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Judith Sandalow Headshot

Grading DC's Mental Health System for Children

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Aaliyah* was 13 when her mother went to prison. A bright seventh grader, she was doing well in school, reading above grade level and excelling in math. Yet in the wake of her mother's sentencing she began to struggle. Her grandmother did the best she could to care for her. But, all of a sudden, Aaliyah began acting out in school, skipping classes and getting suspended.

It may seem obvious that Aaliyah needed help dealing with the sadness and emotional turmoil caused by her mother's incarceration. Unfortunately, like so many other children in the District, she couldn't get timely help.

Though a few schools in the District have school-based mental health services, including Aaliyah's middle school, she wasn't immediately connected to the onsite therapist. Then, when she was referred to the program, staffing changes meant she couldn't get counseling. Her grandmother didn't know where else to turn to get help, even though Aaliyah had Medicaid health insurance that should have helped with programs outside school.

Children like Aaliyah who don't get help for mental health needs are at greater risk of dropping out of school, ending up in prison or worse. Ensuring mental health screenings, assessments and services is especially critical for the District's poorest children who are more likely to experience the trauma of violence, homelessness and family instability than others across the nation. The District government is ultimately responsible for making these services available to the seven out of 10 DC children like Aaliyah who are insured by Medicaid.

Each year, Children's Law Center grades the District on its progress and failures in meeting children's mental health needs. We see some important progress and note some good news in our 2014 Children's Mental Health Report Card, released today. However, the District's mental health system continues to disappoint Aaliyah and the more than 5,000 children like her who are being overlooked.

The good news is that the District has begun a number of mental health reforms that could ultimately get many more children the care they need. For example, the District's proposed FY 2015 budget funds important new programs that will allow pediatricians to better screen, refer, and treat children with mental health issues. We have seen time and again in our work that identifying needs earlier means children have a better chance of getting help sooner and ultimately, a better chance at being able to succeed in school, live safely with their families, and thrive.

For the first time, this year the District is now reporting how Medicaid managed care organizations are meeting children's mental health needs. Because of the new reporting, we can now track how many mental health services are being offered, how many children are getting treatment and how much is being spent on mental health. That means it will be easier to hold their feet to the fire for getting timely, quality services to children like Aaliyah.

However, the 2014 Children's Mental Health Report Card gives the District low marks for its failure to reach many children with mental health needs. Our report notes that Aaliyah's experience is not isolated: far too many children who need services are waiting too long to get the help they need. We found that DC's children waited an average of 22 days to be seen by a community provider once they were referred. Also troubling is that fewer than one-third of children who were released from a psychiatric hospitalization had an outpatient follow-up appointment within a week.

These delays in treatment have serious consequences. Aaliyah's story shows just how harmful delays can be. Unfortunately, as Aaliyah's mental health needs went unaddressed they got much worse, and she was hospitalized for severe emotional and behavioral outbursts that jeopardized her safety. It was a scary time for her and her family.

The District needs to significantly expand programs to reach children like Aaliyah earlier -- and to ensure these programs are of the highest quality. For example, even though Aaliyah's middle school had a mental health provider onsite, she couldn't get help in a timely manner. School can be one of the only constants in a child's life, making it an effective place to house mental health services. While the District set aside funding for more school-based mental health providers in its budget last year, the city failed to fill all the positions. Today, the majority of our public schools still do not offer mental health services.

There is a long road ahead for Aaliyah, though we are hopeful that with the right support she can reach her full potential -- both in school and beyond. We urge the District to make more strides in its mental health reforms so that children will not have to wait to get the care they need. Otherwise, we not only jeopardize their future but also risk stalling important progress that has been made in the District's schools and child welfare system, affecting thousands more children.

*client named was changed to protect her confidentiality.