Lessons Learned In our discussions with organizations, nine common themes emerged:

1. Mentoring can be extremely effective, but is resource intensive 2. Mentoring needs to be tailored to explicit goals that all parties understand 3. There needs to be a plan in place for the inevitable problems 4. Inclusivity can be at odds with the goals of research engagement 5. The best mentor programs are two-way streets 6. Researchers need mentoring as much as patients do 7. Training is essential and more science training is needed 8. There is a need to further develop measures of success 9. PCORI has served as a tipping point in this field, and is well positioned to

support collaboration among like-minded organizations.

Almost all the organization note that when surveyed, participants cite peer mentoring (whether formal or informal) as the most helpful support offered by the organization. Mentor programs can be have simple goals and be very flexible, or they can be carefully orchestrated with prescribed meetings, reports, and evaluations. Mentoring can also be organized around expertise instead of people. One organization describes this kind of arrangement, where experienced participants with a passion for a particular topic offer that specific expertise to newcomers. Regardless of these specifics, ten of the organizations describe the one-on-one “hand-holding” to be essential to the success of their programs. “Nothing can replace an ongoing one on one connection-- no webinar, training, or chat room can build the trust that is needed.”

1. 1. Mentoring can be extremely effective, but is resource intensive

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But building that trust can be expensive. Eight organizations say dedicated staff is absolutely essential. One organization describes how being understaffed resulted in a dropout rate of 50%, and three organizations say they had to double their staff in order to make their programs successful. “These are relationships, and relationships are time consuming…. there are no real shortcuts,” said one. “Without a budget, don’t even bother,” commented another.

Only by “beginning at the end,” that is, designing a program around a very specific activity such as reviewing a proposal, understanding a conference, partnering with a researcher on a specific trial, will the program have the focus it needs for success. Four organizations describe launching a mentor program only to soon revisit it, hone the goals, and retool the program. Five organizations mention problems with inconsistent or vague goals for patient engagement, which in turn muddles the mentoring goals. Six organizations describe problems with ambiguity of roles hindering the success of their programs. Six organizations cite the need for a clear purpose in order to have a clear process. The purpose will shape the program. Some organizations engage patients in setting priorities and developing funding strategies, but consider the review of applications to be purely scientific, so their mentoring and training is not science-focused. Seven of organizations describe two or even three very different roles for patients, ranging from focus-group like input (“Tell us what you need”) to “patient scientist” (“As a colleague using the same criteria as the rest of us, what is your assessment of the research?”). These distinct roles need distinct training and support.

2. Mentoring needs to be tailored to explicit goals that all parties understand

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Four groups focus on participants disseminating knowledge, so they seek to connect with larger communities. At least three organizations specifically reject the notion of a “trained patient,” believing instead that the patient expertise is simply their lived experiences, and training encourages a “professionalization of advocacy.” Mentoring in this context has a very different flavor. At least six organizations describe the importance of preparing patients for roles “that actually exist.” As one interviewee explains “Mentoring to help someone feel more comfortable and confident, without a specific activity in mind, can backfire, creating frustrated advocates who feel abandoned.” Six organizations say expectations for all participants need to be explicit. How many meetings? How many phone calls? Is the commitment for six months, a year or more? Without these details laid out up front, misunderstandings arise. (“Are they calling me again because I did something wrong?” “Her mentor helped her with all her critiques while mine just glanced through my first one. What does that mean?”) Four organizations recommend that any mandatory aspects of the program (such as attending a meeting, participating in a conference, writing an action plan, mentor-mentee meeting in person, etc.) be put in writing and agreed to prior acceptance into the program. This way everyone is (literally) on the same page.

Almost every organization describes their participants as having a wide variety of needs-- often even larger and more varied than anticipated. Six organizations say it can be very difficult to know who will require the most support. For this reason, a program that is

3. There needs to be a plan in place for the inevitable problems

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too proscribed can backfire. “A mentor has to have discretion to handle what comes up-- this is not a cookie cutter job.” Four organizations point out that, while a majority of patients welcome a mentor and respond appreciatively to mentor feedback, not all do. “Needing” mentoring is very different from “wanting” mentoring, and three organizations explain that sometime the participant most in need is the one who wants it least. There is no such thing as involuntary mentoring, so programs need a plan in place for participants unable or unwilling to be mentored. Six organizations describe the challenge of working with patients with health problems; two always have a “back-up” reviewer/committee member in place in case health problems prohibit someone’s participation.

