Mentoring, Task Shifting, and the Paraprofessional Revolution

By Jean Rhodes

In 1979, a young psychology professor named Joseph Durlak published a controversial study in Psychological Bulletin that sent ripples through the helping professions. He combined all published studies that had compared the outcomes of experienced psychologists, psychiatrists, and social workers with those of paraprofessionals (i.e., nonexpert, minimally trained community volunteers and helpers). Overall, paraprofessionals were comparable to trained mental health professionals and in 12 out of 42 evaluations they were actually superior. Durlak concluded, “professionals do not possess demonstrably superior therapeutic skills, compared with paraprofessionals. Moreover, professional mental health education training and experience are not necessary prerequisites for an effective helping person” (Durlak, 1979, p. 6). But there is a critical caveat: paraprofessionals with more experience showed the strongest effects relative to professionals. Moreover, the most effective paraprofessionals were those who were well trained and supervised and whose efforts were focused on specific target problems (e.g., depression, healthy behaviors) as opposed to more general, broad outcomes.

More recently, researchers Kendall D. Smith, Bailey Hall, and Edelyn Verona (2024) have extended Durlak’s early findings with new variables, refining effect size calculations, and applying modern statistical analyses to contextualize paraprofessionals’ success in different environments. They reviewed nine meta-analyses and 13 individual studies, published after 1995. Their goal was to determine whether paraprofessionals could effectively meet the diverse demands of mental health service delivery. Paraprofessional groups were categorized based on training level, i.e.,trainees (such as graduate students) versus limited-training individuals (such as community volunteers or laypersons, to highlight how effectiveness varied according to the paraprofessional’s role, the population served, and the treatment setting.

Their findings echoed some of Durlak’s initial conclusions while offering new insights into where paraprofessionals excel. For example, in university counseling settings, trainee paraprofessionals performed just as effectively as licensed professionals, showing similar rates of client improvement. In community mental health settings, where services are provided to children and adolescents, limited-training paraprofessionals demonstrated significant impact, especially in areas where structured interventions and client rapport were emphasized. These results are consistent with Durlak’s observation that paraprofessionals succeed in specific, well-defined tasks under professional supervision.

Virtual and phone-based service delivery emerged as a unique context in Smith’s study, where paraprofessionals displayed slightly lower fidelity than professionals but showed notable empathy and client success, especially in sensitive areas like suicide prevention. The study also highlights the impact of peer navigators—paraprofessionals who share lived experiences with clients and are well-suited for addressing mental health challenges in marginalized communities. Smith et al. reveal that peer navigators can surpass highly trained professionals by building trust and offering relatable, culturally relevant support.

Implications for Mentoring

These findings align well with a growing theoretical and empirical literature on paraprofessional mentoring. McQuillin, Hagler, Werntz, and Rhodes (2021) proposed a formal framework for paraprofessional youth mentoring, arguing that volunteer and paid mentors represent a largely untapped workforce for extending mental health services to underserved youth. Writing in the American Journal of Community Psychology, they noted that the demand for child mental health services far exceeds the supply, and that approximately 20% of youth internationally suffer from an impairing mental health condition (Belfer, 2008), while only one-third of affected adolescents in the United States receive treatment (Merikangas et al., 2011). They proposed that mentoring organizations could train a subgroup of their volunteers and paid mentors to serve as paraprofessionals, taking on three specific roles: reducing barriers to mental health services, increasing youth engagement in those services, and, in some cases, delivering direct evidence-based interventions under professional supervision. Their framework drew explicitly on the task-shifting tradition from global public health, in which services traditionally reserved for licensed professionals are redistributed to more widely available paraprofessionals with appropriate training and oversight (World Health Organization, 2008). They also noted current limitations of the mentoring field, noting that the majority of volunteer mentors receive fewer than two hours of pre-match training and that most programs lack both the professional supervision structures and the documentation systems that would be required for responsible paraprofessional service delivery (Garringer et al., 2017). They argued that realizing this potential would require competency-based training and evaluation, supervision by licensed professionals, and systematic documentation of services rendered.

Building on this framework, Dow, Simpson, McQuillin, Limberg, Hills, and Huebner (2026) recently completed a scoping review that moved the question from broad program delivery to the level of discrete therapeutic techniques, which the authors term evidence-based ingredients. Published in Behavioral Sciences, the review synthesized literature on social-emotional evidence-based ingredients delivered by paraprofessionals to youth, searching PsycINFO and PubMed and ultimately yielding 19 eligible studies from 4,321 participants ranging in age from 4 to 18 years. Their goal was to identify which specific practices had been delivered, by whom, under what training and supervision conditions, and with what results for youth outcomes including anxiety, depression, suicidality, and subjective wellbeing. The scoping review identified 17 distinct evidence-based ingredients across the 19 studies, with mindfulness skills, relaxation skills, psychoeducation, exposure, and cognitive restructuring appearing most frequently. The paraprofessionals who delivered these ingredients included graduate students, teachers, peers, caregivers, nurses, and in some cases the youth themselves via self-administered technology platforms. Thirteen of the 19 studies found significant improvements in at least one targeted outcome, including reductions in anxiety and depression and increases in subjective wellbeing and suicide-related knowledge and attitudes. Effect sizes for anxiety outcomes ranged from small to large, with several studies reporting notably large effects (e.g., Cohen’s d as high as 3.18 in one school-based trial).

