DC Must Better Address the Behavioral Health Needs of Students of Color and Girls

Chairperson Henderson and members of the Committee, thank you for the opportunity to testify. My name is Qubilah Huddleston, and I am a Senior Policy Analyst at the DC Fiscal Policy Institute (DCFPI). DCFPI is a non-profit organization that shapes racially-just tax, budget, and policy decisions by centering Black and brown communities in our research and analysis, community partnerships, and advocacy efforts to advance an antiracist, equitable future. DCFPI is a member of the Strengthening Families Through Behavioral Health Coalition (SFC)—a coalition committed to ensuring that DC children and families have access to a fully integrated behavioral health care system.  

I am testifying today about the following issues: 

• Behavioral health disparities among DC’s youth;
  
• The progress of the Department of Behavioral Health’s (DBH) cost study on the School-Based Behavioral Health (SBBH) Expansion Program; and
  
• The status of current funding for behavioral health community-based organizations (CBO) grants. 

DC Must Better Address the Behavioral Health Needs of Students of Color and Girls 

DCFPI appreciates the Mayor and DC Council for having consistently invested in the SBBH program within recent years. Those investments have helped the District make more progress toward placing at least one full-time behavioral health clinician in every DC Public School and public charter school. Policymakers should continue to invest so that the SBBH program is stronger, more sustainable, and well-utilized by DC’s students and families. The District should also ensure that investments are leading to more culturally competent care. 

Data on DC from the 2021 Youth Risk Behavior Survey (YRBS) show that Black, Latinx, and Indigenous students bear the brunt of violence and trauma in their communities and face greater behavioral health challenges.^[1] Forty percent of Black middle school students and 43 percent of Indigenous students who were surveyed reported having seen or heard people where they live be violent or abusive, compared to 28 percent of white students who were surveyed.^[2] One-third of surveyed Black, Latinx, and Indigenous students reported seriously considering taking their own lives compared to 20 percent of white students. Disturbingly, Indigenous middle school students were four times more likely to report that they attempted to take their own life compared to white students; Black students were 2.5 times more likely to report that they attempted to take their own life.  

Data among DC’s high schoolers are equally troublesome. Nearly 48 percent of surveyed high school girls reported feeling sad or hopeless^[3] —a proportion that has increased since the pandemic.^[4] Higher percentages of girls and students of color reported that their sadness and hopelessness caused them to stop engaging in everyday activities. Alarmingly, Black and Latinx high schoolers reported being four times more likely to attempt taking their own lives compared to their white peers. The percentage of high school girls and high schoolers of color reporting that they are most likely to talk with a parent or other adult family member about their feelings decreased compared to 2019 data.^[5] The percentage of high school girls and Latinx students that reported receiving the help they needed most of the time or always when they were feeling sad, empty, hopeless, angry, or anxious also declined.  

The disparities in behavioral health outcomes in the District are unacceptable and demand urgency and explicit focus on boosting culturally competent care. More resources and strong program implementation would help ensure that Black and brown youth get the supports that they need to heal, cope, and show up as their best selves in school and in life.  

The Committee on Health Should Host a Public Roundtable on the Results of the SBBH Cost Study 

DC has long needed a stronger and more sustainable SBBH program model and the pandemic has only increased that need. The SBBH program relies on a blended funding model of a DBH-issued grant for CBOs, federal Medicaid reimbursements, and any funds that participating behavioral health CBOs raise on their own. It has become clear that the typical CBO grant amount that DBH awards is inadequate to address the demands and needs of the program. In fiscal year (FY) 2023, the SFC successfully advocated for DBH to conduct a cost study of the program to estimate the true costs of operating the program across DC’s 254 schools. The study is supposed to examine the following costs related to the program: 

• CBO clinician salary and benefits 
• Non-personnel costs such as implementation and technical assistance  
• Various considerations such as the cost of CBOs providing more school-wide and small group services that cannot be billed to Medicaid

By law, DBH was required to share the final study with the DC Council no later than December 31, 2022. However, Public Consulting Group (PCG), the consultants conducting the study, shared that they are still in the data collection process.^[6] PCG did not share a definitive timeline for when they expect to complete their analysis and share a final report with DBH.  

SFC strongly urges the Committee on Health to host a roundtable with public and government witnesses once DBH publicly shares the report. This roundtable would provide the opportunity for  

students, families, educators, school leaders, and CBOs to share their experiences with the program and for the Committee on Health to investigate the bright spots and challenges of the program. Such context can inform important next steps that DBH, the Mayor, and the Council should consider as they take further steps to improve the financial sustainability, quality, and utilization of the program.  

Current Funding for the SBBH Reflects Reality of Needed Investments, Additional Work Remains 

DBH recently shared that the agency is providing FY 2023 grants of nearly $100,000 per clinician to participating CBOs. Notably, the agency increased the grant amount to support CBOs in their recruitment and retention efforts among an acute workforce shortage. DCFPI applauds DBH for proactively taking this action. Still, we were disturbed to hear DBH assert that only $70,000 of the grant is local recurring funding, while the rest includes local and federal one-time funding.^[7] In the FY 2023 budget season, the SFC successfully advocated for the District increase funding to DBH so that it could permanently increase the grant to $80,000. This advocacy followed DBH’s own decision to increase the CBO grant by $10,000 in FY 2022 after determining that the $70,000 had been inadequate amount to meet the compensation and implementation demands of the program. DCFPI urges the Committee on Health to ask DBH what happened to the $10,000 increase in the local, recurring portion of funding for CBOs that the Council provided funding for last year.  

That DBH has increased funding for CBOs and is working to find creative solutions to resolve workforce challenges illustrates the need to increase and sustain local investments in the program. DBH is clearly underfunded to meet the financial realities of the SBBH program, so the District should ensure sustainable funding moving forward. The behavioral health needs of DC’s children are still pressing, and CBOs will only be able to continue their important work if they have access to adequate funding.  

Thank you for the opportunity to testify. I am happy to answer any questions.