Health Care Problem: An estimated 20% of U.S. youth have a mental illness, with higher rates among the publicly insured and minorities. American Indian youth face profound health disparities, such as suicide (the second leading cause of death in 2019 among American Indians aged 10-24), diabetes, substance abuse, teen pregnancy, and obesity.
Mental health and emotional well-being among Native people are closely tied to cultural traditions. In addition, many American Indians lack adequate health insurance and may only have access to the Indian Health Services. These programs and services are typically located in rural and hard-to-staff regions.
The problem is that healthcare providers caring for American Indian youth (1) have limited access to continued learning and sharing best practices, (2) need to understand the limitations of Western psychological approaches in Tribal communities, and (3) do not know how to conduct a Tribal screening and assessment, nor do they understand the concept of screening and assessment as a sacred trust.
Educational Strategy: The program's goal is to share best practices and develop culturally adapted approaches for the prevention and treatment of addiction and mental illness, as well as cultural competencies for providing behavioral health services to Native youth. Educational Strategy: The ECHO model is based on an “all teach, all learn” principle. Led by expert faculty, ECHO participants engage in a virtual community with their peers where they share support, guidance, and feedback.
The Child & Adolescent Mental Health ECHO program was initially piloted with six sessions in June and August 2021, each lasting 90 minutes. Subsequently, in January 2022, we launched the full program, consisting of a General Clinicians/Primary Care Track and a School Mental Health Track. The faculty for this program includes a diverse planning team encompassing physicians, counselors, social workers, PAs, pharmacists, psychologists, and nurses, from different tribal affiliations.
Each session consists of a didactic lecture, a case presentation, and a discussion. Providers are encouraged to submit their own cases via email and work with the Course Director to develop a case vignette. During an ECHO session, a provider presents a real-world patient case. Faculty begin the case discussion by asking learners to share their clarifying questions about the case. Learners are invited to share and discuss their thoughts, strategies for care, and management/treatment options. Expert faculty conclude the session with best practices and additional recommendations, and the moderator summarizes the recommendations discussed for the case.
Patient-Level Outcome(s) Measured: 237 healthcare providers registered for the pilot series, with 116 attending at least one session. The project enabled a broad reach, connecting rural California regions and beyond. The virtual format allowed connections between the 59 California attendees to professionals in other states. Data from the full ongoing series is forthcoming.
At the end of the Pilot, 60 respondents participated in the survey and were asked to respond on a 5-point Likert scale (1=Not well, 5=Extremely Well) This activity achieved the learning objectives of (with all scoring 100% “4 or more”):
In response to: “What changes do you intend to implement in your practice resulting from your participation in this CE activity?”, participants provided open answers such as:
- Closer attention to microaggressions and culturally sensitive interventions. - Continued reminder about humility and how to engage in diversity. - Be more aware of the mental health needs and challenges of our Native American youth and respond appropriately, i.e., identifying a native mentor. - Identify stereotypes and biases in their clinics
As a result of the Child & Mental Health ECHO initiative, providers are making changes in practice, including implementing traditional beliefs and practices into their approach. They need to be remedied to create a culturally sensitive environment.
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.jpg "Laura E. Corbett, n/a photo")