ECHOing Change: Tracking Statewide Participation in a Substance Use Learning Network

ECHOing Change: Tracking Statewide Participation in a Substance Use Learning Network | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article ECHOing Change: Tracking Statewide Participation in a Substance Use Learning Network Hannah Haynie, Stacey Gardner-Buckshaw, Xinyi (Cindy) Mao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6966304/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The Ohio Alcohol and Substance Use Disorder (AUD/SUD) Project ECHO, based at Northeast Ohio Medical University (NEOMED), is a statewide virtual learning initiative launched in 2017 to enhance providers’ capacity to deliver evidence-based addiction care. Initially focused on opioid use disorder, the program has expanded to include alcohol use disorder and emphasizes integrating MOUD and MAUD into behavioral and primary care. The program also aims to reduce professional isolation and promote multidisciplinary collaboration. Methods: This descriptive study examined the program’s reach, engagement, and delivery across two time periods (2017–2021 and 2024–2025). Data were sourced from the ECHO and iECHO platforms, including attendance logs, session frequency, and topic coverage. Analyses focused on trends in participation, session content, and international engagement. Results: The program demonstrated consistent growth in session frequency, topic diversity, and participant engagement from 2017 to 2021. After a funding lapse from 2022 to 2023, the program was relaunched and engaged over 160 unique network members from multiple countries. Sessions covered innovative and clinically relevant topics. Limitations included incomplete logging of case discussions and gaps in tracking demographics and continuing education (CE/CME). Conclusions: The Ohio AUD/SUD Project ECHO has shown strong potential as a sustainable and scalable model for addiction workforce development. Despite some data limitations, the program continues to fill critical training gaps and support healthcare providers during an ongoing public health crisis. Trial registration Not applicable. Project ECHO Alcohol Use Disorder Substance Use Disorder Healthcare Provider Training Sustainability Figures Figure 1 Figure 2 Introduction In response to a growing disparity in providing complex medical care to underserved populations in rural, frontier, and prison settings, the Extension for Community Healthcare Outcomes (ECHO) Model was created to deliver clinical training in complex care management through video-conferencing technology (Arora et al., 2010). Pioneered by Arora and colleagues at the University of New Mexico Health Sciences Center (UNMHSC) in 2003, Project ECHO provided primary care providers (PCPs) with the training and knowledge necessary to manage hepatitis C virus (HCV) from expert inter-disciplinary specialists referred to as “knowledge networks.” Project ECHO aims to enhance PCP independence, skills, and self-efficacy in managing chronic and complex conditions through three interconnected 'learning loops' (Figure 1). These include: (1) longitudinal co-management of patients with specialists via case-based learning, (2) collaboration with fellow community-based PCPs, and (3) focused didactic presentations delivered by specialists. This hub-and-spoke model has been previously described and validated by Arora et al. (2010). Since its inception, the formative ECHO project has gained traction. It has been expanded to various clinical areas, including integrated addictions and psychiatry, chronic pain and headache, and child and adolescent psychiatry (Arora et al., 2010; Zhou et al., 2016). Of focus, many ECHO Models have been administered to combat the rising opioid overdose crisis and additional substance use disorder (SUD) emergencies across the nation (Salvador et al., 2019; Smithenry et al., 2023). Ohio is one of eight states that experienced a doubling of the opioid mortality rate every three years from 1999 to 2016 and has experienced an alarming increase of 169% in unintentional opioid overdoses (Hernandez et al., 2020). In efforts to improve PCP education on SUD diagnosis and treatment, Ohio and its surrounding states, like Pennsylvania, have implemented Project ECHO initiatives to deliver programming for comprehensive SUD care and medication management (Koester et al., 2024; Kawasaki et al., 2019). Designed as a hub-and-spoke model, a central “hub,” or academic health system, connected with “spoke” clinics in which PCPs provide frontline care (Zhou et al., 2016), Penn State Health administered ECHO seminars on Medication-Assisted Treatment (MAT) for SUDs to local primary care offices and found that PCPs demonstrated increased knowledge on MAT and decreased sense of professional isolation following Project ECHO implementation (Kawasaki et al., 2019). Moreover, Koester and colleagues (2024) from the Weitzman Institute Health System partnered with Ohio University Heritage College of Osteopathic Medicine and Buckeye Health Plan to administer a comprehensive SUD (alcohol, opioids, cannabis, tobacco, stimulants, and nicotine) ECHO course for Ohio PCPs and behavioral health providers. Results revealed insightful Project ECHO strengths, including enhancing PCP knowledge, self-efficacy, and skills associated with SUD care through effective didactic learning and complex case discussions. Project ECHO studies have yielded numerous lessons for PCPs' knowledge and confidence in treating patients with complex cases. A study conducted by Sheehan et al. (2022) in Ontario utilized psychiatrists to lead an ECHO-based program for healthcare professionals addressing patients with co-occurring mental and physical health needs. Using Moore’s Evaluation Framework, a globally adopted method for evaluating Project ECHO (Zhou et al., 2016), the study found that overall satisfaction and self-efficacy among PCPs increased, and long-term professional practice changes were implemented in over 80% of participants (Sheehan et al., 2022). McDonnell et al. (2020) demonstrate that incorporating Project ECHO within a rural practice-based research network in Oregon fosters sustained provider participation through relationship-centered mentorship, participant-driven agendas, and relevant training topics despite fiscal uncertainty and resource fluctuations. Most Project ECHO programs receive funding through federal grants (McDonnell et al., 2020). As a result, a recent study identified funding as the primary threat to Project ECHO sustainability, recommending the coordination of multiple ECHO programs and longer-term support for staff to secure diverse funding sources (Larson et al., 2023; Allison et al., 2025). The adaptability and versatility of the ECHO Model (Allison et al., 2025), along with a commitment to lifelong learning (Sockalingam et al., 2022), enable leaders to integrate Project ECHO into existing clinical infrastructure. In a systematic review of 39 Project ECHO studies, Zhou et al. (2016) identified common factors that motivated PCPs to participate in Project ECHO: increasing knowledge, applying knowledge in patient encounters, enhancing collaboration with specialists, and minimizing patient travel time for specialist referrals. Conversely, significant barriers to ECHO implementation and consistent attendance arose from patient priorities and time constraints (Zhou et al., 2016), as well as a lack of program endorsement by clinic leaders (Salvador et al., 2019). Additional upstream policy-level interventions may be crucial for improving access to and funding for technology-based collaborative learning initiatives, such as ECHO (Salvador et al., 2019). Despite common obstacles, Project ECHO is an innovative and versatile tool that helps educate and support primary care providers, behavioral health specialists, and care team members on a wide range of clinical topics through collaboration and discussion. This study builds on the Project ECHO model’s established framework for collaborative clinical training to examine the Ohio AUD/SUD Project ECHO’s innovative approach to addressing Ohio’s addiction crisis. By evaluating the program's reach, engagement, and content delivery from 2017 to 2021 and from 2024 to 2025, readers will gain insights into its growth, resilience amid funding challenges, and scalable strategies for addiction workforce development. We highlight how its expanded focus on AUD/SUD, integration of MOUD/MAUD, and strategic partnerships enhance provider education and care delivery. Background The Ohio Alcohol and Substance Use Disorder (AUD/SUD) Project ECHO, based at Northeast Ohio Medical University (NEOMED), is a pioneering statewide initiative designed to empower Ohio’s healthcare workforce to combat the state’s addiction crisis. Initially launched as the Ohio Opioid Project ECHO on November 3, 2017, the program addressed the urgent need for accessible, evidence-based training on substance use disorders (SUDs). It has since evolved, with a name change to Ohio AUD/SUD Project ECHO proposed by the Ohio House of Representatives in the governor’s budget, reflecting an expanded scope to include alcohol and other substance use disorders such as those involving cannabis, stimulants, and tobacco. This longitudinal learning program fosters collaboration among a multidisciplinary network of physicians, nurse practitioners, physician assistants, nurses, social workers, counselors, and administrators, with a strong emphasis on integrating Medication-Assisted Treatment (MAT) into behavioral healthcare. The program’s structure is built on a strong framework of virtual, one-hour sessions held on the first and third Fridays of each month, made possible through dedicated funding from the State of Ohio. Historically, federal funding through the Substance Abuse and Mental Health Services Administration (SAMHSA) State Opioid and Stimulus Response (SOS) dollars, passed through the Ohio Mental Health and Addiction Services (OhioMHAS), supported