Integrated Behavioral Health Services and Psychosocial Symptoms in Children.

IMPORTANCE

Studies evaluating integrated pediatric behavioral health care using electronic medical record data are limited.

OBJECTIVE

To evaluate the association of receipt of integrated behavioral health services with changes in psychosocial symptoms among children receiving care at federally qualified health centers with behavioral health integration.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used electronic medical record data (June 2020 to April 2023) from children aged 4 to 18 years with an identified behavioral health concern at 4 Massachusetts federally qualified health centers with integrated behavioral health care. Data were analyzed in October 2024.

EXPOSURES

Receipt of integrated behavioral health services, categorized into 3 treatment groups: (1) receipt of behavioral health clinician (BHC) encounters, (2) community health worker encounters, and (3) psychotropic prescriptions. The control group included similar children who did not receive any of these treatments.

MAIN OUTCOMES AND MEASURES

The primary outcome was psychosocial symptom score based on the 17-item Pediatric Symptom Checklist (PSC-17). After applying propensity scores to match children receiving treatment and control groups on their baseline characteristics, associations of receiving a treatment with psychosocial symptoms were estimated by comparing scores before vs after treatment using linear regression models.

RESULTS

Of 942 unique children, 542 (57.5%) received any type of treatment and 400 (42.5%) were in the control group. Children with a BHC encounter and children without any treatment had similar baseline characteristics (female sex: 206 children [58.7%] vs 204 children [56.7%]; mean [SD] age, 11.8 [3.5] vs 11.7 [3.4] years). After having at least 1 encounter with a BHC, PSC-17 scores among children in the treatment group were 1.51 (95% CI, -2.65 to -0.37) points lower compared with the control group. After receiving a psychotropic prescription, PSC-17 scores among children in the treatment group were 2.21 (95% CI, -3.89 to -0.54) points lower compared with the control group. No statistically significant changes were observed among children with at least 1 community health worker encounter (-0.53 points; 95% CI, -1.86 to 0.80 points).

CONCLUSIONS AND RELEVANCE

In this cohort study of children at federally qualified health centers implementing behavioral health integration, receipt of encounters with BHCs and psychotropic prescriptions were associated with improved psychosocial symptoms, suggesting that expanding integrated pediatric behavioral health care might enhance behavioral health outcomes among marginalized pediatric populations.