Project ECHO is a virtual training and mentorship model that connects health care specialists across disciplines to share knowledge and recommendations. Originally created to expand access to specialty care in underserved areas, it connects a hub of experts with community-based providers, empowering them with the knowledge and support needed to serve their communities. This model is being used to help early childhood educators address the mental health needs of young children, providing trauma-informed guidance to those who need it most, and making a difference in classrooms nationwide.
Guests:
LaTrice L. Dowtin, PhD, LCPC, NCSP, RPT-S, Trauma Psychologist, PlayfulLeigh Psyched, and Lourie Center’s TIPS ECHO lead
Alfreda Clark, Center Director, West Lakes Early Learning Center, AdventHealth, and Lourie Center’s TIPS ECHO participant
Host/Producer: Carol Vassar
Announcer:
Welcome to Well Beyond Medicine, the world’s top-ranked children’s health podcast, produced by Nemours Children’s Health. Subscribe on any platform at NemoursWellBeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week we’ll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you’re here, let’s go.
Music:
Let’s go well beyond medicine.
Carol Vassar, podcast host/producer:
In 2003, Dr. Sanjeev Arora from the University of New Mexico developed a unique virtual medical education and care management model. The purpose? To improve access to specialty care in underserved areas. He called it Project ECHO. Project ECHO uses a hub and spoke model to connect a centralized team of experts, the Hub, with community-based care providers, the Spokes, no matter where they’re located. The purpose is for the Hub to provide guidance, education, mentorship, and support to the Spokes so they, in turn, can manage and treat patients or clients locally. Since Project Echo started nearly a quarter of a century ago, it’s been deployed successfully across the spectrum of healthcare specialties.
Today, we’ll examine how one ECHO in the Project ECHO universe is helping preschool teachers address the mental health needs of their young students. Joining me to talk all about their Trauma-Informed Preschool Support ECHO, or the TIPS ECHO are, representing the Hub, Dr. LaTrice L. Dowtin, CEO and Clinical Psychologist at PlayfulLeigh Psyched based in Maryland. She’s also an ECHO lead for the AdventHealth Care’s The Lourie Center for Children’s Social and Emotional Wellness TIPS ECHO Program. Representing the Spokes is Alfreda Clark, Center Director for the AdventHealth for Children West Lake’s Early Learning Center in Orlando, Florida. So, what was the impetus for creating an ECHO focusing on trauma-informed preschool supports? Dr. LaTrice L. Dowtin explains.
Dr. LaTrice L. Dowtin, CEO, PlayfulLeigh Psyched:
It’s really about our passion for serving young children and families and really thinking about, again, from a trauma perspective. So, there’s a lot of different types of trauma that occur in a child’s life or in an adult’s life. So, poverty is one thing that can be looked at as a trauma that can occur in someone’s lifetime. In the United States, about 16% of people under the age of 18 live in poverty. Of those, it’s about one in six children, ages birth to five are living in poverty. And by having poverty, that exposes to other potential risks, health risks, social, emotional, developmental needs. And we have an opportunity to be able to support and reach the people that are in those communities, those teachers, those directors, to be able to give some of the knowledge that I have and the experience that I have to be able to support the children, not just in my neighborhood or my backyard that I can get to, but people across this country.
And so that was amazing to me to be able to do that and to be able to, in the middle of the day sometimes or right after work, to be able to talk with the people who are experiencing the hardships in their classrooms of what it’s like to be able to support a young child who doesn’t have enough to eat, or the young child who is jumpy and scared and we’re not sure why, but maybe it’s something going on at home or something that’s going on in the community that, you know what? We need to make this classroom a really safe place, a trauma-informed place. How do we do that? How do we support their growth and needs? And so, when knowing that ECHO could do that, TIPS was born from that.
Like wait a minute, wait a minute. I have all this knowledge and I am often asked to be consulting in this program or that program, and I’m only one person, but if I can get everybody together and I can get five or fifth classrooms in one place, and we can kind of talk about this case-specific example, what’s happening in your school, and to talk across the lines, really, to be able to think about the other experts. I’m not the only person in the room. Every person that comes to a TIPS ECHO has knowledge to be able to support one another. That collaboration. So, knowing that that was possible, I was like, okay, we create this and I got to be a part of it.
Carol Vassar, podcast host/producer:
So, your offshoot, you’re referring to it as TIPS, that’s an acronym for Trauma-Informed Preschool Support. So, TIPS ECHO. Tell us about it. What makes it unique? It sounds like that community component is really important.
