Building Service Provider Competencies and Skills for Working with Young People
Abstract: This article reviews the current research on best training practices for mental health service providers who work with youth and young adults.
"Building Service Provider Competencies and Skills for Working with Young People" (2018)
By Janet Walker, Pauline Jivanjee, Eileen M. Brennan, & Leigh Grover
Recognizing that young people in the transition years with mental health needs are not always well served, efforts are underway to improve preparation for service providers so that they can offer developmentally appropriate, culturally responsive, and evidence-supported services. As part of these efforts, researchers and service providers have engaged in developing and testing new interventions and programs specifically designed to meet the needs of this population.1 Built on shared practice principles, these approaches promote engagement, positive working relationships, and change processes through strengths-based youth-/young adult-driven strategies that respect young people’s cultures, and help them to increase their self-determination and skills by building connections with supportive adults and peers in development-enhancing contexts.2 Based on a review of relevant research and the lessons learned in Pathways’ research and training projects,3 this article outlines the most promising strategies for increasing providers’ capacities to deliver effective behavioral health services and supports to youth and emerging adults. Existing training approaches aimed at practice change often fail to include needed elements because of their resource-intensive nature; this review suggests some emerging solutions that may increase training effectiveness without exhausting resources.
Best Practices in Training
For widespread delivery of effective, developmentally-appropriate and culturally responsive services, best practices in training are needed. A review of training research draws attention to principles of adult learning: Adults learn best when they are self-directed, internally motivated, and actively engaged in examining their own attitudes and increasing their own knowledge and skills.4 Effective training builds upon what individual participants already know, with content presented in meaningful ways, and with opportunities for active engagement to apply learning to relevant situations.4 To meet the needs of individual learners, training takes account of stages of professional development (novice to expert), learning processes, individual learning modality preferences (auditory, visual, sensory, practical), and learning styles.5
A range of training methods are used to enhance the skills of service providers, each with strengths and limitations. Face-to-face training can be helpful for communicating new knowledge and for changing provider attitudes toward new ideas and practices. Workshops, conferences, and self-paced online trainings are popular with service providers, and have been shown to result in increased knowledge and favorable attitudes toward new practice strategies. However, for new learning to be applied in practice, these short-term training approaches need to be followed by high-quality practice-focused coaching by supervisors, consultants, or expert peers. Effective coaching incorporates observation of practice and the provision of objective practice-focused feedback over time to improve skills.6
Web-based training is seen as a cost-effective approach that can reach wide audiences, with self-paced delivery that is convenient, engaging, and with potential to be used across locations, and some research shows positive outcomes of technology-based approaches for service providers in mental health services.7 There are also benefits from the addition of components such as treatment manuals, workshops, consultation, review of practice recordings, supervisor training, booster sessions, and/or completion of case reviews.8,9
Supportive organizational structures and systems, management practices, and supervisor and peer support have also been found to increase the application of new learning in practice.10 Effective training to serve youth and young adults is also enhanced by the inclusion of young people’s voices to increase understanding of their situations, needs, and preferences.
Barriers to Training
There are also significant obstacles to the use of training best practices. First, the costs of providing high quality training that will lead to sustainable practice change can be high. Engagement in face-to-face training opportunities involves both travel costs and lost time from work, and organizations may have to balance staff training needs against the requirement for staff to provide billable services.11 Additional organizational barriers include resistance to change in situations of limited resources, and the absence of champions to promote the adoption of new approaches.12 Staff turnover within organizations also affects the quality of services, as staff members take on new roles, or leave and are replaced.13 The lack of a consistently supportive supervisor who fosters the implementation of new knowledge and skills and who is familiar with the new approach may also constrain improvements in practice.14
In a recent national transition training needs survey, most participants endorsed expense, heavy workload, shortage of travel funds, distance to training, and limited time off as barriers to receiving needed training. Nearly half of all participants also reported a lack of organizational support and some participants described inadequate access to technology for online training and a lack of supervisor support. Additionally, organizations may have policies that limit access to technological devices or channels and technology-based training programs may not be accessible on the devices that providers use most, including mobile phones.15 Providers may have difficulty adapting to training delivered through technology, or lack the time and motivation to complete self-paced, or self-directed online training programs.
New Approaches to Effective Training
One set of strategies for addressing barriers to the use of training best practices involves creatively combining training modalities and incorporating technology to reduce costs and facilitate training experiences aligned with principles of adult learning. For example, providing “live” trainings partially or fully via web conference eliminates the costs associated with travel for both trainees and trainers. With online delivery of content, training can be spread out over time and skills introduced sequentially, with time to practice and consolidate gains. Similarly, allowing trainees to “observe” real practice by accessing a library of video recordings online eliminates the costs related to bringing in experts. When trainees can access library material as needed, training can be self-paced and matched to individual needs. Additionally, audio or video recordings can be used as a basis for consultation, without the costs of experts shadowing trainees in the field.
Training for specialization in serving specific types of groups or meeting specific needs can be a best practice strategy by allowing service providers to achieve high levels of skill in using technology to provide one or two specific intervention approaches across a wide geographic area.16 Specialization for the role of trainer and practice consultant/coach can also be facilitated technologically to improve cost-effectiveness.
Another approach is based on the idea that many evidence-based interventions share core elements,2,17 and that providers can be trained in these elements (e.g., behavioral contracting, goal setting, guided imagery).18 Once trained, providers can then apply these elements flexibly to meet individual client needs. Another strategy involves creating and testing structured enhancements (e.g., for engagement or communication) to improve practice elements that are shared across interventions.18
As reported elsewhere in this edition of Focal Point, Pathways Research and Training Center has undertaken a national training needs study, Supporting You in Supporting Youth, in collaboration with Youth MOVE National, and implemented several competency-building approaches that incorporate strategies described here. Specifically, Achieve My Plan (AMP)18 increases providers’ competence in building youth strengths, promoting self-determination skills, and basing care on youth priorities via “remote” training and coaching. AMP+, also described elsewhere in this issue, is an adaptation of “original” AMP designed to enhance key competencies of young adult peer support providers. Technology-Enhanced Coaching (TEC) prepares supervisors to effectively coach their staff by providing reliable feedback based on video recordings of providers’ work. Finally, Promoting Positive Pathways to Adulthood (PPPA) is a 10-module online training program based on core transition competencies with an accompanying toolkit of team-based practice activities.
This review has provided support for training and workforce development strategies that build on principles of adult learning, take advantage of new technologies, and reinforce the application of new learning through on-the-job consultation and coaching. To prepare service providers to be able to improve outcomes for youth and young adults with mental health needs, creative uses of a variety of training methods are needed as well as ongoing studies to identify the most effective combinations of training and coaching approaches for service providers at different stages of professional development and with different learning styles. Pathways is committed to further work to understand and disseminate strategies to increase the potential for service providers to support young people to achieve their self-identified goals through developmentally appropriate and evidence-based practices.3
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- Walker, J., Jivanjee, P., Brennan, E.M., & Grover, L. (2018). Building competencies and skills among service providers working with young people who experience serious mental health conditions: State of the science. Retrieved from https://www.pathwaysrtc.pdx.edu/state-of-the-science-articles-2018-pttp
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Walker, J., Jivanjee, P., Brennan, E.M., & Grover, L. (2018). Building Service Provider Competencies and Skills for Working with Young People. Focal Point: Youth, Young Adults, and Mental Health, 32, 25-28. Portland, OR: Research and Training Center for Pathways to Positive Futures, Portland State University.