Chair: Eva Serhal
Attendees: Harriet Eastman, George Foussias, Tom Domjancic, Connie Letton, Sanjeev Sockalingam, Sarah Bromley, Jasmyn Cunningham, Nadia Maruschak
Regrets: Christine Mitchell, Chelsi Major, Milena Gosk, Laura Williams, Peter Mastoraskos, Melinda Wade
Action Items:
1. By end of February 2019, a start date and time for EPI-SET ECHO sessions needs to be established between the Hub Site and all three partner sites – ECHO Project Planning Team
A - Establish length of initial phase of ECHO sessions (1 or 1.5 hours)
B – Current Calendar Hold: last Tuesday of every month from 12-1PM EST starting July 30th, 2019
Niagara site has indicated that they are not available after 1PM on Tuesdays (to be confirmed) - Chelsi
2. CAMH Clinicians & Physicians to observe existing ECHO Sessions → 3 options: Structure Psychotherapy, Complex Patient Management and General Mental Health
Provide schedule of upcoming ECHO sessions – Eva/Christine
Circulate options to clinical team – Nadia
*Christine Mitchell will need to provide all ECHO attendees observer approval**
3. EPI-SET Team to attend ECHO immersion training – Eva/Christine
4. Discuss on-boarding process for new sites and how this process relates to ECHO phases/cycles at Steering Committee Meeting – Nadia
5. Determine frequency of ECHO calls after 9 months (~March 2020) → will these meetings be twice per month or weekly? Will these meetings last 1 or 1.5 hours? – ECHO Project Planning Team
Administrative Items:
ECHO (Eva or Christine) to join next Implementation Committee Wednesday Meetings from 1:15-2:00PM starting February 20th, 2019 (Outlook Invitation sent) – Eva/Christine
ECHO to facilitate and lead Project Planning Sessions – Christine
Project Administration team to coordinate planning sessions and take minutes – Jasmyn/Nadia/Chelsi
Review ECHO Project Planning Session schedule and attendee list at next session – Jasmyn/Nadia/Chelsi
Minutes
Christine Mitchell is the project coordinator for ECHO. She is unable to attend this introductory meeting but will be present moving forward. She will be leading the EPI-SET team through the ECHO project planning sessions. Eva circulated high level project charter/agenda.
Introduction to the ECHO Model:
Started in New Mexico → Clinical capacity building and education model
Two main features of an ECHO Session: 1) Didactic mini-lecture (10-15 minutes) based on evidence-based guidelines → “clinical pearls”. This lecture usually contains no more than 25 slides. 2) Case-based learning
Utilizes a Hub and Spoke model → Hub = centralized site; spokes = community sites
CAMH is our Hub because of significant expertise that we are looking to disseminate to our community partners
ECHO is defined by a multi-directional learning experience and inter-professional audience
Community sites are typically primary community care (e.g., physician office, CMHA)
The EPI-SET case is unique → we are utilizing an existing network audience (EPI)
Key Questions about ECHO: aren’t we already doing this? Isn’t videoconferencing education already ongoing?
Answer: This model is different → the focus is a collaborative learning environment, not one-directional knowledge dissemination
Hub and Spoke language is not utilized as much outside the planning sessions → community partners is the preferred term.
The ECHO model moderated in a way to keep discussion on track → highly structured format
There are multiple Roles within an ECHO Hub → facilitator, librarian, didactic educator - Ex. Facilitator → helps with introductions, building relationships, announcements, introduction of didactic presenter
General ECHO Session Structure:
Case Presentation is summarized for 5 minutes.
All community partners are asked to present clarifying questions and the Hub is prompted to provide clarifying questions about the specific case presented.
The spoke sites bring the cases forward.
After questions, the community partners are asked about clinical recommendations, which may require some guidance from the Hub if these recommendations don’t meet the guidelines/evidence-based practice.
The Hub summarizes and disseminates clinical recommendations to the ECHO spokes. These recommendations are recorded. This process can be conceptualized as an inter-professional consult recommendation.
