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mental health


Interagency Council on Behavioral Health Establishment Amendment Act of 2019

Interagency Council on Behavioral Health Establishment Amendment Act of 2019

Introduced: March 5, 2019

Co-introducers: Councilmembers Elissa Silverman, Brianne Nadeau, Brandon Todd, and Kenyan McDuffie


Summary: To amend The Department of Behavioral Health Establishment Act of 2013 to establish an Interagency Council on Behavioral Health and to describe its members, powers, and duties.

Councilmember Grosso's Introduction Statement:

Today, along with my colleagues Councilmembers Brianne Nadeau, Elissa Silverman, Brandon Todd, and Kenyan McDuffie, I am introducing the Interagency Council on Behavioral Health Establishment Amendment Act of 2019.

Modeled after the Interagency Council on Homelessness, this legislation establishes an Interagency Council on Behavioral Health for the purpose of facilitating cross-sector, cabinet-level leadership in planning, policymaking, program development, and budgeting for a culturally competent, outcome-based, behavioral health system of care.

Just last year, the Office of the Auditor and the Council for Court Excellence completed a robust report focused on the Department of Behavioral Health's work with justice-involved individuals and the criminal justice system broadly.

The report was revealing, highlighting enormous gaps in service and raising serious questions about agency leadership.

It was the culmination of a series of perplexing and deeply troubling events—a trend that unfortunately continues.

In January, federal officials launched an investigation into the Department's mishandling of millions of dollars awarded over the past 2-years to treat opioid addiction and reduce fatal overdoses—money that was never actually spent to that effect.

That audit was just the most recent example of inexcusable lapses on the part of DBH.

In my opinion, we have absolutely failed in the provision of quality behavioral health services for our residents.

There has been an inadequate response to the opioid crisis specifically and almost no prioritization of substance abuse treatment generally; delayed or non-payment to our dedicated community-based providers; the closure of several Core Service agencies; a failure of the iCAMS billing system; poor rollout of the School-Based Mental Health program as well as the continuing challenge to implement it with fidelity; and of course the many issues highlighted within the CCE report.

Further, DBH has been without permanent leadership since November as the Director of DC Health is now forced to split her time between both agencies, an arrangement that is wholly untenable.

For all of these reasons, I believe now is the time to elevate, prioritize, and strengthen our behavioral health system of care.

As a city, it is imperative that we do better for our residents. In order to chart a path forward we have to be honest about our missteps, clear in our vision, and diligent in our effort to provide the highest quality care to some of the most vulnerable among us.

Through this legislation we will ensure that all of the relevant stakeholders are at the table and afforded a meaningful opportunity to shape our system and develop a comprehensive strategic plan to move us forward.



Grosso alarmed by latest move threatening students’ behavioral health

For Immediate Release:
November 29, 2018
Matthew Nocella, 202.286.1987 -

Grosso alarmed by latest move threatening students’ behavioral health

Washington, D.C. – Councilmember David Grosso, chairperson of the Committee on Education and member of the Committee on Health, today sent a letter to the co-chairs of the School-Based Mental Health Coordinating Council, raising serious concerns about the Department of Behavioral Health’s allocation of funding for, and ultimately the provision of, student behavioral health services.

“Let me be clear, as a city we will not close the achievement gap if we do not know, understand, and meaningfully invest in the behavioral well-being of our students,” Grosso wrote.

Several community-based organizations have contacted Grosso with concerns about the DBH allocation of funds in a manner that runs contrary to the Task Force’s recommendations--a move that was made unilaterally by DBH. Without the funding structure recommended, many CBOs would withdraw and our highest need schools would forgo additional delivery of critical services.

“This is wholly unacceptable. Not only does it deviate from what both the Task Force and the Coordinating Council previously committed to, but it undermines the viability of the program,” Grosso wrote. “The program is disintegrating before it ever had a chance for success. It is absolutely imperative that we course correct.”

The School-Based Mental Health program is on its second attempt at expansion, following a lackluster roll out in 2017 that necessitated Council intervention, led by Grosso and Ward 7 Councilmember and Health Committee Chairperson Vince Gray, to create a task force comprised of a diverse group of stakeholders and the Department of Behavioral Health to offer recommendations.

But in his letter to DBH, Grosso called into question the DBH’s and the Executive branch’s motivations and good faith in its participation on the task force and its provision of services that put our students in the best position to succeed academically.

“Not only do I feel the Executive has been grossly dishonest about their intentions as it relates to this program, but I’ve come to believe that the Department is so intent on doing more with less that they are willing to compromise the type and quality of services that we afford our students,” he wrote.

Grosso has requested answers from DBH and the Coordinating Council on the timeline of student service delivery, the decision-making process of the funding reallocation, and contingency plans if the current course of action fails. Those responses are due by end of day December 5th.




