Suicide rates among American Indian Alaska Native (AIAN) children and adolescents are the highest in the United States. Risk factors for suicide among AIAN youth include: strained interpersonal relationships, family instability, depression, low self-esteem, and alcohol use or substance abuse. Protective factors include: caring family relationships, supportive tribal leaders, and positive school experiences. Carefully planned, culturally sensitive, comprehensive programs that address the social determinants of health outcomes such as poverty, school failure, familial conflicts, and limited access to health care, should be the focus of blueprints for change for these vulnerable children. Moreover, culturally competent providers are key elements associated with reducing the suicide rates among AIAN children and adolescents.