ECHO Program Research Articles

Caring for the Caregivers: Improving Mental Health among Health Professionals Using the Behavioral Health Professional Workforce Resilience ECHO Program.

Behavioral health professionals are at high risk for burnout and poor mental health. Our objective was to understand the impact of the Behavioral Health Providers Workforce Resiliency (BHPWR) ECHO Program on the resilience and burnout of participating behavioral health professionals. We assessed the first two years (March 2022 to March 2024) of the BHPWR ECHO, a national program operating from the University of New Mexico (N = 1585 attendees), using a mixed-methods design. We used a retrospective pre/post survey (n = 53 respondents) and focus interviews with 1-3 participants (n = 9 participants) to assess for changes in knowledge and confidence and assess changes in burnout and resilience. We found that participants increased their knowledge of how to respond when (1) their workload was more than they could manage, (2) they felt that they lacked control, (3) their work did not feel rewarding, and (4) they were experiencing compassion fatigue. They increased their confidence in (1) building a support system and (2) using the wellness tools taught in the course. Respondents were less burnt out (score: 26.0 versus 17.8, p < 0.01) and more resilient (29.9 versus 34.9, p < 0.01) compared to when they started attending the program. Tele-mentoring programs like the BHPWR ECHO Program may improve wellness among health care professionals.

Do area- and individual-level sociodemographic characteristics modify the association of air pollution with incident asthma in the ECHO program?

Do area- and individual-level sociodemographic characteristics modify the association of air pollution with incident asthma in the ECHO program?

Assessing the effectiveness and feasibility of the Experienced Carers Helping Others program in relatives of adolescents with eating disorders using an online application format with individual sessions.

Eating disorders (ED) usually involve hospital admission and a high relapse rate, with the return home being a critical moment for patients and their families. After their return home, they often have trouble incorporating the guidelines they have learned into their daily context. ECHOMANTRA intervention program aims to facilitate this transition by offering psychological strategies that involve both patients and their families and carers. Specifically, the ECHO program is aimed at the relatives of these patients. The present study aimed to analyze the efficacy of adding the ECHO program to the usual treatment (TAU) of relatives through a novel format based on individual intervention and with an online format and to examine the acceptability and feasibility of this new format. The study design was multi-center, randomized, controlled, with a longitudinal design and comparing two parallel groups. A total of 108 family members participated. Results indicated that relatives from both groups, TAU and ECHO + TAU, showed improvements in expressed emotion, accommodation, impact of the ED, emotional well-being, and caregiver skills. However, effect sizes in the ECHO + TAU group were slightly larger than the TAU group. In addition, the changes were greater in depression and caregiver skills when the ECHO component was added. Most caregivers (81.48%) completed the ECHO and indicated a high level of satisfaction with the program. These results suggest the efficacy and the feasibility of adding the ECHO intervention program to the usual treatment in an individual online format.

Describing Multidomain Health Outcomes in Autistic Children in the ECHO Program

Describing Multidomain Health Outcomes in Autistic Children in the ECHO Program

Clinical Outcomes of Rural Patients with Diabetes Treated by ECHO-Trained Providers Versus an Academic Medical Center.

Despite clinical practice guidelines prioritizing cardiorenal risk reduction, national trends in diabetes outcomes, particularly in rural communities, do not mirror the benefits seen in clinical trials with emerging therapeutics and technologies. Project ECHO supports implementation of guidelines in under-resourced areas through virtual communities of practice, sharing of best practices, and case-based learning. We hypothesized that diabetes outcomes of patients treated by ECHO-trained primary care providers (PCPs) would be similar to those of patients treated by specialists at an academic medical center. Specialists from the University of New Mexico (UNM) launched a weekly diabetes ECHO program to mentor dyads consisting of a PCP and community health worker at ten rural clinics. We compared cardiorenal risk factor changes in patients with diabetes treated by ECHO-trained dyads to patients treated by specialists at the UNM Diabetes Comprehensive Care Center (DCCC). Eligible participants included adults with type 1 diabetes, type 2 diabetes on insulin, or diabetes of either type with A1c > 9%. The primary outcome was change from baseline in A1c in the ECHO and DCCC cohorts. Secondary outcomes included changes in body mass index (BMI), blood pressure, cholesterol, and urine albumin to creatinine ratio (UACR). Compared to the DCCC cohort (n = 151), patients in the ECHO cohort (n = 856) experienced greater A1c reduction (-1.2% vs -0.6%; p = 0.02 for difference in difference). BMI decreased in the Endo ECHO cohort and increased in the DCCC cohort (-0.2 vs. +1.3 kg/m2; p = 0.003 for difference in difference). Diastolic blood pressure declined in the Endo ECHO cohort only. Improvements of similar magnitude were observed in low-density lipoprotein cholesterol in both groups. UACR remained stable in both groups. ECHO may be a suitable intervention for improving diabetes outcomes in rural, under-resourced communities with limited access to a specialist.

