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36TH LEGISLATURE OF THE VIRGIN ISLANDS COMMITTEE ON CULTURE, YOUTH, AGING, SPORTS AND PARKS The Honorable Senator Angel Bolques, Jr Chair of Committee Testimony Presented By The Honorable Justa Encarnacion, RN, BSN, MBA/HCM Health Commissioner On The rise of youth violence in the Virgin Islands as a public health emergency that demands a comprehensive, trauma-informed response. VIDOH Testimony on Rise of Youth Violence October 31, 2025 2 | P a g e Good day, Honorable Senator Angel Bolques, Jr., Chairperson of the Committee on Culture, 1 Youth, Aging, Sports and Parks; Honorable Senator Hubert Frederick, Vice Chair; Committee 2 members; other Senators in attendance; and members of the listening and viewing public. 3 I am Dr. Nicole Craigwell-Syms, Assistant Commissioner of the Department of Health of the 4 Virgin Islands of the United States, here to provide testimony on behalf of the Honorable Justa 5 Encarnacion, Commissioner of Health. Joining me today are Assistant Commissioner Reuben 6 Molloy, Deputy Commissioner Janis Valmond for Health Promotion and Disease Prevention, 7 Deputy Commissioner Renan Steele with oversight of the Behavioral Health Division, and Gesil 8 Ramos, the Director of Behavioral Health. 9 We extend heartfelt appreciation to the dedicated teams within the Maternal and Child Health 10 and Children with Special Health Care Needs (MCH&CSHCN) Division and the Behavioral 11 Health Division for their unwavering commitment to serving our youth and families. We also 12 thank Governor Albert Bryan Jr. and Lieutenant Governor Tregenza A. Roach, Esq. for their 13 continued leadership and support in advancing behavioral health and wellness throughout the 14 Virgin Islands. 15 Chair and members of the Committee, we thank you for examining youth violence as a public 16 health emergency. We share your concern for the youth of this territory and appreciate your 17 commitment to addressing this crisis through prevention, healing, and long-term community 18 partnerships. The Department of Health views youth violence not merely as a criminal or social 19 issue but as a symptom of deeper trauma and unaddressed behavioral health needs that demand a 20 coordinated, trauma-informed response. 21 When we look into the eyes of our children, we see promise, talent, and unimaginable potential. 22 Yet too often, beneath that potential lies pain they did not choose and burdens they should never 23 have to carry. We agree that their experiences tell a story that demands our attention and our 24 intentional action. 25 Nationally, young people are navigating unprecedented levels of stress, trauma, and behavioral 26 health challenges. Data from the Centers for Disease Control and Prevention show that nearly 27 two-thirds of U.S. adults report at least one Adverse Childhood Experience (ACE), and about 28 VIDOH Testimony on Rise of Youth Violence October 31, 2025 3 | P a g e one in six report four or more. These adverse experiences, such as abuse, neglect, or exposure to 1 household dysfunction, which are often associated with emotional trauma and abuse, 2 significantly increase the risk for later aggression, substance use, and chronic mental health 3 challenges. 4 Youth who are exposed to community violence or poverty carry an even higher burden, often 5 presenting symptoms of post-traumatic stress, depression, and aggression. National data also 6 indicate that one in five high school students is involved in a physical fight each year, and 7 marijuana remains the most frequently used illicit substance among adolescents. Trauma and 8 aggression do not appear suddenly. They are rooted in repeated adversity and the absence of 9 stable support. 10 Although the need is clear, access to services remains limited. Only about one-third of 11 adolescents receive any mental health treatment each year, and close to 40 percent of youth 12 experiencing major depression receive no care at all. Child and adolescent psychiatrists are in 13 extremely short supply across the United States, averaging only about fourteen providers per 14 100,000 youth, and many communities have none. Cost, stigma, transportation, and a lack of 15 culturally responsive services continue to create significant barriers. 16 In the U.S. Virgin Islands, poverty significantly intensifies the behavioral health challenges 17 already seen nationwide. With nearly one third of our children living below the federal poverty 18 level, many face daily insecurity related to food, housing, and community safety. These 19 conditions elevate chronic stress and teach survival-based behaviors that can appear as 20 aggression, while caregiver instability and limited resources further weaken emotional support 21 systems. Local behavioral health services remain under-resourced, difficult to access, and not 22 always aligned with the cultural and lived experiences of our youth. 23 In addition to the pressures of poverty, young people in the Virgin Islands continue to carry the 24 collective trauma of Hurricanes Irma and Maria, followed by the profound disruptions of the 25 COVID 19 pandemic. Research shows that repeated disaster exposure places children and 26 adolescents at higher risk for depression, anxiety, and post-traumatic stress. The burden is even 27 heavier in communities where gun violence is present, especially on St. Croix and St. Thomas, 28 VIDOH Testimony on Rise of Youth Violence October 31, 2025 4 | P a g e where too many youths have witnessed or experienced violence firsthand. In these 1 circumstances, aggression can become a learned survival strategy that reinforces cycles of fear 2 and retaliation. 