth SP coalitions comprising youth, primary & behavioral health care providers, and advocates representing school districts, veterans, LGBTQ+, BIPOC, juvenile justice, emergency response, and attempt & loss survivors, 7-8) update Postvention response plans in Cohort 1 & 2 counties, 9) increase capacity of youth-serving agencies, 10) provide EB, culturally-focused youth SP & intervention trainings to 10,000 diverse youth-serving professionals and community helpers, 11) establish SP trainings for staff & students in at least 30% of elementary, middle and high schools in Cohort 2 counties, 12-16) train 5,000 Oregon Department of Human Services (ODHS) employees in QPR, 1,000 ODHS employees & community members working with children & youth in ASIST, 12 employees or contracts as trainers in Youth SAVE (YS) for Child Welfare (CW), 500 employees in YS for CW, & 300 employees in OCALM, 17) offer 1 EB SP training to all Oregon Youth Authority (OYA) staff & increase to 3 trainings by Year 5, 18) provide 12 OCALM trainings to clinical service providers, totaling 480 clinicians, 19-20) provide 5 EB suicide risk assessment, management & treatment strategies for a total of 450 clinicians across cohorts 21) train 60 SBHC staff & other youth-serving adults in YS, 22) develop Postvention plan for all youth in the care of OYA, 23) OYA representative to serve on local Cohort 1 SP coalitions to improve continuity of care & follow up among OYA facilities & return to community, 24) Cohort 2 counties develop & implement comprehensive continuity of care & follow up plan for youth at risk for suicide, 25) promote integration of suicide safer care practices & metrics for youth among Certified Community Behavioral Health Clinics, 26) hire a Black or African American SPC to reduce health disparities for BIPOC youth in one Cohort 1 county, 27) train 15 trainers for Be Sensitive Be Brave Mental Health & Suicide Prevention (BSBB), 28) train 1,000 youth serving adults in BSBB, 29) provide technical assistance & training to all Cohort 1 & 2 SPCs on role of Trauma Informed Care & DEI in SP.

Project Name: Georgia Plant Hope Project The Georgia Plant Hope project will empower Georgia youth to build hope for the future and counter the stigma surrounding mental health and suicide prevention. Through safe, consistent messaging around suicide, clinical and community-based resources, resiliency building skills and tangible tools, youth will become advocates for their own mental health. The project will target youth, ages 10 to 24, in Newton, Rockdale, Meriwether and Carroll counties, as well as students under age 24 on the campus of Clark Atlanta University. The four target counties selected all have suicide death rates that meet or exceed the state and national average for youth suicide deaths. At the start of the project, community needs assessments will be conducted in each identified county to identify county specific areas of focus, including populations at increased risk. The project will plan to reach 2,000 youth ages 10-24 annually with an expected 10,000 youth to be reached by the end of the 5-year grant period. Strategies/Interventions: Through training, outreach, and implementation of evidence-based practices, the Georgia Plant Hope project will build infrastructure and increase the suicide specific continuum of care that will reduce the burden of suicide mortality and non-fatal suicide attempts among youth ages 10-24 in four targeted counties and one university campus. The two community service boards, Pathways Center CSB and Viewpoint Health, providing services in the identified counties will be responsible for the implementation of clinical services. Pathways Center CSB and Viewpoint Health will hire a Zero Suicide in Healthcare licensed clinician to oversee development and integration of clinical suicide prevention efforts. A peer support specialist will also be hired to incorporate suicide centered lived experience into all services as well as enhance current recovery services. 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; Stanley Brown Suicide Safety Plan Intervention; Collaborative Assessment and Management of Suicide and Cognitive Behavioral Therapy for Suicide Prevention. Project Goals and Measurable Objectives: The 2024 National Strategy for Suicide Prevention and the 2020-2025 Georgia State Suicide Prevention Plan provide a framework to guide a coordinated approach to suicide prevention efforts. Georgia Plant Hope project goals are: Goal 1: Increase the capacity of schools and communities to prevent suicide and related behaviors among students through the implementation of evidence-based upstream prevention programs and education. Goal 2: Promote coordinated, consistent, and safe messaging around suicide prevention targeting youth ages 10-24 with a focus on youth disproportionately affected by suicide. Goal 3: Enhance the integration of suicide prevention into all treatment and crisis care services for youth ages 10-24 through increased collaboration and accountability among hospitals, crisis centers and community-based providers. Goal 4: Provide care and support to youth affected by suicide death and attempts to promote healing and implement community strategies to reduce the prevalence of suicide and suicide related behaviors among youth aged 10-24.