Development and Validation of a Novel Placental DNA Methylation Biomarker of Maternal Smoking during Pregnancy in the ECHO Program.

Maternal cigarette smoking during pregnancy (MSDP) is associated with numerous adverse health outcomes in infants and children with potential lifelong consequences. Negative effects of MSDP on placental DNA methylation (DNAm), placental structure, and function are well established. Our aim was to develop biomarkers of MSDP using DNAm measured in placentas (), collected as part of the Vitamin C to Decrease the Effects of Smoking in Pregnancy on Infant Lung Function double-blind, placebo-controlled randomized clinical trial conducted between 2012 and 2016. We also aimed to develop a digital polymerase chain reaction (PCR) assay for the top ranking cytosine-guanine dinucleotide (CpG) so that large numbers of samples can be screened for exposure at low cost. We compared the ability of four machine learning methods [logistic least absolute shrinkage and selection operator (LASSO) regression, logistic elastic net regression, random forest, and gradient boosting machine] to classify MSDP based on placental DNAm signatures. We developed separate models using the complete EPIC array dataset and on the subset of probes also found on the 450K array so that models exist for both platforms. For comparison, we developed a model using CpGs previously associated with MSDP in placenta. For each final model, we used model coefficients and normalized beta values to calculate placental smoking index (PSI) scores for each sample. Final models were validated in two external datasets: the Extremely Low Gestational Age Newborn observational study, ; and the Rhode Island Children's Health Study, . Logistic LASSO regression demonstrated the highest performance in cross-validation testing with the lowest number of input CpGs. Accuracy was greatest in external datasets when using models developed for the same platform. PSI scores in smokers only () were moderately correlated with maternal plasma cotinine levels. One CpG (cg27402634), with the largest coefficient in two models, was measured accurately by digital PCR compared with measurement by EPIC array (). To our knowledge, we have developed the first placental DNAm-based biomarkers of MSDP with broad utility to studies of prenatal disease origins. https://doi.org/10.1289/EHP13838.

Anxiety and CHD8; TBR1 protein; NIH ECHO program

Anxiety and CHD8; TBR1 protein; NIH ECHO program

Project ECHO in Psychiatric Workforce Development: the Example of a Perinatal Mental Health ECHO.

Perinatal mental health and substance use disorders (PMHSUD) often go unrecognized and untreated. This study examined the use of the Project ECHO model to teach obstetric, primary care, and mental health clinicians about screening, diagnosis, and treatment of PMHSUD. Participants in 3years of the University of Washington's Moms' Access Project (MAP) ECHO program (2019-2022) completed pre- and post-program surveys. Nine participants in year 1 completed qualitative interviews. Dedoose was used for qualitative analysis of interviews. Of 136 participants, 62.5% (15/24) completed both pre- and post-surveys in year 1, 56% (28/50) in year 2, and 32.2% (20/62) in year 3. Most respondents agreed or strongly agreed that they were glad to have participated (96.8%; 60/62) and that they had used information learned in the program in treating a patient (95.1%; 58/61). In all years, respondents endorsed increased confidence regarding learning objectives of the program. Qualitative interviews following year 1 yielded themes of hierarchy of competence, motivation versus results of participation, connection, and politics of change: position and practice type. Findings supported the feasibility, acceptability, and self-reported effectiveness of the ECHO model for workforce development in PMHSUD.

