Introduction to Indiana OUD ECHO: Early Childhood Home Visitors

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Indiana OUD ECHO1. Partnership between community-based providers and

Indiana University-led team of specialists to improve treatment of OUD in rural and other underserved areas

2. Supported by IN Family & Social Services Administration contract as part of state 21st Century Cures Act funding

– Awarded Fall 2017, Renewed spring 2018

– Funds expert panels, 1.5 FTE coordinator, marketing, administration

oudecho.iu.edu

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Cross-Campus Collaborative Teamoudecho.iu.edu

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ECHO Origin Story: HCV Estimated 36,000 individuals in New Mexico with HCV Only 5% were in treatment

Shortage of specialists Only 2 clinics in New Mexico with the necessary expertise

Virtual clinics for providers to treat HCV in their own communities

Increased community capacity Increased access to care Reduction in racial and ethnic disparities in treatment outcomes Healthier communities

• Now programs all over the world mentoring over 250 different complex medical conditions.

Arora, S., Thornton, K., Murata, G., Deming, P., Kalishman, S., Dion, D., ... & Kistin, M. (2011). Outcomes of treatment for hepatitis C virus infection by primary care providers. New England Journal of Medicine, 364(23), 2199-2207.

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Problem Solution

Patients get the right care, in the right place, at the

right time.

People need access to specialty care for

complex conditions

Not enough specialists to treat everyone, especially

in rural communities

ECHO® trains primary care clinicians to provide

specialty care services

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About Project ECHO

ECHO = Extension for Community Healthcare Outcomes

Mission: “…democratize medical knowledge and get best practice care to underserved people all over the world.”

Project ECHO® is a lifelong learning and guided practice model that revolutionizes medical education and exponentially increases workforce capacity to provide best practice specialty care and reduce health disparities through itshub-and-spoke knowledge sharing networks

Adapted from Copyright © ECHO Institute

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All Teach All Learn ModelHub and spoke knowledge sharing creates a learning loop:

Community providers learn from specialists

Community providers learn from each other

Specialists learn from community providers as best practices emerge

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Treating provider retains responsibility for managing patient.

Adapted from Copyright © ECHO Institute

Didactic Presentations

Short! - 20 minutes

Palatable!

Applicable!

Time for Q&A

Learning Objectives

Objectives: Participants of this new ECHO should be able to

1. Get a better understanding of Opioid Use Disorder2. Obtain the ability to engage with families affected by Opioid Use

Disorder3. Understand the stigma associated with OUD and how it can affect

the children/families4. Understanding of Medication Assisted Treatment and how it is an

evidenced based treatment for OUD5. Understanding of how to support the child/family dyad6. Identify appropriate community resources for families affected by

OUD7. Understanding of how babies are screened and diagnosed for

NAS.

Didactic Schedule

Feb 19 Introduction to OUD, MAT and Stigma - Gaby Williams

Mar 26 Perinatal Exposure- Emily Scott

Apr 23 Promote Parent/Child Dyad - Joanna Chambers

May 21 How to Engage Families - Angie Tomlin & Steve Viehweg

Experts (Facilitator) Gabriela Rodriguez – Assn’t Professor of Clinical Psych

at IUSOM

Barb Blaine – Occupational Therapist and Director of Pediplay

Debbi Davis – Executive Director of ProKids

Angie Tomlin – Professor of Clinical Pediatrics at IUSOM

Steve Viehweg– LCSW, Interim Director at IUPUI Center for TranslatingResearch into Practice

Client Case Presentations 1-2 per session

Participant will present de-identified case – NO PHI

Spoke will ask clarifying questions

Experts will ask clarifying questions

Contemplation and recap

Spoke will make recommendations

Experts will make recommendations

Written recommendations will be submitted to presenter only

Follow up presentation will be encouraged

Roles within the ECHO Clinic

Roles: MAIN FACILITATOR during clinic

There will be one designated MAIN facilitator for each clinic.

Main facilitator is like the conductor of the orchestra

Manages the Hub

MAIN FACILITATOR during clinic

Follows the orchestral composition = ECHO Agenda

Adheres to Facilitator Guide

Encourages engagement of audience = Learners

Has a plan if someone is if off key

Allows for deliberate silence

Demonstrates joy in role

Follows ECHO etiquette

Roles: EXPERTS during clinic

Present, in tune and supportive of the whole orchestra

Represents a particular role

Follows conductor

Waits for cue to come in

Contributes to QI during pre-clinic

• Huddle and post-clinic Debrief.

Roles: PARTICIPANTS during clinic

Hopefully they actively participate and turn camera on

Ask questions following didactic

Present de-identified patient cases

Asks clarifying questions

Makes recommendation on case presentation

Complete post session evaluation

Roles: ECHO Staff during clinic Encourages audience to sit in appropriate seats

Log on to Zoom with clinic-site name

Assures stage is solid; lights, camera, action

Observes from the sidelines for

– Audience engagement

– Facilitation

Engages in Post clinic debrief:

– What went well; Room for improvement; offers actions to mitigate issues that arose from particular clinic

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ECHO Etiquette

Always…1…..identify a videoconferencing facilitator to drive the meeting.

2…..identify participants as they sign in late.

3…..be generous in extending greetings & introducing people.

4…..make eye contact with the camera when you are speaking.

5…..speak clearly & in a conversational tone.

6…..be conscious of group discussion dynamics, & give people time to respond

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ECHO Etiquette

Always…7….take a supportive approach to peoples’ learning curves.

8…..use gentle, supportive approaches to correct misinformation.

9…..be encouraging.

10….use “gentle nudges” to help people discover and learn.

11…..start on time and end on time.

12…..excuse yourself and leave the room if you need to have a side conversation or take a phone call.

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ECHO Etiquette

Sometimes…1. …use gentle redirection when someone dominates

time or is critical or confrontational to a colleague.

2. …remind people about the risk of inadvertent disclosure of protected health information.

3. …request feedback from participants who are listening in via telephone.

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ECHO EtiquetteNever…1. …disclose protected health information (PHI).

2. …criticize a person’s ideas, even when they are wrong.

3. ……use sarcasm or ironic humor. It doesn’t translate well.

4. …allow providers to talk about or criticize colleagues.

5. …diminish a person or criticize a past decision.

6. …engage in side conversations.

7. …make extraneous noise, like typing on a keyboard or rustling papers. Conference microphones are very sensitive.

8. …talk over other people. If someone is speaking, let them finish, or signal your wish to talk to the facilitator.

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echo.iu.edu

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Thank you!WEB: oudecho.iu.edu

EMAIL: oudecho@iu.edu

TWITTER: @IndianaOUDECHO

Kristen Kelley: Kelleykr@iu.edu