Cherokee Nation’s Garrett Lee Smith Tribal Youth Suicide Prevention Project goals are designed to increase capacity to identify and respond to suicide risk factors in Native American youth in Cherokee Nation, to enhance and expand referral pathways to mental health services for community partners serving Native American youth in our Cherokee Nation Reservation, and to increase the capacity of communities to reduce suicide risk factors using cultural-based protective factors. Evidence based practices include community, school-wide, and individual interventions including screening, brief interventions, referral and linkage to services, case management, mental health services, cultural classes, and community education to address higher than average suicide rates among Native American youth in our catchment area. Through strategic partnerships with local schools and other youth-serving locations that serve Native American youth, the program will provide services to 1,000 individuals in year one, 1,200 in year two, and 1,500 in years three through five, for a total of 6,700 unduplicated individuals over the five-year project.

The MISSION (Multi-tier Integrated Supports for Suicide prevention Implementation and Outcomes in New York) Project proposes development of a Multi-Tiered System of Support (MTSS) for Staten Island adolescents and young adults ages 10-24 at risk for suicide. The project's catchment area is Staten Island, a diverse county with critical gaps in youth suicide prevention. We will focus on integrating prevention activities across the school district, two college campuses, and four major behavioral health organizations, including school-based, outpatient, inpatient, crisis services, emergency departments, and pediatric primary care. Our approach will offer Tier 1 prevention services to all students and strengthen Tier 2 behavioral health supports, including training adults to identify and refer at-risk youth to an integrated system for rapid closed-loop referrals and providing universal screening and evidence-based interventions in behavioral health settings. Lastly, we will develop a Tier 3 Suicide Prevention Specialty Partnership for crisis stabilization, suicide-specific interventions, and rapid response to divert from emergency services and address the specialized needs of youth with suicidal thoughts and behaviors. We will begin by building much-needed tier 3 provider competency/capacity and configuring bhworks, an innovative software solution for tier integration, before initiating broader early identification efforts aimed at connecting youth in need to services. The MISSION Project will leverage longstanding existing partnerships with the Staten Island Partnership for Community Wellness and build upon NYS’ prior downstream clinical Zero Suicide systems. We selected Staten Island for this implementation effort because it could have a large impact given the county’s high burden of youth suicide and overdose deaths, but also because Staten Island can serve as a good demonstration site for broader NYS dissemination: 1) its youth suicide rate is similar to NYS rates; 2) it is a relatively self-contained area where most residents receive education and healthcare locally; and 3) the borough reflects NYS’s rich racial, ethnic, linguistic, sexual orientation, gender identity, and socioeconomic diversity. The project will provide prevention activities to over 30,000 youth, tier 2 clinical services to 12,000 youth, and tier 3 crisis and specialty services to 2,500 youth over the 5-year period. While limited geographically to Staten Island, the MISSION Project will have broader implications for integrating youth mental health support across the other four boroughs of New York City as well as New York State more broadly.