two completed cycles of the Ohio Opioid Project ECHO. These included early morning sessions (7:00 a.m.) for current prescribers needing continuing education and afternoon sessions (3:00 p.m.) for new prescribers, conducted over 12-week cycles with 12 didactic sessions each Friday. A 2019 SOS grant, in partnership with all Ohio medical schools, supported MAT integration and a qualitative research study examining medical schools’ curricula and barriers to implementation (Gardner-Buckshaw et al., 2021). The program’s current sessions, offered at no cost and accredited for Continuing Education (CE) and Continuing Medical Education (CME) credits, combine expert-led didactic presentations with interactive, case-based discussions. Topics address real-world clinical challenges, such as trauma-informed care, perinatal SUD, concurrent substance use, and cultural considerations in addiction treatment. Participants submit de-identified patient cases, creating a dynamic, peer-to-peer learning environment where providers share insights, resolve uncertainties, and apply evidence-based strategies to enhance patient care. To maximize accessibility, session recordings are available through the iECHO portal, which was upgraded in May 2023 for improved functionality at NEOMED, as well as on a public YouTube playlist, ensuring that learning opportunities extend beyond live attendance. Attendance data from the original iECHO platform and the new system provide insights into the program’s reach. Complementing the ECHO sessions, NEOMED develops independent training modules to support the integration of Medication for Opioid Use Disorder (MOUD) and Medication for Alcohol Use Disorder (MAUD) into primary care. These modules offer practical guidance, case studies, and legal resources, with forthcoming content tailored explicitly to healthcare providers caring for pre- and perinatal women with SUDs. The program’s reach is amplified through targeted in-person training, such as a one-day MAT session for physician assistant students, and localized workshops designed for Ohio’s diverse communities. Strategic partnerships with organizations like the Substance Use Disorder Center of Excellence at Case Western Reserve University, OhioMHAS, and all Ohio medical schools, alongside HRSA-sponsored efforts, have enhanced the program’s ability to deliver tailored education and foster regional collaboration. An unannounced discontinuation of anticipated federal funding in September 2021, despite the program’s good standing and submitted renewal, resulted in a funding lapse until June 2023; however, MOUD trainings continued. Concurrently, the Program Manager sent monthly resource emails (e.g., conferences, meetings, and best practices) to sustain engagement. A hallmark of the Ohio AUD/SUD Project ECHO’s success is its lean yet effective operational model. Managed by a small team, including a part-time Program Director, Program Manager, and a Program Coordinator added in 2023, the program relies on efficient coordination of session scheduling, speaker outreach, participant engagement, and CE/CME documentation. This core team is supported by an interdisciplinary “hub team” of experts in addiction medicine, pharmacy, psychiatry, social work, and family medicine, who deliver high-quality didactic content and provide clinical mentorship during case discussions. This hub team model, consistent since the program’s inception, ensures expert knowledge drives the learning community. Despite its modest staffing, the program has engaged providers across 70% of Ohio’s counties and beyond, with robust promotion through the OhioMHAS newsletter, NEOMED’s Department of Psychiatry webpage, social media, and advocacy from leaders like former President of the Ohio Society of Addiction Medicine, Chris Delos Reyes, MD. The program’s resilience in the face of funding challenges underscores its strength. Before the current two-year funding period (July 2023–June 2025), a funding gap necessitated reliance on NEOMED’s institutional support, volunteer contributions from the hub team, and archived session recordings to maintain minimal operations. Both SAMHSA and OhioMHAS valued the program, but a funding gap halted ECHO sessions, with only communications continuing. An unannounced discontinuation of expected federal funding in September 2021, despite the program’s good standing and submitted renewal, caused a lapse until June 2023; however, MOUD trainings continued. With funder approval, the team transitioned from in-person training to creating video CME modules, using the resulting savings to secure a three-month no-cost extension for ECHO sessions. A timeline of these activities is shown in Fig. 2 . Anticipating a potential funding shortfall after June 2025, this adaptability positions the Ohio AUD/SUD Project ECHO as a scalable model for workforce development. Methods To evaluate the reach, engagement, and content delivery of the Ohio Alcohol and Substance Use Disorder (AUD/SUD) Project ECHO, data were collected from the iECHO platform for two periods: 2017–2021 (original platform) and 2024–2025 (upgraded platform, data through May 16, 2025). The original platform, in use until its upgrade in May 2023, captured session frequency, attendance, case presentations, and topic documentation for Ohio Opiate Continuing Education (CE) ECHO and Mentor Clinic sessions (CE ECHO sessions focused on didactic presentations for accredited continuing education, while Mentor Clinic sessions emphasized interactive case-based mentorship for practical application), conducted virtually on the first and third Fridays of each month. These sessions provided continuing education and mentorship for healthcare providers addressing AUD/SUD. The program’s hub-and-spoke network, led by an interdisciplinary hub team, fosters interactive learning, with participant feedback driving future topic selection. Sessions covered topics like needs assessment, MAT’s financial benefits for primary care, Ohio-specific legal considerations, and polysubstance use. The data included the number of sessions, total attendees, average attendees per session, cases presented, and topics covered. Topic documentation was incomplete from 2017 to 2019, and no continuing education (CE) or continuing medical education (CME) credits were recorded. Participant demographics were not available for 2017–2021. The upgraded iECHO platform (2024–2025) added metrics, including counts of unique network members, gender demographics (Female, Male, Prefer Not to Disclose, Non-Binary), represented countries, and total learning hours. Following the 2021–2023 funding gap, CE ECHO and Mentor Clinic sessions were combined into “general” sessions, integrating didactic education with interactive case discussions to enhance flexibility and engagement. Although case discussions were not formally logged, the Program Manager noted some unrecorded case presentations. CE/CME credits also remained unrecorded. Topics were thoroughly documented in 2024–2025. Descriptive statistical analyses were performed using Microsoft Excel software to summarize session frequency, attendance, case presentations, topic documentation, and, for 2024–2025, unique network members, learning hours, and participant demographics. From 2017 through 2021, data were aggregated by year and session type (CE ECHO vs. Mentor Clinic) to describe trends in engagement and content delivery. For the 2024–2025 period, analyses included the total and average number of attendees per session, learning hours, and participant diversity (in terms of gender and geographic representation). Data integrity was ensured by cross-referencing iECHO records with program reports and archival records maintained by the Program Manager. Limitations included the funding gap (September 2021–June 2023), which prevented data collection for the 2022–2023 period; incomplete topic documentation from 2017 to 2019; unlogged case discussions from 2024 to 2025; and the absence of CE/CME credit data across all years. Results Program Growth and Engagement: 2017–2021 In 2017, the program’s inaugural year, there were 8 Ohio Opiate CE ECHO sessions (16 attendees, 2 attendees/session, 1 case presented) and 8 Mentor Clinic sessions (27 attendees, 3.4 attendees/session, 1 case presented). Topic documentation was limited, with only 2 CE ECHO topics recorded (“First Things First,” “MAT General Info”) and 13 out of 16 sessions (81%) lacking detailed descriptions. In 2018, session frequency increased to 49 CE ECHO sessions (280 attendees, 5.7 attendees/session, no cases) and 48 Mentor Clinic sessions (253 attendees, 5.3 attendees/session, 1 case). Topics were documented for 61 out of 97 sessions (63%) and spanned clinical (e.g., chronic pain, perinatal SUD) and practical (e.g., motivational interviewing, harm reduction) themes. In 2019, there were 46 CE ECHO sessions (460 attendees, 10 attendees/session, no cases) and 46 Mentor Clinic sessions (489 attendees, 10.6 attendees/session, 2 cases), with topics documented for 27 out of 92 sessions (29%), covering clinical issues (e.g., anxiety management, MAT disparities) and practical skills (e.g., patient engagement). In 2020, case presentations increased, featuring 45 CE ECHO sessions with 752 attendees (16.7 attendees per session, covering 27 cases) and 45 Mentor Clinic sessions with 659 attendees (14.6 attendees per session, addressing 40 cases). Topic documentation improved, with 87 out of 90 sessions recorded (97%), covering clinical topics (e.g., provider burnout, relapse prevention) and practical skills (e.g., managing drug test results). In 2021, 37 CE ECHO sessions had 558 attendees (15.1 attendees per session, covering 15 cases) and 37 Mentor Clinic sessions had 600 attendees (16.2 attendees per session, addressing 22 cases), achieving full topic documentation and covering innovative subjects (e.g., memantine for OUD, immunotherapy) and practical areas (e.g., stigma reduction, MOUD workflows). No participant demographics were