Perhaps surprisingly, eight organizations caution that the inclusive nature of grassroots organizing can be a distraction if the primary goal is to improve the usefulness of research. All of these organizations are committed to building community and expanding their reach, and go to great lengths to increase participation. But four of the organizations specifically mention that, over time, they have become much more selective and more strategic about who they bring into their program. Not everyone is suited for this role, and it is better to be exclusive that to have a dysfunctional program. Comments include “Don’t wait for them to come to you,” “Be careful about folks who self-nominate, that can be a red flag,” “Recommendations from a trustworthy source is key.” Three organizations mention the problem of “the one bad experience” creating distrust in the entire process. “Remember one troubled participant can set the whole program back.”

4. Inclusivity can be at odds with the goals of research engagement

21

Not inviting back reviewers (or other participants) can be awkward when an organization’s goal is to bring people in, not shut people out. Three organizations describe difficult situations of “saying no” to eager volunteers. The organizations with the longest running programs emphasize the need to be selective.

Most participants are eager help others, but the most successful programs are designed so mentors do more than “give back.” Benefits for mentors can come in many forms. Two organizations describe bringing experienced patients back to training programs that are normally available only to first-time students. Those experienced patients serve either as a formal mentor or as faculty, but either way, this is an “extra” opportunity to develop their own skills. Compensation is dependent on the culture of the organization and tasks assigned. Six organizations note that even with a small budget, a little support can go a long way. “We can’t do much but they really appreciate the little things, the parking and the meals.” According to four organizations, being “part on the inner circle” is an important benefit for mentors, so finding ways to incorporate them into other aspects of an organization’s work is important. The relationships among patients/mentors are another valuable benefit. One group describes participants who join for the cause and intellectual stimulation, then “stay for the camaraderie.”

Seven organizations say they initially focused almost exclusively on training and supporting patients only to realize that researchers are often less prepared to work with patients than the other way around. A few common themes emerged in terms of training researchers.

5. The best mentoring is a two-way street

6. Researchers need training as much-- or more-- than patients

22

Three organizations recommend focusing on the Chair of the panel/committee. A Chair who is both enthusiastic and understands the purpose of the participation (just one or the other is not adequate) will set the tone for everyone else. Five organizations recommend matching researchers experienced with patient engagement with a researcher with no experience, although only one organization currently has such as program. Providing scientists and patients opportunities to mentor each other can be very beneficial; three organizations describe researchers who began with a “see how inclusive I am?” attitude later describe the collaboration as “very useful to my research.” Two organizations formally mentor and train young scientists on how to engage community members in research collaborations, and both consider this to be an essential component of their program. Resources can serve as a carrot to encourage peer mentoring between scientists and patients. Two organizations describe the value of a dedicated funding stream for collaborative meetings, educational programs and joint presentations.

The few groups that provide (or have provided) in-person training say it is absolutely essential to the success of their program, and the participants are very grateful for the opportunity. Almost all the groups with distance training agree that in-person training is ideal, though often cost-prohibitive. The content of the training is, of course, specific to the organization’s mission, but organizations note a few common themes. The most common theme is the need to for participants to shift from a “me” to “we” mentality so their contributions can reflect the needs of the community rather than their own personal situation. One group specifically

7. Training is essential and there is a particular a need for science training

23

avoids the term “advocate,” which for them implies a personal agenda; they use the more collaborative “advisor.” Nine of the groups specifically require that a participant represent a community group or at least be active in community organizations to ensure that the participant can do much more than “speak for themselves.” Another theme is evidence-based medicine. Almost all the groups that provide training cite the need for more extensive and more interactive science training. Six organizations that do not have formal science training say that developing such a program is a priority for their group. Hitting the right “level” for training can be difficult; motivated adult learners without background in science, and who have likely not been in a classroom for decades, have special educational needs. Four organizations offer patient-tracks or patient orientation as part of a large scientific conference. This model is spreading; two organizations have plans to do something similar.

