Selection versus training in the development of paraprofessionals.

To investigate the relative contributions of selection and training on the performance of paraprofessionals, 80 undergraduate volunteers responded to simulated phone calls. Ss were randomly divided into 4 samples, and 1 group was chosen from each sample. Two groups were chosen on the basis of high scores on the Telephone Counseling Effectiveness Scale (TCES), which was used to rate the responses to the phone call, and 2 groups were chosen randomly. One selection group and one random group were trained in 3 2-hr training sessions. All Ss were then asked to respond to the call again, and once again 3 wks later. All calls were rated using the TCES. Using an analysis of covariance, training was found to have a significant main effect, while selection was not. There was also a 3-way interaction between training, selection, and test. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assertion training for mental health paraprofessionals.

Provided 10 wks of assertion training to 8 mental hospital paraprofessionals who, in turn, served as either counselor or counselee in a microcounseling session with 8 paraprofessionals untrained in assertion training. The data were analyzed by a 2 * 2 completely randomized multivariate analysis of variance. Trained counselors were superior to untrained counselors on a set of counselor-effectiveness measures. Trained counselees differed from untrained counselees on a set of client behaviors. This effect was mediated by the training of the counselor. The problems of conducting scientifically valid research within an institution are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mentally retarded residents as paraprofessionals in modifying mealtime behavior.

Investigated, in 2 experiments, the possibility of employing 2 mildly mentally retarded residents (aged 28 and 39 yrs) to observe the mealtime behaviors of lower level mentally retarded residents (20-65 yr old females). It was found that the residents could rate mealtime behaviors reliably (mean reliability = 95%). The residents were then employed as reinforcing agents, to determine if a retarded "trainer" could modify the observed mealtime behaviors within a multiple baseline design. Since an experimental effect was demonstrated on 4 (proper use of napkin, clean face, clean table, and proper use of utensils) of the 5 target behaviors, it was concluded that such change agents could modify the mealtime behavior of lower functioning residents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating training programs for paraprofessionals and nonprofessionals.

The importance of paraprofessional and nonprofessional human service workers in the current mental health delivery system has resulted in the development of systematic training methods for such personnel. Mental health professionals must begin the complex task of assessing such training. Three major strategies for the comprehensive evaluation of training programs are offered. The 1st strategy concerns the assessment of the differential usefulness of selection vs training of helpers. The 2nd strategy focuses on identifying factors producing effective training, while the 3rd entails an evaluation of the impact of systematically trained helpers on helpees. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Application of supervised and nonsupervised microcounseling paradigms in the training of paraprofessionals.

Studied the effect of supervision on the learning of basic clinical interviewing skills within the microcounseling format. Ss were 12 19-33 yr old paraprofessional counselors (4 women and 8 men) employed in the drug research center of a midwestern psychiatric institute. Each S was assigned randomly to either a supervised or a nonsupervised microcounseling training condition. Trained coders categorized 32 trainee utterances from each S's pre- and posttraining videotaped interviews as 1 or more of the microcounseling skills, 1 or more of the opposite skills, or a miscellaneous skill. Analysis revealed only 1 significant effect indicating more frequent use of microcounseling than opposite skills. No significant differences were found between training conditions or across time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of the practitioner in applying science to practice.

This article deals with the role of the practitioner in the translation of science and practice. Obstacles to a better understanding of the nature of the relation between the science and practice of psychology are described, and suggestions for a better alliance between researchers and practitioners are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of paraprofessionals in university mental health settings; a national survey

A national survey of 218 counseling centers was conducted to determine the extent and nature of paraprofessional use. Responses from 119 centers indicated that only 38% employ paraprofessionals. Those programs that do exist tended to be at larger, public institutions. Paraprofessionals were generally salaried, and they functioned in multiple roles. The selection procedure most frequently employed was professional staff interviews with an emphasis on "interpersonal characteristics" as the selection criterion. Training and evaluation procedures were usually conducted on an ongoing rather than on a "one-shot" basis. Reasons for not employing paraprofessionals varied considerably from center to center.     

The cost-effective delivery of rehabilitation psychology services: The responsible utilization of paraprofessionals.

The new and rapidly changing health care environment necessitates innovation on the part of rehabilitation psychology to achieve cost-effectiveness. This innovation could take the form of rehabilitation psychologists' responsibly using bachelor's-level technicians, or paraprofessionals, in the delivery of clinical services. This article proposes a pyramid model of rehabilitation psychology service delivery using paraprofessionals and psychology trainees. Specific clinical activities appropriate for paraprofessionals are outlined. Controversies regarding use of bachelor's-level paraprofessionals and the inflationary process of over-credentialing doctoral-level psychologists are discussed. It is proposed that psychology interns and residents be cross-trained in allied health skills so that psychology trainees can provide clinical support to other health care disciplines, thereby improving the cost-effectiveness of, and preserving, hospital-based psychology training programs. The article emphasizes the need for doctoral-level rehabilitation psychologists to adopt administrative roles in medical settings in order to implement innovative service models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of practice tests in the accuracy of test predictions on text material.

