Project ECHO: Behavioral Health [Podcast]

Dr. Jennifer McWilliams, Division Chief for Psychiatry in the Department of Behavioral Health at Children’s Nebraska in Omaha, provides details on Project ECHO Behavioral Health.

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Topic Breakdown

2:25 — Project ECHO offers resources to primary care providers to address pediatric mental health provider shortage in Nebraska

4:32 — Project ECHO will look at common issues, such as depression, anxiety, and ADHD

8:15 — Why it’s crucial for providers to address common mental health issues in children early on

9:02 — Screening for mental health concerns in primary care settings


CHN News: Hello, everyone. Welcome to the CHN podcast. We are speaking with Dr. Jennifer McWilliams, who is the Division Chief for Psychiatry in the Department of Behavioral Health at Children’s Nebraska in Omaha, Nebraska.

We are talking to her about Project ECHO Behavioral Health, which goes from all of 2018 to the spring of 2019. Thanks so much for being here.

Dr. Jennifer McWilliams: Thank you for having me.

CHN News: In a nutshell, can you describe Project ECHO generally, and then a little more specifically about the Behavioral Health ECHO?

Dr. McWilliams: Absolutely. ECHO is a really exciting program that’s spread throughout the country, where specialists engage with primary care providers through a series of talks and case studies to help support primary care providers with feeling more comfortable with a specific specialty area.

So, as an example, what we’re going to be doing in behavioral health is a series of 11 lectures — or 11 sessions, rather — which are going to be comprised of a 15- to 20-minute lecture where an expert in a topic from Children’s will be discussing that area — whether it be depression, anxiety, etc.

The next 20 minutes of the session will be a case study where people will be able to present cases — real patients that they’re dealing with — so that the group as a whole can talk through those concerns and what they’re experiencing, and how to handle them.

And then, finally, we end each session with a question and answer time period where people can ask other questions that may have come up.

The goal overall is that as the 11-session series goes on, the primary care providers will not only begin to feel more comfortable in treating pediatric patients with mental health concerns, but they’ll also develop a network of colleagues with whom they can share their experiences and bounce ideas off of.

We’re really trying to build a community of learning as much as providing direct knowledge.

CHN News: Why is this so important for primary care providers, especially pediatricians in Nebraska?

Dr. McWilliams: One of the biggest challenges that we’re facing in Nebraska — and even in the Omaha area — is that there simply aren’t enough pediatric mental health providers. Similarly, looking at psychiatrists, there are only a handful of us in the state of Nebraska. And while we all are dedicated to seeing patients and love our work, we recognize that it’s really hard for patients to get in and see us in a timely manner.

As a result, a lot of primary care providers are left in the trenches having to manage these kids on a day-to-day basis. Many times, they end up feeling overwhelmed, undereducated, unsupported — and this is an opportunity for us to try to help build up that foundation, so that they can feel more comfortable with treating the kids that they end up seeing on a day-to-day basis.

CHN News: Is this something that has been going on for a while in Nebraska — this shortage of child psychiatrists and behavioral health specialists?

Dr. McWilliams: Unfortunately, it’s a chronic problem that’s going on across the country, not even in just Nebraska. The areas of the country that have the highest per-capita population of child mentalists and psychiatrists are still woefully underserved.

But in Nebraska, it’s particularly profound because of some of our geographic issues. Almost all of the child mentalists and psychiatrists live and work primarily in Omaha and Lincoln, leaving the vast majority of the state with virtually no access to pediatric mental health care or pediatric care — unless the patient is willing to drive to Omaha.

CHN News: So, these sessions are particularly useful for pediatricians in rural areas?

Dr. McWilliams: Absolutely. We’re offering it to pediatricians across the state, including the Omaha area, but my goal is that we’ll be able to reach out to our colleagues who are practicing in rural parts of the state.

CHN News: What are some of the topics that you’re going to be covering?

Dr. McWilliams: We’re looking really at a lot of the bread-and-butter disorders that affect kids, realizing that primary care providers are never going to want to be in the position — nor would we want them to be in the position — to treat some of the more significant, chronic mental health concerns like schizophrenia and bipolar disorder, etc.

So, we’re focusing on depression, anxiety, ADHD. We’re going to have a session touching on autism, a session on disruptive behavior disorders. We’re also going to be looking at some more processed-based things: How to do a suicide risk assessment, how to screen for mental health concerns in the primary care setting, looking at the effects of adverse childhood experiences.

