Paraprofessional Counselors Research Articles

Closing the gap in substance use disorder treatment through paraprofessional counselor training

ABSTRACT There is currently an insufficient supply of licensed substance use disorder counselors (SUDCs) to meet demand for services and the gap between supply and demand is projected to grow. Paraprofessional SUDCs offer one path to helping close this gap. The current study presents outcomes from a paraprofessional SUDC certificate program for Bachelor of Social Work (BSW) students. Student data (N = 66) were used to examine pre- to post-program changes in generalized SUDC knowledge and pre- to posttest changes in knowledge and self-efficacy from evidence-based workshops. Paired sample t-tests indicated that program participation significantly increased generalized SUDC knowledge. Participation in workshops significantly increased knowledge of motivational interviewing, integrative medicine, harm reduction, and grief and loss and self-efficacy for integrative medicine and harm reduction. BSW students gained generalized and treatment-specific knowledge via participation in a SUDC certificate program. The deployment of paraprofessionals SUDCs may provide one strategy to reduce treatment gaps.

Closing the gap in substance use disorder treatment through paraprofessional counselor training

ABSTRACT There is currently an insufficient supply of licensed substance use disorder counselors (SUDCs) to meet demand for services and the gap between supply and demand is projected to grow. Paraprofessional SUDCs offer one path to helping close this gap. The current study presents outcomes from a paraprofessional SUDC certificate program for Bachelor of Social Work (BSW) students. Student data (N = 66) were used to examine pre- to post-program changes in generalized SUDC knowledge and pre- to posttest changes in knowledge and self-efficacy from evidence-based workshops. Paired sample t-tests indicated that program participation significantly increased generalized SUDC knowledge. Participation in workshops significantly increased knowledge of motivational interviewing, integrative medicine, harm reduction, and grief and loss and self-efficacy related to integrative medicine and harm reduction. BSW students gain generalized and treatment-specific knowledge via participation in a SUDC certificate program. The deployment of paraprofessional SUDCs may provide one strategy to reduce treatment gaps

Competency-Based Training and Assessment of Listening Skills: A Waitlist-Controlled Study in European Telephone Emergency Services.

Telephone emergency services (TES) provide an essential part of suicide prevention and emotional support services across different health care settings. TES are usually provided by paraprofessional counselors, who need specific training in listening skills to meet the demands of callers. This project developed a competency-based training for listening skills which was then evaluated in a randomized controlled waitlist study across four EU countries (Germany, Hungary, Italy, and the Netherlands). Each country provided one training group and one waitlist group. Across countries, a total of 71 (trained: n = 36, waiting: n = 35) counselor trainees were assessed in a standardized, simulated emergency call with an actor client either before or after training participation. Calls were audiotaped and competencies in listening skills were evaluated by external raters using a standardized rating form. Trained counselors showed significantly better listening skills than participants from the waitlist condition. Results provide support for the efficacy of a competency-based training for listening skills in the field of TES across Europe. Furthermore, results demonstrated that a standardized competency-based assessment with an actor client is suitable to assess listening skills.

A Preliminary Evaluation of the Utility of Sluggish Cognitive Tempo Symptoms in Predicting Behavioral Treatment Response in Children with Behavioral Difficulties.

Interest in symptoms of sluggish cognitive tempo (SCT) has led to a number of studies evaluating how these symptoms respond to treatment commonly utilized in youths with symptoms of ADHD. No study to date, however, has examined the extent to which symptoms of SCT predict behavioral treatment response in youths across multiple domains of functioning. The current preliminary investigation integrates a number of methodological (e.g., direct observations) and analytic (e.g., Poisson regression) refinements to evaluate the extent to which symptoms of SCT predict treatment responses across multiple domains including behavioral (e.g., interruptions, rule violations), social (e.g., social skills, negative verbalizations), and severe behavioral difficulties (e.g., intentional aggression) above and beyond other demographic characteristics (e.g., symptom severity, Full Scale Intelligence Quotient [FSIQ]). A relatively small sample of 37 children, aged six to 12 years (M = 8.03, SD = 1.83, 35 males: 2 females) attending an eight week multi-component intensive behavioral treatment program for youths with behavioral difficulties participated in the current study. Baseline parental perceptions of SCT were collected prior to the initiation of treatment. Results from this preliminary investigation revealed that pre-treatment SCT symptoms only predicted a less robust treatment response to time out which was associated also with parent's perceptions of underlying working memory problems. Results revealed also that pre-treatment SCT symptoms failed to predict paraprofessional counselor's and teacher's improvement ratings of both rule following and social skills following treatment. Notably, other potential predictors (e.g., symptom severity, FSIQ) also largely failed to predict behavioral treatment response.

