The primary objective of this study was to build and test a virtual reality (VR) intervention that teaches adolescents hospitalized for suicide-related risk therapeutic skills and provides them opportunities to practice using these skills in immersive VR scenarios. The Practice Experiences for School Reintegration (PrESR) is facilitated by a clinician to help hospitalized adolescents prepare for their return to school. Our model was informed by input from adolescents with lived experience, school professionals, and hospital professionals, and the intervention was built and iteratively refined based on feedback from a community sample of adolescents (n=6), adolescents previously or currently hospitalized for suicide- related thoughts or behaviors (n=13), and hospital professionals (n=8). This paper describes the iterative development and refinement process leading to the final PrESR intervention, which is currently being tested in a pilot optimization trial.