Strengthening and Expanding Child Services in Low Resource Communities: The Role of Task-Shifting and Just-in-Time Training

Expanding the reach of psychosocial services for youth: Untapped potential of mentor-delivered single session interventions

At present, the mental healthcare system cannot meet the demand for services, and the need-to-access gap is widest among children and adolescents. Single session interventions (SSIs) are brief, intentional, and mechanism-targeted programs that have shown promise in increasing the reach of effective, evidence-based services; yet, a wide gap still remains due to structural barriers (e.g., lack of awareness, workforce shortages). The present paper posits the integration of SSIs and mentor-delivered programs as a promising future step to further overcome the inaccessibility of youth mental health services. Capitalizing on the advantages of mentoring relationships (e.g., the associated interpersonal benefits and mentors' pre-existence in most community settings) has the potential to complement and enhance the value of SSIs, and to expand the acceptability and reach of evidence-based mental health services. In this paper, we discuss the anticipated benefits of mentor-delivered SSIs, as well as cautionary considerations related to the proposed model. To conclude, we highlight the necessary implementation and research implications.

Expanding School-Based Motivational Interviewing Through Delivery by Paraprofessional Providers: A Preliminary Scoping Review

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.

Roles and Functions of School Mental Health Professionals Within Comprehensive School Mental Health Systems

Mental health concerns are on the rise among youth, contributing to a growing need for school-based mental health services. However, challenges to service provision arise due, in part, to workforce shortages, service fragmentation, and inefficient allocation of staff time. The current study describes the professional competencies and time allocation of four school-based mental health professions (i.e., school counselors, school psychologists, school social workers, and school nurses) in order to demonstrate how schools can leverage the skills of their existing staff to coordinate a comprehensive approach to support student mental health. First, we identified the core clinical competencies needed to implement the key features of comprehensive school mental health systems. Then, we crosswalked these clinical competencies with the training standards of the four professions. Finally, we conducted a systematic review of the literature to understand how these professionals' time is allocated, as well as their responsibilities related to the provision of mental health services. Results demonstrated that, although all four professions receive training in most of the core competencies needed to implement comprehensive school mental health services, their skillsets are often underutilized in day-to-day practice. Thus, we concluded that there are at least two untapped opportunities for school leaders to support student mental health-first, maximize the use of school mental health professionals through task-shifting (i.e., reassigning tasks less central to mental health service delivery to other staff), and second, implement an integrated model of school mental health services to efficiently leverage the mental health training of professionals.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12310-022-09535-0.

Strategies for monitoring mentoring relationship quality to predict early program dropout

We examined data from a nationally implemented mentoring program over a 4-year period, to identify demographic and relationship characteristics associated with premature termination. Data were drawn from a sample of 82,224 mentor and mentees. We found matches who reported shared racial or ethnic identities were associated with lower likelihood of premature termination as was mentee's positive feelings of the relationship. We also found that, if data were used as a screening tool, the data were suboptimal for accuracy classifying premature closure with sensitivity and specificity values equal to 0.43 and 0.75. As programs and policymakers consider ways to improve the impact of mentoring programs, these results suggest programs consider the types of data being collected to improve impact of care.

Adapting a School-Based Motivational Interviewing Mentoring Program for Use in India

We report on the process of planning, adapting, and implementing a brief, instrumental, school-based mentoring curriculum originally developed in the United States, in three cities in India. India has the world’s largest population of young adults aged 10-24 years, a developmental period associated with heightened psychosocial stressors and the onset of mental health issues, as well as a dire shortage of mental health professionals. Moving services that are typically provided by highly skilled professionals to individuals with fewer credentials or less formal training (e.g., from psychologists to mentors) can increase access to adolescent mental health services. Yet, transferring programs internationally is accompanied by unique barriers including cultural differences, and should be guided by an established framework. In this paper, we discuss the formation of a research-practice partnership designed to generate applied knowledge through emic cultural perspectives. We describe each stage of the program adaptation process within the Cultural Adaptation Framework ( Fendt-Newlin et al., 2020 ), including our decisions to strategically adjust, remove, or retain content from the original mentoring intervention. Although program delivery was prematurely discontinued due to the COVID-19 pandemic, we provide a brief synopsis of lessons learned through the international partnership.

