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One Tier 2 approach to school-based youth suicide prevention is gatekeeper training, where teachers and school staff learn to respond to students in distress. Although promising, implementation-sensitive prevention efforts could be advanced by providing additional training to natural leaders in the school building, so they can support and coach others. The purpose of this study is to describe the development and initial mixed-methods pilot evaluation of a natural leader training to support the real-world implementation of QPR® gatekeeper training, a Tier 2 (selective) intervention. This study underscores the importance of creating implementation approaches to meet the needs of real-world school contexts.

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