EMPLOYING YOUTH MENTAL HEALTH FIRST AID

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Employing Youth Mental Health First Aid in the Foster Care and Adoption Community

Kaila M. Gregg
Edson College of Nursing and Health Innovation, Arizona State University

Author Note
Kaila M. Gregg is a graduate student in the Edson College of Nursing and Health
Innovation at Arizona State University and a Registered Nurse.
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Kaila M. Gregg, Edson
College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd Street, Phoenix,
AZ 85004 email: Kaila.lovingier@asu.edu

Abstract

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Background and Purpose: Children involved with the child welfare system have a higher
incidence of mental health challenges, and it remains their number one unmet need. Foster,
kinship, and adoptive (resource) parents are often left to handle these challenges without
training. This project aims to implement an evidence-based practice to increase mental health
literacy for resource parents.
Materials and Methods: An agency in the southwest region of the United States that supports
and trains resource parents provided training in Youth Mental Health First Aid (YMHFA). IRB
approval from Arizona State University for an exempt status was secured. Six resource parents
consented to participate in this evidence-based project using the Mental Health Literacy Scale
(MHLS) via a pre- and post-questionnaire to evaluate the effectiveness of YMHFA training. All
participants who completed the course received a certification in YMHFA. Survey Monkey was
used to send the pre and post-MHLS questionnaire to those participants who consented to
participate.
Results: Descriptive statistics and a two-tailed paired samples t-test using Intellectus Statistics™
were completed. Caucasian female participants 4 (67%) made up the majority of participants.
The results were insignificant based on an alpha value of 0.10, t(5) = 1.97, p =.107, indicating
the null hypothesis cannot be rejected but is moving towards significance.
Discussion and Conclusion: The finding suggests the difference in the pre and post-MHLS was
not significant from zero, but the effect outcome variable was high, d=0.80, indicating it was
moving towards significance. The impact of this study is that training may increase resource
parent's ability to recognize signs and symptoms of mental health challenges.
Keywords: Foster care, foster parent, mental health literacy, youth mental health first aid
Employing Youth Mental Health First Aid in the Foster Care and Adoption Community

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Children in or adopted out of foster care are often susceptible to higher rates of mental
and behavioral health challenges. Foster parents, kinship parents, and adoptive parents (resource
parents) are often the first to recognize these challenges in the children they care for. This unique
position allows them to act as mental health gatekeepers. However, knowing what to assess for,
asking for help, and handling a crisis can be overwhelming. Additional training could potentially
help ease this burden.
Problem Statement
In 2020, the United States had 213,964 children enter the foster care system. The total
number of children in foster homes across the U.S. was 407,493, and 45% lived in non-relative
foster homes (The Annie E. Casey Foundation [Casey], 2022). As of July 2022, 6,641 children in
Maricopa County, Arizona, had been placed in out-of-home care by the Department of Child
Safety. In total, Arizona had 11,494 children in out-of-home care (Arizona Department of Child
Safety [AZDCS], 2022). Research has shown that children in foster care have higher rates of
mental and behavioral health problems and learning delays compared to their non-foster peers
(Keefe et al., 2020; York & Jones, 2017). This includes post-traumatic stress disorder (PTSD),
attention-deficit hyperactivity disorder (ADHD), major depression disorder (MDD), anxiety,
oppositional defiant disorder (ODD), cognitive/learning disorders, mood disorders, and more
(Keefe et al., 2020; York & Jones, 2017).
Upwards of 80% of children in foster care have mental health issues compared with 18
to 22% of non-foster youth. The American Academy of Pediatrics acknowledges that mental and
behavioral health issues are the number one unmet healthcare need of children in foster care
(National Conference of State Legislatures [NCSL], 2019). According to the Suicide Prevention
Resource Center (SPRC) (2014), children in foster care are 2.5 times more likely to think about

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suicide and four times more likely to attempt suicide than non-foster peers. In 2020, youth and
young adults between the ages of 10 and 24 across the U.S. accounted for 14% of all suicides,
which was the third leading cause of death in this age group. For children aged 10 to 14 years
old, suicide is the second leading cause of death (Centers for Disease Control and Prevention
[CDC], 2022; National Alliance on Mental Illness [NAMI], 2020).
Purpose and Rationale
Mental health problems often emerge in adolescence but are not diagnosed or treated
until later in life. There is, on average, an 11-year delay between the onset of symptoms and
treatment (Marsico et al., 2022; NAMI, 2020). Resource parents are crucial in caring for children
with mental and behavioral health issues. Resource parents are often the first to realize there is a
problem, yet stigma, fear of causing more harm, and not knowing how to ask for help can lead to
delays in care (Marsico et al., 2022). The purpose of this paper is to improve mental health
literacy in resource parents through the Youth Mental Health First Aid program.

Background and Significance
The stigma around mental illness, lack of resources, and inadequate mental health
awareness contribute to the increased incidence of mental illness in foster care. Often, it is
believed that individuals with mental or behavioral health issues are dangerous, weak, lazy,
rebellious, or lack intelligence (Noltemeyer et al., 2019; SPRC, 2014). Mental health literacy
aims to recognize mental health as a medical condition. Mental health literacy can help change
negative thoughts and beliefs while increasing confidence to help oneself or others dealing with
psychological distress. Mental health stigma is detrimental, and programs like Youth Mental

EMPLOYING YOUTH MENTAL HEALTH FIRST AID
Health First Aid are working to change this by increasing mental health literacy (Aekre et al.,
2016; Noltemeyer et al., 2019).
Population
Children and adolescents who do not receive adequate mental health treatment are at
higher risk for long-term negative consequences. When left untreated, problem behaviors
increase, leading to multiple home disruptions, decreased chance of reunification with family,
and higher chances of incarceration (Conn et al., 2018; Keefe et al., 2020; York & Jones, 2017).
More than 30% of children in foster care will move placements at least twice per year, and 70%
of incarcerated youth have mental health conditions (Casey, 2020; Conn et al., 2018; NAMI,
2020). When left untreated, mental and behavioral health problems follow children into
adulthood, leading to higher unemployment rates, poor relationship skills, drug use, and
homelessness.
Resource parents are faced with the daunting task of caring for children who often have
more social-emotional issues related to mental and behavioral health problems than their nonfoster peers. Resource parents are often not known to the child before being placed in their care,
yet are expected to provide affection, encouragement, and safety while also setting limits,
redirecting behaviors, and managing mental and behavioral health problems (Conn et al., 2018;
Keefe et al., 2020; York & Jones, 2017). Recruiting and retaining resource parents has become
more complicated in recent years. Additional supports that help families feel connected,
educated, and appreciated could help with this issue.
Intervention(s)
Often, people do not know how to recognize a mental health challenge or help someone
struggling. Lack of education leaves people feeling insecure and unsure of how to approach the

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situation, let alone access resources or treatment (Morgan et al., 2018). Mental Health First Aid
(MHFA) was created to address this problem. MHFA originated in Australia in 2001. Since then,
it has been embraced throughout the United States and globally (Rose et al., 2019; York & Jones,
2017). MHFA aims to improve mental health literacy, decrease stigma, and provide the public
with the tools to support someone developing a mental health challenge or crisis.
Youth Mental Health First Aid (YMHFA) was explicitly created to train laypeople to
interact with adolescents aged 12 to 18 years experiencing a mental health challenge
(Noltemeyer et al., 2019; Rose et al., 2019). YMHFA is an eight-hour course that uses the
mnemonic ALGEE to train people to handle budding mental health concerns. ALGEE stands for
A-Assess for risk of suicide or harm; L-Listen non-judgmentally: G-Give reassurance and
information; E-Encourage appropriate professional help; E-Encourage self-help and other
support strategies (Aakre et al., 2016; Marsico et al., 2022; Noltemeyer et al., 2019; Rose et al.,
2019).
Since 2014, SAMHSA (Substance Abuse and Mental Health Services Administration)
has provided over $15 million to states and educational agencies to provide YMHFA to anyone
with contact with youth. As of 2021, the U.S. has trained over 2.5 million people in MHFA
(National Counsel for Mental Well-being [NCMW], 2021; Marsico et al., 2022).
YMHFA has been widely embraced throughout the U.S., leading to federal initiatives
such as the AWARE program (Advancing Wellness and Resilience in Education). The AWARE
program aims to increase mental health awareness in the school setting. AWARE works to train
school personnel to recognize mental health issues, prepare for how to respond to crises, and
help support families in locating services (Walters, 2021). AWARE's target area is primarily the
public school system.

