health equity

Integrating Behavioral Health at FQHCs Improves Access, Treatment for Children of Color

A new study led by R. Christopher Sheldrick calls for the expansion of behavioral health services at federally qualified health centers to provide equity in pediatric behavioral healthcare.

A new study led by the School of Public Health and Boston Medical Center has 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.

Published in the journal Pediatrics, the study demonstrates how federally qualified health centers (FQHCs) can improve equitable care for children of all ages—especially racially and ethnically marginalized children who are more likely to access care at these centers.

The Transforming and Expanding Access to Mental Health Care in Urban Pediatrics (TEAM UP) model expands access to comprehensive, high-quality behavioral health care to medically underserved areas or populations. FQHCs support 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.

For the study, researchers collected data 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 at participating FQHCs identified as non-White or Hispanic, and nearly half were living below the federal poverty level.

Under the TEAM UP model, more than 81 percent of well-child visits at the three FQHCs included behavioral health screenings—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 lead and corresponding author R. Christopher Sheldrick, research associate professor of health law, policy & management and evaluation co-director of TEAM UP for Children. “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.”

Under the TEAM UP model, 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, a pediatrician at BMC and professor of pediatrics at the 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.”