Evaluating comparative studies of paraprofessional and professional helpers: A reply to Nietzel and Fisher.

Discusses the major disagreements between M. T. Nietzel and S. G. Fisher (see record 1981-22035-001) and the present author (see record 1979-31736-001) regarding the methodology to apply in evaluating comparative studies of paraprofessional and professional helpers' effectiveness. There is substantial agreement in both reviews on the conclusions that current data support. Research has failed to demonstrate significant differences in the outcomes obtained by paraprofessionals and professionals. Professional training, education, and experience do not appear to explain much of the variance in clinical outcome. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does professional training make a therapist more effective?

In a recent review, J. A. Hattie et al (see record 1984-23694-001) concluded that patients treated by paraprofessional therapists improve more than those treated by professionals. However, it is argued that this conclusion is based on inappropriate studies and statistical analyses. In the present review, the authors omitted problematic studies and organized the data from 32 studies to permit valid statistical inference. Unlike Hattie et al, the present authors found that professional and paraprofessional therapists were generally equal in effectiveness. The present analyses also suggested that professionals may be better for brief treatments and older patients, although these differences were slight. Current research evidence does not indicate that paraprofessionals are more effective, but neither does it reveal any substantial superiority for the professionally trained therapist. A bibliography of studies included in the present review is included. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment outcome and maintenance in systematic desensitization: Professional versus paraprofessional effectiveness.

Determined the relative effectiveness of paraprofessionals and well-trained professionals in conducting systematic desensitization. 45 anxious college students were tested with the Test Anxiety Behavior Scale and the Symptom Check List and randomly assigned to a wait-list control group, 3 groups facilitated by experienced behavior therapists, and 3 groups led by paraprofessionals. Results of pretreatment, posttreatment, and 5-mo follow-up measures show that paraprofessionals can achieve outcome and maintenance effects equivalent to those of the more rigorously trained professionals. It is suggested that paraprofessionals can conduct desensitization in a high quality, cost-effective manner, thus reducing the professional case load and adding greatly to the scope of programs offered to the consumer. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

EBP ≠ EST: Reply to Crits-Christoph et al. (2005) and Weisz et al. (2005).

Replies to Crits-Christoph et al. (see record 2005-04167-007) and Weisz et al (see record 2005-04167-008). Evidence-based practice (EBP) is not a synonym of empirically supported therapies (ESTs). ESTs reflect 1 kind of evidence that should guide EBP. The authors focus in this response on 4 issues: the distinction between 2 functions of randomized clinical trials (RCTs) with very different methodological and clinical implications, problems with the experimental designs used to test ESTs that have unnecessarily limited their clinical and scientific utility, the question of how to integrate findings from RCTs with findings from other empirical methods to guide evidence-based interventions, and what one means by clinicians (i.e., whether clinicians should be paraprofessionals who implement procedures developed by researchers or full-fledged partners in the development and implementation of evidence-based psychological practice). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative effectiveness of paraprofessional and professional helpers.

The outcome and adequacy of design in 42 studies comparing the effectiveness of professional and paraprofessional helpers are reviewed. Although studies have been limited to examining helpers functioning in narrowly defined clinical roles with specific client populations, it is argued that the findings are consistent and provocative. Paraprofessionals achieve clinical outcomes equal to or significantly better than those obtained by professionals. In terms of measureable outcome, professionals may not possess demonstrably superior clinical skills when compared with paraprofessionals. Moreover, professional mental health education, training, and experience do not appear to be necessary prerequisites for an effective helping person. The strongest support for paraprofessionals has come from programs directed at the modification of college students' and adults' specific target problems and, to a lesser extent, from group and individual therapy programs for non-middle-class adults. Future studies need to define, isolate, and evaluate the primary treatment ingredients of paraprofessional helping programs to determine the nature of the paraprofessional's therapeutic influence. (62 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance of administrators, professionals, and paraprofessionals during community-based brain injury rehabilitation training

OBJECTIVE: Two related studies that evaluated the impact of a continuing education program about community-based rehabilitation on the performance of administrators, professionals, and paraprofessionals are presented. One study contained a second part that examined whether differences between pre-course test performance and post-course test performance might be accounted for by practice effects. DESIGN: Factorial mixed model designs. SETTING: University classroom. PARTICIPANTS: Three hundred and eight professionals, administrators, and paraprofessionals from a variety of community-based rehabilitation programs. INTERVENTION: The 4-day graduate-level course focused on three content areas: brain and behavior relationships, behavioral and cognitive intervention strategies, and a rehabilitation philosophy that emphasizes individual client rights. MAIN OUTCOME MEASURE: An examination completed before and immediately after taking the course. RESULTS: Professionals and administrators perform better than paraprofessionals when tested at the beginning and end of the training. However, the absolute differences among these groups were not substantial. In addition, the rate of learning course content was the same for administrators, paraprofessionals, and professionals. CONCLUSIONS: The results support the usefulness of training for all levels of staff and suggest that all levels of staff benefit in an equal fashion.     

