"A Connected Community": Evaluating the Use of Project ECHO to Support the Implementation of an Evidence-Based Early Psychosis Care Model.

Abstract

Background and hypothesis: The Early Psychosis Intervention-Spreading Evidence-Based Treatment (EPI-SET) is a study evaluating the implementation and impact of NAVIGATE, a manualized model of care for first episode psychosis in geographically diverse EPI programs in Ontario. Project Extension for Community Health Outcomes (ECHO), a virtual training and capacity-building model, was used to support the NAVIGATE implementation for participating programs. We evaluated ECHO EPI-SET in supporting this implementation.

Methods: Using Moore's Evaluation Framework for Continuing Education, attendance and biweekly surveys were used to evaluate clinician engagement and satisfaction with ECHO. A self-reported survey was used to assess self-efficacy across core competencies, determine whether ECHO changed their practice, and describe the nature of any changes. Semi-structured interviews focusing on participants' experience with ECHO EPI-SET were analyzed using thematic analysis.

Results: A total of 92 participants from 6 EPI sites participated across 3 cycles of ECHO EPI-SET. Mean satisfaction ratings were high (>4/5 on a Likert scale). Participants who worked longer at their sites reported higher rates of self-efficacy. The interviews identified 5 major themes: creating a community of practice; supporting NAVIGATE; change in practice/application; implementation support; and strengths and areas for improvement.

Conclusions: This is the first published evaluation of using ECHO in supporting the implementation of a model of EPI care. Participation in ECHO was associated with high levels of clinician satisfaction, engagement, and self-efficacy. Qualitative data suggest that ECHO supported the development of a community of practice, learning, and practice change and may be a helpful tool to support future implementations of NAVIGATE.