Dr. LaTrice L. Dowtin, CEO, PlayfulLeigh Psyched:
Absolutely. That community component is really important. And we really think about the model itself is kind of broken down into the teaching portion, a deductive portion, where we are trying to give some really important information in a short period of time, maybe 15 to 20 minutes, where we’re going to teach on a topic that is relevant to trauma-informed. So, our TIPS for those classrooms. It could be something like what if co-regulation and why is it important? Or what are the ABCs of classroom behavior? Or what exactly does trauma-informed schools look like or trauma-informed preschool classrooms look like? There’s that chunk of it.
And then we have, one of the things that I think is so important is the case presentation or this opportunity for a teacher or director, an educational specialist to bring in a problem, a dilemma that they’re having in their school or their program, and to present these questions and to be able to get live recommendations from not just one person, from a whole team of people who are knowledgeable but then also from one another. So, the other people that are part of, the other participants, right? And I think that that really comes alive because you’re getting, it’s like the big brain. You’re getting all of these brains and all these years of experience to be able to support that learning. And I think that’s different. And so, there’s like this all teach, all learn. We’re all learning. Myself for early childhood education and trauma-informed, I have over 20 years of experience. Everybody on their call has 10 or more years experience.
We have hundreds of years of experience of working with young children and serving them from a trauma-informed approach and figuring out what that looks like. And so, look at how much wealth we can be pouring into our communities by this collaborative model. So that really makes a difference. And it’s live, so you’re getting, hey, here’s my case. Everyone’s going to be able to ask me questions about the case. I’m going to get those live recommendations, and hopefully be able to right then and there, or the next day, go back into my classroom and implement those recommendations and then even come back and say, that really helped, or like, maybe we try something else, or what other recommendations you have? So I think that that really sets us aside because it is broken up into didactic learning and this collaborative’s, hey, let’s think together, let’s problem solve, to be able to provide support for the child that you’re needing help with or the question that you need help with.
Carol Vassar, podcast host/producer:
How did you find people like Alfreda, and Alfreda, we’re going to get to you in just a moment. People who were in the preschool realm, in the classroom serving preschoolers, to become part of TIPS ECHO?
Dr. LaTrice L. Dowtin, CEO, PlayfulLeigh Psyched:
Oh my gosh, so much outreach. Lots of different networks and connections that we have calling. So we wanted to, with our first iteration of TIPS, we wanted to get people from all over and we were able to actually do, I think we were the first national ECHO, so I always want to throw that out there. We’re the first national ECHO, we had programs from people across five different states or so, across the country. And really it was just that outreach. It was calling, it was some of the connections that we have like, hey, this is what we’re starting up. Here’s what this will look like. And I think sometimes framing it for people are like, what is this? Is this just like another CE workshop? And it’s like, no, this is live and collaborative for a program. If we had fireside chats where, hey, here’s a link. We’re going to send this out and you can ask us questions, we’ll do a little presentation, kind of almost modeling what TIPS would look like.
Here’s a little presentation, but then you can also ask us questions about what this could look like, how this could support your community, whatever questions you have. And then, of course, follow up. So it was a lot of recruiting to try to get people to not so much understand the utility, but figure out what it was. And I think once we had people that were like, oh my gosh, and, this is what you can do for us? They were like, where can we sign up? I want my whole staff involved. How do we do this? How do we figure it out? How we can schedule it because I think it is really helpful. Hopefully, people are feeling that way too.
Carol Vassar, podcast host/producer:
Well, Alfreda, I’m going to turn to you. You are a participant in this. You’re a teacher out in the field. Do you remember when you first heard about this? It’s a virtual learning system, it’s a support opportunity. How’d you hear about it and what was your first experience with it?
Alfreda Clark, AdventHealth for Children:
Yeah, so with AdventHealth for Children’s West Lake’s Early Learning Center, one of our investors, our foundational investors as well as partners, the Bainum Family Foundation is the organization that really helped us bridge a relationship with the Lourie Center. We started talking about programs that drive impact. And so in our conversations with the Lourie Center, I just knew that we wanted to really focus our early learning educators to have a multidisciplinary approach. Being a part of AdventHealth as well, that’s already in the clinical space. So how do we utilize some of those practices and some of those learnings that you get from the early learning sector and that you get from the whole health and wellness sector and merge them together? And TIPS ECHO, that framework, seemed to just lead us right to where we wanted to go. What made it unique is that Project ECHO’s effectiveness was proven in rural communities and communities where families were typically under-resourced.