Neurobehavioral effects of gestational exposure to mixtures of non-persistent endocrine disruptors in preschoolers of the ECHO Program

Neurobehavioral effects of gestational exposure to mixtures of non-persistent endocrine disruptors in preschoolers of the ECHO Program

Key conditions for the successful implementation of evidence-based practice in concurrent disorder nursing care with the ECHO® model: Insights from a mixed-methods study

BackgroundPeople with concurrent mental health and substance use disorders have complex biopsychosocial problems but risk not having their healthcare needs met. Nurses are positioned to meet these needs but often lack training in concurrent disorder management. Extension for Community Healthcare Outcomes (ECHO®, University of New Mexico Health Sciences Center, 2003) is a promising technology-enabled collaborative learning model used to implement evidence-based practice and build capacity among healthcare professionals in managing complex, chronic, health conditions. ObjectiveTo understand how an ECHO program for concurrent disorder management impacts nurses’ competency development and clinical practice and uncover key conditions for successful uptake and implementation. DesignA convergent mixed-methods design comprising a quantitative, uncontrolled before-and-after study and a qualitative study using interpretive description methodology. Setting and participantsAn ECHO program for concurrent disorder management was implemented in 2018 at a quaternary academic hospital centre in metropolitan Western Canada. All 65 nurses who registered in the program between 2018 and 2020 were invited to participate in the study. MethodsOnline surveys completed by the participating nurses (N = 28) were administered at baseline and six and 12 months following entry-to-program to measure changes in nurse-related outcomes. The survey data were analyzed using descriptive statistics and repeated measures analysis. Semi-structured interviews were conducted with a nurse subgroup (n = 10) to explore how they developed and implemented competencies and what factors influenced this process. Interview transcripts were analyzed using inductive thematic analysis. Using the Pillar Integration Process, we analyzed results from both methods to provide a richer understanding of the phenomena. ResultsWe identified six interrelated key conditions for successful uptake and implementation of evidence-based practice in concurrent disorder nursing care with ECHO: (1) Practice and validation opportunities; (2) Reciprocal and trusting relationships in an interprofessional education context; (3) Peer-to-peer experience sharing; (4) Collaboration with experts; (5) Reinforcement of positive attitudes towards one's professional role; and (6) Organizational support. ConclusionsOutcome measures, perspectives, and experiences collected over 12 months indicated that ECHO contributed to nurses’ competency development and, under some conditions, to effective nursing practice changes. Given the challenges in implementing clinical guidelines in concurrent disorder nursing care, our results highlight the importance of understanding the key conditions for successful uptake and implementation. This informs approaches to optimally adapt implementation strategies to the needs and specificities of nurses to obtain impactful and sustainable results.

1029-P: Building Diabetes Care Capacity in Rural Underserved Communities—A Comparison of Cardiorenal Risk Factor Outcomes in Patients Treated by ECHO-Trained Providers vs. an Academic Medical Center

Background: National trends in diabetes outcomes, particularly in rural communities, do not mirror the significant benefits seen in clinical trials with emerging therapeutics and technologies. This disconnect is partly attributable to therapeutic inertia around uptake of clinical practice guidelines that have prioritized cardiorenal risk reduction. Project ECHO is a workforce development program that supports implementation of guidelines in under-resourced areas through virtual communities of practice and case-based learning. We hypothesized that the care of patients with diabetes treated by rural ECHO-trained providers would be non-inferior to those treated by specialists at an academic medical center (AMC). Methods: A multidisciplinary team from a minority-majority state-funded AMC launched a weekly 2-hour diabetes ECHO program to mentor care dyads consisting of a primary care provider and community health worker at 10 rural primary care clinics. We compared cardiorenal risk factor changes in patients with diabetes treated by ECHO-trained dyads to patients treated by specialists at the AMC. Multiple regression models were adjusted for age, sex, baseline A1c and BMI, baseline risk factor outcome, and interactions with site. All model assumptions were satisfied. Results: The mean follow-up duration was 21 months in the ECHO cohort and 18 months in the AMC cohort. Compared to the AMC cohort (n=151), patients in the ECHO cohort (n=856) experienced a greater A1c reduction (-1.4% vs -0.3%; P=0.017) and were more likely to achieve an A1c&amp;lt;8% (20.1% vs. 0.3% increase in those achieving A1c&amp;lt;8%; P&amp;lt;0.001). Changes from baseline in BP, LDL, and urine microalbumin were similar between groups (P&amp;gt;0.05). Conclusions: ECHO may be a suitable intervention for improving diabetes and cardiorenal risk factor outcomes in rural, under-resourced communities where access to a specialist is limited. Disclosure M.F.Bouchonville: None. E.B.Erhardt: None. Y.L.Leyva: None. L.Myaskovsky: None. M.L.Unruh: None. S.Arora: None.

