To: The Honorable Christina Henderson, Chair, DC Council Committee on Health

Members of the Committee on Health

From: Patricia Quinn, VP of Policy and Partnerships, DC Primary Care Association

Re: Budget Oversight Hearing for DC Department of Health

Date: April 10, 2023

The DC Primary Care Association (DCPCA) works to build a healthier DC by sustaining community health centers, transforming care delivery, and advancing racial and health equity. Our strategic focus areas include:

• Value-based reimbursement

• HIT innovation for health centers

• Cross-continuum stakeholder relationships

• Equity-oriented programs and innovations

• Health center infrastructure and operations

Our collaborators in this work include community health centers, serving almost 200,000 patients in every ward of the city. Our members serve District residents most impacted by inequity—95% of health center patients are racial or ethnic minority, 88% have incomes below 200% of the federal poverty level, and 37% are best served in a language other than English. Health centers are at the nexus of efforts to rewrite DC’s story of health inequity, and we are grateful for the partnership we have forged over decades with the DC Department of Health. That partnership has only strengthened through the crucible of the COVID pandemic. We appreciate the opportunity to provide testimony regarding the budget of DC Health.

We all learned the importance of a robust public health system through the course of the three-year COVID-19 public health emergency. DC Health’s focus on health and wellness promotion, promoting health equity, and public health systems enhancement requires aggressive funding if we are to address the persistent inequity along race/ethnicity lines that has impacted individual and community well-being in the District.

Home Visiting

DCPCA supports our community health centers’ call for full funding for home visiting services, and for the exploration of sustainable funding through Medicaid. As the District confronts a perfect storm of increasing need for behavioral health services and decreasing access to clinical care, we must amplify sources of support that, while not a replacement for clinical care, do help families to cope with challenges, build connections, and strengthen capacity.

In 2022, the DC Network for Expectant and Parenting Teens (DC NEXT!), a coalition facilitated by DCPCA, conducted a first of its kind Wellbeing Survey of youth in Washington D.C. This report presents emergent findings and policy actions for consideration developed from survey data, deep-dive interviews with young parents in the District and focus groups and dialogues with service providers and youth.

Emergent Findings:

Key Finding #1: Most young parents (63%) reported that they are not thriving, highlighting systems barriers related to housing instability, inadequate access to employment, childcare, and transportation that stand between young parents and the futures they yearn to create.

Key Finding #2: A subset of young parents in DC are facing severe challenges including frequent hunger, frequent housing insecurity, poor mental health, and social isolation.

Key Finding #3: Overall, young parents in DC feel confident and motivated in their parenting role. Figure 1. Consistent with a majority of published survey analyses, we denote all respondents who report their well-being as a 7 or above as “thriving,” and all others as “not thriving.” Using this classification, 63% of our survey respondents reported they are “not thriving.”

Teen pregnancy across the US and in the District of Columbia has dramatically declined over the last decade. Despite an almost 20% reduction in teen births between 2019 and 2021, 265 teen mothers under the age of 20 gave birth in the District of Columbia in 2021. We estimate that at any given time in DC, at least 800 teen mothers and young fathers are endeavoring to care for their children, continue their education, and find meaningful work in the hopes that their families can thrive.

For decades, policymakers and public health officials have focused on preventing teen pregnancy and teen births as keys to anti-poverty strategies, sometimes identifying teen parent families as the cause of family and community instability. But our data–quantitative and qualitative–tells a different story. The young parents we surveyed and interviewed show us that there is nothing inevitable about bad outcomes for teen parents and their children. If we change our response to teen parents, if we drop the stigma and instead raise our expectations and see the powerful, critical opportunity to redirect teens newly committed to succeed, we can change the outcomes for young parents and their children.

Recommendations:

1. Make teen parents the top priority in the District’s investments in effective two-generation income, education, and workforce strategies that impact not only teen parents’ own trajectory, but also that of the young children they parent.

2. Develop and fund a teen parent system of care tailored to meet the needs of adolescent parents and their children including:

• Robust pathways/roadmap to educational attainment and career opportunities

• High quality childcare

• Affordable, convenient transportation

• Housing for young parents who lack family options

• Access to healthy food, particularly through WIC and SNAP

• Mental health support and navigation assistance

3. Support the efforts of DC NEXT! to promote high quality, youth-centered services that recognize teen parents’ commitment and capitalize on their new motivation to achieve.

DC Health, through its home visiting investments, management of the WIC program, and several other healthy food programs plays an important role in building the system of care we envision for young parents. Food programs are particularly critical as the additional SNAP benefits offered during the pandemic sunset. Additionally, through its Office of Health Equity, DC Health spotlights the social and structural drivers of health inequity in the District. Young parents are disproportionately impacted by such drivers and should be a key priority in upstream efforts to improve health and well-being.

Workforce

DCPCA, like other healthcare organizations throughout the District and nationally, is gravely concerned for the state of the healthcare workforce. In 2022 and 2023, DC Health convened the Mayor’s Healthcare Workforce Task Force to identify viable pathways to meet health workforce needs in the short and long term. The task force has specific draft recommendations across six critical workforce areas:

• Strengthening recruitment and retention

• Increasing District resident employment in healthcare occupations

• Improving opportunities for advancement in health careers within the District

• Enhancing access to high-quality allied health training programs

• Retention of DC health professional students post-graduation

• Development of a health careers pipeline strategy

Draft recommendations for licensing, payment, reducing provider burdens, building public trust, eliminating barriers to entry, defining career pathways, tuition support, and youth exposure and immersion opportunities should all be adopted if we hope to ensure residents’ access to high quality health care. We look forward to working with DC Health to operationalize the task force recommendations, and we support robust DC Health investment in innovations that show promise for improving access and outcomes.