Training Paraprofessionals Research Articles

A randomized controlled trial of a virtual community-based mental health and substance use program in the Philippines

Purpose This study aims to evaluate the delivery of a virtual community-based mental health and substance use program for Filipino drug users during the COVID-19 pandemic. Design/methodology/approach It used a randomized control longitudinal design with data collected prior to the program and every two months for 10 months. The programs focused on building recovery skills, life skills and family modules. Program length ranged from a brief intervention of three sessions to 24 sessions depending on whether clients were low risk, moderate risk or those arrested for drug use. Findings Results revealed significant improvements in recovery skills of participants in the treatment group compared to those in the control group. Mental health illness symptoms decreased for both control and treatment groups; however, no differences were found in recovery capital and cravings. Research limitations/implications The lack of significant changes in certain variables, such as recovery capital, requires more data to understand the barriers to enable greater recovery. The study was limited to virtual delivery of rehabilitation services conducted during the COVID-19 pandemic. Future studies may wish to compare modalities of online and onsite delivery to enable a comparison of effectiveness. Practical implications Results suggest the feasibility of virtual delivery of mental health and substance use treatment implemented by trained paraprofessionals. However, it also highlights the necessity to build the capacity of service providers and address connectivity challenges. Social implications Stigma and discrimination prevent people who use drugs from seeking treatment. Virtual delivery of mental health and substance use treatment can provide a platform where people can seek help while maintaining some privacy. Originality/value The study provides evidence from under-represented populations – persons who use drugs in the Philippines.

Training paraprofessionals to collect reading fluency data with accuracy

Many of the decisions made related to student progress and intervention selection rely on data. In their roles, paraeducators often implement academic interventions; therefore, they must be prepared to monitor students’ progress accurately and reliably. This pilot randomized control trial tested the effects of a remote training package on paraeducator’s accuracy in collecting reading fluency data. Furthermore, we wanted to know if the skills developed through the remote training package transferred when paraeducators were given novel data collection probes. The remote training package resulted in statistically significant results with large effect sizes, while participants in the control group made little to no statistically significant improvement. Paraeducators who received training improved their accuracy in data collection and demonstrated strong skill transfer to the novel probes.

The posttraumatic stress interview for children (KID-PIN): development and validation of a semi-structured interview of PTSD symptoms among displaced children in the Middle East.

BackgroundIn populations affected by mass disaster such as armed conflict and displacement, children are at risk of developing mental ill-health, in particular post-traumatic stress disorder (PTSD). Valid and reliable screening instruments are needed to assess the severity of PTSD symptoms among children and to identify individuals in need of treatment.MethodIn the context of an ongoing war in the Middle East, we developed the KID-PIN as a semi-structured interview for PTSD symptoms that can be administered by trained paraprofessionals. To achieve a culturally and contextually appropriate instrument, the development was based on open-ended interviews with affected children and involved both local and international experts. Using the KID-PIN and instruments for constructs associated with PTSD, 332 Iraqi and Syrian displaced children were interviewed. A subset of the sample (n = 86) participated in validation interviews based on experts applying the Clinician-Administered PTSD Scale for DSM-5—Child/Adolescent Version (CAPS-CA-5).ResultsThe KID-PIN demonstrated excellent internal consistency (Cronbach’s alpha = 0.94) with good convergent validity. Confirmatory factor analyses of the KID-PIN showed an acceptable fit with the DSM-5 and other common models; the best fit was reached with the Hybrid model. Receiver operating characteristic analyses indicated that the cut-off score of 28 or higher on the KID-PIN is the optimum cut-off for a probable PTSD diagnosis.ConclusionThe utility of the newly developed KID-PIN as a screening instrument for PTSD in children is supported by the measure’s high internal consistency and good convergent and structural validity, as well as its diagnostic accuracy.

I Don't Know What I'm Doing: Using Limited License Legal Technicians in Family Court to Improve Access to Justice

‘I don't know what I'm doing’ ‐ a phrase often uttered by pro se litigants. The number of pro se litigants appearing in family court proceedings is on an upward trend. Steps must be taken to assist pro se litigants navigate the muddy waters of the family court system. The concept of trained paraprofessionals to assist pro se litigants in court has garnered interest in recent years. Incorporating these trained paraprofessionals into preexisting court based pro se assistance programs or introducing them in the form of a new pro se assistance program could help address the access‐to‐justice gap among the growing number of pro se litigants in family court. This Note proposes a model admission and practice rule that will set guidelines for the implementation of limited license legal technicians in family court. The model rule would (1) authorize limited license legal technicians to render limited legal assistance or advice in family law; (2) set conditions and limitations for the provision of such services; and (3) outline education requirements, continuing license requirements, and ethical standards for limited license legal technicians.

Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center

Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.

A pilot study on the effectiveness of low-intensity cognitive behavioural therapy (LiCBT) for common mental disorders in Hong Kong.

To cope with the rising demand for psychological treatment, evidence-based low-intensity cognitive behavioural therapy (LiCBT) delivered by trained para-professionals was introduced internationally. This pilot study aimed at examining the effectiveness of LiCBT in Hong Kong. This study was of an uncontrolled pre- and post-treatment design, testing LiCBT at a local community mental health centre in Hong Kong. Two hundred and eighty-five Chinese adult help-seekers to the centre attended two or more sessions of LiCBT delivered by trained para-professionals. These participants also rated their depression and anxiety on the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Scale-7 (GAD-7), respectively, at pre- and post-treatment. Comparison of the pre- and post-treatment PHQ-9 and GAD-7 scores of 285 participants indicated significant improvements in depression and anxiety with large effect sizes (depression: d = 0.87; anxiety: d = 0.95). For those participants reaching the clinical level of either depression and/or anxiety at pre-treatment (n = 229, 80.4%), they reported even larger effect sizes (depression: d = 1.00; anxiety: d = 1.15). The recovery rate was 55.9% with a reliable improvement rate of 63.9%. An average of 5.6 sessions was offered to the participants with each session spanning a mean of 42 minutes. The baseline clinical conditions and participants' educational level were predictive of post-treatment recovery. The results supported the effectiveness and cost-efficiency of LiCBT for depression and anxiety at a Hong Kong community mental health centre. The effect sizes and the recovery and reliable improvement rates achieved were comparable to those reported from countries such as the UK and Australia.

A South-to-South Cultural Adaptation of an Evidence-Based Parenting Program for Families in the Philippines.

Rates of child maltreatment are higher in low‐ and middle‐income countries due to risk factors such as social inequities, economic adversity, and sociocultural norms. Given the evidence showing the effectiveness of parenting interventions to prevent child maltreatment, this study embarked on a cultural adaptation of an evidence‐based parenting program with the eventual goal of integrating it within a nationwide conditional cash transfer program for low‐income Filipino parents with children aged 2–6 years. We document the systematic adaptation of the Parenting for Lifelong Health for Young Children program that was developed and tested in South Africa, for low‐resource Filipino families using the heuristic framework for the cultural adaptation of interventions. We underscore the merits of conducting a multistage top‐down and bottom‐up process that uses a participatory approach among cultural insiders and outsiders to develop a parenting intervention that reflects the contextual realities and cultural values of end users. The adapted program, Masayang Pamilya Para sa Batang Pilipino, is the product of a delicate and deliberate effort to balance Filipino childrearing goals and values with the scientific evidence on components of parenting interventions known to promote positive parenting and prevent child maltreatment.

Effectiveness of a Modular Cognitive-Behavioral Skills Curriculum in High-Risk Justice-Involved Youth.

The aim of this study was to evaluate the effectiveness of a flexible modular cognitive-behavioral theory (CBT) skills curriculum delivered by paraprofessionals in a community organization targeting high-risk justice-involved youth. Programmatic data were collected from 980 high-risk young men (Mage, 21.12; SD, 2.30), and Cox proportional hazards regression was used. The results showed that compared with young men with no CBT encounters, those with one or more CBT encounters had a 66% (hazard ratio [HR], 0.34; 95% confidence interval [CI], 0.28-0.42; p < 0.001) lower risk of unenrolling from programming, 65% (HR, 1.65; 95% CI, 1.29-2.12; p < 0.001) higher risk of obtaining a job, and no difference in risk of engaging in new criminal activity while enrolled in programming (HR, 0.99; 95% CI, 0.78-1.25; p = 0.918), despite higher risk factors. Training paraprofessionals to deliver CBT skills to high-risk populations is effective and has scalability potential.

Venezuelan migrants in Colombia: COVID-19 and mental health

Venezuelan migrants in Colombia: COVID-19 and mental health

Policy, Preparation, and Practice . . . Oh My! Current Policy Regarding the Paraprofessional Role and Preparation for Working With Students With Disabilities

Over the past two decades, the paraprofessional role has expanded to include a variety of support roles in both general and special education. Although the most recent 2004 reauthorization of the Individuals with Disabilities Education Act (IDEA) addressed the necessity of paraprofessional preparation, training, and supervision, the field of education continues to struggle with incorporating these necessary components. In this article, we summarize current policies and standards, both state and federal, for training paraprofessionals in special education. Next, we provide possible recommendations for policy, practice, and future research to ensure the preparation of paraprofessionals and ultimately, the success of students who have disabilities.

