Nursing Facility Behavioral Health ECHO Program

The Nursing Facility Behavioral Health ECHO Program cohort 1 was a 24-session group telementoring program by the Oregon ECHO Network designed to improve the knowledge, confidence, and skills of nursing facility staff so they can better recognize the signs and symptoms of mental health issues, support appropriate use of medications, and deliver psychosocial and behavioral support interventions for nursing facility residents with mental health conditions or concerns. The Nursing Facility Behavioral Health ECHO Program used Project ECHO methodology to deliver the project. The overall project purpose was to develop more knowledgeable and skilled front-line nursing facility staff who are better equipped to deliver person-centered care to address their residents’ mental health concerns and behavioral issues.

Initially developed at the University of New Mexico in 2003, Project ECHO is a telementoring format that builds the capacity of participants to manage common conditions that they typically refer to specialists outside of their setting. Using a simple webcam and basic technology, staff from 20 nursing facilities connected through an internet platform to collectively interact with specialists in geriatric mental health, including a geriatric psychiatrist, occupational therapist, gerontologist/psychiatric nurse practitioner, nurse, and licensed social worker. The sessions lasted 90 minutes, and included a 15 minute practical, process-oriented expert presentation by a specialist(s), and discussion of two cases with specialists and nursing facility participants. All cases were de-identified and the nursing facility staff maintained responsibility for care of any residents that were discussed.

The Nursing Facility Behavioral Health ECHO Program in Oregon built upon the success of University of Rochester’s program devoted to geriatric mental health for long term care. Since the program launch in 2014, University of Rochester’s program has engaged more than 50 nursing facilities in ten counties in New York State. University of Rochester’s programs were externally evaluated by New York Academy of Medicine staff and an article that shares program results is summarized in the journal Population Health Management. Among other results, such as positive shifts in the prescription of medications, Fisher et. al’s 2017 Population Health article shared that nursing facility team participation in ECHO resulted in a 24% reduction in emergency department room costs per resident included on that nursing facility team’s panel.[1]

The Oregon Rural Practice-based Research Network (ORPRN) worked closely with the Oregon Health Authority Health Systems Division and the specialist panel to create the 24 session ECHO program that met every other week for 90 minutes. With leadership from the core team, the specialist faculty presented didactic presentations and provided expertise during the case presentations.

The program provided information to nursing facility staff and nurses regarding screening, treatment, and diagnosis of geriatric mental health and cognitive issues. This information concentrated on issues that older adults commonly face including depression, anxiety, dementia, stress disorder, substance use, and behavioral issues (such as paranoia and others). Didactic sessions focused on evidence-based best practices for behavioral treatment, psychiatric medication management, social services, and caregiver support. Participants were invited to present cases related to challenges they face in caring for nursing facility residents with mental health conditions or concerns.

For more information about the program contact, Maggie McLain McDonnell at

[1] Fisher Elisa, Hasselberg Michael, Conwell Yeates, Weiss Linda, Padrón Norma A., Tiernan Erin, Karuza Jurgis, Donath Jeremy, and Pagán José A.. Population Health Management. January 2017, ahead of print. doi:10.1089/pop.2016.0087