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YMHFA targets all populations. Rose et al. (2019) evaluated 79 Masters Level Social
Work students at a large mid-Atlantic university. They found that even with foundational and
advanced courses that directly relate to mental health and child development, those who
completed YMHFA had increased knowledge and self-confidence. Aakre et al. (2016) conducted
a similar study on Social Workers who had completed MHFA and had similar results. Morgan et
al. (2020) studied 384 parents with children aged 12 and 15 who completed YMHFA and found
improved knowledge and confidence in helping their children. The children also reported feeling
improved support from their parents. Marsico et al. (2022) looked at parents in a school setting
and had similar results.
YMHFA has three main goals. The first goal is to increase knowledge that will allow the
trainee to recognize psychological problems quickly while also helping to provide appropriate
resources for care. The second goal is to decrease the stigma around mental health so more
people will feel comfortable interacting with this population. Third, trainees will be confident to
help themselves or others needing mental health intervention (Aakre et al., 2016).
PICOT Question
For foster, kinship, and adoptive parents, how does training in Youth Mental Health First Aid,
compared to no training, affect their mental health literacy, confidence in helping skills, and
help-seeking attitude towards the children in their care.
Search Strategy
The Arizona State University Library website was used to access database searches. The
databases searched included Pubmed, ProQuest, PsychINFO, and Grey literature. The PICOT
question was used strategically to guide the search. The grey literature search produced a yield of

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262 studies. This search did not produce any final studies that were not duplicated in other
database searches.
The search on Pubmed database included the combinations of the words Youth Mental
Health First Aid, foster parents, foster care, mental health literacy, and Mental Health First Aid.
Each search term was linked with the Boolean term AND. The initial search produced 679
results. Using the same database, different word combinations, including youth mental health
first aid, foster carer, mental health first aid, and parent, produced 25 studies. This search
produced two final studies that were not duplicated by other searches.
In ProQuest, the search terms foster parents and mental health literacy, linked with the
Boolean term AND, produced 148 initial results. Using the same database with different word
combinations, including YMHFA and MHFA, using the Boolean term OR produced 467 results.
From this, the terms YMHFA and training was used to produce 37 results. Advanced filters were
applied to include peer-reviewed research articles within the last five years and English language
only. The final number of studies obtained was eight.
The PsychINFO database combined the keywords Mental Health First Aid and parents,
producing 238 results. Using the search terms Mental Health First Aid and foster parent, foster
care, and foster produced no results. Using the term Youth Mental Health First Aid produced 11
results. The term MHFA and training with the Boolean term AND yielded 46 results. Advanced
filters again were applied, resulting in a total of nine studies.
Ten final studies were selected and included in the evaluation table (Appendix A). These
studies included two systematic reviews, one randomized control trial, one quasi-experimental
non-randomized comparison group design., one mixed methods study, one qualitative study, and
four non-randomized pre and post-test studies.

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Critical Appraisal and Synthesis of Evidence
Melnyk and Fineout-Overholt’s (2019) rapid critical appraisal was used to evaluate the
validity, reliability, and applicability of the ten studies selected for this literature review. Out of
the ten studies, six looked at the use of YMHFA in the community, one looked at mental health
literacy in the community, and two looked at the resource family perspective. The final two were
narrative syntheses looking at mental health literacy and resource family perspectives. These
studies were published between 2017 and 2022. The level of evidence ranged from II to IV. The
largest sample size was 9,019 parents and caregivers (Hurley et al., 2019). The setting was
primarily in the community and school setting. YMHFA accounted for six interventions studied,
and MHL accounted for another. Resource parent perspective was assessed in the final three. The
heterogeneous measurement tools used included Likert scales, questionnaires, self-reported
written open-ended responses (SRWOR), mixed methods appraisal tool (MMAT), preferred
reporting times for systematic reviews and meta-analysis (PRISMA), manual screening, pre and
post-test assessment (PPTA), strengths and difficulties questionnaire (SDQ), and mental health
beliefs and literacy scales (MHBLS). All six studies using YMHFA reported significant
increases in mental health literacy and confidence in helping skills. A significant increase was
associated with a p < 0.050. Help-seeking intention increased significantly in four studies, while
mental health stigma decreased significantly in four studies.
Conceptual Framework
The Unified Theory of Behavior (UTB) came about in 1991 when the National Institute
of Mental Health (NIMH) came together to examine different behavior change theories and how
they impact treatment. Although they could not agree on the core elements of behavior change,
they did reach a consensus for a general framework that led to the UTB (Lindsey et al., 2012).

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UTB provides a framework for understanding determinants, which are the barriers and
facilitators of change affecting mental health engagement. UTB focuses on the immediate
determinants of behavior and the determinants affecting employment in behavior change,
including willingness and intention (Banh, 2018; Lindsey, 2012). Eleven factors contribute to
behavior change (Appendix B). These include environmental constraints, knowledge and skills
for behavioral performance, intention or decision to perform a behavior, salience of behavior,
habit and automatic processes, attitudes toward behavior, expectancies, social norms, selfconcept/image, affect and emotions, and self-efficacy (Banh, 2018; Lindsey 2012). YMHFA
aims to provide training that addresses these factors by providing the participant with an
interactive class that increases mental health literacy, decreases stigma, and increases helpseeking attitudes.
Evidence Based Practice (EBP) Model
The Rosswurm and Larrabee Model for evidence-based practice (Appendix C) was
selected to guide the implementation of this project. This model utilizes six steps to implement
change. These six steps include assessing the need for change in practice, linking problems,
interventions, and outcomes, synthesizing best evidence, designing a practice change,
implementing and evaluating the change in practice, and integrating and maintaining the change
in practice (Rosswurm & Larrabee, 1999). Resource parents have expressed the need for more
education related to mental health literacy. YMHFA is an evidence-based program designed to
increase mental health literacy within the community. Increasing resource parents’ mental health
literacy through YMHFA can potentially improve mental health outcomes for youth in care.
Methods

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A non-profit organization in the southwest region of the United States has been created to
support resource families caring for youth who have been involved in foster care. With their
help, a project was designed to provide resource parents with YMHFA training while crediting
them with eight hours of continuing education approved by the Office of Licensing and
Regulation (OLR). In addition to this organization, stakeholders in this project included the
resource parents themselves, OLR, the YMHFA instructors teaching the course, and a local
organization that supplied grant funds to cover the cost of the class.
An exempt IRB approval for this project was obtained in July 2023 from Arizona State
University. This project provided resource parents with the benefits of Youth Mental Health First
Aid Training, which outweighed the potential risk for emotional harm. Participants were warned
about content that may have been sensitive, and an instructor was available at all times during
the course to meet with participants if they needed additional support. No additional support was
needed or reported during or after the completion of the course.
Resource parents were invited via the organization's website to attend a YMHFA
training and were also allowed to participate in this study. The training was offered to resource
parents over 18 who could read and write in English, as no translator service was provided for
this class. Consent was obtained before class participation. This class was limited to twenty
people, so the first twenty resource parents to sign up were given access to this intervention
project.
Upon acceptance to the course, a letter of consent and the Mental Health Literacy Scale (MHLS)
pre-questionnaire (Appendix D) was sent to participants via Survey Monkey, inviting them to
engage in the intervention project. Completing the pre-questionnaire and attending the live
portion of the training was used to validate consent for participation in the project.

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Participants completed approximately two hours of the asynchronous YMHFA
curriculum before attending the class's live session. The class was held from 5 PM to 8 PM via a
live Zoom classroom on October 9th and 10th, 2023. After completing the two-day course, the
post-class work was sent out to all participants so they could receive their certification from
YMHFA. A separate email using Survey Monkey was used to send the post-MHLS
questionnaire (Appendix E) to those participants who had completed the MHLS prequestionnaire.
Data Collection Plan
The MHLS Questionnaire was created by O’Conner and Casey (2015) and is a 35-item,
univariate Likert scale used to assess attributes of mental health literacy in individuals and across
populations. This scale takes approximately 5 to 10 minutes to complete, and features include
recognizing disorders, knowledge of help-seeking information, understanding of risk factors and
causes of mental health concerns, how to self-treat, how to get professional help, and attitudes
that support help-seeking behaviors. Demographic information collected included age, gender,
ethnicity, role as a foster parent, adoptive parent, or kinship placement, and how many years they
had been a resource parent. The MHLS and demographics were sent to participants via Survey
Monkey, where they select a four-digit number code to enter in the participant ID section. This
number was not linked to identifiable information collected during registration, allowing the
participant to stay anonymous. Data collected was securely stored in Survey Monkey and on the
study author's computer throughout the completion of the project. During data analysis,
inferential statistics was used. A paired T-test was run to analyze the data. Cohen’s d was used to
evaluate the effect of the intervention on the outcome variable. A Two-tailed test was run, and
the critical value was set at p < .10.

