Brief distress tolerance interventions aimed at improving ability to tolerate psychological discomfort are being used trans-diagnostically, by both clinicians and paraprofessionals. Such brief interventions, delivered by a range of professionals could help to bridge the current worldwide gap between demand for and availability of mental health support. Despite a good theoretical rationale for the effectiveness of distress tolerance skills, empirical evidence for stand-alone interventions is lacking. This report details an evaluation of a 6- to 8-week distress tolerance intervention delivered in a community mental health setting by clinicians and paraprofessionals, using routinely collected outcome data. The aim was to better understand data completion, the proportion of responders and any pre-intervention differences between responders and non-responders. Pre-intervention routine outcome measures were found to be reasonably complete, with good post-intervention follow-up. Distress tolerance specific measures were less complete. Where it was possible to calculate reliable change (n=163), 58.3% of clients were classified as responders to the distress tolerance intervention which is comparable to CBT outcomes, and response rate is improving over time. There was no evidence that clients were more or less likely to respond depending on their age, presenting problem, mood scores pre-intervention, referrer discipline or the role of the person delivering the intervention. Responders were found to have significantly poorer ability to tolerate distress pre-intervention compared with non-responders. Men were disproportionately likely to be non-responders which may indicate a need for improved access.

Key learning aims

1. (1) To increase practitioners’ understanding of distress intolerance as a factor that may sustain difficulties and serve as a valuable focus for intervention.

2. (2) To demonstrate the potential effectiveness of a brief psychological approach delivered by clinicians and paraprofessionals targeting distress tolerance in achieving meaningful, reliable change.

3. (3) To illustrate how services might identify which clients benefit most from a distress tolerance intervention to inform referral decisions and enhance client outcomes.

The autonomous position of legal professionals is no longer self-evident. Professionals are under increased pressure to reform. This phenomenon is not only true for legal professionals. A broader trend – which is recognised for the medical profession, academic profession and alike – is that paraprofessionals are gaining a more prominent position. In this paper, we focus on the developments in the Dutch public justice system. We conduct a case-study on the role of paraprofessionals in courts and in the public prosecution service – two understudied legal institutions in this regard. By drawing on empirical data unfolding the working routine of the judiciary and the prosecution service, we find two paradigms that define the thinking about professionalism: a traditional ‘pure professional’ paradigm and a new, more hybrid paradigm that includes (policy-based) managerial thinking. The latter appears to be enhanced by a New Public Management (NPM) approach within these institutions. Although we observe resistance among (para)professionals towards professional changes and ambiguity in the relationships between professionals and paraprofessionals, we also observe that managerialism has changed the work processes and the division of labour between professionals and paraprofessionals.

In this article, I summarise the primary content included in a keynote address I delivered via videoconferencing in July 2012 at the national conference of the Australian Association of Special Education, held jointly with the annual conference of the Tasmanian Principals Association in Hobart, Tasmania. The address focused on three major topics pertaining to the utilisation of teacher assistants in inclusive schools: (a) persistent and emerging research trends, (b) contemporary conceptual and data-based concerns, and (c) ideas about what schools can do to provide improved educational opportunities and supports for students with special educational needs in inclusive classrooms. The article concludes that the potential overuse or misuse of teacher assistants is a symptom, not cause. Building integrated models of general and special service delivery in schools can address the challenges associated with questionable teacher assistant utilisation.