S 2204 IS

107th CONGRESS
2d Session
S. 2204

To amend the Public Health Service Act to improve treatment for the mental health and substance abuse needs of women with histories of trauma, including domestic and sexual violence.

IN THE SENATE OF THE UNITED STATES
April 18, 2002

Mr. EDWARDS (for himself and Mrs. MURRAY) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

A BILL

To amend the Public Health Service Act to improve treatment for the mental health and substance abuse needs of women with histories of trauma, including domestic and sexual violence.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Women in Trauma Act of 2002'.

SEC. 2. FINDINGS.

Congress finds as follows:

Researchers have concluded that women may experience significant adverse mental health consequences relating to trauma exposure, often the result of sexual or domestic violence.
The majority of women suffering from both substance abuse and mental health problems have been victims of rape, incest, or physical or emotional abuse and hundreds of thousands of these same women are also severely beaten by their husbands or a significant male intimate. Surveys have indicated that approximately 1,500,000 children are physically abused each year and 700,000 are victims of sexual abuse.
Women with serious mental illnesses are over-represented in samples that experienced trauma, including physical, sexual, and emotional abuse. Between 50 and 70 percent of women hospitalized for psychiatric disorders have a history of trauma.
Even for people whose mental health problems are caused by other factors, a history of early physical or sexual abuse leads to the earlier onset of their illness, a more severe course of illness, and a greater likelihood of suicide and other poor outcomes.
Trauma exposure is generally prevalent in people who suffer from mental health and substance abuse problems, and can worsen the course and overall impact of these illnesses.
In a recent study, 97 percent of homeless women with mental illness were found to have experienced severe physical or sexual abuse and 87 percent experienced this abuse both as children and as adults.
Of women in prisons and jails, 80 to 100 percent have been victims of physical and sexual abuse.
The prevalence of violence- and trauma-related problems among women with mental health and substance abuse problems is not adequately addressed by most treatment practices.
There is an urgent need to provide services that directly address the issue of trauma for women suffering from mental health and substance abuse problems.
To improve mental health and substance abuse services for women, further research to expand the development and implementation of trauma-sensitive services is needed as well as additional services to improve access to comprehensive therapeutic interventions and to the support needed to overcome barriers to recovery.

SEC. 3. GRANTS TO IMPROVE TREATMENT FOR WOMEN WITH HISTORIES OF TRAUMA.

Subpart 3 of part B of title V of the Public Health Service Act (42 U.S.C. 290bb-31 et seq.) is amended by adding at the end the following:

SEC. 520K. GRANTS TO IMPROVE TREATMENT FOR WOMEN WITH HISTORIES OF TRAUMA.

RESEARCH GRANTS-
1. GRANTS AUTHORIZED-
  1. IN GENERAL- The Secretary, acting through the Director of the National Institute of Mental Health and in consultation with the Administrator of the Substance Abuse and Mental Health Services Administration, shall award grants, contracts, or cooperative agreements to public and nonprofit private entities, as well as Indian tribes and tribal organizations, for the purpose of building the evidence base for new treatment interventions that simultaneously address trauma, substance abuse, and psychiatric disorders, including depression and anxiety disorders (including post-traumatic stress disorder, psychotic and dissociative disorders) and the integration of existing interventions for the treatment of trauma, substance abuse, and psychiatric disorders, including depression and anxiety disorders (including post-traumatic stress disorder, psychotic and dissociative disorders).
  2. GEOGRAPHICAL DISTRIBUTION- The Secretary shall ensure that grants, contracts, or cooperative agreements awarded pursuant to this paragraph are distributed equitably among regions of the country and among urban and rural areas.
  3. DURATION OF AWARDS- Grants, contracts, or cooperative agreements awarded pursuant to this paragraph may not exceed 5 years. Such grants, contracts, or agreements may be renewed.
2. APPLICATION-
  1. IN GENERAL- Each entity desiring a grant under this subsection shall submit an application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may reasonably require.
  2. CONTENTS- Each application submitted pursuant to subparagraph (A) shall--
    1. describe the activities for which assistance under this subsection is sought; and
    2. demonstrate that the testing of treatment interventions will be carried out through community-based treatment programs.
3. AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to carry out this subsection, $50,000,000 for fiscal year 2003, and such sums as may be necessary for each fiscal year thereafter.
TREATMENT GRANTS-
1. GRANTS AUTHORIZED-
  1. IN GENERAL- The Secretary, acting through the Administrator of the Substance Abuse and Mental Health Services Administration, shall make grants to public and nonprofit private entities, including Indian tribes and tribal organizations, for the purpose of providing comprehensive community-based mental health and substance abuse services to women who have experienced a history of physical or sexual abuse, or other types of trauma.
  2. GRANTMAKING CONSIDERATIONS- The Secretary shall ensure that--
    1. grants awarded pursuant to this paragraph are distributed equitably among the regions of the country and among urban and rural areas; and
    2. preference is given to applicants with strong ties to minority communities and those that offer services that are culturally and linguistically appropriate.
  3. DURATION- The Secretary shall award grants under this paragraph for a period not to exceed 5 years. Such grants may be renewed.
2. TECHNICAL ASSISTANCE- The Secretary, acting through the Administrator of the Substance Abuse and Mental Health Services Administration, shall provide technical assistance to entities awarded grants pursuant to paragraph (1) with respect to the implementation of programs described in paragraph (3).
3. USE OF FUNDS- An entity awarded a grant pursuant to paragraph (1) shall--
  1. establish and operate 1 or more multidisciplinary integrated systems of community-based care--
    1. to include medical, social, and behavioral services for the simultaneous and coordinated treatment of trauma, substance abuse, and psychiatric disorders, including depression and anxiety disorders (including post-traumatic stress disorder, psychotic, and dissociative disorders);
    2. that specifically addresses the impact of trauma on the lives of women receiving services through the grant; and
    3. that may include services for children of women who are survivors of trauma;
  2. establish avenues for the involvement of women who access the services described in subparagraph (A), in all phases of service delivery and design including in the development of individualized treatment plans;
  3. offer specialized and structured treatment components addressing trauma that are culture- and gender-specific;
  4. implement collaboration among public and private nonprofit entities likely to serve women with histories of trauma including rape and domestic violence programs, hospital emergency rooms, appropriate branches of the criminal justice system, low-income housing authorities, substance abuse and mental health service providers, consolidated health centers, battered women's shelters, and churches and other community-based organizations;
  5. undertake aggressive outreach efforts to encourage women from minority communities, in particular, to participate; and
  6. offer educational materials or training, through subparagraph (D) or other avenues, to agencies and community-based organizations that serve women with histories of trauma to increase awareness of the devastating impact of chronic exposures to traumatic experiences on women's mental health and of the need to address this impact in the context of mental health and substance abuse treatment.
4. ACCESS TO CHILD CARE- An entity awarded a grant pursuant to paragraph (1) may use grant funds to provide child care, either directly or through an off site, licensed child care provider, to women offered services under such grant to facilitate participation and address a primary barrier to care.
5. APPLICATION-
  1. IN GENERAL- Each entity desiring a grant under this subsection shall submit an application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may reasonably require.
  2. CONTENTS- Each application submitted pursuant to subparagraph (A) shall--
    1. describe the activities for which assistance under this subsection is sought; and
    2. describe a plan for the rigorous evaluation of such activities, including both process and outcome evaluation, and the submission of the evaluation at the end of the project period.
6. AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to carry out this subsection, $100,000,000 for fiscal year 2003, and such sums as may be necessary for each fiscal year thereafter.'.
END

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107th CONGRESS 2d Session S. 2204