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The MHLS was selected because it is a psychometrically methodologically robust tool
demonstrating good internal and test-retest reliability and validity (O’Conner & Casey, 2015).
The Cronbach’s alpha was (𝛼𝛼 = .873) for reliability, and construct validity was p < .001

(O’Conner & Casey, 2015). The MHLS was used by Marsico et al. (2022) to evaluate YMHFA

training for parents within the school setting using the pre- and post-questionnaire. The variables
assessed were mental health literacy, help-seeking intentions, help-seeking attitudes, decrease in
stigma, confidence in helping skills, behavioral intentions to support youth with schizophrenia,
and behavioral intentions to support youth with depression. Of the 64 participants who
completed all three surveys, there was an increase in all categories and a decrease in stigma with
p < .001 for all seven variables.
MHLS and the UTB framework complement each other in this project. Both look at and
assess change in behavior towards intention and decision. The goal is for resource parents to
have increased mental health literacy after attending the intervention, as seen in the MHLS posttest. In turn, this would mean a positive change in the eleven areas of the UTB, indicating
improved overall mental health literacy.
Permission was obtained from Matt O’Conner on May 31, 2023, to use the MHLS for
instrumentation in Employing Youth Mental Health First Aid in the Foster Care and Adoption
Community.
Results
Intellectus Statistics ™ was used to store, manage, and analyze this data. There were n=6
resource parents involved in this evidence-based study. The age groups were divided as 35-49
and 50-64 and had equal results. Females comprised most subjects, 4 (67%), and males
accounted for 2 (33%). In the race section, White/Caucasian was 4 (67%), and Latino/Spanish

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represented 2 (33%). In marital status, married was 4 (67%), never married was 1 (17%), and
divorced was 1 (17%). The type of resource parent was comprised of foster parents 4 (67%),
foster/kinship parent 1 (17%), and foster/adopted parent 1 (17%). In Years of experience, 10+
years was 3 (50%), 6-9 years was 1 (17%), and 0-2 years was 2 (33%). Frequencies and
percentages are presented in (Appendix F), Table 1.
The average Mental Health Literacy score before the intervention was 133.50 (SD =
11.84), which ranged from 115 to 149 points out of 160. The median score was 135.50. The
average Mental Health Literacy score after the intervention was 139.17 (SD = 10.03), which
ranged from 123 to 150 points out of 160. The median score was 141.50 points. The summary
statistics can be found in (Appendix F), Table 2.
The two-tailed paired sample t-test result was insignificant based on an alpha value of
.10, t(5) = -1.97, p = .107, indicating the null hypothesis cannot be rejected but is moving
towards significance. This project is like an exploratory pilot study to generate a hypothesis. For
this study, due to the importance of detecting small to moderate differences with a small sample
size (p values >0.05 but <0.10 are referred to as trend), significance was tested at p <0.10
(Fugate Woods Lentz, Mitchell, Heitkemper & Shaver, 1997). This finding suggests the
difference in the mean of Pre-Mental Health Literacy and the mean of Post-Mental Health
Literacy was not significantly different from zero. The effect of the outcome variable was high, d
= 0.80. The results are presented in (Appendix F) Table 3. A bar plot of the means is illustrated
in (Appendix F), Figure 1.
Discussion
While data from this project indicated a null hypothesis, there was an indication it was
moving towards significance. The small sample size n=6 most likely contributed to this null

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hypothesis. Going forward, it is recommended that larger sample sizes be included to see if the
hypothesis changes. The outcome variable was high, which indicates that the study was moving
towards significance but did not have enough data to reach it. The organization in this study
plans to continue to offer YMHFA training to resource parents in the future.
Conclusion
Mental health challenges are on the rise, and children affected by foster care have higher
rates than their non-foster peers. Working to find programs like YMHFA that can help resource
parents learn how to overcome these challenges while caring for these children is paramount.
Organizations like the one involved in this study can continue offering programs like YMHFA to
provide additional training to resource parents. These additional trainings provide needed
information to increase mental health literacy, decrease stigma, and improve attitudes toward
help-seeking.

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Noltemeyer, A., Huang, H., Meehan, C., Jordan, E., Morio, K., Shaw, K., & Oberlin, K. (2020).
Youth mental health first aid: Initial outcomes of a statewide rollout in Ohio. Journal of
Applied School Psychology, 36(1), 1–19.
https://doi.org/10.1080/15377903.2019.1619645
O’Connor, M., & Casey, L. (2015). The mental health literacy scale (mhls): A new scale-based
measure of mental health literacy. Psychiatry Research, 229(1-2), 511–516.
https://doi.org/10.1016/j.psychres.2015.05.064
Patterson, D., Day, A., Vanderwill, L., Willis, T., Stevens, K., Simon, J., Cohick, S., &
Henneman, K. (2019). Maximizing the success of resource parents who care for
adolescents: Training recommendations from caregivers and child welfare professionals.
Journal of Public Child Welfare, 14(3), 357–373.
https://doi.org/10.1080/15548732.2019.1616652
Razali, N. M., & Wah, Y. B. (2011). Power comparisons of Shapiro-Wilk, KolmogorovSmirnov, Lilliefors, and Anderson-Darling tests. Journal of Statistical Modeling and
Analytics, 2(1), 21-33.

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Rose, T., Leitch, J., Collins, K. S., Frey, J. J., & Osteen, P. J. (2019). Effectiveness of youth
mental health first aid USA for social work students. Research on Social Work Practice,
29(3), 291–302. https://doi.org/10.1177/1049731517729039
Rosswurm, M., & Larrabee, J. H. (1999). A model for change to evidence-based practice. Image:
The Journal of Nursing Scholarship, 31(4), 317–322. https://doi.org/10.1111/j.15475069.1999.tb00510.x
Suicide Prevention Resource Center. (2014). Foster care providers: Helping youth at risk of
suicide (March 2014). https://sprc.org/sites/default/files/resource-program/Fostercare.pdf
The Annie E. Casey Foundation. (2022). Child welfare and foster care statistics.
https://www.aecf.org/blog/child-welfare-and-foster-care-statistics
York, W., & Jones, J. (2017). Addressing the mental health needs of looked after children in
foster care: The experiences of foster carers. Journal of Psychiatric and Mental Health
Nursing, 24(2-3), 143–153. https://doi.org/10.1111/jpm.12362
Walters, A. S. (2021). Providing mental health services within schools: A post‐pandemic
imperative. The Brown University Child and Adolescent Behavior Letter, 37(6), 8–8.
https://doi.org/10.1002/cbl.30550
Westfall, P. H., & Henning, K. S. S. (2013). Texts in statistical science: Understanding
advanced statistical methods. Taylor & Francis.

Employing Youth Mental Health First A

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Appendix A

Table 1
Evaluation Table of Quantitative and Mixed Studies

Evaluation and Synthesis Tables

Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

Marsico et al.,
(2022).
Effectiveness of
youth mental
health first aid
training for
parents at
school.

Unified
Theory of
Behavior
Change.

Design:

N= 63
Mothers = 84.11%
Mean age = 44.99
Demographics:
White = 48.60%
Asian = 36.79%

IV1: Training &
certification in
YMHFA

Tools: Pre/post
training
assessments.

Statistical
Tests Used:

DV1: MHL

Setting:
5 training sessions
at local public
schools and one at
university in MD
and PA.
Exclusion:
Participants had to
be parents.

DV3: HSA

Self-report written
open-ended
responses

DV1:
Increase in
MHL,(p <
.001; d =
0.79)

Country: US
Funding:
Graduate
School at
University of
MD, College
Park, Research
and Scholarship
Award

Mixed methods
QUAN+qual
design
Purpose: To
increase parent’s
helping intentions
by increasing selfefficacy,
addressing social
beliefs and
instilling a sense
that using
YMHFA will
positively impact
their children’s
attitudes and
behaviors.

Attrition: 45.32%

DV2: HSI

DV4: STG
DV5: CNF
DV6: BID
DV7: BIS

Likert scales.

