By: Venice Ceballos, Paige Menking, and Sarah Gonzalez Van Horne 1

Imagine an online community, built intentionally to share expert public health knowledge and community-level experience with community health workers. What if this community connected rural CHWs with teams of expert CHWs and medical specialists, who mentored and coached them on the best ways to meet the social and health needs of their patients? What if these communities of practice transformed care provision by providing quality, ongoing training that leveraged case-based learning to achieve better patient outcomes for vulnerable populations across the globe? The ECHO model™ (Extension for Community Health Outcomes), developed at the University of New Mexico (UNM), is an example of just such an on-line approach to CHW training and mentorship that is strengthening CHW capabilities and support.

As in any profession, CHWs are best at their jobs—improving health outcomes and access to services—when they receive ongoing training and support. CHWs’ unique qualities and scope of work call for relevant, tailored, and accessible training as well as ongoing mentorship that equips them to address social determinants of health. However, quality CHW training, especially in rural areas, is costly, requiring trained instructors, specialized curricula, and the allocation of travel time and expenses. In response, the ECHO model aims to address these obstacles by delivering ongoing CHW training and mentorship, maximizing resources by leveraging technology and creating virtual communities of practice.

In 2003 Dr. Sanjeev Arora, a gastroenterologist at UNM, developed the ECHO model to enhance the workforce capacity of community-based clinicians to treat Hepatitis C infection through ongoing telementoring and education. Care providers (“spokes”), often in rural or underserved communities, log onto weekly or monthly teleECHO™ sessions, connecting with their peers and a “hub team” of multidisciplinary specialists. TeleECHO sessions begin with a short skills-based presentation followed by the presentation of real patient cases and feedback/recommendations from the teleECHO community to best address the patients’ needs. The efficacy of the ECHO model is evident in its global scale; today, over 250 partners in 34 countries around the globe are using the model to increase providers’ skills and improve patient outcomes.

The use of case-based learning and long-distance mentorship are what define the ECHO model, and each approach is well suited to the frontline work of CHWs, improving their self-confidence as well as their mastery of patient-centered skills. Unlike other ECHO programs, ECHOs for CHWs often begin with an in-person training component, allowing for relationship building, the incorporation of adult learning principles, and the instruction of hands-on skills. Participants then attend a series of 10-16 teleECHO sessions, in which they connect to the hub team made up of experienced CHWs, nurses and/or behavioral health practitioners, and relevant subject matter experts. These virtual sessions go far beyond a traditional webinar, requiring participants to use their camera to encourage connection with other participants; incorporating games and other dynamic activities; and encouraging interactive presentations.

Since 2009, over 800 CHWs have attended ECHO programs in the U.S., and multiple replication pilots are underway in India. Training topics have included family obesity, diabetes, cancer screening and care, addiction support, mental health, and child abuse prevention. A recent study reported significant improvements in CHW self-confidence to support and drive their clients to improve meal choices and activity levels to tackle family obesity, as well as improvements in CHWs’ motivational interviewing skills related to addiction treatment support. Other studies showed improvements in CHWs’ self-confidence, attitudes and knowledge about diabetes care, both in the context of CHW-specific ECHO programs and team-based ECHO programs that include CHWs.

“The case presentations gave me the tools to deal with some of the same issues that my patients go through.” – CHW participant in the Opioid Addiction Treatment teleECHO program

The ECHO model has been applied internationally and across medical professions and is now being used for non-medical communities such as criminal justice, education, and crisis response. Application of the ECHO model for CHW programs requires careful consideration of existing training and curriculum resources, necessary cultural modifications, technology limitations, and staffing/funding. For more information about the ECHO model or to apply the model to your own training program, please visit our website or contact Paige Menking, Director of CHW Programs at the ECHO Institute™.

 

Author Affliations: 

1. Project ECHO, University of New Mexico Health Science Center