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. What Joe sought to do was to combine 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). His analysis of 42 evaluations led to a provocative conclusion: almost across the board, paraprofessionals were more effective than trained professionals. Overall, paraprofessionals were comparable to trained mental health professionals and in 12 they were actually superior. In only one study were professionals significantly more effective than paraprofessionals in promoting positive mental health outcomes. As 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). Such data challenged mental health professionals to look more closely at the nature and efficacy of mental health practices.
Over the next five years, researchers using more sophisticated, meta-analytic procedures were able to replicate these promising trends, even controlling for the difficulty of the patients with whom professionals were working. “The average person who received help from a paraprofessional was better off at the end of therapy than 63% of persons who received help from professionals” (1984, 536). Similar studies have continued to demonstrate their effectiveness in delivering preventive interventions (Conley, 2016). These studies suggest that, under the right circumstances, mentors and other caring adults can effectively support youth who lack access to trained professionals.
But there is a critical caveat: paraprofessionals with more experience showed the strongest effects relative to professionals. Moreover, the most effective paraprofessionals in Durlak’s study were those whose efforts were focused on specific target problems (e.g., depression, healthy behaviors) as opposed to more general, broad outcomes. For instance, Durlak cites a study by Karlsruher (1976), who found that unsupervised college students were ineffective in helping maladapting elementary school children, whereas carefully supervised students achieved successful results that were equal to those of trained professionals. Many of the paraprofessionals in Durlak’s study had received up to 15 or more hours of training. As Durlak concludes, “Judicious selection, training, and supervision might well account for paraprofessional effectiveness in comparative studies.”
Durlak also made a prescient observation. “Paraprofessional effectiveness in some studies may be due to the development of carefully standardized and systematic treatment programs…In these programs, treatment has consisted of a programmed series of activities. Presumably, the more intervention procedures that can be clearly described and sequentially ordered in a helping program, the easier it will be for less trained personnel to administer them successfully. Paraprofessionals may feel more comfortable and hold higher expectations than professionals when using standardized clinical procedures, and these factors could contribute to paraprofessionals’ clinical effectiveness. Paraprofessionals’ commonsense “real-world” solutions may have been particularly appealing (Baker & Neimeyer, 2003), but their clinical success may be most closely related to professionals’ abilities to define, order, and structure effective sequences of “helping activities when training or supervising paraprofessionals.” In other words, in Durlak’s study, the paraprofessionals may have been outshining the professionals–not because they were inherently more empathic–but because they were more clearly defining and structuring their helping activities, at least relative to the many of the emerging treatments of that time. Recent advances in paraprofessional training, including a new certificate course in therapeutic mentoring through UMass Boston’s Center for Evidence-based Mentoring at UMass Boston, will help us realize this goal. The course is now open for enrollment, so please sign up . The course is being led by a pioneer in therapeutic mentoring, Josephine Cardona, a school psychologist who has served as a therapeutic mentor, and guest speakers, including myself, who represent the communities that mentors serve.
It is tempting to consider where the field of mentoring would now be had it aligned with targeted preventive interventions and taken a deliberate approach to training and supervising paraprofessional mentors. Alas, ideological and professional drivers pushed the pendulum of mentoring away from targeted approaches that deploy well-trained paraprofessionals who followed evidence-based protocols with fidelity (Durlak’s recommendation) to the unspecified, often perfunctory, and only modestly effective formal mentoring relationships we have today. In the meantime, prevention science and the helping professions have become increasingly disciplined and effective. Where would mentoring be today had its allies demanded the rigor and discipline suggested by Joe Durlak more than 40 years ago.
Sign up for the Therapeutic Mentoring Certificate Course here.