Capacity Building in Mental Health for Bihar: Overview of the 1-Year Blended Training Program for Nonspecialist Medical Officers.

Objective The aim of this study is to give an experiential overview of a 1-year blended training program for nonspecialist medical officers (primary care doctors; PCDs) of Bihar State of India. The training program was aimed to enable PCDs identify, diagnose, and treat commonly presenting psychiatric disorders in primary care Methods PCDs had a brief onsite orientation program to psychiatric practice at National Institute of Mental Health and Neuro-Sciences (NIMHANS), followed by 10 months of online blended training. The online program followed the NIMHANS Virtual Knowledge- Extension for Community Healthcare Outcomes (ECHO) model, that is, a hub and spokes model of training Results Twenty-two PCDs participated in this program. Eleven of them got accredited at the end. The onsite orientation consisted of exposure to various psychiatry facilities at NIMHANS, in addition to learning psychiatric history taking and mental status examination. The ECHO model of online learning consisted of fortnightly sessions, lasting 2 hours each. There were 20 such sessions. Each session consisted of a didactic lecture by the psychiatrist followed by a case discussion. The cases were presented by PCDs, moderated by the hub specialists (NIMHANS). At the end of the training, participants rated an average of 4.5/5 on the mode, content and relevance of training and increase in knowledge due to the training. Around 23,000 patients were cared for during the said 1 year by the trained PCDs. Conclusion Training PCDs in a manner that enables retaining the learnt skills is feasible. However, rigorous evaluation protocols are needed in order to test this in a systematic fashion.

Profile of cases discussed in innovative tele-ECHO mentoring program on addiction management.

NIMHANS ECHO (Extension for Community Healthcare Outcomes) model uses a video conferencing app to connect multiple community health care teams simultaneously with addiction treatment specialists and builds treatment capacity via mentorship and case-based learning. The aim was to investigate the characteristics of 102 cases discussed by remote community health providers in 28 weekly tele-ECHO addiction clinics between January to July 2019. Among the presented cases, the lifetime and current use of alcohol was 80 % and 71 %, respectively, and that of tobacco was 60 % and 56 %. Results revealed that only 18.6 % of cases fulfilled ICD 10 criteria for alcohol dependence. Among alcohol users, the mean AUDIT score was 20.6. The patients presented to the community health providers earlier than that of the specialist treatment center. Hence this technology-enabled ECHO model can be considered for capacity building and increase access to care, particularly in low and middle-income countries where there is a significant scarcity of trained human resources.

Effectiveness of NIMHANS ECHO blended tele-mentoring model on Integrated Mental Health and Addiction for counsellors in rural and underserved districts of Chhattisgarh, India.

The present study was conducted to ascertain the effectiveness of Project ECHO, a Hub and Spokes tele-mentoring model to bridge the urban-rural divide in mental health and addiction care in the context of a developing country like India. The Counsellors from 11 rural and underserved districts of Chhattisgarh were periodically connected to NIMHANS multidisciplinary specialists by smartphone app and underwent virtual mentoring to learn and translate "best practices" in Mental health and Addiction by using "patient-centric learning", a core component of NIMHANS ECHO model. The outcome evaluation was modelled on Moore's evaluation framework focusing on participant engagement, satisfaction, learning, competence and performance. Over the period of 6 months i.e. 12 tele-ECHO clinics, 41 patients case summaries were discussed by the Counsellors with NIMHANS Hub Specialists. Half of the counsellors could join >80% clinics and overall there were no drop-outs. There was a significant increase in learning and self-confidence after six months. The participants liked "relevance of the courses to clinical practices". "group based discussions" and "a reduction in professionals isolation". The results indicate promise of the NIMHANS ECHO tele-mentoring model as one with potential for capacity-building in mental health and addiction for remote and rural areas by leveraging technology.