Integrating Mental Health Treatment into Primary Care Can Break Barriers for Underserved Children

The Bottom Line

New research led by Boston Medical Center offers the strongest evidence to date that the TEAM UP model, which integrates mental health into pediatric primary care, can improve access to mental health care for Medicaid-enrolled children.

Context

More than 1 in 5 children in low-income families report a mental health concern. Yet, despite having well-established, evidence-based treatments, less than half of children receive treatment for mental health disorders — and when treatment is provided, it is often both delayed and insufficient in duration. On the other hand, most children in the U.S. have regular access to primary care.

TEAM UP for Children — Transforming and Expanding Access to Mental Health Care in Urban Pediatrics — is an initiative and model of care that works to bring integrated, evidence-based behavioral health care to historically underserved communities. It was co-developed by Boston Medical Center and other federally qualified health centers, and together, 74% of their population are patients of color, 37% receive care in a language other than English, and 67% live at or below the federal poverty level.

Study Objective

To determine if a comprehensive pediatric mental health care integration model is associated with healthcare access, psychotropic medication use, and mental health follow-up care among children at federally qualified health centers who use Medicaid.

The Details

This retrospective cohort study used Massachusetts all payer claims data as well as the 2017 American Community Survey. The study included Medicaid-enrolled children aged 3 to 17 years old who received primary care services at one of nine specific federally qualified health centers in Massachusetts — three of which use the TEAM UP model and six of which were used as comparison sites.

Findings

In total, 20,170 unique children were in the study sample. Children who visited Massachusetts health centers with the TEAM UP model after 1.5 years had relative increases in mental health–related primary care visits and mental health service use compared to the other sites. Yet, the same group did not have increases in use of psychotropic medications.

Pull Quote

“[This study] highlights the importance of addressing the unmet needs of low-income families when accessing mental health services," said co-author Megan Bair-Merritt, MD, MSCE, Chief Scientific Officer at Boston Medical Center in a press release. "Integrating mental health services into pediatric primary care can address the barriers that many children and families encounter."