Final report: Improving Washingtonians’ resilience and recovery from traumatic events with a Trauma-Informed Care ECHO Clinic

Garvey Institute news | April 30, 2022

Our Innovation Grants Program launched in 2020 funded a project led by Kristen Lindgren, PhD, ABPP and Michele Bedard-Gilligan, PhD, called “Improving Washingtonians’ resilience and recovery from traumatic events with a Trauma-Informed Care ECHO Clinic”.

The purpose of this project was to develop and evaluate the acceptability and feasibility of a trauma-informed Extension for Community Healthcare Outcomes (ECHO) Clinic. This ECHO clinic aimed to address gaps in access to trauma-informed care by emphasizing the flexible, culturally-mindful application of evidenced-based practice (cognitive behavioral skills and psychopharmacology) across the lifespan by specialists and non-specialists in underserved communities. Below is their final report.

Project Summary
Our project was pilot of an ECHO clinic aimed at front line mental health clinicians in Washington State. The ECHO clinic focused on teaching empirically supported principles and culturally-responsive practices for helping clients and patients recover from mental health problems resulting from experiencing traumatic events. The clinic was held twice monthly for 6 months (twelve, 60-minute sessions). Providers received CE for participating. We assessed provider and ECHO clinic outcomes at the start and end of the clinic. We found that there was a significant increase in providers’ self-efficacy to implement evidence-based practice, and a positive trend for providers’ self-efficacy to implement culturally responsive trauma care from beginning to end of the ECHO clinic. We also saw a significant increase in agenda setting, a core skill for clinicians that might indicate an increase in ability to structure and direct sessions focused on trauma related content. A majority of clinicians endorsed that the ECHO increased collegial discussion about trauma, provided them with resources for training and mentorship; and improved their access to expertise in treating trauma. All clinicians rated the ECHO clinic positively, with many clinicians noting that the most useful and impactful part of the clinic was the community of providers it created.

Two key lessons were learned that would lead to changes in future trauma recovery ECHO clinics. First, our original aims included collecting patient level data via clinicians and analyzing patient outcomes. Though we set the goal at the start, reiterated it with our clinicians at every ECHO clinic meeting, and sent weekly reminders to encourage compliance, clinician participation was limited. Further, of the clinicians who provided data, almost none provided repeat data for the same client or completed the same measure more than once. As a result, the data collected was scant and will be difficult to analyze. Second, we deliberately kept our focus in this ECHO broad—i.e., empirically supported principles for multiple common mental health problems following trauma (vs. a particular therapy or a particular diagnosis or two) and on clients and patients across the life span (vs. a particular developmental period). Though well-intended, this broad approach may have been too broad, and likely contributed, at least in part the challenges in collecting patient level data. Consequently, we will likely narrow our focus in future clinics.

Project Impact

  • We achieved our primary aims. We recruited 32 frontline community mental health providers across WA State. They came from 13 different zip codes and included providers working in urban and rural settings.
  • Our retention was excellent. We had an 87% retention rate over the six months. Over the course of the clinic, 4 clinicians resigned from the clinic due to job, schedule, or workload changes.
  • Our clinicians are still consulting with one another! They found the community so helpful that they requested that we help them stay in touch with each other. Though we have stepped out from providing consultation, they are still touch and have their own ongoing consulting group. Clinicians also requested that we continue to make materials from the clinic available because they found they them so helpful, and we have done so.
  • We are planning an academic manuscript submission to describe our clinic and findings and discuss lessons learned, particularly because we are one of the first behavioral health clinics to attempt to collect and report on client/patient level data.
  • We also are in discussions with staff at WA HCA and with UW advancement regarding funding for future Trauma Recovery ECHO clinics.

Future Vision and Next Steps
Our hope is to obtain funding from the WA State HCA to continue the ECHO clinic with Washington State providers. Our goal would be to adapt our piloted curriculum to use a more targeted approach- narrowing age range of clients and focusing content on fewer problems linked to trauma exposure. We are also considering different strategies to incorporate into the ECHO clinic to address key lessons learned. Among the options we are considering are the addition of a half day web-based training to begin building a common knowledge set among providers and the recruiting a narrower selection of providers to decrease variability in training background and existing knowledge. In addition, our proposal to HCA also includes the idea of running two ECHO clinics back-to-back – i.e., one every 6 months – as we have learned from the pilot funding that doing so would be more cost efficient.

We also plan to publish our work with the pilot to disseminate both the process and outcomes to others with similar interests in using ECHO to support implementation of evidence based mental and behavioral health care.