Many autistic individuals experience co-occurring psychiatric conditions and require mental health support. Mental health clinicians report limited knowledge and confidence in working with autistic people. The ECHO Autism: Mental Health program aims to address this gap by providing professional development to clinicians via virtual case-based learning. The current study used a qualitative thematic analysis approach to explore the perspectives of 13 clinicians who completed the ECHO Autism: Mental Health program. Three overarching themes developed from the clinicians’ responses: program structure and delivery, perceived challenges, and the impact of participating in the program. Overall, participants highlighted their positive experience in the program, noting the benefits of learning from case discussions and connecting with colleagues who share common clinical needs and difficulties. Some challenges were identified and included time constraints and minor technical issues during the program. The findings can guide future programs to effectively support clinicians in delivering quality care to autistic people.
AdamsD.ClarkM.KeenD. (2019). Using self-report to explore the relationship between anxiety and quality of life in children on the autism spectrum. Autism Research, 12(10), 1505–1515. https://doi.org/10.1002/aur.2155
2.
AdamsD.YoungK. (2021). A systematic review of the perceived barriers and facilitators to accessing psychological treatment for mental health problems in individuals on the autism spectrum. Review Journal of Autism and Developmental Disorders, 8(4), 436–453. https://doi.org/10.1007/s40489-020-00226-7
3.
AroraS.GeppertC. M.KalishmanS.DionD.PullaraF.BjeletichB.SimpsonG.AlversonD. C.MooreL. B.KuhlD.ScalettiJ. V. (2007). Academic health center management of chronic diseases through knowledge networks: Project ECHO. Academic Medicine: Journal of the Association of American Medical Colleges, 82(2), 154–160. https://doi.org/10.1097/ACM.0b013e31802d8f68
4.
AroraS.KalishmanS.ThorntonK.DionD.MurataG.DemingP.ParishB.BrownJ.KomaromyM.ColleranK.BankhurstA.KatzmanJ.HarkinsM.CuretL.CosgroveE.PakW. (2010). Expanding access to hepatitis C virus treatment—Extension for Community Healthcare Outcomes (ECHO) project: Disruptive innovation in specialty care. Hepatology, 52(3), 1124–1133. https://doi.org/10.1002/hep.23802
5.
AroraS.ThorntonK.MurataG.DemingP.KalishmanS.DionD.ParishB.BurkeT.PakW.DunkelbergJ.KistinM.BrownJ.JenkuskyS.KomaromyM.QuallsC. (2011). Outcomes of treatment for hepatitis C virus infection by primary care providers. The New England Journal of Medicine, 364(23), 2199–2207. https://doi.org/10.1056/NEJMoa1009370
6.
BecevicM.NairP.WallachE.HoffmanK.SohlK. (2021). ECHO Autism: Evaluation of participants’ perceptions of collaborative telementoring network. Journal of Patient Experience, 8. https://doi.org/10.1177/23743735211065292
7.
BellesheimK. R.ColeL.CouryD. L.YinL.LevyS. E.GuinneeM. A.KlatkaK.MalowB. A.KatzT.TaylorJ.SohlK. (2018). Family-driven goals to improve care for children with autism spectrum disorder. Pediatrics, 142(3), https://doi.org/10.1542/peds.2017-3225.
8.
BellesheimK. R.KizzeeR. L.CurranA.SohlK. (2020). ECHO Autism: Integrating maintenance certification with extension for community healthcare outcomes improves developmental screening. Journal of Developmental and Behavioral Pediatrics: JDBP, 41(6), 420–427. https://doi.org/10.1097/DBP.0000000000000796
9.
BenevidesT. W.ShoreS. M.PalmerK.DuncanP.PlankA.AndresenM. L.CaplanR.CookB.GassnerD.HectorB. L.MorganL.NebekerL.PurkisY.RankowskiB.WittigK.CoughlinS. S. (2020). Listening to the autistic voice: Mental health priorities to guide research and practice in autism from a stakeholder-driven project. Autism: The International Journal of Research and Practice, 24(4), 822–833. https://doi.org/10.1177/1362361320908410
10.
