Can mentors be trained in cognitive-behavioral therapy? New evaluation has answers

Decades of research have shown that, with the right training and support, mentors and other paraprofessionals can deliver mental health interventions in ways that benefit youth. Doing so could help to bridge the substantial gaps in care. Indeed, less than a third of children and adolescents who need mental health and related care actually receive any services; and most of the services they do receive are not empirically supported. Many youth-serving mental health facilities are at capacity and have long waiting lists and, even if every mental health professional worked around the clock, they would never meet the growing demands for service. Annual rates of staff turnover in the child- and adolescent- serving mental health workforce exceed 50 percent. These shortages, as well as both attitudinal issues (e.g., concerns about stigma, cultural insensitivity, and low treatment effectiveness) and structural issues (e.g., cost, transportation, time, and access) have created overwhelming barriers for many parents who are seeking professional care for their children and lead many to turn to mentoring programs.

Fortunately, there’s a natural alignment between mentoring and mental health care. Most program-based mentors are already trained to engage in evidence-based relationship-building techniques and, although rarely acknowledged and not particularly systematic, they often intuitively draw on a wide array of established therapeutic techniques. In particular, they often draw on principles of cognitive behavioral therapy (CBT). CBT principles are at play when mentors encourage their mentees to think and act in more adaptive ways. Likewise, mentors frequently model and reinforce accurate appraisals, coping strategies, and proactive problem-solving. Mentors can challenge pessimistic thought and behavior patterns and show the links between new approaches and better outcomes. By making CBT training and practice more intentional and deliberate, perhaps mentors could help to bridge our society’s widening gulf between those youth who need help and those who get it.

New study

Jarjoura, G. R., Herrera, C., and Tanyu, M. (2022). Evaluation of Reach & Rise® Program Enhancements to Cognitive Behavioral Mentoring. American Institutes for Research

In a rigorous new evaluation, researchers Roger Jarjoura, Carla Herrera, and Manolya Tanyu (2022) provide some insights into the potential value and pitfalls of trying to enhance mentoring with cognitive behavioral training. The study evaluated the implementation and impact of Cognitive Behavioral Therapy (CBT) enhancements to the YMCA’s Reach & Rise® program (R&R). This included pre-match training modules for mentors on CBT techniques, strategies for augmenting the youth’s “growth plan” (a plan outlining goals and mentoring strategies to achieve those goals for the youth), mentor-support CBT-focused “check-in” tools, and a CBT parent education and support component. The study examined the impact of R&R Mentoring on youth outcomes and whether CBT-Enhanced R&R Mentoring benefited youth more than the standard R&R Mentoring. The enhancements included two extra hours (17 vs. 15) of pre-match training modules for mentors on CBT techniques, including, for example: identifying and interrupting negative thoughts, beliefs, and assumptions; tracking and monitoring progress made toward goals; and celebrating success. The training module also introduced mentors to tools they could use with their mentees, including mood mapping and journaling, and parents were trained and supported in the use CBT strategies with their child at home.

In total, there were 600 youth enrolled into the evaluation. Of these, 457 (76%) signed up in the sites that implemented the enhancements (CBT sites) and 143 (24%) were in the Business-as-Usual (BAU) sites. A total of 316 youth were randomly assigned to the treatment group, and 284 youth were assigned to a waitlist (i.e., the control group) where they were not eligible to be matched with a mentor. Just over two-thirds of those assigned to the treatment group were matched with mentors – this included 160 at CBT sites and 54 at BAU sites. The team sought to determine the impact of R&R and the effects of the programmatic enhancements on mentor-mentee relationship quality, youth outcomes, and caregiver experiences.

Results

Overall, compared to the control group, the R&R program had statistically significant significant impacts on greater connectedness to family and school, greater caregiver-reported academic performance, lower self-reported delinquency, and lower substance use. Contrary to expectations, there were no statistically significant differences in outcomes for youth attending programs with CBT enhancements compared to those attending programs using the standard R&R model.

There were, however, promising signs that stronger program support, additional training, and greater mentor/caregiver adherence to the CBT strategies could benefit thousands of youth.

• Mentors who received more program supports for their use of CBT strategies had mentees who reported more frequent use of these approaches, leading to stronger relationships and more positive outcomes.
• Caregivers who received program supports for their use of CBT strategies were more likely to implement those strategies with their children, leading to more positive youth outcomes.

Taken together, the results point to both the implementation challenges and promises of incorporating CBT trainings into mentoring programs.

Challenges: The study points to some of the common challenges of implementing new practices with fidelity.

• Oversight: Mentors and caregivers reported inconsistent communication with their site directors.
• Staff turnover: 11 of 22 participating sites experienced staff turnover, possibly affecting program support.
• Inconsistent application of CBT principles: Although CBT enhancements were developed, their application was inconsistent. Some mentors felt unsupported, while others struggled with the specific jargon related to CBT strategies.

Promise: The study also points to ways that evidence-based practices could be integrated in the future.

1. Allow adaptation and customization: Site directors creatively adapted CBT enhancements to make them more relatable to participants, which, while affecting fidelity, could have increased staff buy-in and uptake by the participants.
2. Focus on CBT strategies that are easier to describe and use: Strategies like celebrating success and creating new habits were more frequently utilized by mentors, while mood mapping and journaling were less preferred.
3. Improve training and tools: The CBT-focused training module added to the mentor training was content-heavy, and site directors sought ways to make it as interactive and engaging as was true of other sections of the mentor training. Moreover, the tools introduced for monthly check-ins with mentors and caregivers were complex, requiring additional time and skills on the part of the site directors.
4. Engage caregivers: Although the parents who used the CBT manual provided to them as part of the intervention found value in it, very few used it. 
5. Provide leadership training: The commitment level of YMCA leadership to the Reach & Rise® program varied across agencies, impacting the quality of implementation.

The report highlights the potential benefits of providing tools and resources that are easy to use, culturally relevant, and designed with input from the staff who are familiar with the target population. New technology platforms, including MentorPRO, are developing ways to make goal setting, check-in, mentor CBT training, and evidence-based practices more dynamic.

Taken together, the evaluation suggests that with attention to fidelity and evidence-based practices, mentoring programs can help to bridge gaps in mental health care.