SPSS to
analyze data
MCAR test
ANCOVAs
Bonferroni’s
correction
Cohen’s d
Inductive
thematic
analysis
Descriptive
statistics

DV2:
Increase in
HIS, (p <.001;
d=0.37)
DV3:
Increase in
HAS, (p <
.001; d = 0.46
DV4:
Decrease in
STG, (p <

Level of Evidence;
Application to
practice;
Generalization
LOE: III
Strengths: Mixed
methods design
Weakness: Small
sample size, high
attrition rate,
unknown validity.
Feasibility:
Effective in creating
mental health
awareness.
Application:
YMHFA has been
shown to results in
improved MHL

Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A
Citation

Bias: No
perceived bias
in the study.

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

22
Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings
.001; d =
0.46)
DV5:
Increase in
CNF, (p <
.001; d =
1.41)

Level of Evidence;
Application to
practice;
Generalization
knowledge, intention
to use and awareness.

DV6:
Increase in
BID, (p <
.001; d =
0.90)
DV7:
Increase in
BIS, (p <
.001; d =
0.83)

Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A

23

Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

Morgan et al.,
(2018). Does
mental health
first aid training
improve the
mental health of
aid recipients?
The training for
parents of
teenagers
randomized
control trial.
Country:
Australia

Inferred:
Unified
Theory of
Behavior
Change

Randomized
control trial.

N:
IG: 170
CG: 152

IV1: YMHFA for
parents

Strengths and
difficulties
questionnaire

ICC

DV1, DV2
and DV3: No
difference in
number in IG
and CG (p>
0.5).

Funding:
NHMRC
Bias:
CK, BK & AJ
are authors of
YMHFA
course.
MHFA
International
employs CK.

Purpose: The
study was an RCT
with participants
randomized to
YMHFA or PFA
training. The goal
was to assess
adolescent mental
health outcomes
and parental
support towards
adolescents at
baseline 1-year
and 2-year follow
up.

Demographics:
2-parent home (IG
71.8%, CG 75.7%)
Single-parent
home (IG 6.5%,
CG 6.6%)
Median Age (IG
45.2, CG 45.1).
Female Parent (IG
89.4%, CG 86.8%)
Exclusion: People
without children
between the ages
of 12-15.
Attrition:
1-year = 35.4%
2-year = 44.7%
(Parents)

DV1: Adolescent
mental health
DV2: Perceptions of
parent support by
adolescents with a
MH problem
DV3: Quality of
parental support
towards adolescents
with MH problem

Likert scale
Verbatim responses
were scored for
consistency with the
ALGEE action plan
in YMHFA manual.
Verbatim responses
scored.

DV4: MHL
DV5: CNF
DV6: HSI

Validity/Reliability
Cronbach’s α was
used to assess
reliability.

Test-retest
Cohen’s d
MCAR

DV4, DV5,
DV6:
Increased
parental MHL
1-year
(d=0.43) (p <
.001).
2yr (d=0.26),
(p < .05)
CNF (d=0.26)
, (P < .05)
HSI
(d=0.22) at 1year follow
up. (p < .001).

Level of Evidence;
Application to
practice;
Generalization
LOE: II
Strengths: Had an
active control
condition and a long
period follow up for
MH education course.
Weakness: Lack of
power to detect
primary outcome
effects. Study did not
reach recruitment
goal Primary DV1DV3. DV2,
Secondary DV 4-6
did have positive
outcomes in MHL,
HSI and STG
compared to CG.
Feasibility: MHFA
has potential to raise
MH awareness.
Application: Parents
can increase MHL,
CNF and HSI

Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A

24

Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

Rose et al.,
(2019).
Effectiveness of
youth mental
health first aid
USA for social
work students.

Unified
Theory of
Behavior
Change.

Design:
Quasiexperimental nonrandomized
comparison group
design.

IG: 39
CG: 34
Demographics:
Female:
IG 94.9%
CG: 94%
Previous MH
training:
IG 30.8%
CG: 52.9%
Advanced
Academic:
IG: 66.7%
CG: 47.1%
Inclusion: MSW
students enrolled
in field education,
serving youth age
12-18yrs and
trained in
YMHFA. CG was
the same with no
MHFA training
Attrition:
IG: 28%
CG: 29%

IV1:

MHBLS

ANOVA

YMHFA training.

Likert Scale

ANCOVA

DVI:
p< .001
indicating
growth in
student
knowledge in
IG vs. CG.
d= 0.48

Country:
USA
Funding:
First 4 authors
received
financial
support from
University of
Maryland
School of
Social Work
Teaching
Scholars
Award.
Bias:
No conflict of
interest
declared

Purpose: To
identify outcomes
that differed
between Master of
social work
(MSW) students
trained in YMHFA
and those who are
not. Students were
assessed at
baseline, 2wks
after course and at
5 month follow up.

DV1: MHL

Post hoc
analysis

DV2: STG

Cohen’s d

DV3: CNF

MCAR
Validity/Reliability
Bivariate analyses
was used to identify
significant
differences between
group.
The
Cronbach α and
Greenhouse-Geisser
also used to assess
validation
reliability.

DV2:
(p= .174)
indicating no
real change in
stigmatic
views.
However,
importance of
implementing
YMHFA was
p = .02. in IG.
DV3:
Increase in
CNF
(P < .001)
d=0.98

Level of Evidence;
Application to
practice;
Generalization
LOE: III
Strengths: Study
showed significant
difference between IG
an CG in ability to
provide MHFA (p =
.03), confidence (p =
.002), and knowledge
of MHL (p<.001) all
in favor of IG.
Weakness: Small
sample size, was not
randomized, data was
self-reported, the
personal stigma scale
did not meet
reliability criteria in
the sample
Feasibility: YMHFA
is a feasible
intervention to
implement with those
working with youth

Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A

25

Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

Gryglewicz et
al., (2018). An
evaluation of
youth mental
health first aid
training in
school settings.

Theory of
Planned
Behavior.

Design: Study –
nonrandomized
non controlled
trial: Pre and Post
test

N = 356 school
personnel
N = 286 valid data
on all variables.

IV1: YMHFA
training

76-item self-report
questionnaire.

Pairedsample t-test

Likert Scale

Chi-square
tests of
differences.

DV1: 57%
improvement
across sample
(p < .001).

Country: USA
Funding:
National
Institute of
Justice.
Bias: No
conflict of
interest
declared or
noted.

Purpose: YMHFA
was provided to
school personnel
to assess for
increased MHL,
STM and CNF and
training
satisfaction.

Demographics:
83% Female
77% Caucasian
96% bachelor’s
degree or higher
Setting: Five
schools grades K12 in one school
district
Inclusion: All
school personnel
who took
mandated
YMHFA training.
Attrition: 20%

IV2: Training
satisfaction

DV1: MHL
DV2: STG
DV3: CNF
DV4: HSI

Cronbach α
STG- 11 questions
(α = 0.69 pre-test)
(α = 0.70 posttest)

ANOVA

CNF- 12 question
Perceived
Behavioral control
(PBC) scale used.
(α = 0.95)

Bonferroni
Corrections

HIS- 11 item Likert
scale (α= 0.79).
Training
satisfaction- 7 item
Likert scale
(α = 0.73)

OLS
regression

Multivariate
regression
analyses
Bivariate
analyses
Descriptive
analyses
Cronbach α

.

DV2: 64%
reduction (p <
.001).
DV3: 89%
increase (p <
.001).
DV4: 76%
increase (p <
.001).
IVF2: 76% of
first aiders
agreed or
strongly
agreed that
they like the
YMHFA
training.

Level of Evidence;
Application to
practice;
Generalization
LOE: IV
Strengths:
Conducted in the
USA with large
population size, low
risk.
Weakness: Variance
(R2) was relatively
low (ranged 0.5 to
0.11), lack of a
control group, no long
term follow up.
Feasibility: Effective
in increasing MHL,
decreasing STG,
Increasing CNF and
HIS.
Application:
YMHFA can be used
to train school
personnel and
laypersons.
LOE: IV

Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A

26

Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

Noltemeyer et
al., (2020).
Youth mental
health first aid:
Initial outcomes
of a statewide
rollout in Ohio

Inferred:
Unified
Theory of
Behavior
Change

Design:
Uncontrolled
pretest and posttest
study

N: 1,445 at
pretest.
N: 599 at 3-month
N: 271 at 6-month
N: 129 at 9-month
N: 59 at 12-month

IV1: YMHFA
training

Likert scale

Paired t-tests

D1: Increase
in MHL 3months post
training (p <
.001).

Country: USA
Funding:
Substance
abuse and
mental health
services
administration,
U.S.
Department of
Health and
Human
Services.
Bias: No
conflict of
interest
declared or
noted.

