Oklahomans Helping Achieve Needed Access (OHANA): Zero Suicide Implementation, Mobile Crisis, and Health Home Teams in 7 Rural Counties - CREOKS Mental Health Services, Inc. CCBHC project addresses the rising suicide rate in seven counties in Oklahoma by expanding screening and treatment, fielding a children's mobile crisis team, and providing outreach to the at-risk populations of LGBTQAI2S+, Native Americans, and Veterans. CREOKS will also address the specific needs of children 0-8 with serious emotional disturbance (SED) and developmental disabilities (DD) through specialized Health Home teams. From 2018-2020, while the death by suicide rate went down nationally by almost 5%, it rose almost 10% in Oklahoma. The situation is particularly alarming for Oklahomans disproportionately affected by the social determinants of health including Native Americans, Veterans, and LGBTQAI2S+. Native Americans have a 1.8 times higher suicide rate than the general public; Veterans have a 52% higher rate; and LGBTQAI2S+ youth have a 4 times higher risk than other youth. The "Oklahomans Helping Achieve Needed Access (OHANA): Zero Suicide Implementation, Mobile Crisis, and Health Home Teams in 7 Rural Counties" CCBHC advancement project will serve the 306,605 inhabitants of the seven counties of Adair, Cherokee, Creek, Okfuskee, Okmulgee, Sequoyah, and Wagoner with a special emphasis on the 30% who are Native American, the 7.2% Veterans, and the 7.1% LGBTQAI2S+. The overarching goal is to reduce suicide in the general public and these communities by strengthening CREOKS' implementation of the Zero Suicide Model, improving access to integrated behavioral health, expanding the use of evidence-based practices (EBPs), and establishing effective transitions of care. CREOKS will also pilot integrated care Wraparound teams to address the need for specialized services for children with co-occurring SED and DD ages 0-8. Research and local human serving agencies indicate that standard behavior therapies are not adequately addressing the needs of children on the autism spectrum or having ADHD. Strategies to be employed include: 1) conducting a Zero Suicide Organizational Study incorporating input and participation of the high-risk populations; 2) enacting care agreements with community agencies serving high-risk populations to embed behavioral health staff to conduct screening and engage persons in treatment; 3) establish inpatient care transitions; 4) train staff in the evidence-based practices of AFFIRM, CAMS, DBT, Critical Time Intervention, Mental Health First Aid, and Stanley-Brown Safety Planning; 5) Provide community suicide awareness and prevention training to families, civic groups, non-profit and social service agencies through Talk Saves Lives and Mental Health First Aid; 6) field a full-time children's mobile crisis team and integrated Health Home Wraparound teams; 7) improve post-discharge follow-up for engagement to treatment; and 8) make enhancements to the electronic health record to prompt and track adherence to the suicide care pathway and EBPs funded by the OHANA project. Outcomes are measured by the reduction in suicides in these counties, engagement of screened persons in treatment, percentage of people completing the suicide care pathway, mobile crisis diversion rate, persons receiving an outreach service within 12-24 hours post discharge, the 30-day follow-up rate post discharge, and improvement in functioning and reduction in impairment of children enrolled in the Health Home teams. A total of 800 unduplicated persons will be served over four years, with 175 in year one, 225 in year two, 225 in year three, and 175 in year four.