[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1578 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 1578

   To amend the Public Health Service Act to improve the health care 
system's assessment and response to domestic violence, dating violence, 
         sexual assault, and stalking, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 15, 2011

 Ms. Slaughter (for herself, Mrs. Lowey, Ms. Roybal-Allard, Ms. Moore, 
Ms. Norton, Ms. Schakowsky, Ms. Hanabusa, Mr. Hastings of Florida, Mr. 
   Holden, and Ms. DeLauro) introduced the following bill; which was 
            referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend the Public Health Service Act to improve the health care 
system's assessment and response to domestic violence, dating violence, 
         sexual assault, and stalking, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Violence Against 
Women Health Initiative Act of 2011''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Purpose.
 TITLE I--COORDINATED PUBLIC HEALTH INITIATIVE TO END VIOLENCE AGAINST 
                                 WOMEN

Sec. 101. Grants to foster public health responses to intimate partner 
                            violence and sexual assault.
Sec. 102. Training and education of health professionals.
    TITLE II--RESEARCH ON EFFECTIVE PUBLIC HEALTH APPROACHES TO END 
                         VIOLENCE AGAINST WOMEN

Sec. 201. Research on effective interventions to end domestic violence, 
                            sexual assault, and stalking against women 
                            in the health care setting.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) Domestic violence and sexual violence are public health 
        problems and among the most significant social determinants of 
        health for women and girls.
            (2) Nearly one in four women in the United States reports 
        experiencing violence by a current or former spouse or 
        boyfriend at some point in her life, and one in six women 
        reported experiencing a completed sexual assault.
            (3) Violence and abuse can affect health in many ways from 
        physical injuries sustained during violent episodes, trauma 
        symptoms including depression and thoughts of suicide, and 
        harmful health coping behaviors such as alcohol and substance 
        abuse.
            (4) Research published in the Journal of Women's Health in 
        2007 found that women who are victims of violence have 17 
        percent more primary care doctor visits, 14 percent more 
        specialist visits, and 27 percent more prescription refills 
        than non-abused women.
            (5) Women who have experienced violence and abuse are 80 
        percent more likely to have a stroke, 70 percent more likely to 
        have heart disease, and 60 percent more likely to have asthma 
        than non-abused women.
            (6) In addition to utilizing the health system at higher 
        rates, victims are more likely to experience a wide range of 
        reproductive health problems including unintended pregnancies, 
        sexually transmitted disease/HIV transmission, miscarriages, 
        and more. Abuse increases the likelihood of teen pregnancy; 
        adolescent girls in abusive relationships are 3.5 times more 
        likely to become pregnant than their non-abused peers.
            (7) The Centers for Disease Control and Prevention (CDC) 
        have also linked childhood exposure to violence with long-term, 
        chronic health conditions including obesity, arthritis, stroke, 
        and heart disease.
            (8) The CDC conservatively estimates that intimate partner 
        rape, physical assault, and stalking costs the health system 
        and employers $8.3 billion annually from direct injuries and 
        services and lost productivity from work.
            (9) Most professional health organizations, including the 
        American Medical Association, American Nurses Association, 
        American College of Obstetricians and Gynecologists, American 
        Psychological Association, American Academy of Pediatrics, and 
        the Joint Commission on the Accreditation of Health Care 
        Organizations, endorse routine assessment for domestic 
        violence.
            (10) The health system provides an important entry point to 
        reduce violence and abuse and can improve the health status of 
        women, but without training and support on how to assess and 
        respond, providers are not routinely assessing and responding 
        to abuse, missing an important opportunity to help victims and 
        prevent more serious abuse.

SEC. 3. PURPOSE.

    It is the purpose of this Act to develop a public health response 
to abuse by--
            (1) strengthening the health care system's assessment of 
        and response to domestic violence, dating violence, sexual 
        assault, and stalking;
            (2) increasing the number of victims identified and 
        assisted in health or public health settings; and
            (3) expanding research on effective interventions in health 
        settings.

 TITLE I--COORDINATED PUBLIC HEALTH INITIATIVE TO END VIOLENCE AGAINST 
                                 WOMEN

SEC. 101. GRANTS TO FOSTER PUBLIC HEALTH RESPONSES TO INTIMATE PARTNER 
              VIOLENCE AND SEXUAL ASSAULT.

