This needs assessment, conducted for District of Columbia Department of Health (DC-DOH), presents findings from a literature review, analyses of Medicaid enrollment and hospital discharge data, interviews with key informants, a survey of school nurses, and findings from focus groups with young adults with epilepsy and caretakers of young adults with epilepsy in DC. It suggests changes within the health services delivery system for children and youth with epilepsy related to the following goals identified by DC-DOH: early detection, diagnosis, and treatment; improved access to medical homes; reduced stigma; reduced language and cultural barriers; and sustained systems change.