teen Mental Health First Aid (tMHFA) is a training program for teens brought to the United States by the National Council for Mental Wellbeing. It teaches teens in grades 9-12, or ages 14-18, how to identify, understand and respond to signs of a mental health or substance use challenge in their friends and peers. The training gives teens the skills to have supportive conversations with their friends and teaches them how to get help from a responsible and trusted adult.
Iowa’s Prairie Lakes Area Education Agency (PLAEA) has successfully implemented tMHFA in multiple schools since the National Council for Mental Wellbeing began piloting the tMHFA program during the 2019-2020 academic year. Through its ongoing relationship with the National Council’s Mental Health First Aid (MHFA) Client Success Team, PLAEA shares details of its strategic planning for implementation, challenges and best practices, and overall experience to inspire others to pursue a tMHFA training and supportive environment for teens.
In addition to tMHFA, PLAEA implements Youth MHFA as implementation of Youth MHFA is a requirement for the tMHFA program. Youth MHFA, is designed for adults who regularly interact with young people ages 12-18, presents common mental health challenges, reviews typical adolescent development, and teaches a 5-step Action Plan for helping young people in crisis and non-crisis situations. Implementing both products promotes shared language adults and teens can use when addressing and discussing mental health and/or substance use challenges.
“PLAEA developed a behavior health team in 2019, and one of the priorities was offering schools support and learning around mental health. Youth MHFA was the gold star in training and that is what we used. When tMHFA was offered nationally (following the pilot), it was an obvious, natural progress for teaching the signs and symptoms of mental health challenges to an additional and important population — high school students. We believed that by teaching Youth MHFA to the educators and tMHFA to the high school students, we were widening the safety net of noticers who had the knowledge and understanding to help others possibly experiencing a mental health challenge or crisis,” said Kim Bodholdt, school emotional behavior health consultant.
As of February 2024, PLAEA has 30 certified tMHFA Instructors that serve 16 of 30 schools within their service region. In 2023, they trained over 1,000 teens.
Data from teens’ pre- and post-evaluations, reviewed in April 2024, shows that completing the tMHFA program increased teens’ confidence in helping a peer who may show signs of suicidality. In the post-evaluations, 36.7% of teens said they would tell an adult if they were worried about a friend or peer showing signs of suicide — up from 25% in the pre-evaluations. Similarly, 25.8% of teens reported in post-evaluations they would ask a friend if they were thinking of suicide, a significant jump from 8.9% in the pre-evaluations.
| Response | Pre-evaluation | Post-evaluation |
| Would tell an adult if they were worried about a friend or peer showing signs of suicide. | 25.0% | 36.7% |
| Would ask their friend if they were thinking of suicide. | 8.9% | 25.8% |
Overall, 88.5% of teens in Prairie Lakes Area Education Agency said they would recommend tMHFA to a friend.
The tMHFA program offers tMHFA Instructors resources to ensure teens’ safety is maintained during implementation. Resources include guidance on creating a safety protocol to cover procedures on immediate follow-up with a teen that may experience a crisis or be in distress, discuss tMHFA course content, talk with a teen that staff may be concerned about, and review of the Exit Ticket process. The exit ticket process provides a way for learners to let the Instructor(s) know if they want someone to check in on them or a friend. Implementing sites must also utilize mental health professionals on site as needed and inform parents/guardians/caregivers about what’s involved in the tMHFA program.
“Over time we have learned a few tips and tricks that have allowed our trainers to be successful in teaching teen MHFA to their students,” Bodholdt said. “We encourage schools to teach tMHFA to their 10th grade students in the fall of their sophomore year. This maximizes the number of students who are trained in tMHFA in a high school. After teaching tMHFA for three years, 75% of the student body will be trained.” According to PLAEA’s Mental Health Awareness Training (MHAT) grant Impact Report, 90% of the students that completed tMHFA reported that the program improved their understanding of mental health challenges and how to help a friend. Additionally, 93.7% of educators reported being more confident in assisting a teen with a possible mental health challenges after taking the YMHFA course.
tMHFA Instructors are also encouraged to discuss their experiences delivering the program with each other or their tMHFA Site Coordinator. Bodholdt added, “Our agency offers opportunities for our teen MHFA Instructors to collaborate and share best practices with each other on a regular basis.
tMHFA became available in the United States around the onset of the global COVID-19 pandemic, and the National Council pivoted to make tMHFA accessible in a virtual or hybrid learning environment. Despite these changes, PLAEA continued to implement the tMHFA program with fidelity, ensuring they were following processes correctly by maintaining communication with MHFA team members.
Bodholdt explained that finances were the largest barrier to implementation, which led them to apply for the Substance Abuse and Mental Health Services Administration (SAMHSA) MHAT grant. “Many schools did not have the available funds to train a staff member to teach tMHFA to the students and purchase [teen] manuals. Our agency applied for and received a MHAT grant to cover those costs, making it free to schools to offer tMHFA for the life of the grant (five years). This has allowed us to now teach tMHFA in 16 districts in PLAEA, with more schools choosing to join each year. Last year, 90% of the students who completed the tMHFA curriculum stated that the curriculum improved their knowledge and understanding of mental health challenges and their ability to help a friend.
“Our first school staff were trained virtually in July 2020 to teach tMHFA. This was obviously a challenge due to the pandemic … but our agency and our schools also felt this was the perfect opportunity to teach students about tMHFA because we knew the effects of the pandemic were potentially detrimental to mental health.”
There is not a one-size-fits-all style for implementing the tMHFA program in schools or youth-serving organizations. A primary challenge faced by many schools is determining the logistics of how to fit the tMHFA program into a regular school schedule while abiding by the implementation requirements and staying on track with standard course curricula. Bodholdt added, “Our agency serves 36 public and 11 non-public school districts, and each is different and unique. We have worked with each district interested in offering tMHFA to their students to develop a plan that works for them and also meets the criteria for the National Council for Mental Wellbeing.”
PLAEA’s district-wide implementation of tMHFA, demonstrated the meaningful and measurable impact this program can have on the wellbeing of high school students.
Visit MHFA.org/teens to learn how you can bring tMHFA to your school or youth-serving organization. To learn more about how to identify, understand and respond to signs of mental health and substance use challenges in others, find a MHFA training in your community.