Through the Cooperative Agreement for the Garrett Lee Smith State/Tribal Youth Suicide Prevention and Early Intervention SC's Building Hope initiative will focus on youth and young adults 24 and under (POF). Building Hope will have three areas of focus (AOF) within the POF: K-12th grade schools, pediatrician offices, and state and federally-recognized tribes in SC. The goals of this grant are to increase the number of youth-serving organizations that can identify and work with youth at risk of suicide in the AOF and POF, increase the capacity of clinical service providers to assess, manage, and treat youth at risk of suicide in AOF and POF, and 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 departments and inpatient psychiatric units in AOF. This will be achieved by partnering with the Education Development Center (EDC) to assist in developing policies and protocols for schools to recognize and care for people who are at risk of suicide. Building Hope will also partner with Sources of Strength to provide an evidence-based, upstream early intervention for mental health and prevention of adverse outcomes like suicide, violence, bullying, and substance misuse. Finally, the project will also work with SafeSide to provide pediatricians within the POF and AOF to expand assessment, screening, and training for suicide. This project expects to reach a total of 4,500 individuals across the five years of this grant. Table 1 below shows the data supporting the need for services within the POF.

Project Abstract: The Yakama Nation (YN) Garrett Lee Smith Tribal Youth Suicide Prevention and Early Intervention (GLS) program will increase suicide prevention, early intervention, and treatment efforts for youth up to age 24. The geographic catchment area is Yakima County (YC), Washington, with a specific focus on the lands of the Confederated Tribes and Bands of Yakama Nation. The GLS program will increase the tribe's capacity to provide universal (Tier 1) suicide prevention and coping skills programing in area schools, strengthen protective factors in YN youth/young adults at risk for suicide, improve the community's ability to identify, intervene and treat YN youth/young adults experiencing suicidal thoughts or behaviors, engage peers with suicide-centered lived experience in developing messaging and providing support, track and quickly respond to deaths by suicide, and strengthen the tribe's postvention response. The grant will achieve the following goals: 1) Decrease the risk of suicide (increase help seeking behavior) by teaching native youth, young adults, and their families to recognize when they need support. 2) Increase YN and area school districts capacity to provide Tier 1 bullying, substance abuse, violence, and suicide prevention interventions. 3) Increase Yakama Nation's youth-serving agencies, area school districts, and Yakama Nation Behavioral Health Services' (YNBHS) ability to identify, intervene, and refer native youth/young adults at risk for suicide. 4) Strengthen individual, relational, community, and societal protective factors in YN youth/young adults who are at-risk for suicide. 5) Increase access to culturally responsive mental health and suicide care for YN youth/young adults experiencing suicidal thoughts and behaviors and self-harm. 6) Strengthen YNBHS ability to provide post-suicide intervention services to family members, school and community members connected to native youth who have completed suicide. Over the course of the five-year grant, GLS staff will deliver Sources of Strength (SOS) training to 100 elementary students per year; train 200 youth-serving agency staff, behavioral health providers, school personnel and community members in Applied Suicide Intervention Skills Training (ASIST); and train 100 youth-serving agency staff, behavioral health providers, school personnel, and community members in Counseling on Access to Lethal Means (CALM). A therapist II will be hired to provide trauma-informed behavioral health services to 200 youth/ young adults. To address culture specific protective factors, the GLS program will hire two Native young people with suicide-centered lived experience to work as peer support specialists and one suicide prevention natural helper to facilitate Talking Circles, provide support for youth/young adults at risk for suicide, participate in community awareness and education events, and train community members on evidence-based, culturally relevant strategies to identify, intervene, and refer youth/young adults at risk for suicide.

