Just-in-Time Training for Youth Mentors: A Strategy for Implementing Evidence-Based Preventive Interventions for Youth in Rural Communities

University Of Minnesota, Minneapolis MN

Investigators

Abstract

PROJECT SUMMARY Adolescents who live in rural communities have significantly higher rates of depression, suicide, and mental health impairment than urban youth. They are also less likely to receive mental health care due to provider shortages and under-utilization of existing services. Our team is working to expand access to evidence-based practices (EBPs) in rural communities by “task-shifting” delivery from professional providers to youth mentors. Youth mentoring programs are low-cost and often viewed as more favorable in rural communities than professional mental health care. With input from rural youth, parents, and school partners who identified a need for mental health programming that supports interpersonal relationships, we adapted Interpersonal Psychotherapy–Adolescent Skills Training (IPT-AST), an evidence-based depression prevention program, for delivery by mentors of rural youth in an after-school setting. Our work is building on evidence from other task- shifting initiatives that demonstrates that paraprofessionals can be trained to deliver EBPs. The training process for paraprofessionals has typically involved multi-day expert-led workshops that are resource- and time-intensive. The high turnover rate among paraprofessionals can necessitate the need for additional workshops, further exacerbating resource strain. In addition, workshops are delivered weeks or months before the skills are needed, thereby limiting knowledge retention. The next step for realizing the potential of task- shifting EBP delivery for reducing mental health disparities is to develop implementation strategies that can be effective, sustainable, and scalable in low-resource settings with high provider turnover and non-expert supervisors. Just-in-Time Training (JITT) is one promising approach in which providers receive only the training necessary, at the time that it is necessary, to produce high program fidelity. We have developed a novel multi-level JITT implementation strategy (JITT-EBP) that aims to equip mentors and mentor supervisors to implement an EBP with fidelity using methods that are sustainable in rural communities. JITT-EBP integrates (a) self-directed, on-demand, online training modules for mentors and mentor supervisors, (b) synchronous evidence-based supervision strategies, and (c) an apprenticeship delivery model in which EBPs are co-led by an experienced mentor and a novice mentor, providing opportunity for in-the-moment training and support. Our hypothesis is that the use of JITT-EBP will result in IPT-AST fidelity and youth clinical outcomes that are as good as those observed with usual IPT-AST training, but with higher feasibility, acceptability, appropriateness, and perceived sustainability in low-resourced rural settings. To prepare for a subsequent fully-powered hybrid type 2 effectiveness-implementation trial, in this pilot trial, the aims are to optimize the usability, feasibility, and acceptability of JITT-EBP using a sequential mixed method design; and conduct a pilot randomized trial of JITT-EBP versus usual IPT-AST training to evaluate the implementation outcomes of JITT-EBP and the implementation and clinical outcomes of mentor-delivered IPT-AST.