Integrating behavioral health in community-based primary care improves access and treatment for racially and ethnically diverse children

BOSTON - New research led by Boston Medical Center and Boston University School of Public Health found that a model of integrating behavioral health care into pediatric primary care at federally qualified health centers resulted in greater access, more timely care, and higher diagnostic rates of attention deficit hyperactivity disorder (ADHD) for children. These results, published in Pediatrics, demonstrate the role that federally qualified health centers (FQHCs) can have in improving equitable care for children of all ages, especially racially and ethnically marginalized children who are more likely to access care at FQHCs.

The Transforming and Expanding Access to Mental Health Care in Urban Pediatrics (TEAM UP) model developed by Boston Medical Center and three FQHCs in the greater Boston area was designed to expand access to comprehensive, high-quality behavioral health care to medically underserved areas or populations. Providing care in FQHCs supports this goal, as these community-based centers provide care for 1 in every 11 Americans, including more than 1 in 7 who identify as Black, 1 in 6 who identify as LatinX, and 1 in 2 living in poverty each year. Racially and ethnically marginalized children are more likely to face significant barriers to accessing mental health services, including a shortage of mental health professionals and the stigma of mental illness in their communities.

Under the TEAM UP model, behavioral health screening was completed at more than 81 percent of well-child visits at the three FQHCs, a proportion significantly greater than the statewide average of 74 percent. Children who received warm hand-offs to behavioral health staff from their primary care provider were also more likely than those who did not to complete an additional visit.

“We know that before the pandemic, more than 15 percent of children in the United States had a behavioral health condition, with impoverished children bearing disproportionate risk,” says R. Christopher Sheldrick, PhD, evaluation co-director of TEAM UP for Children at Boston Medical Center and a research associate professor of health law, policy and management at Boston University School of Public Health. “Now that there are surging numbers of children requiring behavioral health support following the COVID-19 pandemic, this is the type of model that needs to be replicated to ensure equitable access across the United States.”

Following the implementation of TEAM UP in community health centers, the rate of children following up with a behavioral health clinician within 30 days of diagnosis with ADHD increased from 62.9 percent to 78.3 percent. The number of children with multiple prescriptions for psychotropic medications, often referred to as polypharmacy, also fell.  

“Shortages of mental health professionals can significantly limit access to care for families,” says Megan Bair-Merritt, MD, MSCE, a pediatrician at Boston Medical Center and professor of pediatrics at Boston University School of Medicine. “By engaging children in their medical homes, we are addressing barriers to care and ensuring that all children, of all ages and ethnic and racial backgrounds, can receive high-quality behavioral health support.”

Data for this study was collected between June 2017 and November 2019 from three FQHCs which included 47,437 unique well-child visits for children aged 30 days old to 18 years old. More than 80 percent of patients seen at participating FQHCs identified as non-White or Hispanic and nearly half were living below the federal poverty level. FQHCs reported monthly standardized electronic medical record data which was further analyzed by researchers.

This research was undertaken in collaboration with Codman Square Health Center, the Dimock Center, and Lowell Community Health Center. The TEAM UP initiative is supported by a grant from the Richard and Susan Smith Family Foundation and The Klarman Family Foundation.

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About Boston Medical Center

Boston Medical Center (BMC) is a private, not-for-profit, 514-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. BMC offers specialized care for complex health problems and is a leading research institution, receiving more than $166 million in sponsored research funding in fiscal year 2019. It is the 13th largest funding recipient in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in Boston HealthNet – 12 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit http://www.bmc.org.