The effects of integrating behavioral health into primary care for low-income children

Health Serv Res. 2019 Dec;54(6):1203-1213. doi: 10.1111/1475-6773.13230.


Objective: To evaluate the impact of TEAM UP-an initiative that fully integrates behavioral health services into pediatric primary care in three Boston-area Community Health Centers (CHCs)-on health care utilization and costs.

Data sources: 2014-2017 claims data on continuously enrolled children from a Massachusetts Medicaid managed care plan.

Study design: We used a difference-in-difference approach with inverse probability of treatment weights to compare outcomes in children receiving primary care at TEAM UP CHCs versus comparison site CHCs, in the pre (2014-2016q2)- versus post (2016q3-2017)-intervention periods. Utilization outcomes included emergency department visits, inpatient admissions, primary care visits, and outpatient/professional visits (all cause and those with mental health (MH) diagnoses). Cost outcomes included total cost of care (inpatient, outpatient, professional, pharmacy). We further assessed differential effects by baseline MH diagnosis.

Principal findings: After 1.5 years, TEAM UP was associated with a relative increase in the rate of primary care visits (IRR = 1.15, 95% CI 1.04-1.27, or 115 additional visits/1000 patients/quarter), driven by children with a MH diagnosis at baseline. There was no significant change in avoidable health care utilization or cost.

Conclusions: Expanding the TEAM UP behavioral health integration model to other sites has the potential to improve primary care engagement in low-income children with MH needs.

Keywords: behavioral health integration; cost; mental health; pediatrics; utilization.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Boston
  • Child
  • Child, Preschool
  • Delivery of Health Care, Integrated / economics*
  • Delivery of Health Care, Integrated / statistics & numerical data
  • Female
  • Health Care Costs / statistics & numerical data*
  • Hospitals, Pediatric / economics*
  • Hospitals, Pediatric / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Longitudinal Studies
  • Male
  • Medicaid / economics*
  • Medicaid / statistics & numerical data*
  • Mental Health Services / economics*
  • Mental Health Services / statistics & numerical data
  • Poverty / statistics & numerical data
  • Primary Health Care / economics*
  • Primary Health Care / statistics & numerical data
  • Retrospective Studies
  • United States