Boston University School of Public Health News

New TEAM UP Center Will Extend Behavioral Health Services to 126,000 Children in Massachusetts

(Boston University School of Public Health News) – July 12, 2024 – The new TEAM UP Scaling and Sustainability Center will lead an expansion of the Boston Medical Center-based TEAM UP initiative, which integrates mental health services into pediatric primary care practices to increase access to this critical care among structurally marginalized populations.

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One in five youth in Massachusetts has a behavioral health condition, but it can take an average of 11 years to receive a diagnosis due to workforce shortages, lack of training, and stigma associated with mental health. A new center, whose evaluation arm is codirected by School of Public Health researchers, is breaking down these barriers to connect children and adolescents in the Bay State and beyond to critical mental health screening, treatment, and resources, and help mitigate a crisis that is worsening across the Commonwealth and the nation.

Megan Cole Brahim, associate professor of health law, policy & management, and R. Chris Sheldrick, adjunct associate professor of HLPM, are part of a team that has launched the TEAM UP Scaling and Sustainability Center, based at Boston Medical Center.

The new center will lead an expansion of BMC’s TEAM UP program (Transforming and Expanding Access to Mental Health Care in Urban Pediatrics), an initiative that integrates behavioral health services into pediatric primary care practices. The clinical model focuses on prevention; promotion; early identification of emerging social, developmental, and behavioral health concerns; and prompt access to care. Since its inception in 2015, TEAM UP has supported primary care practices that are implementing the clinical model with in-depth, ongoing clinical training and practice transformation support and data-driven technical assistance customized to the practice. It is currently the standard of care in seven community health centers in Massachusetts and has reached 40,000 patients to date.

Over the next four years, TEAM UP will expand to reach 126,000 children at 29 pediatric primary care practices, closing a gap in disparities in mental healthcare access among medically underserved populations.

“There are significant unmet needs when it comes to screening, diagnosing, and treating behavioral and mental health issues in children,” says Cole, who serves as codirector of research and evaluation with Sheldrick for the new TEAM UP Center. 

In addition to a lack of training or resources, “delays in care also occur in traditional healthcare settings due to referral requirements, limited behavioral health providers who accept Medicaid, or a lack of providers overall, and all of these factors contribute to patients not getting linked to critical services when they need them,” Cole says. “This TEAM UP expansion aims to make these services available directly within pediatric primary care settings, including at community health centers, where access to pediatric primary care is nearly universal for children.”

More than 74 percent of TEAM UP patients identify as racial or ethnic minorities, and 67 percent live at or below the poverty level.

At the center of the TEAM UP Model is a multidisciplinary care team comprised of behavioral health clinicians, community health workers, and primary care providers who coordinate to provide behavioral health screenings and treatment that is both trauma-informed and culturally responsive. 

The approach has proven to be effective, with multiple peer-reviewed studies capturing the model’s successes. A 2023 analysis published in JAMA Network Open found that TEAM UP was associated with increased access to pediatric mental health services, while limiting the use of psychotropic medications. A 2022 analysis published in Pediatrics found that community health centers (CHCs) that implemented the TEAM UP model provided significantly higher screening rates for social, emotional, and behavioral issues than statewide rates. Children who received mental health services over a 12-month period also experienced significant improvement in mental health symptoms, health-related quality of life, and school-related functioning, including fewer missed school days. The model has also been associated with positive effects on the behavioral health workforce.  A Journal of Ambulatory Care Management study showed that this coordinated care alleviated burnout among CHC providers and staff.

“We are confident that TEAM UP has a positive impact on children and families and the behavioral health workforce,” says Anita Morris, executive director of the new center. “The TEAM UP Scaling and Sustainability Center will extend the reach of that positive impact across the Commonwealth and beyond.”

The TEAM UP initiative and expansion also aligns with broader efforts at the state level to increase access to behavioral health services, including a Roadmap for Behavioral Health Reform, originally spearheaded by Marylou Sudders (SSW’78), former Secretary of Health and Human Services for Massachusetts and a TEAM UP Scientific Advisory board member.

“Early identification and treatment of behavioral health conditions is essential for children to be healthy today and thriving adults in the years to come,” said Sudders in a BMC announcement about the expansion. “We see the lasting effects of undiagnosed, untreated mental illness and believe this innovative model of care will truly make a difference for children and their families.” 

Anchor funding for the TEAM UP Center was provided by the Richard and Susan Smith Family Foundation and The Klarman Family Foundation. 

Read the BUSPH News Article