All the organizations interviewed are cognizant of the need to evaluate the impact of patient engagement in research, although some note that the traditional peer review process is not grounded on any compelling evidence. Some organizations have clear and measurable outcomes, and a system in place to document progress. Current metrics include quality of life, lab work, use of available resources, timeliness of information, number of patient/research scientific collaborations, number of trials with patient-centered endpoints, quality of written reviews, number of research related activities undertaken by participants, completion of individualized action plans, and satisfaction of participants. Secondary goals include building membership, promoting community, and reorienting researchers to do a better job explain how their research aligns with organizational goals.

8. There is a need to further develop measures of success

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Still, nine organizations describe program evaluation as “challenging.” Three organizations express interest in collaborating with other organizations to develop more robust metrics.

An unanticipated finding is that PCORI’s substantial investment in patient-centered comparative effectiveness research appears to have served as a tipping point for patient/researcher collaboration. There were no interview questions about PCORI or PCORI’s role, but as part of the interviews we offered to answer questions about PCORI’s program. In those conversations, six organizations describe PCORI’s funding clout, and its insistence on patient engagement in research and in peer review, as having a profound impact on health research. Four organizations believe the establishment of PCORI has been a kind of tipping point for researchers’ acceptance of patient engagement. For most of these research communities, the question is no longer “whether” but “how” to collaborate. Five organizations request additional opportunities to collaborate with PCORI -- and each other-- on the issue of mentoring and training patients engaged in research.

9. PCORI has served as a tipping point in this field, and is well positioned to support collaboration among like-minded organizations.

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Chapter Three: Mentoring in the Literature

A. Overview Mentoring—in various forms and in many disciplines—is an essential tool to empower newcomers to gain and use new skills. This chapter examines mentoring in three fields-- health, education and youth-- to gain insights for PCORI’s mentor program. We conducted an abbreviated review of the literatures in each of these fields. The terms "peer mentor program," “health,” “research” and “professional” were used in Google Scholar and Pub Med. The discussion below reflects this research. The exploration revealed a few common themes-- and lessons learned—that are relevant to PCORI’s work in this area. First and perhaps most important, the research has demonstrated that mentoring can be very effective, efficient and sustainable1 2 but with this important caveat: ineffective mentoring can actually be worse than no mentoring at all.3 Organizations with a mentoring program have to balance effectiveness with efficiency. Effective mentoring programs can be extremely resource intensive and the quality of mentoring can always be improved. This begs the question, what is “enough” mentoring? What the most efficient approach to creating an effective program? These questions must be answered to ensure a mentoring program can be sustained over time.

1 Mentoring Phases and Outcomes, Chao, Georgia T., Journal of Vocational Behavior, 51, (1997). 2 How Effective Are Mentoring Program for Youth? A Systematic Assessment of the Evidence, DuBois, David L., Portillo, Nelson, Rhodes, Jean E., Silverthorn, Naida, and Valentine, Jeffrey C., Psychological Science in the Public Interest, 12(2), (2011). 3 Mentoring Relationships and Programs for Youth, Rhodes, Jean E., DuBois, David L., Current Directions in Psychological Science, 17(4), (2008).

“Mentoring can be effective, efficient and sustainable, but with this important caveat: ineffective mentoring can actually be worse than no mentoring at all.”

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So what works? What does an effective mentoring program have that an ineffective one does not? There is a growing consensus that effectiveness requires the following components.4 5 6 7 8

4 Best Practices in Workplace Formal Mentoring Programs, Finkelstein, Lisa M., Poteet, Mark L. in The Blackwell Handbook of Mentoring, (Wiley-Blackwell, 2010). 5 Contemporary Issues in Mentoring, Grossman, Jean B., A Publication of Public/Private Ventures, (1998). 6 Impact Evaluation of the U.S. Department of Education’s Student Mentoring Program, Bernstein, L., et.al., U.S. Department of Education, (2009). 7 Lessons from Research on Teacher Mentoring: Review of the Literature; Mutchler, Sue E,; Mentoring Beginning Teachers, Lessons from the Experience in Texas; November, 2000. 8 Larson, E. L., Cohen, B., Gebbie, K., Clock, S., & Saiman, L. (2011). Interdisciplinary research training in a school of nursing. Nursing Outlook,59(1), 29–36. doi:10.1016/j.outlook.2010.11.002

Mentoring Best Practices 1. The organization officially sanctions and supports mentoring

relationships by providing some level of structure, guidelines, policies and assistance for starting, maintaining and ending mentoring relationships.

