Although an estimated one in five children in the US has a behavioral health issue, there are substantial unmet needs and systemic barriers to accessing behavioral health care. Progress to integrate behavioral health into pediatric primary care has been slow, especially for low-income communities.
To address the issue, three Boston-area pediatric community health centers began working with Boston University and Boston Medical Center (BMC) in 2016 to implement the Transforming and Expanding Access to Mental Health Care in Urban Pediatrics (TEAM UP) model of fully-integrated pediatric behavioral health within primary care, with support from the Richard and Susan Smith Family Foundation.
Now, a new study led by a School of Public Health researcher finds that, in the first year and a half of the program, children with a mental health diagnosis who were served by the TEAM UP sites—the Dimock Center in Roxbury, Codman Square Health Center in Dorchester, and the Lowell Community Health Center—went for more primary care visits than similar children served by nearby non-participating community health centers. Despite this increase in visits, children who were part of TEAM UP did not see an increase in healthcare costs.
Published in Health Services Research, the study is the first evaluation of a pediatric behavioral health integration initiative to compare participating and non-participating community health centers.
“Notwithstanding the direct investment of implementing the intervention, integrating behavioral health into the pediatric medical home for low-income children has measurable value in as little as one and a half years, without further increasing patient spending,” says lead study author Megan Cole, assistant professor of health law, policy & management.
“If increased engagement in primary care leads to earlier and improved treatment for children with mental health conditions, longer-term cost savings could result.”
Cole and her colleagues used 2014–2017 claims data from BMC HealthNet, a Medicaid managed care plan in Massachusetts, and compared patients older than three months and younger than 18 years old at the three TEAM UP sites and at six nearby and sociodemographically-similar community health centers.
After one and a half years, TEAM UP was associated with a 15-percent relative increase in primary care visits compared with the non-participating sites, driven primarily by children with mental health diagnoses. The researchers found no significant change in avoidable health care utilization (such as emergency department visits or hospitalizations) or in the costs billed to BMC HealthNet.
The study was co-authored by R. Christopher Sheldrick, research associate professor of health law, policy & management. The study’s senior author was Megan Bair-Merritt, professor of pediatrics at the School of Medicine and Boston Medical Center and the primary investigator for the evaluation of TEAM UP. The other co-authors were Qiuyuan Qin and Debra Morley of the Boston Medical Center Department of Pediatrics.
The study will be included in a special “Best of ARM” print issue of Health Services Research in December featuring the top-rated papers from the 2019 AcademyHealth Annual Research Meeting.
Read more about TEAM UP here.