And so they were able to essentially create a community of practice from a body of experts who worked with children in a variety of ways, just as Dr. Dowtin mentioned. And so just having all of that rich history in one space to really focus in and come together and look at specific challenges or areas for improvement or concerns and questions that you have, and to be able to really focus in and talk to and have the support of clinical social workers, for psychologists, for those who’ve been in early learning practices for a very long time, just made sense to us. It was the place that we wanted to go. We had already started what we called MTSS Rounding, so the Multi-Tiered System of Support and Rounding. So we’re like, oh, let’s put education and what we learn in health and wellness together. And this really was a substantial model. And so we are so happy to have found them and for them to have found us and for us to be able to grow as a part of this work together.
Carol Vassar, podcast host/producer:
Alfreda, quick follow-up. Can you cite a particular challenging situation or something that you had to manage in the classroom where TIPS ECHO was really helpful to you in supporting you and providing you with some ideas that you could implement right away?
Alfreda Clark, AdventHealth for Children:
Yes, I think to start with, when the AdventHealth for Children’s Early Learning Center opened, we opened in the middle of COVID, so let’s start there. We were in the middle of a pandemic, and we were seeing all kinds and dynamics that just, we weren’t seeing before. You’re just finding that children are having different social needs. Families were dealing with stress and trauma in terms of counting those adverse childhood experiences, and the list could go through the roof at times because of the stress level that some families were faced with. And for us, we were noticing that children were in need of support that took keen sensitivity, and that drove us to reach beyond what our traditional approaches would’ve been. With TIPS ECHO, we were able to link with other early learning programs, of course, in the country to discover that we’re all facing very similar circumstances.
So that’s first, it’s we now have connectivity because we’re experiencing things that are different even though you’re in another city, state, and even though your demographic can be extremely different. So I found myself being grateful in terms of trying to share with my teaching teams that each TIPS ECHO session, as Dr. Dowtin said, begins with this didactic focus of learning. After that didactic learning was completed, it followed a case study. So we had an opportunity to just share an actual case that we were experiencing in our center, and it centered on our areas of concern about a child in our program. So we would explain, okay, this is what’s going on. These are all of the dynamics. And then our community would say to us, okay, we might have some clarifying questions and we might want to just ask a little bit more so we can really drive down into what the root cause of this particular behavior or issue could be.
So they started to share methods and strategies as well as advice. And I was really stopped when I heard in one of our didactic sessions that regulation is a learned phenomenon. And I’m thinking, okay, I do know that. At the root of things, I know that. I know that behaviors and things that we’re, we’re teaching children everything, we’re teaching them how to hop. We’re teaching them how to skip and how to count. So of course, regulation is also something that can be learned. And so, we need to also focus our attention and our time on helping children cope and learn how to regulate themselves. And then also knowing that even though we’ve done that in our classrooms to help with classroom management, to assist with children, and in a group care setting, we have to also be present to witness when they leave our immediate space, their environment exposes them to other things where regulation might be now challenged differently.
So we’ve got to know to be sensitive to that and to reel our kiddos back in and to say, we have to start at scratch and we have to start a clean slate day, meaning that children are coming in and discovering each step of the way. We’re discovering this together. So just knowing that it’s not a one-and-done, but it’s more of a process, and we are discovering that pathway together. So in terms of what really stood out to me in one of our sessions was regulation is a learned phenomenon. So that’s something that we can teach and share and help children expand and grow on.
Carol Vassar, podcast host/producer:
Dr. Dowtin, I’m seeing you nod your head in agreement. What’s been the experience beyond what Alfreda has talked about today for those who participate?
Dr. LaTrice L. Dowtin, CEO, PlayfulLeigh Psyched:
Yes, I love, I love, thank you so much, Alfreda, even for just talking about it in such a well-rounded way, in a beautiful way. I was nodding also because that’s been our goal. And so to hear someone actually say, we met our goal basically for her covert, I think that’s wonderful. We’ve gotten a lot of that same feedback from our participants, that they love the didactic learning. If they have questions, there’s light bulbs that go off for them. But then also, again, that opportunity to talk about specific cases. And then also there’s learning that happened and hearing someone else’s problem or someone else’s case that they were bringing to us. And they sometimes also feeling empowered like, okay, I do know how to support, so we’ve had a similar student. That community and unity that can come out that we’re not alone. We’re not operating in silos.
The cohort that Alfreda was a part of, a lot of the programs were in rural areas, and so they didn’t have access to communicate and talk about the same types of things we were talking about. And so sometimes it can feel really isolating. So our TIPS ECHO allowed for them to, again, talk with people across the country that were having some of those similar issues and really understand, okay, how do we make our classrooms, our school environment, and our relationship with one another, more trauma-informed? So we’ve got wonderful feedback about just that collaborative piece and the fact that the learning that happens is at least in part because there’s still only other people experiencing some similar challenges.