2. Mentors are selected and based on a combination of experience, knowledge, skills and motivation. These skills include technical knowledge, empathy, ability to model desired work styles and behaviors, confidence, patience, good listening and good questioning skills, and a high level of motivation to mentor. A nomination process ensures the pool of candidates is appropriate.

3. Mentees are matched with mentors to whom they can relate, and are given some choice about whether or not to be mentored.

4. Mentors receive training on coaching and feedback skills, conflict resolution, role modeling, negotiation skills and motivation techniques.

5. Mentors and mentees have shared agreements about their work, such as a contract, written goals or action plan.

6. Mentors and mentees meet regularly over a sustained period of time. A year is often deemed the minimum time period unless the goals of the mentoring program are more time limited.

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B. Definition of mentoring Generally, mentoring is a process in which a more experienced person encourages learning and reflection within a less experienced person. In an organizational context, mentoring is typically done by more seasoned members of an organization to less experienced employees to increase the likelihood that they become successful members of the organization. Mentoring relationships are usually focused on the growth and accomplishment of an individual. Informal mentoring is common but only with “formal” mentoring--when an organization sanctions mentoring and clearly defines the role of the both mentor and the mentee9-- can any impact be assessed. Even with formal mentoring, evaluation is difficult because there can be tremendous variability in how mentoring is implemented. It is also a challenge to control for the other factors that affect the performance and behavior of the mentee. 10

C. Types of mentoring Despite these slippery definitions, mentoring happens in a myriad of ways that reflect important differences in the mentoring goals, process and outcomes.

9 Id. 10 Id.

What do mentors do?

ü Teach the mentee about a specific issue

ü Coach the mentee on a particular skill ü Facilitate the mentee’s growth by

sharing resources and networks ü Challenge the mentee to move beyond

his or her comfort zone ü Create a safe learning environment

for taking risks ü Focus on the mentee’s total

development

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Professional and Master Mentors Professional health coaches mentor by providing healthcare information and support. Peer mentors --individuals currently facing the health problem-- coach each other. Master mentors or coaches have previously faced the challenge and have demonstrated that they are capable of successfully coping with the situation.11 Peer Mentoring Peer mentoring is especially relevant in the growing movement to involve patients in health research. Matched peer mentor pairs are often drawn from the patient population, with the mentor having more experience engaging with and evaluating health research. A slight variation on these categories is referred to as “Near-Peer Teaching,” which refers to slightly senior students or professionals mentoring junior students or professionals.12 Although peer mentoring has gained popularity in recently years, there has been little research done to determine its effectiveness. One recent review found that peer review mentor programs benefit not only the mentee but also the mentor, who enhance their own self-esteem and improve their academic performance as a result of their involvement in these programs.13 Cascading Mentoring Sometimes mentoring can flow through a chain of learners. One mentor program was designed to transfer knowledge and skills from faculty to medical students to undergraduate students and finally to high school students.14

11 A Randomized Controlled Pilot Study Testing Three Types of Health Coaches for Obesity Treatment: Professional, Peer, and Mentor, Leahey, Tricia M., and Rena R. Win,. “Obesity (Silver Spring, Md.) 21.5 (2013): 10.1002/oby.20271. PMC. Web. 13 Apr. 2015. 12 Mentoring programs for physicians in academic medicine: a systematic review, Kashiwagi DT, Varkey P, Cook DA., Acad Med. 2013 Jul;88(7):1029-37. doi: 10.1097/ACM.0b013e318294f368. Review. 13 A Win-Win Peer Mentoring and Tutoring Program: A Collaborative Model, Dennison, S., Journal of Primary Prevention, 20, (2002). 14 A novel enrichment program using cascading mentorship to increase diversity in the healthcare professions, Afghani B1, Santos R, Angulo M, Muratori W., Acad Med. 2013 Sep;88(9).