Councilmembers Grosso and Nadeau seek clarity on services for transgender youth in CFSA's care

On Oct. 4, Councilmember David Grosso, chairperson of the Committee on Education, and Councilmember Brianne K. Nadeau, chairperson of the Committee on Human Services, sent a letter to the Child and Family Services Agency (CFSA) seeking clarification of its policies regarding the provision of medical services to transgender youth in the agency’s care.

“The governor of California recently signed legislation in that state…setting the appropriate care for youth in foster care to receive gender-affirming health care, including mental health care. Media outlets praised the state as being the first to ensure these rights for transgender youth,” the two councilmembers wrote. “However, it is our belief that this should have already been policy in the District of Columbia based on the provisions of our Human Rights Act and its interpretation, particularly with regards to the Mayor’s Order from February 27, 2014 prohibiting discrimination in health insurance based on gender identity or expression.”

CFSA Director Brenda Donald responded to Grosso and Nadeau on Oct. 19, reaffirming its commitment to provide youth in its care with all appropriate medical and mental health services, including related to maters of sexual orientation and gender identity.

“In the District of Columbia, youth in the care of CFSA have a right to be provided with timely, adequate, and appropriate medical and mental health services from health care professionals, which includes medical care, behavioral health care, and counseling,” Donald wrote.

“CFSA’s practice is to support and ensure that transgender youth obtain and have access to gender-affirming healthcare, gender affirming mental healthcare, and any other support and services they might need. Should a youth express an interest in undergoing gender reassignment surgery with their social worker, health care professional, or foster parent, CFSA would treat such request as we would any medical request. The agency will refer the youth to the appropriate medical and mental health services, establish what is medically covered, and determine the best way forward to ensure that all medical needs are met. If a youth requests reassignment surgery, CFSA must ensure that the youth receives the appropriate mental health support. The Department of Health Care Finance (DHCF) will cover sex reassignment procedures for beneficiaries with an established diagnosis of gender dysphoria.”

Read the full letter to CFSA, and their response to Councilmembers Grosso and Nadeau, below.



Grosso's opening statement at the markup of B21-361, the Youth Suicide Prevention and School Climate Survey Amendment Act of 2015

Good afternoon. The time is now 2:07pm, we are in Room 123 of the John A. Wilson Building, and I am calling this additional meeting of the Committee on Education to order.

I’m David Grosso, Chairman of the committee on Education. I’d like to recognize the presence of a quorum. We have two items on our agenda today.

First on the agenda is Bill 21-361, the Youth Suicide Prevention and School Climate Survey Amendment Act of 2015. This legislation was introduced by myself and Councilmembers Allen, McDuffie, Bonds, Cheh, Nadeau, May, Todd, Silverman, and Chairman Mendelson.



Committee Approves Grosso’s Bill to Improve Health of LGBTQ Residents

For Immediate Release: 
December 9, 2015
Contact: Darby Hickey
(202) 724-8105

Committee Approves Grosso’s Bill to Improve Health of LGBTQ Residents

Washington, D.C.--Today, Councilmember David Grosso (I-At Large) joined his colleagues on the D.C. Council Committee on Health and Human Services in a unanimous vote to approve the LGBTQ Cultural Competency Continuing Education Amendment Act of 2015. Introduced by Grosso and Councilmember Yvette Alexander in April, the legislation requires medical professionals, renewing their licenses in D.C., to take two credits of cultural competency training focused on patients who identify as lesbian, gay, bisexual, transgender, gender nonconforming, queer, or questioning their sexual orientation or gender identity.

During the hearing on this bill, we heard truly heart breaking stories from LGBTQ residents about mistreatment they experienced at the hands of medical providers,” said Grosso. “In particular, our transgender friends and neighbors face disrespect and misunderstanding in medical settings, and this bill will continue our work to correct this serious problem.”

As many as one in five transgender people in D.C. have been denied medical care due to their gender, according to research released by the D.C. Trans Coalition last month in the "Access Denied" report. Locally and nationally, higher instances of chronic conditions among LGBTQ individuals have been documented, including higher rates of STDs and HIV, suicide attempts, mental illness, and some cancers.

“Quality medical care is often a life or death issue, and it is always a human right,” said Grosso. “I am grateful to Committee on Health and Human Services Chairperson Alexander for moving this legislation forward, for the health and well-being of our residents.” 




Mayor expects to back ‘cultural competency’ bill

By Lou Chibarro, November 3, 2015, Washington Blade

D.C. Mayor Muriel Bowser on Monday said she expects to support the current version of a bill pending before the City Council that would require continuing education programs for licensed healthcare professionals that include LGBT-related “cultural competency” training.

Bowser’s comment follows testimony on Oct. 29 by her director of the city’s Department of Health, Dr. LaQuandra Nesbitt, calling for major changes to the bill – the LGBTQ Cultural Competency Continuing Education Amendment Act of 2015. LGBT advocates oppose her suggested changes.

