Project ECHO: An Evidence-Based Pathway to Build Child and Adolescent Mental Health Workforce in Pakistan

Most mental health disorders present by age 14 years but less than fifty percent youth receive any treatment. Most present to non-mental health disciplines secondary to mental health workforce deficits. Mental health access is lower in developing countries like Pakistan and worse in the rural areas of the country which houses majority of the population. The growing need to manage child and adolescent mental health disorders in a timely manner necessitates use of innovative professional training approaches to increase mental health workforce. Project ECHO is a hub-and-spoke model that uses videoconferencing to connect general providers ("spokes") with specialists (the "hub") overcoming the site and location specific barriers which often impede access. Our 12 month curriculum was developed to expand child and adolescent mental health workforce using ECHO platform. Participants (n = 227) completed surveys;78.3% were from healthcare sector including pediatrics, family community medicine and behavioral health specialties and the rest represented school counselors and community organizations. Interestingly, patients with anxiety disorders were most commonly seeking care from family/community medicine (p = .040) while mood and autism from pediatricians and psychiatrists. Knowledge and confidence of participants improved significantly after sessions (p = <.001). Most expressed satisfaction with the ECHO sessions (93.8%). Main barriers to implementing the evidence-based recommendations included time, clinic support and patient compliance. Results support interprofessional training to increase child and adolescent mental health workforce and reflect benefit of brief tele mentoring to improve training beyond profession specific competencies. Future studies should explore clinical and provider level outcomes with similar professional education approaches.