Does All That Training Matter?!: New Study Compares Professional Helpers to Paraprofessionals

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 process 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.

Now, 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—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 fresh 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.

Reflections

Smith et al.’s study suggests that, while professionals may perform slightly better on treatment fidelity, paraprofessionals present significant advantages in terms of cost-effectiveness and accessibility. This suggests that paraprofessionals may be particularly effective in a stepped-care models, where they handle less intensive tasks, alleviating the workload of licensed professionals who can then focus on more complex cases. The study also emphasizes the importance of structured training and professional supervision for paraprofessionals, recommending that paraprofessional programs adopt standardized guidelines and certification to ensure consistent quality of care across diverse settings. New certifications in therapeutic mentoring may be particularly important in this regard.

As these findings suggest, 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.

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