Nesbitt told the Council’s Committee on Health and Human Services during a public hearing on the bill that she and Bowser support the general intent of the measure but believe it should be expanded to include cultural competency training “for all populations and sub-groups to whom healthcare professionals provide services.”

LGBT healthcare advocates joined more than a dozen representatives of healthcare organizations, including doctors and clinical social workers, in testifying at the hearing in favor of the version of the bill introduced in April by Council members David Grosso (I-At-Large) and Yvette Alexander (D-Ward 7). Alexander chairs the Health and Human Services Committee.

“I expect that we’ll support the Council bill,” Bowser told the Washington Blade following a news conference on Monday. “We will probably go with how they wrote it and if there are ways to enhance it down the line that’s what we would do,” she said.

The mayor’s comment will likely generate a collective sigh of relief from LGBT activists who expressed concern that Nesbitt had been pushing for a broader bill that could decrease its effectiveness in addressing the need for cultural training on medical issues impacting LGBT people.

Grosso told the Washington Blade he has no objection to cultural competency training pertaining to other population groups. But he said adding other groups to the bill would dilute its ability to address what he and others have said is lack of understanding and cultural sensitivity by many doctors and other health care providers toward LGBT patients.

The current version of the bill would amend an existing health care licensing law to require health care professionals, including doctors and mental health practitioners, to receive two credits of instruction on LGBT subjects as part of their continuing education programs.

“Despite the District’s strong policies against discrimination, our community, which is more than 10 percent of the District’s population, remains at risk,” said Rick Rosendall, president of the Gay and Lesbian Activists Alliance, in his testimony before the committee.

“[R]egarding the scope of this bill: Why is it limited to LGBTQ?” Rosendall asked. “For one thing, only so much can be covered meaningfully in two credits worth of training time. More crucially, our community faces the particular challenge of invisibility,” he continued. “If we are subsumed under a generic, all-encompassing category, we are effectively excluded.”

Alison Gill, senior legislative counsel for the Human Rights Campaign, told the committee that a 2009 nationwide survey found that more than half of LGBT respondents reported being refused needed care or being treated in a “discriminatory, disrespectful manner” by health care providers.

“Culturally competent care is especially important for LGBT people, as they continue to face substantial disparities in health, resulting from the stress of pervasive stigma; substance abuse and other health-endangering coping strategies; a reluctance to seek medical care due to fear of and actual healthcare discrimination; and the disproportionate impact of sexually transmitted disease,” Gill told the committee.

With the exception of Nesbitt, all of the nearly 20 witnesses testifying at the Council hearing expressed strong support for the bill as introduced by Alexander and Grosso. However, the executive vice president of the Medical Society of the District of Columbia, K. Edward Shanbacker, submitted a letter to the committee opposing the bill.

“The Medical Society believes strongly that the medical profession alone has the responsibility for setting standards and determining curricula in continuing medical education,” Shanbacker said in his letter. “In the District, the mechanism for that is the Board of Medicine, which has in the past opposed content-specific requirements surrounding continuing medical education,” he said.

Grosso said he has an answer to those, including the Medical Society, who say only doctors’ organizations and medical licensing boards should develop continuing education training on cultural competency matters.

“My answer to them is well you haven’t put this one in place and it would be important for us to put it on the books now,” he said, referring to LGBT cultural competence training.

He pointed to testimony by witnesses at last week’s Council hearing who told of LGBT patients who have been treated in a disrespectful manor and sometimes refused treatment by doctors unfamiliar with the special health needs of LGBT people, especially transgender people.

Dr. Raymond Martins, senior director of clinical education and training at D.C.’s Whitman-Walker Health, told the committee many of the mostly LGBT patients he has seen at Whitman-Walker have reported unpleasant experiences with other physicians and healthcare providers.

“Sadly, in this metropolitan area as well as throughout the country, physicians and other health providers do not receive adequate LGBT clinical and cultural competency training during medical school and their post graduate years,” he said. “This unfortunately leads to discrimination and poor health outcome for LGBT people,” Martins testified.

Grosso said he is hopeful that the bill will be finalized and brought up for a vote by the full Council before the end of the year. Eight other members of the 13-member Council signed on as co-sponsors of the bill.



Grosso Introduces “Youth Suicide Prevention and School Climate Survey Act of 2015”

Throughout the summer, Councilmember Grosso’s office worked with advocates from The D.C. Center, the Trevor Project, the American Foundation for Suicide Prevention, and others on the “Youth Suicide Prevention and School Climate Survey Act of 2015” which Councilmember Grosso introduced today along with Councilmembers Nadeau, Allen, May, McDuffie, Todd, Bonds, Silverman, and Cheh.

According to the Youth Risk Behavior Survey (a federal survey by the Centers for Disease Control last administered in 2012), 38% of our LGBTQ middle school students had attempted suicide in their lifetime and 28% of our LGBTQ high school students had attempted suicide within the last year.



