Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Trinitas Regional Medical Center

Name of Innovative Program: 
Trinitas ECHO CARES
Sponsoring Organization
Trinitas Regional Medical Center
Name of Innovative Program Lead: 
Lucille Esralew, Ph.D.
E-mail Address of Innovative Program Lead: 
lesralew@trinitas.org
Physical Address of Innovative Program: 
655 East Jersey Street Elizabeth NJ 07206-1252
Project Description: 

Trinitas in partnershipwith the University of New Mexico has launched a free telementoring behavioral health program Extension for Community Healthcare Outcomes (ECHO) in New Jersey. This model enhances the capacity of professional and family caregivers to better manage behavioral and mental healh challenges of communit dwelling adults with intelletual and/or developmental disabilities. The program provides regularly scheduled  review of complexcases by an interprofessional team utilizing a multi-point videocomfeerencing Zoom platform which is easily accessible through iPhones, tablets, laptops and desktops or via phone. Virtual grand round are held bi-weekly  for 1.5 hours. Psychiatry, nursing, psychology, behaviorists, and social workers  review cases with partnering facility staff and families. A didactic on a topic relevant for understanding the case follows the team review. Recommendations are genererated by the team including guided practice opportunities.

How does the innovative program work to improve behavioral health access?: 

Individuals with intellctual and developmental disabilities constitute a complex and underserved behavioral health population. This approach offers local providers access to experts via a mentoring relationship with an interprofessional team of experts. Learning occurs through co-management of complex  cases. Communication flows betweenpartners and members of the interprofessional team and among partners. This democratizes knowledge and best practice an improves access by moving knowledge to people rather than expecting people to find specialists. It helps overcome geographic and financial barriers to accessing expert knowledge. Local providers who know their constituents are thereby better equipped to meet the complex needs of their clients inplace and to better utilize scarce resurces such as specialists and the acute care system.

How does the innovative program work to improve behavioral health quality? : 

Trinitas ECHO works to improve behavioral health quality by stdanrdardizing best practice guidelines for partners involved in virtual rounds. ECHO diffuses expert knowledge via case review and didactics and infuses best practice approaches by proiding guided practice opportunities to the right pople at the right time thereby eliminating the cost and delay involved in bringining individuals to specialists. Members of the interprofessional team model critical thinking and problems solvin applied to case eview; each session includes a didactic on a topic relevant tto case revies. Following these sessions, Trinitas's existsing crisis responser workers (via grant from NJ DMHAS) follows up on site to assist in implementation of guided practice recommendations previously generated by the interprofessional team.This ensures timely and effective behavioral health response; those in need are referred to acute care services while most can be managed in place.

How does the innovative program work to address behavioral health costs? : 

There is no charge for participation in ECHO. Trinitas's affiliation with UNM allows for free use of Zoom by Trinitas and our partners. The interprofessional team consists of employees of Trinitas. Partners do incur the cost of covering services in their units while staff is involved in trainings for approximately 4 hours per month. This model reduces the cost of transporting service recipients to specialists or the cost of outreach by mental health clinicians to underserved and remote areas. Local providers learn to handle complex cases which encourages embedding practitioners in local communities who can dispense behavioral healh services. This also reduces the liklihood of unnecessary ED presentations.

Creativity and Innovation: 

There is a dearth of behavioral interventionists, psychiatry and therapists for this population of adults with intellectual and/or developmental disaiblities and co-occurring mental health problems. Our innovation is assembling an interprofessional team of experts who can review cases with local providers and promote best practice at the level of Direct Service Professionals, nurses and primary care physicians. We are utilizing limited resources in a way that  promotes best practice, equips local providers and allows for both the diffusion of state-of-the-art knowledge and the infusion of best practice into caregiving and supports.

Leadership: 

The Clinical Administrator of this project will recruit partners from among agencies and family groups that provide support to the target behavioral health population. Virtual grand rounds will foster critical thinking about cases, build skills in data collection, non-pharmacological intervention and program evaluation and promote the generalization of these skills across community settings. Positive Behavior Support practices will be applied to clinical poulatoins across day programs, residential and family settings.

Sustainability: 

Trinitas has been tasked by the state of New Jerey to develop Learning Networks that will equip family and professional caregivers to effectively respond to the support care needs  of adults with intellectual and developmental  disaiblities. ECHO has been a key features of our multi-tiered effort to build capacity through clinical consultation and training. Future efforts will include extending this model outside the contract to family groups and utilizing a subscription or pay-or-use arrangement with provider agencies. We will also be looking to extend this model to youth with IDD and co-occurring behavioral health challenges and will look to seek funding from agencies that provide services to this target population.

Replicability: 

Trinitas will outreach to agencies throughout NJ that are potential stakholders in provision of behavioral health servies to this population. Trinitas will seek to disseminate this model of interprofessional case review and guided practice through this network of interested stakeholders. We will utilize this model to promote an integrated multi-disciplinary approach to health for this population and promotion of non-pharmacological interventions.

Results/Outcomes: 

Participating agencies will be asked to completed a pre-training readiness assessment of knowledge, attitude and skills and will be asked to complete post-training surveys. These findings will be aggregated and analyzed. Our goal is to infuse professional caregiving with best practice.

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