Community ECHO (Extension for Community Healthcare Outcomes) Project Promotes Cross-Sector Collaboration and Evidence-Based Trauma-Informed Care
Authors: Buysse Christina A. , Bentley Barbara , Baer Linda G. , Feldman Heidi M. 
Published: July 2021

Background

Adverse Childhood Experiences (ACEs) are traumatic events that occur before age 18 years. ACEs, associated with negative health behaviors and chronic health disorders, disproportionately impact people from poor and marginalized communities. Toxic stress from ACEs can be prevented and treated with trauma-informed care. Inadequate training prevents the maternal and child workforce from providing evidence-based trauma-informed care. Cross-sector collaboration between pediatric care sectors is crucial to providing systems-wide trauma-informed care, but significant barriers impede cross sector communication. Training and formal cross-sector communication networks are needed to create strong systems of trauma-informed care in communities.

The Stanford ACEs Aware ECHO (Extension for Community Healthcare Outcomes) program was created with 3 workforce development goals: 1) introduce the California Office of Surgeon General-led ACEs Aware Initiative to the maternal and child health workforce in 3 California counties, 2) disseminate trauma-informed evidence-based best practices, 3) bridge community silos to increase collaboration between care sectors to promote trauma-informed care systems.

Methods

Participants were recruited from Federally Qualified Health Centers, county public health departments, community behavioral health organizations, educational institutions, and agencies that serve low-income children and families. 100 unique participants representing 3 counties and 54 agencies joined sessions. Twelve virtual educational sessions were convened over 6 months using the Project ECHO® model via Zoom technology. Sessions consisted of didactic lectures and whole-group case-based discussions.

Results

After completing the educational series, participants expressed commitment to increased cross-sector collaboration, and reported increased knowledge and confidence in using trauma-informed skills. After participation, a significant number of participants had also completed another recommended California ACEs Aware Initiative online training.

Conclusion

An ECHO series of virtual workforce development sessions on trauma-informed best practices promoted cross-sector communication and was associated with strong participant engagement and satisfaction. The educational series increased knowledge and confidence in use of evidence-based trauma-informed best practices.

Key Messages

Adverse Childhood Experiences (ACEs) are stressful or traumatic events that occur before the age of 18 years and are associated with high human and economic costs to society.

Evidence-based trauma-informed Care (TIC) has been shown to prevent and treat toxic stress caused by ACEs, but training programs for the maternal and child workforce have historically provided inadequate training in TIC best practices.

Cross-sector collaboration to provide systems-level trauma-informed care is known to improve population health and promote health equity, but funding and staffing barriers to optimized collaboration exist.

The Project ECHO® (Extension for Community Healthcare Outcomes) model uses distance learning teleconferencing to create learning communities across geographic distance and care sector, educate and mentor participants, and elevate quality of care in community settings.

The Stanford ACEs Aware ECHO effectively delivered a curriculum about TIC to a tri-county community of maternal and child workforce participants that promoted cross-sector collaboration. Participation was associated with high levels of engagement and satisfaction. Participants reported increased confidence and knowledge to provide systemic evidence-based TIC.