Although peer mentoring has gained popularity in recently years, there has

been little research done to determine its effectiveness.

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Group Mentoring Mentoring can be a traditional one-on-one relationship, but it does not have to be. One interdisciplinary research program, which by definition incorporates a broad range of expertise, provides a three-person mentor team to their students.15 Online Mentoring A few studies examine the effectiveness of online mentoring, although none directly compare in-person mentoring to online mentoring.16 One program matched mentors via an online algorithm, which they deemed was effective for large-scale mentoring programs.17 Speed Mentoring Successive, structured and timed mentor mini-meetings are being used as a fun and efficient way to mentor. In one study of healthcare academics, 60 mentees were matched with 60 mentors. Each mentee met with 6 mentors for 10 minutes for each dyad. All participants reported finding the process to be very helpful and pleasant.18 Almost Mentoring There are some innovative training and support in the field that are not described as mentoring per se, but they are designed to promote sharing of expertise in a supportive environment so in this broad sense they, too, are mentors programs. In real-time peer review, for example, researchers present work and receive feedback at the same

15 Facilitated peer mentorship: a pilot program for academic advancement of female medical faculty., Files JA1, Blair JE, Mayer AP, Ko MG., J Womens Health (Larchmt). 2008 Jul-Aug;17(6):1009-15. 16 Development and Implementation of a Peer Mentoring Program for Early Career Gerontological Faculty, Bryant, A. L., Aizer Brody, A., Perez, A., Shillam, C., Journal of Nursing Scholarship. E. O. (2015) 17 Near-Peer Teaching in Paramedic Education: Results from 2011 to 2013, Brett Williams, Kate Hardy, Lisa McKenna, Medical Science Educator, 2015, 1-8. 18 The Value of Speed Mentoring in a Pediatric Academic Organization, Academic Pediatrics, Volume 14, Issue 4, July–August 2014, Pages 335-340 Janet R. Serwint, Melissa M. Cellini, Nancy D. Spector, Maryellen E. Gusic

Mentoring can be a traditional one-on-one relationship, but it

does not have to be.

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conference. This model has been shown to increase the amount of peer-reviewed professional journal literature generated from that conference.19

Cross Discipline Mentoring The emerging field of interdisciplinary research can provide some insights into how to combine diverse expertise effectively-- and more specifically, how to mentor and train participants for such collaboration. In an article discussing Columbia University’s interdisciplinary research mentoring program, the authors explain:

...the goal of interdisciplinary research is to apply various approaches and methodologies to solving intractable problems that have not been amenable to resolution by any single discipline… research suggests that an interdisciplinary culture must be well-planned and executed to maximize the potential for success...Disparate values, knowledge bases, and approaches to inquiry can hinder research collaboration.20

These same words could easily be applied to patient/researcher collaborations. Patient-centered research cannot be accomplished by a single discipline; disparate values, knowledge and approaches are the key challenges to blending patient advocate expertise with health research expertise.

D. Mentoring in health, education and youth Intentional mentoring is becoming more common in a wide range of disciplines. Just why do organizations create formal mentoring programs? They cite a wide range of reasons: to facilitate recruitment, improve retention, reduce turnover costs, enhance

19 Real-Time Peer Review: An Innovative Feature to an Evidence-Based Practice Conference, Eldredge, Jonathan D., Holly E. Phillips, and Philip J. Kroth, Medical reference services quarterly 32.4 (2013): 10.1080/02763869.2013.837690. PMC. Web. 13 Apr. 2015. 20 Development of a student-mentored research program between a complementary and alternative medicine university and a traditional, research-intensive university, Sullivan BM1, Furner SE, Cramer GD., Acad Med. 2014 Sep;89(9).