Storybooks to facilitate children’s communication following parental suicide: paraprofessional counselors’ perceptions

Children often have difficulty talking openly about a parent’s suicide. Bibliotherapy can help, but no bibliotherapy studies address parental suicide. We gave a focus group (5 paraprofessionals) 15 children’s books addressing grief, parental suicide, and emotional expression, asking them which books were most helpful. They emphasized individualizing treatment to fit the child, recommending the books that honestly portrayed suicide, showed a way forward, provided hope, and assured children that they are not alone. The most highly recommend books were Bart Speaks Out: Breaking the Silence on Suicide and After a Suicide Death: A Workbook for Grieving Kids.

When is Enough, Enough? How the Absence of Dose-Determination Trials Impedes Implementation of HIV Behavioral Interventions

Carefully controlled clinical trials have determined that theory-based behavioral interventions delivered by adherence nurses, professional and paraprofessional counselors, and case managers improve ART adherence and viral suppression. However, there are no studies that empirically inform how much intervention is needed for which patient populations and at what cost. This Editorial raises the issue of how a lack of intervention dosing limits interpretation of trial results and impedes implementation, therefore calling for behavioral intervention dose-finding studies.

Strengthening support for children and youth in Singapore: a personal therapy approach to training paraprofessional counsellors

ABSTRACTAlthough personal therapy was advocated as a route to personal and professional growth of therapists, it was rarely used in the training of non-professional counsellors, such as teachers and youth workers. This qualitative study explored the experiences of 15 undergraduate preservice teachers and youth workers from a university in Singapore who attended mandatory individual and group personal development sessions as part of para-counsellor training. Twelve subcategories in four categories were identified using Strauss’ and Corbin’s grounded theory methodology. Participants perceived that personal therapy influenced their personal and professional growth, and changed their perception of counselling from negative to positive. Their beliefs in the efficacy of counselling were validated, and they were more willing to seek help through counselling in future.

Secondary Traumatic Stress and Burnout of North Korean Refugees Service Providers.

ObjectiveThe current study investigated the burnout and secondary traumatic stress of service providers for North Korean (NK) refugees based on the conceptual framework of theJob Demands-Resources (JD-R) model of workplace burnout.MethodsA cross-sectional self-administered survey was conducted with a national sample consisting of all 63 organizations in direct services to North Korean refugees. Of the estimated total number of 230 service providers comprising of social workers, psychotherapists, job counselors and paraprofessional counselors, 179 completed the survey, a 77.8% return rate.ResultsWhile job resources such as personal commitment to work and organizational support indicated inverse relations to burnout, job demands such as workload, work environment and secondary traumatic stress (STS) showed a positive relationship to worker burnout. The STS were present in more than half of the respondents (51.3%), of which 20.7% of them indicating a severe level of STS. The STS proved to be the most significant risk to worker burnout as it showed strong relations to all three dimensions of burnout.ConclusionStructural issues of chronic work overload and poor work environment need to be addressed to reduce staff burnout. STS is a serious occupational hazard in working with North Korean refugees.