Leveraging tele-mentoring and remote learning to strengthen the emergency care capacity of health workers in Uganda

A robust emergency care system is a cost-effective method of reducing preventable death and disability, especially in low-and middle-income countries. To scale emergency care expertise across the country, the Uganda Ministry of Health and Seed Global Health established the Emergency Medical Services (EMS) ECHO program. We describe the process of establishing the program in a resource-limited setting, best practices, and lessons learned in Uganda. Investigators conducted a mixed-methods evaluation to assess the initial 4 months' implementation of the EMS ECHO. We conducted pre/post-program assessments of healthcare worker knowledge, self-efficacy, and professional's satisfaction with the program. The analysis compared the differences between pre/post-test scores descriptively. The EMS ECHO was initiated in November 2021. A phased curriculum was developed with the initial phase focusing on the ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) approach to the emergency patient. This phase reached 2,030 health workers cumulatively across 200 health facilities. The majority of the participants were medical doctors (n=751, 37%), and nurses (n=568, 28%). Majority of participants (95%) rated the sessions as informative. On whether the ECHO sessions diminished professional isolation, 66% agreed or strongly agreed. Similar to other ECHO program evaluation results, Uganda's EMS ECHO program improved knowledge, skills, and the development of a virtual community of practice thereby diminishing professional isolation. It also demonstrates that through a planned stepwise process, virtual learning and telementorship can be used efficiently to improve healthcare worker knowledge,skills and multiply the limited number of emergency care experts available in the country.

The Associations of Maternal Health Characteristics, Newborn Metabolite Concentrations, and Child Body Mass Index among US Children in the ECHO Program.

We aimed first to assess associations between maternal health characteristics and newborn metabolite concentrations and second to assess associations between metabolites associated with maternal health characteristics and child body mass index (BMI). This study included 3492 infants enrolled in three birth cohorts with linked newborn screening metabolic data. Maternal health characteristics were ascertained from questionnaires, birth certificates, and medical records. Child BMI was ascertained from medical records and study visits. We used multivariate analysis of variance, followed by multivariable linear/proportional odds regression, to determine maternal health characteristic-newborn metabolite associations. Significant associations were found in discovery and replication cohorts of higher pre-pregnancy BMI with increased C0 and higher maternal age at delivery with increased C2 (C0: discovery: aβ 0.05 [95% CI 0.03, 0.07]; replication: aβ 0.04 [95% CI 0.006, 0.06]; C2: discovery: aβ 0.04 [95% CI 0.003, 0.08]; replication: aβ 0.04 [95% CI 0.02, 0.07]). Social Vulnerability Index, insurance, and residence were also associated with metabolite concentrations in a discovery cohort. Associations between metabolites associated with maternal health characteristics and child BMI were modified from 1-3 years (interaction: p < 0.05). These findings may provide insights on potential biologic pathways through which maternal health characteristics may impact fetal metabolic programming and child growth patterns.

Perinatal Outcomes during versus Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program.

