Brief Oral Papers

Education & Career Development

Brief Oral Papers Session 02 - Training, Education, Mentorship, and Career Development

Integration Through Education: Utilizing Project ECHO to Mitigate Fragmentation and Support Adaptive Expert Care in HIV Psychiatry

Friday, November 8, 2024

11:05 AM – 12:20 PM EST

Location: Monroe

Presenting Author(s)

DC

Deanna Chaukos, MD FRCPC

Physician Lead, Medical Psychiatry
Sinai Health
Toronto, Ontario, Canada

PDF

Co-Author(s)

SG

Sandalia Genus, PhD

Research Coordinator
Sinai Health
Toronto, Ontario, Canada
MM

Maria Mylopoulos, PhD

Scientist and Associate Director of Training, The Wilson Center
The Wilson Center, University Health Network
Toronto, Ontario, Canada

Abstract: Background

Care of patients with HIV and mental illness requires integration across hospital and community settings to address complexity.1 Patient complexity includes multimorbidity, in addition to adverse childhood events and other barriers to the social determinants of health.2 Adaptive expertise is an emerging model in health professions education that directly addresses the challenge of preparing providers for future uncertain practice.3,4 Adaptive experts have the ability to integrate diverse kinds of knowledge, which demands collaborative competencies.3 Patients with complex problems, like HIV and mental illness, can present to care with ambiguous problems, and thus adaptive expert abilities are integral.5 Utilizing the Project ECHO model, we developed an educational offering to equip frontline community workers in the HIV sector with integrative abilities that support care of complex patients with psychiatric illness.

Methods

Project ECHO (Extension for Community Healthcare Outcomes) in HIV Psychiatry was created for frontline workers serving clients with HIV and mental illness. ECHO is a distance education model with case-based and collaborative learning, increasing access to specialized training.6 Our goal was to implement learning from prior education research, which demonstrated that adaptive expertise can be cultivated in frontline workers through education that emphasizes collaboration, invites uncertainty, and integrates diverse perspectives towards problem-solving ambiguous problems.1 To evaluate impact, we conducted a qualitative study including thematic analysis7 of participant observation and interviews over the course of three ECHO cycles, including interviews 3-6 months post-participation.

Results

Participation in the ECHO was robust, with significant on-camera engagement ( >80%). Participants attributed success of the ECHO to key themes: explicit value placed on diverse kinds of knowledge (not simply clinical knowledge), emphasis on approaches for navigating ambiguity in care of complex patients/clients, and engagement in perspective exchange for integrated, team-based care. Participants demonstrated evidence of adaptive expertise and attributed this learning to the ECHO – namely that difficult problems are difficult for everyone, even for experts; and thus require a collaborative approach. Participants described instances where they collaborated with other services (clinical and community) based on their experience in the HIV Psychiatry ECHO. Participants attributed this collaborative behavior to being part of a community of practice, and also having a clearer idea of what psychiatry or other mental health roles can offer their clients. Importantly, stigma against psychiatry – or minimal awareness or belief that psychiatry can help – were important barriers for frontline workers to engage psychiatric services for their clients before attending the ECHO.

Discussion

Beyond learning about psychiatric care or offerings, the ECHO model created a psychologically safe learning environment to challenge stigma, engage in perspective exchange, and facilitate adaptive expert abilities.

Conclusion: Integrated care is essential for our most complex patients, and yet few initiatives support the acquisition of integrative competencies necessary for its implementation. Here we demonstrate that educational initiatives can support frontline staff towards adaptive expert skills.