The requested funding will enable the Tule River Indian Health Center, Inc. (TRIHCI) to implement the Youth Connections Expansion Project. The project will expand and enhance the organization’s Youth Connections Project and continue to establish a healthy network of systems, services, and partnerships to help prevent and reduce suicidal behavior and substance misuse, reduce the impact of trauma, and promote mental health among American Indian/Alaska Native (AI/AN) youth up to age 24 living in Tulare County, California (CA). The TRIHCI serves 2,500 Native Americans on and off the reservation. The highest percentages of AI/AN residents in Tulare County are in Porterville and Visalia. The reservation is an identified economically disadvantaged community. The per capita income on the Tule River Indian Reservation is $24,276, which is two-thirds the amount of the U.S. $37,638 per capita income; and 43% of Tule River children under 18 live in poverty. In Tulare County, 24% of AI/AN 7th graders had 3+ monthly absences from school, much higher than any other race; 26% experienced chronic sadness/hopelessness, 10% have considered suicide, and 4% use alcohol/drugs. In 2022, of the youth served by TRIHCI, no suicides, no substance overdoses, one suicide attempt, and two suicide ideations were recorded. However, TRIHCI staff are well aware that incidents of suicide, overdose, suicide attempt, and suicide ideation among youth are drastically underreported. According to post-event reports from patients/loved ones to TRIHCI staff who live on the reservation, an estimated 10-15 non-fatal, unreported overdose incidents occur monthly and many overdose deaths on the reservation are reported as “accidental” due to the stigma/shame of an overdose for tribal members. Historically, incidents related to suicide on the reservation have been reported as accidental deaths based on law enforcement policy to only identify a death as a suicide if a suicide note is present. Far too many incidences go unreported, which means youth who need intervention services are not being identified or served. TRIHCI is aware that this protocol presents a distorted impression of the growing risk of suicide among tribal youth and limits TRIHCI’s ability to identify youth and loved ones at risk of suicide clusters. Relatives and friends of suicide victims are 65% more likely to attempt suicide than if the person died from natural causes. The risk of attempted suicide is one in 10 if the relative or friend died of suicide.10 Individuals who self-injure are nine (9) times more likely to attempt suicide, and many individuals who report self-harm also describe chronic suicidal thoughts at the time of injury. Underreporting suicide puts AI/AN youth at significant risk. The goals of the project are: 1) develop and implement transparent, practical crisis protocols in an emergency, including follow-up procedures to care for at-risk youth; 2) strengthen infrastructure support in the fight against youth suicide/substance misuse; 3) expand and enhance accessible youth-focused behavioral health care, grounded in the AI/AN traditions in Tulare County; 4) enhance Protective Factors to build resilience against suicide and substance misuse among AI/AN youth up to age 24; 5) reduce the impact of risk factors for suicide and substance misuse in AI/AN youth; and 6) implement Tier III strategies to provide interventions for AI/AN youth with higher level needs related to risk of suicide and/or substance misuse. The Youth Connections Expansion Project will establish a stakeholder advisory board, establish a youth advisory board, complete a community needs assessment, complete a community readiness assessment, and develop and implement a tribal strategic action plan.