Summary report of public roundtable on "The Value of Investing in the Trauma-Informed Public Schools and Support Services"

Since taking over the as Chairperson of the Committee on Education, Councilmember David Grosso has been focused on putting every student in the best position to succeed. Part of this work includes addressing issues beyond the classroom that affect students such as trauma. On June 23, 2015, the Committee on Education held a public roundtable on “The Value of Investing in Trauma-Informed Public Schools and Support Services.” This report is a summary of that roundtable.



Upcoming hearings and roundtables for the Committee on Education

All hearings and roundtables will be at the John A. Wilson Building, 1350 Pennsylvania Ave NW.

June 22 –- PERAA Roundtable Part II -– 11am (Rm 500)

This is the continuation of a public roundtable on the summative evaluation of public schools in the District of Columbia as required by the Public Education Reform Amendment Act of 2007. Please contact Christina Henderson at  by close of business Thursday, June 18 to testify.


June 23 -- Value of Investing in Trauma-Informed Public Schools and Support Services –- 1pm (Rm 123)

The purpose of this roundtable is to learn more about the importance of trauma-informed schools and environments. How do we identify students affected by trauma? What exactly does it mean to be trauma-informed? What types of existing services and trainings are available to students and school-based staff in this regard? How can the District of Columbia better coordinate and improve mental health services for students? Please contact Christina Henderson at  by close of business Friday, June 19 to testify.


June 29 –- Joint Education & Committee of the Whole Roundtable on Truancy -– 11am (Rm 123)

The purpose of this roundtable is to receive testimony from government witnesses and partners, including the Office of the Deputy Mayor for Education, the Office of the State Superintendent of Education, the Child and Family Services Agency, the District of Columbia Public Schools, the Public Charter School Board, and the Justice Grants Administration regarding truancy in the District and the continued implementation of truancy reform initiatives. Please contact Christina Setlow at by close of business Thursday, June 25 to testify.


July 1 -– Joint Education, Judiciary & Committee of the Whole Hearing on B21-66, the Language Access for Education Amendment Act of 2015 -– 11am (Rm 412)

The purpose of the hearing is to receive testimony on B21-0066, the Language Access for Education Amendment Act of 2015. Please contact Kate Mitchell at by close of business Friday, June 26 to testify.


July 6 -– Hearing on B21-239, the Testing Integrity Amendment Act of 2015 -– 1pm (Rm 123)

The purpose of the hearing is to receive testimony on B21-0239, the Testing Integrity Amendment Act of 2015. Please contact Christina Henderson at  by close of business Thursday, July 2 to testify.


July 8 -– Joint Education and Transportation & the Environment Roundtable on DGS Contracting and Procurement Practices for Constructing and Modernizing District of Columbia Public Schools -– 11am (Rm 500)

This roundtable is specifically on the Department of General Services contracting and procurement practices for constructing and modernizing facilities for DCPS. Please contact Aukima Benjamin at  by close of business Monday, July 6 to testify.



Prioritizing Mental Health & Substance Abuse Treatment

The District of Columbia has a fairly strong healthcare delivery system, particularly for children.  We also rank among the top jurisdictions that provide health insurance coverage for the majority of our residents.  Unfortunately, our strengths in the physical health coverage arena have not translated into increased access to and use of behavioral health services.  This is troubling considering that residents with serious mental illnesses are known to have a life expectancy that is 25 years shorter than the residents without such mental illnesses.

According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2013 Health Barometer, 23,000 D.C. adults experienced serious thoughts of suicide between 2011 and 2012.  Additionally during this timeframe, 14,000 adults were identified as suffering from a serious mental illness.  Nationally, it is estimated that 1 in 4 adults will experience some mental illness in their lifetime (i.e. depression, etc.) unfortunately, a significant number of these individuals will not seek treatment.  The scope of this problem highlights the critical need to expand access to treatment and services for all residents.  This is particularly true when we look at our performance in treating children experiencing mental health or substance abuse problems. 

Between 2011 and 2012, 25% of middle and high school students self-reported symptoms of depression, while one in seven youth actually made a plan about how they would attempt suicide.  Annually, 10% of youth experience a severe mental health problem.  In addition to mental health challenges, national estimates for D.C. indicate that anywhere between 2,000 and 3,000 youth below the age of 17 are abusing or are dependent on alcohol and drugs.  Further, in 2013, 350 D.C. children were referred for substance abuse treatment, yet only an estimated 70 children completed the treatment program.

The picture is crystal clear—our residents need mental health and substance abuse services.  They need early preventative care that identifies their needs and treats them appropriately.  Reflecting on this problem in our city, this summer I took the opportunity to tour seven specialty mental health clinics and substance abuse providers across the city, as well as, Saint Elizabeth’s Hospital. 

During my tours, I learned about a wide range of treatment programs, including assertive community treatment (ACT).  ACT is a service delivery model that combines comprehensive psychiatric treatment with rehabilitation and includes the necessary support for persons with serious and persistent mental illness.  ACT team members see clients where they are, frequently making home visits and coordinating with a host of partners to provide high-quality services. 