Training paraprofessionals who work with students with intellectual and developmental disabilities: What does the research say?

AbstractFederal law allows for paraprofessionals to provide instruction to students with developmental disabilities if they are adequately trained and supervised, but how to best provide this training and support remains unclear. In this paper, we update a systematic review of experimental studies that test the efficacy of paraprofessional‐implemented interventions for students with developmental disabilities. We identified 36 studies published 2012–2019. An exciting development is that some researchers are shifting to testing teacher‐implemented training, therefore beginning to address important questions about the feasibility of widespread implementation under real‐world conditions. Based on findings across studies, recommendations for practice include that (a) paraprofessional roles be well‐defined and focused on the implementation of evidence‐based practices; (b) paraprofessional training should feature modeling, an implementation checklist, and performance feedback that is sustained over time; and (c) administrators should ensure that teachers have the time and support that are required for effective paraprofessional training and supervision.

Effects of Delayed Video-Based Feedback and Observing Feedback on Paraprofessional Implementation of Evidence-Based Practices for Students With Severe Disabilities

Coaching with live observation and immediate performance feedback is an effective means to train paraprofessionals, but might not always be feasible. We used a multiple baseline across participants design with six paraprofessionals who taught elementary students with severe disabilities to test the efficacy of two innovations designed to improve the feasibility of delivering feedback. We found a functional relation between delayed, video-based performance feedback and paraprofessional implementation fidelity of two systematic prompting strategies. Observing a colleague receive feedback did result in some improvement, but did not enable all paraprofessionals to meet the training criterion. These findings suggest that delayed, video-based feedback is an effective and feasible training tool, but only observing a colleague receive feedback might be insufficient.

Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 1): Randomized Controlled Trial.

BackgroundThe frenzy of postbirth events often takes a toll on mothers’ mental well-being, leaving them susceptible to postpartum psychological disorders such as postnatal depression (PND). Social support has been found to be effective in restoring the emotional well-being of new mothers. Therefore, mothers need to be supported during the crucial postpartum period to buffer the negative after effects of childbirth and to promote healthier maternal well-being.ObjectiveThis study aimed to evaluate the effectiveness of a technology-based peer-support intervention program (PIP) on maternal outcomes during the early postpartum period.MethodsA randomized, parallel-armed controlled trial was conducted. The study recruited 138 mothers (69 in intervention group, 69 in control group) at risk of PND from a tertiary hospital in Singapore. To support these mothers, 20 peer volunteers were recruited by word of mouth and trained by a psychiatrist in social support skills before the intervention commenced. The 4-week–long intervention included a weekly follow-up with a peer volunteer through phone calls or text messages. The intervention group received peer support in addition to the standard care offered by the hospital. The control group only received postnatal standard care. Maternal outcomes (PND, postnatal anxiety [PNA], loneliness, and perceived social support) were measured with reliable and valid instruments. Data were collected immediately postpartum, at 1 month postpartum and at 3 months postpartum. The general linear model was used to compare the groups for postpartum percentage changes in the outcome variables at first and third months, and the linear mixed model was used to compare the trend over the study period.ResultsThere was a statistically significant difference in Edinburgh Postnatal Depression Scale scores (d=–2.11; 95% CI −4.0 to −0.3; P=.03) between the intervention and control groups at 3 months postpartum after adjusting for covariates. The intervention group had a significant change over time compared with the control group.ConclusionsThe technology-based PIP was found to be effective in reducing the risk of PND among new mothers and showed a generally positive trend in reducing PNA and loneliness and increasing perceived social support. This study highlights the importance of training paraprofessionals to provide needed support for new mothers postpartum. A further long-term evaluation of the PIP on maternal and family outcomes and its cost-effectiveness is needed to inform clinical practices.Trial RegistrationISRCTN Registry ISRCTN14864807; https://www.isrctn.com/ISRCTN14864807International Registered Report Identifier (IRRID)RR2-10.2196/resprot.9416

Mental health facilitator service implementation in Mexico: a community mental health strategy

ABSTRACTNBCC’s Mental Health Facilitator (MHF) program is designed to increases service accessibility by training paraprofessionals. Interviews from community stakeholders in Mexico were analyzed with Consensual Qualitative Research to explore the multi-year impacts of MHF. Positive findings corroborate prior research from other countries, however this sample highlights long-term barriers to implementation. Implications for practice and future research are discussed.

Supporting Students in the Classroom: Training Paraprofessionals to Teach Self- Advocacy and Self-Determination Skills

Students with disabilities lack the skills to become independent self-advocates. This article details a training program that was implemented for paraprofessionals who support students with disabilities in public school classrooms in the United States. Results indicated that advanced training of paraprofessionals improved student support which led to greater independence for the students with disabilities.