3 According to the 2017 Youth Risk Behavior Survey (YRBS), among high school students, 4 35.5% felt so sad or hopeless almost every day for two or more weeks in a row that they stopped 5 doing some usual activities, 17% had seriously considered attempting suicide, 13.6% made a 6 plan to commit suicide, and 10.3% had actually attempted suicide. 7 Among middle school youth, 16.2% reported ever having carried a weapon, 65.1% recalled ever 8 being in a physical fight, 22.5% seriously thought about killing themselves, 14.3% reported they 9 made a plan, and 8.5% tried to kill themselves. Further, 32.5% felt so sad or hopeless almost 10 every day for two or more weeks in a row that they stopped doing some usual activities. 11 The impact of these behaviors is often magnified when adults minimize or dismiss the emotions 12 and concerns of adolescents, sending the message that their pain does not matter. When young 13 people feel unheard or invalidated, frustration and aggression can grow as one of the few ways 14 they feel they can make themselves seen. 15 Cultural stigma further complicates access to care, as seeking behavioral health support is often 16 viewed as a weakness, particularly for boys and young men. As a result, many youths internalize 17 distress, self-medicate, or act out rather than receiving the help they need. Addressing these 18 challenges requires lifting youth's voices, validating their experiences, and providing safe, 19 culturally grounded pathways to care that meet them where they are. 20 Addressing these concerns requires a shift toward immediate, community-centered solutions. We 21 will begin with public, private, and non-profit collaboration throughout our territory. The Virgin 22 Islands Department of Health, through its Behavioral Health Division, leads the core network of 23 mental health and substance use services across the territory. 24 Both our Behavioral Health Division and Maternal Child Health and Children with Special 25 Healthcare Needs (MCH&CSHCN) Program make routine school visits simply to talk with 26 students, identify emotional needs and provide strategies for coping with symptoms. The 27 VIDOH Testimony on Rise of Youth Violence October 31, 2025 5 | P a g e Behavioral Health Division enhances its outreach by taking the “Zen Van” on the road to visit 1 junior high and high school campuses territory wide. The Zen Van provides a calming mobile 2 environment where students can access on-site mental health counseling and resources. 3 The Behavioral Health Division has also partnered with the U.S. Virgin Islands High Intensity 4 Drug Trafficking Area (USVI HIDTA), Puerto Rico HIDTA, the U.S. Drug Enforcement 5 Administration (DEA), the VI Police Department, and the VI Department of Education on a 6 prevention initiative called “Positive Vibes Alone.” This territory-wide program promotes 7 healthy decision-making and aims to reduce substance use among youth. 8 Since its launch on September 3rd, the team has visited 10 schools reaching more than 1,700 9 students across St. Croix. The initiative uses relatable conversations to inspire youth and to 10 encourage self-respect and responsible life choices. Topics include substance misuse, peer 11 pressure, violence prevention, opioids (prescribed and illicit), edibles, marijuana, alcohol, 12 vaping, and bullying, which was added by request of students themselves. Together, this 13 partnership empowers youth through education, dialogue, and connection. 14 Additionally, the activation of the 988 Suicide and Crisis Lifeline across the territory and 15 legislative action to enhance our mobile Psychiatric Emergency Response Team reflects 16 meaningful progress toward improved crisis care. 17 Our behavioral health services are also strengthened by other essential partners to include 18 Federally Qualified Health Centers, Schneider Regional Medical Center, Juan F. Luis Hospital, 19 and the Myrah Keating Smith Community Health Center, as well as community organizations 20 such as The Village – VI Partners in Recovery, which support prevention and treatment efforts 21 for adolescents. 22 The Virgin Islands Child Psychiatry Access Program (VICPAP) within MCH&CSHCN, works 23 in collaboration with the Behavioral Health Division and the Virgin Islands Department of 24 Education to ensure timely consultation and access to child psychiatric support. In addition, 25 approval for biennial data collection will guide the expansion of telehealth services across 26 districts, improving coordination with private providers, and ensuring earlier diagnosis and care 27 for youth in need. MCH&CSHCN has also been awarded a federal grant for a Zen Room pilot 28 VIDOH Testimony on Rise of Youth Violence October 31, 2025 6 | P a g e program to provide calm spaces in schools and to train staff on identifying and addressing early 1 signs of emotional or behavioral distress. 