We sought to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on perinatal outcomes while accounting for maternal depression or perceived stress and to describe COVID-specific stressors, including changes in prenatal care, across specific time periods of the pandemic. Data of dyads from 41 cohorts from the National Institutes of Health Environmental influences on Child Health Outcomes Program (N = 2,983) were used to compare birth outcomes before and during the pandemic (n = 2,355), and a partially overlapping sample (n = 1,490) responded to a COVID-19 questionnaire. Psychosocial stress was defined using prenatal screening for depression and perceived stress. Propensity-score matching and general estimating equations with robust variance estimation were used to estimate the pandemic's effect on birth outcomes. Symptoms of depression and perceived stress during pregnancy were similar prior to and during the pandemic, with nearly 40% of participants reporting mild to severe stress, and 24% reporting mild depression to severe depression. Gestations were shorter during the pandemic (B = - 0.33 weeks, p = 0.025), and depression was significantly associated with shortened gestation (B = - 0.02 weeks, p = 0.015) after adjustment. Birth weights were similar (B = - 28.14 g, p = 0.568), but infants born during the pandemic had slightly larger birth weights for gestational age at delivery than those born before the pandemic (B = 0.15 z-score units, p = 0.041). More women who gave birth early in the pandemic reported being moderately or extremely distressed about changes to their prenatal care and delivery (45%) compared with those who delivered later in the pandemic. A majority (72%) reported somewhat to extremely negative views of the impact of COVID-19 on their life. In this national cohort, we detected no effect of COVID-19 on prenatal depression or perceived stress. However, experiencing the COVID-19 pandemic in pregnancy was associated with decreases in gestational age at birth, as well as distress about changes in prenatal care early in the pandemic. · COVID-19 was associated with shortened gestations.. · Depression was associated with shortened gestations.. · However, stress during the pandemic remained unchanged.. · Most women reported negative impacts of the pandemic..

Effects of COVID-19 Financial and Social Hardships on Infants' and Toddlers' Development in the ECHO Program.

The financial hardships and social isolation experienced during the COVID-19 pandemic have been found to adversely affect children's developmental outcomes. While many studies thus far have focused on school-aged children and the pandemic-related impacts on their academic skills and behavior problems, relatively less is known about pandemic hardships and associations with children's development during their early years. Using a racially and economically diverse sample, we examined whether hardships experienced during the pandemic were associated with children's development with a particular focus on communication and socioemotional development. Participants from eight cohorts of the Environmental influences on Child Health Outcomes program provided data on pandemic-related financial and social hardships as well as child developmental outcomes. Financial hardship was defined as at least one parent experiencing job loss or change, and social hardship was defined as families' quarantining from household members or extended family and friends. The development of children under 4 was assessed longitudinally, before and during the pandemic (N = 684), using the Ages and Stages Questionnaire (ASQ). The Generalized Estimating Equations, which accounted for within-child correlation, were used for analysis. Families from minority backgrounds and low socioeconomic status disproportionately experienced pandemic-related hardships. Male children had higher odds of experiencing negative changes in communication and personal social skills from pre- to during-pandemic visits (ORs ranged between 2.24 and 3.03 in analysis with binary ASQ outcomes and ranged from -0.34-0.36 in analyses with ASQ z-scores, ps = 0.000). Pandemic-related hardships in the social and financial areas did not explain within-individual changes in children's developmental outcomes. Negative developmental changes from pre- to during-pandemic were found in boys, yet we did not find any associations between increased experience of pandemic-related hardships and children's development. E how pandemic hardships affect development using a larger sample size and with longer follow-up is warranted.

Evolving Project ECHO: delivery of pediatric pain core competency learning for interprofessional healthcare providers.

