PROJECT ABSTRACT Over 44,000 people die annually by suicide in the United States (US) making suicide the 10th leading cause of death overall and the second leading cause of death among those 10-44. In addition, 9.8 million adults contemplate suicide annually, and one million will make a suicide attempt. From 2006 to 2013, the rate of ED visits for suicidal ideation among adults increased by 12% on average annually. While millions are devoted annually to prevent suicide, suicide rates are rising in the US. Our ultimate aim is to reduce deaths by suicide while also reducing unnecessary hospitalization, emergency department (ED) and hospital readmissions, and stop the revolving-door of acute crisis care through the use of innovative technologies. In Phase I, we proposed to: (1) develop and scientifically validate an avatar for use by suicidal ED patients that delivers the Collaborative Assessment and Management of Suicidality (CAMS), an efficacious and cost-effective intervention developed by David Jobes, PhD; and (2) to design clinical support tools and Just-in- Time training for use by ED medical providers to enhance their delivery of an evidence-based suicide protocol and facilitate an evidence-based approach to discharge disposition. Our work was also guided by Phase I reviewers’ concerns. We fully met and exceeded project aims. Most notably, we created a 15-minute avatar (“Dr. Dave”) who performed a portion of the CAMS Suicide Status Interview which was well-liked and described as helpful by suicidal ED patients who interacted with “Dr. Dave.” In Phase II, we propose to complete the development of Virtual CAMS patient and provider tools and to ready it for EHR integration into EPIC. We will again use an agile process of development and seek feedback from target end-users. A diverse group of advisors will consult to us to ensure product excellence and readiness for commercialization. To ensure thorough testing of the product’s provider and patient tools, we will use a two-condition, randomized study to evaluate Virtual CAMS’ efficacy in preventing suicidal behaviors and inappropriate/unnecessary hospital admissions, and improving self-efficacy for coping with acute distress.