Pediatric behavioral health (BH) conditions are present in approximately 20% of children. Primary care providers are assuming more aspects of their patients’ BH care and desire education about common BH conditions. A primary care BH Extension for Community Healthcare Outcomes (ECHO) program conducted bi-monthly tele-educational sessions to community pediatricians in a health network. Sessions provided best practice information about a variety of BH topics. Participants completed surveys about satisfaction with the educational program and self-assessment of confidence and competence in treating BH disorders before and after the ECHO program. Survey results showed providers reported increased knowledge and competence in many aspects of BH care including screening, providing education, management (BH strategies and medication), and knowledge of resources. A BH ECHO program is a promising approach to addressing the challenges primary care providers face in caring for youth with BH needs.
BitskoRHClaussenAHLichsteinJ, et al. Mental health surveillance among children—United States, 2013-2019. MMWR Suppl. 2022;71(2):1-42. doi:10.15585/mmwr.su7102a1
ShimRSzilagyiMPerrinJM.Epidemic rates of child and adolescent mental health disorders require an urgent response. Pediatrics. 2022;149(5):e2022056611. doi:10.1542/peds.2022-056611
4.
ShahidullahJDHostutlerCACokerTRAllmon DixsonAOkorojiCMautoneJA.Child health equity and primary care. Am Psychol. 2023;78(2):93-106. doi:10.1037/amp0001064
NjorogeWFMHostutlerCASchwartzBSMautoneJA. Integrated behavioral health in pediatric primary care. Curr Psychiatry Rep. 2016;18(12):106. doi:10.1007/s11920-016-0745-7
7.
WilliamsJKlinepeterKPalmesGPulleyAFoyJM.Diagnosis and treatment of behavioral health disorders in pediatric practice. Pediatrics. 2004;114(3):601-606. doi:10.1542/peds.2004-0090
8.
BrisendineAETaylorEGriffinSDuerJ.Children’s behavioral and mental health in primary care settings: a survey of self-reported comfort levels and practice patterns among pediatricians. Fam Syst Health. 2024;42:608-613. doi:10.1037/fsh0000867
9.
Committee on Psychosocial Aspects of Child and Family Health and Task Force on Mental Health. The future of pediatrics: mental health competencies for pediatric primary care. Pediatrics. 2009;124(1):410-421. doi:10.1542/peds.2009-1061
10.
HorwitzSMStorfer-IsserAKerkerBD, et al. Barriers to the identification and management of psychosocial problems: changes from 2004 to 2013. Acad Pediatr. 2015;15(6):613-620. doi:10.1016/j.acap.2015.08.006
11.
BettencourtAFFerroRAWilliamsJL, et al. Pediatric primary care provider comfort with mental health practices: a needs assessment of regions with shortages of treatment access. Acad Psychiatry. 2021;45(4):429-434. doi:10.1007/s40596-021-01434-x
12.
CooperSValleleyRJPolahaJBegenyJEvansJH.Running out of time: physician management of behavioral health concerns in rural pediatric primary care. Pediatrics. 2006;118(1):e132-e138. doi:10.1542/peds.2005-2612
13.
ArrojoMJBrombergJWalterHJVernacchioL.Pediatric primary-care integrated behavioral health: a framework for reducing inequities in behavioral health care and outcomes for children. Pediatr Clin North Am. 2023;70(4):775-789. doi:10.1016/j.pcl.2023.04.004
14.
HostutlerCWolfNSniderTButzCKemperARButterE.Increasing access to and utilization of behavioral health care through integrated primary care. Pediatrics. 2023;152(6):e2023062514. doi:10.1542/peds.2023-062514
15.
SorterMStarkLJGlauserT, et al. Addressing the pediatric mental health crisis: moving from a reactive to a proactive system of care. J Pediatr. 2024;265:113479. doi:10.1016/j.jpeds.2023.113479
16.
