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Erika Harding explains Project Echo

Erika Harding explains Project ECHO at Billings Clinic.

Billings Clinic rolled out on Wednesday a new program aimed at connecting mental health and substance abuse experts with Montana Department of Corrections clinicians in order to offer a wider range of expertise and knowledge in treating offenders.

Called Project Extension for Community Healthcare Outcomes (ECHO), the effort is the first Montana-based hub of a global initiative of the same name headquartered in New Mexico that works to team clinicians in smaller or rural areas with larger panels of specialists at medical centers through weekly virtual meetings.

"Our vision is really to expand upon the mental health care that we already provide," said Tricia Ayers-Weiss, the Department of Corrections clinical services division bureau chief.

The Montana panel, led by Billings Clinic, will initially include a psychiatrist, pharmacist, nurse and social worker, along with personnel from the Rimrock Foundation and the Montana Department of Corrections.

Beginning as soon as February, the panel will meet with behavioral health and addictions clinicians who work with offenders within the Department of Corrections getting ready to transition back into the community, going over related topics and spending an hour or so of members lending their individual expertise to specific cases.

The idea is that they can share their expertise and knowledge with the workers to improve the overall care of the people being treated while at the same time educating the clinicians.

"They feel empowered," said Dr. Eric Arzubi, Billings Clinic's psychiatry chair. "It helps the clinicians and it helps the patients. It's a win-win."

The Project ECHO hub will start out as a pilot, working initially only with the Passages Women's Pre-release center in Billings and will take on at most 40 weekly cases and consultations.

However, the goal is to expand its reach to other areas of the DOC, including other prerelease centers and possibly the state prisons.

Ayers-Weiss said that increasing the access to collaboration with the panel will help to address the limited access to psychiatric services within the Department of Corrections, all with the goal of preparing offenders to move back into the community.

"If we invest now in mental health before they get out, it sets them up before they're out to be successful," she said.

Arzubi said that, ultimately, he'd like to see it grow outside the corrections community.

"What we're trying to do with our next iteration is to provide support to primary care around the state," he said.

He called the lack of mental health services and workers in Montana a crisis and said that, while Project ECHO wouldn't put new workers into rural areas, it could help physicians and other medical staff in treating mental health or addiction issues they didn't have the resources or education to treat before.

"Let's take that knowledge and disseminate it," Arzubi said. "It's access to knowledge."

A $66,000 grant to Billings Clinic from the Montana Mental Health Trust in late 2015 is helping to fund the project.

Erika Harding, director of replication initiatives with the ECHO Institute at the University of New Mexico, said that the project's broader goal is to share knowledge and improve care through connecting experts through technology, sharing best practices, addressing complex issues through case-based learning and building a database to monitor results.

Project ECHO was developed by Dr. Sanjeev Arora, who was working to treat Hepatitis C in rural and underserved New Mexico, as a way for primary care physicians to treat people in their own communities.

Since then it has grown to operate 72 hubs focusing on more than 45 diseases, conditions or issues in 22 states and six countries.

"This is not a telemedicine model," Harding said. "This is a capacity-building model ... The point of ECHO fundamentally is to de-monopolize knowledge."

Officials will evaluate the Montana hub after six weeks and begin a formal evaluation in November.

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