By Jean Rhodes
Since the early 1990’s, the major risks facing young people have shifted from physical struggles like teen pregnancy and substance to mental health struggles like anxiety, depression, suicide and self-harm. Indeed, the American Academy of Pediatrics recently issued a report noting that “mental health disorders are the most common cause cause of “impairment and limitation” among adolescents. And, last December, the U.S. Surgeon General warned of a “devastating” mental health crisis among American teenagers. But, as the New York Times recently highlighted, therapeutic and medical systems have been unable to keep up, and teens and their parents are flooding emergency rooms and pediatricians offices with complex psychiatric issues. The 2019 A.A.P. report concluded that pediatricians and other providers need to step up if we are going to bridge gaps in care. But even if they worked around the clock, they would never be able to serve all the youth in need. Consequently, volunteer mentors and other paraprofessional helpers have an important role to play. In a recent publication (excerpted and reformatted below) my colleagues, Sam McQuillin, Matt Hagler, Alexandra Werntz, and I offered a framework for engaging mentors and programs who want to to help me the mental health challenges of today.
“…Volunteer mentors are rarely thought of as paraprofessionals or even as sitting on the same continuum of therapeutic care. The fact remains, however, that volunteer mentoring relationships and therapeutic relationships share much in common.
- they are typically situated somewhat outside of the youth’s network of family, friends, and community and involve weekly “sessions.”
- They are both characterized by inherent power differentials and a focus on only one member’s improvement.
- Mentoring also adheres to the same rituals as therapeutic relationships…
- Formal mentors frequently draw on a wide array of established therapeutic techniques.
- When mentoring is effective, it also appears to produce positive outcomes in a similar manner to psychotherapy, with a positive relationship serving as the foundation for more functional goal-focused activities and experiences (Lyons et al., 2019).
Research suggests that mentoring programs can successfully move the needle on youth mental health symptoms….
[Four ways that Mentors as Paraprofessionals Can help Addressing Today’s Youth Mental Health Crisis.]
- Addressing barriers to engaging in mental health treatment-…At a very practical level, mentors can provide logistical assistance by helping to schedule appointments, reminding youth and families of appointment times, and providing or facilitating transportation to appointments. Among the most common reason that adolescents cite for missing appoint-ment is simply forgetting about them and routine reminders, particularly text messages, have been shown to boost adherence significantly …In addition to these practical difficulties, there are several less tangible, but significant, barriers to care, particularly among minority, low-income, and other marginalized families. These include mental health stigma (Corrigan et al., 2014) and concerns about the cultural sensitivity of care due to dominant Western-centric models of healing that have pathologized minority cultures and failed to contextualize mental health difficulties in broader social ecologies…If paraprofessional mentors can be integrated with professional systems of care, they might serve as cultural brokers or service liaisons…
- Facilitating between-session practice and real-world application of skills- Most effective, evidence- based interventions emphasize the importance of between- session “homework,” noting that, in most cases, a very small percentage of clients’ time is actually spent in therapy sessions, particularly in outpatient modalities. Between-session practice facilitates the generalization, adaptation, and real-life application of therapeutic skills that, if only practiced in session, may only be artificially learned and have little impact on one’s actual life (Kazant- zis & Ronan, 2006)…Mentors could also serve as a liaison between providers and parents, particularly when parents cannot attend sessions in person, or when there are cultural differences between the family and treatment team…
- Supporting youth as they engage in mental health apps (MHapps) and other technology-delivered interventions (TDIs), which may be particularly appropriate for youth with somewhat milder presenting concerns or those who are otherwise unwilling or unable to engage in in-person therapy. MHapps, in particular, are increasingly being used to address youth’s most common mentee behavioral and mental health con- cerns. A growing number of TDIs include paraprofes- sional coaching, which provides users with “supportive accountability,” that is, regular check-ins, monitoring, and troubleshooting (Mohr et al., 2011). Mentors who are trained in supportive accountability may thus have a vital role to play in supporting youth’s use of TDIs (Rhodes, 2020).
- Direct provision of evidence-based interventions Paraprofessionals can be trained to competently deliver evidence-based psychological interventions, particularly those that are highly structured and manualized. As discussed above, direct service provision by paraprofessionals requires development of protocols, training, and supervision, as well as research establishing efficacy and effectiveness in real-world practice. Paraprofessionals should not take the place of professionals without rigorous empirical evidence for their ability to deliver particular treatments effectively, as well as the conditions under which they are able to do so…
Overall, our proposal is not to shift the focus of all mentoring programs and all mentoring dyads to the delivery of mental health interventions. A focus on relationship building, companionship, and recreation may be suitable for many mentees and families who carry some risk but have not yet manifested mental health symptoms, or whose symptoms are being adequately addressed else- where. Larger programs may consider developing specialized therapeutic mentoring arms that will support a subgroup of their matches. The development of specialized arms of larger mentoring programs is not unprecedented. For example, Big Brothers Big Sisters of America already has specialized programs for children of incarcerated parents and children of military families. Through the use of technology-based training and supervision, even mentors in more remote chapters may be able to develop a therapeutic specialty and access the expertise of a relatively small number of professional staff. Overall, for the paraprofessional approach to succeed, structures and procedures must be in place.
Mentoring programs are well positioned to help bridge gaps in service for youth facing mental health challenges. To achieve this, mentors can be leveraged to serve as paraprofessionals and can task-shift to support or even deliver evidence-based care.”
Note: This is an excerpt from a longer article on the topic.
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. https://doi.org/10.1002/ajcp.12546 [PDF]