The benefits of librarians participating in Project Extension for Community Healthcare Outcomes (Project ECHO™) program

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By Daphne Horn, MI, Terri Rodak, MA, MISt and Sarah Bonato, MIS

For the past five years, Librarians at Centre for Addiction and Mental Health (CAMH) have been participating in multiple Project Extension for Community Healthcare Outcomes (Project ECHO™) programs, resulting in numerous benefits for staff, program participants, the library and librarians. 

ECHO is an innovative continuing education model that creates virtual communities of practice and builds healthcare capacity in underserved communities. The ECHO model leverages scarce healthcare expertise and resources by connecting “hubs” and “spokes” using tele-video-conferencing technology.  Practitioners in community settings (the spokes), and inter-professional specialists based at hospitals or academic centers (the hub) engage in multidirectional learning.

An ECHO session generally includes a didactic presentation from a hub member or guest, followed by a case presentation by a spoke participant.  Subsequent group discussion results in a list of recommendations for the case presenter (Babineau et al).

Librarians participate in seven of the nine ECHOs hosted by CAMH, either in embedded or consultative roles. As part of the inter-professional hub team, they work collaboratively to provide evidence-based information and tools for both the hubs and spokes.    

In the embedded model, a librarian is attached to a specific ECHO from the planning stage through to the final session. Before the cycle begins, the librarian might conduct literature searches to inform the curriculum and gather evidence to support didactic presentations (Rodak & Bonato).  The librarian then attends all sessions (approx. 16-32 weekly sessions) presenting at the start of each session the resources they gathered from the previous week’s questions, and posting them on the “library resources” section of the online participant portal.  Librarians provide resources that answer explicit questions that arise from the sessions and by attending the sessions they see gaps in knowledge and provide resources to help answer unspoken questions.

In the consultative model, the librarians do not attend the ECHO sessions.  Any questions that arise from the session are sent to the library and distributed to one of our three librarians based on their workload.

For the librarians, ECHO provides many unique opportunities including relationship-building with internal and external clinicians, learning the language and concepts used by different professional groups in mental healthcare, increasing the visibility of medical librarianship within the hospital and in the community, generating funds for the library, and providing valuable training for librarians new to the mental health and addiction field.

Benefits for ECHO participants include access to the expertise of medical librarians and curated collections of high-quality, evidence-based resources to supplement discussion topics, answer their specific questions, and enhance their clinical practice.   Resources are shared in a virtual Community of Practice Hub for continuous learning by ECHO participants.

While the benefits of participating in ECHOs are many, there have been some challenges.  The resources that the librarians gather must be open access to accommodate the spokes varying degrees of access to paid resources.  For similar reasons, grey literature is a common source of information, but it needs to be critically appraised.  It is important not to inundate the spokes with too much information so librarians must appraise similar resources to select the most suitable (Rodak & Bonato). Capacity is another challenge, as our small library has limited human resources to attach to ECHOs, and at times has strained to support multiple ECHO’s while maintaining other projects and work.  Lastly, hearing case presentations about patients can be mentally and emotionally taxing.  Recognizing that librarians do not have the same training or professional experience as their clinical colleagues, we are currently working with leadership to establish a skills development session for new non-clinical ECHO participants. 

With over 960 ECHO programs in 45 countries, your library is likely able to find opportunities to become involved in this impactful and rewarding initiative. 

The authors Daphne Horn, MI, Terri Rodak, MA, MISt and Sarah Bonato, MIS work at the Centre for Addiction and Mental Health, Toronto, Canada. Contact


  • Babineau, J., Zhao, J., Dubin, R., Taenzer, P., Flannery, J. F., & Furlan, A. D. (2018). The embedded librarian in a telehealth continuing medical education program. Journal of Hospital Librarianship, 18(1), 1-14.
  • Rodak, T., & Bonato, S.  (2021).  Coping with COVID: Supporting the Mental Health and Professional Practice of Healthcare Workers Through Embedded Librarianship.  Ontario Library Association SuperConference.  February 3, 2021.  Online.


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