The Oregon Adult Zero Suicide (ZS) Initiative will focus on adults (age 25+) in 6 Oregon counties (Clackamas, Deschutes, Jackson, Josephine, Multnomah and Washington). An estimated 14,308 at-risk adults will be served, 2,808 healthcare providers will be trained, and statewide infrastructure supports will eventually serve 100% of adults at risk for suicide who come into contact with Oregon health systems. The project goal is to establish evidence-based, systematic, suicide-safer care across Oregon through the development of sustainable mechanisms to support ZS in all HS statewide and direct implementation of ZS in 12 systems with added supports for high-risk sub-populations: older adults, veterans, and Oregonians with severe mental illness (SMI). Objectives include the following: 1) hire a project director, 2) convene a statewide ZS advisory committee, 3) conduct an assessment of statewide ZS implementation, 4) expand the online Oregon ZS toolkit, 5) train at least 360 healthcare providers to train others in the ZS framework, 4) require ZS implementation for Community Mental Health Programs, 5) fund two advance practice health systems to solidify system-level initiatives and provide support to health systems in earlier phases of ZS adoption; 6) host a ZS Academy for at least 12 health systems, 7) launch a ZS community of practice, 8) host an advanced practice ZS event, 9) identify and address barriers to implementing Oregon Administrative Rules related to discharge and care transitions, 10) develop supports for ZS implementation for regional Medicaid Coordinated Care Organizations, 11) complete a needs assessment and disparity issue briefs for older adult, SMI and Veteran populations, 12) convene advisory committee workgroups to guide work with these populations, 13) develop training tools to address the needs of the disparity populations, 14) award at least three mini grants to pilot ZS-related system changes specific to older adults, SMI and/or Veteran populations, 15) evaluate the pilot programs and share findings, 16) enable at least 12 health systems in Oregon to actively implement ZS with high fidelity to all 7 ZS elements, and 17) ensure that 100% of discharged at-risk adults at ZS EDs and psych units in the 12 ZS systems receive referrals, safety planning, and at least one follow-up contact.