    Section 399P of the Public Health Service Act (42 U.S.C. 280g-4) is 
amended--
            (1) in subsection (a)--
                    (A) by amending paragraph (1) to read as follows:
            ``(1) In general.--The Secretary, acting through the 
        Director of the Office on Women's Health in the Office of the 
        Secretary, and in consultation with the Director of the Family 
        Violence Prevention and Services Office, shall award grants to 
        eligible State, tribal, territorial, or local entities to 
        strengthen the response of State, tribal, territorial, or local 
        health care systems to domestic violence, dating violence, 
        sexual assault, and stalking and prevent and respond to 
        physical and sexual violence across the lifespan.'';
                    (B) in paragraph (2), by amending subparagraph (A) 
                to read as follows:
                    ``(A) be--
                            ``(i) a State department (or other 
                        division) of health, a State, tribal, or 
                        territorial domestic violence or sexual assault 
                        coalition or victim services program, a State 
                        law enforcement task force, or any other 
                        nonprofit, nongovernmental State, tribal, or 
                        territorial entity with a history of effective 
                        work in the fields of domestic violence, dating 
                        violence, sexual assault, or stalking, and 
                        health care, including physical or mental 
                        health care; or
                            ``(ii) a local victim services program, a 
                        local department (or other division) of health, 
                        a local health clinic, hospital, or health 
                        system, or any other community-based 
                        organization with a history of effective work 
                        in the field of domestic violence, dating 
                        violence, sexual assault, or stalking, and 
                        health care, including physical or mental 
                        health care;''; and
                    (C) in paragraph (3), by striking ``2 years'' and 
                by inserting ``36 months''; and
            (2) in subsection (b)--
                    (A) by amending paragraph (1) to read as follows:
            ``(1) In general.--An entity shall use amounts received 
        under a grant under this section to design or enhance and 
        implement comprehensive strategies to improve the response of 
        the health care system to domestic violence, dating violence, 
        sexual assault, or stalking in clinical, public health, 
        hospital, managed care (including behavioral and mental 
        health), and other health settings.'';
                    (B) by amending paragraph (2) to read as follows:
            ``(2) Mandatory strategies.--Strategies implemented under 
        paragraph (1) shall include the following:
                    ``(A) The implementation, dissemination, and 
                evaluation of policies and procedures to guide health 
                professionals and public health staff in responding to 
                domestic violence, dating violence, sexual assault, and 
                stalking, including strategies to ensure that health 
                information is maintained in a manner that protects the 
                patient's privacy and safety and health information 
                technology is used to improve documentation, 
                identification, assessment, treatment, and follow-up 
                care.
                    ``(B) The development of on-site access to services 
                to address the safety, medical, mental health, and 
                economic needs of patients who are victims of domestic 
                violence, dating violence, sexual assault, or stalking, 
                either by increasing the capacity of existing health 
                professionals and public health staff to address 
                domestic violence, dating violence, sexual assault, and 
                stalking, or by contracting with or hiring victim 
                service providers to provide the services or to model 
                other services appropriate to the geographic and 
                cultural needs of a site.
                    ``(C) The provision of training and followup 
                technical assistance to health professionals, public 
                health staff, and allied health professionals to 
                identify, assess, treat, and refer clients who are 
                victims of domestic violence, dating violence, sexual 
                assault, or stalking.
                    ``(D) The development, replication, refinement, and 
                testing of model strategies in adolescent health 
                settings to prevent and respond to violence and 
                abuse.'';