Purpose: To
evaluate the
outcomes of
YMHFA training
throughout the
state of Ohio
through project
AWARE.

Demographics:
Of the 1,224 who
provided
demographics 842
were white
females with
average age of 42.
Setting/Inclusion:
Throughout the
state of Ohio open
to anyone.
Attrition: 58%

DV1: MHL

OLS
regression

DV2: STG

Cronbach α

DV3: CNF

Descriptive
statistics.

DV4: HIS

Validity/Reliability:
All four scales had a
reliability rating
higher than
Cronbach’s α of .83
for both pre and
posttest.

DV2:
Decrease in
STG 3months post
training (p <
.001).
DV3:
Increase in
CN, 3-months
post training
(p < .001).
DV4:
Increase in
HIS, 3months post
training (p <
.001).

Level of Evidence;
Application to
practice;
Generalization
Strengths: Follow up
after 3 months,
completed in USA,
available to anyone,
Non-invasive
Weakness: No
control group, low
response rate after
month 3, high
attrition rate.
Feasibility: YMHFA
training can be
offered to wide
variety of individuals
and have positive
outcomes.
Application: YMFA
can be applied to
community members.

Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A

27

Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

Childs et al.,
(2020). An
assessment of
the utility of the
youth mental
health first aid
training:
Effectiveness,
satisfaction, and
universality.

Inferred:
Unified
Theory of
Behavior
Change

Design:
Uncontrolled
pretest and posttest
study

N: 1,709
participated in
training. Final
sample was 893.
Demographics:
65% Caucasian
83% Female
77% youth
focused or SA
training in the
past.
Setting: 81
YMHFA trainings
across 12 counties
in Southeastern
state at community
events.
Inclusion:
Work in child
welfare, justice
system, non-profit
support services or
education.

IV1: YMHFA
training

Likert scale

ANOVA

Multi-item, selfreported
questionnaire

ANOVAs

DV1:
Increase in
CNF, (p <
0.05)

Country: USA
Funding: None
stated.
Bias: Author
denies any
conflict of
interest. No
perceived bias.

Purpose: To
assess the
effectiveness,
satisfaction, and
universality of
YMHFA across
child-serving
occupations.

DVI: CNF

DV4: MHL

Pairwise
comparisons
using
Bonferroni
method

DV5: Satisfaction
across fields

Chi-square
tests

Validity/Reliability
Cronbach’s α

Paired
sample ttests

Satisfaction: α =
0.65

OLS
regression

DV2: HSI
DV3: Preparedness

CNF: α = 0.94
HIS: α = 0.71

DV2:
Increase in
HIS, (p <
0.01)
DV3: Increase
in
Preparedness,
(p < 0.05)

Level of Evidence;
Application to
practice;
Generalization
LOE: IV
Strengths: Training
was provided across
multiple occupations
confirming utility,
effectiveness, and
satisfaction.
Weakness: No
follow-up data, to
measure sustainability
of training. No
control group.

DV4:
Increase in
MHL, (p <
0.05)

Feasibility: YMHFA
training can be
offered to wide
variety of individuals
and have positive
outcomes.

DV5:
Satisfaction of
training
across fields,
(p = 0.09)

Application: Can
increase MHL, CNF,
and HSI across
occupations.

Attrition: 48%
Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A

28

Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

Hurley et al.,
(2019). A
systematic
review of
parent and
caregiver
mental health
literacy.

MHL
Framework

Design:
Systematic
reviews and metaanalyses using the
PRISMA-Protocol
guidelines for
preferred
reporting.

N: 21 studies with
a total of 9,019
parents and
caregivers

IV: MHL

Mixed methods
appraisal tool
(MMAT)

Narrative
Synthesis

DV1: Degree
& nature of
knowledge,
knowledge
source,
Correlates of
knowledge

Country:
Australia, UK
Funding: The
Movement
Foundation;
The Australian
MH initiative.
Bias: No
conflict of
interest
declared or
noted.

Quantitative: 13
Qualitative: 7
Mixed methods: 1

Purpose: Review
MHL in parents
and caregivers of
children and
adolescents.

DV1: Knowledge
and understanding
DV2: Attitudes and
beliefs
DV3: Help-seeking
and support
DV4: Mental health
literacy intervention

Thematic
Summary

DV2: stigma,
role of parent,
attitudes to
help-seeking,
fear and
worry
DV3: source
of support,
help-seeking
strategies,
factors
influencing
help-seeking
DV4:
Improved
MHL with
some
intervention

Level of Evidence;
Application to
practice;
Generalization
LOE: II
Strengths: Used the
PRISMA-P
guidelines for
measurement.
Weakness: Narrative
synthesis was not able
to statistically pool
quantitative data or
determine the strength
of association
between the DV’s in
the study.
Application:
Providing training in
MHL to parents and
caregivers can
improve knowledge,
understanding,
attitudes, beliefs,
help-seeking, support
and MHL literacy.

Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A

29

Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

Kaasbøll et al.,
(2019). Foster
parents’ needs,
perceptions and
satisfaction
with foster
parent training:
A systematic
literature
review.

None
indicated

Systematic review
based on peerreviewed academic
journals. Methods
were followed as
outlined by
PRISMAStatement

N = 13 studies
with a total of
2,042 foster
parents.

IV1: Foster parent
training programs or
modules

EndNote X8 for
Windows

Systematic
literature
review

DV1: Showed
satisfaction in
quan study,
but qual
suggested
need for more
specific
knowledge.

Country:
Norway
Funding:
Norwegian
Directorate for
children, youth
and family
affairs, SINTEF
Digital,
Department of
Health
Research and
NTNU Social
Research.

Thematic synthesis

Purpose: To
explore foster
parents’
perceptions of and
satisfaction with
foster parent
training and what
they need out of
training.

Quantitative = 9

DVI: Satisfaction
with training

Mixed methods =
4

DV2: Need for
training in specific
themes.

Exclusion:
Focusing on
adoption or
biological parent
training including
parents who have
children in foster
care.

DV3: Flexibility,
format and approach
DV4: Training needs
beyond existing
preservice/in-service
sessions

Manuel screening

Level of Evidence;
Application to
practice;
Generalization
LOE: II
Strengths: First
compilation of foster
parents’ perceptions
of foster parent
training.

DV2: Showed
high levels of
satisfaction
yet expressed
unmet needs
for children
with special
needs and
real-life
situations.

Weakness: Low
sample size and
response rate.
Findings regarding
foster parents’ needs
and perceptions of
training were sparse
and difficult to
synthesize.

DV3: Online
options seem
promising

Application: This
systematic review
supports the need for
increased training
related to children
with special needs,

DV4:
Increased
need for
Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A
Citation

Bias: No
conflict of
interest
declared or
noted.

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

30
Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings
training
related to
children with
special needs,
MH,
behavior,
diversity, and
culture

Level of Evidence;
Application to
practice;
Generalization
MH, behavior
problems, more
information on
diversity and culture.

Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A
Citation

Barnett et al.,
(2017). Foster
and adoptive
parent
perspectives on
needs and
services: a
mixed methods
study.
Country: USA
Funding: US
Department of
Health and
Human
Services,
Administration
for Children
and Families,
Children’s
Bureau
Bias: No
conflict of
interest noted.

Theoretical/
Conceptual
Framework
None
indicated.

31

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

Design: Mixed
methods, focus
groups and survey

Focus group: 27

IV1: Foster/adoptive
parents’ perspective
of needs and
services.

91 -item survey

Data was
uploaded
into Dedoose
(Version
7.0.23)

DV1: Parents
discussed
poor
communicatio
n and
inclusion in
case planning.

Purpose: To
assess foster and
adoptive parents
perspectives of
needs and services.

Survey: 512 (215
adoptive parents,
168 foster parents,
66 both
foster/adoptive
parents)
Online user
satisfaction
survey: 7 social
workers and 22
foster parents.
Demographics:
Focus group 70%
female.
Survey 74%
female.
Mean age was 47

DV1:
Communication &
collaboration across
providers and
families

DV2: Child welfare
agency culture and
context

Likert scales of
quality, usefulness,
frequency and
satisfaction.
Three point scale
assessed availability
of mental health
services and use of
available resources.
One open-ended
question looking at
preparedness of
foster parents.

DV3: Preparation to
foster and adopt

DV4: Need for
mental health
services for children

Validity: The
survey engaged a
large sample to
further test foster
and adoptive parent
experiences lending

Stata (v.13)
Descriptive
statistics.

DV2: Focus
group
reported low
levels of
perceived
respect from
child welfare
agency and
courts.
DV3:
expressed
feeling illprepared to
foster or
adopt.