I explored another critical program, trauma-informed care, on my tour of Community Connections.  Trauma-informed care programs recognize that many individuals suffering from mental illness and co-occurring substance abuse have experienced some sort of physical, sexual, mental or emotional trauma in their lifetime, necessitating a comprehensive look at the factors that have contributed to their mental illnesses. 

The trauma-informed care program was eye-opening because it reinforced the fragility of our circumstances.  Any life event, from the death of a loved one, the loss of a job, involvement in a car accident can be traumatic, leading to bouts of grief.  Falling into homelessness is a prime example of a trauma that could send any of us along a downward spiral and the city’s housing and homelessness crisis is well-known. 

Our housing challenges were further underscored as I visited Pathways to Housing, a provider that specializes in housing our mentally ill.  Pathways to Housing employs a “housing first” model, providing immediate, low-barrier access to permanent housing and then combining it with supportive treatment services.  The apartment homes are scattered throughout the city and while the program maintains an 85% retention rate, barriers persist.

For example, the D.C. Housing Authority (DCHA) provides vouchers to help pay for apartments across the city.  Due to rising rental prices however, many residents are being steered to properties located in Wards 7 and 8 because vouchers for those apartments cover the entire rental cost, with money left over—while, in more affluent sections of the city, the vouchers rarely cover even half of the rental cost.  Despite this challenge, Pathways to Housing continues to press forward and typically is able to house a person, from the point of entry into the program through housing placement, within three weeks.

While touring McClendon Center, I had the opportunity to observe a day services program, which enables those dealing with mental illnesses, primarily schizophrenia and other psychotic disorders, to learn life skills to assist them in readjusting to life back in society.  Day services programs challenge participants to engage with others, learn about their illnesses and how to manage them and assist them in becoming advocates for themselves.  What struck me about this particular program is that while the service is often viewed as “glorified adult day care,” participants are less likely to be re-hospitalized, demonstrating that this treatment effort not only brings about long-term cost savings by reducing hospitalizations, but significantly improves a participant’s quality of life. 

During several of my visits I learned, in greater depth, about Health Homes, similar in concept to a patient-centered medical home, but with an explicit component addressing the delivery of addiction and substance abuse services.  The Affordable Care Act’s (ACA) Health Home provision allows a state entity to define a vulnerable population, provide primary care integration and receive 90% Federal Financial Participation through Medicaid for two years, rather than the current 70%.  This program is important because people with serious mental illnesses have a greater number of medical problems, often caused by smoking or self-neglect, co-occurring substance use, or even the medications they take for their psychiatric illnesses.  Because mental health consumers often do not tend to these conditions, they continue to worsen and treatment becomes increasingly more costly.  For this reason, the integration of medical services into a mental health facility is critical.  In addition, it is also valuable to have mental health providers in the medical clinics.   Health Homes is necessary, which is why the District of Columbia is currently working to implement this model with a proposed start date in 2015.

For me, the most heartbreaking tour took place at a facility specializing in the treatment of children impacted by grief and trauma.  The Wendt Center employs the Resilient Scholars Program, which is currently available in 21 different schools (charter and DCPS) in D.C.  The program helps children cope with trauma, which is challenging because many of the students suffer from polytraumas, the occurrence of multiple traumas.  These students are burdened by poverty, the experience of violence in their home or community, and so much more.  Recognizing that the stress of all this weight sometimes manifests as physical pain, the Resilient Scholars Program helps students to identify where they are hurting and why they are hurting; helping them to develop healthy mechanisms to begin to heal.  Viewing the students’ artwork was painful.  To read about their daily struggles and view the images of violence they had drawn was overwhelming and highlighted the critical need for this type of program in all of our schools.  The District of Columbia’s increased emphasis on standardized testing is an added stressor but programs like this one can work to improve student performance by addressing their grief and trauma. 

A common thread across all of the mental health and substance abuse clinics was a fervent commitment to the humanization of mental illness.  This was never more apparent than at Saint Elizabeth’s.  Saint Elizabeth’s residents are treated with dignity.  Upon their admission they are no longer, “prisoners” or “patients,” they are simply individuals receiving care.  The facility provides “homes” where residents are housed in dormitory style living quarters and afforded the opportunity to participate in various programs and other outlets to include a Patient Advisory Council.  Further, those residents preparing to transition back into the community are equipped with life skills such as learning to cook, do laundry, and operate a computer. 

Perhaps the most interesting part of my Saint Elizabeth’s tour was that residents, those on the transitional therapy floor, are not quarantined off from staff but allowed to freely walk the halls and actively participate in their treatment.  At the new facility, residents are not stigmatized; they are not caged nor subjected to a prison inspired atmosphere but treated as whole human beings.  By the conclusion of my tour, I was impressed with the staff, the facility and the level of care provided.

