Integrating care for children and young people through Project ECHO

Abstract

Introduction: Children’s Health Queensland Hospital and Health Service (CHQ) is increasingly adopting Project ECHO® as a practical enabler of integrated care for children with chronic conditions living in areas of need. Description of practice: ECHO® is a model of inter-professional education and case-based learning, which seamlessly integrates advice from professionals from within medicine, allied health and education, as well as parents, in training and mentoring primary care providers (PCPs) and educators. Using a hub and spoke structure and videoconference technology, expertise is disseminated. Aim: To deliver best-practice, integrated care to children in rural, remote and underserved parts of the state by empowering PCPs and educators to work at the top of their scope of practice. Targeted population and stakeholders: Target population is children 0-18yr living in rural, remote or underserved areas, with the following chronic conditions or challenges.\xa0 Hub panel members vary according to topic and are shown in brackets.\xa0 Spoke participants can be PCPs of any discipline, or educators, including teachers, principals and guidance officers.\xa0\xa0 Behavioural and mental health concerns (paediatrician, psychiatrist, psychologist, social worker) ADHD (parent, paediatrician, psychologist, teacher) Refugee background (parent, paediatrician, guidance officer, cultural worker, psychologist) Persistent pain (pain specialist, OT, physiotherapist, music therapist) Obesity (paediatrician, dietician, exercise physiologist) Congenital foot anomalies (physiotherapist, child health nurse) Funder varies according to topic and may be State Department of Health, philanthropic organisation or Primary Health Networks. Timeline: CHQ’s ECHO program has expanded from a small pilot for ADHD in 2017, to an ongoing program. Highlights, impact and outcomes: Since May 2017, CHQ has trained 132 PCPs and educators to manage a range of common, chronic and complex paediatric conditions.\xa0 Early evaluation shows a statistically significant increase in provider knowledge and self-efficacy after completion of a series, as well as high satisfaction with this model of learning. The parent representative in the original ADHD ECHO® series was supported to complete an undergraduate university placement at CHQ through participation in this work. Sustainability and transferability: We have demonstrated transferability of the model from rural New Mexico, where it was developed, to an Australian setting.\xa0 Additionally, we have demonstrated transferability of the model to a variety of topics; two of which - refugee kids and foot anomalies - are world firsts. A comprehensive external evaluation in late 2018 will examine cost-effectiveness, however sustainability of funding for ECHO® will remain a challenge. Conclusion/ discussion/ lessons learned CHQ has shown that Project ECHO® can be an effective mechanism to integrate expertise from multiple disciplines, and upskill PCPs and educators in the management of children with complex conditions. Learning from the lived experience of consumers – our parent representatives – has been highly valued by participants. During 2019, CHQ will further expand its implementation of Project ECHO® into indigenous health and palliative care, with a focus on PCPs in remote aboriginal communities. Our key learning is that successful ECHO® series must be learner-centric, with a curriculum driven by the needs of consumers and providers in underserved areas, rather than traditional specialist teaching.