Level of Evidence;
Application to
practice;
Generalization
LOE: III

Strengths: Both a
focus group and
survey group were
used with a large
sample size.

Weakness: In this
study the surveyed
parents gave more
positive feedback
then the focus group
which could have
been influenced by
conformity norms or
biases.
Application: There is
room for improved
training and more
specific topics that
directly affect foster
and adoptive parents.

DV4: felt MH
providers did
Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A
Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

32
Sample/Setting

Variables

Measurement/
Instrumentation

DV5: Support for
foster and adoptive
parents

to increased
construct validity.

Data
Analysis

Results/
Findings
not
understand
the need of
children in
care.

Level of Evidence;
Application to
practice;
Generalization

DV5: felt
there was a
lack of
resources

Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A

33

Table A2
Evaluation Table for Qualitative Studies
Citation

Theory/
Conceptual
Framework

Design/ Method/
Sampling

Sample/ Setting

Major Themes
Studied/
Definitions

Measurement/
Instrumentation

Data Analysis

Findings/
Themes

Patterson et al.,
(2019).
Maximizing the
success of
resource parents
who care for
adolescents:
training
recommendations
from caregivers
and child welfare
professionals.

Adult Learning
Theory

Design: Mixed
methods

Sample: (n= 44)

21st Century
Learning
Theories

Qual+quan

• RQ1
How can
training be
delivered to
prepare
resource
parents to care
for adolescents
adequately?

Data Collection:
Two teams
collaborated to
collect data. The
first team recruited
participants,
collected data for
study and provided
de-identified data
to the other team.
The evaluation
team then
completed the data
analysis. Both
teams codeveloped the
interview and
survey protocols.

Data was
examined
word by
word to
develop code
list. The data
was coded by
a team of
seven
analysts with
at least two
analysts
coding each
interview or
survey (95%
agreement).
Analysts then
reviewed
coded
patterns and
relationships
creating
categorical
formation

(1)
Participants
felt training
should be
more
interactive vs.
didactic.

Country: USA
Funding: U.S.
Children’s
Bureau

Method: Qualitative
semi-structured
interviews with
foster/adoptive
families.
Online survey for
child welfare workers.

Purpose: To explore
the perspectives and
recommendations of
foster/adoptive
parents and child
welfare professionals
on training

Demographics:
18 foster/adoptive
parents.
26 child welfare
workers.
88% of
participants were
women.
61% Caucasian
Setting: Both by
phone and in
person for
interviews. Survey
was done through
Survey Monkey.

Definitions:
Resource
parents = foster
and adoptive
parents

(2) Training
should be
taught by a
foster or
adoptive
parent and
include youth
input to gain a
more realistic
training
experience
with people
who have
lived it.

Level/ Quality of
Evidence; Decision
for/ Application to
practice;
Generalization

Level of Evidence:
III
Strengths: Study
includes the
perspectives of both
foster/adoptive
parents and child
welfare workers.
Weakness: Less
foster/adoptive
parents then child
welfare workers.
Majority of
participants were
female and
Caucasian.

Feasibility: Finding
foster/adoptive
Bias: No conflict
parents to lead
of interest
trainings that are
declared or
more interactive is
noted.
Attrition: 0
feasible.
Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A

34

Key: Key: AA- African American, ALGEE- Assess risk of suicide, listen non judgmentally, give advice and information, encourage professional help, encourage self-help, ANOVARepeated measures of analysis of variance, ANCOVAs- Analysis of covariance, AWARE- Advancing wellness and resilience in education, BID- Behavioral intentions to support
youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNF- Confidence in helping skills, d- Cohen’s d,
HSA- Help-seeking attitudes, HSI- Help-seeking intentions, ICC- Inter-rater reliability, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence, LS- Likert scale,
MCAR- Missing completely at random, MD- Maryland, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health
literacy, N- Number of participants, NHMRC- National Health and Medical Research Council, OLS- Ordinary least squares, p- P-value/probability, PA- Pennsylvania, PFA- Red cross
provide first aid course, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre posttest assessment, qual- Qualitative, Quan- Quantitative, RCTRandomized control trial, Resource- foster/adoptive, RQ- Research question, SA- Substance abuse, SDQ- Strengths and difficulties questionnaire, SPSS- Statistical package for the
social sciences, SRW- Self report written, STG- Stigma, YMHFA- youth mental health first aid, ↑- Increase, * P< 0.050.

Employing Youth Mental Health First A
Table A3
Synthesis Table
Study
(Author, year)
Design
LOE

Sample size/studies
Community Setting
Measurement Tools

YMHFA
MHL
Resource Parent
perspective

35

Barnett et al.,
2017
III

Childs et al.,
2020
IV

Gryglewicz et
al., 2018
IV

27 Focus GP
512 Survey
X
LS, SRW,
Questionnaire

893

286

X
LS,
Questionnaire

Questionnaire,
LS

X

X

Hurley et al.,
2019
II

Kaasbøll et al.,
2019
II

Study Characteristics
21 studies
13 studies

MMAT

PRISMA-S
Manuel
screening
Intervention

Marsico et al.,
2022
III

Morgan et al.,
2018
II

Noltemeyer et
al., 2020
IV

Patterson et
al., 2019
III

Rose et al.,
2019
II

63

322

1,445

44

73

X
PPTA, LS,
SRWOR

X
SDQ, LS,
SRWOR

X
LS

X
SRWOR,
Questionnaire

MHBLS, LS

X

X

X

X

NS
Q

NS

X

Outcomes
MHL
HSI
HSA
STG

↑*
↑*

CNF
BID
BIS
Preparedness to
Foster/adopt
Training Satisfaction
Flexibility format and
approach

↑*

↑*

↑*

↑*

↑*
↑*

↓*

NS
NS
NS

↑*
↑*
↑*
↓*

↑*
↑*

↑*
↑*
↑*

↑*

↑*

↑*

↓*

↓*

↑*

↑*

Q
NS
NS

Q

Key: BID- Behavioral intentions to support youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNFConfidence in helping skills, d- Cohen’s d, HSA- Help-seeking attitudes, HSI- Help-seeking intentions, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence,
LS- Likert scale, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health literacy, MMAT- Mixed methods
appraisal tool, N- Number of participants, NS- Narrative synthesis, p- P-value/probability, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre
post test assessment, Q-qualitative feedback given, qual- Qualitative, Quan- Quantitative, RCT- Randomized control trial, Resource- foster/adoptive, SDQ- Strengths and difficulties
questionnaire, SRWOR- Self report written open ended responses, STG- Stigma awareness, YMHFA- youth mental health first aid, ↓-Decrease, ↑- Increase, * p< 0.050,

Employing Youth Mental Health First A
Study
(Author, year)
Support for resource
family
Need for MH services
Communication&
Collaboration
Adolescent MH
Adolescent
perspective of
parental support
Quality of parental
support toward MH

Barnett et al.,
2017
Q

Childs et al.,
2020

36
Gryglewicz et
al., 2018

Hurley et al.,
2019

Kaasbøll et al.,
2019

Marsico et al.,
2022

Morgan et al.,
2018

Noltemeyer et
al., 2020

Patterson et
al., 2019
Q

Rose et al.,
2019

Q
Q
Q
Q

Q

Key: BID- Behavioral intentions to support youth with depression, BIS- Behavioral intentions to support youth with schizophrenia, DV- Dependent Variable, CG- Control group, CNFConfidence in helping skills, d- Cohen’s d, HSA- Help-seeking attitudes, HSI- Help-seeking intentions, IG- Intervention group, IV- Independent Variable, LOE- Level of evidence,
LS- Likert scale, MH- Mental health, MHBLS- Mental health beliefs and literacy scale, MHFA- Mental health first aid, MHL- Mental health literacy, MMAT- Mixed methods
appraisal tool, N- Number of participants, NS- Narrative synthesis, p- P-value/probability, PRISMA- Preferred reporting items for systematic reviews and meta-analyses, PPTA- Pre
post test assessment, Q-qualitative feedback given, qual- Qualitative, Quan- Quantitative, RCT- Randomized control trial, Resource- foster/adoptive, SDQ- Strengths and difficulties
questionnaire, SRWOR- Self report written open ended responses, STG- Stigma awareness, YMHFA- youth mental health first aid, ↓-Decrease, ↑- Increase, * p< 0.050,

EMPLOYING YOUTH MENTAL HEALTH FIRST AID
Appendix B
Conceptual Framework
Unified Theory of Behavior