In addition to the facilities mentioned, I also had the opportunity to tour Green Door, Catholic Charities and CATAADA House of Calvary Healthcare.  All of these tours left me with the sense that our city is moving in the right direction.  While our mental health providers are unsung heroes treating some of the most vulnerable among us, there is still work to do.  With the deinstitutionalization of mental health services in D.C., community mental health providers expanded significantly.  At the time, the supply of services met the demand; however, as time has worn on the demand for services continues to increase.  This has presented some challenges, especially for our youth, who find it increasingly more difficult to get treatment from qualified child psychiatrists due to their scarcity.  Additionally, as providers ready themselves for the ability to now bill Medicaid for substance abuse treatment, new concerns will arise. 

We have a significant number of residents, especially youth, who need services but are not getting treatment.  This cannot continue.  City agencies and the providers themselves must continue to reduce the stigma associated with mental illness and substance abuse and actively work to market and promote their services.  Our residents deserve the best treatment and it appears to me that we are providing it but those in need cannot take advantage of what they do not know about.  Mental illness and substance abuse issues affect us all.  The links between homelessness and mental illness as well as the mental illnesses of those that are incarcerated are well-studied.  For this reason, I made it a priority to not only visit our service providers but also a homeless shelter and the D.C. jail to better understand the full spectrum of these complexities.  The health and wellness of our residents is a priority for me and I will continue to advocate for quality services and work with D.C. agencies and providers to address the barriers that they face and promote the services they provide.



Grosso statement on proposed Commission on Health Disparities Establishment Act

Thank you Chairwoman Alexander and thank you to all of the witnesses here to testify today on Bill 20-572, the “Commission on Health Disparities Establishment Act of 2013.”

The District of Columbia has the seventh highest incidence rate and the highest death rate from breast cancer in the United States. And although the incidence rate for breast cancer is higher for white women in this city, African-American women from Wards 5, 6, 7, and 8 are overrepresented among those dying from the disease.

Even more troubling, African American women in the District are showing up for treatment with advanced breast cancer at rates that are almost double the national average. 

In a report published by the Center for Disease Control (CDC) in 2013, it was found that D.C. residents died at a higher rate from preventable heart attacks than any other jurisdiction in the country. 

The CDC report found that, in the District, the rate of avoidable deaths from heart disease, stroke and hypertensive disease was 99.6% per 100,000 population.  The most affected demographic was African-American males ranging in age from 65-74.

These disparities are also found when we discuss behavioral health.  A few years ago there was only one child psychiatrist that was east of the River.  Additionally, 35 percent of the District’s transgender population has experienced suicidal ideation while 39 percent do not have a physician for routine health care as reported by the DC Center for the LGBT Community.

Further, 58 percent of the District’s African-American males having sex with other males are living with HIV, which is significantly higher than the national average at 29 percent. 

We cannot allow these disparities to persist in our communities.  In February, the Department of Health compiled a very comprehensive Community Health Needs Assessment, the first of its kind for the District and I want to applaud the Department for this effort.

All District residents, regardless of race, ethnicity, age, sexual orientation, or gender identity deserve access to quality physicians, screenings and treatment.  I will continue to follow this issue very closely and I am eager to hear from and engage with the witnesses in the discussion to follow.



Performance Oversight Hearings Week in Review March 3-7, 2014

Last week was supposed to conclude the D.C. Council oversight hearings, but thanks to the snow days there will be a couple more scattered through the rest of the month. The schedule was not quite as packed as the week before, but it was still challenging to keep up with every hearing when so many happen at the same time. Councilmember Grosso hustled between hearings by the Committee of the Whole, Committee on Education, and Committee on Health. This is our latest recap—be sure to check out our write-ups for the weeks of February 17th and February 24th.


Quote of the Week:

Public Witness from Americans for Safe Access: “There are no known instances of overdosing on marijuana, and as a Maryland physician testified, you would have to smoke a joint the size of a telephone pole for that to happen.”


The  Committee of the Whole wrapped up its oversight hearings last week with testimony about the Contract Appeals Board, District of Columbia Retirement Board, Retiree Health Contribution, Teacher’s Retirement System, Police Officer’s and Firefighter’s Retirement System, Office of Zoning, and the Office of Planning.