Effect of counseling by paraprofessionals on depression, anxiety, somatization, and functioning in Indonesian torture survivors

The Indonesian population has faced political violence, victimization, and torture throughout the last 70 years. Due to the scarcity of mental health professionals in many low and middle-income countries, counseling programs are increasingly utilizing paraprofessionals to provide support to the affected population as a strategy of task shifting. In this article, we would like to examine the effectiveness of counseling services provided by such trained paraprofessionals. This study was part of program evaluation to determine whether the participants (torture survivors) improved after counseling services provided by trained paraprofessionals in Indonesia. Local communities were invited to join the psychosocial program created and implemented by an NGO in 2005. The 178 participants were recruited from Jakarta, Papua, and Aceh, Indonesia for the program, which aimed to help survivors of violence suffering from "heavy hearts." The intervention lasted three months, and the follow-up intake was conducted after four months. The results indicated the participants' anxiety symptoms, depressive symptoms, somatic symptoms, and functioning improved from the intake to the follow-up. The program appeared to have been effective in reducing the participants' symptoms and impairment in functioning. This indicates that in countries where there is a scarcity of mental health professionals, working with paraprofessionals has the potential to help survivors of torture and violence.

Evaluation of Interactive Computerized Training to Teach Paraprofessionals to Implement Errorless Discrete Trial Instruction

Efficient and effective training strategies for paraprofessionals in special education settings face many challenges. Interactive computerized training (ICT)—a self-paced program that incorporates audio narration, video models, interactive activities, and competency checks—is one potential solution. ICT has been successful in training college students and special education teachers to implement discrete trial instruction (DTI), but its effectiveness to train paraprofessionals is unknown. Using a multiple-baseline design, we evaluated the feasibility of ICT, to train six paraprofessionals to implement DTI with an errorless learning procedure. Following ICT, the fidelity of implementation of DTI increased for all participants when implemented with a student in their classroom; however, competency varied. We added additional training components that progressed from low to more intensive feedback delivered remotely in attempt to increase fidelity to 90% or higher implementation. We also evaluated generalization to novel instructional programs and maintenance of instruction in the absence of feedback.

Early Intervention Paraprofessional Standards: Development and Field Validation

Personnel standards are the foundations for how states and nations approve a program, engage in systemic assessment, and provide effective professional development to its early childhood professionals. However, despite the extensive use of paraprofessionals in early intervention/early childhood special education programs, there is a lack of national- and state-level guidance for training paraprofessionals. This article presents the process followed for development and validation of statewide personnel standards for paraprofessionals who work in early intervention settings and the results of this validation study. The development and validation process for these new knowledge and skills competencies followed the process used by Division for Early Childhood and the Council for Exceptional Children for development and validation of personnel standards and K-12 special education paraeducator professional development standards. Challenges, limitations, and future directions are discussed.

Promoting Cultural Competency: A Nutrition Education Model for Preparing Dietetic Students and Training Paraprofessionals in an International Setting

Diversity sensitivity and cultural competence must become fundamental components of university curricula. A multi-dimensional nutrition education model was developed for a train-the-trainer program that included training dietetic students who would then train paraprofessionals instrumental in providing education and care for individuals in a community. This model effectively integrated diversity sensitivity, cultural competence, and nutrition competencies for the dietetics students. Eight culturally specific modules on basic nutrition, food sanitation and safety, and prevention, identification and management of prevalent non-communicable chronic diseases were developed during Spring semester 2009. A nutrition education workshop was held for twenty Community Health Aides in the Commonwealth of Dominica during summer (July) 2009. The dietetic students presented the modules and conducted evaluations of the model. Workshop participants rated the modules favorably. Dietary workshops for Community Health Aides can be extremely useful tools for developing a larger base of knowledge, increasing health awareness, and strengthening education and outreach. Likewise, this service learning model exposes students to skills related to grant writing, research, curriculum development, and teaching. This program encouraged students to apply innovative, critical thinking skills necessary to succeed in a dynamic, global profession. Utilizing this educational model will prepare students to be leaders in an increasingly challenging environment.

Assessing UNC-Greensboro’s Reference Interns Program: Enhancing the employability of LIS students

For decades libraries have been highly dependent on student interns to provide reference and other library services. In recent years, the roles and responsibilities of reference librarians have undergone significant changes. With the emergence of technology and development of virtual communication channels, reference service is no longer limited to a single physical space. In many academic libraries, the reference desk is either staffed by highly trained paraprofessionals or by student workers. In other instances, the reference desk has been dissolved or merged with other service points such as circulation or access services. Some libraries have moved to a system where patrons are referred to subject librarians or liaisons when specialized expertise and in-depth research techniques are required.