A novel peer-to-peer coaching paraprofessional training program to support digital mental health

Rosenberg, B. M., Kodish, T., Cohen, Z. D., Gong-Guy, E., & Craske, M. G. (2022). A novel peer-to-peer coaching program to support digital mental health: Design and implementation. JMIR Mental Health, 9(1), e32430.

Summarized by Saniya Soni

Notes of Interest:

• Paraprofessional support models are a significant pathway to bridge the gap in mental health care and improve engagement. Digital mental health interventions (DMHIs) can reach more individuals than traditional brick-and-mortar mental health approaches
• Combining paraprofessionals and DMHIs has the unique potential to bolster engagement and breadth of high-quality evidence-based treatments, but high demand and lower resources have impacted fidelity.
• This paper highlighted one way to develop a training program for a combined paraprofessional & DMHI approach that highlights fidelity while maintaining scalability.
• UCLA STAND’s program provides students with free mental health care in a variety of approaches, one of those being digital CBT with certified peer-to-peer coaching
• Researchers highlight how they maintained fidelity during their coaching program:
  • Supervision & training are provided by grad students in a clinical psych program The training program consists of 4 levels that include digital CBT content, role-play exercises, invite corrective feedback, supervision, and video recordings
  • The design of the training was influenced by learning theory and competency-based supervision
• Paraprofessional training was done via videoconferencing to ensure scalability did not suffer at the hands of fidelity.
• Ultimately, in order to continue to improve paraprofessional delivery of DMHI’s, fidelity considerations must be taken into account alongside scalability.

Introduction (Reprinted from the Abstract)

Many individuals in need of mental health services do not currently receive care. Scalable programs are needed to reduce the burden of mental illness among those without access to existing providers. Digital interventions present an avenue for increasing the reach of mental health services. These interventions often rely on paraprofessionals, or coaches, to support the treatment. Although existing programs hold immense promise, providers must ensure that treatments are delivered with high fidelity and adherence to the treatment model. In this paper, we first highlight the tension between the scalability and fidelity of mental health services. We then describe the design and implementation of a peer-to-peer coach training program to support a digital mental health intervention for undergraduate students within a university setting. We specifically note strategies for emphasizing fidelity within our scalable framework, including principles of learning theory and competency-based supervision. Finally, we discuss future applications of this work, including the potential adaptability of our model for use within other contexts.

Implications (Reprinted from the Discussion)

In this paper, we outlined 1 example of a scalable peer-to-peer mental health paraprofessional training and supervision program. Although many models of paraprofessional support have been described and tested previously, high demand and minimal resources have often corresponded with a reduced focus on fidelity monitoring and quality assurance [8]. Lack of standardized methods for paraprofessional training and supervision may have contributed to the disparate empirical support for paraprofessional, and specifically peer paraprofessional, models. Here we described a standardized and replicable model of training and supervision suitable for evaluation.

We believe this model has several notable strengths. Of note, our program focuses explicitly on fidelity, while also attending to the need for scalable care. As illustrated, the focus on fidelity is integrated into the program in 2 primary ways: digital technology as the primary agent for CBT content delivery [83] and continuous, standardized procedures for fidelity monitoring of coaches who support digital CBT provision. In addition, our training and supervision program is grounded in key findings from the learning theory literature, aligned with data suggesting that optimized learning can serve as a pathway to higher fidelity of treatment delivery [70,78]. The integration of learning theory as a mechanism for enhancing fidelity is aligned with existing lay health worker training frameworks that focus on augmenting initial one-off training with on-the-job direct supervision, coaching, and feedback systems [28]. We believe that paraprofessional models anchored in learning theory principles have the greatest potential to improve quality of care.

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