The Pueblo of San Felipe (SF) has incredibly high rates of suicidal ideation and behavior. In the recent CDC Youth Risk and Resiliency survey 21.3% of SF high school and 44.4% of middle school students reported that they seriously considered suicide and 16.2% of high school students and 18.2% of middle school students reported that they attempted suicide in the past year compared to 19% and 7% respectively statewide. SF has made significant progress raising awareness about youth suicide prevention over the past 15 years of GLS funding. However, prior grants have not focused on youth involved with Family Services for abuse and neglect, a high need population that warrants specialized attention. Furthermore, there has never been a specific focus on assisting youth who identify as LGBTQIA+ and are a higher risk for suicidality. Finally, prevention services have not been fully integrated with local School Based Health Center primary care services, and other child and youth serving organizations. Thus, San Felipe GLS (SF GLS) will focus on Native American (NA) youth experiencing mental illness, co-occurring substance use disorders, and/or suicidality. The purpose of SF GLS is to implement youth (up to age 24) suicide prevention and early intervention strategies in schools, educational institutions, juvenile justice systems, substance use programs, mental health programs, foster care systems, pediatric health programs, and other SF child- and youth-serving organizations. The goals of SF GLS are to: (1) increase the number of youth-serving organizations who are 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 to be at risk for suicide, including those who have been discharged from emergency department and inpatient psychiatric units; and (4) utilize a continuous quality improvement (CQI) approach to ensure that data informs decision-making. These goals will be accomplished by implementing evidence-based prevention and intervention programming in five schools and in collaboration with all child and youth-serving organizations working with SF youth and families. Activities will include behavioral health promotion activities such as Teen and Youth Mental Health First Aid, and school based promotion activities such as the SF developed Katishtya Intergenerational Cultural Knowledge Seminars (KICKS); universal screening using the PHQ-9 and AUDIT-C; clinical intervention using Cognitive Behavioral Therapy for Suicide Prevention, Counseling on Access to Lethal Means, and Zero Suicide; and instituting continuity of care practices across child and youth serving organizations to ensure smooth transitions into crisis and inpatient services and back to community-based treatment. SF GLS is expected to serve 800 NA youth with promotion and prevention activities, 200 with behavioral health screens, and 75 with direct services annually. SF GLS will also provide MHFA, YMHFA, and other related trainings to 100 community members, youth-serving organization staff and school personnel annually, thereby ensuring breadth and depth of services.

Founded in 1986, GPTLHB is a formal representative board of the seventeen tribal nations and one service unit in the GPA. The mission of Great Plains Tribal Leaders Health Board (GPTLHB), a 501(c)(3) community-based tribal entity, is to work with tribal communities and provide quality public health support and healthcare advocacy to improve the health status and eradicate health disparities among the region's tribal members.1 The vision of the GPTLHB is for all tribal nations and communities to reach optimum health and wellness through lasting partnerships and culturally significant values empowered by tribal sovereignty. Hecel Oyate Kin Nipi Kte, So That The People May Live. GPTLHB intends to continue implementing a navigator program for American Indian and Alaska Native youth, ages 0-24, and their families, who are at risk for suicide in the He Sapa area (Rapid City, South Dakota). The Teca Kici Okijupi-Connecting With Our Youth (CWOY) navigator program, currently funded by SM-19-006, will provide suicide prevention and early intervention strategies in child- and youth-serving organizations. GPTLHB’s Oyate Health Center (OHC), a tribally managed walk-in clinic, has over 22,200 active users, with 5,657 under 18. In 2023, OHC serviced at least 4,255 individuals aged 24 and under, which comprise 26.6% of total patients who receive services at the clinic. The suicide ideation or attempt rate for youth seen at OHC is alarming. Based on OHC data from 2017 through 2023, the male suicide or attempt rate for youth 17 and under is 219 per 100,000. More alarming, the female suicide or attempt rate is 711 per 100,000. Between 2017 and 2023, OHC recorded 488 suicide ideations or attempts by patient relatives. Out of the 488, 143 attempts or ideations were made by individuals 24 and under. There is a rising need for enhanced infrastructure to increase the capacity to implement, sustain, and improve effective behavioral health services around suicide prevention, intervention, and postvention in the region. Inpatient and outpatient behavioral health services throughout Rapid City have long waitlists, staff shortages, and transportation barriers. Though the 2024 National Strategy for Suicide Prevention identifies the need to improve availability and access to culturally relevant suicide prevention information and activities, there is only one culturally oriented suicide prevention program serving American Indian and Alaska Native youth in Rapid City, and that is the Connecting With Our Youth program The program proposes goals to 1) increase the number of youth-serving organizations that can 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 who have been discharged from the emergency department and inpatient psychiatric units. Program staff will achieve these goals by strengthening a referral system and providing one-on-one support to youth identified to be at risk for suicide, including those who have been discharged from the emergency department and inpatient psychiatric units, The program will also facilitate relevant trainings, such as Lakota Mental Health First Aid, for youth, families, clinical providers, and community organizational staff.

