Use of the Extension for Community Health Outcomes (ECHO) model for public health emergency response in Alaska

ABSTRACT

Project ECHO (Extension for Community Healthcare Outcomes) is a telehealth and virtual mentoring model. It is a scalable platform to create peer communities where professionals can gain knowledge, skills, and relevant information to their work and clinical practice. Key informant interviews of Alaska public health leaders, clinical providers, ECHO staff, and local government representatives were conducted to evaluate the effectiveness and utility of the Project ECHO for COVID-19 response. Project ECHO session attendance and evaluation data were also reviewed. A combined total of 41,255 attendees participated in a COVID-19 response ECHO July 1, 2019 – June 30, 2022. Eight key informant interviews were conducted with individuals involved in leading or coordinating COVID-19 response efforts. Key informants identified four themes impacting the effectiveness of the Project ECHO model in responding to the COVID-19 pandemic: (1) Engagement, (2) Amplification, (3) Adaptability, and (4) Trust. In a rapidly changing pandemic, the ECHO model provided adaptive and effective virtual spaces where Alaskan providers, communities, elected officials, educators, and other stakeholders were able to receive tailored and up-to-date information on mitigation, treatment, and other concerns exacerbated by COVID-19.

KEYWORDS:

• Project ECHO
• medical education
• community outreach
• COVID-19
• public health response
• Alaska
• remote learning

Introduction

In late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, causing coronavirus disease 2019 (COVID-19), an infectious illness affecting respiratory function. Highly contagious and novel in humans, SARS-CoV-2 spread rapidly across the globe, eliciting wide-scale closures and shut-downs of governments, healthcare agencies, and educational settings. The need for rapid alternatives to these traditional institutional methods of communication and collaboration arose.

Project ECHO (Extension for Community Healthcare Outcomes), a telehealth and virtual mentoring model developed at the University of New Mexico (UNM) in 2003, provided a scalable platform for collaboration and information dissemination with existing technology and infrastructure [1]. A typical ECHO session will be a webinar broadcast on Zoom and Facebook. The model consists of a “Hub team” of public health experts that will usually start with a didactic lecture of current health trends around the state. Some ECHOs will have case study presentations or a question-and-answer (Q&A) session with a panel of subject matter experts. A more in-depth look at ECHO operations will be discussed in the Materials and Methods section. The model’s “all teach, all learn” philosophy connects subject matter experts with rural and underserved communities, emphasising knowledge sharing and using technology to amplify limited resources [1]. Project ECHO was initially designed to be used in health-focused fields, it has since expanded to also support engagement in education and civics.

University of Alaska Anchorage Center for Human Development has utilised Project ECHO since 2017, initially hosting four health-focused ECHO series. Beginning in 2019, the Center for Human Development (CHD) ECHO Hub attained Superhub status, meaning staff had received additional training in the ECHO model and were certified to begin training other organisations in implementing the ECHO model and becoming ECHO Hubs themselves.

In March 2020, Dr. Sanjeev Arora, founder and director of the first iteration of a Project ECHO programme at The University of New Mexico (UNM), called on all Project ECHO organisations to work with local partners to support COVID-19 response. As a result, CHD Project ECHO partnered with the Alaska Department of Health (DOH; formerly the Alaska Department of Health and Social Services, DHSS) to develop and implement a range of ECHO series as part of a state-wide response to COVID-19. From May through June 2020, nine new ECHO series launched to provide science-based COVID-19 education to medical providers in rural and urban environments, vaccine distributors, contact tracers, local and state government leaders, communities, and other key audiences. Beginning in July 2020, ECHO offerings were expanded to include 17 regular series and one pop-up ECHO series which could be quickly deployed to respond to emergent public health issues or communities at increased risk for COVID-19 infection or serious sequelae resulting from COVID-19 infection. A COVID-19 response ECHO series continued through June of 2022, with the number of active sessions varying based on epidemiologic trends and statewide transmission rates. The Hub team also managed the Alaska Department of Health, Division of Public Health, Coronavirus Response dashboard (https://alaska-coronavirus-vaccine-outreach-alaska-dhss.hub.arcgis.com/) which documents COVID-19 cases, deaths, hospitalisations, bed capacities, vaccinations, and dose administration. As changes in these variables occurred in real time, the Hub team would provide applicate content in response.