Healthcare providers (HCPs) practicing in community settings are critical to improving access to pain care, yet there are significant gaps in training opportunities designed for interprofessional learners. Project Extension for Community Healthcare Outcomes (Project ECHO®) is an established model for delivering online HCP education through virtual clinics and cultivating a community of practice. However, to our knowledge, the integration of pain core competency education into the ECHO® model has not been previously attempted. This innovation could enhance the ECHO® model while also addressing the growing calls for more accessible interprofessional pain curricula. This paper describes efforts to implement and evaluate core competency curricula within the context of Pediatric Project ECHO for Pain, one of the first pediatric-pain focused ECHO programs in the world. Needs assessments informed curricula development. The first delivered core competency model consisted of synchronous webinar-style sessions while the second model included a mixture of asynchronous (eLearning course) and synchronous (virtual clinical debrief) elements. A convenience sample of HCPs was recruited from ECHO program registrants. Participants completed baseline and follow-up surveys to assess core competency acceptability as well as impact on knowledge and self-efficacy related to managing pediatric pain. Usability of the eLearning platform (model 2 only) was also evaluated. Surveys used 5-point Likert scales to capture outcomes. A priori targets included mean scores ≥4/5 for acceptability and ≥80% of learners reporting knowledge and self-efficacy improvements. The study received local research ethics approval. The core competency was found to be highly acceptable to interprofessional learners (n = 31) across delivery models, surpassing a priori targets. Specifically, it was characterized as a worthwhile and satisfactory experience that was helpful in supporting learning. The core competency was also associated with improvements in knowledge and self-efficacy by 97% and 90% of learners, respectively. The eLearning platform was reported to have high usability with clinically realistic cases (100% of respondents) that were helpful to inform care delivery (94% of respondents). The integration of core competency learning within the Project ECHO® model was a successful approach to deliver pediatric pain education to interprofessional HCPs.

The Associations of Maternal Health Characteristics, Newborn Metabolite Concentrations, and Child Body Mass Index among US Children in the ECHO Program

The Associations of Maternal Health Characteristics, Newborn Metabolite Concentrations, and Child Body Mass Index among US Children in the ECHO Program

1365. Public Health’s Role in ECHO via the Experiences of a State Department of Public Health

Abstract Background In April 2019, Georgia became the second state department of public health to implement and utilize an ECHO program to unite the Ryan White Part B HIV community. Project ECHO is a global telementoring program used to provide cutting-edge medical techniques and knowledge to medical providers in rural settings with fewer resources. Today, the GA-DPH ECHO program reaches over 300 individuals at the local, state, national, and international levels, providing essential insight to healthcare workers and a forum for discussion in several key fields, including infectious diseases and viral hepatitis. The objective is to reveal via participation and demographical data drawn from ECHO sessions the challenges and successes in implementing and potential expanded utility of this type of program within public health, ultimately demonstrating why public health has an important role within the ECHO community. Image 1Map of United States showing outreach of GA-DPH Project ECHO. The map does not include one user based in Africa. Methods iECHO, a partner relations management tool, was utilized in extracting demographical and participation from all GA-DPH ECHO sessions from 2019 to 2021. Data was chosen based on participation over time for each ECHO in addition to who was attending sessions while determining variations in attendance. Once compiled, data was charted into tables with iECHO software utilization to construct graphs illustrating trends over time for each ECHO to be analyzed for future expansion and evaluate the challenges. Results The data revealed a steady growth of GA-DPH ECHO specifically the pilot infectious disease ECHO in 2019 which has grown from 14 attendees at the time to 20. A large attendance spike coincided with ECHO initiations of acute stroke and cancer registry in January 2021, with March 2021 the most attended month for the three ECHOs existing at the time. Initiated in April 2021, viral hepatitis quickly produced the most didactic sessions than any other program. ECHO Figure 1 Graph of participation in 2021 for all five ECHOs with the highest attendance for three ECHOs during March 2021. Sessions are scheduled monthly or bi-monthly (representing months with 0 attendance) and are 1-hour in length Figure 2Graph of participation for Infectious Disease ECHO from 2019-2021, noted as the first GA-DPH ECHO, starting 21 months prior to other GA-DPH ECHOsTable 1Average and total attendees for each ECHO in addition to the date of initiation and a total number of sessions. Average number of attendees include individuals registered with GA-DPH ECHO as well as anonymous (unregistered) users who join via invitation. Conclusion GA-DPH Project ECHO has grown in attendees with a variety of sessions offered and plans for further growth and initiation of new ECHO topics. While there have been challenges, there have been far more successes with the development of 5-ECHOs. The hope is experiences of GA-DPH ECHO will show how this platform may be utilized in departments of public health across the globe. Disclosures All Authors: No reported disclosures.

