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Project ECHO® Case Report: Billings Clinic

Eric Arzubi, MD, a psychiatrist at Billings Clinic in Billings, Montana, uses the ECHO model for a pilot project of an addictions and behavioral health ECHO. The project is part of a larger collaborative effort with the State of Montana's Department of Corrections, the Rimrock Foundation (a local addiction services clinic), and Billings Clinic, and is funded through a grant from the Montana Mental Health Trust.

Reflecting on what prompted him to start using Project ECHO, Dr. Arzubi says simply, “common sense;” Montana faces many challenges that are very similar to those of New Mexico and other communities that have implemented this model. Montana is at the epicenter of a mental health crisis, posting the highest suicide rate in the U.S. There are many remote, rural populations with highly vulnerable citizens, including many veterans and Native Americans. Additionally, Montana is one of only three states that does not host a psychiatry residency program, making the shortage of clinicians in Montana especially acute.

Introducing Project ECHO to this collaborative effort in Montana has sparked conversations that may not have been possible six months prior. Thanks to the pilot of the addictions and behavioral health ECHO, Dr. Arzubi and his colleagues are actively engaged in identifying systems gaps for the incarcerated population with mental health problems. Without the ECHO model, the clinicians would not be engaging in regular, consistent collaboration with the State of Montana Department of Corrections or its clinicians working in prisons, jails, and pre-release centers in Montana. Additionally, Montana's SIM Council is now working on implementing the model to help integrate primary care and behavioral health on a much larger scale.

When asked about the barriers to implementation, Dr. Arzubi comments that the customer service delivered by the ECHO Institute at the University of New Mexico is outstanding and makes rollout very user-friendly. For him, the most important ingredient for introducing and sustaining Project ECHO participation has been a set of champions among the stakeholders and some seed money to help fund the project initially.

To date, Dr. Arzubi and his colleagues have completed three teleECHO™ clinic sessions. After the first session, the State of Montana Department of Public Health and Human Services began focusing on Project ECHO to learn about the model and how it might fill gaps in the mental health system of care. The Montana addictions and behavioral health ECHO has promoted dialogue, facilitating the development of a common language between two diverse systems in corrections and health care and inspiring stakeholders to think differently about the State's health care challenges.

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