Ex. Psychotherapy ECHO → breaks down sub-components of CBT/DBT with role playing and applies the modelling to the case
ECHO Sessions are focused on capacity building
Case Presentations:
All case presentations are de-identified → rotating introductory slide provides guidelines
Standardized forms are sent prior to the case presentation on RedCap and sent directly to the Hub
ECHO has multiple case presentation templates for different ECHO sessions and patient populations
Hub usually receives the case presentation at least 1 week before the ECHO session
ECHO has developed methods to ensure cases are on file and back-up cases are generated as a last resort
Each session attempts to match the didactic lecture to the case presentation
Our EPI-SET ECHO case presentations would be consistent with the NAVIGATE intervention → early psychosis cases
EPI-SET ECHO:
ECHO’s Role in the EPI-SET research trial is to support the capacity building and sustainability of the NAVIGATE model across Ontario
Any major capacity building deficits would be supported by the NAVIGATE post-training support calls and by the PSSP Team
If the Hub identifies knowledge areas or gaps in one particular team ECHO can integrate a ‘Flex Session’
If case discussion component of the ECHO identifies a prominent knowledge gap, this can be built into the ECHO didactic curriculum in real time and addressed during subsequent ECHO sessions.
Onsite boot camps coupled with ECHO are also possible → we are frontloading EPI-SET sites with pre-training, in-person training and booster training calls prior to April 2019
If a persistent gap in knowledge and training is identified → PSSP or an additional knowledge/education intervention may need to be added outside of ECHO’s role/scope
EPI-SET Project Team will need a structured way to document these knowledge gaps and subsequent interventions.
EPI-SET ECHO Project Planning
To be considered an ECHO requires training and 4 foundational pillars: 1) Case based learning 2) Didactic presentation based on best clinical practices and evidence-based guidelines 3) Measure outcomes in some way → ECHO uses Moore’s 7-level framework 4) Leverage Technology → Zoom
Metrics are inherently integrated as part of the EPI-SET research project design
We would want to additionally collect data about the ECHO component of the EPI-SET project relating to topics. E.g., are we increasing competence and knowledge through EPI-SET’s ECHO component?
These metrics can be co-created with clinicians to developed ECHO-specific metrics for the EPI-SET research project.
There is a lot of flexibility outside of these four pillars to design your ECHO
1 hour is the shortest ECHO length and the inclusion of role playing components will increase the length of a session.
Mental health case presentations can be lengthy given the nature of the case and its complexity
Sessions can have 40-50 participants at one time → our EPI-SET sessions will have 20-30 participants
Our projected ECHO Session timeframe is 1.5 hours
ECHO sessions can have rolling registration versus closed → the team supported closed registrations to promote engagement and attendance.
Potential EPI-SET ECHO Design: - One type of ECHO for the research component of the project. This ECHO would have a closed research design which is more conducive for a research study. - We could develop a different type of ECHO after the study ends for long-term sustainability goals of the project and intervention. - The ECHO component of this project could be designed in phases → bring back to the Steering - This is to be discussed at future Steering Committee meetings.
Our EPI-SET ECHO will change over time → clinicians and physicians will change, ECHO Hub roles will rotate and spoke members could eventually join the Hub.
Project ECHO is funded by the Ministry on an annual basis → the infrastructure for ECHO will always be available.
EPI-SET ECHO Didactics & Training:
The NAVIGATE model, theory, and skills will be the basis of the didactic component of our ECHO
The ECHO Project planning sessions will help build our didactic curriculum.
Each ECHO cycle involves one curriculum. It is possible to have an open rolling curriculum or closed
ECHO will identify didactic needs and gaps by examining the guidelines and best practices set out by the NAVIGATE model. ECHO will distill and organize this information based on education principles.
All of the didactic planning components are supported by project ECHO.
The ECHO team will also develop metrics to evaluate the efficacy of ECHO
An Education Specialist is available to the ECHO team.
ECHO will also provide training to the core facilitators and facilitate the technological component of the sessions. Our team will join training sessions involving simulations and problem solving scenarios.
The ECHO Immersion training supports the technological facilitation piece.
EPI-SET ECHO Long-Term Planning:
How to integrate new sites into EPI-SET ECHO?
Paul Kurdyak suggested a wedge design → teams would come on gradually and not all sites would be up and running at the same time. We need to have some flexibility to bring in other sites and to document and track this on-boarding process.
Sanjeev → each new site needs to have the same on-boarding process → this is a Steering Committee discussion.
George → new sites will receive improved training process → need to document if this is successful or not
Implementation Sub-Committee → ECHO will need to be present in the near future, attend at least one meeting per month.
ECHO is currently slotted at a frequency of once per month starting as of July 2019 until end of March 2020.
The frequency of ECHO sessions after March 2020 will need to be determined (e.g., twice a month or weekly; 1.5 hours or 1 hour?)
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