Past Project ECHO Communities

This opportunity was sponsored by Dartmouth-Hitchcock, JSI Research & Training Institute, Inc., and the NH Citizens Health Initiative at the UNH Institute for Health Policy and Practice, in collaboration with the ECHO Institute at University of New Mexico and the Institute for Healthcare Improvement (IHI) from November 2020 to August 2021.

Summary of Participants

Participants consisted of nursing home teams, including (but not limited to) medical directors, nurses, and administrators; direct care workers, social workers, and resident and family representatives. Across Northern New England, the project reached 106 nursing homes.

Goals Achieved

From November 2020 through August 2021, over 50 sessions were held across four participant cohorts covering a variety of topics with the goal of achieving the objectives below.

Keeping SARS-CoV-2 from entering nursing homes where it had not entered
Identifying residents and staff who had been infected with SARS-CoV-2 early
Preventing the spread of SARS-CoV-2 between staff, residents, and visitors
Providing safe and appropriate care to residents with mild and asymptomatic cases of SARS-CoV-2
Ensuring staff had the knowledge, skills, and confidence to implement best-practice safety measures to protect residents and themselves
Reducing social isolation for residents, families, and staff during these difficult times

The Chronic Pain Self-Management ECHO was formed to provide educational content and a networking opportunity for those in rural New Hampshire and New England who work with individuals with chronic pain. This opportunity was in collaboration with the NH Citizens Health Initiative at the UNH Institute for Health Policy and Practice and the UNH Extension team. Six sessions were offered from September 2021 to March 2022. This ECHO series established a learning community to equip professionals with the knowledge and skills to assist individuals with self-management strategies to reduce risks of opioid misuse.

Summary of Participants

There were 71 attendees from interdisciplinary backgrounds who joined at least one ECHO session. Participants consisted of professionals who works with individuals with chronic pain, including nurse practitioners, medical doctors, behavioral/mental health counselors, community health workers, educators, recreational therapists, nutritionists, physical therapists, nurses, social workers, and paraprofessionals.

Goals Achieved

Increased the knowledge and confidence of health care and community professionals in utilizing low-risk, self-management strategies, improving patient-provider relationships, and developing techniques for supporting sustained motivation.

Funding Source

This project was supported by the FY2020 Substance Abuse and Mental Health Services Administration Rural Opioid Technical Assistance Grants # 1H79TI083274-01.

Additional Notes

Please contact unh.projectecho@unh.edu with any questions.

Related publications: https://scholars.unh.edu/ihpp/145/

In response to the increasing recognition of negative mental health impacts on children and adults to climate change, the UNH Graduate Public Health Program and the UNH Institute for Health Policy & Practice, New Hampshire Citizens Health Initiative partnered to offer the Connecting Mental Health, Climate Justice, and Nature ECHO. The 4-session pilot ECHO series brought together professionals, students, indigenous people, and persons with lived experience from over 20 states and 7 countries. Participants learned about mental health concerns triggered by climate change, nature-based treatments for persons experiencing mental health disease, and care options for populations impacted by climate change. A climate inquisitive learning community was simultaneously developed through case-based interactive discussion, shared expertise and distribution of references for local and national resources.

Summary of Participants

A total of 81 participants from over 20 states and 7 countries joined the ECHO series. Participants were from a variety of sectors including climate educators, environmental scientists, emergency responders, behavioral health professionals, clinicians, pediatricians, university researchers, social workers, marine biologists, nutritionists, mindfulness trainers, psychiatrists, public health analysts, school-based mental health workers, occupational therapists, and students.

Goals Achieved

Increased knowledge around the intersection of mental health and climate
Access to an informal learning community offered support beyond individual practices, organizations and local experts
Exposure to nature-based & main-stream treatment options, tools and resources to best serve both patients and self

Funding Source

This project was funded by the New Hampshire Healthcare Workers for Climate Action, The Nature Conservancy, and the Southern New Hampshire Area Health Education Center.

The Northern New England (NNE) ECHO Collaborative was formed to advance the use of Project ECHO^® (Extension for Community Healthcare Outcomes) across ME, NH and VT. In partnership with Qualidigm in New England, Vermont Program for Quality Health Care, and the NH Citizen’s Health Initiative received a HRSA Rural Health Network Development Grant to build the Collaborative.