How effective are minimally trained/experienced volunteer mental health counsellors? Evaluation of CORE outcome data

AbstractBackground: Existing research findings indicate that minimally trained/experienced paraprofessional counsellors can be as effective as professionally trained and experienced counsellors. More research into the effectiveness of paraprofessionals with specific client populations is required to determine the conditions under which they can be most effective. Aims: To evaluate the effectiveness of a group of 12 minimally trained/experienced volunteer mental health counsellors. Method: Data were collected over a one year period on 118 clients referred to a voluntary sector counselling agency. The CORE‐OM was used to measure clients' levels of distress on a session‐by‐session basis. Clients and counsellors also completed a range of additional self‐report measures. A benchmarking strategy was used to evaluate the outcomes achieved by participants in this study against three benchmark studies selected from published literature. Results: Paraprofessionals in this study were less effective than their professional counterparts. Results showed that participants in this study achieved an effect size of .70 compared to effect sizes of 1.36, 1.39 and 1.42 in the selected benchmark studies. Implications: Findings suggest that minimally trained/experienced paraprofessional counsellors working in mental health settings may benefit from longer and more targeted training programmes before engaging in practice. Conclusions: The benchmarking strategy provided a valuable and practical means of evaluating the comparative effectiveness of paraprofessional and professional counsellors. Findings should be interpreted cautiously as the selected benchmarks are not precise measurements and may not reflect the organisational factors operating within voluntary sector counselling agencies.

Psychosocial Counselling in Nepal: Perspectives of Counsellors and Beneficiaries

The aims of this qualitative study were (1) to add to the understanding of the growing field of psychosocial counselling in Nepal, and (2) gather concrete points for improvement of services. Semi-structured interviews were conducted with clients (n = 34), para-professional counsellors (n = 26) and managers (n = 23) of organizations in which psychosocial counselling was taking place. The main findings were that stakeholders generally presented a positive view of the significance and supportive function of psychosocial counselling, while providing useful suggestions for improvement. Matters of ongoing training and supervision, confidentiality and integration of counselling within mainstream care provision need to be addressed and potentially adapted. Implications for other non-Western countries with little mental health resources are discussed.

Trauma healing in refugee camps in guinea: A psychosocial program for Liberian and Sierra Leonean survivors of torture and war.

From 1999 to 2005, the Minneapolis-based Center for Victims of Torture (CVT) served Liberian and Sierra Leonean survivors of torture and war living in the refugee camps of Guinea. A psychosocial program was developed with 3 main goals: (a) to provide mental health care, (b) to train local refugee counselors, and (c) to raise community awareness about war trauma and mental health. Utilizing paraprofessional counselors under the close, on-site supervision of expatriate clinicians, the treatment model blended elements of Western and indigenous healing. The core component consisted of relationship-based supportive group counseling. Clinical interventions were guided by a 3-stage model of trauma recovery (safety, mourning, reconnection), which was adapted to the realities of the refugee camp setting. Over 4,000 clients were provided with counseling, and an additional 15,000 were provided with other supportive services. Results from follow-up assessments indicated significant reductions in trauma symptoms and increases in measures of daily functioning and social support during and after participation in groups. The treatment model developed in Guinea served as the basis for CVT's ongoing work with survivors in Sierra Leone and Liberia. ((c) 2006 APA, all rights reserved).

Obstacles to the adoption of low risk drinking goals in the treatment of alcohol problems in the United States: A commentary

Although moderation and harm reduction approaches to the treatment of alcohol problems are accepted in many parts of the world, they continue to be rare in the US. A major reason for this state of affairs has to do with the way alcohol treatment services in the US developed, and in particular the creation of a group of paraprofessional counselors many of whom attributed their recovery to the 12-step philosophy. While it is unlikely that these counselors will offer moderation services, the provision of services to problem drinkers in primary care medical settings presents a promising alternative.

Training for paraprofessional counsellors: Evaluating the meaning and impact of a common factors approach

A group of 12 people participated in a short (40 hours) counselling training programme for paraprofessional counsellors, which emphasised the importance of common factors in accounting for therapeutic effectiveness. The general framework, language and skills of a brief, solution‐focused approach was used as a means of translating the theoretical/conceptual ideas of the common factors model into specific counsellor behaviours and also to provide structure and focus for counselling sessions. A pluralist methodology was employed to assess the personal meaning of the training for participants and the impact of the training on the development of counselling skills and awareness. Results indicated the training impacted positively on the development of counselling skills and ability to handle difficult client behaviours but less so on personal values and ability to deal with process issues. The majority of participants believed the training contributed positively toward their personal development.

