The proposed study is part of the research project for a National Institute of Mental Health K01 grant to Dr. Haroz. The overall research project is focused on understanding how to sustain evidenced-based mental and behavioral health programs in tribal contexts. The aim of this study is to pilot test sustainment strategy interventions across tribal settings using mixed-methods.

Among the most pressing issues in mental health Dissemination and Implementation research (D&I) is the lack of knowledge about how to sustain mental health prevention and treatment services for which there is substantial evidence of impact. Most D&I studies focus on adoption and initial implementation, with few studies (<20) rigorously exploring sustainment. The sustainment of services has been described as "one of the greatest, yet least understood, challenges in the field of implementation science." The gap in knowledge is even greater for low-resource contexts, as few studies have focused on these settings. This project aims to address this gap by developing and testing sustainment strategies for an evidenced-based youth suicide prevention program in a low-resource, American Indian (AI) contexts.

Inclusion Criteria:

• Knowledgeable about the implementation of the suicide prevention program
• Over the age of 18
• Available to participate in required study meetings and assessments
• Fluent in English

Exclusion Criteria:

• Factors identified at baseline that preclude full participation including: being under the influence of a substance; active psychosis or mania; any other condition that makes an individual lack capacity to give consent.

There were no adverse event tracking or reporting. It was declared non-human subjects research as it focused on understanding implementation.