The Utah Rural Hope for Youth Project is a comprehensive approach to youth suicide prevention in rural Utah. Two local mental health authorities that serve rural regions of the state in Central and Southeast Utah will implement the Zero Suicide Framework within their clinics, expanding services for youth and families at risk for suicide. To address the prevalence of firearms in rural communities in Utah, this project proactively provides safe storage options for lethal means and tailored messaging around lethal means access reduction for youth and their families. URHYP provides upstream prevention initiatives through community-focused activities that build a sense of belonging, family harmony, and development of tactile coping skills through service-learning projects. Building intergenerational connections within families and within communities through programs like the Foster Grandparent program will provide mutually beneficial relationships for seniors and youth. URHYP will partner with community organizations such as 4-H to hold mental health screening events for youth and their families, accompanied by evidence-based mental wellness and resilience education.

This project will consist of a partnership between the Arizona Department of Education (ADE), Arizona Department of Health Services (ADHS), Cochise County Education Service Agency (CCESA), The Inter-tribal Council of Arizona (ITCA), and The University of Arizona (UArizona). The purpose of Arizona Project Bright Futures is to address the urgent needs around youth suicide in Arizona, specifically in rural and remote communities. The demographics for this proposed project include the overall population of Arizona, which consists of 23% children where more than 6 out of 10 children are children of color. The youth population in Arizona is 45% Latino/a, 38% White, 4% two or more races, 4% American Indian, 5% Black, and 3% Asian. According to the Children's Action Alliance, 16% of children in Arizona are living in poverty. Moreover, children of color in Arizona disproportionately experience poverty with 39% of American Indian children living in poverty and 20% of Latino/a children living in poverty. Additionally, Arizona is home to 22 federally recognized American Indian tribes and has the largest total American Indian population of any state in the county, with Arizona schools serving 47,707 American Indian/Alaska Native students. With this, there is a strong importance on ensuring suicide prevention and early intervention project strategies are culturally and linguistically appropriate to all youth who represent the state of Arizona. The demonstration CESA is Cochise County, which is in the southeastern corner of Arizona. The population of Cochise County is 54.6% White, 35.9% Hispanic or Latino, 4.4% Black or African American, 2.2% Asian, 1.9% American Indian or Alaska Native, and 3.6% two or more races (US Census Bureau, 2023). The total poverty rate in Cochise County is 17.7%, with a median household income of $58,421. In Cochise County, 22% of the population is comprised of children under the age of 18, and 25% of children live in poverty. It is intended that all youth served by CCESA will have access to the goals, activities, and resources proposed in this project, and there is potential to replicate activities in other rural counties in Arizona, therefore expanding the reach of impact of Arizona Project Bright Futures. The four main goals for this proposed project include; (a) resources and support for staff, (b) resources and support for students, (c) increased capacity and infrastructure, and (d) continuity of care. Data around youth access, referral, and services for suicide prevention and intervention and the number of staff trained to conduct suicide assessments will also be collected, as required by the funding opportunity. Arizona Project Bright Futures will utilize a train the train the model to ensure suicide prevention and early intervention training opportunities are accessible in rural and remote communities in Arizona. Further, staff and students will be trained in suicide awareness, prevention, and intervention using evidence-based, culturally relevant, and linguistically appropriate programming and curriculum. Arizona Project Bright Futures also aims to develop and implement a universal response system for Arizona’s educational communities to utilize when referrals for youth with thoughts of suicide or suicide attempts occur, which includes a strong emphasis on continuity of care once youth have been stabilized. The partnerships with ITCA and CCESA strengthen Arizona Project Bright Futures by emphasizing the needs of indigenous, rural, and remote communities and how each community requires unique supports to increase the availability of evidence-based, culturally relevant, and linguistically appropriate supports. Finally, sustainability is a guiding light for Arizona Project Bright Futures, as emphasis is placed on increasing formal written policy and procedures to support the work of this grant beyond the