A Scoping Review of the Role and Training of Para-professionals Delivering Psychological Interventions for Adults with Post-traumatic Stress Disorder

Abstract

Background: The delivery of interventions for traumatic stress disorders by paraprofessionals is of interest across mental health systems as decision-makers work to meet growing need for services and demand for evidence-based care. Given the need for any system change to reflect scientific evidence, our scoping review aimed to identify and summarize the research on paraprofessional-delivered trauma-focused psychological interventions for adults, with a particular focus on the role and training of paraprofessionals. Method: We searched seven databases for peerreviewed published studies that employed controlled trial designs to evaluate paraprofessional-led interventions for traumatic stress. Using Covidence software, we completed iterative eligibility screening and extracted study data. Descriptive statistics were used to identify trends and gaps in the literature and inform synthesis of findings. Results: Fourteen studies met inclusion criteria. The majority of studies (71%; 10/14) evaluated interventions that were delivered face-to-face across a diverse patient populations and clinical contexts. Training of paraprofessionals ranged in length from two training sessions (approx. 16 hours) to a 6-week full day, in-person course. Ongoing supervision of paraprofessionals during the intervention was reported in 64% (9/14) of the studies, but few details of supervision processes were reported. Conclusion: Paraprofessionals are taking on therapeutic roles in the delivery of trauma-focused psychological interventions but there are significant knowledge gaps around training and supervision they require. Lack of consensus on the defining characteristics of a "paraprofessional" makes synthesizing this literature particularly challenging.

Lay-delivered talk therapies for adults affected by humanitarian crises in low- and middle-income countries

“…This will require more consistency in how lay workers are defined. As observed by Xiong et al (2019) in their recent scoping review on paraprofessional psychological interventions for PTSD [109], often terms like "non-specialists" or "counsellors" are employed, with no specification of their education or training level.…”

Asian Indians in the United States and Posttraumatic Stress Disorder Interventions: A Narrative Literature Review

“…Drawing from existing evidence, it may be helpful for paraprofessionals working with Asian Indians to be literate in the native language, have good interpersonal and therapeutic skills (e.g., empathy), demonstrate motivation for this kind of work, and share some cultural values as the target group (Jain, 2010; Neuner et al, 2008). Also, evidence suggests that paraprofessionals can effectively administer trauma interventions with beneficial therapeutic outcomes, can lead group discussions, and also can serve as peers to individuals who seek treatment for PTSD symptoms (Dowling et al, 2006; Jain, 2010; Neuner et al, 2008; Xiong et al, 2019). Further, it would be helpful to provide regular and effective supervision to paraprofessionals to prevent burnout, to integrate them into treatment teams effectively, and to ensure ethical and legal compliance to therapeutic procedures (Jain, 2010; Rahman et al, 2008).…”

“…Further, it would be helpful to provide regular and effective supervision to paraprofessionals to prevent burnout, to integrate them into treatment teams effectively, and to ensure ethical and legal compliance to therapeutic procedures (Jain, 2010; Rahman et al, 2008). Paraprofessionals would benefit from intensive and time-limited training (e.g., 2 weeks) in how to make referrals to specialized services and to skilled professionals when appropriate (i.e., skills around how to triage and when to externally refer individuals for topics outside of their scope of practice), in general counseling skills, in skills needed for CA PTSD interventions, as well as in relevant cultural components (Neuner et al, 2008; Xiong et al, 2019). Relatedly, there is a need to diversify the mental health profession and discipline with steps such as increasing the training, recruitment, and retention of mental health professionals identifying as Asian Indians.…”

Paraprofessional delivery of online narrative exposure therapy for firefighters

“…In line with prior studies demonstrating therapeutic alliance in virtual environments (Lingley‐Pottie & McGrath, 2007), quantitative measures suggested a therapeutic alliance was built between participants and paraprofessionals. Previous studies describe variations in the training and supervision of paraprofessionals (Xiong et al., 2019). In the present study, paraprofessionals were extensively trained and supervised on a regular basis and met amongst themselves for peer support.…”