We will be examining how the ECHO model has been used by programmes to support public health responses to the COVID-19 pandemic, this paper explores Project ECHO’s utility in emergency response efforts, particularly in rural and remote communities. It also evaluates the effectiveness of using Project ECHO for COVID-19 response in Alaska, and assesses the utility of the ECHO model in wide-spread public health response.

Materials and methods

Design

Project ECHO is a virtual, Zoom-based, model for professional engagement and education. An ECHO session is an individual meeting between the Hub team and viewers that runs for approximately 60 minutes. An ECHO series is the collective ECHOs that discuss the same health-related topic. For example, topics can include school health which would be directed at faculty and staff of K-12 schools across the state. All ECHOs are on Zoom but also broadcasted on Facebook. All ECHOs are recorded and recordings can be found in a Box folder that is also free to access to the public. While the ECHO model can centre on a variety of topic areas, currently CHD only supports health-focused ECHO series. Marketing materials for ECHO series are sent out through CHD, Alaska Department of Health (DOH), and other stakeholder networks. Participants register through Zoom to receive meeting invitations and other information on specific ECHO series.

While the ECHO model is flexible in its design and implementation, some standards are commonly found across ECHO series. The traditional ECHO structure consists of didactic presentation(s), question and answer (Q&A), case presentation(s), and discussion. The purpose of the structure is to allow multi-directional communication between presenters, subject matter experts, and participants. An example of some of the speakers and subject matter experts can be found in Table 1.

Table 1. Key Informant Interviewees by Name, Role and Organisation.

Name and Credentials	Role and Organization
Anne Zink, MD, MPH	Chief Medical Officer, State of Alaska Dept of Health
Joseph McLaughlin, MD	Section Chief, State of Alaska Dept of Health, Section of Epidemiology
Barbara Pennington, RN	School Health Nurse Consultant, State of Alaska Dept of Health
Ellen Hodges, MD	Chief of Staff, Yukon-Kuskokwim Health Corporation
Jeffrey Demain, MD	Founder, Allergy, Asthma & Immunology Center of Alaska; Medical Director, COVID Physician Office Coalition, Providence Alaska Medical Center
Faith Kelly	Former Director of Operations for Project ECHO UAA CHD; Project ECHO Superhubs Manager, University of New Mexico Health Sciences Center
Meghan Clark, MBA	Former ECHO Director; Deputy Director, Training and Technical Assistance at Alaska Primary Care Assoc.
Nils Andreassen	Executive Director, Alaska Municipal League

ECHO session topics are identified by a group of subject matter experts that represent a clinical care team, these experts are called a “Hub team”. A hub team consist of members attend most live sessions and provide clinical insight and feedback throughout the session, particularly during the Q&A and case presentation discussion on the public health climate during the COVID-19 pandemic. Participants are encouraged to engage with Hub team members and their online peers in the Zoom audience throughout the session by asking and answering questions and participating in case presentation discussions. Sessions are recorded, so participants and other members of the learning community can access the materials after the live session. CHD hosts session recordings and materials on a free online platform called Box.

Methods

Data on ECHO participants were collected via Zoom through registration and attendee reports and entered into iECHO, a Project ECHO web-based proprietary data management tool that tracks ECHO series, topic, attendance, and presentation information. ECHO series data, at minimum, includes noted self-reported participant name, email address, city, state, and/or zip code. Additional information about participant profession, credentials, speciality, and associated professional organisation was also collected, though not consistently across all ECHO series. Results from end-of-year satisfaction surveys sent to all ECHO participants in Alaska State Fiscal Year FY2020 [1 July 2019 – 30 June 2020], FY2021 [1 July 2020 – 30 June 2021] and FY2022 [1 July 2021 – 30 June 2022] were also analysed because they also included the self-reported data used in analysis. The satisfaction data from these surveys can be found at the University of Alaska Anchorage Center for Human Development.

iECHO data were analysed using descriptive statistics to summarise the number of ECHO sessions, topics covered by sessions, characteristics of attendees, and reach of the ECHO format. For participants where self-reported organisational data were collected, data were analysed using SPSS, a statistical software package, to assign organisational representation to one of 15 core organisational types. (Figure 2) Organisations that could not be assigned to one of the 15 types were grouped as “Other”. For participants who provided credentials, data were analysed using SPSS to assign self-reported credentials into 18 core credential types. Credentials that could not be assigned to one of the 18 other types were grouped as “Other”.

