Expanding Access for Rural, Highly Mobile, and Military-Connected Families

Project ECHO® professionals meet regularly in person and virtually. Pictured from left to right, the in-person staff members are Jessica Simacek—who led the Department of Defense study and directs ICI’s TeleOutreach Center—and researchers Adele Dimian and Andrea Castillo.

The University of Minnesota’s TeleOutreach Hub is creating a provider ecosystem to help military families and those living in geographically dispersed areas who have developmental, emotional, or behavioral (D/E/B) health concerns.

Researchers and clinicians from the University’s Masonic Institute for the Developing Brain (MIDB) and the Institute on Community Integration are connecting with providers across the state through Project ECHO® , a telehealth and tele-mentoring series for practitioners working with highly mobile, rural, and military-connected families that is based on a collaborative model first developed at the University of New Mexico.

The effort addresses extreme shortages of developmental pediatricians, child and adolescent psychiatrists, psychologists, behavioral specialists, and early intervention providers, which are even more difficult to access for highly mobile and geographically dispersed families. Wait times for intervention services can stretch up to three years. In large states with dispersed populations, long distances to care create more barriers.

During more than three dozen virtual Project ECHO sessions, groups of professionals are meeting to discuss best practices with didactic and case-based learning. Nearly 40 sessions, which began in April, are planned through the remainder of 2024. Topics include autism, attention deficit hyperactivity disorder, social/emotional concerns, and behavioral challenges.

The work is part of a $3.5 million appropriation through the Biden Administration to MIDB to lower barriers to care for these families. The Department of Defense study, A Research Collaboratory to Explore Best Practices for Expanding Access to Care Through Expansion and Support of Telehealth Care for Children and Families with Behavioral Health Needs, is led by Dr. Jessica Simacek, principal investigator and director of ICI’sTeleOutreach Center, and Dr. Damien Fair , co-principal investigator and co-director of the MIDB.

“The MIDB was designed and originated based on the basic principle that by bringing together University experts with community knowledge and our public institutions, we can advance brain health in our youth across the state and beyond,” said Dr. Fair. “The Department of Defense work exemplifies that vision and highlights what can be accomplished when we work together.”

Several additional MIDB service hubs collaborate with the University of Minnesota TeleOutreach Center, including Analytics, Community Engagement and Education, and Informatics. University-wide collaborators are the Center for Applied Research and Educational Improvement, the College of Education and Human Development, Educational Technology Innovations, Health Sciences Technology, the Institute on Community Integration, and University of Minnesota Extension.

“It’s an ‘all-teach, all-learn model,’ where didactics are shared for rapid translation of research-based practices, and everyone participates in case-based learning, where we are truly all learning from each other,” Simacek said of the Project ECHO® series, which stands for Extension for Community Healthcare Outcomes. “It is inter-professional, so we all are coming together from our respective fields with that shared goal of improving access to high-quality mental, emotional, developmental, and behavioral health, regardless of where a family lives in Minnesota.”

The series captures the ingenuity and drive of the collective group, and the technology allows extremely busy providers to come together frequently without the challenges of live meetings. The sessions allow clinical providers working with military and geographically dispersed families to connect with each other and with academic researchers and clinical specialists over time to develop relationships and create a professional learning community.

Simacek said the effort is geared mainly toward reaching highly mobile, military, and rural populations that traditionally have lacked access to specialty services. It continues to draw professionals looking to take advantage of consistent access to specialist expertise to help serve those in their care. Sessions cover a variety of topics within autism, ADHD, mood disorders, complex case management, and related behavioral health and emotional concerns.

Dr. Andrew Barnes, a developmental pediatrician and fellowship program director for the Division of Clinical Behavioral Neuroscience at the University of Minnesota Medical School’s Department of Pediatrics, and Dr. Gail Bernstein, a child and adolescent psychiatrist in the University’s Department of Psychiatry and Behavioral Health, are investigators on the project and core MIDB hub team members.

Barnes, whose father served in the military reserve force, said the opportunity to assist clinicians serving highly mobile and rural families was particularly gratifying.

“I had previously participated in ECHO® projects as a learner, and this opportunity to facilitate support for the rural workforce is important because there are kids in greater Minnesota experiencing complex needs that can include trauma and maltreatment, autism, and other conditions. Providers we’re meeting with are looking for guidance and resources for families,” Barnes said. “Talking through how to navigate multiple concerns helps participants feel more confident and get kids into interventions sooner, even while waiting for multidisciplinary assessment. It has struck me how important it is to empower professionals in their local network to take advantage of resources they already have.”

The series is helping to build a community and a set of practices to address challenging situations, said Dr. Adele Dimian, an investigator on the project, core MIDB hub team member, and associate director of the TeleOutreach Center.

“I always come away from these sessions having learned something new and am struck by how hard-working and committed the community partners and the other team members are,” Dimian said.

The investigators said the series helps bridge the divide between research and implementation. It leverages the latest conferencing technology to bring all voices to the conversation and allows everyone to hear it.

“It’s such a great way to connect and a wonderful tool to share information,” Dimian said.

Bernstein is a member of the MIDB hub team and has also presented sessions. She has recruited several colleagues to present on topics including eating disorders, tic disorders, fetal alcohol syndrome, substance use, depression, and suicide.

“Providers are dealing with very challenging situations, and they are innovative and looking for new approaches,” she said. “They are also finding it valuable as a way to find out about opportunities for participating in research.”

ICI’s knowledge translation team is packaging portions of the sessions into accessible modules that will be used as an asynchronous continuing education option for providers to access on demand.

“We have found that we are doing a lot more than training. This model and these efforts have been building a provider community. Many providers attend regularly, weekly or monthly. We build off of previous learnings or stay with a topic over time to get comfortable asking more in-depth questions and having valuable conversations,” Simacek said. “And it fosters the relationship between the University and our communities.”

For more information regarding Project ECHO® at the University of Minnesota TeleOutreach Center, please contact tele4families@umn.edu. Read more about the Department of Defense Child Collaboration Study here . Study partners are the Kennedy Krieger Institute, Georgetown University, and the Uniformed Services University.