OSU’s ECHO Program Aims to Improve Children’s Mental Health

A happy, healthy child is every parent’s wish. When a child is not feeling well or is sad, parents naturally want to make everything better. But sometimes listening to a favorite story, taking a dose of medicine or getting some extra sleep won’t help, especially when a child is struggling with mental health. Unless properly diagnosed and treated, mental illness can negatively impact the lives of afflicted kids and teens, potentially affecting their mood and self-esteem, and ability to positively interact with others and focus on everyday tasks, making it impossible for them to thrive and live life to the fullest.

Recognizing the link between mental health and quality of life, Oklahoma State University Center for Health Sciences (OSU-CHS) has launched its Pediatric Behavioral and Emotional Health ECHO. The primary goal of this program is to enable primary care clinicians to provide more effective mental health care to their pediatric patients, eliminating the need for a referral to a specialist and the accompanying difficulties that some families encounter when forced to look elsewhere for help.

“We have a lot of children with behavioral and emotional problems in Oklahoma who are not receiving the quality evidence-based care they deserve,” said Sara Coffey, D.O., assistant clinical professor of psychiatry at OSU-CHS and co-leader of the pediatric ECHO program. “Often, children and teens who are struggling with emotional and behavioral health issues are referred to specialists who may be inaccessible for several months or are miles away from those living in rural or underserved areas. My experience is that it is not uncommon for wait lists for child and adolescent psychiatry to be several months long. Typically these families say that their children have been struggling for years without evaluation or intervention.”

Through OSU’s ECHO program, participating primary care clinicians can get the tools they need to broaden their knowledge on diagnosing and treating behavioral and emotional health, thereby enabling their patients to receive the same level of care from them that they would have received from a specialist.  Each week, the ECHO group meets via videoconference, making it easy for providers to attend, regardless of their location. At each meeting, OSU’s team of mental health specialists delivers a lecture on a chosen topic, and attending participants have the opportunity to seek personalized guidance on diagnosing and treating specific patients within their own practices.

Toni Ramos, D.O., who heads the pediatrics department at Community Health Connection, began attending the pediatric ECHO clinics earlier this year and initially got involved with the program after struggling to identify the best treatment for a long-term patient with ADHD who was not responding to a variety of treatment combinations and types. In hopes of finding a better solution for her patient, Dr. Ramos presented the case at an ECHO meeting.

“I received such helpful feedback concerning her diagnosis and treatment options,” said Dr. Ramos. “The team was able to help me take a step back and look at this case with fresh eyes. I was able to see that I was missing some key information from my patient history that would have helped me in my patient’s assessment. We began to formulate a plan of action that I was able to take back to my patient and her family and continue with her care.”

After having such a positive first experience, Dr. Ramos felt that there was a lot she could gain from the program and has continued to attend meetings.

“Sometimes reading or learning the ‘standard of care’ for the management of certain conditions is not good enough,” she said. “It is nice to have multiple listening ears to get feedback from, and to help you when what is recommended was attempted and failed.”

Dr. Coffey shared one doctor and patient’s success story that affirms the idea that having knowledge beyond the standard of care is not only beneficial, but essential for correctly diagnosing patients and subsequently preventing consequences that come with incorrect diagnoses.

“The primary care doctor was concerned for a diagnosis of Bipolar Disorder, often a severe and persistent mental illness,” Dr. Coffey said. “However, after a thorough discussion about the symptoms this patient was experiencing, our team felt she was struggling with a Major Depressive Disorder and we offered recommendations based on this. Had this adolescent been diagnosed with Bipolar Disorder she might not have received the treatment that would help her symptoms, potentially being prescribed medications with more concerning side effects and a diagnosis that was likely not correct.”

Over time, OSU-CHS hopes to bring positive change and many more success stories like this one to the state. Area physicians, physician assistants, nurses, school counselors and therapists are invited to join the ECHO program. Rural health providers can participate free of charge thanks to support provided by The Anne and Henry Zarrow Foundation, Blue Cross and Blue Shield of Oklahoma, and the Telligen Community Initiative.

For more information about the ECHO program, visit www.health.okstate.edu, or contact Tara Jackson, tara.m.jackson@okstate.edu, 918-561-1460.


While the ECHO program is intended for health professionals, it is vital for parents to know how to recognize signs that their child might be struggling with a mental health issue. The following is a Q&A with Dr. Coffey, who offers some tips for parents who play such an important role in the lives of their children.

What are some things that parents can look for to help kids who may be struggling with mental health disorders?

I think a great resource for parents comes from the American Academy of Child and Adolescent Psychiatry: “When to Seek Help for Your Child.” From the time our babies are born, it is important to be talking about the emotional needs of our children. Social and emotional health is really the foundation of all that we do and helping children and adolescents know they can come to us when they are struggling is imperative to their wellbeing. (For signs that your child or teen may need a psychiatric evaluation, visit www.aacap.org and search “When to seek help for your child.”)

 What should a parent do if he or she feels that a child may need help for such conditions?

I always encourage parents to talk with their pediatrician or primary care doctor if they have concerns. Not every emotional or behavioral concern needs specialty treatment. Developmentally, children can struggle at times throughout childhood, think the toddler tantrum of the terrible twos or some mild anxiety about starting a new school. Oftentimes pediatricians can help determine if symptoms require additional attention. A great book I often recommend is “Raising Your Spirited Child” by Mary Sheedy Kurcinka. Sometimes reflecting on our parenting style and the personality of our children can be helpful for these struggles. However, we do know that up to 20 percent of children will have a diagnosable mental illness in their lifetime, so it is not rare, and, if parents are concerned, help from a mental health provider can be indicated.

In the news, we sometimes hear of instances in which a child’s or teen’s ongoing mental health struggles are not treated and ultimately lead to devastating consequences for the individual and/or the people around them. In some of these cases, the parents or guardians might have seen signs that something wasn’t right, but may have been in denial, afraid, or simply didn’t know what to do to help their child. Do you have any recommendations for parents who may see signs of mental illness in their child, but don’t know how to proceed safely and effectively?

This is a great question. I think we all need to start talking about this. Unfortunately, mental illness continues to have stigma around it and this can prohibit kids and adults from getting treatment. However, just like the heart and lungs have a function, so too does the brain. And just like the heart and lungs can have illness and stress, so too can the brain. I often have this talk with families. We know the lungs help us to breathe and some kids will have asthma, a disease that makes it hard for them to breathe; we know we give these kids medicine to help them with breathing. We know the brain helps us to think, to feel and to perceive the world (amongst many other things) and sometimes the brain has illnesses that make it hard for us to do these things too (anxiety, depression, ADHD, etc.). In these instances we can help the brain to heal either with therapy, medications or other interventions. It is important for parents and children to know brain illness/mental health is not their fault and it is treatable and with treatment kids and adults can have meaningful and successful lives.

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