Additionally, key informant interviews were conducted with persons involved in the development and implementation of Project ECHO as an intervention to address COVID-19 in Alaska. Key informants were identified by their involvement in the implementation and/or creation of at least one ECHO series, and by the leadership role they played in the statewide response to COVID-19. Institutional Review Board (IRB) exempt research approval was granted by the University of Alaska Anchorage IRB.

All key informants were asked the central research question: “How did the ECHO model assist the State of Alaska Department of Health in coordinated statewide COVID-19 response with both clinical care providers and the public, including successes and barriers to [the] Project [ECHO] implementation and reach?” Probing follow-up questions related to initial responses were used to expand upon concepts and clarify meaning.

Interviews were conducted via Zoom and ranged from 30 minutes to one hour long. Verbal consent for participation was collected. Transcripts were generated from recorded interviews, coded, and analysed using a thematic network approach [2]. An illustrative quote from each theme is presented with a description per theme.

Results

Over the course of the pandemic, ECHO frequency scaled up or down in response to changing public health priorities. For example, the rises in case numbers and hospitalisations. In FY21, seven of the original COVID-19 response ECHO series continued, and 11 additional series covering a variety of audiences and specialisations were added. In addition to these regularly scheduled series, 14 special “pop-up” ECHOs were produced. These pop-ups were stand-alone ECHOs delivered rapidly in response to evolving public health needs and served to complement existing ECHO programmes.

CHD Project ECHO implemented 21 ECHO series consisting of 733 unique sessions and 707 learning hours. In addition to the regular series, 29 pop-up ECHO events were implemented, totalling 762 unique ECHO sessions and 736 total hours of educational programming (Figure 1).

Figure 1. ECHO Series, Sessions, and Total Education Hours by Fiscal Year.

Reach of Project ECHO

A combined total of 41,255 (non-unique) attendees are known to have participated in ECHO. Of these participants, 77% (n = 31,848) listed their organisation, and of those, 18036 (57%) of the organisations could be categorised into one of the 15 core organisational types (Figure 2). The remaining 13,812 organisations were classified as “Other”. The organisational types were picked by Project ECHO staff. They were decided after looking at the raw data and categorising the organisations thematically to be better analysed and interpreted.

Figure 2. ECHO Attendee Organization Type (n = 18,036).

Of 18,036 ECHO participants whose organisation could be categorised into one of the 15 core organisational types, the majority represented K-12 Schools (n = 4,239) which includes staff, principals, school nurses, etc., Universities (n = 2,774) which includes, faculty, staff, and students, Tribal Organisations (n = 2,617), or Primary Care (n = 2,203).

The majority of ECHO participants were from Alaska. Of the 27,343 participants who reported their State/Territory, 26842 (98%) were from Alaska. Of the remaining participants, 499 (2%) were from another US State or Territory and 2 (<0.1%) were from another Country. Within Alaska, ECHO participants represented 121 Alaskan communities covering all seven Public Health regions of the state.

Of the 41,255 (non-unique) attendees known to have participated in ECHO sessions, 65% (n = 27,021) reported their professional credentials or profession. Of those who provided a credential, 26192 (97%) reported a credential or profession that could be categorised into one of the 18 profession groups (Figure 3). The groups were decided by Project ECHO staff. They were decided after looking at the raw data and categorising the professions thematically to be better analysed and interpreted.

Figure 3. ECHO Attendees by Profession (n = 26,192).

The most common credential type reported by ECHO participants was Nurse or Nurse Practitioner (NP; n = 7,598), followed by Leadership (Administrator/Director/Manager/Chief; n = 7,365), Community Health Worker (n = 2,656), and Medical Doctor or Doctor of Osteopathic Medicine (MD/DO; n = 2,550). 829 (3%) had credentials categorised as “Other”. The remaining 14,236 participants did not provide a credential.

Qualitative findings

A total of eight (n = 8) interviews were conducted. Respondents were State of Alaska DOH staff (n = 3; 38%), community clinical care providers (n = 2; 25%), former CHD Project ECHO staff involved in the initial implementation of COVID-19 response activities (n = 2; 25%) and a local government representative (n = 1; 13%). During the key informant interviews, four themes impacting the effectiveness of the Project ECHO model in COVID-19 pandemic response emerged: (1) Engagement, including collaboration driving creative solutions and offering needed support; (2) Amplification, including dissemination of information and development of platforms to support and deepen the scope of information being shared, leading to improved outcomes and spaces for community members to access and contribute to timely and rapidly changing public health information; (3) Adaptability, including the ability to rapidly respond to changes in the pandemic; and (4) Trust, through the ability of the ECHO model to offer predictable and structured space for respectful communication.