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professional development, improve productivity, and elevate knowledge transfer. 21 Other goals include linking employees and volunteers with valuable information, relying on employees (instead of outside consultants) as internal experts for professional development, and supporting the creation of a multicultural workforce by creating relationships among diverse employees.22 Health Fields Mentoring programs are commonly used to support career development in health care professions, and in terms of career development, they tend to be successful.23 24 Indicators of success include publication in peer-reviewed journals, promotions and self-reported satisfaction with the program. A subset of studies focuses specifically on women, who appear to benefit even more than men from professional mentoring.25 Achieving diversity in the workforce and supporting nontraditional students is also a focus of some mentoring programs,26 though at least one study suggests that a positive, proactive and inclusive approach is more effective than targeting students considered to be “at risk.”27 Mentoring programs are also very common in medical and other health professional schools. Indicators of success include acceptance by professional schools, self-reported knowledge, skills, and attitudes such as the ability to write career goals and align activities with those goals.28 21 What Benefit Does a Company Gain with Mentoring Programs?, Travis, Eryn, Chron, (2012). 22 Organizational Benefits of Mentoring, Wilson, James A., Elman, Nancy S., Academy of Management Perspectives, 4(4), (1990). 23 Development and Implementation of a Peer Mentoring Program for Early Career Gerontological Faculty, Bryant, A. L., Aizer Brody, A., Perez, A., Shillam, C., Journal of Nursing Scholarship. E. O. (2015) 24 A Facilitated Peer Mentoring Program for Junior Faculty to Promote Professional Development and Peer Networking., Fleming GM, Simmons JH, Xu M, Gesell SB, Brown RF, Cutrer WB, Gigante J, Cooper WO. Acad Med. 2015 Mar 31. 25 Facilitated peer mentorship: a pilot program for academic advancement of female medical faculty., Files JA1, Blair JE, Mayer AP, Ko MG., J Womens Health (Larchmt), 2008 Jul-Aug;17(6):1009-15 26 A conceptual model for faculty development in academic medicine: the underrepresented minority faculty experience, Daley SP1, Broyles SL, Rivera LM, Brennan JJ, Lu ER, Reznik V., J Natl Med Assoc,. 2011 Sep-Oct;103(9-10):816-21. 27 Developmental student support in undergraduate medical education: AMEE Guide No. 92, John Sandars, Rakesh Patel, Helen Steele, and Martin McAreavey, December 2014, Vol. 36, No. 12, Pages 1015-1026 28 Id.

Mentoring programs are commonly used to support

career development in health care professions, and in terms

of career development, they tend to be successful.

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Patient mentoring is often incorporated into health care as a way of tapping into the expertise of those who “have been there.” HIV positive parents are matched with others in the same condition,29 veterans who have overcome mental health problems work with veterans still suffering from mental illness,30 new parents facing serious health problems for their newborns are matched with parents who have recently had a similar experience,31 and obese patients struggling to lose weight are coached by people who have succeeded doing just that.32 In each case, measurable improvements in outcomes such as continued breastfeeding, reduction of depression and anxiety, and weight loss were reported. Public School Teachers Primary and secondary public schools have embraced mentoring as a key strategy for improving the quality of education. More than half the states in the country now require mentoring programs for entry-level teachers.33 School districts have also begun to provide mentoring to veteran teachers who have new assignments. These programs have become progressively more structured, more formal and with deep support structures within schools at the level of superintendents, principals, veteran teachers and new teachers. Mentoring in K-12 public education is used in three ways. First, it is used as a recruiting tool, offering potential candidates additional built-in support to succeed. Second, it is used to improve teacher retention rates, which are deteriorating. In 2009, 9% of

29 Rotheram-Borus, MJ; Richter, LM; Van Heerden, A; Van Rooyen, H; Tomlinson, M; Harwood, JM; et al.(2014). A cluster randomized controlled trial evaluating the efficacy of peer mentors to support South African women living with HIV and their infants. PLoS ONE, 9(1). doi: 10.1371/journal.pone.0084867. UCLA: 415801. 30 Rotheram-Borus, MJ; Richter, LM; Van Heerden, A; Van Rooyen, H; Tomlinson, M; Harwood, JM; et al.(2014). A cluster randomized controlled trial evaluating the efficacy of peer mentors to support South African women living with HIV and their infants. PLoS ONE, 9(1). doi: 10.1371/journal.pone.0084867. UCLA: 415801. 31 NICU parent-to-parent partnerships: a comprehensive approach, Levick J, Quinn M, Vennema C., Neonatal Netw. 2014 Mar-Apr;33(2):66-73. 32 A Randomized Controlled Pilot Study Testing Three Types of Health Coaches for Obesity Treatment: Professional, Peer, and Mentor, Leahey, Tricia M., and Rena R. Win,. “Obesity (Silver Spring, Md.) 21.5 (2013): 10.1002/oby.20271. PMC. Web. 13 Apr. 2015 33 Creating a Teacher Mentoring Program; a Report of the National Foundation for the Improvement of Education (Fall, 1999).

