(PS4-23) Adaptation of the Extension of Community Healthcare Outcomes (ECHO) Model to Support Children with Neurodevelopmental Disabilities in Humanitarian Contexts

An estimated 535 million children (nearly 1 in 4) live in countries affected by conflict or disaster, often without access to medical care, quality education, proper nutrition, or protection (UNICEF, 2016). Africa and the Middle East are home to the majority of this global population. Children living through violent conflicts face a number of direct and indirect impacts including trauma exposure, health risks, and loss of educational opportunities (Kadir et al., 2018). Children with pre-existing disabilities face additional impacts such as missed opportunities for intervention and interruptions of traditional support systems. Although several initiatives have been developed to broadly address mental health needs in children living through humanitarian crises (e.g., World Health Organization, 2013), no reliable interventions to date exist in supporting children with neurodevelopmental disorders (NDD) in these contexts. The World Health Organization (WHO) Eastern Mediterranean Region (EMR), which is composed primarily of Arab nations, faces significant challenges in addressing the needs of children with NDD (e.g., limited access to evidence-based interventions, and disparities in healthcare, education, and employment opportunities). Moreover, the region faces additional challenges in supporting children and their families in the context of humanitarian emergencies. The current humanitarian crisis in the EMR is worsening and effects are compounded upon previous challenges. Therefore, it is vital and timely to develop and evaluate a model that can bolster capacity building for providers to support children with NDD in humanitarian contexts. This project aims to identify community needs, and subsequently adapt and pilot ECHO-NDD in Humanitarian Contexts (ECHO-NDD/HC) in order to increase the capacity of providers in these settings. ECHO is a tele-based training and mentoring model for building knowledge and competencies among non-specialized providers. The ECHO model engages individuals with specialized experience to serve as expert “hub” team members, who utilize didactics and case-based learning to share clinical guidelines and best practices to participants (“spokes”). We present on the preliminary aims of this project which include the assessment of key stakeholder needs regarding working with children with NDD in humanitarian contexts and the systematic process of adapting the ECHO to ensure its impactful deployment. We established a Community of Practice consisting of experts in NDD in humanitarian settings across clinical practice, advocacy, teaching, and research. We developed a systematic process through key informant interviews and mapping to assess feasibility and identify specific contextual needs and constraints, followed by iterative refinements of the ECHO model guided by feedback from field practitioners. Engaging key informants and adapting the ECHO model are promising steps towards understanding and addressing the unique challenges of serving children with NDD in humanitarian contexts. Ongoing project initiatives include piloting and assessing the feasibility and acceptability of ECHO-NDD/HC to address the specific needs of vulnerable populations in humanitarian settings.