Summary of Participants

47 organizations throughout Northern New England, including community practice centers, municipalities, hospice, law enforcement, and nursing homes. 92 total individual participants, ten faculty members, including MD Geriatricians, psychologist, psychiatrist, social worker, occupational therapist, geriatric nurse practitioners, pharmacist, & facilitator.

Goals Achieved

Developed a collaborative approach that had primary impact of improving the health, care, supports, and quality of life for older adults diagnosed with dementia and their care partners living within their community.

The Northern New England (NNE) ECHO Collaborative was formed to advance the use of Project ECHO^® (Extension for Community Healthcare Outcomes) across ME, NH and VT. In partnership with Qualidigm in New England, Vermont Program for Quality Health Care, and the NH Citizen’s Health Initiative received a HRSA Rural Health Network Development Grant to build the Collaborative.

Summary of Participants

27 Practice teams from New Hampshire and Maine, representing an average of 58 Spoke participants per session
7 experts from Maine and New Hampshire representing Family Medicine Practitioners and Prescribers, Addiction Medicine, Psychiatry, Behavioral Health, Pharmacy, and Peer Recovery & Support. With the addition of 2 addiction specialists and 3 adjunct members, representing Health and Human Services and legal sectors.

Goals Achieved

Increase in confidence of practice team members in assessing, treating, and assisting patients with substance use disorder. Highlights include:

36% increase in confidence in managing high-risk, special population patients with SUD (i.e., pregnant women, persons experiencing homelessness, adolescents, etc.)
26% increase in confidence in addressing risk of drug overdose in MAT patients
21% increase in confidence in the practice team's ability to screen for substance use disorder (SUD), including Opioid Use Disorder (OUD)
20% increase in prescriber's confidence to correctly prescribe and manage medication treatments for OUD

The NH Mental Health Care Access in Pediatrics (MCAP) program strives to increase the availability and accessibility of networks of pediatric mental health teams through telehealth consultation, training, technical assistance, and referral. MCAP launched the MCAP ECHO series in March 2020. The ECHO sessions provided opportunities for consultation, training, and referral across the learning community while also providing as needed access to individual provider to provider teleconsults with Subject Matter Experts. MCAP participants also had access to an electronic referral directory, available on the NH PIP website. MCAP provided four ECHO cohorts targeting primary care teams over four years plus a school cohort with the use of expansion funding provided by HRSA.

Cohort 1: Mar 2020-Dec 2020 Pediatric Anxiety & Depression
Cohort 2: Feb 2021-Nov 2021 Pediatric ADHD & Trauma
Cohort 3: Feb 2022-Nov 2022 Promoting Child & Family Resilience & Healing
Cohort 4: Feb 2023-Jun 2023 Early Childhood Mental Health
School Cohort: May 2023 Collaborating to Support Student Mental Health

Summary of Participants

Cohorts 1-4:

A total of 137 individuals participated in the series including primary care and behavioral health clinicians; 13 of which participated in more than one Cohort. The series targeted those working in pediatric primary care settings in NH and included physicians, nurses, nurse practitioners, physician assistants, administrators, case managers, behavioral health clinicians, and students and residents. This series reached 44 practices across 90% of NH counties.

School ECHO:

A total of 95 individuals participated in the School ECHO. The series targeted school staff working in K-12 public education settings in NH and included school counselors, psychologists, social workers, nurses, administrators, and teachers. This series reached 41 schools and 15 district offices spanning all ten NH counties.

Goals Achieved

Increased knowledge and confidence in identifying, screening, and treating pediatric patients with mental health concerns
Increased knowledge of strategies to engage with family and community resources
Access to provider to provider teleconsultation with a Subject Matter Expert
Support and consultation provided by an informal learning community made up of peers and Subject Matter Experts

Funding Source

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $445,000 with 20% financed with non-governmental sources. NH MCAP is a collaboration between NH DHHS and the University of New Hampshire Institute for Health Policy and Practice.

Additional Notes

For more information about NH MCAP, see Projects | New Hampshire Pediatric Improvement Partnership (nhpip.org)

The Northern New England (NNE) ECHO Collaborative was formed to advance the use of Project ECHO^® (Extension for Community Healthcare Outcomes) across ME, NH and VT. In partnership with Qualidigm in New England, Vermont Program for Quality Health Care, and the NH Citizen’s Health Initiative received a HRSA Rural Health Network Development Grant to build the Collaborative.