Paraprofessionals, partners, peers, paraphernalia, and print: Expanding mental health service delivery.

Presents a model that defines 5 types of nonprofessional therapeutic agents–paraprofessionals, partners, peers, paraphernalia, and print—and proposes their use at 3 levels of intervention—prevention, treatment, and maintenance. Selected research using these nonprofessional agents is described, and additional therapeutic applications are suggested. Implications of the model for treatment effectiveness, the role of mental health professionals, and cost-effective service delivery are also explored. (5? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing a stress management training: Comparative trainer effectiveness.

Participants who were recruited from various organizations were randomly assigned to 1 of 2 stress management training (SMT) conditions or an assessment-only control group. The groups in the 1st SMT condition were led by external clinical psychologists. The groups in the 2nd SMT condition were led by individuals who held posts within the organizations involved, referred to as paraprofessionals. Results show favorable effects of the SMT program both in the short term as well as at 6-month follow-up. Results showed no serious differences in effectiveness between trainers. It is argued that, to be effective, the SMT program does not necessarily have to be given by clinical psychologists only but may instead be given by individuals from other professional orientations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Isolating factors related to paraprofessional effectiveness.

In a precollege counseling program, 7 paraprofessionals (graduate students) received higher ratings than the 20 full-time professional counselors. A total of 1,769 entering freshmen participated in the program. It is hypothesized that the common bond of being students helped the paraprofessionals in counseling these students. There was inconclusive evidence concerning the contribution of naive enthusiasm to paraprofessional effectiveness. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resolving issues raised by the Fort Bragg evaluation: New directions for mental health services research.

Replies to comments by J. R. Weisz et al, K. Hoagwood, P. H. DeLeon and J. G. Williams, L. Saxe and T. P. Cross, L. Behar, and S. Feldman (see records 84-32869, 32806, 32791, 32850, 32776, and 32800 respectively) regarding the author's (see record 83-31861; L. Bickman et al, 1995) Fort Bragg study. Six major concerns are addressed: timing, cost and decision making, service effectiveness, nature of mental health treatments, generalizability of results, and present and future directions as a result of the study. The author stresses the need for mental health professionals to face the issues raised by this study and to assume responsibility for improving the effectiveness of services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of pain assessment, second edition.

Reviews the book, Handbook of pain assessment, second edition edited by Dennis C. Turk and Ronald Melzack (see record 2001-05101-000). This book is a comprehensive review of the state of the art of pain assessment. The book consists of 36 chapters organized in six major sections, an introduction and a conclusion. The sections are: measurement of pain, assessment of behavioural expressions of pain, medical and physical evaluations, psychological evaluation, specified pain states, and methodological issues. The Handbook of pain assessment should be in every university and health centre library. All health professionals and students who see patients who have pain (and that is probably all of them) should have this text readily available. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epistemological status of equivocal death analysis.

Discusses several points raised in the N. Poythress et al (see record 1993-19880-001) article on equivocal death analysis (EDA). The authors argue that since they are law enforcement professionals who use EDA as an investigative technique, they are not mental health professionals and do not need to hold to American Psychological Association guidelines. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A step in the right direction: A resource for collaboration on health-related issues.

Reviews the book, Health-related disorders in children and adolescents edited by L. Phelps (see record 1998-07780-000). This edited text provides an overview of 96 medical conditions that place children at risk of developing psychological or educational problems. The central feature of this book is that it is intended as a reference tool for professionals who collaborate with medical professionals. Increasingly, there have been many vehicles for school psychologists to collaborate with medical professionals, including comprehensive school health care programs and school-based health clinics, and community-based coordinated services that provide children and youth comprehensive care. In this regard, school psychologists are likely to encounter increasing numbers of children who experience health disorders, along with more traditional areas of practice including mental health and educational issues. Although not a purely medically oriented text, Phelps has taken a perspective that school psychologists work within the context of a multidisciplinary team of professionals who are likely to provide services for these children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The nature, assessment, and treatment of adolescent self-injury.