available for the years 2017 to 2021. Program Relaunch and Continued Engagement: 2024–2025 Following a funding gap from 2022 to 2023, the program resumed in 2024 with 20 sessions, totaling 387 learning hours, averaging 19.3 attendees per session, and no reported cases. It engaged 93 unique network members from the U.S., India, and Uganda, comprising 78% female, 20% male, and 2% who preferred not to disclose their gender. Fully documented topics included clinical areas (e.g., diagnosing AUD, pharmacotherapy trends), practical issues (e.g., SAMHSA MAT training, SBIRT), and innovative themes (e.g., virtual reality empathy training, recovery capital), with 8 out of 20 sessions, or 40%, addressing innovative approaches. From the start of the year until May 16, 2025, 10 sessions consisting of 222 learning hours and an average of 22.2 attendees per session engaged 69 unique network members from the U.S., Sudan, and Uganda, with a demographic breakdown of 64% female, 32% male, 3% preferring not to disclose, and 3% identifying as non-binary. The fully documented topics covered clinical areas (e.g., HCV screening, PTSD-AUD comorbidity), practical themes (e.g., OBOT regulations), and innovative approaches (e.g., fetal alcohol spectrum disorder), with 4 out of 10 sessions, or 40%, focusing on innovative topics. The Program Manager noted that unlogged case discussions in 2024 and 2025 were not captured in the iECHO system. No CE or CME credits were recorded during either period. The data were derived from the iECHO platform and analyzed using Microsoft Excel software. Overall, the Ohio AUD/SUD Project ECHO demonstrated sustained engagement from 2017 to 2021 and from 2024 to 2025, despite facing challenges including incomplete topic documentation, unlogged case discussions, and a lack of recorded CE/CME credits. Table 1 , below, summarizes the frequency of sessions, attendance, cases presented, and topic documentation by year. Table 1 Summary of Project ECHO and Mentor Clinic Sessions by Year Year Session Type Sessions Total Attendees Avg. Attendees per Session Cases Presented Topics Documented (%) Unique Network Members Learning Hours 2017 CE ECHO 8 16 2.0 1 2/8 (25%) – – 2017 Mentor Clinic 8 27 3.4 1 1/8 (13%) – – 2018 CE ECHO 49 280 5.7 0 36/49 (73%) – – 2018 Mentor Clinic 48 253 5.3 1 25/48 (52%) – – 2019 CE ECHO 46 460 10.0 0 13/46 (28%) – – 2019 Mentor Clinic 46 489 10.6 2 14/46 (30%) – – 2020 CE ECHO 45 752 16.7 27 43/45 (96%) – – 2020 Mentor Clinic 45 659 14.6 40 44/45 (98%) – – 2021 CE ECHO 37 558 15.1 15 37/37 (100%) – – 2021 Mentor Clinic 37 600 16.2 22 37/37 (100%) – – 2024 General 20 380* 19.3 0 20/20 (100%) 93 387 2025 General 10 220* 22.2 0 10/10 (100%) 69 222 Footnote : 2024: 73 Female (78%), 19 Male (20%), 1 Prefer Not to Disclose (2%); 2025: 44 Female (64%), 22 Male (32%), 2 Prefer Not to Disclose (3%), 2 Non-Binary (3%). Discussion Given the prevalence of substance use disorders and particularly opioid use and overdoses in Ohio (Hernandez et al., 2020), the Ohio AUD/SUD Project ECHO was implemented to combat the growing public health crisis. Through topic-focused presentations, case-based learning, and clinical mentoring, all original aspects of the ECHO Model (Arora et al., 2010), as well as independent training modules developed by NEOMED, this program supported healthcare providers in treating substance use and enhancing education in historically challenging clinical situations. This study evaluates participant engagement, reach, and content delivery of the Ohio AUD/SUD Project ECHO, potentially enabling whole-person recovery care for thousands of patients. The Ohio Alcohol and Substance Use Disorder (AUD/SUD) Project ECHO has demonstrated notable resilience and sustained provider engagement across two significant periods: 2017–2021 and 2024–2025. Despite a complete pause in operations due to a funding gap from 2021 to 2023, the program recovered with strong attendance and consistent topic documentation, underscoring the durability of the ECHO model when adapted for use in addiction medicine (Koester et al., 2024). Engagement grew from 43 attendees in 2017 (2.0–3.4 attendees per session) to a peak of 1,411 in 2020 (14.6–16.7 per session), followed by a successful relaunch in 2024–2025 with 608 estimated attendees (19.3–22.2 per session). This recovery illustrates the effectiveness of sustained institutional support and the adaptability of virtual learning models, supported by findings in Allison et al. (2025), emphasizing the versatility and accommodating structure of both the ECHO program and its participants and audience. Additionally, Allison et al. (2025) identified funding as the primary threat to Project ECHO sustainability, illustrated in the OHIO AUD/SUD Project ECHO funding gap. Continuous efforts during the funding hiatus, such as monthly resource emails, dissemination of archived session recordings, and internal advocacy at Northeast Ohio Medical University (NEOMED), likely contributed to the program’s ability to regain momentum quickly. This reflects the findings of Larson and colleagues (2023), where ongoing programming and in-house staff commitment contributed to the success of the ECHO Model. Although specific engagement metrics (e.g., email open rates or resource access) were not tracked, these strategies mirror recommendations from previous ECHO research that emphasize maintaining engagement through community-building and asynchronous learning (Larson et al., 2023; Salvador et al., 2019). Content quality and documentation also improved over time. The percentage of sessions with documented topics rose from 19% in 2017 to 100% by 2021 and remained consistent in 2024–2025. Notably, 40% of the didactic lessons during the most recent sessions addressed innovative approaches, such as virtual reality empathy training and interventions for fetal alcohol spectrum disorder (FASD). While no formal case presentations were logged in 2024–2025, qualitative reports from the Program Manager confirm that interactive learning and case-based discussions continued, albeit undocumented. To develop a robust evaluation of the ECHO Model, Larson et al. (2023) suggest focusing on measuring program satisfaction and self-reported participant learning in programs with limited funds, as well as routinely reporting program outcomes to attract new participants and additional funding opportunities. The program’s lean operational model, featuring a small, interdisciplinary hub team and engaged facilitators, ensured efficiency and sustainability, resulting in substantial cost savings compared to in-person conferences. This structure aligns with the ECHO Institute’s hub-and-spoke model, which emphasizes leveraging expert networks to disseminate knowledge efficiently (Zhou et al., 2016). Strategic partnerships with the Ohio Department of Mental Health and Addiction Services (OhioMHAS) and all Ohio medical schools further expanded the program’s reach, with participation covering over 70% of Ohio counties and extending internationally (U.S., India, Uganda, Sudan). Larson et al. (2023) highlight the importance of leveraging partnerships to access alternative funding sources, as well as engaging institutional support and leadership to bolster ECHO programming. The findings suggest that the Ohio AUD/SUD Project ECHO effectively delivered clinical education and programming to a growing audience through innovative solutions during funding disruptions. The results of this evaluation, combined with the existing literature, demonstrate remarkable adaptability and versatility across various clinical questions and program settings. Limitations Despite these strengths, several limitations should be noted. The funding disruption between 2021 and 2023 halted operations and interrupted continuity. Incomplete documentation of session topics from 2017 to 2019, along with the absence of CE/CME credit tracking across all years, hindered comprehensive program evaluation. Furthermore, while engagement in 2024–2025 remained high, the absence of logged case presentations limits the ability to assess interactive learning during this period. Participant demographic data were only available for the most recent years, restricting longitudinal equity analysis. Future Directions Looking ahead, future iterations of the Ohio AUD/SUD Project ECHO should prioritize: Digital Infrastructure- Develop systems to automate session documentation, CE/CME tracking, and case logging, perhaps leveraging artificial intelligence tools. Sustainability Planning- Pursue multi-year funding through proactive grant applications and institutional commitments to avoid future service disruptions. Expanded Evaluation- Incorporate mixed-methods research to assess better educational outcomes, including knowledge gains, clinical behavior changes, and patient-level impacts. Partnership Development- Strengthen cross-institutional collaborations and explore policy-level support to secure the program’s role in state-wide workforce development. These findings reinforce the Ohio AUD/SUD Project ECHO as a scalable, adaptable model for advancing addiction care education. The program’s ability to sustain participation, improve content delivery, and recover from disruptions offers actionable insights for similar initiatives aiming to build resilient, distributed learning communities in public health and behavioral health care. Conclusion Project ECHO is an innovative and versatile model that empowers primary care leaders and team members to approach and treat complex clinical cases like substance use disorders. The Ohio AUD/SUD Project ECHO aims to provide virtual, community-engaged, evidence-based addiction care to healthcare providers in Ohio by offering expert-led didactics with case-based learning, independent training modules, and collaborative mentorship. The purpose of this study was to assess the reach, engagement, and delivery of the AUD/SUD Project ECHO program. Through an in-depth evaluation of the program data collected between two