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teachers left the profession after a year and by 2014 that number had risen to 20%.34 An additional 11% of teachers leave the first school in which they worked after a year to take a new job in a place where teachers are better supported. This rate of turnover has a devastating effect on student learning. and mentor programs are designed to counter this trend. And third, mentoring is used to improve the skills and knowledge of teachers, and in this, there has been some success. One study of mentoring has shown a 50% reduction in teachers who needed remedial intervention. The efficacy of mentoring is linked to the amount of time the mentor and mentee spend together. In another study 88% of teachers report an improvement in their instructional skills when they are mentored at least once a week.35

Research of public school teacher mentoring programs indicate that careful identification of what the new teachers need from their mentors is essential to success, along with assessing, evaluating and documenting of the program. 36 Selecting, training and supporting mentors is also key to program effectiveness. In addition, everyone who has a stake in the outcome of the mentoring program needs to be

fully involved in its planning and implementation. 37 Youth Development When done well, youth mentoring holds great promise in helping young people succeed in life. Studies of both well-established and newer programs that provide youth with formal one-to-one mentoring relationships show a reduction of delinquency, substance

34 On the Path to Equity: Improving the Effectiveness of Beginning Teachers, A Report of the Alliance for Excellent Education, (July, 2014). 35 Preparing Teachers and Developing School Leaders for the 21st Century. Schleicher, Andreas, (OECD Publishing, 2012). 36 Id. 37 Establishing High Quality Professional Development, A report of the National Foundation for the Improvement of Education (1998).

Research of public school teacher mentoring

programs indicate that careful identification of what the new teachers

need from their mentors is essential to success.

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use and academic failure. Other positive outcomes include improved self-esteem, social skills and knowledge of career opportunities. In all settings, caring, capable, and committed adults invested in the lives of young people are the most important ingredients to reducing levels of problem/risk behaviors (e.g., substance use or bullying).38 In one study the presence of mentors was found to be the most important asset for positive youth development that exists in communities.39 While not discounting the importance of natural mentoring relationships, mentoring that occurs within the context of youth development programs may be particularly beneficial.40 For instance, effective, high-quality and enduring mentoring is associated with the capacity for youth to engage in high-quality social relationships, to have greater academic achievement, school engagement, school adjustment, and to view their futures more positively.41

38 Mentoring, a Key Resource for Promoting Positive Youth Development, Lerner, Richard M., Brittain, Aerika S., Fay, Kristen E., A research in Action Report of MENTOR, (2006). 39 Observed Ecological Assets in Families, Schools, and neighborhoods, Theokas, C., Lerner, R.M., Applied Developmental Science 10(2), (2006); and Mentoring College Students: What Makes Mentoring Relationships Work, Larson, R.W. This Wek in Mentoring Research (October, 2010). 40 Effectiveness of Mentoring Programs for Youth: A Meta-Analytic Review’ Dubois, David L., Holloway, Bruce E., Valentine, Jeffrey C., Cooper, Harris, American Journal of Community Psychiatry 30(2), (April, 2002). 41 A Model for the Influence of Mentoring Relationships on Youth Development, Rhodes, Jean E., Spencer, Renee, Keller, Thomas E., Liang, Belle, Noam, Gil, Journal of Community Psychology 34(6), (2006).

Effective, high-quality and enduring mentoring is

associated with the capacity for youth to engage in high-quality social relationships,

to have greater academic achievement, school engagement, school

adjustment, and to view their futures more positively.

