Can Integrated Mental Health Care Improve Pediatric Outcomes? New BMC Research Will Find Out

The idea behind TEAM UP is simple, even when the work is not: Meet children where they already are, in the place their families trust, and make mental health care part of growing up. 

Transforming and Expanding Access to Mental Health Care Universally in Pediatrics (TEAM UP) at Boston Medical Center embeds behavioral health clinicians and community health workers directly into children’s primary care medical homes, so that their emotional wellbeing is treated in the same visit, with the same urgency as a fever or a broken bone. It’s been active at Boston Medical Center (BMC) for nearly a decade. Now, with funding from the Patient-Centered Outcomes Research Institute (PCORI), TEAM UP is preparing comparative clinical effectiveness research to test whether fully integrated mental and behavioral health produces measurably better outcomes for children than following evidence-based clinical guidelines alone. The funding award has been approved, pending completion of PCORI’s business and programmatic review and issuance of a formal award contract.

The trial builds on a decade of discovery. Before asking whether integrated care improves outcomes, TEAM UP researchers first had to establish that the model could work in real-world pediatric settings — reaching children, connecting them to care, and supporting clinicians to make mental and behavioral health a routine part of primary care. 

“For nearly 10 years, our team has generated evidence showing that TEAM UP improves access to behavioral health services, particularly for children from lower income families or marginalized communities who face heightened barriers to accessing behavioral health care,” said Megan Cole Brahim, PhD, MPH, associate professor of population medicine at Harvard Medical School and co-director of Research and Evaluation for TEAM UP.

Increasing access to mental and behavioral health care for kids 

Researchers at TEAM UP tested whether integrated care could reach the children who needed it, and early signs were encouraging. At community health centers implementing the TEAM UP model, more than 81% of well-child visits included behavioral health screenings, well above the Massachusetts average, and when a provider personally  connected a family to a behavioral health colleague — a “warm hand-off” — children were far more likely to return for the behavioral health care they’d been connected to. 

 Additionally, researchers found that children at TEAM UP sites showed significant increases in mental health–related primary care visits and service use at federally qualified health centers without increasing costs. The findings suggested that integrated care could do more than promise access; it could make behavioral health services a more routine part of children’s regular care.

“Each TEAM UP study has brought us closer to understanding what integrated care can do, and just as importantly, what it takes to sustain.”

Anita Morris, MSN, FNP-BC, Executive Director of TEAM UP 

But access alone wasn’t enough. For integrated care to work over the long term, the teams delivering it also needed to be able to sustain the model. A study of burnout among providers and staff at four Boston-area community health centers found that emotional exhaustion remained below national averages after integrating behavioral health clinicians and community health workers into primary care teams through the TEAM UP model — a signal that integration, done well, could also support clinical teams.  

“The support provided by integrated teams has been a game-changer for primary care providers and the ability to meet the needs of families and children. As a PCP at a TEAM UP health center, my colleagues have expressed that they could never return to practicing without the type of support that TEAM UP provides,” said Emily Feinberg ScD, CPNP, senior director of TEAM UP and professor of health services, policy and practice at Brown University School of Public Health.

Proving the promise of integrated mental and behavioral pediatric health care 

With evidence that integrated care could expand access and support the teams delivering it, researchers turned to its potential impact on children themselves. The benefits of integration extended beyond the care team, with researchers finding that school-age children receiving integrated mental and behavioral health care through the TEAM UP model showed significant improvements over 12 months in mental health symptoms, quality of life, and school-related functioning. Additionally, working with a behavioral health clinician through TEAM UP was associated with a 1.51-point drop in symptom scores for children, which suggests that behavioral health symptoms improved.  

“Each TEAM UP study has brought us closer to understanding what integrated care can do, and just as importantly, what it takes to sustain,” said Anita Morris, MSN, FNP-BC, Executive Director of TEAM UP. 

Together, these findings suggest that integrated mental and behavioral health care can improve access, support the primary care workforce, and help children to heal. However, comprehensive integrated models like TEAM UP require more resources and time to build and support. The next phase of TEAM UP’s research is focused on making the model more feasible to implement and sustain in primary care settings. 

Testing what it takes to make integrated care sustainable 

The new comparative clinical effectiveness research will support 12 pediatric practices, serving approximately 48,000 school-age children and adolescents and 25,000 preschool-age children, in implementing guideline-based primary care, including universal mental and behavioral health screening at well-child visits and treatment of common conditions like ADHD, anxiety, and depression. Then, by random assignment, each practice will step up to comprehensive integrated care either 6, 10, 14, or 18 months later, with a coach from TEAM UP guiding the transition. 

Researchers will measure mental and behavioral health symptoms using common screening questionnaires completed during routine visits, with follow-up extending up to 21 months. They will also study how the TEAM UP model works, analyzing whether symptom improvements trace to specific services.  

“This is an amazing opportunity to show how well TEAM UP works, but also how its many components can best meet the needs of children, their families, and the dedicated pediatric clinicians and staff who serve them,” said Chris Sheldrick, PhD, professor of psychiatry and behavioral sciences at UMass Chan Medical School and dual principal investigator of the new PCORI-funded study.  

The mental health crisis among children and adolescents has only deepened, and the call to expand services in primary care has grown more urgent. TEAM UP’s decade of research suggests what is possible when mental and behavioral health is woven into the fabric of pediatric care, and this new trial could shape how pediatric care is delivered for generations to come. 

“What TEAM UP has shown is that mental and behavioral health doesn’t have to live outside of primary care, but rather it can be woven into the fabric of every well-child visit,” said Megan Bair-Merritt, MD, MSCE, vice president and chief scientific officer at BMC Health System and dual principal investigator of the new PCORI-funded study. “This trial will help us understand not only whether that approach works, but also how to make it sustainable in the primary care practices that serve families with the greatest barriers to mental health care so that everyone can benefit.”