Behavioral Health Needs of DC Children: Prevalence, Treatment Rates and Unmet Needs

Today's blog features the newest publication from our partners DC Behavioral Health Association.

By many measures, the District of Columbia has a strong healthcare system for children. D.C. has a high rate of insurance coverage. The District ranks second among states for children with health coverage,[1] and Medicaid covers 70 percent of the children living in the District.[2] D.C. also ranks 5th among states whose children received medical and preventive care in the past year. [3]

These strengths do not translate into a strong access to and use of behavioral health services by children experiencing mental health or substance abuse problems. The Commonwealth Fund ranks the District at 38th in meeting children’s mental health needs. The District’s performance on meeting child substance abuse needs is even worse. This section takes a deeper look at the need and performance of the D.C. Medicaid system when it comes to identifying and meeting children’s need for behavioral health treatment.

Mental Health: 3 of 4 children in need do not get treatment

With some limitations,[4] national data suggests that the prevalence of mental health problems in the District of Columbia are similar to national rates. [5],[6] These sources indicate that:

  • One in four middle and high school students self-report symptoms of depression; [7]
  • One in seven youth made a plan about how to attempt suicide; [8]
  • One in ten youth experiences a severe mental health problem annually.[9]

In FY2013, the D.C. Medicaid program insured 93,000 children. In the same year, 5,953 children received an outpatient or community-based mental health service paid by the D.C. Medicaid program,[10] indicating that only 6.4% of child beneficiaries receive treatment.

Three out of every four children experiencing a mental health need do not get treatment.

The data presented above indicates that there is a wide gap between the number of children experiencing diagnosable mental health conditions and those receiving outpatient or community-based services to treat those conditions.

If 25% of children are reporting mental health needs but only 6.4% are receiving treatment, nearly 17,300 children enrolled in the Medicaid program need but do not receive treatment annually. In other words, 3 out of every 4 children experiencing a mental health need does not get treatment – even though the child has insurance.

One in nine youth experiencing addiction is referred to treatment, and only one in 43 successfully completes it.

Substance Abuse: 8 in 9 children in need do not get treatment

D.C. youth use marijuana, inhalants, heroin and methamphetamines at higher rates than their national peers.[11] Only a subset of youth using alcohol or drugs require specialized treatment. National estimates for the District of Columbia indicate that 2,000 to 3,000 youth below the age of 17 are abusing or dependent on alcohol and drugs.[12]

In FY2013, 350 D.C. children were referred for substance abuse treatment. [13] Only an estimated 70 children completed treatment,[14] a drop-out rate more than double expected outcomes.[15]

  • One in nine youth needing addiction treatment receives it;
  • One in 43 youth experiencing an addiction successfully completes treatment.



[1] Radley, David, et. al., (2014) “Aiming Higher: Results from a Scorecard on State Health System Performance, 2014.” Commonwealth Fund. Downloaded from the World Wide Web on July 18, 2014:

[2] Source: Kenney, G., Anderson, N. and Lynch V. (2013) Medicaid/CHIP Participation Rates Among Children: An Update. Washington, DC: The Urban Institute.

[3] See note 1 supra.

[4] Although we rely on these estimates to develop a local estimate, there is good reason to believe that national data undercounts behavioral health prevalence in the District of Columbia. National estimates are based on school surveys or in-home interviews. The District of Columbia experiences high rates of truancy, and children with mental health conditions are five to six times more likely to engage in truancy. Thus, a school survey would under-report the number of youth experiencing mental health conditions. Similarly, home-based interviews are likely to exclude low-income families, where the prevalence of need may be higher.

[5] Center for Disease Control and Prevention, “Youth Risk Behavior Surveillance Survey, District of Columbia and National Results, 2013.” 

[6] Substance Abuse and Mental Health Services Administration, “Behavioral Health Barometer, District of Columbia, 2013” (HHS Publication No. SMA-13-4796DC).

[7] Id.

[8] Id.

[9] See Substance Abuse and Mental Health Services Administration, “Behavioral Health Barometer, District of Columbia, 2013” at page 8; see also National Center for Children in Poverty, “Children’s Mental Health: Facts for Policy-Makers”(November 2006); available at:

[10] Dept. of Health Care Finance data on file with author.

[11] Center for Disease Control and Prevention, “Youth Risk Behavior Surveillance Survey, District of Columbia and National Results, 2013,”

[12] SAMHSA, State Estimates, at Table 20.

[13] Cite Steve Baron for utilization data.

[14] Cite FY14 performance data in budget request for adherence rate.

[15] Schivoletto et al, “The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil.” 2012 PMCID: PMC3248598.

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