Using ECHO to connect professionals from the bush to the beach
Perrin Moss, Dana Newcomb and Phil Nixon, Australia, February, 2020
The Australian healthcare landscape continues to evolve as patients’ and families’ needs change over time – and with them, the delivery of clinical support. Patients, families and clinicians often report a growing need for governments and the broader community to improve the mental health of children and young people, and to provide more responsive services that are easier to access in local communities. Mental and behavioural health needs also rank as top priorities in government health spending.
Connecting with other providers is an important part of improving service delivery, particularly for those in rural and remote contexts where there may be a lack of services and supervision. The benefits for patients and families in rural and remote areas include:
- avoiding unnecessary travel and receiving care closer to home
- reduced time away from work and study
- improved quality of care, supported by specialist advice; and
- improved coordination of care.
For providers in rural and remote areas, the benefits of connecting regularly with peers include:
- access to supervision and mentoring, by peers and specialists
- co-management of cases
- improved coordination of care; and
- reduced professional isolation.
Integrating care using the ECHO model
Children’s Health Queensland Hospital and Health Service (CHQ) has implemented Project ECHO as a key enabler of its Integrated Care Strategy, to improve the health outcomes of children and young people from the front lines of community care across Australia.
ECHO is an interactive model of collaborative learning through case discussions. In ECHO, professionals from rural or under-served areas gain access to a panel of specialists through regular videoconferencing sessions. At every session, participants present de-identified cases for group discussion and gain advice from specialty experts, as well as other peers in the network. The group of varied professionals forms a community of practice, which serves as a sustainable mechanism for ongoing knowledge sharing and mentorship.
The origins of ECHO
The ECHO model was initially introduced in New Mexico, USA. The model has since spread rapidly across the globe after a study published in the New England Journal of Medicine demonstrated that adult patients with hepatitis C had equivalent health outcomes when treated by ECHO-trained primary care doctors, compared to hospital specialists (Arora et al. 2011).
ECHO is a proven model shown to improve the capacity of diverse frontline professionals in a range of topics in healthcare, education and other human service sectors. The model has been applied and studied in a range of health conditions internationally (Zhou et al. 2016). The ECHO Institute indicates that health conditions that are well-suited to ECHO:
- are common
- are complex
- require evolving treatments
- carry a high societal impact
- have serious outcomes if left untreated; and
- show improved outcomes with ongoing management.
ECHO networks that are used to support professionals working in behavioural and mental health tick all of the above boxes. There are currently 100 behavioural and mental health ECHO networks operating in eight countries worldwide. Increasingly, ECHO networks are also supporting professionals in the education sector, as well as strengthening quality improvement initiatives such as patient safety and care transitions.
The Children’s Queensland ECHO story
The ECHO model was first implemented in Queensland in 2017 to address the clinically unacceptable wait times for children with attention-deficit/hyperactivity disorder (ADHD) to access care. Legislation in the state of Queensland allows GPs to prescribe stimulants; however, historically they have not done so due to various barriers, including lack of training (Shaw et al. 2002). The ADHD ECHO network supports GPs and other primary care providers to deliver holistic and family-centred care closer to home.
Kids and Teens Mental Health and Behaviour ECHO Network
Following positive feedback from the ADHD ECHO network, a weekly Kids and Teens Mental Health and Behaviour ECHO network was launched to support providers across Australia in effective mental health and behavior management in children and young people. The initiative aims to increase collaboration between sectors, by bringing together GPs, nursing and allied health professionals, guidance officers and other education professionals, and human service professionals. The panel consists of a Developmental Paediatrician, Child and Adolescent Psychiatrist, Psychologist, and Social Worker.
The Network has discussed and provided recommendations for the support of children and young people presenting with the following concerns:
- suicide and self-harm behaviours
- school refusal
- mood disorders
- substance misuse.
ECHO outcomes and evaluation
An ongoing evaluation process has been utilised to assess:
- participant numbers
- key learnings from each session
- content and accessibility of the program; and
- pre/post self-efficacy.
To date, more than 500 participants from 20 different professions have participated in at least one of seven CHQ ECHO networks. Participants have been primarily based in Queensland but are also located interstate and in New Zealand.
Feedback from participants continues to be positive:
“Participating in ECHO is like having a friendly weekly check-in with an expert panel to round out your complex consultations. The value to my patients in providing a well-rounded opinion to them, after presenting their child’s complex presentation to the ECHO panel, is amazing. It has opened up my mind to the possibilities of multidisciplinary case conferences where I previously thought them an impossible dream for general practice.”
Panel members have also reported unanticipated benefits of participating in an ECHO network, such as an increased appreciation of different contexts and the capabilities of frontline generalists in caring for patients and families with complex needs.
Where to from here?
There is growing interest in the ECHO model in Australia, with several new hubs launching ECHO networks in 2020. CHQ is now an ECHO Superhub, which can train other organisations to replicate the model. As a Superhub, CHQ can also support robust evaluation approaches across these new launches. This will further demonstrate the value ECHO provides to the health and human services system, including impact on patient outcomes.
For further information or to register for CHQ’s child and youth-focused ECHOs, please visit the CHQ ECHO website.
Arora, S., Thornton, K., Murata, G., Deming, P., Kalishman, S., Dion, D., … Qualls, C. (2010). Outcomes of treatment for Hepatitis C virus infection by primary care providers. New England Journal of Medicine 364(23), 2199-2206.
Shaw, K., Wagner, I., Eastwood, H., & Mitchell, G. (2003). A qualitative study of Australian GPs’ attitudes and practices in the diagnosis and management of attention-deficit/hyperactivity disorder (ADHD). Family Practice 20(2), 129-134.
Zhou, Z., Crawford, A., Serhal, E., Kurdyak, P., & Sockalingam, S . (2016). The impact of Project ECHO on participant and patient outcomes: A systematic review. Academic Medicine 91(10), 1439-1461.