Background : Project ECHO is an evidence-informed learning model established to bring expert front-line care to underserved and rural areas throughout the United States. Funded by the U.S. Bureau of Primary Health Care, The National LGBT Health Education Center adapted the ECHO model to establish TransECHO, which disseminates best practices to clinical care teams not yet trained to serve transgender and non-binary patients. We hypothesized that TransECHO program participation by healthcare organizations would be associated with improved clinician competence and confidence serving gender-diverse clients, as well as longitudinal transgender health program growth.
Methods : Using a “hub-and-spoke” dissemination model, we assembled a panel of transgender health experts (hub) dedicated to sharing knowledge with a large cohort of federally qualified health centers (FQHCs; spokes). Using Zoom technology, we bring our panel of primary care and behavioral health clinicians together monthly to lead twelve 2-hour learning sessions over one year. Each session begins with a didactic presentation on a topic related to clinical practice for transgender patients. Together, these didactics constitute a longitudinal curriculum. For the remainder of each session, FQHCs present challenging scenarios for case consultation. Expert faculty facilitate a discussion among the FQHCs, creating a rich learning environment for the cohort.
Results : Over 600 healthcare organizations applied to participate in TransECHO over five cycles. TransECHO has included more than 100 FQHCs from over 36 states/territories, including Puerto Rico. We have educated over 200 primary care and behavioral health clinicians, who then train others within their health centers. We will present longitudinal program evaluation data from participating FQHCs across the U.S. on change over time in staff competence and confidence serving transgender and non-binary patients, as well as transgender health program growth over time.
Conclusions : TransECHO has successfully increased access to gender-affirming care for transgender and non-binary people at FQHCs. We have expanded the reach of TransECHO by serving three simultaneous learning cohorts with a total of up to 75 health centers in parallel.