periods (2017–2021 and 2024–2025) from the ECHO and iECHO platforms, consistency was observed in session frequency, participant and audience engagement, and topic variety. The program’s ability to persist through a lapse in funding and consistently grow in engagement and content delivery reflects the strength of the ECHO model, as well as the dedication of its leadership and sustained momentum from participants. These results provide promising insights into Project ECHO as a coordinated learning model that delivers sustainable education despite various financial and structural challenges, and serve as a template for future ECHO programs aimed at providing enriching educational frameworks. Abbreviations AUD - Alcohol Use Disorder SUD - Substance Use Disorder ECHO - Extension for Community Healthcare Outcomes NEOMED - Northeast Ohio Medical University MOUD - Medication for Opioid Use Disorder MAUD - Medication for Alcohol Use Disorder PCP - Primary Care Provider HCV - Hepatitis C Virus MAT - Medication-Assisted Treatment CE - Continuing Education CME - Continuing Medical Education SAMHSA - Substance Abuse and Mental Health Services Administration OhioMHAS - Ohio Mental Health and Addiction Services SOS - State Opioid and Stimulus Response HRSA - Health Resources and Services Administration SBIRT - Screening, Brief Intervention, and Referral to Treatment FASD - Fetal Alcohol Spectrum Disorder OBOT - Office-Based Opioid Treatment Declarations Human Ethics and Consent to Participate Declarations Not applicable Funding Declaration : This project was supported by funds allocated to the Ohio Alcohol and Substance Use Disorder (AUD/ SUD) ECHO at Northeast Ohio Medical University through the 2023–2025 Governor's Budget of the State of Ohio, with oversight provided by the Ohio Department of Mental Health and Addiction Services. Author Contribution H.H., S.G-B., and X.M. contributed to the conception and design of the study. H.H. and X.M. collected and analyzed the data from the iECHO platform. S.G-B. provided oversight and expertise in addiction medicine and Project ECHO methodology. H.H. wrote the initial draft of the manuscript, including the abstract, introduction, and discussion sections. X.M. contributed to the literature review, methods, and results sections, and generated Table 1 and data visualizations. S.G-B. prepared the methods and results sections with X.M. All authors (H.H., S.G-B., X.M.) reviewed and edited the manuscript, ensuring accuracy and alignment with the study’s objectives. Acknowledgements: Not applicable Availability of Data and Materials: The datasets generated and analyzed during this study are not publicly accessible due to the inclusion of confidential program evaluation data and participant information that could compromise privacy. 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Sockalingam S, Rajaratnam T, Gambin A, Soklaridis S, Serhal E, Crawford A. Interprofessional continuing professional development programs can foster lifelong learning in healthcare professionals: experiences from the Project ECHO model. BMC Med Educ. 2022;22(1):432. Gardner-Buckshaw S, Beverly E, Boltri J, Fischbein R. Implementing the comprehensive opioid and pain management curriculum in Ohio’s medical schools: a qualitative study. Paper presented at: Family Medicine Education Consortium Annual Meeting; 2021 Oct 8–10; Pittsburgh, PA. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6966304","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485395594,"identity":"23d0c537-01c4-4139-a336-7279aa4fb980","order_by":0,"name":"Hannah Haynie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBACAwkwySAH4bIB8QEitRiTqoWBIbGBaC3m0s3PpAsKbNK3szcf3fChjEGO70YCfi2Wc46ZSc8wSMvd2XMs7eaMcwzGkoS0GNxIMJPmMTicu+FGjtlt3jaGxA2EtaR/A2r5n25w/43Z7b9tDPVEaMkB2XIgweAGj9ltxjYGIIOwlmJrHoNkww1n0tJu9pyTMJx55gFBh228zfPHTt7g+OFjN36U2cjzHSdgCxCwSCBxJHAqQwbMH4hSNgpGwSgYBSMXAAAeFEjcYigJVwAAAABJRU5ErkJggg==","orcid":"","institution":"Northeast Ohio Medical University","correspondingAuthor":true,"prefix":"","firstName":"Hannah","middleName":"","lastName":"Haynie","suffix":""},{"id":485395595,"identity":"a048b9f3-4639-4f95-8822-531c19f1238b","order_by":1,"name":"Stacey Gardner-Buckshaw","email":"","orcid":"","institution":"Northeast Ohio Medical University","correspondingAuthor":false,"prefix":"","firstName":"Stacey","middleName":"","lastName":"Gardner-Buckshaw","suffix":""},{"id":485395596,"identity":"0742c759-5cbd-4354-88f4-1c5d62937de0","order_by":2,"name":"Xinyi (Cindy) Mao","email":"","orcid":"","institution":"Northeast Ohio Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xinyi","middleName":"(Cindy)","lastName":"Mao","suffix":""}],"badges":[],"createdAt":"2025-06-24 13:38:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6966304/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6966304/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87036802,"identity":"19c4fcd6-0cc4-4e60-81fb-4ee279d17ae8","added_by":"auto","created_at":"2025-07-18 13:22:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":170723,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStructure of ECHO Hub-and-Spoke Model (Adapted from Arora et al., 2010)\u003c/strong\u003e\u003cbr\u003e\nVisual representation of the ECHO model’s three “learning loops”: (1) case-based co-management with specialists, (2) peer collaboration among community PCPs, and (3) brief, focused didactics by the hub team.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6966304/v1/8621a9ccfe1d557d90e3858c.png"},{"id":87033465,"identity":"b360e2f9-b2e2-4008-a3b8-6c6f8b4d3159","added_by":"auto","created_at":"2025-07-18 13:06:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":336023,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTimeline of the Ohio AUD/SUD Project ECHO Model\u003c/strong\u003e\u003cbr\u003e\nThe figure illustrates key phases of the Ohio AUD/SUD Project ECHO program: initial launch, in-person training, transition to asynchronous video CME modules, and a three-month no-cost extension. Projected activity is scheduled to run through June 2025, with anticipated funding challenges highlighted.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6966304/v1/267308ee3368ffd675738220.png"},{"id":92653663,"identity":"007a8ea9-262a-4392-b74a-41c16f461664","added_by":"auto","created_at":"2025-10-02 12:47:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1180094,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6966304/v1/7b6ffbe4-bc12-4355-b9b8-bed29b09fe22.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"ECHOing Change: Tracking Statewide Participation in a Substance Use Learning Network","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn response to a growing disparity in providing complex medical care to underserved populations in rural, frontier, and prison settings, the Extension for Community Healthcare Outcomes (ECHO) Model was created to deliver clinical training in complex care management through video-conferencing technology (Arora et al., 2010). Pioneered by Arora and colleagues at the University of New Mexico Health Sciences Center (UNMHSC) in 2003, Project ECHO provided primary care providers (PCPs) with the training and knowledge necessary to manage hepatitis C virus (HCV) from expert inter-disciplinary specialists referred to as \u0026ldquo;knowledge networks.\u0026rdquo; Project ECHO aims to enhance PCP independence, skills, and self-efficacy in managing chronic and complex conditions through three interconnected \u0026apos;learning loops\u0026apos; (Figure 1). These include: (1) longitudinal co-management of patients with specialists via case-based learning, (2) collaboration with fellow community-based PCPs, and (3) focused didactic presentations delivered by specialists. This hub-and-spoke model has been previously described and validated by Arora et al. (2010).\u003c/p\u003e\n\u003cp\u003eSince its inception, the formative ECHO project has gained traction. It has been expanded to various clinical areas, including integrated addictions and psychiatry, chronic pain and headache, and child and adolescent psychiatry (Arora et al., 2010; Zhou et al., 2016). Of focus, many ECHO Models have been administered to combat the rising opioid overdose crisis and additional substance use disorder (SUD) emergencies across the nation (Salvador et al., 2019; Smithenry et al., 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOhio is one of eight states that experienced a doubling of the opioid mortality rate every three years from 1999 to 2016 and has experienced an alarming increase of 169% in unintentional opioid overdoses (Hernandez et al., 2020). In efforts to improve PCP education on SUD diagnosis and treatment, Ohio and its surrounding states, like Pennsylvania, have implemented Project ECHO initiatives to deliver programming for comprehensive SUD care and medication management (Koester et al., 2024; Kawasaki et al., 2019). Designed as a hub-and-spoke model, a central \u0026ldquo;hub,\u0026rdquo; or academic health system, connected with \u0026ldquo;spoke\u0026rdquo; clinics in which PCPs provide frontline care (Zhou et al., 2016), Penn State Health administered ECHO seminars on Medication-Assisted Treatment (MAT) for SUDs to local primary care offices and found that PCPs demonstrated increased knowledge on MAT and decreased sense of professional isolation following Project ECHO implementation (Kawasaki et al., 2019). Moreover, Koester and colleagues (2024) from the Weitzman Institute Health System partnered with Ohio University Heritage College of Osteopathic Medicine and Buckeye Health Plan to administer a comprehensive SUD (alcohol, opioids, cannabis, tobacco, stimulants, and nicotine) ECHO course for Ohio PCPs and behavioral health providers. Results revealed insightful Project ECHO strengths, including enhancing PCP knowledge, self-efficacy, and skills associated with SUD care through effective didactic learning and complex case discussions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eProject