Summary of Participants

Nine-member, multidisciplinary faculty team, with representation from Maine, New Hampshire, and Vermont. Our program faculty includes a Geriatrician, Psychiatrist, Psychologist, Pharmacist, Geriatric Occupational Therapist, Family Nurse Practitioner, Geriatric Nurse Practitioner, and a Social Worker who is also a representative from an Area Agencies on Aging.

Goals Achieved

Increased knowledge in:

Assessment skills to accurately diagnose and treat geriatric patients living with complex conditions specific to older adult populations, more accurately
New techniques for managing conditions that are commonly associated with dementia, increasing familiarity with methods of managing behavioral issues in patients with dementia and late-life mood disorders, learning both pharmaceutical and non-pharmaceutical interventions
Identifying high-risk medications and “de-prescribing”
Engaging caregivers and reducing risk of caregiver burnout
Helping patients and families navigate difficult palliative and end of life decisions

Starting in 2018, The University of New Hampshire’s Institute for Health Policy and Practice, Citizens Health Initiative, and the Department of Nursing developed the Partnership for Academic-Clinical Telepractice – Medications for Addiction Treatment (PACT-MAT), a Project ECHO® learning community. This innovative ECHO was the first in the world to incorporate family nurse practitioner students and post masters psychiatric nurse practitioner students combined with community agencies together in a virtual “All Teach, All Learn” environment with the goal to address the access and equity of services for patients with opioid use disorder in New Hampshire.

Funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), the goals of the grant were to increase provider and student knowledge and confidence in prescribing for opioid use disorder treatment. The curriculum within the University of New Hampshire post masters nursing program was also revamped to include substance use disorder and specifically opioid use disorder training. Participants learned to utilize non-stigmatizing language and approach care from an unbiased, person-centered perspective.

Summary of Participants

Over the course of 3 years, a total of 342 participants and students from 37 health care and community organizations participated, including primary care practices, county and state correctional facilities, community mental health centers, addiction treatment centers, and peer support and recovery organizations. An interdisciplinary subject matter expert team including psychiatry, recovery, occupational therapy, nursing, and more assisted in the development of curriculum. Over 178 total family nurse practitioner students and post-masters psychiatric nurse practitioner students went through the PACT-MAT program.

Goals Achieved

PACT-MAT was the first ECHO in the world to include nurse practitioner students and align with nursing curricula with the treatment of substance use disorder as a chronic disease. This ECHO increased knowledge and confidence in prescribing medications for opioid use disorder (MOUD) of the providers and students, connected all learners to a network of interdisciplinary health care and community professionals across the state of NH and the New England Region, and resulted in an increase in prescribing of medications for OUD.

Our personalized onboarding of participants and subject matter experts enabled the team to create a learning community with robust case-based discussions and didactic presentations, as well as connect with organizations on an individual level to create a secure and trusted environment.

Based on results from the continuing education surveys administered, 93% of participants agreed either very or extremely that the information presented in this training was important. Other data indicated an increase in confidence in prescribing (73%), an increase in knowledge and experience with substance use disorder treatment (83%), an increase in awareness of harm reduction, bias, and stigma (87%), and 86% agree that they became part of an MOUD learning network.

In 2022, The University of New Hampshire Institute for Health Policy and Practice, NH Citizens Health Initiative continued the expansion of the PACT-MAT program and launched the Substance Use Disorder ECHO (SUD ECHO). This ECHO takes a regional approach across rural areas of ME, NH, VT, and Northern NY in collaboration with the University of Vermont Center on Rural Addiction (UVM CORA) and builds off of the previous foundation laid by the PACT-MAT ECHO program. The curriculum expands beyond MOUD and dives deeper into stigma awareness and substance use disorders. *Link to SUD ECHO once language finalized

Funding from Substance Abuse and Mental Health Services Administration #1-H79-TI081677-01

The Northern New England (NNE) ECHO Collaborative was formed to advance the use of Project ECHO^® (Extension for Community Healthcare Outcomes) across ME, NH and VT. In partnership with Qualidigm in New England, Vermont Program for Quality Health Care, and the NH Citizen’s Health Initiative received a HRSA Rural Health Network Development Grant to build the Collaborative.

