The training and research aims of this proposal are intended to provide the applicant with the skills necessary to become an independent mental health services investigator capable of studying the processes and outcomes of care received by adolescents following a suicide attempt. Each year in the U.S., nearly 700,000 adolescents receive medical attention following a suicide attempt. Improvement of outcome after a suicide attempt has important economic and public health implications. Despite the scale of the problem, our knowledge of how to provide effective care to suicidal youth remains limited. The career development and research programs will build on the applicant's strong training in psychiatric epidemiology and biostatistics and provide him with additional skills in (1) health services and quality of care research, (2) clinical assessment and decision-making, and (3) qualitative research methods. These goals are consistent with NIMH's recommendations of bridging science and service. The research aim of this application is to conduct a mixed-methods study of the quality of care received by adolescents following a suicide attempt. The first project will be a qualitative evaluation of adolescent suicide attempters and their parents to develop an in-depth understanding of perceptions of ideal characteristics of care, family and service barriers to care, and issues that promote or impede adherence to treatment recommendations. The second project will be a naturalistic, longitudinal follow-up investigation of a consecutive sample of 180 adolescents who present to the Western Psychiatric Institute and Clinic's emergency room (ER) following a suicide attempt. Subjects will be re-interviewed 3 months following their initial ER admission. The primary goals of this project will be to characterize youth who receive or fail to receive elements of guideline recommended care following a suicide attempt, and identify demographic, psychosocial, and clinical patient characteristics associated with receiving GRC. As an exploratory aim, we will probe whether failing to receive guideline recommended care increases the risk of repeated suicide attempt, controlling for known risk factors of reattempt. Together, these projects will inform the design of a future R01 proposal aimed at studying quality of care factors and outcome for at-risk youth across a broader range of service providers and treatment settings.