Engagement

“I think Project ECHO … honestly without it we would just be still spinning in a circle … I think it facilitated outreach to multiple groups at different levels and provided exceptional information and I think helped clarify a lot of misinformation that was out there”. – Clinical Care Provider Key Informant

Multiple respondents referenced the utility of the ECHO model in facilitating engagement and collaboration. The number and variety of ECHO series provided unique forums for groups of professionals and community members to learn from each other and the State public health team. This ability to coordinate with peers, Alaska DOH staff, and other members of the care team was particularly valuable to clinical care providers outside of Anchorage. Alaska is a large state with diverse many communities that do not have access to the same healthcare information as the urban areas. Many of these communities are underserved or do not offer culturally competent care that is offered year-round. These collaborations served to drive creative solutions to some of the challenges professionals were facing in the midst of the COVID-19 pandemic, as well as providing a platform for community building and offering needed social support to urban and rural areas.

ECHO also contributed to improved communication within the Department of Health (DOH). Multiple respondents noted that at the start of the pandemic, silos existed between different sections of the DOH, most notably between the Section of Public Health Nursing (PHN), which operates Public Health Clinics across the state coordinated by regional leadership, and the rest of the Public Health team who were primarily based out of the urban hubs of Anchorage and Juneau. The ECHO virtual space helped to improve intra-agency communication as well as communication with external partners and stakeholders.

Challenges associated with engagement included lack of time and Zoom fatigue. Although ECHO sessions took place on a variety of days and times, many professionals were balancing multiple/various/array priorities and clinical obligations, thus attending live sessions was not always feasible. Zoom fatigue, particularly in the latter half of the COVID-19 pandemic, made participation and engagement in online communities difficult.

Amplification

“It [ECHO] impacted clinical care. I could then disseminate [information] for every provider who couldn’t call in to ECHO because they were busy or whatever. You could disseminate that information, and we developed clinical guidelines specific to our region and used a lot of

that information”. – Clinical Care Provider Key Informant

Six of the eight key informants discussed the ability of the ECHO model to help amplify best practices across groups and geographic regions. Attendees and hub team members were able to take information they received during ECHO sessions and share those practices within their organisation, community, and region.

One of the Clinical Care Provider key informants highlighted the role of Project ECHO as a mechanism for dissemination of information but also a forum for discussion. They noted that ECHO provided a “ripple effect” which enhanced the reach of clinical networks to provide needed information and support to areas of the state not previously engaged in existing networks. This amplification not only resulted in participants from 121 Alaskan communities attending at least one ECHO session, it provided local professionals and involved parties with information that they could share back with their community.

Challenges in amplification, such as difficulties accessing durable electronic repositories of ECHO session recordings and materials through the Box system were also identified.

Adaptability

“I think, as a learning tool, it was really effective. Even if you didn’t have case presentations … usually we had subject matter experts talking about various aspects of COVID treatment, testing, you know, any manner of things related to the pandemic so I feel like that was an effective tool even if we didn’t really use the [traditional ECHO model]”. – Clinical Care Provider Key Informant

While many ECHO series maintain fidelity to the ECHO model (e.g. didactic presentations, case presentations, Q&A, etc.), adaptability, and the ability to innovate in response to community needs is also an integral part of the ECHO approach. Five of the eight key informants discussed the adaptability of the ECHO model as a factor which contributed to its success in helping to disseminate information during the COVID-19 pandemic.

CHD staff person who supported the initial implementation of COVID-19 response ECHOs in early 2020 noted “Dr. Arora, who is the founder and leader of Project ECHO from its inception before the Alaska team was formed, reached out to [ECHO Hubs] asking that if there were ways that we could utilise the ECHO model and the connections and experiences already in place to get information out about COVID-19” then we should do so. In response, ECHO staff at CHD coordinated with the Alaska Department of Health to adapt existing ECHO approaches to best reach clinical providers, elected officials, community members, the media, and other priority populations to broadly disseminate accurate and evidence-based information. As a result, while some of the ECHO series stayed true to the core ECHO model, others adapted to meet the needs of their specific audiences. Examples of adaptations discussed by key informants include not incorporating case presentations, using presenter panels instead of a single didactic lecture, discussing systems-level interventions rather than specific patients during case presentations, live-streaming ECHOs on Facebook, use of in-session poll questions to identify future topics or priorities, and utilising the Zoom Webinar feature to offer a structured way for community members to interact directly with the Public Health leadership team.

