Behavioral Health
Catherine Sanders, PhD (she/her/hers)
MECLA Lead/Sr Program Manager
MCD Global Health, Maine, United States
Sherri Billings, MAT
Project Coordinator
MCD Global Health, United States
Nicole Criss, DHS
Training Manager
MCD Global Health, South Carolina, United States
Location: Room 208
Abstract Information: One of the biggest impediments to getting people with Opioid Use Disorder (OUD) the help they need is stigma, or the false impression that people with OUD somehow deserve their struggle. This workshop examines the power of storytelling in combatting stigma (and evaluating interventions that combat stigma) among healthcare workers about people with OUD. Medication for OUD (MOUD) is an evidenced-based intervention that reduces deaths from overdose by 50% or greater. Yet, despite its proven effectiveness, MOUD uptake in the U.S. has been slow as healthcare workers perceive it as “enabling” or a “crutch”. One of the reasons for this, the authors feel, is not enough storytelling. In our experience, getting people with diverse experiences in a room to share their stories can be life-altering, and interventions that do so can save lives, beyond providing statistical evidence. The Extension for Community Healthcare Outcomes (ECHO) Project uses case-based learning, technology, relationship-building, and evaluation to provide learning in an “all teach, all learn” model, essentially imparting lived experience through storytelling in case-based narrative combined with discussion. MCD Global Health has martialed this mode of knowledge sharing in behavioral health interventions in a way that aims to reduce stigma, build mentorship among providers and other healthcare workers, and increase access to information through diverse voices and case-based learning. In this workshop, we will conduct an ECHO Project demonstration, whereby the authors, from an ECHO Hub in Maine, will offer a brief didactic evaluation of our behavioral health interventions via case-based learning, followed by 1 or more case presentations facilitated by our Subject Matter Experts (SMEs) in Behavioral Health. Workshop participants will gain experience with the ECHO model as a teaching tool; they will learn from one another by sharing experiences with behavioral health interventions; finally, they will gain an understanding of the evaluation results of the case-based ECHO model as operated in Maine. As practitioners take their practice to evaluation and their evaluation to practice in the form of storytelling, stigma drops away and we are able to deal at last with treating a chronic disease and its impacts.
Relevance Statement: Storytelling in evaluations shows the power of drug characteristics in MOUD in destigmatizing SUD in populations especially prone to experience bias, and in showing evidence of improving relationships with providers as well as improving overdose outcomes. We already know that merely showing evidence of best practices is not sufficient to foster the kind of engagement with evaluation methods that is needed to provide meaning, enter hearts, and change minds. In the field of Behavioral Health, what seems to make the biggest difference is in recognizing the "nearness" of someone else's desperation to what could be our own. Through stories, doctors, administrators, and other healthcare professionals recognize the tenuousness of pain, hear about the episodes that would push even the most stalwart over the line, and see themselves in their patients. The ECHO Project modality seems especially suited to leveraging story for applicable learning in behavioral health. Beebe, T. J., Harrison, P. A., McRae Jr, J. A., & Asche, S. E. (2003). Evaluating behavioral health services in Minnesota's Medicaid population using the experience of care and health outcomes (ECHO™) survey. Journal of health care for the poor and underserved, 14(4), 608-621. Cheng, A., Badolato, R., Segoshi, A., McDonald, R., Malone, M., Vasudevan, K., ... & Tofighi, B. (2022). Perceptions and experiences toward extended-release buprenorphine among persons leaving jail with opioid use disorders before and during COVID-19: an in-depth qualitative study. Addiction Science & Clinical Practice, 17(1), 4. DeFlavio, J. R., Rolin, S. A., Nordstrom, B. R. & Kazal Jr., L. A. (2015). Analysis of barriers to adoption of buprenorphine maintenance therapy by family physicians. Rural and Remote Health, 15, 3019. Hager, B., Hasselberg, M., Arzubi, E., Betlinski, J., Duncan, M., Richman, J., & Raney, L. E. (2018). Leveraging behavioral health expertise: practices and potential of the project ECHO approach to virtually integrating care in underserved areas. Psychiatric Services, 69(4), 366-369. Jackman, K., Scala, E., Nwogwugwu, C., Huggins, D. & Antoine, D. G. (2020). Nursing impact of educational workshop. Journal of Nursing, 31(3), 213-220. doi: 10/1097/JAN.0000000000000351. Komaromy, M., Duhigg, D., Metcalf, A., Carlson, C., Kalishman, S., Hayes, L., ... & Arora, S. (2016). Project ECHO (Extension for Community Healthcare Outcomes): A new model for educating primary care providers about treatment of substance use disorders. Substance abuse, 37(1), 20-24. Schuler, M. S. & Horowitz, J. A. (2020). Nursing students’ attitudes toward and empathy for patients with substance use disorder following mentorship. Journal of Nursing Education 59(3). http://dx.doi.org.library.capella.edu/10.3928/01484834-20200220-05 Wakeman, S. E. & Barnett, M. L. (2018). Primary care and the Opioid-Overdose Crisis-Buprenorphine myths and realities. The New England Journal of Medicine, 39(4), 1-4. http://dx.doi.org.library.capella.edu/10.1056/NEJMp1802741.