Using the Project ECHO Model to Increase Pediatric Primary Care Provider Confidence to Independently Treat Adolescent Depression

Overview

Journal Acad Psychiatry

Publisher Springer

Specialty Psychiatry

Date 2023 Jun 6

PMID 37280470

Authors

Courtney Cinko

Andrea Thrasher

Ciscily Sawyer

Kathy Kramer

Sara West

Emily Harris

Affiliations

Soon will be listed here.

Abstract

Objective: The model for the Extension for Community Healthcare Outcomes (Project ECHO®) was used to extend specialist support to the pediatric medical home for the treatment of adolescent depression by taking a comprehensive, disease-specific approach.

Methods: Child and adolescent psychiatrists constructed a course to train community pediatric primary care providers (PCPs) to screen patients for depression, initiate evidence-based interventions, and provide ongoing management. Participants were assessed for changes in clinical knowledge and self-efficacy. Secondary measures included self-reported practice change and emergency department (ED) mental health referrals 12 months pre- and post-course completion.

Results: Sixteen out of 18 participants in cohort 1 and 21 out of 23 participants in cohort 2 completed the pre- and post-assessments. Clinical knowledge and self-efficacy showed statistically significant improvement pre- and post-course completion. ED mental health referrals from participant PCPs decreased by 34% (cohort 1) and 17% (cohort 2) after course completion.

Conclusions: These findings indicate that utilizing the Project ECHO format to provide subspecialist support and education on the treatment of depression can improve pediatric PCPs' clinical knowledge and confidence in their ability to independently treat depression. Secondary measures suggest that this can translate into practice change and improved treatment access with decreased ED referrals for mental health assessments by participant PCPs. Future directions include more robust outcomes measurement and developing more courses with an in-depth approach to a single or similar cluster of mental health diagnoses such as anxiety disorders.

Citing Articles

The Influence of Project ECHO and Integrated Behavioral Health in Primary Care on Emergency Department Visits Among Youth Diagnosed with Depression.

McClure J, Mara C, Stark L, Anderson J, Young M, Aggarwal A J Behav Health Serv Res. 2025; .

PMID: 39789399 DOI: 10.1007/s11414-024-09928-w.

References

Kessler R, Berglund P, Demler O, Jin R, Merikangas K, Walters E . Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6):593-602. DOI: 10.1001/archpsyc.62.6.593. View

Mojtabai R, Olfson M, Han B . National Trends in the Prevalence and Treatment of Depression in Adolescents and Young Adults. Pediatrics. 2016; 138(6). PMC: 5127071. DOI: 10.1542/peds.2016-1878. View

Kataoka S, Zhang L, Wells K . Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. Am J Psychiatry. 2002; 159(9):1548-55. DOI: 10.1176/appi.ajp.159.9.1548. View

Racine N, McArthur B, Cooke J, Eirich R, Zhu J, Madigan S . Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatr. 2021; 175(11):1142-1150. PMC: 8353576. DOI: 10.1001/jamapediatrics.2021.2482. View

Mannan M, Mamun A, Doi S, Clavarino A . Prospective Associations between Depression and Obesity for Adolescent Males and Females- A Systematic Review and Meta-Analysis of Longitudinal Studies. PLoS One. 2016; 11(6):e0157240. PMC: 4902254. DOI: 10.1371/journal.pone.0157240. View

Knol M, Twisk J, Beekman A, Heine R, Snoek F, Pouwer F . Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia. 2006; 49(5):837-45. DOI: 10.1007/s00125-006-0159-x. View

Glied S, Pine D . Consequences and correlates of adolescent depression. Arch Pediatr Adolesc Med. 2002; 156(10):1009-14. DOI: 10.1001/archpedi.156.10.1009. View

Vujeva H, Furman W . Depressive symptoms and romantic relationship qualities from adolescence through emerging adulthood: a longitudinal examination of influences. J Clin Child Adolesc Psychol. 2011; 40(1):123-35. PMC: 3021789. DOI: 10.1080/15374416.2011.533414. View

Naicker K, Galambos N, Zeng Y, Senthilselvan A, Colman I . Social, demographic, and health outcomes in the 10 years following adolescent depression. J Adolesc Health. 2013; 52(5):533-8. DOI: 10.1016/j.jadohealth.2012.12.016. View

10.

McBain R, Kofner A, Stein B, Cantor J, Vogt W, Yu H . Growth and Distribution of Child Psychiatrists in the United States: 2007-2016. Pediatrics. 2019; 144(6). PMC: 6889947. DOI: 10.1542/peds.2019-1576. View

11.

Rushton J, Bruckman D, Kelleher K . Primary care referral of children with psychosocial problems. Arch Pediatr Adolesc Med. 2002; 156(6):592-8. DOI: 10.1001/archpedi.156.6.592. View

12.

Costello E, Edelbrock C, Costello A, Dulcan M, Burns B, Brent D . Psychopathology in pediatric primary care: the new hidden morbidity. Pediatrics. 1988; 82(3 Pt 2):415-24. View

13.

Heneghan A, Garner A, Storfer-Isser A, Kortepeter K, Stein R, Horwitz S . Pediatricians' role in providing mental health care for children and adolescents: do pediatricians and child and adolescent psychiatrists agree?. J Dev Behav Pediatr. 2008; 29(4):262-9. DOI: 10.1097/DBP.0b013e31817dbd97. View

14.

Arora S, Geppert C, Kalishman S, Dion D, Pullara F, Bjeletich B . Academic health center management of chronic diseases through knowledge networks: Project ECHO. Acad Med. 2007; 82(2):154-60. PMC: 3855463. DOI: 10.1097/ACM.0b013e31802d8f68. View

15.

Cheung A, Zuckerbrot R, Jensen P, Laraque D, Stein R . Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management. Pediatrics. 2018; 141(3). DOI: 10.1542/peds.2017-4082. View

16.

Hostutler C, Valleru J, Maciejewski H, Hess A, Gleeson S, Ramtekkar U . Improving Pediatrician's Behavioral Health Competencies Through the Project ECHO Teleconsultation Model. Clin Pediatr (Phila). 2020; 59(12):1049-1057. DOI: 10.1177/0009922820927018. View

17.

Sohl K, Rynkiewicz A, Nanclares-Nogues V, Curran A, Scorah J, Steiman M . Project Extension for Community Health Outcomes (ECHO) Autism: A Successful Model to Increase Capacity in Community-Based Care. Brain Sci. 2022; 12(3). PMC: 8946611. DOI: 10.3390/brainsci12030327. View