P3.R341: Evaluation of a Pediatric Behavioral Health Primary Care ECHO Program; An Opportunity to Increase Primary Care Provider Confidence in the Management of Behavioral Health Conditions

Background: The rate of pediatric and adolescent mental health disorders remains at an epidemic rate, yet there are barriers to accessing services with behavioral health providers, including a limited specialty workforce. Thus, many children with behavioral health conditions are managed by their primary care provider (PCP). However, there is variability in PCP comfort and competence in managing behavioral health disorders. Experts from several national medical organizations (including the American Academy of Pediatrics) have called for innovative strategies to improve access to mental health care in primary care. Use of a telementoring behavioral health education program through Project Extension for Community Health Outcomes (ECHO) could improve PCPs’ confidence in managing common behavioral health disorders and improve patient access to mental health care in the medical home.

Methods: This study was approved by the institution’s IRB. A 12-session (July 2023 – January 2024) pediatric primary care behavioral health ECHO Program was offered to PCPs at 20 offices and 2 school-based health centers within a tertiary care children’s hospital network. Session topics included ADHD, Anxiety, Depression, Autism, Behavior Management, School Difficulties, and Medication Management. Each session included a didactic lecture presented by content experts on best practices for assessing and treating a condition and case-based discussions. Participants completed post-session surveys at the end of each ECHO session and post-program surveys at the end of the 12-topic series. These REDCap surveys asked 5-point Likert scale questions (1-strongly disagree, 3-neutral, 5-strongly agree) about the effectiveness of the teaching sessions and change in provider knowledge and confidence on each topic. A comparative analysis was performed on provider responses to pre- and post- session and program survey questions.

Results: Ninety-nine providers registered for the ECHO program with 38-68 providers attending each session. Seventy post session evaluation surveys were completed and 67% of participants reported improved knowledge of the behavioral health topic. Additionally, participants reported the didactic session (96%) and the case-based discussion (89%) increased their confidence in managing behavioral health disorders in primary. 100% of the participants indicated they are likely to use what they learned in their work. Ninety-nine providers received post program surveys with a 23% completion rate. Review of survey responses indicates a possible trend towards increased confidence (agree/strongly agree) in the following: ability to diagnosis behavioral health conditions, provide education to families, prescribe medication (stimulants, nonstimulants, and SSRIs) for treatment of ADHD, anxiety, and depression, manage polypharmacy, and effectively manage medications in children with co-occurring ADHD and autism.

Conclusion: Education received through Behavioral Health ECHO programs may improve PCP confidence and competence treating children and adolescents with behavioral health disorders. This telementoring intervention is a feasible strategy to address the increasing gap between patients needing behavioral health care and availability of specialty providers.