The adaptability of the ECHO model also allowed presenters and subject matter experts to adjust their communication to specific audiences. One Clinical Care Provider key informant noted “the way you talk to clinicians about testing and treatment, it’s very different than how you talk to patients. Trying to make sure that your language and your cultural communication is appropriate for the audience that you’re talking to … ECHO helped a lot”. The creation of these adaptable virtual spaces where subject matter experts could tailor their communication and language to specific audiences in a culturally and regionally appropriate way helped support not only implementation of best practices but other aspects of community support and engagement.

“I think the multiple different platforms you had [that] specialized to different groups–the school nurse group would be an example–the situational awareness group for physicians, the public health group for the media, and all those were very nicely tailored to each of those groups with different levels of communication”. – Clinical Care Provider Key Informant

In addition to the adaptability of the ECHO model, the flexibility of having ECHO series that could rapidly pivot to address specific emerging topics or trends was valuable. An Alaska DOH staff key informant discussed how “frequent downloads of information that was changing so rapidly during the pandemic” was integral to COVID-19 response, adding that the model not only allowed providers to “stay abreast of the new evolving science as well as guidance that was coming out, but again they had the opportunity to ask questions and get questions answered very quickly”. ECHO individual sessions could also be scaled to address imminent need, with some ECHO series, which included many sessions, offering extended sessions of 90 minutes and others offering brief question-and-answer-based sessions of 30–45 minutes.

In 2022, as emergency response to the COVID-19 pandemic began to wind down, the adaptability of the ECHO model also allowed for ECHO series geared towards specific topics or audiences to pivot to address other public health issues that may have faced service disruptions or gaps during the pandemic. ECHO series such as the School Health ECHO and Vaccine for Providers ECHO were able to begin addressing both COVID-19 and other emerging public health priorities during their sessions. Other strategies, such as developing planned curricula and beginning to offer continuing education credit for key audiences such as physicians, nurses, and pharmacists were also implemented. These adaptations were able to help maintain engagement with target audiences even as the urgency of COVID-19 response began to decrease. An Alaska DOH staff member added that these types of adaptations “always got good feedback … especially when we were able to start offering continuing education credits”.

Trust

“[It] was really important that they [local governments] got a chance to engage directly with and have access to state officials who were in charge of pandemic. Like that was critical for them … that reinforced some of what they were hearing, and they could follow up and have more direct engagement after that. They got to share stories and I think there’s a lot of successful ‘my community is doing this, and my community’s doing that’ and that was important. It felt like a safe space and so not only was it a shared space, but it was safe”. – Local Government Representative Key Informant

All eight key informants discussed the importance of ECHO in generating safe spaces for discussion or developing trust between different groups. Having a defined and safe virtual environment where stakeholders could interact with each other, “ask questions and not be judged about what was going on”, “share stories” about what they were experiencing, and “reflect and share rather than being on edge” was an integral part of growing trust between sometimes very diverse groups. One key informant added that having a third-party entity like CHD available to implement and facilitate ECHOs was helpful, as it provided a neutral framework where diverse and sometimes dissimilar groups could engage and communicate respectfully.

ECHO also helped to “build trust and collaboration with our policy makers, with the public, and with our healthcare teams”, at a time when, nationally, trust between those groups was low. By providing avenues for community members and elected officials to interact with public health officials and clinical care providers, ECHO provided a space where Alaskans could share their concerns and receive immediate responses rooted in best practices.

I think healthcare has very much moved more towards shared decision making and I think public health has been challenged during the pandemic in finding ways to do shared decision making with the public and I think that the ECHO tool allowed us in a way that no other tool did. – State of Alaska DOH Staff Key Informant

An increase in trust and the maintenance of safe spaces where “no question is too stupid to ask” and where the Hub team who were subject matter experts, would sometimes be “a dozen or more people all with different areas of expertise” also helped to combat misinformation and increased the quality of knowledge being shared in networks. Increased trust between participants in different fields of expertise, geographic regions, or organisational types also expanded communication outside the ECHO environment, growing communities of support and collaboration. One key informant noted that ECHO created “a forum for collaboration and brainstorming between agencies”, while another discussed how the ECHO model helped push the traditional clinical model to one where the conversations focused on “how we can collaborate with you to understand this patient and how to manage them collectively”.