CHN News: Are these sessions eligible for CME credit?

Dr. McWilliams: Yes. We have gotten each of the sessions approved for CME credit through Children’s Nebraska. CME will be offered for each session individually. And in addition, providers who participate in a certain number of the sessions will be able to participate in a maintenance of certification project, which will give them credit towards board certification and recertification.

CHN News: Since this is very beneficial for rural providers, are they going to have to come into Omaha to do this, or is this through teleconferencing — how does it work, exactly?

Dr. McWilliams: That’s what makes ECHO so cool. We recognize that it’d be impossible to get everybody to come and even spend a day with us. The way the sessions are structured is that we use web-based technology — Zoom technology. So, it’s all on people’s local desktops or some groups, if there’s more than one provider in a setting that want to sit down together in a conference room and project the screen, all they have to do is be able to log into the web.

And then, for better or worse, they’ll be able to see us as we give our presentations and we go through the case reviews. They’ll be able to participate and work with us through the video conference call — all from the comfort of their office or their home.

We’ve tried to set the sessions up so that they’re consistently going to be on Thursdays from noon until 1:15, with the hope that over the lunch hour we’ll hopefully be least restrictive for people — and we’ll do that every few weeks.

CHN News: Can people listen in afterward if they aren’t able to attend?

Dr. McWilliams: Yes, we’re going to be recording all of the sessions and then posting them on our website so that eventually we’ll have the full series up there for people to review. Currently, we have the sessions from the ECHO series that we did on pediatric obesity on the web as well.

So, long-term, our goal is to have an archive of different topics that people can refer back to.

CHN News: Which of these topics are you most excited about? Which topic do you think is going to be the most surprising for people who are participating?

Dr. McWilliams: That’s hard, but obviously I’m a child psychiatrist and mentalist, so I love it all. I think really focusing on depression and anxiety — I think those two sets of topics are going to be the most profound. I think there’s a lot of misperceptions among providers that it’s risky and dangerous to treat kids with those disorders.

In reality, the sooner kids can get treatment for depression and anxiety, the sooner they respond, the better their long-term outcomes. And the treatment options that we have are very safe and very effective. So I’m really hoping, personally, that we can hit home what a huge population health problem depression and anxiety are for children and adolescents — and how important it is that we all work together to treat these kids as early and as effectively as possible.

CHN News: How do you anticipate participation in these sessions will impact patient care?

Dr. McWilliams: One of the topics that we’re going to be talking about is screening in primary care settings. We’re going to be specifically looking at the PHQ-9, which is a depression screening tool that a lot of primary care providers are already aware of, if not completely comfortable with.

Our goal — and we’re actually folding this into the maintenance of certification piece and project — is that as people get more comfortable with using the PHQ-9 and screening more patients in their clinics, that they will recognize some of the more subtle, subclinical cases where depression is either just starting to develop or where the kids are doing a good job of masking those symptoms. So that we’ll be able to identify kids earlier and more effectively, so that we can start getting them the treatment they need.

CHN News: Do you know of any other programs in the country that have done something like this that have been successful?

Dr. McWilliams: ECHO is a nationwide program. It started out in New Mexico, I believe with adult gastroenterology. There have been ECHO projects that have been done across the US and there are a number that have been looking at behavioral health, but I’m not aware of any others that are specifically focusing on pediatric mental health.

But, the more the merrier. I think we need to get this out everywhere across the country.

CHN News: Is this program only open to primary care providers or is it open to anyone who is involved in care of children?

Dr. McWilliams: Right now our target audience is primary care providers — so pediatricians, family practice doctors, advanced nurse practitioners, physician assistants, and all of the staff that work with those folks.

CHN News: How can people get more information or sign up to participate in Project ECHO?

Dr. McWilliams: People can go to Children’s Nebraska website for Omaha and they’ll see a link to the ECHO program. The registration is linked in there. It’s free, it’s easy, and if anybody has any questions, they’re more than welcome to the Behavioral Health Department here at Children’s: 402-955-3900 and ask to speak either to myself or my partner in crime, Dr. Vance. We’d be happy to help guide people on how to get registered and participate as well.

CHN News: Dr. McWilliams, thank you so much for being here with us today.

Dr. McWilliams: Thanks for having me. I really enjoyed it!

CHN News: You have been listening to the Children’s Health Network podcast. That was Dr. Jennifer McWillams from the Children’s Nebraska in Omaha, Nebraska.


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