This article reviews the prevalence of suicide and suicidal ideation among American Indian adolescents. Unique risk and protective factors are reviewed for this population. Historical trauma and its associated symptoms are then described within a cumulative stress model of precipitating factors leading to American Indian adolescent suicide. The need for culturally-sensitive interventions is underscored. An example of a reservation-community initiated intervention, the American Indian Life Skills Development Curriculum, is provided. Once the development and evaluation of the intervention is reviewed, innovative uses of the intervention implemented by American Indian community gatekeepers are described. Psychological interventions respectful of American Indian history, healing traditions, cultural norms and traditional values are highly recommended with this population, especially in reservation settings.