                    (C) in paragraph (3)--
                            (i) by amending subparagraph (A) to read as 
                        follows:
                    ``(A) The development of training modules and 
                policies that address domestic violence, dating 
                violence, sexual assault, and stalking over the 
                lifespan, including child abuse, childhood exposure to 
                domestic and sexual violence, and elder abuse.'';
                            (ii) in subparagraph (B), by striking ``and 
                        stalking prevention'' and by inserting ``, 
                        stalking prevention, and healthy 
                        relationships'';
                            (iii) by amending subparagraph (D) to read 
                        as follows:
                    ``(D) The inclusion of the health effects of 
                lifetime exposure to violence and abuse as well as 
                related behavioral risk factors in health professional 
                training schools including medical, dental, nursing, 
                social work, and mental health curricula, and allied 
                health service training courses.'';
                            (iv) by amending subparagraph (E) to read 
                        as follows:
                    ``(E) The integration of knowledge of domestic 
                violence, dating violence, sexual assault, and stalking 
                into health care accreditation and professional 
                licensing examinations, such as medical, dental, social 
                work, and nursing boards, and where appropriate, other 
                allied health exams.''; and
                            (v) by adding at the end the following new 
                        subparagraph:
                    ``(F) The development, expansion, and 
                implementation of sexual assault forensic medical 
                examination programs.''; and
                    (D) by adding at the end the following:
            ``(4) Building evidence of model programs.--Strategies 
        implemented under paragraph (1) may include research and 
        evaluation of programs funded under this section to build 
        evidence of model programs to be disseminated. As a condition 
        on receipt of a grant for such research and evaluation, an 
        applicant shall agree to release any findings resulting from 
        the research and evaluation to the general public no later than 
        90 days after the findings are available. The Secretary shall 
        facilitate the wide dissemination of such findings by means of 
        multiple media, including the Internet.''; and
            (3) by striking subsections (c) and (d) and inserting the 
        following:
    ``(c) Preference.--In selecting grant recipients under this 
section, the Secretary shall give preference to applicants based on the 
strength of their evaluation strategies, with outcome-based evaluations 
prioritized.
    ``(d) Technical Assistance.--
            ``(1) In general.--The Secretary may provide technical 
        assistance with respect to the planning, development, and 
        operation of any program or service carried out pursuant to 
        this section. The Secretary may provide such technical 
        assistance directly or through grants or contracts.
            ``(2) Availability of materials.--The Secretary shall make 
        materials on training, best practices, evaluation, and other 
        subjects developed by grantees under this section publicly 
        available to the extent feasible, including through the use of 
        electronic media, replication of materials, and tailoring of 
        materials to meet varying geographic and jurisdictional needs.
    ``(e) Reporting.--The Secretary shall publish a biennial report 
on--
            ``(1) the distribution of funds under this section; and
            ``(2) the programs and activities supported by such funds.
    ``(f) Definitions.--Except as inconsistent with this section, the 
definitions in section 40002 of the Violence Against Women Act of 1994 
shall apply to this section.
    ``(g) Authorization of Appropriations.--
            ``(1) In general.--There is authorized to be appropriated 
        to carry out this section $5,000,000 for each of fiscal years 
        2012 through 2016, to remain available until expended.
            ``(2) Allocation of funds.--
                    ``(A) Administrative costs.--Of the funds made 
                available to carry out this section for any fiscal 
                year, the Secretary shall not use more than 2.5 percent 
                for administration and monitoring of grants awarded 
                under this section.
                    ``(B) Research and evaluation.--Of the funds made 
                available to carry out this section for any fiscal 
                year, the Secretary shall not use more than 15 percent 
                to award funds for research and evaluation under 
                subsection (b)(4).''.

