American Indian (AI) adolescents have the highest suicide death and attempt rates of any U.S. group, yet few interventions have been developed or evaluated for this population. This paper presents the first adaptation of a brief evidence-based intervention for AI adolescents from one reservation who made a suicide attempt. We describe our community-driven approach to intervention development and a small pilot study (n = 13). Preliminary findings indicate reductions in adolescents' negative thinking, depression, and suicidal ideation, and an increase in psychological service utilization. Key innovations include delivery by AI paraprofessionals and potential to strengthen the continuum of care between emergency department and outpatient settings.