Bernales-TurpoD.Quispe-VelasquezR.Flores-TiconaD.SaintilaJ.Ruiz MamaniP. G.Huancahuire-VegaS.Morales-GarcíaM.Morales-GarcíaW. C. (2022). Burnout, professional self-efficacy, and life satisfaction as predictors of job performance in health care workers: The mediating role of work engagement. Journal of Primary Care & Community Health, 13. https://doi.org/10.1177/21501319221101845
11.
BilaverL. A.SobotkaS. A.MandellD. S. (2021). Understanding racial and ethnic disparities in autism-related service use among Medicaid-enrolled children. Journal of Autism and Developmental Disorders, 51(9), 3341–3355. https://doi.org/10.1007/s10803-020-04797-6
12.
Bottema-BeutelK.KappS. K.LesterJ. N.SassonN. J.HandB. N. (2021). Avoiding ableist language: Suggestions for autism researchers. Autism in Adulthood, 3(1), 18–29. https://doi.org/10.1089/aut.2020.0014
13.
BraunV.ClarkeV. (2022). Thematic analysis: A practical guide. Sage.
14.
Brookman-FrazeeL.DrahotaA.StadnickN.PalinkasL. A. (2012). Therapist perspectives on community mental health services for children with autism spectrum disorders. Administration and Policy in Mental Health, 39(5), 365–373. https://doi.org/10.1007/s10488-011-0355-y
15.
BuranovaN.DampfM.StevensonB.SohlK. (2022). ECHO Autism: Early intervention connecting community professionals to increase access to best practice autism intervention. Clinical Pediatrics, 61(8), 518–552. https://doi.org/10.1177/00099228221090710
16.
BuranovaN.MaddoxB.BolesK.MahurinM.HoffmanK.McCartneyI.SohlK. (2025). ECHO Autism: Mental health prepares professionals to better serve autistic clients with co-occurring mental health conditions. Advances in Autism, 11(4), 233–252. https://doi.org/10.1108/AIA-03-2025-0026
17.
Camm-CrosbieL.BradleyL.ShawR.Baron-CohenS.CassidyS. (2019). ‘People like me don’t get support’: Autistic adults’ experiences of support and treatment for mental health difficulties, self-injury and suicidality. Autism, 23(6), 1431–1441. https://doi.org/10.1177/1362361318816053
18.
CantorJ.McBainR. K.KofnerA.SteinB. D.YuH. (2020). Fewer than half of US mental health treatment facilities provide services for children with autism spectrum disorder. Health Affairs (Project Hope), 39(6), 968–974. https://doi.org/10.1377/hlthaff.2019.01557
19.
CarlinL.ZhaoJ.DubinR., et al (2018). Project ECHO telementoring intervention for managing chronic pain in primary care: Insights from a qualitative study. Pain Medicine, 19, 1140–1146. https://doi.org/10.1093/pm/pnx233
20.
Cheak-ZamoraN.FarmerJ. G.CrossmanM. K.MalowB. A.MazurekM. O.KuhlthauK.StobbeG.LoftinR.Mirza-AgrawalM.TapiaM.HessA.DavisK.SohlK. (2021). Provider perspectives on the extension for community healthcare outcomes autism: Transition to adulthood program. Journal of Developmental and Behavioral Pediatrics: JDBP, 42(2), 91–100. https://doi.org/10.1097/DBP.0000000000000872
21.
ChristonL. M.MyersB. J. (2015). Family-centered care practices in a multidisciplinary sample of pediatric professionals providing autism spectrum disorder services in the United States. Research in Autism Spectrum Disorders, 20, 47–57. https://doi.org/10.1016/j.rasd.2015.08.004
22.
Committee on Hospital Care. (2003). Family-centered care and the pediatrician’s role. Pediatrics, 112(3), 691–696. https://doi.org/10.1542/peds.112.3.691
23.
CooperK.LoadesM. E.RussellA. (2018). Adapting psychological therapies for autism. Research in Autism Spectrum Disorders, 45, 43–50. https://doi.org/10.1016/j.rasd.2017.11.002
DreilingN. G.CookM. L.LamarcheE.KlingerL. G. (2022). Mental health Project ECHO Autism: Increasing access to community mental health services for autistic individuals. Autism, 26(2), 434–445. https://doi.org/10.1177/13623613211028000
26.
