Testimony of Rachel White: Better Futures are Possible for Youth When We Provide Better Care

Good morning, Chairperson Henderson and members of the Committee on Health.

Thank you for the opportunity to testify today. My name is Rachel White, and I am here to highlight barriers to mental health services for youth experiencing homelessness and to advocate for the Department of Behavioral Health (DBH) to provide co-located behavioral health services at youth homelessness services sites.

Youth experiencing homelessness have unmet behavioral health needs

DBH pre-hearing oversight responses report that they served 81 youth under the age of 21 who self-identified as homeless in FY24. However, this vastly understates the true scope of need among youth  facing housing instability. Many young people experiencing homelessness do not disclose their housing status due to stigma, fear of systems involvement, or the limitations of intake assessments. DBH relies on the annual Point-in-Time (PIT) count, in conjunction with DHS and The Interagency Council on Homelessness (ICH) to develop the engagement and outreach strategies across agencies to engage and connect consumers to care. Please note, the PIT count provides only a one-night snapshot and does not fully capture the transient and hidden nature of youth homelessness, such as couch-surfing or unstable housing situations but based on the PIT count alone there were 583 youth ages 18-24 who were experiencing homelessness January 2024. 

To further expand on the scope of youth homelessness,  according to research conducted by the Urban Institute, one in five District youth, or 9,726 young people ages 18 to 24, experience housing insecurity. 

We know that homelessness and mental health challenges are bidirectional (they exacerbate one another) and that youth experiencing homelessness have significantly higher rates of suicide, depression, anxiety, and substance use disorders than their housed peers.

• 49% of DC’s unaccompanied youth experiencing homelessness report impaired mental health in 2023 with an even higher rate for parenting youth Applying this to the number of 18-21 year-olds served by DHS in fiscal year 2023, there would be nearly 300 youth in this age range in need of services, far more than the 81 DBH served in fiscal year 2024. Barring a drastic shift between the years, it seems clear that far more young people need support than are getting it from DBH currently.
• District middle and high school students experiencing homelessness are three times more likely to attempt suicide than their housed peers. And children who experience homelessness are more likely to become youth who experience homelessness. 

Despite these alarming numbers, youth remain underserved and disconnected from the District’s behavioral health system.

DBH has acknowledged the importance of outreach-based behavioral health services for adults through the Projects for Assistance in Transition from Homelessness (PATH) program, which deploys outreach workers to shelters, encampments, and other community spaces to connect people to a Community Services Agency for ongoing care, help them access benefits they may be entitled to, and help them navigate the process from homeless to permanent housing. However, no equivalent youth-focused program exists.

•  In FY 24 the PATH team served 522 adults experiencing homelessness. To date in FY25, the team is engaged with approximately 300 people.
• Of the 522 adult consumers enrolled with PATH in FY24, 447 were connected to a CSA or other community mental health provider, 397 of these individuals had housing eligibility determinations completed, and 155 achieved temporary or permanent housing, demonstrating the ability of this initiative to promote housing stability.

While DBH has initiated an informal partnership with DC Doors to provide initial assessments and linkages to community agencies offering behavioral health services, this approach should be extended to all youth homelessness providers. Currently, DBH’s partnership with DC Doors consists of a two-person team visiting the drop-in center twice per week to conduct brief assessments and connect youth to external services. This initiative has been recognized as beneficial by both the youth served and DC Doors’ leadership. However, it remains a limited, site-specific effort rather than a citywide, systemic solution. Key shortcomings of the current approach include:

• Limited availability of DBH staff, restricting access to behavioral health assessments and referrals.

• Youth must wait for scheduled visits rather than receiving immediate, on-demand support.

• Youth who receive referrals must still travel off-site to receive continuous therapy services  

• The absence of permanently embedded behavioral health professionals at youth homelessness sites.

• Insufficient coverage across youth homelessness service providers citywide.

At a minimum, the model established between DBH and DC Doors—where youth are connected to external, ongoing behavioral health services—must be expanded to all providers serving youth experiencing homelessness. I hope Wednesday’s hearing with government witnesses will delve further into the success and challenges of this pilot and discuss DBH’s plans and needs for expansion in this current fiscal year.  

However, even pilot expansion will not go far enough. To truly meet the needs of young people experiencing homelessness and housing instability, DBH must ensure that regular, co-located therapeutic services are available on-site at youth homelessness programs, providing immediate, consistent care where youth are already seeking support.

Structural barriers prevent youth from accessing care

Although DBH mandates that all their certified providers offer services to those seeking care, referral-based systems alone are insufficient for youth experiencing homelessness. Many young people face insurmountable barriers to accessing services, including:

• Lack of transportation to community providers.
• Difficulty navigating intake processes that require multiple steps and documentation.
• Mistrust of traditional behavioral health systems, due to past trauma or negative experiences with institutions.

As a result, many youth do not follow through with referrals, leading to untreated mental health conditions, worsening crises, and increased risks of harm.

That is why we continue to advocate for co-located therapeutic behavioral health services at youth homelessness service sites. 

To eliminate barriers and improve access, DBH should implement a youth-focused outreach model ensuring behavioral health professionals are physically present at youth homelessness sites, including:

• Drop-in centers where youth seek food, showers, and case management.
• Youth shelters and transitional housing programs, where staff can immediately connect young people with care.
• Street outreach teams, ensuring that behavioral health services are accessible even to unsheltered youth who are otherwise disconnected from services.

Co-located referral services have already shown success based on personal accounts of participants at DC Doors, where a DBH team provides brief mental health assessments and referrals. Expanding this model into a permanent, citywide framework that meets the full mental health needs of youth experiencing homelessness would allow for:

1. Immediate access to trauma-informed mental health and substance use care.
2. Increased engagement by embedding behavioral health professionals in youth-friendly spaces.
3. Better coordination of services between DBH and youth homelessness providers.

DBH has the tools and program models  to expand this model and should not wait for another crisis to act.

Better futures are possible for youth when we provide better care

DBH has made strides in engaging individuals experiencing homelessness, but the current framework fails to account for the unique needs of transition-aged youth (ages 18-24). To truly address youth homelessness, I urge DBH to:

1. Expand the DC Doors model into a permanent, structured program for all youth-serving organizations.
2. Provide data on how many youth referred to behavioral health services complete intake and receive ongoing care. Data is key to identifying and solving for persistent barriers to care. 
3. Work toward  providing co-located therapeutic behavioral health services at youth homelessness sites citywide.

By bringing behavioral health services directly to youth experiencing homelessness where they already seek support, DBH can remove critical barriers to care and ensure young people receive the mental health support they need to transition out of housing stability.

Thank you for your time, and I welcome any questions.