A mixed method approach to evaluate the tele-ECHO mentoring model for counselors from rural India in the management of Substance Use Disorders (SUDs)

Substance use disorders (SUDs) are a growing public health problem in India. In addition, a large treatment gap exists between people requiring care for SUD and available human resources. To address this enormous need the National Institute of Mental Health and Neuro Sciences (NIMHANS) adopted the ECHO (Extension of Community Health and Outcome) model. We conducted periodic tele-ECHO clinics with a team of 37 remote counselors from an Indian state, linking them with NIMHANS multidisciplinary addiction experts. We used digital tools like whatsapp and sli.do to engage the participants and evaluate their learning. We collected monthly reports from participants to understand the number of SUD cases seen by them. Pre-tests and post-tests were done to understand if the training program had made any impact on their knowledge and confidence. Finally, we administered a written survey to assess their satisfaction level with the training program. We used a mixed method approach to analyze the program. Findings suggest that the program led to significant improvements in participants’ knowledge, treatment practices, and self-confidence in the management of substance use and related disorders. There was a difference in the mean scores from the pre-test (M=6.94±1.69) to the final post-test scores (M=10.03±1.74). The t-test value for paired means was statistically significant at 7.1017 (p<0.0001). 3195 patients (including follow ups) have received treatment from these tele-mentored counselors over the period. All the participants rated themselves as confident in their knowledge. All the participants reported that their skills for handling patients with SUDs have improved through this training program. NIMHANS ECHO tele-mentoring model can be an effective model in providing quality training in substance use and related disorders to counselors working in the rural and underserved areas.