Leveraging the Extension of Community Health Outcomes (ECHO) telementoring program to improve family-centered and communication about early mental health risk in pediatric primary care

PROJECT SUMMARY — RESEARCH PROJECT 1 (RP1) Universal, parent-reported screening tools for toddlers in primary care can improve early detection of mental health risk, facilitate preventive intervention, and reduce barriers to child mental health services access. Multiple parenting programs for this age group can improve behavioral control and prevent the development of mental health problems. However, families of toddlers who screen “at-risk” may be at different stage in the process of problem recognition and readiness for engagement in services—informed by their personal experiences and beliefs, background, and knowledge about development, mental health, and prevention. Furthermore, pediatric primary care clinicians are rarely trained to discuss toddler mental health risk, and evidence-based communication strategies are lacking. Effective and family-centered communication about early childhood mental health risk requires building clinician confidence to: (a) manage uncertainty in prevention-oriented discussions about early childhood mental health; (b) employ systematic strategies for decision-making about what and how to communicate; and (c) engage in family-centered communication that considers families’ identities and experiences. Despite these challenges, there has been little focus on how to help pediatric clinicians build confidence and competence to make decisions about and communicate with families from different backgrounds about toddler mental health risk. This Mental Health Earlier (MHE) ALACRITY Center Research Project - Leveraging the Extension of Community Health Outcomes (ECHO) telementoring program to improve family-centered and communication about early mental health risk in pediatric primary care (TEAM4Access) -addresses this gap through development and testing of a telementoring program for primary care pediatric clinicians. It aims– to advance systematic and universally applied implementation of toddler mental health risk screening in primary care. Program development and delivery will occur in partnership with ECHO- Chicago, a pioneering and widely disseminated program building workforce capacity in primary care through case-based learning series over videoconferencing. TEAM4Access goals are to improve (1) clinician self-efficacy for decision-making and communicating about toddler mental health risk and intervention, and thereby (2) families’ trust and engagement with preventive mental health interventions. We will achieve our goals by: (1) Collaborating with pediatric clinicians and caregivers to iteratively refine the TEAM4Access ECHO series using human centered design methods; (2) Conduct a single-arm feasibility and acceptability test of the TEAM4Access curriculum- and case-based videoconferencing ECHO series; and (3) Pilot test the TEAM4Access ECHO series in a cluster randomized controlled trial. TEAM4Access makes important contributions to the MHE Center via its emphasis on a unique implementation strategy to build pediatric clinician self-efficacy with developmentally-informed and family-centered decision-making and communication about toddlers’ mental health risk.