Testimony of Qubilah Huddleston at the Performance Oversight Hearing Before the DC Department of Behavioral Health DC Council Committee on Health

Chairman Gray and members of the Committee, thank you for the opportunity to testify. My name is Qubilah Huddleston and I am a policy analyst at the DC Fiscal Policy Institute (DCFPI). DCFPI is a nonprofit organization that promotes budget choices to address DC’s racial and economic inequities through independent research and policy recommendations. DCFPI is a member of the Strengthening Families Through Behavioral Health Coalition—a coalition committed to ensuring that DC students, children, youth, and families have access to a fully integrated behavioral health care system.

I am testifying today to highlight the growing need for behavioral health services in the District, particularly for DC’s littlest learners and public school students. DCFPI deeply appreciates the new investments that the Council made in fiscal years (FYs) 2020 and 2021 that allowed the Department of Behavioral Health (DBH) to expand the city’s school-based mental health program to nearly 70 percent of all public schools. Yet, the coronavirus pandemic and the resulting stress and trauma from the illness, deaths, social isolation, and economic fallout have pushed the city to the brink of a major mental health crisis. In the months ahead, policymakers will need to act even more boldly to ensure that DC’s most overburdened and under-resourced children and families have the necessary behavioral health supports to recover from the pandemic.

Mental Health Supports for Families with Infants and Toddlers is Crucial to DC’s Recovery

DCFPI is pleased that the Mayor and Council have consistently funded the Department of Behavioral Health’s (DBH) Healthy Futures program in recent years. This program provides mental health consultations to early learning educators at child care centers and can additionally connect families to community-based behavioral health resources that they may need for their babies. We have been told that the program is operating completely virtually in light of the health pandemic, and that mental health consultants are supporting parents and staff by hosting workshops focused on self-care. Some consultants have reported noticeable behavioral changes among infants and toddlers, including increased anxiety and “acting out”. Additionally, many early childhood educators and parents have reported that they are concerned about the negative impact of babies’ loss of opportunities to develop their social-emotional skills.

Despite some technology and connectivity challenges with delivering services virtually, Healthy Futures has a 100 percent satisfaction rate from child care center directors and staff.[1] Earlier program evaluations have shown that Healthy Futures can be effective in reducing negative child behaviors and improving educator-child interactions.[2] That it continues to be rated highly among early childhood education providers even during the pandemic reflects the program’s strength, and policymakers should expand its budget by $675,000 to meet the needs of more young children, their educators, and their families.

COVID-19 is Likely Devastating Student’s Mental Health Unequally

While we do not yet have data on the mental health toll of the pandemic in DC, pre-existing data on disparities in student mental health outcomes in the District, coupled with data on the uneven burden of COVID-19 sickness and deaths on Black and Latinx residents and communities in the eastern parts of the city,[3] suggests that students are not carrying the mental health burden of the pandemic equally. Before the pandemic, Black and Latinx middle and high school students were more likely to report suicidal thoughts or suicide attempts than their white peers, according to data from the 2019 Youth Risk Behavior Survey.[4] Alarmingly, middle school students in Wards 7 and 8—DC’s majority Black and most economically excluded communities—were more likely to report suicidal thoughts and suicide attempts before the pandemic.[5] Right now and in the immediate aftermath of the pandemic, DC leaders should use their power, privilege, and responsibility to end inequitable race- and place-based mental health outcomes among students.

DC’s School-Based Mental Health Expansion Program Is Key to Connecting Children to Services, Even During the Pandemic

Providing mental health supports to students in schools is a promising strategy to reduce barriers in cost and access to health care.[6] DC’s School-Based Mental Health Expansion program is currently in 161 public schools, putting the District on track to expand to the remaining 80 public schools not yet participating in the program. DBH has supported licensed clinicians from community-based organizations (CBOs) by advocating for necessary policy changes (such as modifying billing rules that allow providers to bill Medicaid for telehealth services) and working closely with DC Public Schools, the public charter schools, and educational agencies to ensure a successful implementation of the expansion program as students remotely or via a hybrid model. DCFPI is appreciative and impressed with DBH’s nimble thinking and willingness to do things differently and creatively so that students’ mental health needs can be met.

DBH is currently developing an evaluation of the program, and we believe that this data will be crucial in informing how the program is structured and implemented for future cohorts. While DBH has reported success across several metrics (e.g. percentage of schools matched with a CBO clinician), there are some limitations. For example, the program currently only places one clinician per school. While this is a good baseline goal, large schools and high-poverty schools in reality need more than one clinician to adequately address students’ needs. Another example of a challenge is students not being connected to a clinician or receiving a referral for community-based services in a timely manner. DCFPI will continue to monitor the development of the evaluation process, and we eagerly await more data and insights into the implementation and effectiveness of the school-based mental health expansion program.

More progress is needed to address the persistent and now growing need for behavioral health supports for students. The school-based mental health expansion program is one of many tools the District can use to deliver services deliver services to address students’ mental and emotional health needs. DBH has and continues to take steps to make sure students can get services and is even finding ways to provide supports to parents and educators. We strongly urge the Mayor and Council to keep up the funding momentum for the program. An investment of an additional $6.4 million in the next budget cycle would allow DC to address pressing student mental health needs alongside academic ones.

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

[1] Notes from a conversation with Barbara Paulson, Deputy Director of Children/Youth Services and other staff at DC Department of Behavioral Health, January 11, 2021.

[2] Deborah Perry and Sarah Deardorff. “Healthy Futures: Year One Evaluation of Early childhood Mental Health Consultation by the District of Columbia Department of Mental Health,”; Deborah Perry and Sarah Deardorff, “Healthy Futures Year Two Evaluation Report,” Sept. 30, 2012; Sept. 30, 2011; Deborah Perry, “Healthy Futures: Year Three Evaluation of Early Childhood Mental Health Consultation,” Sept. 30, 2013.

[3] Doni Crawford and Qubilah Huddleston, “The Black Burden of COVID-19,” DC Fiscal Policy Institute, April 16, 2020.

[4] Office of the State Superintendent, “District of Columbia Youth Risk Behavior Survey 2019.”

[5] Office of the State Superintendent.

[6] Michelle Rones and Kimberly Hoagwood, “School-Based Mental Health Services: A Research Review,” Clinical Child and Family Psychology Review, 3(4), 223-241, 2000.