The suicide rate has increased 28% over the past two decades while heart disease, diabetes, and cancer mortality has declined. Starting in 2011, new standards have led to improved adoption and reach of suicide risk surveillance in primary and specialty care. Treatment, however, has lagged. Collaborative Care (CoCM) in primary care settings has demonstrated small but significant reductions in suicidal ideation when a recognized psychological treatment model is included but not when Collaborative Care only includes medication management, suggesting that improvements to psychological treatments in Collaborative Care could further improve suicide outcomes. Developed in a series of conferences in Aeschi Switzerland, the “Aeschi Model” based on the clinical narrative has become an established approach to suicide care endorsed by leaders across the suicidology field – including the developers of major evidence-based suicide interventions. With support from the Methods Core, this Exploratory (R34) study of the University of Washington Practice-Based Suicide Prevention Research Center will co-design and pilot test the Aeschi Model in Collaborative Care (AM-CoCM) to intervene at the treatment and follow-up steps on the suicide care pathway with adolescent and young adult patients in Collaborative Care who do not require immediate crisis intervention. This study will focus on increasing therapeutic alliance – a key proposed mechanism of the Aeschi approach and the Center. The aims of AM-CoCM are to partner with the University of Washington Primary Care clinics to (1) Co-design Aeschi and Collaborative Care intervention components into AM-CoCM with health care providers, adolescents and young adults with a history of suicidality, and family members of suicidal patients through human centered design; (2) Conduct iterative treatment development of AM-CoCM to test and refine usability, and then (3) Conduct a pilot test of the AM-CoCM intervention components compared to treatment as usual in six primary care clinics to determine (a) usability and acceptability of the intervention components to patients and providers and (b) the components' potential impact on therapeutic alliance and patient and provider self-efficacy, and (c) potential impact on suicidal outcomes. Given the strong theoretical basis for AM-CoCM, this proposal has the potential to develop a high impact intervention for the treatment and follow-up steps of the suicide care pathway in Collaborative Care that will reduce suicide risk and improves therapeutic alliance – potentially without any increase in the quantity of care.