This case study was first developed in 2024; the data reflects that timeline.
In 2019, the National Council for Mental Wellbeing began piloting teen Mental Health First Aid (Teen MHFA), an evidence-based training program that teaches students in grades 9-12 (ages 14-18) how to recognize signs of mental health or substance use challenges among their peers.
Shortly after the national pilot program, Iowa’s Prairie Lakes Area Education Agency (PLAEA) began integrating Teen MHFA into a broad, coordinated approach to youth mental health education. 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.
The success of the Teen MHFA program has been evident. As of February 2024, in PLAEA:
30
certified TMHFA Instructors are active
16 out of 30
of the population may school regional school districts have implemented MHFA
1,000+
students trained in 2023 alone
“We encourage schools to teach TMHFA to their 10th-grade students in the fall of their sophomore year. After teaching TMHFA for three years, 75% of the student body will be trained”
— Kim Bodholdt, School Emotional Behavior Health Consultant, PLAEA
Building a Layered Safety Net
PLAEA implemented TMHFA as part of a broader behavioral health strategy focused on strengthening mental health awareness and response across schools.
A key component of this strategy was pairing TMHFA, for students, with Youth MHFA, which is for adults who work with young people ages 12-18.
“Youth MFHA was the gold star in training, and that is what we used,” said Kim Bodholdt, school emotional behavior health consultant. “When TMHFA was offered nationally, it was an obvious, natural progression for teaching the signs and symptoms of mental health challenges to an additional and important population — high school students.”
By training both adults and the students they worked with, PLAEA promoted a shared language for mental health across school communities.
“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,” Bodholdt said.
Data-driven Results
Evaluation data collected from student pre- and post-assessments demonstrates clear improvements in teens’ confidence and willingness to respond to warning signs of suicide in their peers.
| 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% |
Further student feedback highlighted strong overall impact:
- 88.5% of students said they would recommend TMHFA to a friend.
- 90% reported improved understanding of mental health challenges and how to help peers.
Educators experienced similar gains: 93.7% of adults who completed Youth MHFA reported increased confidence in supporting a teen with a potential mental health challenge.
Safe and Supportive Implementation Practices
Discussions around mental health and substance use challenges are essential, but they can be difficult. That’s why MHFA builds support systems into each training. Certified Instructors are supported with tools and protocols to ensure participants’ wellbeing throughout delivery.
Resources include clear communication with parents and caregivers about program content and supports, safety protocol for follow-ups with participants who may be in distress, and use of Exit Tickets at the end of each session, allowing students to discreetly request follow-up support.
Overcoming Challenges
TMHFA became available nationally at the onset of the COVID-19 pandemic. As schools and workplaces around the world pivoted to new working models, the National Council followed, making MHFA accessible in both virtual and blended (hybrid) formats.
“Our first school staff were trained virtually in July 2020 to teach TMHFA,” Bodholdt said. “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.”
“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.” — Kim Bodholdt
Financial barriers initially limited schools’ ability to participate. In response, PLAEA secured a Mental Health Awareness Training (MHAT) grant from the Substance Abuse and Mental Health Services Administration.
“Many schools did not have the available funds to train a staff member to teach TMHFA to the students and purchase manuals,” Bodholdt said. “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.”
Moving Forward
PLAEA’s implementation of TMHFA and Youth MHFA shows that when schools invest in coordinated, data-informed mental health education, the results are measurable, scalable and sustainable.
By giving teens necessary, life changing resources, increasing confidence in suicide prevention behaviors and aligning adult and student training, PLAEA has built a replicable model for strengthening mental health support systems in schools nationwide.
