Massachusetts youth behavioral health in 2026—and how Eliot is helping make systemic change

Part 1 of a 3-Part Series

The state of youth behavioral health in Massachusetts

Across Massachusetts, more children and teens are struggling with behavioral health needs than ever before—and families are increasingly hitting barriers when they try to access help. Statistics from the 2022 KIDS COUNT Data Book found that from 2016 to 2020, the share of Massachusetts children ages 3–17 diagnosed with anxiety and/or depression rose from 12.2% to 18.4% (a 51% increase).

At the same time, demand is colliding with workforce constraints and service availability—especially for intensive, home- and community-based care. In a December 2023 issue brief, the Massachusetts Association for Behavioral Healthcare (ABH) reported 4,214 children waiting across home- and community-based services in 2023, up from 3,302 the year prior.

Youth needs sit inside a larger behavioral health network—often a fragmented one

Youth behavioral health doesn’t exist in a silo. Families frequently interact with multiple systems at once: schools, pediatric care, outpatient therapy, in-home services, emergency departments, inpatient units, and payer-specific rules. When pathways don’t align, families can get bounced between “next steps” that regularly don’t connect.

Massachusetts has worked to strengthen community-based access through the Community Behavioral Health Center (CBHC) model launched in 2023. A Massachusetts legislative document citing MassHealth impact reporting noted 770,997 CBHC-based visits provided to 58,379 MassHealth members since January 2023 (through June 2024). That scale is meaningful. But scale alone doesn’t eliminate confusion at the front end—especially for youth and families navigating multiple stressors, eligibility rules, and levels of acuity.

Why families get stuck: the “front door” problem

In a roundtable discussion with leaders from across Eliot’s Behavioral Health Division, Eliot COO Aaron Katz described the system in a single word that likely feels familiar to many families: “Fractured.” He talked about a “tapestry of confusion” created by layers of agencies, payers, and service pathways that don’t always align. This sentiment was echoed, noting that even when new services exist, families can still get lodged at the front door—unsure where to start and receiving different answers depending on what agencies, providers or payers with which they connect.

Melissa Jadhav, Eliot’s Division Director of Behavioral Health, underscored that insurance variations and levels are a prominent challenge, as well. “The insurance issue is a huge stuck point for so many families. They often will qualify for CBHC services because more payers approve that, but not CSA, or maybe CSA but then not FIT (Family-Based Intensive Treatment). It’s a huge barrier,” she said. 

These realities are at the heart of what recent Community Service Agency (CSA) programs expansion at Eliot is meant to address: not just “more services,” but a clearer path—so families can get oriented quickly, connected to the right level of care, and supported across systems (school, home, community) without having to stitch it together alone. 

“No wrong door” and no waitlist—how CSA expansion is reshaping access for families

CSAs exist to coordinate care for youth with complex needs, particularly when success requires multiple players working together effectively (family, school, clinicians, state agencies, community supports). Done well, CSA becomes an anchor that stabilizes day-to-day life, aligns service plans, and prevents families from falling through cracks created by decades of fragmentation. Through Eliot’s CSA expansion into communities surrounding Lynn and across northern Essex County, transformations in behavioral health quality of life are gaining momentum.  

Eliot’s response is a deliberate move toward de-siloing services and functioning more like a coordinated front door—so families can enter anywhere and still get to the right level of care. Furthermore, since the launch of CBHCs in 2023, Eliot has maintained no waitlist for individuals and families seeking services, and the CSA program expansion operates exactly the same. This expediency makes all the difference in strengthening both short- and long-term outcomes.

“There’s no wrong door to these services,” Katz said “and we’re designing this so that services across Eliot and the broader community continuum of care are working together, without delay.” 

Zane FitzGerald, Director of Youth and Family Community Behavioral Health at Eliot, framed this as a core CSA mission: building “systems of care” within communities—bringing together stakeholders across schools, state agencies, outpatient providers, and in-home services: “A huge part of the mission and vision for CSAs is to be the hub for service access… and building that group to a point where there are clear access points, clear collaboration.” This means that regardless of the socioeconomic, cultural or insurance circumstances from which youth and their families engage a specific service, their needs will be assessed and triaged to the right programming for immediate and lasting impact.

He pointed to Eliot’s new CSA expansion in Haverhill as an example of what this looks like in practice—especially in historically underserved areas: “Our investment in trying to build a multi-stakeholder continuum of care within that city has been a really big deal, and I think will pay dividends for a historically underserved community.” He further added that the systemic approach Eliot is deploying is predicated on amplifying access to an intentionally interconnected network of services: “The front door is not only to our own services, but a conduit to connecting to lots of other resources that support kids and families.”

Why this matters now

When thousands of children are waiting for intensive services, and family stress can escalate quickly, a model that improves navigation, coordination, and continuity isn’t a “nice to have.” It’s a practical redesign aimed at reducing preventable crises and improving long-term outcomes for children, youth and families living at the intersection of multiple high risks.

Up next

Part 2 focuses on the next piece of the continuum: Family-based Intensive Treatment (FIT)—why Eliot added it, how it complements CSA and CBHC services, and why “warm handoffs” and family-systems care can change what families experience when they need help urgently.