Integrated Behavioral Health in Pediatric Primary Care: 'You're Treating the Kid, but the Family Is the System'

Only about 20% of the children in the United States who experience behavioral health issues receive specialized care, and it's not hard to understand why. Thanks to a nationwide shortage of providers and mazelike insurance plans, a simple referral from a pediatrician can easily turn into an odyssey of forms, fees, missed phone calls, and weeks-long waits for appointments. For parents who are managing the stresses of living in poverty or negotiating cultural or language barriers, the experience can be even more daunting.

For over a decade, pediatricians and psychiatrists have made a push to integrate behavioral health services into primary care settings, in order to streamline communication, facilitate prevention and care, and reduce long-term healthcare costs. The early results have been promising, and the evidence that behavioral health integration can improve outcomes for children is getting stronger. At the same time, national surveys have continued to highlight vast numbers of untreated children and ongoing racial disparities in care, signaling that much work remains to be done.

Behavioral health integration comes in many forms, ranging from minimal collaboration across separate locations to fully merged practices. One model at the latter end of this broad spectrum, TEAM UP for Children, has pushed the definition of integration even further, to emphasize close partnerships with families and community partners. TEAM UP is currently found at three community health centers in Massachusetts and is planning to expand to three or four more over the next several years, with support from the Richard and Susan Smith Family Foundation and The Klarman Family Foundation.

At the core of the model is a three-person team that includes a pediatrician, a behavioral health clinician, and a navigator role called the family partner. This team works together — often in the same exam room, during the same appointment — to connect patients seamlessly to behavioral health services. Just as important, they also provide support to families and serve as a liaison to schools and other outside entities, in many cases long before an official diagnosis arises.

Genevieve Daftary, MD, one of several clinicians who helped shape the TEAM UP model, is the pediatric medical director at Codman Square Health Center in Dorchester, Massachusetts. HealthCity sat down with Daftary recently to talk about the challenges her patients face, the need to reframe behavioral health, and what makes the TEAM UP model unique.

Read the full article on BMC's HealthCity platform.