  • Councilmember Grosso was splitting his time between the Committee of the Whole hearing and the Committee on Health hearing happening at the same time.  He heard testimony from and asked questions of Marc Loud, Chief Administrative Judge of the Contract Appeals Board (CAB).  The CAB hears both appeals (i.e., adversarial proceedings wherein either the government or a contractor under an existing contract initiate a lawsuit for damages for breach of contract performance or payment) and they hear protests (i.e., adversarial proceedings wherein a disappointed bidder challenges a contract award or solicitation).   The D.C. government is always a named party in either type of appeal because all of the cases have government contracts at issue.
  • The three recently appointed CAB Judges inherited a backlog of 41 cases and for those of you who are unfamiliar with this type of work…that is a lot.  The Judges and their staff narrowed this number down to six legacy cases without creating a second generation of backlog appeals.
  • All of the Judges and staff attorneys (five in total) are barred and in good legal standing in the District.  We wish this was not a question we had to ask, but with the current climate of not-so-good government it is important that the awkward questions get asked, too.
  • There were over thirty witnesses who came to testify about the the Office of Zoning (OZ) and the Office of Planning (OP) prior to the government witnesses.  Most of the public witnesses testified about the Comprehensive Plan and the Zoning Regulation Revisions (ZRR) The ZRR is roughly 1,000 pages of changes and edits meant to bring the regulations into the 21st century.   After more than five years of hearings on the revisions, we are starting to feel like by the time it is complete it will be time to start all over again. 
  • With the government’s loss of our former city planner, Harriet Tregoning, the Office of Planning is moving ahead with its plans (no pun intended?) for the city and to continue to accomplish new development while still preserving the city’s historic character.  The Councilmember was not able to stay for the government witness testimony, but his position on the matter is documented in our blog post from last year.  


The Committee on Education also held its final performance oversight hearing last week, with the DC Public Charter School Board (PCSB).

  • The PCSB has definitely stepped up its oversight of school discipline policies over the past year and as a result the expulsion and out of school suspension rates are down. While all were pleased with this news, the PCSB said they would look more closely at mid-year withdrawals to ensure that students are not being “counseled out” in lieu of expulsion. Councilmember Grosso asked the PCSB to take a closer look at their preschool school discipline policies. In data provided to the Committee by the PCSB, some charters schools are suspending students in PK-3 and PK-4. Why would a school ever need to suspend a child that young?
  • The PCSB recently redeveloped its Performance Management Framework (PMF) tool that helps schools disaggregate their data by subgroups to see where they are falling short in terms of the annual evaluation.
  • It does not seem like the PCSB will be working in collaboration with D.C. Public Schools (DCPS) anytime soon to ensure that new charter schools are not opening up right down the street from a DCPS school. Let the competition continue, we guess. Though is that really the most efficient use of taxpayer dollars?
  • There seems to be some inconsistency between school evaluations conducted by PCSB and the Office of the State Superintendent of Education (OSSE). The PCSB closed one school for poor performance rating under the PMF that was labeled as a “Reward” school (highest ranking a school can achieve) by OSSE. This isn’t a good situation but there is no obvious resolution right now.


Our week ended spending a lot of time with the Committee on Health on various agency performance oversight hearings.

Department of Behavioral Health

  • From recovering addicts, to rehabilitated former criminals, to survivors of the 1977 Hanafi siege of the Wilson Building, this hearing was filled with very impassioned testimony.  Many public witnesses praised DBH’s Certified Peer Specialist Program which they touted as life-changing and extremely effective.
  • Councilmember Grosso noted that the depression rate among African-American women is estimated to be almost 50% higher than that of Caucasian women and inquired about the Department’s efforts to reduce the stigma and market its services to this demographic.  DBH said they are addressing this disparity, for example with a program for young mothers who are TANF recipients, and continuing to try to increase access points for communities of color.
  • Concerned about the issues facing our homeless residents, Councilmember Grosso asked DBH what they are doing to cut down the wait times (25.1 months) for consumers to access housing.  DBH received 1,068 Housing Waiting List applications from consumers self-reporting as homeless in FY13. Director Baron noted that this area is a challenge due to extremely low supply of affordable housing in the face of high demand.  Currently, DBH offers 1,600 affordable housing units paid for with DHCD capital funds.  Although the waiting list does continue to grow, DBH is actively working with DHCD through monthly calls to address this issue.
  • Despite the high number of District residents who receive healthcare through Managed Care Organizations (MCOs), DBH has no full time employees dedicated to working directly with MCOs. However, the Department does frequently collaborate with DHCF to address issues around behavioral health treatment within the MCOs. We are going to keep a close eye on this topic, including during the budget process.


Department of Healthcare Finance

  • If you care about domestic policy, you always need to follow the money involved in healthcare. In FY13, DHCF spent nearly $2.3 billion to implement both Medicaid and Alliance programs. The entire budget of the District of Columbia is about $6 billion. DHCF’s Medicaid Managed Care program is the single largest item on the agency budget covering over 160,000 beneficiaries, via managed care organizations (MCOs).
  • For the first time ever, DHCF released a performance report for the MCOs ( This information will inform DHCF decisions regarding contract renewal.  Councilmember Grosso has been pushing for more oversight of MCO spending and outcomes and this is a welcome first step.
  • It’s clear the agency is learning from past mistakes. Currently, MCOs are required to have a risk-based capital level ratio of about 1.50, which ensures that the MCO has reserves to pay for services that have been provided but not yet reimbursed. When Committee Chairwoman Alexander asked Director Turnage why there was a requirement, Turnage’s response was simple: “To avoid what happened with Chartered.”
  • Much of the growth in spending can be attributed to the long-term care program which has had year-to-year growth rates of more than six times the levels observed for the entire Medicaid program over the same period in the last few years. You have maybe heard of the Medicaid fraud investigation?
  • Speaking of which, the federal fraud investigations for the Personal Care Attendant program has required DHCF to suspend payments for 52% of home health providers, which covers about 79% of the beneficiaries. DHCF is working to ensure that this doesn’t mean people lack access to necessary medical services.
  • One of the greatest concerns raised during this hearing centered on the Elderly & Persons with Disabilities Medicaid Waiver program.  Many witnesses testified that waivers have been wrongly terminated rendering them unable to recertify for months at a time, worsening their conditions.