Summary of Participants

Eight-program faculty consisted of a multidisciplinary team, including Perinatal Outreach Nurse Educator, Social Worker, Nurse-Midwifery, Perinatal Nurse Coordinator, Obstetrician, Psychiatrist, Neonatologist, an Addiction Medicine Clinician, and a Pharmacist.

Goals Achieved

Increased knowledge and confidence in understanding the needs of SUD patients, especially mothers and infants.

The Preceptor ECHO to Enhance Rotations (PEER) was launched to improve clinical rotations for nurse practitioner students nationwide. PEER was funded through the Advanced Nursing Education Workforce project and was a collaborative effort of NH Citizens Health Initiative through the UNH Institute for Health Policy and Practice, UNH Department of Nursing, and Southern New Hampshire Area Health Education Center. This ECHO® series hosted three cohorts from November 2020 through April 2023:

Cohort 1: December 2020 - June 2021
Cohort 2: November 2021 – May 2022
Cohort 3: November 2022 – April 2023

This program was supported by the health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $2.8 million dollars with a percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official view of, nor an endorsement by HRSA, HHS, or the U.S. Government. For more information please visit http://www.hrsa.gov.

Summary of Participants

Clinical preceptors, providers interested in becoming a clinical preceptor, office managers/HR staff, and NP students from 84 organizations and 24 states participated in the 3 cohorts of PEER. Participants joined from Colleges, Universities, NP Residency Programs, Federally Qualified Health Centers, Community and Rural Health Centers, NP Owned Family Practices, Primary Care, Pediatrics, Urgent Care, Hospitals, Provider Offices within Hospital Systems, Critical Access Hospitals, Mental Health, U.S. Government Agencies, Area Health Education Centers, Non-Profit Public Health Agencies, Specialty and Ambulatory Surgery Centers, Nursing Homes, and Virtual Health Care Centers.

Goals Achieved

Promoted case-based shared learning across clinical preceptor sites throughout New England and beyond
Developed a learning community of preceptors and practice sites
Shared and developed competencies for rural and underserved preceptor sites
Expanded the primary care workforce pipeline for rural and underserved populations
Enhanced preceptor knowledge and confidence by sharing best practices and case studies combined with shared discussions, recommendations, and resources
Provided tools and shared experiences/innovations for practice efficiency while precepting students
Boosted professional connections and create a supportive community among preceptors in New England and beyond

Funding Source

This program was supported by the health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $2.8 million dollars with a percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official view of, nor an endorsement by HRSA, HHS, or the U.S. Government. For more information please visit http://www.hrsa.gov.

Building on previous work done in the Partnership for Academic Clinical Telepractice: Medications for Addiction Treatment (PACT-MAT) ECHO, the Substance Use Disorder (SUD) ECHO expanded its focus from medications for opioid use disorder to a wider breadth of SUD-related topics, including vaccination, special populations, reduction of stigma and bias, overdose prevention, and more. This ECHO target rural areas of New Hampshire, Maine, Vermont, and northern New York and brought together an interdisciplinary group of subject matter experts and participants of all learning levels.

Summary of Participants

Participants included: Students, RNs, Pharmacy, Peer Recovery and Support, Primary Care, Prescribers, Allied Health (Behavioral Health, Social Work, OT), Carceral System, Community Health Workers, Hospitals and ERs, and State Government all joined this series to offer their varied perspectives and experiences with substance use disorder treatment.

Goals Achieved

Enhanced knowledge and confidence of substance use disorder treatment and stigma awareness. Highlights include:

Education on treating individuals with a substance use disorder
Increased confidence in prescribing
Increased knowledge of stimulant use disorder, stigma and bias, treatment of co-occurring disorders, and how to engage in discussions around vaccinations
Engaged in a community of peers to learn about supports outside of each practice/organization

In response to the COVID-19 pandemic and ongoing opioid crisis, MCD Global Health (MCD) and the Institute for Health Policy and Practice (IHPP) at the University of New Hampshire, with federal funding from the Health Resources and Service Administration (HRSA), are developing Project ECHO® programs to serve rural Maine, New Hampshire, Vermont and New York's North Country. This initiative is called the Collaborative for Advancing Rural Excellence and Equity (CARE2). In October of 2022, CARE2 launched “Substance Use Disorder ECHO: Fostering Connections to Drive Assessment, Treatment, and Outcomes”. This 8-session ECHO^®series discussed best practices for treatment of SUD using a person-centered approach, explored the roles of stigma and bias in SUD, identified strategies for connection and engagement between providers and patients, and sought to understand the effects of COVID-19 on the behavioral health of persons with SUD.

