Supporting Documentation - Sole Source UNMHSC COVID-19 ECHOs.pdf

The ECHO Institute, University of New Mexico Health Sciences Center

UNM • MSC-074245, 1 University of NM, Albuquerque, NM, 87131• Phone (505) 750-3246 • Fax (505) 272-6906

July 9, 2020

MEMORANDUM

TO: Chris Fore, PhD

Director, TeleBehavioral Health Center of Excellence

FROM: Joanna G. Katzman, MD, MSPH

Bruce B. Struminger, MD, MA

Senior Associate Directors

The ECHO Institute

RE: Sole Source Contract Justification: Project ECHO’s COVID 19 Work and IHS Experience

Summary: The ECHO Institute has a unique capacity to deliver telementoring to IHS Clinicians on a variety of medical and public health topics, and has successfully collaborated with IHS since 2009. The ECHO model delivers education in evidence-based practices, using adult learning approaches that encourage dialogue among participants and subject matter experts, and are informed by the practice context, including rurality and culture.

Throughout the history of this collaboration, ECHO faculty has worked with IHS experts and session participants to ensure that program content reflects an understanding of American Indian cultures and patients, and meets the needs of practitioners, community support staff and patients. ECHO faculty include physicians, advanced practice clinicians, addiction psychiatrists, behavioral health providers, community health representatives, and nurses. Previous IHS-ECHO and IHS-UNM collaborations have built a foundation of trust with participants across Indian Country, and resulted in joint development of educational materials and approaches to care.

The COVID-19 pandemic has disproportionately affected AI/AN communities. Healthcare providers serving those communities are in urgent need of ongoing training and support in best practices to treat the virus and prevent ots spread. The ECHO Institute proposes to build on its long history of collaboration with the IHS to strengthen the clinical and public health capacity of healthcare practitioners and community health representatives serving AI/AN populations. ECHO will work with IHS subject matter experts and community stakeholders to develop training and telementoring programs to rapidly disseminate COVID-19 best practices among those providers.

Background: The ECHO Institute’s IHS collaborative efforts have included: Chronic Pain and Opioid Management ECHO, Indian Country HCV ECHO, Indian Country HIV ECHO, Indian Health Service TB ECHO, and IHS Rheumatology ECHO. In addition, the Community Health Worker (CHW) program at ECHO has multi-year experience training community health representatives (CHRs) in diabetes care, cardiovascular disease and stroke prevention, and peer support for patients in recovery or seeking treatment for OUD and chronic pain. Currently, the CHW team is completing a project with the CDC and AASTEC to train CHRs related to primary care skills. The ECHO Institute has developed IHS Enduring Continuing Medical Education for many conditions. As infectious disease outbreaks have occurred, the ECHO Institute was able to leverage its established IHS-ECHO network to rapidly convene subject matter experts for one-time sessions to train IHS clinicians.

UNM • MSC-074245, 1 University of NM, Albuquerque, NM, 87131• Phone (505) 750-3246 • Fax (505) 272-6906

Previous Collaboration Between UNM and Indian Health Service related to Pain and Substance Use Disorder:

In 2013, the UNM Pain Center and ECHO Pain Faculty began a formal collaboration with the IHS. Pain Center faculty launched an IHS Pain and Opioid ECHO that responded to the specific cultural needs of patients suffering with chronic pain and opioid substance use disorder. This led to the development of the first mandated pain and opioid training in the country for Federal clinicians. Prospective research, co-authored by IHS and UNM Pain Faculty demonstrated that the several thousand clinicians who participated in this 5-hour virtual training improved their knowledge, self-efficacy, and stated that it was relevant to their practice1. Between 2016-2019, the ECHO Pain team travelled to 6 IHS regions to deliver hands-on pain skills courses and medication assisted treatment trainings to IHS clinicians. Dr. Snehal Bhatt serves as the official IHS consultant for addiction and he frequently travels to the IHS combined council meeetings. In addition, both Drs. Bhatt and. Katzman are frequently consulted regarding information needed on the Heroin and Opioid Prevention and Education Committee (HOPE).

Project ECHO and IHS COVID-19 response: Since the U.S. outbreak of COVID-19, Project ECHO faculty, IHS and other national experts have collaborated to implement just-in-time ECHO progams and sessions delivering content that focuses on improving patient care, minimizing the risk to staff, and supporting staff resiliency. Total attendance numbers for the period March 15-June 30 are in parentheses after each description.

IHS/Project ECHO COVID Webinars, delivering weekly updates on COVID 19 by an expert panel of IHS leadership and other national experts, with attendance from across the US (2,864)

COVID 19 Multi-Specialty ECHO, updating COVID-19 epidemiology, its impact on communtities and sovereign nations, and best practices for testing, initiating treatment and containing viral spread (2,021).

COVID 19 Infectious Disease ECHO, discussing COVID-19 as an infectious disease, including best practices for decontamination,care delivery, and emerging treatment research (2,601).

COVID Critical Care ECHO, discussing critical care approaches to the COVID-19 patient for hospitalists and frontline practitioners treating or transferring patients to hospitals (1,309).

First Responder Resiliency ECHO, assisting all frontline and direct care personnel to identify and manage their COVID-related stress and trauma (2,473).

Community Health Worker COVID ECHO, delivered in separate English and Spanish sessions ,to assist CHWs and CHRs with COVID-19 community education and response. (598 English/324 Spanish sessions).

COVID-19 ECHO attendance (March 11- June 25) for New Mexico practitioners serving the highest impact counties for Navajo and Pueblo COVID-19 illness appears below:

1 Katzman, J. G., Fore, C., Bhatt, S., Greenberg, N., Griffin Salvador, J., Comerci, G. C., ... & Bradford, A. (2016). Evaluation of American Indian health service training in pain management and opioid substance use disorder. American journal of public health, 106(8), 1427-1429.

McKinley County 223

Sandoval County 269

San Juan County 148

UNM • MSC-074245, 1 University of NM, Albuquerque, NM, 87131• Phone (505) 750-3246 • Fax (505) 272-6906

The proposed new ECHO Institute contract intends to address the urgent and compelling needs for: rapid dissemination of evidence-based COVID-19 best practices in prevention, risk reduction, screening, treatment, referral and operations; the ongoing need to address chronic pain and substance use disorder as patients’ access to care has significantly contracted; ongoing needs for community education about COVID-19 prevention and recovery; and offering skills for practitioners to respond to their own and their community’s COVID-related grief and trauma in culturally appropriate ways that build their resiliency to continue to deliver care and services.

The four new programs identified by the Indian Health Service are:

1. Substance Use and Chronic Pain teleECHO

2. Mental Health and Resiliency teleECHO

3. Community Health Worker/Representative COVID-19 teleECHO

4. COVID-19 teleECHO program

The ECHO Institute and IHS subject matter experts will build the initial curriculum for these new ECHO program offerings, and intend to involve participants in assessing their learning needs, so dynamic content will respond to them and remain culturally congruent. A combination of case-based learning and didactic presentations will remain the hallmark for these four bi-weekly programs. No-cost CME will be provided to the participants and an evaluation of the four programs will also be performed.