TY - JOUR
AU - J. Kim
AU - M. B. Cole
AU - J. Rosenberg
AU - A. Morris
AU - E. Feinberg
AU - R. C. Sheldrick
A1 - 
AB - 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.
AD - Research Support Services Department, Boston Medical Center, Boston, Massachusetts.; Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, Massachusetts.; Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island.; Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester.
AN - 40956583
BT - JAMA Netw Open
C5 - Healthcare Disparities
CP - 9
DA - Sep 2
DO - 10.1001/jamanetworkopen.2025.32020
DP - NLM
ET - 20250902
IS - 9
JF - JAMA Netw Open
LA - eng
N2 - 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.
PY - 2025
SN - 2574-3805
SP - e2532020
ST - Integrated Behavioral Health Services and Psychosocial Symptoms in Children
T1 - Integrated Behavioral Health Services and Psychosocial Symptoms in Children
T2 - JAMA Netw Open
TI - Integrated Behavioral Health Services and Psychosocial Symptoms in Children
U1 - Healthcare Disparities
U3 - 10.1001/jamanetworkopen.2025.32020
VL - 8
VO - 2574-3805
Y1 - 2025
ER -