2 Overall, however, our capacity remains stretched. The Virgin Islands is federally designated as a 3 mental health professional shortage area. Access to child and adolescent behavioral health 4 specialists is limited, and families, particularly on St. John, experience challenges in traveling to 5 appointments. While the Department of Health continues to expand the reach of behavioral 6 health services, demand continues to outpace available resources. These constraints underscore 7 the urgent need to strengthen the behavioral health workforce, increase school and community- 8 based support, and ensure that care is accessible for every young Virgin Islander. 9 While Medicaid and sliding fee options help reduce financial barriers, many specialized 10 behavioral health services still require referrals off island, which can delay care and place 11 additional stress on families. Services are also often based on mainland models that do not 12 always reflect the cultural values or lived experiences of Virgin Islanders. 13 14 Our young people frequently seek guidance from trusted figures such as coaches, pastors, family 15 elders, and close relatives rather than from clinicians. These sources of community support are 16 essential, yet they are not consistently integrated into prevention and outreach efforts. Expanding 17 culturally grounded approaches that elevate these trusted messengers would strengthen early 18 intervention, reduce stigma, and make care more accessible and meaningful for youth and 19 families. 20 To effectively address trauma and aggression among young people in the Virgin Islands, we 21 must commit to a coordinated and comprehensive strategy that responds to both behavioral 22 health needs and the conditions that shape them. Data collected through the 2024 and 2025 23 Youth Risk Behavior Surveys will provide a critical starting point. Establishing clear baselines 24 for youth violence, substance use, and school connectedness on each island will allow us to 25 design targeted interventions and measure real progress over time. Immediate expansion of crisis 26 response capacity is also essential. Fully staffing and deploying mobile crisis teams in 27 collaboration with the 988 system will help ensure that youth in acute distress receive timely, 28 VIDOH Testimony on Rise of Youth Violence October 31, 2025 7 | P a g e developmentally appropriate care that avoids unnecessary law enforcement involvement or 1 hospitalization. 2 Schools remain the most direct and consistent point of contact for our youth and must be 3 equipped as the first line of trauma prevention and intervention. Implementing programs like the 4 Student Assistance Program (SAP), Cognitive Behavioral Intervention for Trauma in Schools 5 (CBITS), and LifeSkills Training can reduce aggression, strengthen coping skills, and improve 6 emotional regulation. At the same time, culturally grounded solutions are required. Coaches, 7 pastors, and community mentors should be trained and mobilized to deliver behavioral health 8 literacy and reduce stigma. This is particularly important for boys and young men, whose distress 9 is often overlooked or labeled as misconduct rather than recognized as a call for support. Early 10 identification, restorative responses to behavior, and gender-responsive care models are key 11 strategies for breaking this cycle. 12 Workforce development must also be prioritized. By maximizing federal loan repayment 13 opportunities, expanding training partnerships with the University of the Virgin Islands, and 14 increasing clinical supervision capacity, we can grow and retain a skilled local behavioral health 15 workforce. These actions will increase access to specialized care and reduce reliance on off- 16 island referrals. 17 It is important to note that the VI Department of Human Services is the primary agency for child 18 protection, family welfare, and youth social services. When a young person is exposed to 19 violence or neglect, the VI Department of Human Services leads the safety and case management 20 response, while the VI Department of Health addresses the behavioral health and trauma 21 treatment needs. Together, we form a continuum of care — the VI Department of Human 22 Services stabilizing the environment and the VI Department of Health treating the emotional and 23 psychological impact — to help youth recover and thrive. 24 In closing, the path forward is clear. We must invest in the wellbeing of our youth by 25 strengthening the systems that support them, addressing the conditions that place them at risk, 26 and ensuring that every young person in the Virgin Islands has access to timely, culturally 27 VIDOH Testimony on Rise of Youth Violence October 31, 2025 8 | P a g e responsive behavioral health care. The Department of Health is committed to this work. It will 1 require collective action across schools, families, community organizations, and this body. 2 When we choose to prioritize prevention, expand care in the places where youth naturally seek 3 support, and ensure that their voices guide our decisions, we create safer communities, stronger 4 families, and a healthier future for our territory. 5 Our young people are resilient, but resilience should not be their only defense. With the support 6 and investment of this body, we can break cycles of trauma and aggression and give the youth of 7 the Virgin Islands what they deserve: the opportunity to grow, to heal, and to thrive. 8 Mr. Chair, this concludes our testimony. We thank you for the opportunity to speak on this issue 9 and stand ready to respond to any questions you may have. 10 11