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The Influence of Project ECHO and Integrated Behavioral Health in Primary Care on Emergency Department Visits Among

Jessica M McClure1,2, Constance A Mara3,4, Lori J Stark3,4

  • 1Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC15018, Cincinnati, OH, 45229, USA. jessica.mcclure@cchmc.org.

The Journal of Behavioral Health Services & Research
|January 9, 2025
PubMed

Insights

Integrated behavioral health services significantly reduced youth depression emergency department visits. Project ECHO alone or combined with integrated care did not show similar impacts on reducing these visits.

Area of Science:

  • Pediatric primary care
  • Mental health services research
  • Public health

Background:

  • Youth depression rates and emergency department (ED) visits for untreated symptoms are increasing.
  • Early identification and intervention for depression are critical across all healthcare levels.
  • Pediatric primary care settings are key locations for addressing youth mental health needs.

Purpose of the Study:

  • To evaluate the impact of Project ECHO and integrated behavioral health (IBH) services on mental health-related ED visit rates among youth diagnosed with depression.
  • To compare outcomes between practices with and without IBH programs.
  • To assess the combined effect of Project ECHO and IBH.

Main Methods:

  • A binominal mixed-effects model analyzed monthly data from 5,388 youth diagnosed with depression across 28 pediatric practices (2019-2022).
  • The study compared mental health-related ED visit rates in practices with and without IBH, and examined the role of Project ECHO participation.
  • Statistical analysis included incident rate ratios (IRR) and confidence intervals (CI).

Main Results:

  • Practices implementing IBH showed a significantly lower rate of mental health-related ED visits compared to those without IBH (IRR=0.80, p=0.005).
  • No significant impact was found for Project ECHO participation alone on ED visit rates.
  • There was no significant interaction effect between Project ECHO and IBH combined.

Conclusions:

  • Integrated behavioral health services in pediatric primary care are effective in reducing mental health-related ED visits for youth with depression.
  • Project ECHO, in isolation or combination with IBH, did not demonstrate a significant effect on reducing these ED visits in this study.
  • Findings support the integration of behavioral health services as a strategy to improve care and reduce acute care utilization for pediatric depression.

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