(Lindsey et al. 2012)

37

EMPLOYING YOUTH MENTAL HEALTH FIRST AID
Appendix C
Evidence Based Practice (EBP) Model
Rosswurm & Larrabee Model for Evidence-based Practice

(Rosswurm & Larrabee, 1999)

38

EMPLOYING YOUTH MENTAL HEALTH FIRST AID
APPENDIX D
MHLS PRE-QUESTIONNAIRE
DEMOGRAPHICS
We want to know a little bit more about you. Please tell us more.
1. Are you Hispanic, Latino, or Spanish origin? (Mark ONE box.)
Yes
No
2. What is your race? (Mark one or more.)
______White/Caucasian
Black/African American
Native Hawaiian or Other Pacific Islander
Other race:
(specify)
3. How old are you?
18-24
25-34
35-49
50-64
65+

4. What is your gender?
Female
Male
Other

5. What is your marital status?
Never Married
Married

(specify)

Asian
American Indian/Alaska Native

39

EMPLOYING YOUTH MENTAL HEALTH FIRST AID
Divorced
Widowed
Separated (Legally)

6. What type of resource parent are you currently? (Mark one or more.)
Foster Parent
Kinship
Adoptive Parent

7. Please tell us how many years you have been a resource parent (foster, kinship, adoptive).
0-2yrs
3-5yrs
6-9yrs
10+ yrs

Mental Health Literacy Scale
The purpose of these questions is to gain an understanding of your knowledge of various aspects
to do with mental health. When responding, we are interested in your degree of knowledge.
Therefore when choosing your response, consider that:
Very unlikely = I am certain that it is NOT likely
Unlikely = I think it is unlikely but am not certain
Likely = I think it is likely but am not certain
Very Likely = I am certain that it IS very likely
1

40

EMPLOYING YOUTH MENTAL HEALTH FIRST AID

41

If someone became extremely nervous or anxious in one or more situations with other people
(e.g., a party) or performance situations (e.g., presenting at a meeting) in which they were afraid
of being evaluated by others and that they would act in a way that was humiliating or feel
embarrassed, then to what extent do you think it is likely they have Social Phobia
Very unlikely
Unlikely
Likely
Very Likely
2
If someone experienced excessive worry about a number of events or activities where this level
of concern was not warranted, had difficulty controlling this worry and had physical symptoms
such as having tense muscles and feeling fatigued then to what extent do you think it is likely
they have Generalized Anxiety Disorder
Very unlikely

Unlikely

Likely

Very Likely

Very unlikely

Unlikely

Likely

Very Likely

Very unlikely

Unlikely

Likely

Very Likely

Very unlikely

Unlikely

Likely

Very Likely

Very unlikely

Unlikely

Likely

Very Likely

3
If someone experienced a low mood for two or more weeks, had a loss of pleasure or interest in
their normal activities and experienced changes in their appetite and sleep then to what extent do
you think it is likely they have Major Depressive Disorder
4
To what extent do you think it is likely that Personality Disorders are a category of mental
illness

5
To what extent do you think it is likely that Persistent Depressive Disorder (Dysthemia) is a
disorder
6
To what extent do you think it is likely that the diagnosis of Agoraphobia includes anxiety about
situations where escape may be difficult or embarrassing

7
To what extent do you think it is likely that the diagnosis of Bipolar Disorder includes
experiencing periods of elevated (i.e., high) and periods of depressed (i.e., low) mood
Very unlikely
Unlikely
Likely
Very Likely
8
To what extent do you think it is likely that the diagnosis of Substance Abuse Disorder includes
physical and psychological tolerance of the drug (i.e., require more of the drug to get the same
effect)
Very unlikely

Unlikely

Likely

Very Likely

9
To what extent do you think it is likely that in general in the United States, women are MORE
likely to experience a mental illness of any kind compared to men

EMPLOYING YOUTH MENTAL HEALTH FIRST AID

42

Very unlikely

Unlikely

Likely

Very Likely

Very unlikely

Unlikely

Likely

Very Likely

10
To what extent do you think it is likely that in general, in the United States, men are MORE
likely to experience an anxiety disorder compared to women

When choosing your response, consider that:
•
•
•
•

Very Unhelpful = I am certain that it is NOT helpful
Unhelpful = I think it is unhelpful but am not certain
Helpful = I think it is helpful but am not certain
Very Helpful = I am certain that it IS very helpful

11
To what extent do you think it would be helpful for someone to improve their quality of sleep
if they were having difficulties managing their emotions (e.g., becoming very anxious or
depressed)
Very unhelpful

Unhelpful

Helpful

Very helpful

Very unhelpful

Unhelpful

Helpful

Very helpful

12
To what extent do you think it would be helpful for someone to avoid all activities or situations
that made them feel anxious if they were having difficulties managing their emotions

When choosing your response, consider that:
•
•
•
•

Very unlikely = I am certain that it is NOT likely
Unlikely = I think it is unlikely but am not certain
Likely = I think it is likely but am not certain
Very Likely = I am certain that it IS very likely

EMPLOYING YOUTH MENTAL HEALTH FIRST AID

43

13
To what extent do you think it is likely that Cognitive Behavior Therapy (CBT) is a therapy
based on challenging negative thoughts and increasing helpful behaviors
Very unlikely

Unlikely

Likely

Very Likely

14
Mental health professionals are bound by confidentiality; however there are certain conditions
under which this does not apply.
To what extent do you think it is likely that the following is a condition that would allow a
mental health professional to break confidentiality:
If you are at immediate risk of harm to yourself or others
Very unlikely
Unlikely
Likely
Very Likely
15
Mental health professionals are bound by confidentiality; however there are certain conditions
under which this does not apply.
To what extent do you think it is likely that the following is a condition that would allow a
mental health professional to break confidentiality:
if your problem is not life-threatening and they want to assist others to better support you
Very unlikely

Unlikely

Likely

Very Likely

Please indicate to what extent you agree with the following statements:
Strongly
Disagree
16. I am confident that I know
where to seek information about
mental illness
17. I am confident using the
computer or telephone to seek
information about mental illness
18. I am confident attending face
to face appointments to seek
information about mental illness
(e.g., seeing the GP)
19. I am confident I have access
to resources (e.g., GP, internet,
friends) that I can use to seek
information about mental illness

Disagree

Neither
agree or
disagree

Agree

Strongly
agree

EMPLOYING YOUTH MENTAL HEALTH FIRST AID

44

Please indicate to what extent you agree with the following statements:
Strongly
Disagree

Disagree

20. People with a mental illness
could snap out if it if they wanted
21. A mental illness is a sign of
personal weakness
22. A mental illness is not a real
medical illness
23. People with a mental illness
are dangerous
24. It is best to avoid people with
a mental illness so that you don't
develop this problem
25. If I had a mental illness I
would not tell anyone
26. Seeing a mental health
professional means you are not
strong enough to manage your
own difficulties
27. If I had a mental illness, I
would not seek help from a
mental health professional
28. I believe treatment for a
mental illness, provided by a
mental health professional, would
not be effective

Neither
agree or
disagree

Agree

Strongly
agree

Probably
willing

Definitely
willing

Please indicate to what extent you agree with the following statements:
Definitely
unwilling

29. How willing would you be to
move next door to someone with
a mental illness?
30. How willing would you be to
spend an evening socializing with
someone with a mental illness?
31. How willing would you be to
make friends with someone with
a mental illness?

Probably
unwilling

Neither
unwilling
or willing

EMPLOYING YOUTH MENTAL HEALTH FIRST AID
Definitely
unwilling

Probably
unwilling

32. How willing would you be to
have someone with a mental
illness start working closely with
you on a job?
33. How willing would you be to
have someone with a mental
illness marry into your family?
34. How willing would you be to
vote for a politician if you knew
they had suffered a mental
illness?
35. How willing would you be to
employ someone if you knew
they had a mental illness?

