Overcoming Barriers to Behavioral Health Integration in Pediatrics Through Co-Development

Integrating behavioral health services in pediatric primary care has been identified as a core strategy for closing the worrying treatment gap faced by young people with depression, anxiety, ADHD, and other common conditions. Pediatricians and psychiatrists have stressed the importance of addressing behavioral health in primary care settings for more than a decade, but in the same breath, they’ve also acknowledged the many administrative and financial barriers that stand in the way of behavioral health integration.

Four years ago, the Smith Family Foundation and an interdisciplinary group of clinicians and researchers from Boston Medical Center (BMC) and Boston University (BU) took aim at these barriers with an initiative known as TEAM UP for Children. Pushing further than most integrated models, TEAM UP seeks to not only transform pediatric behavioral healthcare at community health centers (CHCs), but also to build the lasting capacity at CHCs necessary to sustain the transformation well into the future.

Just as innovative as the model itself is the way TEAM UP set about creating it. Within some broad parameters, every aspect of TEAM UP’s implementation and evaluation was co-developed alongside the CHCs. Inspired by quality improvement frameworks and methods drawn from implementation science, a field of study focused on facilitating the adoption of evidence-based clinical practices, TEAM UP’s collaborative, iterative approach was designed to avoid the potholes that have hobbled behavioral health integration in the past.

TEAM UP is now starting to roll out its early results. A recent qualitative study surfaced key themes from in-depth interviews with dozens of CHC clinicians and staff, and a second study, published in Health Services Research, was an important first step in establishing TEAM UP’s sustainability. The latter study — the first to report hard data from the initiative — compared health claims from the three TEAM UP sites and non-participating CHCs and found an increase in primary care engagement at the former without a corresponding increase in avoidable healthcare costs.

In the fall of 2019, with added support from The Klarman Family Foundation, TEAM UP is expanding to four more CHCs. As the second phase of the initiative kicks off, the co-leads of the evaluation team — pediatrician Megan Bair-Merritt, MD, MSCE, of BMC and the BU School of Medicine, and Chris Sheldrick, PhD, of the BU School of Public Health — sat down with HealthCity to discuss TEAM UP’s novel approach to implementation and evaluation.

Read the full article on BMC’s HealthCity platform.