The ECHO Effect

By Jessica Rosencrans on May 16, 2024 October 29, 2024

Rural North Dakota is home to dedicated healthcare professionals who provide exceptional healthcare services. However, given the very nature of rural communities, accessing resources and support systems can be a challenge for providers living in rural areas.

Recognizing this disparity within rural healthcare, Project ECHO (Extension for Community Healthcare Outcomes) strives to share the wealth of information and resources with rural North Dakota healthcare providers.

The idea for Project ECHO originally began at the University of New Mexico's School of Medicine in 2003. The goal of the program was to increase access to knowledge in rural and underserved areas by connecting providers to support systems and subject matter experts virtually.

Project ECHO became a part of the UND School of Medicine & Health Sciences (SMHS) Center for Rural Health (CRH) in 2017.

All Teach, All Learn

While there are several Project ECHO hubs around the U.S., and around the world, the Project ECHO program located at CRH focuses on reaching providers within North Dakota and the surrounding areas. This allows ECHO sessions to address unique needs and challenges healthcare professionals face in the state.

We heavily encourage participation during the sessions and having a back and forth in terms of questions and answers. That's the best way to learn from one another.

Nicole Crouch*, project coordinator with Project ECHO, explained the program's philosophy. "The main idea is: 'all teach, all learn,'" Crouch said. "We heavily encourage participation during the sessions and having a back and forth in terms of questions and answers. That's the best way to learn from one another."

Each ECHO session is different, with different topics, speakers, and learning strategies showcased within the program. However, the foundational aspects of Project ECHO stay consistent: free access to virtual presentations.

"The most participation we get is generally from hospitals, nursing homes, rehab facilities, and other similar organizations throughout North Dakota. Our goal is to connect providers across the state to help them provide the highest level of care and to have access to resources outside of their immediate community," said Crouch.

Although most series are designed for professionals to attend, anybody can sign up for an ECHO that interests them. The diversity of Project ECHO stems from the ability of outside stakeholders to commission ECHO events on topics they've identified as important.

"If there's an external audience that has the desire to run an ECHO, they can approach us about hosting an ECHO on their topic," said Rebecca Quinn, associate director at CRH.

Life-Long Learning

Currently, the North Dakota Health and Human Services Health Equity Office is hosting an ECHO series on Behavioral Health in Primary Care. As part of the series, a three-part session was held on lesbian, gay, bisexual, transgender, queer (LGBTQ+) populations and suicide prevention. Faye Seidler, who has been providing education on LGBTQ+ populations and suicide prevention for 10 years, presented at these ECHO events.

"I got into this work because I personally experienced the many ways kids can fall through the cracks," Seidler said. "I'm a survivor of suicide, and I've dedicated my life to doing everything I can to making sure people have hope."

The conversation to have Seidler host a series began when she reached out to Quinn to thank Project ECHO for their work with rural health and community engagement.

"A lot of my work is networking with professionals, uplifting them, and asking how I can help," Seidler said. "As it turned out, I was asked to provide professional development training to the Project ECHO series. There was an identified interest in improving comfort around LGBTQ+ topics, as well as outcomes."

Seidler's presentation created a lot of buzz for those who participated.

"Faye is the premier resource within North Dakota related to LGBTQ+ populations and suicide prevention," said Crouch. "People really enjoyed her presentation. It's a very important topic, especially within a healthcare setting, and the information was very well-received."

Seidler emphasized the importance of what she shares.

If you don't know your patient is LGBTQ+, you won't know they have an increased likelihood of suicide, substance use, or adverse childhood experiences.

"What we don't measure, doesn't get addressed. I think a lot of providers don't see LGBTQ+ identity as being something to worry about within healthcare. However, if you don't know your patient is LGBTQ+, you won't know they have an increased likelihood of suicide, substance use, or adverse childhood experiences."

As Seidler put it, her presentation "doesn't teach providers a completely new system of medicine." Admitting that most physicians don't need one hundred hours of exposure to be competent with the LGBTQ+ population, Seidler adds that most docs "just need a short training to realize all their current tools are adequate, it isn't that difficult to incorporate LGBTQ+ inclusion within daily work, and a person doesn't need to be an expert on the topic to provide great care to patients."

Living in North Dakota is also a strength Seidler uses to connect with her audience.

"People especially appreciate that I'm also a North Dakotan. I live here and understand our culture. I spend my time not shaming them to be better, but instead telling people to be kinder to themselves because we all do our best."

Impacts 'ECHOing' out

What makes Project ECHO unique is its plethora of benefits, for both audiences and presenters. The format of the program ensures that everyone involved takes away something from the experience.

"We try to focus on different aspects of the topic for each session, so you learn something new each time you attend," Crouch said. "We don't want it to be repetitive or redundant from month to month. Participants also fill out evaluations during the sessions to give them an opportunity to give feedback on what sort of topics they might be interested in hearing about in the future. So, we take those into consideration as well."

These evaluations provide valuable feedback to presenters, to help them hone their skills and finely tune their presentations.

"I liked the evaluation process and the many meaningful questions asked of the participants following the completion of the training," Seidler shared. "So often there is not much measurement for the effectiveness of any given presentation, but the evaluation for the ECHO series also judged metrics of improvement on the topic, ascertained if the learning goals were actually met, and what commitment to improving services each participant would declare."

Participants of ECHO sessions also have the option to gain continuing medical education credits for attending the events. ECHO coordinators at CRH are cognizant of the busy schedules with which many healthcare professionals work. Keeping that in mind, ECHO events always take place virtually from noon to 1:00 pm Central, giving working professionals an opportunity to get credit for learning applicable information over their lunch break.

Currently, Project ECHO at the UND SMHS is hosting virtual learning networks around the topics Behavioral Health in Primary Care, Geriatric Care, and Pediatric Mental Health. The Pediatric Mental Health and Geriatric Care topics are ongoing, with no set end date for these series and clinics held at least monthly.

Previous topics covered by Project ECHO include Stroke Rehabilitation, Opioid Use, Oral Health in Primary Care, COVID-19 in Nursing Homes, and Diabetes Care, among others.

Project ECHO is founded on the idea of actions echoing out into greater impacts. Not knowing where such reverberations will lead is one of the reasons Seidler encourages everyone to consider participating in Project ECHO, regardless of the role they may play.

Any opportunity for training, especially from subject matter experts, is very valuable. What I love about the principle of ECHO is how holistic the vision is.

"I think any opportunity for training, especially from subject matter experts, is very valuable. What I love about the principle of ECHO is how holistic the vision is," she said. "Philosophically, we have this idea of the butterfly effect, that small changes thousands of years ago could lead to a different world today. What we sometimes fail to account for is that what we do today also affects the course of our future. Our impact echoes out in profound ways we can never really fully measure."

*Nicole Crouch left the Center for Rural Health in late October 2024.

Jessica Rosencrans is the communication specialist with the Center for Rural Health at the University of North Dakota School of Medicine & Health Sciences in Grand Forks.

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