Paraprofessional Youth Mentoring: A Framework for Integrating Youth Mentoring with Helping Institutions and Professions

The demand for child mental health services, including those provided by psychologists, counselors, and social workers, exceeds the supply. This trend is expected to continue or worsen unless there are substantial structural changes in how mental health services are provided. We propose a framework for paraprofessional youth mentors, defined as a subgroup of professionally supervised, non-expert volunteer or paid mentors to whom aspects of professional helping tasks are delegated. Our proposal is aligned with historical and modern solutions to scaling mental health services, and this framework could simultaneously increase the number of youth receiving evidence-based mental health services and reduce the burden on existing systems of care. The framework defines three plausible tasks for paraprofessional mentors: (1) reducing barriers to mental health service, (2) increasing engagement in services, and (3) providing direct services. The safety and effectiveness of these task-shifting efforts will hinge on competency-based training and evaluation, supervision by professionals, and documentation of services rendered, all of which the field of youth mentoring currently lacks. We describe several requisite scientific, institutional, and regulatory advances that will be necessary to realize this variant of youth mentoring for a subgroup of youth who are presenting for assistance with mental health problems.

Scaling up evidence-based treatments in youth behavioral healthcare: Social work licensing influences on task-shifting opportunities

Youth behavioral healthcare workforce shortages have inhibited the scale-up of evidence-based treatments to address longstanding unmet needs andinequitable service coverage. Task-shifting is a strategy that could bolster workforce shortages. Legal and regulatory barriers, such as scope of practice licensing regulations, have hampered the use of task-shifting. Social workers make up the majority of the behavioral healthcare workforce in the U.S. and most social workers provide services to children and families. As such, social workers would play a pivotal role in any scale-up effort. In this guest editorial, we discuss the importance of social work licensing and use a case example to illustrate the unintended consequences that certain licensing regulations have on scaling-up evidence-based treatments via task-shifting. We conclude with recommendations on how social workers could be involved in taskshifting efforts to scale-up evidence-based treatments.

A National Study of Mentoring Program Characteristics and Premature Match Closure: the Role of Program Training and Ongoing Support

Mentoring programs are a popular approach to preventing problem behavior and promoting positive youth development. However, mentoring relationships that end prematurely may have negative consequences for youth. Previous research has investigated match-level indicators of premature match closure, highlighting possible individual mentor- or mentee-level characteristics that might influence the match staying together. However, less work has investigated the importance of program-level variables in match retention. Mentor training and support may be one key modifiable program-level feature that could curtail the risk of premature match closure. In this study, we used data from a national survey of youth mentoring programs (N = 1451) to examine training and other potential predictors of premature match closures (Garringer et al. 2017). We used a Bayesian Additive Regression Trees (BART) model to predict program-reported premature match closure rates from a set of four training-related variables and 26 other covariates (e.g., program size, budget, demographic composition). Findings indicate that the set of predictors explained about one-fifth of the variation in reported rate of premature match closure (cumulative pseudo R² = .21), and the strongest, and only statistically significant, predictor of premature match closure was the frequency of ongoing training and support contacts per month. Overall, findings indicate that there is substantial noise in predicting program-reported premature match closure, but program-reported provision of ongoing training and support seems to emerge as a relatively stable signal in the noise.

GPS: A Randomized Controlled Trial of Sexual Health Counseling for Gay and Bisexual Men Living With HIV

Gay, bisexual, and other men who have sex with men (GBM) continue to have high rates of HIV and sexually transmitted infections, including syphilis. GBM have therefore been identified by public health agencies as a high-priority population to reach with prevention initiatives. Despite the importance of mental health in preventing HIV and related infections, there is a shortage of credentialed mental health professionals to deliver behavioral Counseling interventions. The current study evaluated the efficacy of GPS, a community-based and peer-delivered sexual health promotion motivational interviewing-based intervention for HIV-positive GBM who engaged in condomless anal sex (CAS) in the past 2 months. GPS prevention counseling demonstrated a 43% relative reduction at 3-month follow-up in CAS with serodiscordant partners and significant reductions in sexual compulsivity. The study demonstrated that community-based counselors can administer an efficacious motivational interviewing program, and suggests a continued benefit of counseling methods to promote the sexual health of higher risk populations.

