Integrated mental health care in pediatric primary care linked to improvements in school functioning, study finds

New research led by Boston Medical Center and Boston University School of Public Health found that children who received integrated mental health care showed improvements in both mental health and school performance.

These findings, published in the Journal of Developmental & Behavioral Pediatrics, examined changes over time in outcomes among 6-12-year-old children receiving integrated behavioral health care at three federally qualified health centers (FQHCs) that implemented the TEAM UP Model of care.

The study, which included 51 children serviced by FQHCs in Massachusetts, found that over 12 months of receiving integrated mental health care, children's mental health symptoms, health-related quality of life, and school-related functional outcomes significantly improved, supporting the potential benefits of pediatric integrated behavioral health care.

TEAM UP for Children—Transforming and Expanding Access to Mental Health Care in Urban Pediatrics— is a pediatric integrated behavioral health initiative co-developed by Boston Medical Center and seven FQHCs designed to equip health centers to deliver high-quality, evidence-informed, trauma-responsive, integrated behavioral health care in historically marginalized communities.

In these health centers, where 74% of the patient population is from a racial and/or ethnic minoritized group, 37% are best served in a language other than English, and 67% live at or below the federal poverty level, TEAM UP has created a sustainable, adaptable, and replicable model that strengthens pediatric primary care.

"Unmet service needs are significant for children experiencing mental health problems, especially for children from historically marginalized communities and those from low-income families," said Dr. Chris Sheldrick. "The TEAM UP Model aims to address this challenge by fully integrating behavioral health care into primary care at FQHCs, where children from historically marginalized communities regularly access care."

The research fills a gap in the existing evidence of the relationship between mental health symptoms and school-related functioning. The study found that improvements in internalizing symptoms and mental health-related quality-of-life were associated with improvements in school attendance, suggesting that changes in mental health could positively impact school functioning.

"Integrated behavioral health care implemented in FQHCs which serve minoritized populations—as demonstrated by the TEAM UP model—shows promise in enhancing overall child well-being," said Dr. Jihye Kim, Visiting Assistant Professor at the University of Nevada, Las Vegas, and a researcher for TEAM UP.

The researchers hope their findings will encourage more FQHCs to integrate behavioral health services into their pediatric primary care practices.

According to co-author Megan Bair-Merritt, MD, MSCE, Chief Scientific Officer at Boston Medical Center, "In the wake of the COVID-19 pandemic, children across the country have struggled with mental health challenges. These results are promising in suggesting the potentially positive impact of behavioral integration on children's mental health, health-related quality of life, and school-related functioning."