45
Neither
unwilling
or willing

Probably
willing

Definitely
willing

Reference
O’Connor, M., & Casey, L. (2015). The mental health literacy scale (MHLS): A new scale-based
measure of mental health literacy, Psychiatry Research,
http://dx.doi.org/10.1016/j.psychres.2015.05.064

EMPLOYING YOUTH MENTAL HEALTH FIRST AID

46

APPENDIX E
MHLS POST-QUESTIONNAIE
(Post-Questionnaire)
The purpose of these questions is to gain an understanding of your knowledge of various aspects
to do with mental health. When responding, we are interested in your degree of knowledge.
Therefore when choosing your response, consider that:
Very unlikely = I am certain that it is NOT likely
Unlikely = I think it is unlikely but am not certain
Likely = I think it is likely but am not certain
Very Likely = I am certain that it IS very likely
1
If someone became extremely nervous or anxious in one or more situations with other people
(e.g., a party) or performance situations (e.g., presenting at a meeting) in which they were afraid
of being evaluated by others and that they would act in a way that was humiliating or feel
embarrassed, then to what extent do you think it is likely they have Social Phobia
Very unlikely
Unlikely
Likely
Very Likely
2
If someone experienced excessive worry about a number of events or activities where this level
of concern was not warranted, had difficulty controlling this worry and had physical symptoms
such as having tense muscles and feeling fatigued then to what extent do you think it is likely
they have Generalized Anxiety Disorder
Very unlikely

Unlikely

Likely

Very Likely

3
If someone experienced a low mood for two or more weeks, had a loss of pleasure or interest in
their normal activities and experienced changes in their appetite and sleep then to what extent do
you think it is likely they have Major Depressive Disorder
Very unlikely
Unlikely
Likely
Very Likely
4
To what extent do you think it is likely that Personality Disorders are a category of mental
illness
Very unlikely
Unlikely
Likely
Very Likely
5
To what extent do you think it is likely that Persistent Depressive Disorder (Dysthemia) is a
disorder
Very unlikely

Unlikely

Likely

Very Likely

EMPLOYING YOUTH MENTAL HEALTH FIRST AID

47

6
To what extent do you think it is likely that the diagnosis of Agoraphobia includes anxiety about
situations where escape may be difficult or embarrassing
Very unlikely

Unlikely

Likely

Very Likely

EMPLOYING YOUTH MENTAL HEALTH FIRST AID

48

7
To what extent do you think it is likely that the diagnosis of Bipolar Disorder includes
experiencing periods of elevated (i.e., high) and periods of depressed (i.e., low) mood
Very unlikely
Unlikely
Likely
Very Likely
8
To what extent do you think it is likely that the diagnosis of Substance Abuse Disorder includes
physical and psychological tolerance of the drug (i.e., require more of the drug to get the same
effect)
Very unlikely
Unlikely
Likely
Very Likely
9
To what extent do you think it is likely that in general in the United States, women are MORE
likely to experience a mental illness of any kind compared to men
Very unlikely

Unlikely

Likely

Very Likely

Very unlikely

Unlikely

Likely

Very Likely

10
To what extent do you think it is likely that in general, in the United States, men are MORE
likely to experience an anxiety disorder compared to women

When choosing your response, consider that:
•
•
•
•

Very Unhelpful = I am certain that it is NOT helpful
Unhelpful = I think it is unhelpful but am not certain
Helpful = I think it is helpful but am not certain
Very Helpful = I am certain that it IS very helpful

11
To what extent do you think it would be helpful for someone to improve their quality of sleep
if they were having difficulties managing their emotions (e.g., becoming very anxious or
depressed)
Very unhelpful

Unhelpful

Helpful

Very helpful

Very unhelpful

Unhelpful

Helpful

Very helpful

12
To what extent do you think it would be helpful for someone to avoid all activities or situations
that made them feel anxious if they were having difficulties managing their emotions

When choosing your response, consider that:

13

•
•
•
•

Very unlikely = I am certain that it is NOT likely
Unlikely = I think it is unlikely but am not certain
Likely = I think it is likely but am not certain
Very Likely = I am certain that it IS very likely

EMPLOYING YOUTH MENTAL HEALTH FIRST AID

49

To what extent do you think it is likely that Cognitive Behavior Therapy (CBT) is a therapy
based on challenging negative thoughts and increasing helpful behaviors
Very unlikely
Unlikely
Likely
Very Likely
14
Mental health professionals are bound by confidentiality; however there are certain conditions
under which this does not apply.
To what extent do you think it is likely that the following is a condition that would allow a
mental health professional to break confidentiality:
If you are at immediate risk of harm to yourself or others
Very unlikely

Unlikely

Likely

Very Likely

15
Mental health professionals are bound by confidentiality; however there are certain conditions
under which this does not apply.
To what extent do you think it is likely that the following is a condition that would allow a
mental health professional to break confidentiality:
if your problem is not life-threatening and they want to assist others to better support you
Very unlikely

Unlikely

Likely

Very Likely

Please indicate to what extent you agree with the following statements:
Strongly
Disagree
16. I am confident that I know
where to seek information about
mental illness
17. I am confident using the
computer or telephone to seek
information about mental illness
18. I am confident attending face
to face appointments to seek
information about mental illness
(e.g., seeing the GP)
19. I am confident I have access
to resources (e.g., GP, internet,
friends) that I can use to seek
information about mental illness

Disagree

Neither
agree or
disagree

Agree

Strongly
agree

EMPLOYING YOUTH MENTAL HEALTH FIRST AID

50

Please indicate to what extent you agree with the following statements:
Strongly
Disagree

Disagree

20. People with a mental illness
could snap out if it if they wanted
21. A mental illness is a sign of
personal weakness
22. A mental illness is not a real
medical illness
23. People with a mental illness
are dangerous
24. It is best to avoid people with
a mental illness so that you don't
develop this problem
25. If I had a mental illness I
would not tell anyone
26. Seeing a mental health
professional means you are not
strong enough to manage your
own difficulties
27. If I had a mental illness, I
would not seek help from a
mental health professional
28. I believe treatment for a
mental illness, provided by a
mental health professional, would
not be effective

Neither
agree or
disagree

Agree

Strongly
agree

Probably
willing

Definitely
willing

Please indicate to what extent you agree with the following statements:
Definitely
unwilling

29. How willing would you be to
move next door to someone with
a mental illness?
30. How willing would you be to
spend an evening socializing with
someone with a mental illness?
31. How willing would you be to
make friends with someone with
a mental illness?

Probably
unwilling

Neither
unwilling
or willing

EMLOYING YOUTH MENTAL HEALTH FIRST AID
Definitely
unwilling

32. How willing would you be to
have someone with a mental
illness start working closely with
you on a job?
33. How willing would you be to
have someone with a mental
illness marry into your family?
34. How willing would you be to
vote for a politician if you knew
they had suffered a mental
illness?
35. How willing would you be to
employ someone if you knew
they had a mental illness?

Probably
unwilling

51
Neither
unwilling
or willing

Probably
willing

Definitely
willing

1. What will you do differently now that you’ve attended this course?

2. How likely are you to recommend this course to a friend/colleague?

3. Do you think this course was useful for resource parents? Why or why not?

Thank you for your time and effort filling out this survey. You are appreciated!!!
Reference
O’Connor, M., & Casey, L. (2015). The mental health literacy scale (MHLS): A new scalebased measure of mental health literacy, Psychiatry Research,
http://dx.doi.org/10.1016/j.psychres.2015.05.064

EMLOYING YOUTH MENTAL HEALTH FIRST AID

52

APPENDIX F
Statistical Data
Table 1
Frequency Table for Demographic Variables
Variable

n

%

Age
50-64
3
50.00
35-49
3
50.00
Gender
Male
2
33.33
Female
4
66.67
Race
4
66.67
White/Caucasian
2
33.33
Latino_Spanish
Marital_Status
Married
4
66.67
Never Married
1
16.67
Divorced
1
16.67
Resource_Parent
Foster
4
66.67
Foster/Kinship
1
16.67
Foster/Adopted
1
16.67
Years_of_Experience
10+ yrs
3
50.00
0-2yrs
2
33.33
6-9yrs
1
16.67
Note. Due to rounding errors, percentages may not equal 100%.

Table 2
Summary Statistics Table for Pre- and Post-Mental Health Literacy Intervention
Variable
M
SD n
Min
Max
Mdn
Pre-Mental Health Literacy 133.50 11.84 6 115.00 149.00 135.50
Post-Mental Health Literacy 139.17 10.03 6 123.00 150.00 141.50

EMLOYING YOUTH MENTAL HEALTH FIRST AID
Table 3
Two-Tailed Paired Samples t-Test for the Difference Between Pre-Mental Health Literacy and
Post-Mental Health Literacy
Pre-Mental Health Literacy Post-Mental Health Literacy
M
SD
M
SD
t
p
d
133.50
11.84
139.17
10.03
-1.97 .107 0.80
Note. N = 6. Degrees of Freedom for the t-statistic = 5. d represents Cohen's d.

Figure 1
The means of Pre-Mental Health Literacy and Post-Mental Health Literacy with 95.00% CI
Error Bars

53