Reducing youth suicide in the U.S. is a national public health priority. Sexual and gender minority adolescents are at elevated risk for suicide. Safer school environments, however, can decrease this risk. This study capitalizes on the critical role of school nurses in improving the mental health of this vulnerable population through implementation and sustainment of evidence-based strategies to enhance school environments. In addition to suicide, the conceptual framework and methods for this novel, nurse-led intervention can be applied to address the health-related concerns of other pediatric populations encountered in school settings as well.

Reducing youth suicide in the U.S. is a national public health priority. A supportive and safe school environment is pivotal to preventing youth suicide, and schools are now widely accepted as part of the de facto mental healthcare infrastructure for adolescents. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth are at elevated risk for suicide. Safer school environments decrease this risk. The school nurse is well positioned to implement evidence-based (EB) strategies to enhance school environments and improve the mental health of all students, particularly members of this vulnerable population. These strategies include the creation of "safe spaces," adoption of harassment and bullying prohibitions, improved access to community health and mental health providers experienced in working with youth and LGBTQ people, school staff development, and incorporation of LGBTQ-specific information into health education curricula. These strategies promote positive mental health outcomes for LGBTQ youth, and their cisgender, heterosexual peers as well.

The investigators of this nursing intervention model is called "RLAS" (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide). The model builds on the Exploration, Preparation, Implementation, and Sustainment conceptual framework and the Dynamic Adaptation Process (DAP), a structured methodology for implementing the EB strategies. The DAP accounts for the multi-level context of school settings, facilitates appropriate expertise and feedback to make them "implementation ready," and provides for targeted training of school nurses. Per the DAP, the nurses and other school professionals will convene and lead Implementation Resource Teams (IRTs) consisting of counselors, social workers, health educators, and youth. With the guidance of coaches, the IRTs will engage in an iterative process of assessment and planning to build school capacity and implement the EB strategies. To evaluate this model, the investigators will combine qualitative methods with population-based surveys and pursue three specific aims.

First, the investigators will utilize the DAP to enable specially-trained nurse champions and IRTs to implement and sustain EB strategies to address the needs of LGBTQ high school students. Second, the investigators will conduct a cluster randomized controlled trial (RCT) to assess whether sexual minority students and their peers in RLAS schools report reductions in suicidality, depression, substance use, and bullying, and increased safety compared to those in usual care schools. Third, the investigators will examine the individual, school, and community factors influencing both implementation and outcomes. The RLAS keeps with national priorities to: (a) improve school-based services for pediatric populations; (b) focus on LGBTQ youth mental health; and (c) revolutionize the role of nurses in U.S. healthcare. Through its collaborative processes to refine, improve, and sustain EB strategies in these systems, the RLAS also represents a novel and innovative contribution to implementation science.

Inclusion Criteria for schools:

• Located within New Mexico;
• Designated public high school;
• School nurse that is willing and available to support the RLAS intervention and to lead and convene an IRT; and
• School administrator that is willing and available to support the RLAS intervention.

Exclusion criteria for schools:

• Unable to participate in the NM-YRRS.