Why my daytime job might put my nighttime job out of business!

by Dr. Alexandra Werntz, Ph.D., Associate Director, Center for Evidence-Based Mentoring

When I talk to people about what I do, I say that my daytime job (with the Center for Evidence-Based Mentoring and MentorPRO) is focused on putting my nighttime job (therapist in private practice) out of business. As a licensed clinical psychologist and therapist in Virginia, I see firsthand the struggles of youth and their families. I also know that although my training, skills, and experience are necessary for treating some mental health disorders and challenges, many youth struggling do not need a licensed professional. In an ideal world, no youth would struggle and therapists would be obsolete. But after that, one solution would be to have a stepped-care approach to supporting youth. 

Our team at the Center for Evidence-Based Mentoring has been at the forefront of working with various groups to advance a paraprofessional workforce of mentors to support the well-being of youth. There is a mental health crisis among the youth in the US. COVID played a role, forcing youth to isolate during critical developmental stages. There are also not enough highly-trained providers to ameliorate the crisis alone. And, that there is a spectrum of need among youth struggling: of course some need intensive care from psychiatrists, pediatricians, and psychologists, however not all youth need this level of support. In our paper, we put forth a framework to start considering how a paraprofessional workforce of trained and supervised mentors may be able to play a critical role in this crisis. We argue that in a stepped-care model, youth with lower-intensity challenges may benefit from a mentor who is trained in the necessary helping skills of empathy, active listening, relationship-building, reflection, and maybe even basic evidence-based psychological intervention tools that everyone can benefit from (e.g., naming emotions, challenging thoughts). In our paper we outline that training, supervision, documentation, and ongoing evaluation will be critical to building this workforce. 

Recently, Jean Rhodes and I have been involved in a few endeavors that are seeking to move the field forward. One is a program funded by the Boston Public Health Commission at the University of Massachusetts Boston (UMB): Transforming Boston Access to Mental Health (BAMH), co-lead by UMB faculty, Amy Cook, PhD, and Lindsay Fallon, PhD. Through this program, fellows (graduate and undergraduate students at UMB) take courses on mental health care and then complete clinical internships in Boston. Dr. Rhodes and I created and are teaching the course in Therapeutic Mentoring, which is designed to teach undergraduate students how to build strong mentoring relationships and use evidence-based psychological interventions in their relationships. 

The history of Therapeutic Mentoring in Massachusetts began with the 2001 lawsuit Rosie D. v. Romney, filed on behalf of Medicaid-eligible children under 21 who were not receiving necessary mental health services. The 2006 court ruling required Massachusetts to provide comprehensive home-based services, including therapeutic mentoring. In response, the state implemented the Children’s Behavioral Health Initiative (CBHI), which includes therapeutic mentoring. This involves structured, one-on-one support between a trained mentor and youth, focusing on daily living, social, emotional, and communication needs. Therapeutic mentors, considered community health workers, help youth achieve personal goals and potential alongside other mental health services.

In the therapeutic mentoring model, mentors support youth who are already receiving services – like outpatient therapy – to extend the reach of those clinical services. In our course, undergraduates learn how to support cognitive-behavioral treatment plans, like helping youth practice identifying thoughts, feelings, and behaviors, and modeling healthy emotional expression. Therapeutic mentors help with supervised practice, a critical component of youth interventions. Anecdotally, we loved teaching this course. The undergraduates were motivated to learn these skills – often reserved for graduate-level training – and to discuss how they were relevant for their upcoming internships in the field. 

We have also been teaching versions of Mentoring for Youth Mental Health for mentors and program staff through our Center and through MentorPRO Academy. I’ve taught 12-session, virtual, live courses and Dr. Liz Raposa of Fordham University just wrapped up her version of the course this spring. She’s now offering it as a pre-recorded, 9-session course. At the end, learners earn a certificate from our Center. The course is designed to provide mentors with the basics in evidence-based mental health skills that they can take back to any mentoring relationship. The course is not designed to encourage mentors to diagnose or treat mental health conditions, but instead to allow them to infuse what we know works in healthy emotional expression, thinking in helpful ways, and doing behaviors that are in line with our values and goals. We also believe that supportive accountability is a critical part of a mentor’s role in working with any mentee. 

So what can mentors do? Personally and professionally, I know that mentors play a unique and critical role in the lives of their mentees. A stepped-care model that incorporates paraprofessional mentors to support youth mental health has benefits, including lower cost for families with youth who do not need a professional, and a more appropriate allocation of resources. Of course this model will also come with challenges, but I believe that those can be overcome. This will take innovative approaches within mentoring programs and will require a shift in mindset for others. However, I believe that this is not only possible, but is the future of mentoring.