School Counselor Telementoring with Project ECHO

The Virginia Partnership for School Mental Health (VPSMH) is a statewide partnership that aims to:

1. Improve school mental health services by improving the pipeline of graduate students in school counseling, school social work and school psychology.
2. Improve the capacity of school mental health professionals through professional learning activities.
3. Build an interprofessional network of school mental health professionals.

The partnership includes nine universities, nine school divisions, and the Virginia Department of Education. One method through which we have achieved our objectives is telementoring.

Telementoring involves training and support practices conducted virtually, emphasizing collaborative relationships among various groups and individuals. One specific telementoring approach is Project ECHO (Enhancing Community Health Outcomes), which originated from the University of New Mexico to improve case consultation among medical professionals. The ECHO model has evolved and expanded into various disciplines, including education and school mental health.

The ECHO model consists of regularly scheduled live virtual meetings with an interdisciplinary team of four to five university faculty, referred to as the “hub,” who have research experience and content knowledge, alongside 20–30 community providers referred to as the “spokes.” The VPSMH engages university faculty representing the school mental health fields such as school counseling, school psychology and school social work. The participants are school mental health professionals employed by our partner school districts.

ECHO sessions are designed to cultivate a sense of community among participants in which “all teach, all learn.” The framework of the program offers participants opportunities to engage in case conceptualization and interdisciplinary collaboration, and to make research-informed decisions to support student mental health. Below is a synopsis of an ECHO.
 

Anatomy of a VPSMH ECHO

When?

• One hour each month, September through May, for nine total sessions.

Who?

• Hub Team: university faculty and school district leaders (4–5)
• Spokes: school mental health providers (20–30)
• Moderator: university faculty or staff member, or doctoral student
• Technology Support: one staff member

Pre-ECHO
A few weeks before the scheduled ECHO, the moderator emails the participants to request case submissions. The moderator reviews the submitted cases and selects one that they believe will be most beneficial for the entire group. They collaborate with the case presenter to create a PowerPoint presentation (using a simple template) to ensure that the information is anonymized and concise. A few days before the ECHO, the moderator sends the case materials to the hub team to review in advance. The hub team meets 30 minutes before the scheduled ECHO to discuss the case.

ECHO Session
The first 5-10 minutes of each ECHO involve introductions, intended to build and sustain community. The moderator facilitates the introductions and calls each participant by name. Participants unmute and state their name, role  and school district. After introductions, the moderator presents a didactic session for approximately 15 minutes. The goal of the didactic is for each participant to leave with a relevant skill. For example, a recent didactic was titled, “Broaching Race with Colleagues” and the moderator provided participants with several methods and sentence stems to broach race. The remainder of the ECHO focuses on the case presentation and discussion. A spoke, or practitioner, delivers the brief, anonymized, case presentation with the following format: 

• Guiding question: Each case presentation begins with a guiding question that the presenter designs to ensure they receive relevant feedback. For example, “How can I, a high school counselor, best support a student a student returning to school after several short-term psychiatric hospitalizations?”
• Relevant background information: Presenter discusses important information about the student and/or family.
• Strengths and challenges: Presenter discusses student strengths and challenges, current and/or previous.
• Current and previous interventions: Presenter outlines interventions that have been implemented, along with relevant information concerning length of implementation and results.
• Repeat guiding question: The presenter repeats the guiding question to ensure the discussion remains focused on the presenter’s needs.
• Clarifying questions: The moderator opens the floor for the hub and spokes to ask questions of the presenter. The moderator ensures that questions are relevant to the case and guiding question. This portion typically takes 10–15 minutes.
• Recommendations: After questions are posed, the moderator asks participants to provide relevant recommendations to assist the case presenter with the guiding question. This process takes 10–15 minutes.
• Summary: The moderator summarizes recommendations and asks the case presenter which interventions they plan to implement.

Afterwards, the ECHO is dismissed, and the hub team transitions into a breakout room to debrief. During the debrief, the hub team finalizes recommendations, and the moderator emails the final recommendations to the group. The moderator then follows up with the case presenter in 3–4 weeks.

In summary, ECHOs represent a viable and sustainable method for assisting school mental health professionals in addressing challenging problems of practice. The structure of an ECHO provides school mental health providers with opportunities to participate in community building, case consultation, case conceptualization and supervision. ECHOs offer a feasible and accessible means for school mental health providers to collaborate and engage in relevant, continuous professional learning.

Julia V. Taylor, Ph.D., is an associate professor at the University of Virginia and co-director of the Virginia Partnership for School Mental Health.