[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1810 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                S. 1810

  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

                            October 31, 2003

Mr. Daschle (for Mr. Edwards) 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 2003''.

SEC. 2. FINDINGS.

    Congress finds as follows:
            (1) Researchers have concluded that women may experience 
        significant adverse mental health consequences relating to 
        trauma exposure, often the result of sexual or domestic 
        violence.
            (2) 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.
            (3) 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 mental health disorders have 
        a history of trauma.
            (4) 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.
            (5) 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.
            (6) 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.
            (7) Of women in prisons and jails, 80 to 100 percent have 
        been victims of physical and sexual abuse.
            (8) 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.
            (9) 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.
            (10) 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.

    ``(a) Research Grants.--
            ``(1) Grants authorized.--
                    ``(A) 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 
                mental health 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 mental health 
                disorders, including depression and anxiety disorders 
                (including post-traumatic stress disorder), psychotic 
                and dissociative disorders.
                    ``(B) 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.
                    ``(C) 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.--
                    ``(A) 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.
                    ``(B) Contents.--Each application submitted 
                pursuant to subparagraph (A) shall--
                            ``(i) describe the activities for which 
                        assistance under this subsection is sought; and
                            ``(ii) demonstrate that the testing of 
                        treatment interventions will be carried out 
                        through community-based treatment programs.
            ``(3) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this subsection, 
        such sums as may be necessary.
    ``(b) Treatment Grants.--
            ``(1) Grants authorized.--
                    ``(A) 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.
                    ``(B) Grantmaking considerations.--The Secretary 
                shall ensure that--
                            ``(i) grants awarded pursuant to this 
                        paragraph are distributed equitably among the 
                        regions of the country and among urban and 
                        rural areas; and
                            ``(ii) preference is given to applicants 
                        with strong ties to minority communities and 
                        those that offer services that are culturally 
                        and linguistically appropriate.
                    ``(C) 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--
                    ``(A) establish and operate 1 or more 
                multidisciplinary integrated systems of community-based 
                care--
                            ``(i) to include medical, social, and 
                        behavioral services for the simultaneous and 
                        coordinated treatment of trauma, substance 
                        abuse, and mental health disorders, including 
                        depression and anxiety disorders (including 
                        post-traumatic stress disorder), psychotic and 
                        dissociative disorders;
                            ``(ii) that specifically addresses the 
                        impact of trauma on the lives of women 
                        receiving services through the grant; and
                            ``(iii) that may include services for 
                        children of women who are survivors of trauma;
                    ``(B) 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;
                    ``(C) offer specialized and structured treatment 
                components addressing trauma that are culture- and 
                gender-specific;
                    ``(D) 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;
                    ``(E) undertake aggressive outreach efforts to 
                encourage women from minority communities, in 
                particular, to participate; and
                    ``(F) 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.--
                    ``(A) 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.
                    ``(B) Contents.--Each application submitted 
                pursuant to subparagraph (A) shall--
                            ``(i) describe the activities for which 
                        assistance under this subsection is sought; and
                            ``(ii) 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 are 
        authorized to be appropriated to carry out this subsection, 
        such sums as may be necessary.''.
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