Giving psychology away: The promise of paraprofessional mentors
by Jean Rhodes
More than fifty years ago, community psychologist George Albee (and my mentor) pointed to the wide and unbridgeable gaps between the small number of highly trained mental health professionals and the vast number of people who need care and support. He called for new models in which psychologists and other helping professionals move from providing direct service to supporting frontline lay providers:
“Let me emphasize, I do not see psychology as the care-delivery field. We can never have the manpower to meet the demands. Rather, we must create the theory, and show how it is applicable, to enable care to be given by bachelor’s level people. . . . Psychology can only be the developer of the conceptual models and of the research underpinning.”
American Psychological Association President George Miller echoed this sentiment the following year in his presidential address, arguing that professionals’ responsibility is less to “try to apply psychology ourselves, than to give it away to the people who really need it. . . . I can imagine nothing we could do that would be more relevant to human welfare, and nothing that could pose a greater challenge to the next generation of psychologists, than to discover how best to give psychology away.”He made this rallying cry amid the growing calls of community psychologists to expand mental health services by offering affordable clinics in neighborhoods and by empowering affected individuals and their communities to create their own solutions. Innovative ideas—from developing mutual support groups to training bartenders, beauticians, and cab drivers in therapeutic techniques—were tested by community psychologists who saw the potential of lay providers on the continuum of care, recognizing that they were able to provide help that was comparable, and in some cases even preferable, to that of experts.
Curiously, mentoring programs never really registered these clarion calls. Although they were essentially providing quasi-therapeutic care, volunteer mentors were rarely thought of as paraprofessionals (i.e., non-expert paid or volunteer care providers) 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. And, although rarely acknowledged and not particularly systematic, formal mentors frequently draw on a wide array of established therapeutic techniques. For example, as mentors encourage their mentees to think and act in more adaptive ways, they may draw on principles of cognitive behavioral therapy (CBT), which help young people develop the skills needed to effectively address many of the most common psychological problems. Providing mentors with more systematic guidance for applying such tools may serve the additional purpose of increasing their sense of self-efficacy in the relationship, which is related to program effectiveness and match length. With targeted tools and training, volunteer mentors can help to bridge our society’s widening gulf between those youth who need help and those who get it.
Moreover, although funders may prioritize other issues, such as school success, it is important to note that mental health struggles often precede academic, social, and career difficulties. When youth learn and develop behavioral and emotional regulation skills (e.g., self-awareness, social awareness, decision making, self-management, and relationship skills) they are better positioned to keep impulses in check and focus on schoolwork.[Such skills are vital to youth who have been exposed to toxic stress. Exposure to violence and stressors can trigger automatic fight-or-flight neural connections (or circuits) and these impulses are in opposition to the more intentional responses needed to ignore distractions, pay attention, and learn.
Decades of research have shown that, with the right training and support, paraprofessionals can deliver interventions just as effectively as professionals—if not more so—in ways that could help to bridge the substantial gaps in care. Less than a third of children and adolescents who need mental health and related care actually receive any services; most of the services they do receive are not empirically supported, and these rates are even lower in ethnic minority populations. Many youth-serving mental health facilities are at capacity and have long waiting lists, and 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. Yet, left untreated, many of the early social, emotional, behavioral, and academic struggles that emerge in childhood and adolescence grow more complicated and difficult to resolve. One solution is for youth to first work with paraprofessionals and then step up to more intensive professional services as needed.
One way to ensure that mentors are able to provide evidence-based care is to harness the growing array of effective, technology-delivered interventions. Although most youth struggle to stick with technology-delivered interventions on their own, their engagement in self-administered programs deepens when blended with coaching and face-to-face support. When supplemented with support, technology-delivered interventions produce outcomes that rival those of face-to-face interventions, often at no cost and in ways that are more geographically, financially, and socially acceptable to youth and their families. This blended mentoring model has the potential to revolutionize how targeted, evidence-based interventions are delivered in large, nonspecific programs. These models shift mentors’ roles from delivering interventions to supporting and practicing the targeted, evidence-based interventions that are delivered by professionals (embedded mentoring) or through technology (blended mentoring). Although ensuring engagement and practicing new skills with mentees may seem like trivial tasks, they dramatically improve outcomes. Compared to instruction-only skills modules, programs that provide young people with supervised opportunities to practice and receive feedback on the skills and behaviors they are learning yield far stronger effects than those without the practice component.
Particularly in light of the global shortage of mental health providers and other youth-serving professionals, the length and cost of professional training, the expense and difficulties associated with accessing services, and the stigma and distrust that professional services carry in many marginalized communities, mentors and other volunteers can and should be trained and supervised to support and/or deliver evidence-based care. As we move in this direction, programs should find ways to ecognize and credential volunteers with professional recognition, credits, and micro-credentials such as certifications and digital badges.
To this end, the Center of Evidence-Based Mentoring at UMass Boston will be offering a certificate in therapeutic mentoring this coming semester. Our new course on Therapeutic Mentoring is open for enrollment to anyone in the world, so please sign up We are continuing to work closely with the State to get this course approved for certification and it’s only a matter of time. But worst case, students will receive University certification and continuing ed credits. The course is being taught by me but also a pioneer in therapeutic mentoring, Josephine Cardona, a school psychologist who has served as a therapeutic mentor, and guest speakers who represent the communities that mentors serve.