Summary of Participants

Over the course of 8 sessions, we had 72 unique participants from New Hampshire, Maine, Vermont, and North Country New York. Participants included community health workers, community-based organizations, medical librarians, nurses, occupational therapist, peer recovery and support professionals, pharmacists, practice administrators, mental health professionals, social workers, students, and more.

Goals Achieved

Increased knowledge of treating individuals with a substance use disorder
Accessed tools and resources to best serve participant patients and clients
Engaged in a community of peers to learn about supports outside of participant practices and organizations

Funding Source

The project described was supported by grant number U3IRH43508 from the Office for the Advancement of Telehealth, Health Resources and Services Administration, DHHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA/HHS or the U.S. Government. is a collaboration between MCD Global Health and University of New Hampshire Institute for Health Policy and Practice.

In response to the COVID-19 pandemic and ongoing opioid crisis, MCD Global Health (MCD) and the Institute for Health Policy and Practice (IHPP) at the University of New Hampshire, with federal funding from the Health Resources and Service Administration (HRSA), are developing Project ECHO® programs to serve rural Maine, New Hampshire, Vermont and New York's North Country. This initiative is called the Collaborative for Advancing Rural Excellence and Equity (CARE2). In June of 2022, CARE2 launched “Substance Use Disorder ECHO: Stigma, Bias, and the Principles of Harm Reduction”. This 4-session pilot ECHO^®series focused on recognizing and minimizing the challenges presented by stigma and bias in treating persons with substance use disorder and sharing best practices around harm reduction.

Summary of Participants

Over 60 participants joined the 4-session series. Participants included: Students, RNs, Pharmacy, Peer Recovery and Support, Primary Care, Prescribers, Allied Health (Behavioral Health, Social Work, OT), Community Health Workers, Hospitals and ERs, and State Government all joined this limited series to offer their varied perspectives and experiences with harm reduction.

Goals Achieved

Enhanced knowledge and confidence of harm reduction strategies and stigma awareness. Highlights include:

Provided strategies to promote harm reduction principles in treatment of individuals with a substance use disorder
Educated on harm reduction best practices and awareness of stigma
Identified impacts of COVID-19 on behavioral health in rural persons with substance use disorder

Funding Source

The project described was supported by grant number U3IRH43508 from the Office for the Advancement of Telehealth, Health Resources and Services Administration, DHHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA/HHS or the U.S. Government. CARE2 is a collaboration between MCD Global Health and University of New Hampshire Institute for Health Policy and Practice.

In response to the COVID-19 pandemic, the NH Citizens Health Initiative launched Telehealth for Special Populations During COVID-19 and Beyond on May 13^th, 2020. This 4-session pilot ECHO series focuses on implementing telephonic/telehealth care with older adults, pediatric populations, and persons with a substance use disorder with complicating social determinants of health. This is the first ECHO in NH to bring together participants from both primary care practices, community-based social services organizations, mental health and behavioral health practices, family and peer recovery and support, and more. This ECHO is a pilot program for this unique format. Best practices and lessons learned for this approach will be shared. This telepractice learning experience is supported by the Advanced Nursing Education and Workforce Initiative (ANEW), Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services.

Summary of Participants

113 Participants throughout New Hampshire and Northern New England including seven additional States. Participants included 32 Primary Care Practices, 17 Community-Based Social Services Organizations, 13 Mental Health and Behavioral Health Practices, 30 Higher Education Institutions, 6, State/Local Public Health Agency/Networks, 6 Public Health Organizations, 2 Family and Peer Recovery and Support Organizations, 1 Payer and 5 Categorized as ‘other’.

Goals Achieved

Enhanced knowledge and confidence in the use of telephonic/telehealth care with older adults, Pediatric populations, persons with Substance Use Disorder (SUD) with complicating social determinants of health by:

Promoting best practices for efficient and effective telephonic/telehealth care visits
Linking clients/patients to local and web-supported services and resources to accommodate care barriers
Developing a sustainable model to support current care needs

Past Project ECHO Communities