ECHO studies have yielded numerous lessons for PCPs\u0026apos; knowledge and confidence in treating patients with complex cases. A study conducted by Sheehan et al. (2022) in Ontario utilized psychiatrists to lead an ECHO-based program for healthcare professionals addressing patients with co-occurring mental and physical health needs. Using Moore\u0026rsquo;s Evaluation Framework, a globally adopted method for evaluating Project ECHO (Zhou et al., 2016), the study found that overall satisfaction and self-efficacy among PCPs increased, and long-term professional practice changes were implemented in over 80% of participants (Sheehan et al., 2022). McDonnell et al. (2020) demonstrate that incorporating Project ECHO within a rural practice-based research network in Oregon fosters sustained provider participation through relationship-centered mentorship, participant-driven agendas, and relevant training topics despite fiscal uncertainty and resource fluctuations. Most Project ECHO programs receive funding through federal grants (McDonnell et al., 2020). As a result, a recent study identified funding as the primary threat to Project ECHO sustainability, recommending the coordination of multiple ECHO programs and longer-term support for staff to secure diverse funding sources (Larson et al., 2023; Allison et al., 2025). The adaptability and versatility of the ECHO Model (Allison et al., 2025), along with a commitment to lifelong learning (Sockalingam et al., 2022), enable leaders to integrate Project ECHO into existing clinical infrastructure.\u003c/p\u003e\n\u003cp\u003eIn a systematic review of 39 Project ECHO studies, Zhou et al. (2016) identified common factors that motivated PCPs to participate in Project ECHO: increasing knowledge, applying knowledge in patient encounters, enhancing collaboration with specialists, and minimizing patient travel time for specialist referrals. Conversely, significant barriers to ECHO implementation and consistent attendance arose from patient priorities and time constraints (Zhou et al., 2016), as well as a lack of program endorsement by clinic leaders (Salvador et al., 2019). Additional upstream policy-level interventions may be crucial for improving access to and funding for technology-based collaborative learning initiatives, such as ECHO (Salvador et al., 2019). Despite common obstacles, Project ECHO is an innovative and versatile tool that helps educate and support primary care providers, behavioral health specialists, and care team members on a wide range of clinical topics through collaboration and discussion. This study builds on the Project ECHO model\u0026rsquo;s established framework for collaborative clinical training to examine the Ohio AUD/SUD Project ECHO\u0026rsquo;s innovative approach to addressing Ohio\u0026rsquo;s addiction crisis. By evaluating the program\u0026apos;s reach, engagement, and content delivery from 2017 to 2021 and from 2024 to 2025, readers will gain insights into its growth, resilience amid funding challenges, and scalable strategies for addiction workforce development. We highlight how its expanded focus on AUD/SUD, integration of MOUD/MAUD, and strategic partnerships enhance provider education and care delivery.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eThe Ohio Alcohol and Substance Use Disorder (AUD/SUD) Project ECHO, based at Northeast Ohio Medical University (NEOMED), is a pioneering statewide initiative designed to empower Ohio\u0026rsquo;s healthcare workforce to combat the state\u0026rsquo;s addiction crisis. Initially launched as the Ohio Opioid Project ECHO on November 3, 2017, the program addressed the urgent need for accessible, evidence-based training on substance use disorders (SUDs). It has since evolved, with a name change to Ohio AUD/SUD Project ECHO proposed by the Ohio House of Representatives in the governor\u0026rsquo;s budget, reflecting an expanded scope to include alcohol and other substance use disorders such as those involving cannabis, stimulants, and tobacco. This longitudinal learning program fosters collaboration among a multidisciplinary network of physicians, nurse practitioners, physician assistants, nurses, social workers, counselors, and administrators, with a strong emphasis on integrating Medication-Assisted Treatment (MAT) into behavioral healthcare.\u003c/p\u003e\u003cp\u003eThe program\u0026rsquo;s structure is built on a strong framework of virtual, one-hour sessions held on the first and third Fridays of each month, made possible through dedicated funding from the State of Ohio. Historically, federal funding through the Substance Abuse and Mental Health Services Administration (SAMHSA) State Opioid and Stimulus Response (SOS) dollars, passed through the Ohio Mental Health and Addiction Services (OhioMHAS), supported two completed cycles of the Ohio Opioid Project ECHO. These included early morning sessions (7:00 a.m.) for current prescribers needing continuing education and afternoon sessions (3:00 p.m.) for new prescribers, conducted over 12-week cycles with 12 didactic sessions each Friday. A 2019 SOS grant, in partnership with all Ohio medical schools, supported MAT integration and a qualitative research study examining medical schools\u0026rsquo; curricula and barriers to implementation (Gardner-Buckshaw et al., 2021). The program\u0026rsquo;s current sessions, offered at no cost and accredited for Continuing Education (CE) and Continuing Medical Education (CME) credits, combine expert-led didactic presentations with interactive, case-based discussions. Topics address real-world clinical challenges, such as trauma-informed care, perinatal SUD, concurrent substance use, and cultural considerations in addiction treatment. Participants submit de-identified patient cases, creating a dynamic, peer-to-peer learning environment where providers share insights, resolve uncertainties, and apply evidence-based strategies to enhance patient care. To maximize accessibility, session recordings are available through the iECHO portal, which was upgraded in May 2023 for improved functionality at NEOMED, as well as on a public YouTube playlist, ensuring that learning opportunities extend beyond live attendance. Attendance data from the original iECHO platform and the new system provide insights into the program\u0026rsquo;s reach.\u003c/p\u003e\u003cp\u003eComplementing the ECHO sessions, NEOMED develops independent training modules to support the integration of Medication for Opioid Use Disorder (MOUD) and Medication for Alcohol Use Disorder (MAUD) into primary care. These modules offer practical guidance, case studies, and legal resources, with forthcoming content tailored explicitly to healthcare providers caring for pre- and perinatal women with SUDs. The program\u0026rsquo;s reach is amplified through targeted in-person training, such as a one-day MAT session for physician assistant students, and localized workshops designed for Ohio\u0026rsquo;s diverse communities. Strategic partnerships with organizations like the Substance Use Disorder Center of Excellence at Case Western Reserve University, OhioMHAS, and all Ohio medical schools, alongside HRSA-sponsored efforts, have enhanced the program\u0026rsquo;s ability to deliver tailored education and foster regional collaboration. An unannounced discontinuation of anticipated federal funding in September 2021, despite the program\u0026rsquo;s good standing and submitted renewal, resulted in a funding lapse until June 2023; however, MOUD trainings continued. Concurrently, the Program Manager sent monthly resource emails (e.g., conferences, meetings, and best practices) to sustain engagement.\u003c/p\u003e\u003cp\u003eA hallmark of the Ohio AUD/SUD Project ECHO\u0026rsquo;s success is its lean yet effective operational model. Managed by a small team, including a part-time Program Director, Program Manager, and a Program Coordinator added in 2023, the program relies on efficient coordination of session scheduling, speaker outreach, participant engagement, and CE/CME documentation. This core team is supported by an interdisciplinary \u0026ldquo;hub team\u0026rdquo; of experts in addiction medicine, pharmacy, psychiatry, social work, and family medicine, who deliver high-quality didactic content and provide clinical mentorship during case discussions. This hub team model, consistent since the program\u0026rsquo;s inception, ensures expert knowledge drives the learning community. Despite its modest staffing, the program has engaged providers across 70% of Ohio\u0026rsquo;s counties and beyond, with robust promotion through the OhioMHAS newsletter, NEOMED\u0026rsquo;s Department of Psychiatry webpage, social media, and advocacy from leaders like former President of the Ohio Society of Addiction Medicine, Chris Delos Reyes, MD.\u003c/p\u003e\u003cp\u003eThe program\u0026rsquo;s resilience in the face of funding challenges underscores its strength. Before the current two-year funding period (July 2023\u0026ndash;June 2025), a funding gap necessitated reliance on NEOMED\u0026rsquo;s institutional support, volunteer contributions from the hub team, and archived session recordings to maintain minimal operations. Both SAMHSA and OhioMHAS valued the program, but a funding gap halted ECHO sessions, with only communications continuing. An unannounced discontinuation of expected federal funding in September 2021, despite the program\u0026rsquo;s good standing and submitted renewal, caused a lapse until June 2023; however, MOUD trainings continued. With funder approval, the team transitioned from in-person training to creating video CME modules, using the resulting savings to secure a three-month no-cost extension for ECHO sessions. A timeline of these activities is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Anticipating a potential funding shortfall after June 2025, this adaptability positions the Ohio AUD/SUD Project ECHO as a scalable model for workforce development.