Testimony of Rachel White, Senior Youth Policy Analyst, before the Committee on Health

April 11, 2024
Testimony
Person Testifying: Rachel White
Title: Senior Youth Policy Analyst, DC Action
Testimony Heard By: Committee on Health
Type of Hearing: Budget Hearing

Good morning Chairman Henderson and staff of the Committee on Health. I’m Rachel White, Senior Youth Policy Analyst at DC Action. We use research, data, collective action, and a racial equity lens to break down barriers that stand in the way of all kids reaching their full potential. We are also the home of DC KIDS COUNT, an online resource that tracks key indicators of child and youth well-being. 

DC Action is home to four coalitions, including the Youth Economic Justice and Housing Coalition, which advocates with youth and youth-serving organizations in the District of Columbia for policies, funding, and programs that expand access to comprehensive support and services that youth experiencing homelessness need to successfully transition into stable and productive adulthood. 

Together with our coalition partners, we have advocated for data- and accountability-driven solutions to end youth homelessness and disrupt the pipeline of young people entering into the District’s adult homeless system. One way to mitigate homelessness and disrupt the trajectory of chronic homelessness is by making behavioral health supports more accessible.

The relationship between mental health and youth homelessness is complex and bidirectional, meaning that each can contribute to the other. In the District, 32% of youth experiencing homelessness reported impaired mental health. The most common diagnoses for youth experiencing homelessness include depression, anxiety, post-traumatic stress disorder (PTSD), a history of adverse childhood experiences (ACEs), and substance use disorders. These conditions contribute to homelessness, as individuals struggle to maintain employment, housing, or relationships due to mental health challenges

Homelessness itself can be traumatic. The experience of living on the streets, in shelters, or in other unstable and unsafe environments can exacerbate mental health issues. Young people experiencing homelessness may face violence, sexual exploitation, and discrimination, all of which can lead to severe trauma. The lack of a stable and supportive social network can lead to feelings of extreme loneliness and depression. Many youth who experience homelessness may turn to substance abuse as a way to cope with the stresses and challenges of their situation, which leads to a higher risk of comorbid disorders

Increasing access to behavioral health supports is a matter of urgency. While there are services available to unaccompanied youth experiencing homelessness through DBH, the existing supports are missing the mark as they are not fully accessible to youth experiencing homelessness. In conversations with DBH, they have acknowledged there is a gap in outreach efforts to reach youth experiencing homelessness. In addition to being unaware of the behavioral health services available to them through DBH, youth have also reported that, once they are connected to DBH, transportation is a barrier when they are  referred to clinicians not in their vicinity. Often they are met with caseworkers and providers who are not linguistically and culturally competent or LGBTQ+ affirming. Youth homelessness service providers have reported there is a lack of accessible, youth-friendly, and culturally competent mental health services throughout the District, which is a major barrier to youth achieving long-term stability. 

DBH behavioral health services are underutilized by youth experiencing homelessness. In 2022, DBH’s programs provided behavioral health care to just 288 16 to 24 year olds experiencing homelessness, despite the District serving almost 1,700 youth in this age range through its homeless services operations. And the count of 1,700 does not include youth who are not using District shelters or other services. This large service gap further endangers unhoused youth, given their vulnerability and complex mental health needs.

Youth experiencing homelessness need consistent and proactive access to mental health services, such as DBH-hired or -funded counseling services embedded in youth drop-in centers and shelters, as well as counselors that can travel to a client on a regular basis, rather than making a young person come to them. The creation of a continuous care model designed to meet youth experiencing homelessness where they are will help reduce reliance on crisis response. 

Lastly, despite there being over 8,000 youth experiencing homelessness within DC Public and Charter schools, and 57% of homeless students reporting higher rates of depression compared to 43% of housed students nationally, the mayor has decreased the School Based Behavioral Health (SBBH) program budget by $9.97 million. We stand in solidarity with Strengthening Families through Behavioral Health and urge the Council to restore funding to sustain compensation for school-based behavioral health clinicians and to make targeted investments to bolster other elements of the SBBH Program to enhance its reach and efficacy. 

In closing, we are asking the Committee on Health to : 

  • Allocate funding to increase DBH’s capacity to provide targeted outreach to youth experiencing homelessness to increase access to services. 
  • Coordinate with the Committee on Housing to share committee funds to increase funding for youth homelessness providers’ contracts to expand capacity for embedded mental health services. Similarly, DBH could work with DHS to facilitate partnerships with these service providers to bring DBH-hired clinicians physically into youth housing programs on a regular basis to create a quasi-embedded model of mental healthcare where hiring and supervision are not falling on under resourced nonprofits. 
  • Allocate additional resources to DBH in this budget, to develop and execute a plan to increase the number of behavioral health professionals in the district that is akin to the District’s targeted efforts to entice individuals to join the police force, including hiring bonuses, housing assistance, career pipelines, and access to vehicles.
  • Allocate $1.7 million to fund a traveling behavioral health unit to bring services to youth experiencing homelessness where they physically congregate. 

Making DBH services more convenient and proactive for youth experiencing homelessness would help youth transition seamlessly into DBH’s broader array of community services for long-term support that can help address youth trauma, substance abuse, and medication management, all of which will decrease the likelihood of sustained or future homelessness. Recognizing that the children, youth, and families served by the public behavioral health care system in the District are primarily individuals of color, improving our system is a matter of equity. Improved access to behavioral health services is proven to be transformative for children and families and can boost the long-term overall health and productivity of communities.

Thank you for your time and consideration. I would be happy to answer any questions.