35

E. Lessons Learned At its core, mentoring is a relationship, and relationships thrive on trust and respect. “Chemistry,” often cited as key to a successful mentorship, is difficult to replicate. But mentoring is not magic and it does not have to be mysterious. In the field of youth mentoring, to be considered high-quality a mentor program needs to accomplish its objective in ways that are not only effective (i.e., relationships are established that are high in quality and that yield positive impacts), but also safe (i.e., no youth are inadvertently harmed), efficient (i.e., resources are used in a cost-effective manner), and sustainable/growth-oriented (i.e., the program is able to continue to operate over an extended period of time and serve increasing numbers of youth). These are the basic components of any high quality mentor program, in any field. Effectiveness To be effective, mentors need training on coaching and feedback skills, conflict resolution, role modeling, negotiation skills and motivation techniques. These may seem like “common sense” skills but research is clear that investment in training is directly correlated with program success. 42 Mentors and mentees should meet regularly (typically once a week) over a sustained period of time. In one study of 669 mentors who were involved either in one-on-one community-based or school-based programs, those mentors who indicated they had attended fewer than two hours of pre-match orientation or training reported the lowest levels of closeness and supportiveness in their relationships with their mentees, whereas those mentors reporting the strongest relationships had attended six or more hours of orientation or training prior to the match. These associations were evident for mentors in both types of programs.43

42 Mentorship Behaviors and Mentor Quality Associated with Mentor Success, Allen, T.D., Lentz, E., Day, R., Journal of Career Development, 91(3), (May, 2006). 43 Mentoring in Schools: An Impact Study of Big Brothers Big Sisters School-Based Mentoring, Herrera, Carla, Grossman, Jean B., Kauh, Tina J. McMaken, Jennifer, Child Development, 82(1), (February, 2011).

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A year is often deemed the minimum time, unless the goals of the mentoring program are more time limited. Shared plans and agreements about work and goals are also key to an effective program; when both mentors and mentors know what they are trying to achieve it dramatically increases the chances of achieving it. Efficiency To be efficient, mentors need to be selected carefully, based on a combination of experience, knowledge, skills and motivation. The mentor needs technical knowledge, empathy, ability to model desired work styles and behaviors, confidence, patience, good listening and good questioning skills, and a high level of motivation to mentor. A nomination process ensures the pool of candidates is appropriate. Without these policies in place, programs run the risk of wasting enormous remedying mistakes. Sustainability One way to increase sustainability of a program is to ensure mentoring is a two-way street.44 45 In addition to the satisfaction in sharing expertise with others, mentors can develop professional skills and feel their own career re-energized. Another key ingredient to sustainability is strong organizational support. Without being officially sanctioned and supported with structure, guidelines and policies a mentoring program will likely be too flimsy to withstand inevitable bumps in the road. Risk of Harm Mentoring does not always produce the desired results. In a meta-analysis of 55 different evaluations of youth mentoring programs), about 10 percent show average effects in a negative direction (i.e., youth who received mentoring were worse off), one-third yielded effects that were close to zero (i.e., neither positive nor negative), and the

44 The Columbia nursing school interdisciplinary mentor program provides interdisciplinary mentoring to pre- and post-doctoral health sciences students researching antimicrobial resistance, note that their Research Mentors “drop out” of the Center unless there are clear benefits to them in terms of expanding or enhancing their own work. 45 A novel enrichment program using cascading mentorship to increase diversity in the healthcare professions, Afghani B1, Santos R, Angulo M, Muratori W., Acad Med. 2013 Sep;88(9). It was designed to give high school students a glimpse of life in medical school, but also to enhance the teaching and leadership skills of underrepresented undergraduate and medical students

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remainder exhibited positive impacts that ranged in size from small to large.46 Findings further indicate that the typical youth received only modest benefits from participating in a mentoring program (average Cohen’s d effect size of .18, which would be considered small). Outside of youth mentoring the notion of harm may seem irrelevant, but disappointed expectations can be deflating in any field. Mentees engage expecting benefits. They want feedback related to their performance and an opportunity to network with an influential person. In the education and health care professions, mentees want to develop a sharper focus on what is needed to grow professionally within the organization, and learn specific skills about an organization’s culture and unspoken rules that can be critical for success. In the case of youth, mentees want to develop skills and gain insights that will help them lead better lives. An ineffective mentor program is not only a lost opportunity but also a source of great frustration, because the potential benefits for a motivated mentee with a strong learning orientation are enormous.

46 DuBois Op Cit.