Is professional training worth the bother? A review of the impact of psychotherapy training on client outcome

This article reviews the research literature on the effectiveness of paraprofessional counsellors and the impact of psychotherapy training on client outcome. Methodological and conceptual difficulties that have hampered previous research in this area are noted, and several well-designed individual studies are highlighted. The existing evidence supports the efficacy of paraprofessional counsellors, although professional training may lead to better outcome in specific areas, such as greater client retention, briefer therapy, and better overall wellbeing for clients. However, methodological limitations of the research prohibit definitive conclusions. Guidelines for future research are offered.

Methodology for Discovering and Teaching Countertransference Toward Elderly Clients

This article will describe a method that has been effective in helping students, paraprofessional counselors as well as mental health professionals identify countertransference reactions in themselves. It offers instructors and clinical supervisors a way to teach about countertransference toward elderly clients. This technique can be utilized in a variety of work settings such as classrooms, mental health clinics, multi-purpose centers for older adults and private practice.

A psychological epidemiology of people seeking HIV/AIDS counselling in Kenya: an approach for improving counsellor training.

This study develops a typology of psychological problems reported during HIV/AIDS counselling. This typology provides a framework for training paraprofessional counsellors (PPCs) in East Africa. Study participants included 307 Kenyans tested for HIV at any of six clinics in Nairobi specialising in STDs, tuberculosis and other infectious diseases. Pre-test, post-test, and follow-up counselling was provided by 16 PPCs who are themselves HIV-positive. Data consisted of demographic, physical and psychological information reported by 168 clients who sought follow-up counselling. Counselling data were coded using an ipsative method; a unique code was assigned to every distinct topic. Factor analysis with a Varimax rotation reduced the original psychological variables into logical groupings. Multivariate analysis examined the relationship of factors and demographic characteristics. Clients reported 1-10 physical and 1-23 psychological complaints in a single session. Sixty-five percent of female clients reported > or = eight psychological problems; 49% of males reported > or = eight psychological problems. Factor analyses allowed the 109 reported psychological events to be assigned to 15 categories of problems. Multivariate analyses explained little of the variance in the relationship between each client's demographic profile and the psychological factors. Training for PPCs should be relevant to problems encountered during counselling. Results indicate that PPCs can expect clients to present one or more of the 15 factors during counselling. Demographic characteristics explained small amounts of variance in the distribution of factor scores. The 15 factors produced in this study, although descriptive and preliminary, could form the basis of a training curriculum for HIV PPCs.

Participant modelling training programme: Tutoring the paraprofessional

A participant modelling training programme designed to improve self-efficacy and the ability to cope effectively with stressful situations was implemented with paraprofessional young counsellors who work in conjunction with youth advancement counsellors. Self-efficacy was measured by assessing their beliefs about their ability to cope effectively and successfully with various situations. Their motivation to engage in such a task was also assessed before and after the training programme. Contrary to prediction, following the training the self-efficacy of subjects decreased significantly. However, their motivation to get started and become involved with the disadvantaged youth significantly increased. The results are discussed in terms of reality perception and participant modelling training.

THE SUICIDE INTERVENTION RESPONSE INVENTORY: A REVISION AND VALIDATION

The Suicide Intervention Response Inventory (SIRI) was developed by Neimeyer and MacInnes (1981) to assees the ability of paraprofessional counselors to recognize appropriate responses to suicidal clients. Although several studies have supported the validity of the scale, concerns have been raised about its ceiling effect when administered to more highly trained counselors. Psychometric improvements were therefore attempted, and the original dichotomous scoring system was replaced with a Likert scale format, in the SIRI-2. Because respondents were required to make more subtle judgments concerning the appropriateness of each response as defined by a criterion group of highly expert suicidologists, the ceiling effect that limited the use of the original measure was eliminated. Construct and discriminant validity were demonstrated in both verisons of the instrument. Internal consistency and test-retest reliability showed improvement with the SIRI-2. Overall, the SIRI-2 shows promise as an index of suicide counseling effectiveness, especially among more skilled counselors.

