Integrated Behavioral Health Care Helps Kids in Underserved Communities

Credit: Adobe Stock/JenkoAtaman

Behavioral health concerns, such as anxiety, depression or attention issues, are common among children and can affect their overall well-being, school performance and relationships. Federally Qualified Health Centers (FQHCs) are community-based clinics that provide care to underserved populations, and many are working to integrate behavioral health services directly into primary care. This approach makes it easier for families to access mental health support without needing referrals to outside specialists.

A new study looked at nearly 1,000 children (ages 4 to 18 years) with identified behavioral health concerns who received care at four FQHCs in Massachusetts between 2020 and 2023. Investigators wanted to know whether integrated behavioral health services were linked with improvements in children’s psychosocial symptoms — such as emotional struggles, attention problems or social challenges.

“Integrated behavioral health (BH) services in pediatric primary care are increasingly recommended to address insufficient access to quality BH care,” wrote Jihye Kim, Ph.D., of the Research Support Services Department at Boston Medical Center. “The rational is clear — pediatric primary care is associated with high engagement and low stigma as compared with specialty care; thus, it is perceived as an ideal setting to improve access to BH care.”

One example of this is the TEAM UP program, which is an approach that brings mental health care directly into children’s regular doctor visits at community health centers. These clinics often serve families who may have trouble accessing high-quality care. TEAM UP works by screening children for mental health needs, identifying concerns early and connecting families to care.

Children in TEAM UP clinics were more likely to get the mental health services they needed and had better engagement with their doctors. Research also suggests that children who received TEAM UP services had fewer behavioral health symptoms and did better in school.

The current study divided children into different groups depending on the type of care they received:

• Behavioral health clinician (BHC) encounters — visits with a trained behavioral health professional
• Community health worker encounters — meetings with staff who provide support and resources but not direct clinical care
• Psychotropic prescriptions — medications prescribed to manage mental health symptoms
• Control group — children with similar concerns who did not receive these services

Results showed that children who had at least one appointment with a behavioral health clinician experienced improvements in their psychosocial symptom scores compared with children who did not receive treatment. Similarly, children who received a psychotropic prescription also showed improvements. However, children who met only with a community health worker did not show significant changes in their symptom scores.

The takeaway is that integrated behavioral health services at FQHCs can make a real difference for children struggling with emotional or behavioral issues, especially when care includes direct clinical support from behavioral health specialists or appropriate medications.

While community health workers play an important role in connecting families with resources, this study results suggest that symptom improvement is more likely when children receive clinical interventions.

“Receiving services from a BHC or receiving psychotropic medications in the context of integrated care were associated with improved BH symptoms,” investigators concluded. “These findings suggest that BH integration within FQHCs may be a promising vehicle for expanding the reach of pediatric BH care and for improving the health outcomes within marginalized populations.”