EliacinJ.FlanaganM.Monroe-DeVitaM.WasmuthS.SalyersM. P.RollinsA. L. (2018). Social capital and burnout among mental healthcare providers. Journal of Mental Health, 27(5), 388–394. https://doi.org/10.1080/09638237.2017.1417570
27.
GabovitchE. M.CurtinC. (2009). Family-centered care for children with autism spectrum disorders: A review. Marriage & Family Review, 45(5), 469–498. https://doi.org/10.1080/01494920903050755
28.
GaiggS. B.FlaxmanP. E.McLavenG.ShahR.BowlerD. M.MeyerB.SouthM. (2020). Self-guided mindfulness and cognitive behavioral practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools. Autism, 24(4), 867–883. https://doi.org/10.1177/1362361320909184
29.
GiachettoG.CasuriagaA. L.SantoroA.KanopaV.GarridoG.FernándezJ.. . .SohlK. (2019). Extension for Community Healthcare Outcomes Uruguay: A New Strategy to Promote Best Primary Care Practice for Autism. Global Pediatric Health, 6. https://doi.org/10.1177/2333794X19833734
30.
GreenleeJ. L.MosleyA. S.ShuiA. M.Veenstra-VanderWeeleJ.GothamK. O. (2016). Medical and behavioral correlates of depression history in children and adolescents with autism spectrum disorder. Pediatrics, 137(Suppl. 2), S105–S114. https://doi.org/10.1542/peds.2015-2851I
31.
HollocksM. J.LerhJ. W.MagiatiI.Meiser-StedmanR.BrughaT. S. (2019). Anxiety and depression in adults with autism spectrum disorder: A systematic review and meta-analysis. Psychological Medicine, 49(4), 559–572. https://doi.org/10.1017/S0033291718002283
32.
HossainM. M.KhanN.SultanaA.MaP.McKyerL. J.AhmedH. U.PurohitN. (2020). Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses. Psychiatry Research, 287, 112922. https://doi.org/10.31124/advance.11497014.v1
33.
JaneA.KanigsbergL.PatelA.EldonS.AnagnostouE.BrianJ.PennerM. (2023). Summative content analysis of the recommendations from Project ECHO Ontario Autism. Frontiers in Rehabilitation Sciences, 4, Article 1096314. https://doi.org/10.3389/fresc.2023.1096314
34.
KeeferA.WhiteS. W.VasaR. A.ReavenJ. (2018). Psychosocial interventions for internalizing disorders in youth and adults with ASD. International Review of Psychiatry, 30(1), 62–77. https://doi.org/10.1080/09540261.2018.1432575
35.
KernsC. M.RastJ. E.ShattuckP. T. (2020). Prevalence and correlates of caregiver-reported mental health conditions in youth with autism spectrum disorder in the United States. The Journal of Clinical Psychiatry, 82(1), 11637. https://doi.org/10.4088/jcp.20m13242
36.
KoganM. D.StricklandB. B.BlumbergS. J.SinghG. K.PerrinJ. M.van DyckP. C. (2008). A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005–2006. Pediatrics, 122(6), e1149–e1158. https://doi.org/10.1542/peds.2018-0286
37.
KõlvesK.FitzgeraldC.NordentoftM.WoodS. J.ErlangsenA. (2021). Assessment of suicidal behaviors among individuals with autism spectrum disorder in Denmark. JAMA Network Open, 4(1), Article e2033565. https://doi.org/10.1001/jamanetworkopen.2020.33565
38.
LaiM. C.KasseeC.BesneyR.BonatoS.HullL.MandyW.SzatmariP.AmeisS. H. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: A systematic review and meta-analysis. Lancet Psychiatry, 6(10), 819–829. https://doi.org/10.1016/S2215-0366(19)30289-5
39.
MaddoxB. B.CrabbeS.BeidasR. S.Brookman-FrazeeL.CannuscioC. C.MillerJ. S.NicolaidisC.MandellD. S. (2020). “I wouldn’t know where to start”: Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults. Autism: The International Journal of Research and Practice, 24(4), 919–930. https://doi.org/10.1177/1362361319882227
40.