An Evaluation of a Newsletter Intervention for Divorced Mothers

Separation and divorce have become normative life events for many families in the United States. Despite some recent indications that the rate of divorce may be leveling off, Martin and Bumpass (1989) estimated that about two thirds of all first marriages are likely to be disrupted by separation or divorce. These trends suggest that scholars and clinicians interested in family life will continue to need to address issues related to marital transitions. While separation and divorce are becoming more common among families, this has not resulted in a decrease in the potential negative effects that this experience can have for family members. In a recent review of the short-term effects of divorce on adults, Chase-Lansdale and Hetherington (1990) reported that divorced persons, when compared with never-divorced persons, experience more problems with daily living, economics, well-being, and parenting. A recent longitudinal study documents some of the short-term psychological consequences of divorce. In a comparison of divorced and married women over a 2-year period, Wilcox (1986) found that divorced women reported a greater number of problems and less satisfaction with family life, housework, and finances at 2 years following the divorce. In terms of mental health, Wilcox reported that divorced mothers, when compared with never-divorced mothers, had lower levels of overall well-being throughout the 2-year period and higher levels of depression. Indeed, the findings suggest that about 30% of the divorced women would be classified as in need of psychological treatment for depression at 2 years following divorce. These findings highlight the need for preventive interventions following divorce. The adverse reactions experienced by divorced persons have prompted clinicians and family life educators to develop intervention programs to help families coping with marital disruption. Several early studies have demonstrated that brief counseling or educational programs can result in better divorce adjustment and improved emotional health (Kessler, 1978; Thiessen, Avery, & Joannings, 1980). Recent and more rigorous efforts to examine the effects of divorce interventions with adults indicate more mixed outcomes. Warren and Amara (1984) compared participants and nonparticipants in a self-study program for divorced persons and reported significant improvements in the participants' level of depression immediately following the program; however, this effect was not present at a 1-year follow-up. One of the most promising approaches to intervention was designed by Bloom and his colleagues (Bloom, Hodges, & Caldwell, 1982; Bloom, Hodges, Kern, & McFaddin, 1985). This program included the use of paraprofessional counselors who were available to clients and a series o workshops addressing parenting, psychological adjustment, financial, legal, and household issues. Posttests immediately following the intervention, as well as a 2-year follow-up, indicated that the treatment group showed greater improvements in life satisfaction and psychological well-being than the nontreatment group. These results demonstrate that some interventions can be effective over time. Although these studies demonstrate that under some circumstances educational and clinical interventions can facilitate adjustment to the divorce transition, there is still a need to further our understanding of effective intervention strategies. A central problem with group methods is that they reach only a small segment of the population. Studies that have examined how adults would like to receive information consistently find that meetings and support groups are ranked very low (Hughes & Durio, 1983; Spiegel & Conone, n.d.). On the other hand, written materials in the form of newsletters and pamphlets are viewed more favorably by parents. Recently, there has been some promising evidence that sequential newsletters sent through the mail may be a promising strategy for delivering parenting information. …

Attitudes Toward Counseling Among Asian International and Native Caucasian Students

Asian international and native born Caucasian students indicated the source of help they would go to first if they had a personal problem; rated the importance of four counselor characteristics: ethnicity, university degree, age, and gender; and completed Fischer and Turner's scale of attitudes about seeking professional psychological help. There was no difference between Asian and Caucasian Students in the sources of help they would seek. Asian students indicated it was more important that a conselor be or similar ethnicity and older. There were no ethnic differences in attitudes toward professional help. Women were no ethnic differences in attituses toward professional help. Women were more likely to report indicate a need for help regardless of ethnic group. Caucasian women were more tolerant of the stigma of being a client, likely to report interpersonal openness, and to express confidence in mental health practitioners than Asian women or men form either group. Colleges should consider the use of older paraprofessional counselors of the same nationality as interantional student clients.