Discussion

The Project ECHO model is designed to help bridge healthcare gaps caused by isolation, distance, and lack of access. The COVID-19 pandemic necessitated mitigation practices of social distancing and a reduction of congregate settings. Many work and social environments transitioned online. Project ECHO’s structural dynamism, in particular its ability to rapidly scale its programming, allowed existing ECHO programmes to quickly pivot their focus towards COVID-19 [3]. Widespread government and institutional funding in response to the pandemic also supported the urgent creation of new ECHO programmes and series [4–6] which were able to be quickly implemented to effectively disseminate pertinent information related to COVID-19 [7].

Early pandemic guidelines encouraged healthcare institutions and providers to utilise telemedicine and social distancing to offer continuity of care while reducing the spread of disease. Previous research on the utility of the ECHO model in public health response found that while some patients may benefit from telemedicine and telehealth limiting the need to travel to receive care, others might not be able to access, afford, or be able to use the technology necessitated for it [8]. In those instances, ECHO programmes were able to support providers in rural and remote regions of the state who are often the sole practitioners in their areas, delivering up-to-date information and educational resources which aided their treatment of patient populations facing access challenges due to income, geography, and time.

Previous research also found that, of surveyed participants from across 10 programmes designed specifically in response to COVID-19 by University of New Mexico (UNM) Project ECHO, those in rural counties were more likely to attend the critical care and education ECHOs than participants from metropolitan counties [3], suggesting that such educational programming is especially appealing to participants in rural and remote areas. In Namibia, where Project ECHO is integrated nation-wide into the infrastructure of all major hospital districts and high-volume healthcare centres, emerging information about the SARS-CoV-2 virus, including national and international guidance, was able to be quickly dispatched to “all regions … despite travel restrictions [7]. ” Further, the speed and virtual delivery of information allowed those in healthcare settings to have a greater degree of preparedness and ability to triage care which helped to sustain in-person treatment access to particularly vulnerable patient populations, such as those with underlying medical conditions, like HIV, who are at greater risk from COVID.

The existence of ECHO programmes has also been found to amplify reach to populations experiencing greater risk for sequelae and other negative health outcomes [3,9]. Existing ECHO programmes in Pennsylvania were able to quickly pivot their focus to improve outreach to Hispanic communities disproportionately impacted by the SARS-CoV-2 virus by quickly producing free educational sessions in Spanish and English relating to COVID-19 resources, mitigation, and its intersection with chronic diseases prevalent within the targeted communities [9].

Our evaluation had limitations. Due to the expeditious nature of ECHO series launch and internal staff turnover, participant data collected across each individual ECHO series varied. Initially, due to the urgency of delivering fast-changing COVID-19 information to as many people as possible, registration data for multiple series was either minimal or not collected at all in effort to reduce barriers to access.

User data is underreported for some ECHO sessions due to changes in Zoom account settings rendering Zoom reports inaccessible for that period of time. Additionally, if multiple participants utilised the same Zoom or telephone account, they would be counted as one user.

Key informant interviews were conducted with staff of CHD, taking part in the project as named participants and as representatives of their employer. The lack of anonymity as well as the need to maintain professional boundaries and support organisational policies may have influenced participant candour. Key informant interviews were conducted by CHD staff also involved in the implementation and support of Project ECHO activities included in this analysis, which may have impacted participant candour, particularly when discussing limitations or challenges.

Conclusions

In a rapidly changing pandemic, the ECHO model provided adaptive and effective virtual spaces where providers, communities, elected officials, educators, and other stakeholders were able to receive tailored and up-to-date information on mitigation [5], treatment [1], and other concerns exacerbated by COVID-19 [9–12]. In Alaska, collaboration between the State of Alaska Department of Health and the Center for Human Development to launch and maintain extensive ECHO networks during the COVID-19 pandemic served to increase connections between diverse communities, amplify messages rooted in evidence-based best practices, and grow trust between public health, healthcare providers, and the community. While there are some limitations to this model, ECHO was an effective and helpful tool to help address public health emergency response during the COVID-19 pandemic.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/22423982.2023.2244768.

Additional information

Funding

The work was supported by the Alaska Department of Health, Division of Public Health [RSA G14317].