Patients from Cape Verde, Ecuador, Haiti, and Brazil, including many new immigrants, come for routine doctor’s appointments, urgent care, and more at Brockton Neighborhood Health Center—their medical home. The transition to a new life isn’t easy, and staff see the youngest patients shouldering those burdens.
“For pre-teens and teens, we see a lot of depression and anxiety,” shares Kira Rosa, the pediatrics-obstetrics behavioral health manager at Brockton Neighborhood Health Center. “For younger kids, whose parents are still getting established in this country, housing, food insecurity, transportation to appointments are all issues. Kids are struggling.”
Brockton looked to BMC’s Transforming and Expanding Access to Mental Health Care Universally in Pediatrics (TEAM UP) for help.
Integrating medical and mental health
Brockton always had an integrated approach to mental health. Social workers and community health workers were integrated into the clinical workflow, but follow-up was targeted to high-risk patients leaving little time for preventive efforts. Patients were falling through the cracks. In 2019, Brockton partnered with BMC’s TEAM UP to close those gaps.
TEAM UP integrates behavioral healthcare into pediatric clinics by providing clinical training, implementation support, and technical assistance—removing barriers to care for patients in structurally marginalized communities. More than 74% of the program’s patients identify as racial or ethnic minorities, and 67% live at or below the poverty level. Services are delivered on site by a team that includes primary care providers, behavioral health clinicians, and community health workers, many multilingual and representing the cultural diversity of the children they serve.
“Mental health is as important as physical health, and it should be housed where you receive all medical care,” shares Rosa. “They are intertwined, especially at a young age. With TEAM UP, the doctors and nurse practitioners become trained in the importance of mental health and how it is impacting their patients. Behavioral health clinicians can be consulted immediately. If we discover something, we can address it then and there. Before integration, medical staff would give phone numbers to mental health centers and tell families they’d need to figure it out. With a more robust, integrated workforce, patients don’t get lost in the system. The difference is night and day.”
Now with anchor funding from the Richard and Susan Smith Family Foundation and The Klarman Family Foundation, BMC is launching the TEAM UP Scaling and Sustainability Center, charged with expanding the program from seven clinics to 29 in the next four years. This growth will make it possible to reach up to 126,000 children across the Commonwealth.
Expansion enables early identification and intervention
Well beyond Brockton, kids in Massachusetts are struggling. One in five children and adolescents has a behavioral health condition, but it can take years to receive a diagnosis and treatment due to stigma, workforce shortages, and social factors that prevent timely care.
“The TEAM UP expansion comes after multiple studies showing that the model’s approach to early identification, intervention, and treatment is making a meaningful difference,” shares Anita Morris, executive director of BMC’s TEAM UP Scaling and Sustainability Center. “We’re improving child health and reducing clinician burnout. Patients are connected with behavioral health services within their pediatric medical home—often on the same day a concern is identified.”
Over a 12-month period, children receiving mental health services in TEAM UP health centers experienced significant improvement in mental health symptoms, health-related quality of life, and school-related functioning, including fewer missed school days. To date, at least 40,000 patients have been served through TEAM UP since the program launched in 2015.
“It’s hard to put into words the relief on parents’ faces when I tell them that our team is ready, today, to help their child,” shares Huy Nguyen, MD, a pediatrician at DotHouse Health, a TEAM UP partner site. “That’s been the remarkable impact of TEAM UP—our system of care is so much stronger, empowering me to respond to the mental health crisis in my community.”
BMC leadership views TEAM UP as another example of its commitment to reimagining where and how care is delivered to improve health outcomes for all.
“Mental health is a crucial component to overall health, and TEAM UP’s integrated approach is breaking down barriers to care to reach children in communities where the need is significant,” says Alastair Bell, MD, MBA, president and CEO of Boston Medical Center Health System. “The expansion of this new model of care is an important step in driving more equitable health outcomes in the Commonwealth.”
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