Inspiring Transformation in Clinical Practice Through the ECHO Educational Model

Abstract: Background:
Interdisciplinary education is a core responsibility of Consultation Liaison Psychiatrists. Education of perinatal clinicians such as obstetric and primary care providers is important in decreasing the perinatal mental health treatment gap (Cox, 2016). Project ECHO is an interdisciplinary educational program that uses videoconferenced didactics and case discussions to connect specialty experts with community-based clinicians (Arora, 2011). We present data from Mom’s Access Project ECHO, the first perinatal mental health ECHO in the United States.



Methods:

Each year, MAP ECHO enrolls a cohort of healthcare providers for 10 monthly sessions focused on perinatal mental health. We analyzed data from the first three cohorts (2019-2022). Quantitative data included participant number, type, county, attendance, satisfaction ratings, and patient volume and insurance. Qualitative data included responses from satisfaction and end surveys. We will use thematic content analysis to summarize themes arising in the free text responses of the surveys.



Results:

For the first three years of MAP ECHO sessions, we engaged 184 providers from 18 of 39 counties in Washington State, collectively serving approximately 5,906 perinatal patients monthly. In our current cohort, 65% of participants’ patients are Medicaid-insured. Participants reported high satisfaction rates ( >90%) and a marked increase in their confidence to diagnose and treat perinatal mental health disorders with 85% reporting applying knowledge gained. We will present results from the qualitative analysis of surveys.

Discussion:

MAP ECHO has been successful in terms of provider engagement, satisfaction rates, self-reported increases in knowledge and confidence, and participant reports of using knowledge gained. This is consistent with results of ECHO teaching series across medical specialties (Zhou, 2016). Project ECHO’s use of videoconferencing allows community practitioners from distant and underserved communities to access specialty-level consultation and learning. Consistent with this model, MAP ECHO engaged participant cohorts from across the state who treated large numbers of perinatal patients, most Medicaid-insured. This is crucially important given demonstrated perinatal mental health disparities (Declercq, 2022).

Conclusions:

Project ECHO is an effective educational model to increase provider knowledge and confidence and has the potential to transform community practice of perinatal mental health care.



References:
1. Cox EQ, Sowa NA, Meltzer-Brody SE, Gaynes BN. The perinatal depression treatment cascade: baby steps toward improving outcomes. J Clin Psychiatry 2016; 77:1189-1200.
2. Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364(23):2199-2207.
3. Zhou C, Crawford A, Serhal E, Kurdyak P, Sockalingam S. The impact of project ECHO on participant and patient outcomes: A systematic review. Acad Med. 2016;91(10):1439-1461.
4. Declercq E, Feinberg E, Belanoff C. Racial inequities in the course of treating perinatal mental health challenges: results from listening to mothers in California. Birth 2022; 49:132-140.