Investigated the role of practice tests in predictions about test performance on texts. Generally, Ss predicted their relative performance on tests accurately. However, answering practice-test questions that were drawn from the same pool as criterion-test questions did not improve prediction accuracy. The main reason for this was that practice-test scores for specific texts did not correlate with criterion-test scores. In addition, neither practice tests that were identical to the criterion tests nor practice tests consisting of the question stems improved the accuracy of test predictions relative to no-practice tests. With identical practice and criterion tests, accuracy of self-generated feedback correlated positively with the accuracy of test predictions. For similar practice and criterion tests, however, accurate experimenter-provided feedback reduced test-prediction accuracy, presumably because of the lack of reliability. (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.     

A symposium on skill dissemination for paraprofessionals: Models of training, supervision, and utilization.

Proposes designing better programs for training mental health paraprofessionals and presents a comprehensive training package focusing on skills that facilitate client life development. A broad conception of the roles proper for paraprofessionals is needed, and potential new roles are suggested. (76 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The scope of professional practice in specialist practice

The Scope of Professional Practice (UKCC, 1994a) now offers nurses, midwives and health visitors new opportunities to develop their clinical role. Role expansion is at the centre of debate in the health service. In the spirit of Scope, trusts and regional health authorities have been experimenting with new roles that combine medical and nursing practice in order to promote a holistic approach to health care. Education, experience and the appropriate clinical competency are the foundations for role expansion and the development of professional practice. However, some of the new roles and innovative practices have also been targeted at reducing junior doctors' hours (Read and Graves, 1994). New roles must be evaluated before they are allowed to develop and there is an urgent need for national evaluation of the initiatives underpinning Scope. This article examines the changing role of practitioners in specialist practice. The ethical, professional and legal issues surrounding these changes will also be considered.     

Defining the practice population in fee-for-service practice

OBJECTIVE: To develop and validate a technique for defining a practice population of discrete individuals based on multiyear family practice fee-for-service billings data. DATA SOURCES/STUDY SETTING: Nineteen family physicians in Ontario, Canada who converted from fee-for-service to capitation payment. Data sources were fee-for-service billings data for the three-year period prior to the conversion from fee-for-service to capitation payment and the rosters of enrolled patients for the first and third years after the change to capitation payment. STUDY DESIGN: The billings-based definition of the physician's practice population was compared against the Year 1 roster. We also compared the billings-based practice population and the Year 1 roster to the physician's Year 3 roster to identify patients who might have been missed during the roster development process. Our principal analyses were an assessment of the sensitivity of the billings-based definition of the practice population (EPP), the positive predictive value of EPP, and the agreement between EPP and the rostered patient population (RPP). We also examined the ratio between EPP and RPP to determine EPP's accuracy in estimating the practice denominator. DATA COLLECTION/EXTRACTION METHODS: The practice population for each physician at the time of conversion from fee-for-service to capitation payment was defined as (a) all persons for whom the physician billed the provincial health insurance plan for at least one visit during the year immediately prior to joining the capitation-funded program; and (b) all additional patients for whom the physician billed the plan for at least one service in each of the two preceding years. Data extraction was carried out within the Ministry of Health in order to preserve the anonymity of patients and physicians. Data were provided to the investigators stripped of patient and physician identifiers. PRINCIPAL FINDINGS: The mean sensitivity and positive predictive value of EPP were 95.3 percent and 87.4 percent, respectively. The level of agreement between EPP and RPP averaged 84.4 percent. The mean ratio of EPP to RPP was 1.21 (95 percent C.I. 1.030-1.213). Correction for roster false-negatives increased the sensitivity, positive predictive value, and agreement between EPP and the practice population, and reduced the mean ratio of EPP to the practice population to 1.068 (95 percent C.I. 1.010-1.127). CONCLUSIONS: The practice population can usefully be defined in fee-for-service family practice on the basis of multiyear fee-for-service billings data. Further research examining alternative encounter-based practice population definitions would be valuable.     

Negotiating the role of the practice nurse in general practice

The debate about the role of the practice nurse is not only about practice nursing per se, but raises broader issues about the organization of primary health care. Two related issues emerge as significant: the role of the practice nurse in providing primary health care; and the effective use of the practice nurse resource in the 'new' National Health Service. This paper, by drawing on material from a qualitative study, specifically examines the type of work performed by practice nurses and the factors that influence this. The responses of practice nurses, general practitioners, Family Health Service Authority (FHSA) advisers, community nurse purchasers and managers of community nursing provider units suggest that a consensus on the future development of practice nursing is unlikely. The different stakeholders emphasized different issues, reflecting their own priorities and backgrounds. Practice nurses' accounts of the future, for example, focused on professional issues. General practitioners stressed the importance of role development which met their General Medical Service responsibilities. Purchasing agencies, provider units and FHSAs adopted a wider perspective and were more concerned to develop an effective and integrated primary health care service. The tensions generated by their different interests and perspectives, and the subsequent organizational and policy initiatives that emerge, will provide the context in which the role of practice nurses will be negotiated.