Teaching DBT Skills to DACA Recipients and their Families: Findings from an ECHO Program.

Deferred Action for Childhood Arrivals (DACA) offers temporary administrative relief from deportation for undocumented immigrant adolescents and young adults who were brought as children to the United States. Accordingly, DACA has contributed to creating a different landscape of opportunities for this group. However, DACA has been and continues to be highly contested in the national political climate. Threats to DACA give rise to considerable anxiety, fear, and distress among its recipients, who face significant barriers to accessing mental health care services. Thus, a group of psychologists partnered with a leading immigrant rights advocacy organization and formed a reciprocal collaboration to understand and meet the mental health needs of undocumented communities. A major focus of the collaboration is to foster learning and support members of the immigrant community in contributing to their own well-being. The collaborative developed and delivered a stand-alone web-based mental health education session to DACA recipients and their families and practitioners serving this population. The session presented the use of dialectical behavioral therapy skills, three emotion regulation and four distress tolerance skills, as a strength-based approach to managing painful emotions and distress. Session content was adapted to include culturally informed examples for each skill. Quantitative and qualitative findings show that those who participated in the web-based program benefited from the education received. Findings also underscored participants' need for learning culturally sensitive coping strategies for managing stress. We provide recommendations on the delivery of culturally congruent healing interventions for immigrants with a focus on enhancing access among immigrant communities.

The Next Step in Telehealth Education in a Low-Income Setting: Implementing a Project Echo for Sickle Cell Disease

Background and Aims: Sickle Cell Disease affects nearly 100 million people worldwide and disease complications are responsible for over 50% of deaths among those affected with the most severe form. It is estimated that each year, over 300,000 children are born annually with this disease and over 70% of these births occur in Sub-Saharan Africa. In Kenya, approximately 14,000 children are born with Sickle Cell Disease each year with a greater incidence in malaria endemic areas including lake-region, western, and coastal regions. Advances have been made in the United States to reduce the disease related mortality at 5 years of age to 3%. However, in developing countries of Sub-Saharan Africa, this number is greater than 50%. Since 2011, hematologists from North American institutions have partnered with Kenyan specialists to deliver educational seminars in African counties with a high incidence of Sickle Cell Disease. As an expansion of these efforts, a telehealth educational platform has been developed, capable of providing ongoing collaboration and mentorship for high risk communities. Methods: The combined team of Kenyans and North American providers collaborated to launch a Project ECHO program focusing on Sickle Cell Disease. The virtual educational platform - a hub and spokes teaching model - was implemented based on previous success with other chronic diseases in the region. A complete panel of experts consisting of pediatric and adult hematologists from Kenya and the United States, nursing leadership, patient advocates, social workers, and local physician leaders was assembled as the hub team. Recruitment for the ECHO began in April 2022 in Western Kenya and consisted of participants from prior educational workshops and participants from other ECHO programs at county referral hospitals. A curriculum was built focusing on infant screening, infection prevention, and utilization of Hydroxyurea, with expanding topics based on community needs. The ECHO program occurred at monthly intervals utilizing the Zoom platform. The sessions consisted of both a scheduled didactic and a case-based discussion. The didactic was given by a Kenyan expert while the cases were submitted by ECHO participants from the community. Attendance was tracked by the ECHO platform automatically including recurrent attendance and participant county. Surveys were utilized on a semi-annual basis to further assess educational impact. Results: The program launched in June 2022 with initial success. Participation at early sessions averaged 60 attendees with participants attending from 24 of the 47 total counties in Kenya. ECHO leadership maintained fidelity to the model with an emphasis on dialogue, collaboration, and mentorship. The ECHO community has also flourished outside of the virtual sessions as evidenced by increased dialogue amongst participants via electronic messaging and an increase in Sickle Cell Disease referral patterns. Conclusions: Significant morbidity and mortality persists for sickle cell disease in low- and middle-income countries such as Kenya and education at the community level is a key mechanism to address these disparities. The utilization of a telehealth education program such as Project ECHO represents a strong mechanism to continue building local, regional, and international partnerships to improve care together.