Carol Vassar, podcast host/producer:
I think it’s important to raise the fact that this is being shared in communities that are underserved, that are in rural communities. And that’s really a key piece of this, isn’t it, Dr. Dowtin?
Dr. LaTrice L. Dowtin, CEO, PlayfulLeigh Psyched:
I mean, that is a huge, huge piece of it, because when we think about schools and programs that are well-resourced, that are very, very well-resourced, that have all this excess, they don’t, they can always benefit from TIPS, but they don’t necessarily at the same level need that community because that community is already there. They already have the school right now down the street that they can talk to. They sometimes are calling. I’ve worked in some of those schools that were more well-resourced, and I’ve worked in schools that were under-resourced, and there’s a definite difference. Also when we think about working with children that have experienced, that have those ACEs, Adverse Childhood Experiences, or that have experienced trauma in some way, shape, or form, we cannot forget that the educator is also experiencing some of the ramifications of that child’s life and what they’re experiencing.
So you can’t go into a classroom and say you care about children and not be affected emotionally, empathically, by what they are bringing in. And then, sometimes, because of what they experience, they become big behaviors, right? Big emotions and bigger behaviors occur in every preschool classroom across the world. And sometimes those behaviors are so hard for the educator. You have this child that is having a full-on tantrum or throwing things, or you’re trying really hard to engage them, and they don’t want anything to do with you. That is hard on us. We are humans first. And so being able to hear that people are experiencing that and collaborating that way in a community that’s already maybe isolated or, again, already being pulled in multiple directions to try to really help the children in their classroom and the families that they serve. TIPS does that in a way that I think that a lot of programs haven’t yet tried to tap into or aren’t able to.
Carol Vassar, podcast host/producer:
And teachers are stressed enough as it is. Alfreda, talk about how this has provided you and your team support overall in what it is that you do and how you feel.
Alfreda Clark, AdventHealth for Children:
Yes. To be able to, again, just connect with other educators and to understand that they’re facing very similar problems or very similar challenges and concerns, just really starts to level set the entire process. It lets us know that you are in a familiar space and we all are facing things that we recognize and that we have concerns about. And we’re wondering how can we reach, how can we go beyond what we’ve traditionally done to find these pathways together? One of the things that I know in terms of our spending time in these communities is goodness, we have some very different ways in which we look at things. And so lending all of those perspectives at one time really gauges you to say, oh, my word, I need to now look at this a little bit differently. Or I hadn’t really thought about that, or I’ve tried it, but I haven’t tried it in exactly that way.
So we talk about ways, utilizing methods of breathing, utilizing ways to create safe spaces for children, or just when we talk about even the thoughts of Dr. Dowtin was mentioning, ACEs, the Adverse Childhood Experiences that children are facing, also the educator may come from a space of ACEs and trauma. They might also still be living in a space of trauma. And so it allows the educator to take a look at where they are and start to understand that some of their triggers or responses to children or to things in their own environment are guided or led by something that has been outside of their power. And so now it allows the educator to come with a fresh new perspective as they approach the children. And to ask the question, not what’s wrong with you, but what happened to you? And so when you approach a child with that kind of reference, it opens the door to many more opportunities.
And so you can take more tools into your toolkit and say, let me try it and let me approach it in a different way. And knowing that it may work for a while, it may work for a couple of weeks, and then the child may shift or something new may be introduced to the child’s environment. And so now you, along with that shift, have to look at what is something different? What’s a different path? What’s something else that I can try to really impact this child? And it’s really all about determining how we can get across this line together. We want the child to have health and well-being and to feel safe. We want you to know that when you come through this classroom door, you are now safe. You are also seen, and you are also heard, and you’re not competing for that. There’s a space that’s right there for you. And that’s what we’ve been learning and feeling and being able to identify and grasp in our TIPS ECHO sessions.
Carol Vassar, podcast host/producer:
So it’s great for the kids, it’s great for the educators, Dr. Dowtin?
Dr. LaTrice L. Dowtin, CEO, PlayfulLeigh Psyched:
I just wanted to say that one of the things that Alfreda alluded to was what we call our mindful moments or mindful minutes that we have at the, pretty much what’s the very start of our TIPS ECHO sessions. One of the reasons that that was really important for me to put that in there is because especially our first two to three sessions to me are heavy. They’re emotionally heavy because they learn about trauma and child abuse and the stats in our country. And it’s sad to think about and it impacts us. And what we wanted to show is that you are a person that educators that are on our call, in our sessions of participants, are people. And how we are feeling has a direct impact on how we show up in our lives, in our classrooms, and with the children.