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eTo evaluate the reach, engagement, and content delivery of the Ohio Alcohol and Substance Use Disorder (AUD/SUD) Project ECHO, data were collected from the iECHO platform for two periods: 2017\u0026ndash;2021 (original platform) and 2024\u0026ndash;2025 (upgraded platform, data through May 16, 2025). The original platform, in use until its upgrade in May 2023, captured session frequency, attendance, case presentations, and topic documentation for Ohio Opiate Continuing Education (CE) ECHO and Mentor Clinic sessions (CE ECHO sessions focused on didactic presentations for accredited continuing education, while Mentor Clinic sessions emphasized interactive case-based mentorship for practical application), conducted virtually on the first and third Fridays of each month. These sessions provided continuing education and mentorship for healthcare providers addressing AUD/SUD. The program\u0026rsquo;s hub-and-spoke network, led by an interdisciplinary hub team, fosters interactive learning, with participant feedback driving future topic selection. Sessions covered topics like needs assessment, MAT\u0026rsquo;s financial benefits for primary care, Ohio-specific legal considerations, and polysubstance use. The data included the number of sessions, total attendees, average attendees per session, cases presented, and topics covered. Topic documentation was incomplete from 2017 to 2019, and no continuing education (CE) or continuing medical education (CME) credits were recorded. Participant demographics were not available for 2017\u0026ndash;2021. The upgraded iECHO platform (2024\u0026ndash;2025) added metrics, including counts of unique network members, gender demographics (Female, Male, Prefer Not to Disclose, Non-Binary), represented countries, and total learning hours. Following the 2021\u0026ndash;2023 funding gap, CE ECHO and Mentor Clinic sessions were combined into \u0026ldquo;general\u0026rdquo; sessions, integrating didactic education with interactive case discussions to enhance flexibility and engagement. Although case discussions were not formally logged, the Program Manager noted some unrecorded case presentations. CE/CME credits also remained unrecorded. Topics were thoroughly documented in 2024\u0026ndash;2025.\u003c/p\u003e\u003cp\u003eDescriptive statistical analyses were performed using Microsoft Excel software to summarize session frequency, attendance, case presentations, topic documentation, and, for 2024\u0026ndash;2025, unique network members, learning hours, and participant demographics. From 2017 through 2021, data were aggregated by year and session type (CE ECHO vs. Mentor Clinic) to describe trends in engagement and content delivery. For the 2024\u0026ndash;2025 period, analyses included the total and average number of attendees per session, learning hours, and participant diversity (in terms of gender and geographic representation). Data integrity was ensured by cross-referencing iECHO records with program reports and archival records maintained by the Program Manager. Limitations included the funding gap (September 2021\u0026ndash;June 2023), which prevented data collection for the 2022\u0026ndash;2023 period; incomplete topic documentation from 2017 to 2019; unlogged case discussions from 2024 to 2025; and the absence of CE/CME credit data across all years.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eProgram Growth and Engagement: 2017\u0026ndash;2021\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn 2017, the program\u0026rsquo;s inaugural year, there were 8 Ohio Opiate CE ECHO sessions (16 attendees, 2 attendees/session, 1 case presented) and 8 Mentor Clinic sessions (27 attendees, 3.4 attendees/session, 1 case presented). Topic documentation was limited, with only 2 CE ECHO topics recorded (\u0026ldquo;First Things First,\u0026rdquo; \u0026ldquo;MAT General Info\u0026rdquo;) and 13 out of 16 sessions (81%) lacking detailed descriptions. In 2018, session frequency increased to 49 CE ECHO sessions (280 attendees, 5.7 attendees/session, no cases) and 48 Mentor Clinic sessions (253 attendees, 5.3 attendees/session, 1 case). Topics were documented for 61 out of 97 sessions (63%) and spanned clinical (e.g., chronic pain, perinatal SUD) and practical (e.g., motivational interviewing, harm reduction) themes. In 2019, there were 46 CE ECHO sessions (460 attendees, 10 attendees/session, no cases) and 46 Mentor Clinic sessions (489 attendees, 10.6 attendees/session, 2 cases), with topics documented for 27 out of 92 sessions (29%), covering clinical issues (e.g., anxiety management, MAT disparities) and practical skills (e.g., patient engagement).\u003c/p\u003e\u003cp\u003eIn 2020, case presentations increased, featuring 45 CE ECHO sessions with 752 attendees (16.7 attendees per session, covering 27 cases) and 45 Mentor Clinic sessions with 659 attendees (14.6 attendees per session, addressing 40 cases). Topic documentation improved, with 87 out of 90 sessions recorded (97%), covering clinical topics (e.g., provider burnout, relapse prevention) and practical skills (e.g., managing drug test results). In 2021, 37 CE ECHO sessions had 558 attendees (15.1 attendees per session, covering 15 cases) and 37 Mentor Clinic sessions had 600 attendees (16.2 attendees per session, addressing 22 cases), achieving full topic documentation and covering innovative subjects (e.g., memantine for OUD, immunotherapy) and practical areas (e.g., stigma reduction, MOUD workflows). No participant demographics were available for the years 2017 to 2021.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProgram Relaunch and Continued Engagement: 2024\u0026ndash;2025\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFollowing a funding gap from 2022 to 2023, the program resumed in 2024 with 20 sessions, totaling 387 learning hours, averaging 19.3 attendees per session, and no reported cases. It engaged 93 unique network members from the U.S., India, and Uganda, comprising 78% female, 20% male, and 2% who preferred not to disclose their gender. Fully documented topics included clinical areas (e.g., diagnosing AUD, pharmacotherapy trends), practical issues (e.g., SAMHSA MAT training, SBIRT), and innovative themes (e.g., virtual reality empathy training, recovery capital), with 8 out of 20 sessions, or 40%, addressing innovative approaches. From the start of the year until May 16, 2025, 10 sessions consisting of 222 learning hours and an average of 22.2 attendees per session engaged 69 unique network members from the U.S., Sudan, and Uganda, with a demographic breakdown of 64% female, 32% male, 3% preferring not to disclose, and 3% identifying as non-binary. The fully documented topics covered clinical areas (e.g., HCV screening, PTSD-AUD comorbidity), practical themes (e.g., OBOT regulations), and innovative approaches (e.g., fetal alcohol spectrum disorder), with 4 out of 10 sessions, or 40%, focusing on innovative topics. The Program Manager noted that unlogged case discussions in 2024 and 2025 were not captured in the iECHO system. No CE or CME credits were recorded during either period. The data were derived from the iECHO platform and analyzed using Microsoft Excel software.\u003c/p\u003e\u003cp\u003eOverall, the Ohio AUD/SUD Project ECHO demonstrated sustained engagement from 2017 to 2021 and from 2024 to 2025, despite facing challenges including incomplete topic documentation, unlogged case discussions, and a lack of recorded CE/CME credits. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, below, summarizes the frequency of sessions, attendance, cases presented, and topic documentation by year.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eSummary of Project ECHO and Mentor Clinic Sessions by Year\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSession Type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSessions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal Attendees\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAvg. Attendees per Session\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCases Presented\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTopics Documented (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUnique Network Members\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eLearning Hours\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCE ECHO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2/8 (25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMentor Clinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1/8 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCE ECHO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e280\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e36/49 (73%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMentor Clinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25/48 (52%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCE ECHO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e460\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13/46 (28%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMentor Clinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e489\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14/46 (30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCE ECHO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e752\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e43/45 (96%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMentor Clinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e659\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e44/45 (98%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCE ECHO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e558\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e15.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e37/37 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMentor Clinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e600\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e16.