ZhouCCrawfordASerhalEKurdyakPSockalingamS.The impact of project ECHO on participant and patient outcomes: a systematic review. Acad Med. 2016;91(10):1439-1461. doi:10.1097/ACM.0000000000001328
17.
MaizelJFilippSLZoriG, et al. Project extension for community healthcare outcomes intervention evaluations: a scoping review of research methods. J Contin Educ Health Prof. 2025;45(2):89-100. doi:10.1097/CEH.0000000000000572
18.
Osei-TwumJAWilesBKillackeyTMahoodQLallooCStinsonJN.Impact of project ECHO on patient and community health outcomes: a scoping review. Acad Med. 2022;97(9):1393-1402. doi:10.1097/ACM.0000000000004749
19.
HagerBHasselbergMArzubiE, et al. Leveraging behavioral health expertise: practices and potential of the project ECHO approach to virtually integrating care in underserved areas. Psychiatr Serv. 2018;69(4):366-369. doi:10.1176/appi.ps.201700211
20.
BakerRTCasanovaMPWhitlockJNSmithLHSeegmillerJG.Expanding access to health care: evaluating project Extension for Community Health Care Outcomes (ECHO) Idaho’s tele-education behavioral health program. J Rural Ment Health. 2020;44(4):205-216. doi:10.1037/rmh0000157
21.
KomaromyMMaddenEFHagerB, et al. Improvement in behavioral health symptoms and functioning among rural patients cared for by primary care teams using the extension for community health care outcomes model. J Rural Ment Health. 2019;43(2-3):73-80. doi:10.1037/rmh0000115
22.
HarrisonJNSteinbergJWilms FloetAML, et al. Addressing pediatric developmental and mental health in primary care using tele-education. Clin Pediatr. 2022;61(1):46-55. doi:10.1177/00099228211059644
23.
CinkoCThrasherASawyerCKramerKWestSHarrisE.Using the project ECHO model to increase pediatric primary care provider confidence to independently treat adolescent depression. Acad Psychiatry. 2023;47(4):360-367. doi:10.1007/s40596-023-01800-x
24.
CasanovaMPReevesAJMooreJD, et al. Evaluating a project extension for community health outcomes pediatric behavioral health series in a rural and frontier state: an exploratory investigation. Telemed Rep. 2023;4(1):10-20. doi:10.1089/tmr.2022.0033
25.
HostutlerCAValleruJMaciejewskiHMHessAGleesonSPRamtekkarUP.Improving pediatrician’s behavioral health competencies through the project ECHO teleconsultation model. Clin Pediatr. 2020;59(12):1049-1057. doi:10.1177/0009922820927018
26.
HarrisPATaylorRThielkeRPayneJGonzalezNCondeJG.Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. doi:10.1016/j.jbi.2008.08.010
27.
HarrisPATaylorRMinorBL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. doi:10.1016/j.jbi.2019.103208
28.
KraschnewskiJLFelixLLCichyS, et al. Supporting rural primary care through project ECHO: a brief case report. J Clin Transl Sci. 2025;9(1):e267. doi:10.1017/cts.2025.10196
29.
VickerstaffVOmarRZAmblerG.Methods to adjust for multiple comparisons in the analysis and sample size calculation of randomised controlled trials with multiple primary outcomes. BMC Med Res Methodol. 2019;19(1):129. doi:10.1186/s12874-019-0754-4
30.
FormanSGLekwaAJShahidullahJD.Behavioral health engagement and treatment strategies: pediatric chief resident perspectives. Fam Syst Health. 2021;39(3):434-442. doi:10.1037/fsh0000611
31.
DonaldsonALKrejchaKMcMillinA.A strengths-based approach to autism: neurodiversity and partnering with the autism community. Perspect ASHA Spec Interest Groups. 2017;2(1):56-68. doi:10.1044/persp2.SIG1.56
CDC. Data and Statistics on ADHD. Attention-Deficit / Hyperactivity Disorder (ADHD). Published November 2024. Accessed March 9, 2026. https://www.cdc.gov/adhd/data/index.html
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