And so we would come together in our session to say, you know, we’re going to start here at a grounded place. We’re going to start here feeling safe and being mindful ’cause we’re together. And it was really important for me to be able to do that. And of course, we were able to, we picked out mindful moments that we can also do in the classroom. So you learn this for yourself and we practice it together. And yes, you can also use these with children because we’re modeling the beginning steps of that co-regulation, how we regulate our emotions and how we help children learn that ability. And I thought that was just so important. And I love hearing Alfreda talk about that. She got it. You picked up on it.
Carol Vassar, podcast host/producer:
This all sounds so wonderful, so positive. Anything I haven’t asked you, anything we haven’t covered that you’d like to share? Either of you.
Alfreda Clark, AdventHealth for Children:
Just to know that a multidisciplinary approach is paramount. Is paramount for really being able to drive down what the root cause of an issue or concern is. Within West Lakes, which is housed in Orlando, we have found that we’re a part of a collective impact model already. Where you have partnering organizations coming together to drive investment from cradle to career. And that piece, that component alone really is the approach that we use in a lot of different facets. We want to make sure that we talk about connecting collaborating and so that we can have a comprehensive outlook on how we work through our program models. And within early learning, work like TIPS ECHO gives you that from the very start. And it allows you to network with those that you may not have an opportunity to touch, yes, across the country, but also these experts who can assist and guide you to be able to answer some of the questions that you’re wrestling with.
And you feel like you’re isolated, that you are in silos, that you are operating alone, and you find out, no, I’m not alone. And I’m even empowered when I leave that conversation. Empowered so much that now I can find how I can start to utilize my own resources to continue to support the children and families that we serve. And so I think that’s really the most important part of the biggest learning for us, because our model is, like I said, we’re providing support to an under-resourced community, but we know that, goodness, even with this intersection of health equity meets education equity, there’s still more, and the more is found in community.
Dr. LaTrice L. Dowtin, CEO, PlayfulLeigh Psyched:
Yes, more is found in community. And I also think that when we’re thinking about supporting young children from a trauma-informed approach, we’re really remembering that we’re supporting everybody that that child touches or those young children touch. And that includes the teachers, the families, the administrative assistant. One of the things that I also think is unique about the experts that are on the panel for TIPS ECHO is that we are multidisciplinary. Most of us have had time in the classroom, in a classroom, and then we branched off into other special fees. So we have psychiatry, psychology, clinical mental health, we have clinical social work, we have school administrative assistant, we have center director and assistant director. So these are people who, again, really understand what it’s like to be boots to the ground, supporting the children in the classroom.
And also what it’s like to need that support for themselves. To be faced with their own histories and their background, but then also to have to go into that classroom, go into that school each day and support others. And so, TIPS ECHO provides the opportunity for them to, yes, be thinking about what’s happening in a classroom, but also, I hope, be a port into for them as people as well, because that’s where the ripples happen, right? Often, we work with young children, or often, we work with people who have experienced tragedies. We have this idea we have to do all for them. We do a lot for them, but you matter too. And I hope that my belief is that TIPS helps people understand that you matter too. And we do this in service of young children.
Carol Vassar, podcast host/producer:
Dr. LaTrice L. Dowtin is a clinical psychologist and the CEO at PlayfulLeigh Psyched based in Bethesda, Maryland. She was joined in conversation by Alfreda Clark, Center Director for the AdventHealth for Children West Lake’s Early Learning Center in Orlando, Florida.
Music:
Well beyond medicine.
Carol Vassar, podcast host/producer:
Thanks so much to Dr. Dowtin and Alfreda for joining us on the Nemours Well Beyond Medicine podcast. And as always, thanks to you for listening. Have an idea for an upcoming episode of the podcast? We’re all ears. Leave a voicemail on our website, NemoursWellBeyond.org, or email us at [email protected]. Also, head to that website if you’re interested in finding previous podcast episodes. There you can also subscribe to the podcast and leave a review. Again, that’s NemoursWellBeyond.org. Our production team for this episode includes Cheryl Munn, Susan Masucci, and Lauren Teta. Join us next time as we talk with Dr. Nikole Hadi-Bender, Chief Medical Officer of Talkspace. I’m Carol Vassar. Until then, remember, we can change children’s health for good, well beyond medicine.
Music:
Let’s go well beyond medicine.
