PROJECT ABSTRACT Suicide is the second leading cause of death for 15-to-24-year-olds in the United States. Compared to their heterosexual and cisgender peers, sexual and gender minority (SGM) adolescents report significantly higher rates of suicidal ideation and suicide attempts. Unfortunately, many barriers complicate the implementation of suicide prevention in SGM communities. SGM youth often report feeling unwelcome and misunderstood in traditional behavioral health service organizations. Consequently, treatment attendance and retention remain low. Instead, this population generally seeks mental health services in community organizations for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. Unfortunately, these organizations are often unprepared for this clinical challenge. The Behavioral Health-Works (BH-Works) suicide risk management system may offer a potential solution to this problem. BH-Works is an evidence-based, comprehensive youth suicide prevention program. It offers support for policy development, staff training, suicide and behavioral health screening, technology-assisted safety planning, an electronic patient referral system, real-time data analytics for program monitoring, and a learning collaborative structure to support sustainability. All functions are supported on a web-based software platform that facilitates implementation, adoption and expansion. BH- Works has been used in both clinical and non-clinical settings. In this project, we will adapt this program for LGBTQ organizations. This project builds upon robust partnerships with two diverse LGBTQ organizations (Mazzoni Center, in Philadelphia and Diversity Camp Inc., in rural Southwest, Virginia) and partnering behavioral health sites. We will use an Effectiveness-Implementation Hybrid Type 2 design (Curran et al., 2013) with a historical comparison group to pilot the BH-Works program within the two LGBTQ organizations. Informed by the Consolidated Framework for Implementation Research, we will pilot test a sequenced implementation strategy. This strategy focuses on promoting engagement, building partnership, , and creating sustainability In Year 1, we will collect treatment as usual data, work with our partners to adapt BH-Works content, practices, and workflow. We will also train staff/providers in suicide risk management, family engagement and affirmative care. In Year 2, we will begin pilot testing the SGM BH-Works screening and referral systems. We will evaluate primary program outcomes (increased suicide identification and successful referrals), secondary outcomes (program acceptability), and explore program mechanisms (training impact, partnership development, software usability and caregiver involvement). The proposed research responds to the growing national need to identify and refer vulnerable youth at risk for suicide. A future R01 will test program effectiveness with a larger sample and different implementation strategies.

PROJECT NARRATIVE Sexual and gender minority (SGM) youth are at higher risk for suicidal ideation and attempts than their heterosexual and cisgender counterparts; yet, this community faces many barriers that complicate the implementation of suicide prevention programs. In this project, we aim to adapt, implement and test an empirically-informed, multicomponent youth suicide prevention program, Behavioral-Health Works, in organizations serving this population. We will evaluate primary program outcomes (increased suicide identification and successful referrals), secondary outcomes (program acceptability), and exploratory program mechanisms (training impact, partnership development, software usability, and caregiver involvement).