The review’s findings on training and supervision are particularly instructive for mentoring practitioners. Most of the 19 studies provided some form of initial training for their paraprofessionals and designated supervisors to support delivery; however, the degree of support varied considerably and was often inconsistently reported, with only three studies including fidelity checks. The authors observed that graduate students with prior coursework in psychology often required less intensive oversight, while peers, caregivers, and youth themselves generally needed more structured guidance and ongoing supervision to ensure fidelity. Likewise, some evidence-based ingredients, such as mindfulness and relaxation skills, appeared more readily deliverable with brief training, while others, such as cognitive restructuring and exposure techniques, likely require more intensive preparation and monitoring to minimize risk.[ppl-ai-file-

Dow et al. (2026) specifically flag mentors as a promising and underutilized workforce for this kind of task-shifting, noting that mentors already occupy a trusted position in youth’s proximal social systems and that quality mentoring relationships characterized by both positive relational support and targeted activities tend to yield the strongest outcomes (Lyons et al., 2019; Werntz et al., 2023). The review’s authors recommend that future research focus on optimizing mentor training for specific evidence-based ingredients and developing brief, modular interventions that can be flexibly applied within existing mentoring relationships and school behavioral health systems.

Reflections

Taken together, these studies build a progressively more specific and actionable case for a paraprofessional service delivery revolutino. Smith and colleagues confirm that paraprofessionals remain broadly effective across mental health settings, with particular advantages in cost-efficiency, accessibility, and peer-based rapport. McQuillin and colleagues situate this evidence within the mentoring context, outlining a theoretically grounded framework for how programs could be restructured to harness this potential. And Dow and colleagues push the field further still, demonstrating that it may not be necessary to train mentors to deliver entire manualized treatment packages. Instead, discrete evidence-based ingredients such as mindfulness, relaxation, and psychoeducation can be feasibly delivered by a range of non-licensed individuals when appropriate training and supervision structures are in place.

This suggests that mentors trained as paraprofessionals could be pivotal in providing accessible mental health support for young people, reducing barriers, and helping mentees engage with professional services more readily. By equipping mentors with structured training and aligning them with best practices, youth mentoring programs could meet an urgent need for accessible, scalable mental health interventions. These studies also reinforce the case for the kind of stepped-care and tiered support models including emerging that could formalize and credential these roles while ensuring consistent quality of care across diverse settings.

References

Christensen, K. M., Hagler, M. A., Stams, G. J., Raposa, E. B., Burton, S., & Rhodes, J. E. (2020). Non-specific versus targeted approaches to youth mentoring: A follow-up meta-analysis. Journal of Youth and Adolescence, 49(5), 959–972. https://doi.org/10.1007/s10964-020-01233-x

Dow, B. R., Simpson, S. B., McQuillin, S. D., Limberg, D., Hills, K. J., & Huebner, E. S. (2026). Building school behavioral health capacity: A scoping review of evidence-based ingredients delivered by paraprofessionals. Behavioral Sciences, 16, 835. https://doi.org/10.3390/bs16060835

DuBois, D. L., Portillo, N., Rhodes, J. E., Silverthorn, N., & Valentine, J. C. (2011). How effective are mentoring programs for youth? A systematic assessment of the evidence. Psychological Science in the Public Interest, 12(2), 57–91. https://doi.org/10.1177/1529100611414806

Durlak, J. A. (1979). Comparative effectiveness of paraprofessional and professional helpers. Psychological Bulletin, 86(1), 80–92. https://doi.org/10.1037/0033-2909.86.1.80

Garringer, M., McQuillin, S., & McDaniel, H. (2017). Examining youth mentoring services across America: Findings from the 2016 National Mentoring Program Study. MENTOR: The National Mentoring Partnership. https://www.mentoring.org/wp-content/uploads/2020/03/Mentor_Survey_Report_FINAL_11_15_18_Sm.pdf

Jarjoura, G. R., Tanyu, M., Forbush, J., Herrera, C., & Keller, T. E. (2018). Evaluation of the Mentoring Enhancement Demonstration Program: Technical Report. https://www.ncjrs.gov/pdffiles1/ojjdp/grants/252167.pdf

Lyons, M. D., McQuillin, S. D., & Henderson, L. J. (2019). Finding the sweet spot: Investigating the effects of relationship closeness and instrumental activities in school-based mentoring. American Journal of Community Psychology, 63(1–2), 88–98. https://doi.org/10.1002/ajcp.12283

McQuillin, S. D., Hagler, M. A., Werntz, A., & Rhodes, J. E. (2021). Paraprofessional youth mentoring: A framework for integrating youth mentoring with helping institutions and professions. American Journal of Community Psychology. Advance online publication. https://doi.org/10.1002/ajcp.12546

Merikangas, K. R., He, J.-P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., et al. (2011). Service utilization for lifetime mental disorders in U.S. adolescents: Results of the National Comorbidity Survey. Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 32–45. https://doi.org/10.1016/j.jaac.2010.10.006

Raposa, E. B., Rhodes, J., Stams, G. J. J. M., Card, N., Burton, S., Schwartz, S., et al. (2019). The effects of youth mentoring programs: A meta-analysis of outcome studies. Journal of Youth and Adolescence, 48(3), 423–443. https://doi.org/10.1007/s10964-019-00982-8

Smith, K. D., Hall, B., & Verona, E. (2024). The use of paraprofessional service delivery in psychological helping settings: Comparative effectiveness and considerations. Professional Psychology: Research and Practice. Advance online publication. https://doi.org/10.1037/pro0000597