Comparing Fidelity Outcomes of Paraprofessional and Professional Delivery of a Perinatal Depression Preventive Intervention

Abstract

Mothers and Babies (MB), a perinatal depression preventive intervention, has proven effective in decreasing depressive symptoms and preventing onset of major depression. An ongoing cluster-randomized trial is comparing the effectiveness of the six-session MB group intervention led by paraprofessionals versus mental health professionals. Twenty percent of all audio-recorded intervention sessions were randomly selected for fidelity checks. Analyses assessed mean facilitator adherence and competency overall, by study arm, and by session; and, examined site, facilitator, and client-specific effects. There were no significant differences found between study arms. Findings show paraprofessionals can deliver MB with similar fidelity as mental health professionals.

An equivalence analysis of provider education in youth mental health care

“…Our findings suggest that provider education had little impact on training engagement and outcomes. They are consistent with those of other studies finding small or no associations between provider education and EBT delivery‐related outcomes, 38‐41,64,65 as well as studies finding advantages for providers without advanced degrees 42,45 . This study extends earlier work by using equivalence testing to answer this question in a large sample of providers delivering services to children and families.…”

“…Overall, we found that providers with and without advanced de- finding small or no associations between provider education and EBT delivery-related outcomes, [38][39][40][41]64,65 as well as studies finding advantages for providers without advanced degrees. 42,45 This study extends earlier work by using equivalence testing to answer this question in a large sample of providers delivering services to children and families. Our exploratory analyses of family clinical outcomes were largely inconclusive.…”

“…intervention than those with advanced degrees, 42 while other research has found no associations between provider education and skills or fidelity in mental health and child welfare interventions. [38][39][40]43,44 Within child mental health specifically, a metaanalysis of treatment outcome research found that providers without advanced degrees were more effective than professional or student providers, although effects differed by patient age, gender, and problem type.…”

“…For example, providers with more advanced degrees have been found to exhibit more competence in some studies, 36,41 but less competence in others 37 . One study found that providers without advanced degrees had greater adherence to a manualized intervention than those with advanced degrees, 42 while other research has found no associations between provider education and skills or fidelity in mental health and child welfare interventions 38‐40,43,44 . Within child mental health specifically, a meta‐analysis of treatment outcome research found that providers without advanced degrees were more effective than professional or student providers, although effects differed by patient age, gender, and problem type 45 .…”

Future Directions in Lay Health Worker Involvement in Children’s Mental Health Services in the U.S.

“…Though findings from LMICs are promising on LHWdelivered EBPs, minimal research has investigated if there are differences in clinical outcomes depending on provider experience and education level (Barnett, Gonzalez, et al, 2018). One recent study found similar levels of fidelity and effectiveness between LHW and professional delivery of a perinatal depression preventive intervention (Diebold et al, 2020;Tandon et al, 2021), but few other studies have made these comparisons. If LHWs are less effective at delivering EBPs than mental health professionals or their roles in auxiliary care diminishes effectiveness, disparities could be exacerbated for marginalized populations.…”