Evaluation of a tracheostomy education programme for speech-language therapists

BACKGROUND

Tracheostomy management is considered an area of advanced practice for speech-language therapists (SLTs) internationally. Infrequent exposure and limited access to specialist SLTs are barriers to competency development.

AIMS

To evaluate the benefits of postgraduate tracheostomy education programme for SLTs working with children and adults.

METHODS & PROCEDURES

A total of 35 SLTs participated in the programme, which included a 1-day tracheostomy simulation-based workshop. Before the workshop, SLTs took an online knowledge quiz and then completed a theory package. The workshop consisted of part-task skill learning and simulated scenarios. Scenarios were video recorded for delayed independent appraisal of participant performance. Manual skills were judged as (1) completed successfully, (2) completed inadequately/needed assistance or (3) lost opportunity. Core non-medical skills required when managing a crisis situation and overall performance were scored using an adapted Ottawa Global Rating Scale (GRS). Feedback from participants was collected and self-perceived confidence rated prior, immediately post and 4 months post-workshop.

OUTCOMES & RESULTS

SLTs successfully performed 94% of manual tasks. Most SLTs (29 of 35) scored > 5 of 7 on all elements of the adapted Ottawa GRS. Workshop feedback was positive with significant increases in confidence ratings post-workshop and maintained at 4 months.

CONCLUSIONS & IMPLICATIONS

Postgraduate tracheostomy education, using a flipped-classroom approach and low- and high-fidelity simulation, is an effective way to increase knowledge, confidence and manual skill performance in SLTs across patient populations. Simulation is a well-received method of learning.

New Perspectives on the Child- and Youth-Serving Workforce in Low-Resource Communities: Fostering Best Practices and Professional Development

The professionals and paraprofessionals who work daily with youth in low-resource, marginalized communities are integral to youth wellbeing; yet, their professional development, and the factors that promote it, are not well understood. In this introduction to the special issue, Understanding and Strengthening the Child- and Youth-Serving Workforce in Low-Resource Communities, we focus on understudied practitioners operating in an array of sectors and settings, such as home visitors, mental health paraprofessionals, early childhood assistant teachers, teachers in low-income countries, school resource officers, juvenile justice staff, and after-school and community-based program workers. We put forward a conceptual model detailing the interactive, layered set of proximal-to-distal ecological factors that influence the practice and professional development of these workers, and show how papers in the current issue address these layers in their examination of workforce development. We conclude with a summary of the contributions and lessons from this work - including the value of a whole-person approach, the importance of sharing process across research stages, and the need to build on the foundation provided by community psychology and implementation science - toward the twin goals of understanding and building the skills and strengths of the workforce, and ultimately, enhancing youth development.

Strengthening the Child- and Youth-Serving Workforce: Surveying the Landscape, Overcoming Challenges

This special issue addresses a neglected but important topic in our field: strengthening the child- and youth-serving workforce. Investing in this workforce should be a national priority because considerable evidence has shown that investments in early childhood education and development, particularly in low-resource contexts, that are reinforced through skills-based programs in adolescence and adulthood, have beneficial impacts throughout life. Investing in quality child- and youth-serving programs also has the additional benefit of creating a productive and capable future workforce. The editors and authors of the special issue should be commended for producing the first special issue on this topic in our field or in related fields, one that is long overdue. Articles in this issue survey the landscape of an amorphous and complex area of practice and research and describe key challenges for the field. In this commentary, I offer organizing frameworks to characterize the child- and youth-serving workforce, note emerging issues when addressing specific challenges, and identify areas for future research.