Operationalizing Task-Sharing: Enhancing Paraprofessional Competence and Confidence Using Remotely Administered Deliberate Practice

Abstract

Background:

A nationwide shortage of credentialed mental health (MH) care providers has resulted in widespread incorporation of paraprofessional counselors into care systems as service enablers. This model, called task-sharing, allows paraprofessionals to provide basic interventions and reserves intensive clinical work for MH care providers, extending the reach of services. However, research suggests the greatest barrier to realizing task sharing’s potential is a widespread lack of resources and guidance for training and supervising paraprofessional counselors. Increasingly adopted across master’s and doctoral programs in social work and psychology, Deliberate Practice is a promising avenue for providing rapid, quality training in counseling. We developed and tested a model of Deliberate Practice (DP) training in basic cognitive-behavioral skills that crosscut evidence-based interventions for a sample of United States Air Force mental health technicians (MHTs) who work as provider extenders for military psychologists and social workers. We sought to assess (a) improvements in target skill areas, (b) spontaneous employment of these skills in session, and (c) changes in uptake of evidence-based interventions (EBIs) in work with service members.

Methods:

In accordance with a DP framework, we operationalized 20 individual counseling skills (e.g., empathic reflection, challenging cognitive distortions) and launched an intensive, remotely administered, 22-hour training program for MHTs (N = 24) in small cohorts (n ~ 6 MHTs). For 10 weeks, MHTs participated in weekly one-hour group didactics (introducing and modeling operationalized skills [e.g., empathic reflection]) and one hour individual 1:1 skills practice (i.e., repeated skill attempts with expert feedback). Progress in target skill development was rated weekly. MHTs also completed videotaped simulated patient actor sessions to assess therapeutic competence and reported specific interventions and resources used with service member patients at pre- and post-training. Multiple linear regressions were performed to assess change.

Results:

Results suggest that a remotely administered DP intervention for MHTs can improve objectively rated psychotherapeutic competence, as well as specific skill acquisition. Notably, select core psychotherapy skills appear less amenable to rapid learning (e.g., opposite action) than others (e.g., behavioral activation). Engagement in EBIs generally increased from pre-to-post training, and MHTs reported applicability of training to their work and increases in confidence to use specific evidence-based skills and techniques.

Implications:

Results have implications for the training of paraprofessionals and contribute to the growing body of literature supporting task-shifting in mental health. Our findings suggest that targeted, high-fidelity counseling skills training can substantially improve both the competence and confidence of paraprofessional providers. The increase in both objectively rated competence and subjective confidence indicates that this model of training may enhance implementation fidelity by fostering provider self-efficacy. This study validates DP as a viable training mechanism and shows promise as a remotely administered training model for paraprofessionals who are geographically separated from supervision, such as those in rural or occupational settings. However, the variability in skill acquisition suggests that more complex skills may require extended or repetitive training sessions to obtain competence and should be carefully considered.