Reviews the book, Adolescent self-injury: A comprehensive guide for counselors and health care professionals by Amelio A. D'Onofrio (see record 2007-02689-000). To date there have been few publications in the professional literature addressing the needs of school personnel in regards to self-injury in school-age populations. This book attempts to address this gap in the literature. According to the author, the intent of the book is to assist "frontline professionals in developing a working understanding of the nature, meaning, and function of adolescent self-injurious behavior." In doing so, the author presents information from the research literature in such disparate areas as psychology, psychiatry, nursing, sociology, and feminist studies. Although written for both school and health care professionals, there is a strong focus in the book on school-based practice. The book is divided into three parts that together provide an overview of self-injury, strategies for assessment and treatment, and information on related issues. The text is well-written and provides practical, evidence-based information that should prove highly useful to school psychologists and other professionals responding to and working with adolescents who engage in self-injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structure of Job Diagnostic Survey for public sector occupations.

Investigated the factor structure of the Job Diagnostic Survey (JDS) for 1,632 public sector employees. The JDS measured skill variety, task identity, task significance, autonomy, and feedback for state and county government employees who were administrators, professionals, technicians, paraprofessionals, clericals, and service and technical workers. In general, matrices supported the dimensionality of the JDS. However, for technicians and service and maintenance workers, 2 items designed to tap autonomy had higher loadings on the feedback, task identity, task significance, and skill variety factors. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Leadership for older adults: Aging with purpose and passion.

Reviews the book, Leadership for older adults: Aging with purpose and passion by Sandra A. Cusack and Wendy J. A. Thompson (see record 1999-02171-000). While this is an interesting book, holding promise and providing suggestions for those who wish to take on leadership roles, or for those who work with others who might be encouraged to seek such roles, it also raises many questions about the process of who gets to be leaders of whom and how we can empower those traditionally seen as not worthy of such positions in organizations. The authors state that their book is intended to be used by "dedicated professionals and voluntary leaders" and for anyone who "shares the belief in the infinite possibilities of old age and wants to make a difference" (p.xvii). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Divorced families: A multidisciplinary developmental view.

Review of Divorced families: A multidisciplinary developmental view (see record 1987-97107-000). This book is intended to provide all professionals working in the context of family issues and transitions with the beginnings of a model of the normal processes of divorce. As such, it is of interest to sociologists, policy makers, lawyers, mediators, researchers, and clinicians such as psychologists and social workers, in fact anyone who is interested in the changing face of the North American family. In general, this is a satisfying and inspiring work. It is comprehensive, covers a difficult and complex area in a systematic and integrated fashion, and suggests a positive health-promoting role for professionals in this field. It is above all highly relevant to a wide range of professionals, in that the process of divorce is viewed as a sociological fact, a personal stressful experience, a crisis of family restructuring, and a phenomenon calling for more empirical research and theoretical model building. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perspectives on the professional in alcoholism.

Reviews relevant literature regarding the professional in alcoholism, an area in which nonprofessionals, often recovered alcoholics, and self-help fellowships have unusual influence. Professional values regarding research, innovation, and evaluation conflict with the "craft" and ideological commitment of paraprofessionals are discussed. Examples of the conflict of ideology vs research include the notions of irreversibility of alcoholism, loss of control over drinking, and alternative treatment goals. Professionals must also cope with the stigma of working in a "stigmatized" area. Role functions of professionals and value changes among paraprofessionals are suggested. (French abstract) (58 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Skills training versus psychosocial occupational therapy for persons with persistent schizophrenia

OBJECTIVE: The authors compared the community functioning of outpatients with persistent forms of schizophrenia after treatment with psychosocial occupational therapy or social skills training, with the latter conducted by paraprofessionals. METHOD: Eighty outpatients with persistent forms of schizophrenia were randomly assigned to receive either psychosocial occupational therapy or skills training for 12 hours weekly for 6 months, followed by 18 months of follow-up with case management in the community. Antipsychotic medication was prescribed through "doctor's choice" by psychiatrists who were blind to the psychosocial treatment assignments. RESULTS: Patients who received skills training showed significantly greater independent living skills during a 2-year follow-up of everyday community functioning. CONCLUSIONS: Skills training can be effectively conducted by paraprofessionals, with durability and generalization of the skills greater than that achieved by occupational therapists who provide their patients with psychosocial occupational therapy.     

Meditation, biofeedback, and the relaxation controversy: A cognitive-behavioral perspective.

Summarizes data from 2 clinical manuals by the present author (1985, in press) to illustrate that D. S. Holmes's (see PA, Vol 71:25288; see also 1985) conclusion that there is little evidence that meditation reduces somatic arousal and A. H. Roberts's (see record 1986-11198-001) questioning of the effectiveness of biofeedback in treating a variety of somatic conditions are based on outdated assumptions about the nature of relaxation and relaxation training. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)