Echo (Extension for Community Healthcare Outcomes) As a Workforce Development Tool for Social Work and Behavioral Healthcare

Background: Project ECHO (Extension for Community Healthcare Outcomes) is a continuing education model developed in 2003. It is used to provide remote workforce development for healthcare issues (e.g., autism and opioid use disorder [OUD]) via didactic and case-based learning over videoconferencing software. While most ECHO programs have focused on supporting medical providers, Indiana’s OUD ECHO includes a uniquely-tailored track for behavioral healthcare providers, including social workers. Very little research, however, has examined levels of knowledge and confidence about ECHO for behavioral healthcare workers. This study helps to fill this gap by examining the evaluation findings from two 12-session behavioral healthcare OUD ECHO tracks.

Methods: Data were collected using a cross-sectional survey design. Questionnaires were administered before the first session and after the last session of each ECHO track. Attendance was documented at each session. The analytic sample in this study included participants attending at least one behavioral healthcare ECHO session (n=75). Most participants were social workers (51.4%), and the rest included clinical psychologists (5.6%), registered nurses (4.2%), recovery coaches (2.8%), and ‘other’ (36.1%; e.g., marriage and family therapist). On average, participants had practiced for 12.5 years (SD=9.28) in their current role and had completed their most recent advanced professional training 10.1 years (SD=9.33) prior to baseline. Among attendees (≥1 session), 22.7% completed a post-test instrument.

To identify geospatial distribution of education provided, we coded minutes of training by 5-digit zip code tabulation areas (ZCTA5) of participants’ primary work location. We measured knowledge about OUD using seven multiple-choice questions (e.g., “What would be the best alternative treatment for Janet?” in response to a five-line case summary) designed by the ECHO Institute at University of New Mexico. The items were dichotomized (1=correct, 0=incorrect).  Confidence in managing OUD was measured by six Likert-type questions (1-Very low confidence; 5-Very high confidence). Overall confidence was expressed as the mean value of the six items (pre-test α=.892).  Paired-sample t-tests were used to compare scores between pre- and post-assessments after checking for distribution normality and absence of univariate outliers.

Results: The behavioral health OUD ECHO program provided 35,370 minutes of continuing education across 53 Indiana zip codes (heat map available: http://go.iu.edu/2ajG). Baseline knowledge was high among clinically-practicing participants (M=0.77, SD=.15) and was higher at post-test (M=0.85, SD=.10), albeit non-significantly (t=-1.17, df=12, p=.264). Confidence in managing OUD was above-average at baseline (M=3.71, SD=.79), and higher at post-test (M=4.12, SD=.74), but not significantly so (t=-1.60, df=8, p=.211).

Implications: The Indiana OUD ECHO program successfully disseminated continuing education on OUD to behavioral healthcare providers throughout the state using an online format. The wide variety of credentials and skillsets among attendees suggests that ECHO may be a way for social workers to engage in interprofessional education regarding management of OUD. While modest, non-significant improvements in knowledge and confidence were observed, participants provided high baseline values, making it difficult to assess learning and shifts in belief. Future ECHO programs involving social workers may wish to include more difficult, social-work-specific evaluation knowledge questions to more effectively measure educational outcomes.