BU and Boston Medical Center Launch Master's Track to Train Counselors for Pediatric Primary Care

Boston University's Chobanian & Avedisian School of Medicine has launched a child and adolescent integrated behavioral healthcare concentration within its master's program in mental health counseling and behavioral medicine, aimed at expanding the number of counselors who work with young patients in primary care settings, BU Today reported.

The program was developed with Boston Medical Center's TEAM UP Scaling and Sustainability Center. Carryl Navalta, a clinical associate professor of psychiatry who directs the concentration, said he believes it is the first and only master's-level specialty track in the country that provides comprehensive behavioral health education, clinical training and competency-based preparation for pediatric integrated care. Boston Uncut could not independently verify that claim.

The need is local as well as national. "At Boston Medical Center (BMC), we can have a waitlist of approximately 100 children and adolescents needing to be seen," said Rachel Levy-Bell, a clinical psychologist who directs the master's program. BMC is BU's primary teaching hospital.

BU Today framed the program against a 2021 advisory from then-U.S. Surgeon General Vivek Murthy, who wrote that mental health challenges are the leading cause of disability and poor life outcomes in young people, "affecting up to 1 in 5 US children ages 3 to 17 with a reported mental, emotional, developmental, or behavioral disorder." The article said only half of adolescents nationally receive the mental health support they need, and cited a survey finding that more than 85 percent of primary care practices face significant barriers to accessing adolescent mental health advice and services.

Up to 10 of the 40 to 48 students admitted to the counseling program each year will participate in the concentration. Students are placed on teams of medical providers in traditional medical settings, where they learn to provide behavioral health care as part of primary care.

In the integrated model, a concern can be flagged by a family member, a school or a routine screening at a pediatrician's office. The primary care provider can then bring in an on-site counselor, so the child is seen during the same appointment. "The parent is hearing this from someone they trust," Navalta said.

Sonia Erlich, TEAM UP's director of workforce development and training and a graduate of the program, said referrals elsewhere often fail. "The minute you let someone walk out that door and ask them to make follow-up phone calls to find mental health support elsewhere, you lose them," she said, citing inconvenience, unreturned calls and insurance barriers.

Navalta has worked with Erlich and TEAM UP for two years with support from a federal Health Resources and Services Administration grant; the new agreement formalizes that relationship. TEAM UP began developing a pediatric integrated behavioral health model with Massachusetts federally qualified community health centers in 2015 and has since expanded to 14 pediatric practices in the state and beyond, according to BU Today.

Emily Feinberg, TEAM UP's senior director and an adjunct professor of pediatrics, was among its founders. TEAM UP originated with a request from the Richard and Susan Smith Family Foundation to bring child and adolescent mental health care to settings positioned to close access gaps. It works with practices serving historically marginalized communities and uses state-mandated school-entry physical exams, repeated annually, to screen for mental health issues. A community health worker on each team helps build trust through knowledge of the community's language and culture.

Cost is a barrier for students entering the field. Levy-Bell said more incoming students want to work with children and adolescents but face tuition and Boston's high cost of living. "Without financial support, this can force them to choose between completing the concentration and meeting their financial obligations, or to forgo community-based practice for higher-paying private sector positions," Navalta said.

The Inspirational Futures Foundation, a private grant-maker that supports programs serving children, teens, young adults and families, awarded the concentration a $50,000 grant. It provides $10,000 stipends to each of four students, with the remaining $10,000 covering suicide prevention training fees.

Navalta said other pressures, including high caseloads, trauma exposure, limited resources and administrative duties, drive burnout in the field, and that team-based care helps counter isolation. Alana Nicker, a second-year student in the concentration, said the approach "helps you to stay curious, to stay learning."