Suicide in Missouri is a significant public health issue that has taken the lives of 8351 individuals over the last decade. The recognition of suicide as an imminent concern has led to the development of evidence-based prevention programs to decrease suicide-related mortality. One program, question, persuade, refer (QPR), has become the most widely-distributed gatekeeper training program in the world. This article presents both immediate and 2-year follow-up analyses of QPR trainees who work with youth, specifically examining changes in knowledge, self-efficacy, and help-giving behaviors. Results indicate both short- and long-term positive outcomes in knowledge and self-efficacy, supporting use of QPR.