Integrating mental health into primary care in the community improves access and treatment for a wide range of children.
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, according to new research led by Boston Medical Center and Boston University School of Public Health.
These findings, which were published in Pediatrics, show how federally qualified health centers (FQHCs) can help improve equitable treatment for children of all ages, particularly those who are racially and ethnically marginalized and are more likely to seek care at FQHCs.
The TEAM UP (Transforming and Expanding Access to Mental Health Care in Urban Pediatrics) strategy, developed by Boston Medical Center and three FQHCs in the greater Boston region, was created to provide medically underserved areas or populations with comprehensive, high-quality behavioral health care.
FQHCs contribute to this aim by providing care to 1 in every 11 Americans, including more than 1 in 7 African-Americans, 1 in 6 Latinos, and 1 in 2 people living in poverty each year.
Children who are racially and ethnically marginalized are more likely to experience major hurdles to mental health care, such as a shortage of mental health specialists and the stigma associated with mental illness in their community.
Behavioral health screening was performed at over 81 percent of well-child visits at the three FQHCs under the TEAM UP model, which is much higher than the statewide norm of 74 percent.
Children who received a friendly hand-off from their primary care provider to behavioral health professionals were also more likely to complete an additional visit than those who did not.
“We know that more than 15% of children in the United States had a behavioral health condition prior to the pandemic, with impoverished children bearing a disproportionate risk,” says R. Christopher Sheldrick, Ph.D., evaluation co-director of TEAM UP for Children at Boston Medical Center and research associate professor of health law, policy, and management at Boston University School of Public Health.
‘”Now that the COVID-19 pandemic has resulted in a surge in the number of children requiring behavioral health services, this is the type of approach that needs to be replicated to assure fair access across the United States.”
The rate of children seeing a behavioral health clinician within 30 days of being diagnosed with ADHD increased from 62.9 percent to 78.3 percent after TEAM UP was implemented in community health centers. The number of children having several psychiatric medication prescriptions, often known as polypharmacy, decreased.
Megan Bair-Merritt, MD, MSCE, a pediatrician at Boston Medical Center and professor of pediatrics at Boston University School of Medicine, warns that shortages of mental health specialists can severely limit access to care for families.
“By involving children in their medical homes, we are removing barriers to care and ensuring that all children, regardless of age, ethnicity, or racial background, have access to high-quality behavioral health care.”
Between June 2017 and November 2019, data for this study was collected from three FQHCs, totaling 47,437 individual well-child visits for children aged 30 days to 18 years old.
More than 80% of patients seen at participating FQHCs were non-White or Hispanic, with nearly half of them falling below the federal poverty line. FQHCs provided researchers with monthly standardized electronic medical record data, which they evaluated.