Adolescent refugees from the Middle East and North Africa (MENA) region face significant acculturation challenges and stressors in the United States. This qualitative study draws upon the integrated motivational-volitional model to understand MENA-background adolescents’ psychosocial wellbeing and suicide risk in three U.S. cities. Local service providers served as key informants ( n = 27), sharing in-depth reflections on supporting newcomer students in education, mental health, and refugee services. Analysis also includes focus group discussions with MENA-background adolescents ( n = 11) who participated in a photovoice activity. Four key themes emerged: (1) acculturation stressors; (2) influence of family contexts; (3) community belonging, expectations, and support; and (4) school belonging. Service providers and students described adolescents’ challenges in navigating dual identities, conflicting expectations, and strong cultural norms surrounding gender and mental health. Implementation and evaluation of interventions to address both systemic and identity-based acculturative challenges are central to improving mental health and reducing suicide risk among this population.