Department of Health

  • BIG NEWS on medical marijuana: Director Garcia testified that as a physician he does not believe there should be a list of qualifying conditions for medical marijuana and that it should be a decision solely between the patient and their doctor. No other regulation requires this kind of pre-clearance from the Department of Health of physicians. We look forward to having Director Garcia’s support in moving D.C. law and regulations to that goal.
  • DOH has funding ($200K) to provide local farmer’s markets with matching funds for low-income residents who use EBT cards to purchase fresh produce. DOH is working to get that money distribute to local markets before the farmer’s market season starts in April.
  • High school students from the Young Women’s Project testified on the Wrap MC peer educator program on sexual health, sponsored by HIV/AIDS, STI, Tuberculosis Administration at the Department of Health. Students recommended some type of sexual health and education program be available beginning in middle school. DOH reported they are in conversations with DCPS about similar Wrap MC programs in middle school. Please don’t clutch your pearls at this idea. Believe it or not, the average age of sexual debut in the District is between 11 and 12 years old, and these young people need to know how to protect themselves and be safe.
  • While the infant mortality rate is on the decline in D.C., there are a couple of Wards where the rate is as high as 12%--double the national rate of 6%. Most of these patients are insured, which is most troubling.



Grosso Statement at the AmeriHealth Behavioral Health/Physical Health Integration Summit

As you all know, one of the major challenges for effective health care delivery is the integration of services, particularly behavioral health and physical health programs. It is very rare that patients come to health clinics or providers with just one issue and if we can do our best to treat the whole person, it improves quality of care and outcomes for our residents.

I’ve brought this up in every meeting I’ve had with AmeriHealth staff and so it’s very exciting and impressive that AmeriHealth, who is new to the District, has called for this summit.

For a long time in the District, behavioral health programs were solely reliant on grant funding and therefore the services were not as expansive or as available as they should have been for all of our residents.

Many health plans did not offer coverage for behavioral health services. Providers were not accessible in all parts of the city – for example, a few years ago there was only one child psychiatrist that was east of the River. And there was little outreach to our African-American communities who were long reluctant to discuss mental health and illness even though many of those residents were dealing with incidents causing mental trauma on a daily basis.

As a result, there is a gap in the District of Columbia between our white and higher income residents and their minority and low-income counterparts when it comes to considering behavioral health and receiving proper care.

According to the U.S. Department of Health and Human Services Office of Minority Services, African Americans are 20 percent more likely to report having “serious psychological distress” than non-Hispanic Whites. Yet, young adult African Americans are less likely to seek mental health services than their White counterparts.  In fact, the depression rate among African American women is estimated to be almost 50 percent higher than that of Caucasian women.

We know that when individuals are facing mental illness or challenge, and essentially cope and suffer in silence, the problem doesn’t go away; it just tends to manifest in other physical health issues becoming more costly and problematic as time goes on. This is why I think integration of behavioral health and physical health programs are key and I’m excited that you all are here to identify integration projects and make firm commitments to implementing them in 2014-15.

We have certainly come a long way in the District in terms of behavioral health services. I sit on the Committee on Education at the Council and every time I visit a school they are not just talking about the guidance counselor anymore, we now have psychologists and family therapists along with nurses and dentists who are coming directly to the schools to provide services because we realize how important it is to take care of the health of the whole child.

This summer I visited 12 primary health clinics throughout the District. With the rollout of the Affordable Care Act and the increase demand for health care, I wanted to get an on-the-ground feel of what health access is really like in the District. What I found were successful, mission-driven health clinics that are going above and beyond to meet the whole needs of the patients they serve. While they all were borne out of a need to serve a particular community or treat a specific health issue, they’ve evolved to treat the whole person. Behavioral health services are now integrated into all of them.

We need more clinics and health providers who see this importance in the District. That is why a couple of weeks ago when I sent my budget priorities for FY15 to the Mayor, I included a request that he infuse $3 million into the health professionals recruitment fund to help our clinics and hospitals recruit more providers to work and setup practice in our neediest of neighborhoods. Treating the whole patient is the only way we are really going to move the needle in terms of improving health outcomes for patients and reducing overall costs for care.

I want to thank you all for taking time out of your schedules to have these conversations. They are imperative for District residents and the patients you all serve!