Leadership Principal Investigators: Dedra S. Buchwald, MD Hub Activity Sites Seattle Indian Health Board, Seattle, Washington Project Overview Urban American Indian/Alaska Native (AI/AN) young adults are at high risk for attempted suicide and for serious mental disorders, substance abuse, gang activity, teen pregnancy, and interpersonal violence. Although many AI/AN youths reside in urban areas, there is limited research to inform the best prevention strategies to address the high rates of suicide among urban AI/AN young adults. Most people who die by suicide have contact with a primary care provider in the prior year, and many are seen in the month before their death. “Screening, Brief Intervention, and Referral to Treatment” (SBIRT) is an evidence-based practice that co-locates behavioral health clinicians in primary care teams and substantially reduces suicide risk through immediate intervention by behavioral health clinicians. However, retention in SBIRT has been a challenge and it has not been tested in urban AI/AN communities to screen for suicidal thoughts or behaviors. This effort will address suicide risk and disparities in receiving prevention support in AI/AN urban young adults ages 18-34 via a multilevel approach targeting both the healthcare system and the individual.