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e37/37 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e380*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e19.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20/20 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e387\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e220*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e22.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10/10 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e222\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003cb\u003eFootnote\u003c/b\u003e: 2024: 73 Female (78%), 19 Male (20%), 1 Prefer Not to Disclose (2%); 2025: 44 Female (64%), 22 Male (32%), 2 Prefer Not to Disclose (3%), 2 Non-Binary (3%).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eGiven the prevalence of substance use disorders and particularly opioid use and overdoses in Ohio (Hernandez et al., 2020), the Ohio AUD/SUD Project ECHO was implemented to combat the growing public health crisis. Through topic-focused presentations, case-based learning, and clinical mentoring, all original aspects of the ECHO Model (Arora et al., 2010), as well as independent training modules developed by NEOMED, this program supported healthcare providers in treating substance use and enhancing education in historically challenging clinical situations. This study evaluates participant engagement, reach, and content delivery of the Ohio AUD/SUD Project ECHO, potentially enabling whole-person recovery care for thousands of patients.\u003c/p\u003e\u003cp\u003eThe Ohio Alcohol and Substance Use Disorder (AUD/SUD) Project ECHO has demonstrated notable resilience and sustained provider engagement across two significant periods: 2017\u0026ndash;2021 and 2024\u0026ndash;2025. Despite a complete pause in operations due to a funding gap from 2021 to 2023, the program recovered with strong attendance and consistent topic documentation, underscoring the durability of the ECHO model when adapted for use in addiction medicine (Koester et al., 2024). Engagement grew from 43 attendees in 2017 (2.0\u0026ndash;3.4 attendees per session) to a peak of 1,411 in 2020 (14.6\u0026ndash;16.7 per session), followed by a successful relaunch in 2024\u0026ndash;2025 with 608 estimated attendees (19.3\u0026ndash;22.2 per session). This recovery illustrates the effectiveness of sustained institutional support and the adaptability of virtual learning models, supported by findings in Allison et al. (2025), emphasizing the versatility and accommodating structure of both the ECHO program and its participants and audience.\u003c/p\u003e\u003cp\u003eAdditionally, Allison et al. (2025) identified funding as the primary threat to Project ECHO sustainability, illustrated in the OHIO AUD/SUD Project ECHO funding gap. Continuous efforts during the funding hiatus, such as monthly resource emails, dissemination of archived session recordings, and internal advocacy at Northeast Ohio Medical University (NEOMED), likely contributed to the program\u0026rsquo;s ability to regain momentum quickly. This reflects the findings of Larson and colleagues (2023), where ongoing programming and in-house staff commitment contributed to the success of the ECHO Model. Although specific engagement metrics (e.g., email open rates or resource access) were not tracked, these strategies mirror recommendations from previous ECHO research that emphasize maintaining engagement through community-building and asynchronous learning (Larson et al., 2023; Salvador et al., 2019).\u003c/p\u003e\u003cp\u003eContent quality and documentation also improved over time. The percentage of sessions with documented topics rose from 19% in 2017 to 100% by 2021 and remained consistent in 2024\u0026ndash;2025. Notably, 40% of the didactic lessons during the most recent sessions addressed innovative approaches, such as virtual reality empathy training and interventions for fetal alcohol spectrum disorder (FASD). While no formal case presentations were logged in 2024\u0026ndash;2025, qualitative reports from the Program Manager confirm that interactive learning and case-based discussions continued, albeit undocumented. To develop a robust evaluation of the ECHO Model, Larson et al. (2023) suggest focusing on measuring program satisfaction and self-reported participant learning in programs with limited funds, as well as routinely reporting program outcomes to attract new participants and additional funding opportunities.\u003c/p\u003e\u003cp\u003eThe program\u0026rsquo;s lean operational model, featuring a small, interdisciplinary hub team and engaged facilitators, ensured efficiency and sustainability, resulting in substantial cost savings compared to in-person conferences. This structure aligns with the ECHO Institute\u0026rsquo;s hub-and-spoke model, which emphasizes leveraging expert networks to disseminate knowledge efficiently (Zhou et al., 2016). Strategic partnerships with the Ohio Department of Mental Health and Addiction Services (OhioMHAS) and all Ohio medical schools further expanded the program\u0026rsquo;s reach, with participation covering over 70% of Ohio counties and extending internationally (U.S., India, Uganda, Sudan). Larson et al. (2023) highlight the importance of leveraging partnerships to access alternative funding sources, as well as engaging institutional support and leadership to bolster ECHO programming. The findings suggest that the Ohio AUD/SUD Project ECHO effectively delivered clinical education and programming to a growing audience through innovative solutions during funding disruptions. The results of this evaluation, combined with the existing literature, demonstrate remarkable adaptability and versatility across various clinical questions and program settings.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDespite these strengths, several limitations should be noted. The funding disruption between 2021 and 2023 halted operations and interrupted continuity. Incomplete documentation of session topics from 2017 to 2019, along with the absence of CE/CME credit tracking across all years, hindered comprehensive program evaluation. Furthermore, while engagement in 2024\u0026ndash;2025 remained high, the absence of logged case presentations limits the ability to assess interactive learning during this period. Participant demographic data were only available for the most recent years, restricting longitudinal equity analysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFuture Directions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eLooking ahead, future iterations of the Ohio AUD/SUD Project ECHO should prioritize:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDigital Infrastructure- Develop systems to automate session documentation, CE/CME tracking, and case logging, perhaps leveraging artificial intelligence tools.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eSustainability Planning- Pursue multi-year funding through proactive grant applications and institutional commitments to avoid future service disruptions.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eExpanded Evaluation- Incorporate mixed-methods research to assess better educational outcomes, including knowledge gains, clinical behavior changes, and patient-level impacts.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePartnership Development- Strengthen cross-institutional collaborations and explore policy-level support to secure the program\u0026rsquo;s role in state-wide workforce development.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eThese findings reinforce the Ohio AUD/SUD Project ECHO as a scalable, adaptable model for advancing addiction care education. The program\u0026rsquo;s ability to sustain participation, improve content delivery, and recover from disruptions offers actionable insights for similar initiatives aiming to build resilient, distributed learning communities in public health and behavioral health care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eProject ECHO is an innovative and versatile model that empowers primary care leaders and team members to approach and treat complex clinical cases like substance use disorders. The Ohio AUD/SUD Project ECHO aims to provide virtual, community-engaged, evidence-based addiction care to healthcare providers in Ohio by offering expert-led didactics with case-based learning, independent training modules, and collaborative mentorship. The purpose of this study was to assess the reach, engagement, and delivery of the AUD/SUD Project ECHO program. Through an in-depth evaluation of the program data collected between two periods (2017\u0026ndash;2021 and 2024\u0026ndash;2025) from the ECHO and iECHO platforms, consistency was observed in session frequency, participant and audience engagement, and topic variety. The program\u0026rsquo;s ability to persist through a lapse in funding and consistently grow in engagement and content delivery reflects the strength of the ECHO model, as well as the dedication of its leadership and sustained momentum from participants. These results provide promising insights into Project ECHO as a coordinated learning model that delivers sustainable education despite various financial and structural challenges, and serve as a template for future ECHO programs aimed at providing enriching educational frameworks.