New review discusses how paraprofessional providers can expand school-based motivational interviewing

Hart, M. J., McQuillin, S. D., Iachini, A., Weist, M. D., Hills, K. J., & Cooper, D. K. (2023). Expanding school-based motivational interviewing through delivery by paraprofessional providers: A Preliminary Scoping Review. School Mental Health. 

https://doi.org/10.1007/s12310-023-09580-3

Summarized by Ariel Ervin

Notes of Interest:

• Schools are a common source of mental health for youths with elevated symptoms or diagnoses and the general public.
• Although the school mental health (SMH) field has made progress in bolstering positive youth outcomes, many school systems still experience workforce and resource shortages.
• Task-shifting* can potentially alleviate the burden professional mental health providers experience.
  • For instance, paraprofessionals can administer low-intensity mental health interventions, while more qualified professionals can conduct more intense ones.
• This paper reviews the literature on training paraprofessionals in motivational interviewing (MI)**.
• Training paraprofessionals in MI can encourage positive behavioral changes in different populations and bolster mental health, social service, and medical workforces.
• MI task-shifting can be used to approach unique needs – this is especially important since SMH programs consist of myriads of targets and initiatives.
• Although the review shows how flexible it is to administer task-shifting, professionals and their clients are recommended to have some commonalities (e.g., having similar experiences and belonging to the same community).
• Engaging with paraprofessionals with specific professional or personal qualities (e.g., having experience in human services) can promote better programming.
• Although the durations and frequencies of training varied in all of the examined studies, conducting at least an initial workshop-style exercise can help paraprofessionals develop basic approaches and skills to utilize.
• This study demonstrates the potential paraprofessional delivery of MI has in addressing the mental health service gap in schools.
• Effective task-shifting requires a) rigorous and continuous evaluations and b) significant restructuring & planning to ascertain that professional providers/roles are responsibilities are appropriately adapted.
• Future studies need to evaluate how the practice of task-shifting-related training doesn’t overburden supervisors and administrators.

* = Task-shifting refers to a process where responsibilities are appropriately distributed to healthcare workers who have fewer qualifications and training experience (aka paraprofessionals, non-professionals, etc.) than healthcare professionals. 

** = Motivational interviewing (MI) is an interpersonal approach that fosters behavioral changes among equivocal people.

Introduction (Reprinted from the Abstract)

The supply of school mental health (SMH) providers and services cannot meet the demand of students in-need, and this gap is expected to widen in coming years. One way to increase the reach of helpful services for youth is to grow the SMH workforce through task-shifting to paraprofessionals. Task-shifting could be especially promising in expanding Motivational Interviewing (MI) interventions, as MI can be molded to target a number of academic and behavioral outcomes important to schools. However, no review of training exclusively paraprofessional samples in MI has yet been conducted. The current paper provides a scoping review of 19 studies of training paraprofessional providers to use MI to evaluate trainee characteristics, training content and format, and outcomes. Of these 19 studies, 15 reported that paraprofessionals improved in using MI following training. Nine studies reported that task-shifting MI was positively received by clients and/or providers. Six studies examined task-shifting MI in youth-serving contexts, and four examined the practice in traditional school contexts, suggesting its potential for use in SMH. Other findings and implications, such as client behavior change and provider fidelity, are shared, along with ideas for advancing research, practice, and policy in this subfield.

Implications (Reprinted from the Discussion)

This scoping review examines previous studies of training paraprofessionals to use MI, thereby expanding the existing knowledge base of MI training in a novel way. Further, this review was conducted with attention to each study’s relevance to SMH, trainee characteristics, training content and measures, and outcomes. Findings largely support that, when trained in MI, paraprofessionals can complement and expand medical, mental health, and social service workforces, and can instill or prompt positive behavior changes among varied populations with whom they work. Though most studies reviewed in the present paper were preliminary investigations, their findings indicate that expanding and strengthening health- and social-service workforces by task-shifting MI holds potential.

These findings can be applied to SMH initiatives in efforts to close the current and projected wide gap between available professionals who traditionally provide SMH services and students who could benefit from or need additional, specialized supports. For example, paraprofessional school-based providers could deliver lower-intensity mental health interventions to students at mild or moderate risk for deleterious outcomes, while professionals’ attention and expertise would be directed to more severe cases. Similarly, more highly trained professionals could shift to systems-level consultation and intervention work. Hart and colleagues (2021) propose a detailed model for incorporating paraprofessional mentors into traditional school contexts, which could inform efforts to actualize task-shifting MI in SMH. These recommendations should be coupled with existing best practices for school-related trainings to allow for applications that are contextualized and effective.

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