Helping Patients Find Hope: VHAN’s First Project ECHO Helps Pediatricians Manage Rising Rates of Pediatric Depression

Depression has been on the rise among youth for at least a decade, with 4.1 million adolescents having at least one major depressive episode in the past year and 12% of those experiencing severe impairment.

This situation worsened significantly during the COVID-19 pandemic when young people were separated from their schools, peers and normal social routines. Isolated and lacking socialization, these adolescents experienced negative impacts on their behavior, mood and overall outlook on the world. Many pediatricians felt ill-equipped to treat mounting behavioral health issues such as pediatric anxiety and depression. These compounding factors have created critical gaps in care.

VHAN Responds to the Crisis
The Vanderbilt Health Affiliated Network (VHAN) behavioral health team took on the challenge of managing pediatric depression by making it the subject of the network’s first Project ECHO program. Project ECHO (Extension for Community Healthcare Outcomes) seeks to address health care disparities with low-cost, high-impact interventions. The educational outreach program seeks to give patients with complex and treatable conditions greater access to the specialty care they need—particularly in underserved or remote areas.

VHAN’s first Project ECHO—”Managing Mild to Moderate Depression in Primary Care”—ran for eight biweekly sessions from September 2022 to December 2022. Led by Margaret Benningfield, MD, director of the Division of Child and Adolescent Psychiatry, and Melissa Cyperski, PhD, licensed clinical psychologist, the program focused on educating pediatricians about depression and giving them mental health resources tailored to young patients. These experts were joined by Terri Brady, VHAN’s senior director of network development, and Danielle McDonough, licensed clinical social worker.

Pediatricians receive very little psychology education during their residency, so they often refer young patients to specialists,” McDonough explains. “Unfortunately, psychiatry access is minimal, and patients wait a long time for mental health care.

“We want pediatric providers to be able to provide mental health diagnoses and interventions to their patients in the primary care setting,” she continues. “With the support of a consulting psychiatrist, pediatricians and pediatric nurse practitioners can talk these kids through a medication plan and provide effective treatment, ultimately giving them quicker access to care.”  

How Project ECHO Works
Now a global health movement, Project ECHO was founded in 2003 by Dr. Sanjeev Arora at the University of New Mexico. The program has been used to improve health care outcomes in numerous disease areas following these principles:

  • Use technology to leverage scarce resources
  • Share best practices to reduce disparities
  • Apply case-based learning to master complexity
  • Evaluate and monitor outcomes

In VHAN’s Project ECHO sessions, participants were asked to watch a pre-recorded didactic video before each session. During the 60-minute session, 20 VHAN pediatricians discussed real cases with VHAN behavioral health subject matter experts, learning from each other in an “all-teach/all-learn” environment.

Topics covered included initial assessment and diagnosis, the stress/depression connection, medication management, and risk assessment and safety planning for depressed adolescents. Participants also discussed the social stigma around families affected by mental health challenges. The virtual meeting format helped attendees maximize their limited time together.

“These were rich and lively discussions,” says Dr. Cyperski. “VHAN pediatricians were open and honest about the support they need, and about the complex cases they experience day-to-day. The group provided much-needed validation and support as well as new strategies they could use to address critical behavioral health concerns.”

A Growing Behavioral Health Toolkit
VHAN’s Project ECHO program is a natural extension of the behavioral team’s continuing efforts to assist pediatricians with level-of-care determinations and navigate patients and families through clinical care services. These efforts include a Pediatric Behavioral Health Consult Line available weekdays from 9 a.m. to 5 p.m., as well an ongoing series of educational webinars.

“Drs. Benningfield and Cyperski are committed to helping our pediatricians feel more comfortable addressing mental health in their practice,” Brady says. “After Project ECHO was over, they opened their offices to attendees and set aside time to answer questions over the Zoom and Microsoft Teams platforms.”

VHAN’s Project ECHO yielded significant benefits: building community, fostering collaborative relationships and closing the time gap for young people to receive psychiatric help. But Dr. Benningfield identifies one key takeaway that can’t be so easily quantified.

“For many of our pediatricians, the primary intervention here is hope,” she says. “When we asked them to reflect at the end of the ECHO sessions, they said they felt more confident and more comfortable talking with kids and families about depression. To be able to share with families that they’re not alone and that this team is available to partner with them—that’s a huge intervention in itself.”

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