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eAUD\u003c/strong\u003e - Alcohol Use Disorder\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSUD\u003c/strong\u003e - Substance Use Disorder\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eECHO\u003c/strong\u003e - Extension for Community Healthcare Outcomes\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eNEOMED\u003c/strong\u003e - Northeast Ohio Medical University\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMOUD\u0026nbsp;\u003c/strong\u003e- Medication for Opioid Use Disorder\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMAUD\u003c/strong\u003e - Medication for Alcohol Use Disorder\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePCP\u0026nbsp;\u003c/strong\u003e- Primary Care Provider\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHCV\u003c/strong\u003e - Hepatitis C Virus\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMAT\u003c/strong\u003e - Medication-Assisted Treatment\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCE\u003c/strong\u003e - Continuing Education\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCME\u0026nbsp;\u003c/strong\u003e- Continuing Medical Education\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSAMHSA\u0026nbsp;\u003c/strong\u003e- Substance Abuse and Mental Health Services Administration\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eOhioMHAS\u003c/strong\u003e - Ohio Mental Health and Addiction Services\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSOS\u003c/strong\u003e - State Opioid and Stimulus Response\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHRSA\u003c/strong\u003e - Health Resources and Services Administration\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSBIRT\u003c/strong\u003e - Screening, Brief Intervention, and Referral to Treatment\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFASD\u003c/strong\u003e - Fetal Alcohol Spectrum Disorder\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eOBOT\u0026nbsp;\u003c/strong\u003e- Office-Based Opioid Treatment\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003ch2\u003eHuman Ethics and Consent to Participate Declarations\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eFunding \u003cstrong\u003eDeclaration\u003c/strong\u003e:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThis project was supported by funds allocated to the Ohio Alcohol and Substance Use Disorder (AUD/ SUD) ECHO at Northeast Ohio Medical University through the 2023\u0026ndash;2025 Governor\u0026apos;s Budget of the State of Ohio, with oversight provided by the Ohio Department of Mental Health and Addiction Services.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eH.H., S.G-B., and X.M. contributed to the conception and design of the study. H.H. and X.M. collected and analyzed the data from the iECHO platform. S.G-B. provided oversight and expertise in addiction medicine and Project ECHO methodology. H.H. wrote the initial draft of the manuscript, including the abstract, introduction, and discussion sections. X.M. contributed to the literature review, methods, and results sections, and generated Table 1 and data visualizations. S.G-B. prepared the methods and results sections with X.M. All authors (H.H., S.G-B., X.M.) reviewed and edited the manuscript, ensuring accuracy and alignment with the study\u0026rsquo;s objectives.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements:\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAvailability of Data and Materials:\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and analyzed during this study are not publicly accessible due to the inclusion of confidential program evaluation data and participant information that could compromise privacy. Nevertheless, de-identified data may be available from the corresponding author upon reasonable request, pending approval by the Northeast Ohio Medical University Institutional Review Board to ensure adherence to ethical and privacy standards.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eArora S, Kalishman S, Thornton K, Dion D, Murata G, Deming P, Parish B, Brown J, Komaromy M, Colleran K, Bankhurst A. Expanding access to hepatitis C virus treatment\u0026mdash;Extension for Community Healthcare Outcomes (ECHO) project: disruptive innovation in specialty care. Hepatology. 2010;52(3):1124\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou C, Crawford A, Serhal E, Kurdyak P, Sockalingam S. The impact of project ECHO on participant and patient outcomes: a systematic review. Acad Med. 2016;91(10):1439\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalvador J, Bhatt S, Fowler R, Ritz J, James R, Jacobsohn V, Brakey HR, Sussman AL. Engagement with project ECHO to increase medication-assisted treatment in rural primary care. Psychiatr Serv. 2019;70(12):1157\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmithenry DW, Besante J, Hopping D, Patterson K, Pickerl P, Gastala N, Sorrell T, Karnik NS. Building a statewide network of MOUD expertise using tiered ECHO\u0026reg; mentoring opportunities. Drug Alcohol Depend. 2023;245:109823.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHernandez A, Branscum AJ, Li J, MacKinnon NJ, Hincapie AL, Cuadros DF. Epidemiological and geospatial profile of the prescription opioid crisis in Ohio, United States. Sci Rep. 2020;10(1):4341.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoester M, Motz R, Porto A, Reyes Nieves N, Ashley K. Using project extension for community healthcare outcomes to enhance substance use disorder care in primary care: mixed methods study. JMIR Med Educ. 2024;10:e48135.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKawasaki S, Francis E, Mills S, Buchberger G, Hogentogler R, Kraschnewski J. Multi-model implementation of evidence-based care in the treatment of opioid use disorder in Pennsylvania. J Subst Abuse Treat. 2019;106:58\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSheehan KA, Pereira C, Brierley N, Alloo J, Bonta M, Sockalingam S. Building complex care capacity in primary care: an educational evaluation of project ECHO Ontario integrated mental and physical health. J Acad Consult Liaison Psychiatry. 2022;63(5):454\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcDonnell MM, Elder NC, Stock R, Wolf M, Steeves-Reece A, Graham T. Project ECHO integrated within the Oregon Rural Practice-based Research Network (ORPRN). J Am Board Fam Med. 2020;33(5):789\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLarson RS, Day SK, Dodsworth-Rugani K, Janota AD, Jorgenson TC, Lee K, Mason J, Porto A, Serhal E, Dearing J, Calabrese T, Schrag J, Israel B, Junge-Maughan L, Janota A. PROJECT ECHO Implementation: Guidance from the Field Frequently Asked Questions Study sites, ECHO program topics, and implementation fellows. [No further publication details provided in the original text].\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAllison MK, Bogulski CA, McCoy HC, Silva R, Hayes CJ, Andersen JA, Eswaran H. Facilitators and barriers to implementing the Project ECHO model: perspectives of 8 ECHO implementation teams. Med Educ Online. 2025;30(1):2473476.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSockalingam S, Rajaratnam T, Gambin A, Soklaridis S, Serhal E, Crawford A. Interprofessional continuing professional development programs can foster lifelong learning in healthcare professionals: experiences from the Project ECHO model. BMC Med Educ. 2022;22(1):432.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGardner-Buckshaw S, Beverly E, Boltri J, Fischbein R. Implementing the comprehensive opioid and pain management curriculum in Ohio\u0026rsquo;s medical schools: a qualitative study. Paper presented at: Family Medicine Education Consortium Annual Meeting; 2021 Oct 8\u0026ndash;10; Pittsburgh, PA.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Project ECHO, Alcohol Use Disorder, Substance Use Disorder, Healthcare Provider Training, Sustainability","lastPublishedDoi":"10.21203/rs.3.rs-6966304/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6966304/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eThe Ohio Alcohol and Substance Use Disorder (AUD/SUD) Project ECHO, based at Northeast Ohio Medical University (NEOMED), is a statewide virtual learning initiative launched in 2017 to enhance providers\u0026rsquo; capacity to deliver evidence-based addiction care. Initially focused on opioid use disorder, the program has expanded to include alcohol use disorder and emphasizes integrating MOUD and MAUD into behavioral and primary care. The program also aims to reduce professional isolation and promote multidisciplinary collaboration.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eThis descriptive study examined the program\u0026rsquo;s reach, engagement, and delivery across two time periods (2017\u0026ndash;2021 and 2024\u0026ndash;2025). Data were sourced from the ECHO and iECHO platforms, including attendance logs, session frequency, and topic coverage. Analyses focused on trends in participation, session content, and international engagement.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eThe program demonstrated consistent growth in session frequency, topic diversity, and participant engagement from 2017 to 2021. After a funding lapse from 2022 to 2023, the program was relaunched and engaged over 160 unique network members from multiple countries. Sessions covered innovative and clinically relevant topics. Limitations included incomplete logging of case discussions and gaps in tracking demographics and continuing education (CE/CME).\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e\u003cp\u003eThe Ohio AUD/SUD Project ECHO has shown strong potential as a sustainable and scalable model for addiction workforce development. Despite some data limitations, the program continues to fill critical training gaps and support healthcare providers during an ongoing public health crisis.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"ECHOing Change: Tracking Statewide Participation in a Substance Use Learning Network","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 13:06:23","doi":"10.21203/rs.3.rs-6966304/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6a5bf93e-5c01-4f7a-85ae-08200be1b7a9","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-02T12:38:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 13:06:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6966304","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6966304","identity":"rs-6966304","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}