MaddoxB. B.CrabbeS. R.FishmanJ. M.BeidasR. S.Brookman-FrazeeL.MillerJ. S.NicolaidisC.MandellD. S. (2019). Factors influencing the use of cognitive-behavioral therapy with autistic adults: A survey of community mental health clinicians. Journal of Autism and Developmental Disorders, 49(11), 4421–4428. https://doi.org/10.1007/s10803-019-04156-0
41.
MaddoxB. B.DicksonK. S.StadnickN. A.MandellD. S.Brookman-FrazeeL. (2021). Mental health services for autistic individuals across the lifespan: Recent advances and current gaps. Current Psychiatry Reports, 23(10), 66. https://doi.org/10.1007/s11920-021-01278-0
42.
Malik-SoniN.ShakerA.LuckH.MullinA. E.WileyR. E.LewisM. E.FrazierT. W. (2022). Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood. Pediatric Research, 91(5), 1028–1035. https://doi.org/10.1038/s41390-021-01465-y
43.
MalowB. A.MazurekM.StobbeG.AgrawalM. M.LoftinR.CaudelD.SohlK. (2023). ECHO Autism adult healthcare: Training community clinicians to provide quality care for autistic adults. Autism Research, 16(8), 1619–1629. https://doi.org/10.1002/aur.2996
44.
MasonD.MackintoshJ.McConachieH.RodgersJ.FinchT.ParrJ. R. (2019). Quality of life for older autistic people: The impact of mental health difficulties. Research in Autism Spectrum Disorders, 63, 13–22. https://doi.org/10.1016/j.rasd.2019.02.007
45.
MayesS. D.GormanA. A.Hillwig-GarciaJ.SyedE. (2013). Suicide ideation and attempts in children with autism. Research in Autism Spectrum Disorders, 7(1), 109–119. https://doi.org/10.1016/j.rasd.2012.07.009
46.
MazurekM. O.BrownR.CurranA.SohlK. (2017). ECHO Autism: A new model for training primary care providers in best-practice care for children with autism. Clinical Pediatrics, 56(3), 247–256. https://doi.org/10.1177/0009922816648288
47.
MazurekM. O.CurranA.BurnetteC.SohlK. (2019). ECHO Autism STAT: Accelerating early access to autism diagnosis. Journal of Autism and Developmental Disorders, 49, 127–137. https://doi.org/10.1007/s10803-018-3696-5
48.
MazurekM. O.HarkinsC.MenezesM.ChanJ.ParkerR. A.KuhlthauK.SohlK. (2020). Primary care providers’ perceived barriers and needs for support in caring for children with autism. The Journal of Pediatrics, 221, 240–245. https://doi.org/10.1016/j.jpeds.2020.01.014
49.
MazurekM. O.ParkerR. A.ChanJ.KuhlthauK.SohlK. (2020). Effectiveness of the extension for community health outcomes model as applied to primary care for autism: A partial stepped wedge randomized clinical trial. JAMA Pediatrics, 174(5), Article e196306. https://doi.org/10.1001/jamapediatrics.2019.6306
50.
MazurekM. O.StobbeG.LoftinR.MalowB. A.AgrawalM. M.TapiaM.. . .SohlK. (2020). ECHO Autism transition: Enhancing healthcare for adolescents and young adults with autism spectrum disorder. Autism, 24(3), 633–644. https://doi.org/10.1177/1362361319879616
51.
MontesG.HaltermanJ. S. (2011). White-Black disparities in family-centered care among children with autism in the United States: Evidence from the NS-CSHCN 2005–2006. Academic Pediatrics, 11(4), 297–304. https://doi.org/10.1016/j.acap.2011.02.002
52.
NicholasD. B.MuskatB.ZwaigenbaumL.GreenblattA.RatnapalanS.KilmerC.. . .SharonR. (2020). Patient-and family-centered care in the emergency department for children with autism. Pediatrics, 145(Suppl. 1), S93–S98. https://doi.org/10.1542/peds.2019-1895L
53.
