Leveraging the Extension of Community Health-Outcomes (ECHO) telementoring program to improve family-centered and equitable communication about early mental health risk in pediatric primary care

PROJECT SUMMARY — RESEARCH PROJECT 1 (RP1) Mental health symptoms emerge as early as the preschool years, emphasizing the need for preventive approaches that start in toddlerhood. Universal, parent-reported screening tools for toddlers in primary care can improve early detection of mental health risk, facilitate preventive intervention, and reduce child mental health

inequities related to delayed care. For toddlers who screen at risk, multiple parenting programs for this age group can improve behavioral control and prevent the development of mental health problems. However, families of

toddlers who screen positive (i.e., “at-risk”) can each be at a different stage in the process of problem recognition and readiness for engagement in services—informed by their personal experiences and beliefs, cultural background, and knowledge about development, mental health, and prevention. Furthermore, pediatric primary

are clinicians are rarely trained to discuss toddler mental health risk, and so rely primarily on their personal perspectives and comfort levels, leaving them vulnerable to implicit bias. Effective and equitable communication about early childhood mental health risk requires building clinician confidence to: (a) manage uncertainty in

prevention-oriented discussions about early childhood mental health; (b) employ anti-racist strategies for minimizing bias in decisions about what and how to communicate; and (c) engage in family-centered communication that considers families' cultural identities and experiences. Despite these challenges, there has

been little focus on how to help pediatric clinicians build confidence and competence to make decisions about and communicate with families from diverse backgrounds about toddler mental health risk. The Mental Health Earlier (MHE) ALACRITY Center Research Project 1 (RP1) addresses this gap through development and testing

of a telementoring program for primary care pediatric clinicians – Talking Early About Mental health for Equity (TEAM4Equity) – to advance equitable implementation of toddler mental health risk screening in primary care. Program development and delivery will occur in partnership with ECHO (Extension for Community Health

Outcomes) Chicago, a pioneering and widely disseminated program building workforce capacity in primary care through case-based learning series over videoconferencing. Our goals with TEAM4Equity are to improve 1) clinician self-efficacy for decision-making and communicating about toddler mental health risk and recommended

interventions, and thereby 2) families' trust and engagement with preventive mental health interventions. We will achieve our goals by 1) Collaborate with pediatric clinicians and caregivers to iteratively refine the TEAM4Equity ECHO series using human centered design methods; 2) Conduct a single-arm feasibility and acceptability test

of the TEAM4Equity curriculum- and case-based videoconferencing ECHO series; and 3) Pilot test the TEAM4Equity ECHO series in a cluster randomized controlled trial. RP1 makes an important contribution to the MHE Center via its emphasis on a unique implementation strategy to build pediatric clinician self-efficacy with

developmentally and culturally-informed decision-making and communication about toddlers' mental health risk.