Strengthening and Expanding Child Services in Low Resource Communities: The Role of Task‐Shifting and Just‐in‐Time Training

Abstract

Highlights• Task-shifting refers to redistributing tasks from professionals to workers who have less training.• Task-shifting may be a key strategy in expanding child services in low resource communities.• Just-in-Time Training (JITT) refers to efficient, on-demand training experiences. • JITT may strengthen task-shifting efforts.• Task-shifting and JITT involve unique ethical considerations.Abstract In the United States, the demand for child mental health services is increasing, while the supply is limited by workforce shortages. These shortages are unlikely to be corrected without significant structural changes in how mental health services are provided. One strategy for bridging this gap is task-shifting, defined as a process by which services that are typically delivered by professionals are moved to individuals with less extensive qualifications or training. Although task-shifting can increase the size of the workforce, there are challenges related to training new workers. In this paper, we propose Just-In-Time Training (JITT) as one strategy for improving task-shifting efforts. We define JITT as ondemand training experiences that only include what is necessary, when it is necessary, to promote competent service delivery. We offer a proof of concept from our own work shifting counseling and academic support tasks from school mental health professionals to prebaccalaureate mentors, citing lessons learned during our iterative process of JITT development. We conclude with a series of key considerations for scaling up the pairing of task-shifting and JITT, including expanding the science of JITT and anticipating how task-shifting and JITT would work within the context of dynamic mental health service systems.

Paraprofessional Youth Mentoring: A Framework for Integrating Youth Mentoring with Helping Institutions and Professions

“…Despite the demonstrated effectiveness of paraprofessional and lay helpers' delivery of interventions, taskshifting has not been systemically adopted in mental health care, in general, or in youth mentoring, specifically. McQuillin et al (2019) recently proposed task-shifting as a useful framework for paraprofessional mentoring, though they highlight the importance of rigorous evaluation, training, and supervision, and they caution mentoring organizations from fully embracing task-shifting before rigorous scientific evidence (i.e., on efficacy and best practices) and infrastructures (e.g., training and supervisory standards, regulatory mechanisms, credentialing bodies) are in place.…”

“…In recent decades, prevention and intervention scientists have made notable advances in their efforts to reduce the severity and functional impairment of mental health and behavioral difficulties in children. Nonetheless, mental and behavioral disorders remain widespread and burdensome, particularly among children from low-resource communities who are exposed to multiple cumulative risk factors and have insufficient protective factors (McQuillin et al, 2019;World Health Organization, 2010). Internationally, approximately 20% of youth suffer from a impairing mental health condition (Belfer, 2008), and in the United States, 50% of youth are affected by at least one mental health disorder with 22% of adolescents struggling with severe impairments (Merikangas et al, 2010).…”

Expanding the Reach of Psychosocial Services for Youth: Untapped Potential of Mentor-Delivered Single Session Interventions

“…Nesting mentor-delivered SSIs into existing, wellestablished, and nationally-implemented stepped care models (e.g., special education in public schools) may also allow mentors to receive supervision and support from professionals with more extensive and specialized training (e.g., school psychologists, licensed professional counselors, or clinical social workers). In addition to connecting mentors to professional MENTOR-DELIVERED SSIs assistance with decisions and recommendations, this positioning provides needed protections and regulations surrounding mentors' conduct with youths (McQuillin et al, 2019). In sum, embedding mentor-delivered SSIs into existing stepped-care systems could increase efficiency and equity in the distribution of mental health services on a structural level, while safeguarding against unregulated practices.…”

“…The use of intentionally brief and structured programs (a) accommodates mentors' typical lack of professional training in mental health services as lay providers, and (b) hinges on the idea that training is a continuing process, as mentors may receive training (e.g., from a psychologist in a MENTOR-DELIVERED SSIs 16 supervisory role) or train themselves to use an SSI on an as-needed basis (i.e., through "just-intime" training; McQuillin et al, 2019). As such, our approach offers a time-efficient training model.…”

“…These programming features are crucial to supporting mentors as lay providers, keeping checks MENTOR-DELIVERED SSIs 20 and balances for the safety of youth participants, and ensuring program fidelity. Recognizing constraints (e.g., mentors cannot and should not replace professional mental healthcarealthough mentor-delivered SSIs may serve as useful adjunctive or stand-alone supports for many youth) is vital to effective task-shifting (McQuillin et al, 2019), and specific limitations will vary by context and the resources available. Future research work should also explore how mentor-delivered SSIs can augment existing systems.…”