Staff Perspective: Using Project ECHO® to Address the Needs of Military-Connected Youth

Staff Perspective: Using Project ECHO® to Address the Needs of Military-Connected Youth

Dr. Andrea Isreal

There have been several points in my career where I was the sole (or sole pediatric) provider in a particular area. I remember those periods with a mixture of emotions: gratitude for the opportunity to serve those in need coupled with concern that I lacked geographically close colleagues or referral options for my patients. Consultation with colleagues (usually far away) was a lifeline and a way to ensure I offered the best evidence-based care I could, especially when patients were on long waitlists for referrals to other specialists who needed to be involved in their care. Nonetheless, at times I felt like I was operating within the echo chamber of my mind (pun intended).

I have no doubt these experiences were part of what drew me to my current work at the Center for Deployment Psychology, where I have the great fortune to participate in the DoD Child Collaboration Study along with our partners at Kennedy Krieger Institute, Georgetown University, the University of Minnesota, and other departments at USUHS (Pediatrics and Family Medicine). The study is an innovative effort to use telehealth and other technology-based approaches to address disparities in access to care and support for the approximately 20% of military-connected youth with mental health, emotional, developmental and/or behavioral (MEDB) needs (Eunice Kennedy Shriver National Institutes of Child Health and Human Development, 2014; Perkins et al., 2021; Defense Health Board, 2017).

One arm of the study is assessing the role of Project ECHO® in enhancing professionals’ readiness to address the unique needs of military-connected youth with complex MEDB conditions, wherever those professionals and military-connected youth may be.

What is Project ECHO®?
Project ECHO® was developed by Dr. Sanjeev Arora in 2003 as an effort to decrease wait times in his clinic and increase access to specialized care for the patients he served. Conceptually, the idea was to use a tele-consultative model to take knowledge to the patients, versus physically bringing patients to the knowledge (University of New Mexico Project ECHO®, 2023).

As a model for increasing professional expertise, Project ECHO® uses an “all teach, all learn” philosophy in a hub-and-spoke model. More specifically, a hub of professionals provides brief didactics, and participants in the spokes join the hub in offering consultation to a participant who presents a case. The case consultation in combination with telementoring is intended to be a force multiplier: more patients get access to better care while more providers increase their confidence and competence to address patient needs while decreasing feelings of isolation.

While Project ECHO® was conceptualized and initially implemented within healthcare, it has been extended to many other disciplines, including education and social services (Bessell et al., 2023; Zhou et al., 2016). There are currently almost 6,500 Project ECHO® programs, with hubs in 63 countries and participants in 191 countries (University of New Mexico Project ECHO®, 2023). In addition, the ECHO model has been utilized by the U.S. military to enhance outcomes for specific conditions (such as amputee care, diabetes, and pain management) and support of better care to active duty service members and their dependents (Katzman et al., 2021).

Using Project ECHO® to Support Access to Efficacious Care for Military-Connected Kids
The United States continues to be experiencing an uptick in identification of behavioral health needs amongst youth (The U.S. Surgeon General’s Advisory, 2021), which includes (but is not specific to) military-connected youth. Access to evidence-based care is not always readily available, serving as a potential barrier to addressing widespread youth MEDB needs. Importantly, access to healthcare for youth with special healthcare needs is a challenge for military-connected youth with TRICARE, much as it is for civilian youth with similar needs (Hero et al., 2021). However, for military youth with an active duty parent, continuity in medical care can be an additional barrier to receiving high-quality care, particularly due to frequent relocations associated with Permanent Change of Station (PCS; Hero et al., 2021).

The DoD Child Collaboration Study uses Project ECHO® to help build professionals’ capacity to deliver evidence-based, culturally competent treatments to military youth, wherever they may be. As I describe further below, the study is using the Project ECHO® model in several geographic areas and targeting different military-connected child needs. I intentionally stated “professionals” instead of “providers” as the study’s current Project ECHOs® span healthcare and educational environments.

I have greatly enjoyed the opportunity to work with our partners on this aspect of the study, including participating in the hub of some of the Project ECHOs® at Kennedy Krieger Institute and a school-based one with Georgetown University. Dr. Erin Frick, Psy.D. and I were pleased to present some of our early findings at the AMSUS Annual Meeting this year (Frick et al., 2024), where we reported that providers participating in the initial DoD Child Collaboration Project ECHOs® identified themselves as experiencing increased confidence while also increasing their knowledge on the topics presented in the series. As a provider who has previously found herself isolated from colleagues, I am especially proud that our study’s Project ECHOs® are also supporting professionals’ feelings of connectedness with colleagues.

Learning More
The DoD Child Collaboration Study’s Project ECHOs® are open to all military and civilian professionals who would like to participate in learning more about how to utilize best practices to support military-connected youth. Organized by the hosting organization, the study’s Project ECHOs® include:

Current Offerings from Kennedy Krieger Institute:

Current Offerings from Georgetown University:

  • Georgetown CAP-ECHO for Primary Care Providers: target audience is pediatric and family medicine practitioners who treat youth in military families with focus on adolescent (age 9-21) mental health.
  • Provider ECHO Registration:
  • Georgetown CAP-ECHO for Schools: target audience is educators and school-based clinicians who work in schools serving youth in military families.
  • School ECHO Registration:

Current Offerings from the University of Minnesota:

To learn more about Project ECHO®, please visit

To learn more about the DoD Child Collaboration Study, please visit

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Andrea Israel, Ph.D., is a clinical psychologist serving as a Military Behavioral Health Child Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Bessell, E., Kim, J. S., Chiem, L., McDonald, A., Thompson, D., Glozier, N., Simpson, A.,
     Parcsi, L., Morris, R., & Koncz, R. (2022). Effectiveness of project echo programs in
     improving clinician knowledge and confidence in managing complex psychiatric
     patients: A waitlist-controlled study. Academic Psychiatry, 47(1), 25–34.

Defense Health Board. (2017). Pediatric health care service report.

Eunice Kennedy Shriver National Institutes of Child Health and Human Development. (2014).
     Military connected children with special health care needs and their families: Conference
     summary and recommendations. milies_Summary.pdf

Frick, E., Crockett, J., Israel, A., Heflin, K., Leppert, M., Williams, J., Steinberg, J., Tash, J.,
     Paxton Willing, M. M., & Riggs, D.S. (2024, February 12-13). DoD Child Collaboration
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Hero, J. O., Gidengil, C. A., Qureshi, N. S., Tanielian, T., & Farmer, C. M. (2021). Access to
     health care among TRICARE-covered children. RAND Corporation.

Katzman, J., Tomedi, L., Swift, R., Castillo, E., Morrow, C., Lutz, L., Galloway, K. T.,
     McCoy-Stafford, K., Klein, Z., Turner, G., Beckman, D. J., Terrell, J., Forde, S., Martin,
     C., & Morgan, S. (2021). Extension for community healthcare outcomes (ECHO)
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Perkins, E. M., Sorensen, I., Susi, A., & Hisle-Gorman, E. (2021). The impact of having a child
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University of New Mexico Project (UNM) ECHO (2023). Project ECHO 2022 Annual Report.
     Available at:

U.S. Surgeon General’s Advisory (2021). Protecting youth mental health. Available at:

Zhou, C., Crawford, A., Serhal, E., Kurdyak, P., & Sockalingam, S. (2016). The impact of
     Project ECHO on participant and patient outcomes. Academic Medicine, 91(10),