NingM.DanielsJ.SchwartzJ.DunlapK.WashingtonP.KalantarianH., et al (2019). Identification and quantification of gaps in access to autism resources in the United States: An infodemiological study. Journal of Medical Internet Research, 21, Article e13094. https://doi.org/10.2196/13094
54.
NowellK.ChristopherK.SohlK. (2020). Equipping community-based psychologists to deliver best practice ASD diagnoses using the ECHO autism model. Children’s Health Care, 49(4), 403–424. https://doi.org/10.1080/02739615.2020.1771564
55.
OlsonK.MarchalikD.FarleyH.DeanS. M.LawrenceE. C.HamidiM. S.. . .StewartM. T. (2019). Organizational strategies to reduce physician burnout and improve professional fulfillment. Current Problems in Pediatric and Adolescent Health Care, 49(12), 100664. https://doi.org/10.1016/j.cppeds.2019.100664
56.
OskiJ. (2020). Do you hear what I hear? ECHO and autism. The Journal of Pediatrics, 221, 1–3.
57.
PezzimentiF.HanG. T.VasaR. A.GothamK. (2019). Depression in youth with autism spectrum disorder. Child and Adolescent Psychiatric Clinics, 28(3), 397–409. https://doi.org/10.1016/j.chc.2019.02.009
58.
Project ECHO. (2024). ECHO Institute. University of New Mexico Health Sciences Center. https://hsc.unm.edu/echo/
59.
SchottW.NonnemacherS.SheaL. (2021). Service use and unmet needs among adults with autism awaiting home-and community-based Medicaid services. Journal of Autism and Developmental Disorders, 51, 1188–1200. https://doi.org/10.1007/s10803-020-04593-2
60.
SharmaS.HuckerA.MatthewsT.GrohmannD.LawsK. R. (2021). Cognitive behavioral therapy for anxiety in children and young people on the autism spectrum: A systematic review and meta-analysis. BMC Psychology, 9, 1–16. https://doi.org/10.1186/s40359-021-00658-8
61.
SimonoffE.PicklesA.CharmanT.ChandlerS.LoucasT.BairdG. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry, 47(8), 921–929. https://doi.org/10.1097/CHI.0b013e318179964f
62.
SmithK. A.GehrickeJ. G.IadarolaS.WolfeA.KuhlthauK. A. (2020). Disparities in service use among children with autism: A systematic review. Pediatrics, 145(Suppl. 1), S35–S46. https://doi.org/10.1542/peds.2019-1895G
63.
SohlK.MazurekM. O.BrownR. (2017). ECHO Autism: Using technology and mentorship to bridge gaps, increase access to care, and bring best practice autism care to primary care. Clinical Pediatrics, 56(6), 509–511. https://doi.org/10.1177/0009922817691825
64.
SpainD.SinJ.ChalderT.MurphyD.Happé F. (2015). Cognitive behaviour therapy for adults with autism spectrum disorders and psychiatric co-morbidity: A review. Research in Autism Spectrum Disorders, 9, 151–162. https://doi.org/10.1016/j.rasd.2014.10.019
65.
TongA.SainsburyP.CraigJ. (2007). COnsolidated criteria for REporting Qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042
66.
VinsonA. H.IannuzziD.BennettA.ButterE. M.CurranA. B.HessA.. . .SohlK. (2022). Facilitator reflections on shared expertise and adaptive leadership in ECHO Autism: Center engagement. Journal of Continuing Education in the Health Professions, 42(1), e53–e59. https://doi.org/10.1097/CEH.0000000000000395
67.
WijnhovenL. A.Niels-KesselsH.CreemersD. H.VermulstA. A.OttenR.EngelsR. C. (2019). Prevalence of comorbid depressive symptoms and suicidal ideation in children with autism spectrum disorder and elevated anxiety symptoms. Journal of Child & Adolescent Mental Health, 31(1), 77–84. https://doi.org/10.2989/17280583.2019.1608830
68.
WoodJ. J.KendallP. C.WoodK. S.KernsC. M.SeltzerM.SmallB. J.. . .StorchE. A. (2020). Cognitive behavioral treatments for anxiety in children with autism spectrum disorder: A randomized clinical trial. JAMA Psychiatry, 77(5), 474–483. https://doi.org/10.1001/jamapsychiatry.2019.4160
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