Testimony at the Budget Oversight Hearing for the Department of Behavioral Health

Chairperson Gray and members of the Committee, thank you for the opportunity to submit testimony. My name is Qubilah Huddleston, and I am a 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 Co-Chair of the Strengthening Families Through Behavioral Health Coalition (SFC).  The SFC brings together a diverse group of advocates who share a commitment to improving DC’s behavioral health care system for children and families. Our coalition’s mission is to ensure DC has a fully integrated behavioral health care system in which all DC students, children, youth, and families have timely access to high-quality, consistent, affordable, and culturally responsive care that meets their needs and enables them to thrive.

Today, DCFPI urges the Health Committee to:

  • Invest an additional $2.4 million to stabilize community-based organization (CBO) grant funding.
  • Provide $300,000 to fund a cost study to determine the actual costs and needs of the District’s School-Based Behavioral Health (SBBH) program.
  • Adequately fund the Community of Practice.
  • Invest in a workforce pipeline of culturally competent clinicians.
  • Expand information-sharing and family engagement efforts. And,
  • Invest $700,000 to the Healthy Futures program.

DC Must Immediately Stabilize CBO Grant Funding

While most children are no longer learning remotely, the mental, emotional, and physical toll of the pandemic on DC students is more pronounced than ever. Last fall, thousands of child health physicians and hundreds of children’s hospitals declared a national state of emergency in child and adolescent mental health.[1] Additionally, new research is emerging that shows how damaging the pandemic has been to student mental health. For example, one new study found that early COVID-19 pandemic school closures were associated with negative student mental health symptoms, such as anxiety and distress, among students ages zero to 19.[2]

The Mayor and DC Council approved an FY 2022 budget with enough funding to both ensure that every DC Public School (DCPS) and public charter school could have at least one full-time clinician through the SBBH program and that DBH could continue providing a $10,000 grant supplement to partnering behavioral health CBOs that place clinicians in schools. For FY 2023, the Mayor is proposing several new investments in SBBH, including funds for additional clinicians, new DBH staff to support the infrastructure and evaluation of the SBBH program, and boosting DBH’s workforce pipeline efforts. While these investments are welcomed, the Mayor’s proposal eliminates the $10,000 grant supplement that DBH has provided to CBOs over the last two years. The Health Committee must act so that DC does not lose ground on the progress the District has made to ensure that all students have access to SBBH services.

The pandemic has shifted both student and educator behavioral health needs in profound ways that has required CBOs to expand the breadth and depth of services they provide inside schools. Prior to the pandemic, most CBOs could expect to cover at least 50 percent of their expenses via billing Medicaid for intensive supports, or Tier 3 supports, they provided to individual students. Since the pandemic, however, CBOs have provided less Tier 3 services to students, with Medicaid billing declining by 50 percent during the pandemic, according to DBH. [3]  CBOs have been providing more Tier 1 and 2 supports that are less intensive like mindfulness and anti-cyber bullying curricula, benefit the whole school.[4] Unfortunately, these services are not billable to Medicaid. If not for the $80,000 grant, many existing CBOs would find their partnership with DBH financially infeasible. Furthermore, a higher grant amount is better suited to attract new CBOs the District needs to reach its goal of at least one full-time clinician per school. Policymakers should pass a budget that permanently provides this amount to CBOs and provides annual inflation adjustments moving forward.

DC Needs to Determine What It Truly Costs to Implement the SBBH Program, Now and in the Future

DCFPI urges the Health Committee to provide $300,000 so that DBH can determine how the needs of individual schools, providers, and communities drive program costs and build a more financially sustainable model for the future.

Since 2016, DBH has provided CBOs a grant amount based on estimates and data the department gathered at that time. Without actual expenditure data and other statistics, it is a wonder how DBH is accurately calculating the cost of the program or determining the grant amounts that CBOs need to sustainably deliver vital behavioral health services to students. As previously mentioned, CBO clinicians provide a wide range of services, yet they are only able to be reimbursed by Medicaid for intensive services provided to individual students. At a time when clinicians are providing so much more to schools, such as school-wide suicide prevention curriculum or small-group sessions that target the needs of students at risk of developing more significant behavioral health challenges, policymakers must both ensure that DBH’s budget meets the behavioral health demands of students today and that DBH can adequately fund CBO grants.

The DC Council Must Support Effective Implementation of the SBBH Program

DCFPI thanks the Mayor and DC Council for taking action to ensure that every DCPS and public charter school have at least one full-time clinician through the SBBH program. However, DCFPI and our allies know that one clinician per school is the floor, not the ceiling. Many more schools will likely need additional CBO clinicians to meet the full needs of their students. In addition, there are several other components of the SBBH program that the Mayor and DC Council should invest in to ensure that SBBH is implemented well.

Adequately Fund the Community of Practice

The Community of Practice (CoP) is a collaborative learning environment that brings providers, school staff, and school leaders together to share SBBH best practices, and provides technical assistance to all participating schools. The CoP has expanded the type and quantity of technical assistance and training to its members throughout the pandemic. However, given how the pandemic has changed CoP members’ training and support needs and the fact that the CoP is now responsible for providing support to all 251 schools in the District, the CoP needs additional resources to build more capacity.

Invest in a Culturally Competent Clinician Workforce Pipeline

The pandemic has made an already limited school-based behavioral health workforce pool even smaller. Policymakers and DBH need to make a concerted effort to strengthen the pipeline of behavioral health providers in the District. More importantly, the city needs to make efforts to recruit clinicians that can relate to their students and be competently responsive to their students’ cultural needs.

Workforce development strategies that policymakers should consider investing in include:

  • Relationship building with area colleges and universities with social work and psychology graduate programs.
  • Exam and certification prep programs, especially for Black and brown behavioral health professionals.
  • “Grow your own” initiatives starting in local high schools to ensure a steadier pipeline of culturally competent school-based clinicians.
Expand Information-Sharing and Family Engagement Efforts

Not all students and families in DC are aware that behavioral health services are available at their school, even though many parents would first turn to a school-based behavioral health professional if their children had behavioral health needs.[5] Families are essential partners in making SBBH a success. Policymakers must address the current gaps in information-sharing and help DBH and CBOs better mitigate the barriers that families are facing to ensure that ongoing investments in SBBH services truly reach the student and families who need them most. For example, DBH, the Office of the State Superintendent of Education, DCPS, and public charter schools should work together to list regularly updated contact information of behavioral health and wellness staff and behavioral health service offerings on school profiles and websites, My School DC, and the DC School Report Card.

Fund Healthy Futures

Healthy Futures is an evidence-based, early childhood mental health consultation program run out of DBH that promotes positive social and emotional development in young children. DCFPI asks the Committee to increase funding for the Healthy Futures program by at least $700,000 to enable DBH to make much needed updates to the program’s infrastructure, hire personnel, and increase capacity to expand to 35 from 25 additional child care developmental facilities.

Consultants with the Healthy Futures program are doing an excellent job of making mental health services available to families trying to navigate their way through our shifting pandemic. This support has been invaluable to teachers, parents, and young children in these extraordinarily difficult and stressful times. The return to classrooms has been stressful for children and their parents in what feels like a never-ending pandemic. They need more mental and behavioral health supports now than ever to adjust to our ever-shifting new normal. Healthy Futures is the best-positioned program to respond to this impending stressor in many families’ lives and should be expanded to meet this need.

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

[1] American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association, “Declaration of a National Emergency in Child and Adolescent Mental Health,” October 19, 2021.

[2] Russell Viner, Simon Russel, and Rosella Saulle, “School Closures During Social Lockdown and Mental Health, Health Behaviors, and Well-being Among Children and Adolescents During the First COVID-19 Wave: A Systemic Review,” JAMA Pediatrics, January 18, 2022.

[3] Department of Behavioral Health, “Question 24, FY 21 Pre-Hearing Performance Oversight Questions,” DC Council, Committee on Health.

[4] Department of Behavioral Health, “Question 22, FY 21 Pre-Hearing Performance Oversight Questions,” DC Council, Committee on Health.

[5] Parents Amplifying Voices in Education, “Back to School Survey Fall 2021,” PAVE.