SEC. 102. TRAINING AND EDUCATION OF HEALTH PROFESSIONALS.

    Section 758 of the Public Health Service Act (42 U.S.C. 294h) is 
amended to read as follows:

``SEC. 758. INTERDISCIPLINARY TRAINING AND EDUCATION ON DOMESTIC 
              VIOLENCE, SEXUAL ASSAULT, AND OTHER TYPES OF VIOLENCE AND 
              ABUSE.

    ``(a) Grants.--The Secretary, acting through the Director of the 
Office on Women's Health in the Office of the Secretary, and in 
consultation with the Administrator of the Health Resources and 
Services Administration and the Director of the Family Violence 
Prevention and Services Office, shall award grants to eligible entities 
to develop interdisciplinary training for health professionals, public 
health staff, and allied health professionals, and education programs 
that provide undergraduate, graduate, or postgraduate medical, 
psychology, and nursing (including advanced practice nursing) students, 
and current health professionals, with an understanding of, and 
clinical skills pertinent to, domestic violence, dating violence, 
sexual assault, and stalking across the lifespan.
    ``(b) Eligibility.--
            ``(1) In general.--To be eligible to receive a grant under 
        this section, an entity shall be--
                    ``(A) an accredited school of allopathic or 
                osteopathic medicine, psychology, nursing, social work, 
                or allied health;
                    ``(B) a health care provider membership or 
                professional organization, or a health care system;
                    ``(C) a nonprofit organization with a history of 
                effective work in the field of training health 
                professionals with an understanding of, and clinical 
                skills pertinent to, domestic violence, dating 
                violence, sexual assault, or stalking, and lifetime 
                exposure to violence and abuse; or
                    ``(D) a State, tribal, territorial, or local 
                entity.
            ``(2) Additional requirements.--To be eligible to receive a 
        grant under this section, an entity shall prepare and submit an 
        application to the Secretary including at a minimum--
                    ``(A) strategies for the dissemination and sharing 
                of curricula and other educational materials developed 
                under the grant to other interested medical, 
                psychology, social work, and nursing schools and 
                national resource repositories for materials on 
                domestic violence, dating violence, sexual assault, and 
                stalking; and
                    ``(B) a plan for consulting with domestic violence 
                or sexual assault coalitions, or national nonprofit 
                organizations or racial and ethnic minority-specific 
                organizations with demonstrated experience and 
                expertise in domestic violence, dating violence, sexual 
                assault, or stalking.
            ``(3) Preference.--In selecting grant recipients under this 
        section, the Secretary shall give preference to applicants 
        based on the strength of their evaluation strategies, with 
        outcome-based evaluations prioritized.
    ``(c) Use of Funds.--
            ``(1) Required uses.--Amounts provided under a grant under 
        this section shall be used--
                    ``(A) to plan and develop--
                            ``(i) interdisciplinary health training and 
                        education for medical, psychology, social work, 
                        nursing, and other health professions students, 
                        interns, residents, fellows, or current health 
                        care providers to identify and provide health 
                        care services (including mental or behavioral 
                        health care services and referrals to 
                        appropriate community services) to individuals 
                        who are victims of domestic violence, dating 
                        violence, sexual assault, or stalking; and
                            ``(ii) culturally and linguistically 
                        competent clinical components for integration 
                        into approved internship, residency, and 
                        fellowship training or continuing medical 
                        education training that address physical and 
                        mental health issues related to domestic 
                        violence, dating violence, sexual assault, and 
                        stalking, along with other forms of violence as 
                        appropriate, and include the primacy of victim 
                        safety and confidentiality; or
                    ``(B) in the case of a grant recipient described in 
                subsection (b)(1)(B), to--
                            ``(i) develop and provide guidance to 
                        members, constituents, institutions, and 
                        stakeholders to increase assessment and 
                        referral to services; and
                            ``(ii) facilitate cross-training and 
                        provide collaborative opportunities between 
                        partners and public health agencies.
            ``(2) Permissive uses.--Amounts provided under a grant 
        under this section may be used to--
                    ``(A) offer community-based training opportunities 
                in rural areas, which may include the use of distance 
                learning networks and other available technologies 
                needed to reach isolated rural areas to train health 
                professions students, interns, residents, and fellows 
                on domestic violence, dating violence, sexual assault, 
                stalking, and other forms of violence and abuse;
                    ``(B) provide stipends to students who are 
                underrepresented in the health professions as necessary 
                to promote and enable their participation in offsite 
                training experiences designed to develop health care 
                clinical skills related to domestic violence, dating 
                violence, sexual assault, and stalking;
                    ``(C) provide clinical research fellowships to 
                explore the relationship between victimization or 
                exposure to abuse, and physical and mental health 
                status; or
                    ``(D) evaluate innovative curricula, training 
                models, or programs.
            ``(3) Building evidence of model programs.--Amounts 
        provided under a grant under this section may be used to 
        conduct research and evaluation of programs funded under this 
        section to build evidence of model programs to be disseminated. 
        As a condition on receipt of a grant for such research and 
        evaluation, an applicant shall agree to release any findings 
        resulting from the research and evaluation to the general 
        public no later than 90 days after the findings are available. 
        The Secretary shall facilitate the wide dissemination of such 
        findings by means of multiple media, including the Internet.
            ``(4) Requirements.--
                    ``(A) Confidentiality and safety.--Grantees under 
                this section shall ensure that all educational programs 
                developed with grant funds address issues of 
                confidentiality and patient safety, and that faculty 
                and staff associated with delivering educational 
                components are fully trained in procedures that will 
                protect the immediate and ongoing security of the 
                patients, patient records, and staff. Organizations 
                with demonstrated expertise in the confidentiality and 
                safety needs of victims of domestic violence, dating 
                violence, sexual assault, and stalking shall be 
                consulted on the development and adequacy of 
                confidentially and security procedures, and shall be 
                fairly compensated by grantees for their services.
                    ``(B) Rural programs.--Rural training programs 
                carried out under paragraph (2)(A) shall reflect 
                adjustments in protocols and procedures or referrals 
                that may be needed to protect the confidentiality and 
                safety of patients who live in small or isolated 
                communities and who are currently or have previously 
                experienced violence or abuse.
                    ``(C) Child and elder abuse.--Issues related to 
                child and elder abuse may be addressed as part of a 
                comprehensive programmatic approach implemented under a 
                grant under this section.
    ``(d) Technical Assistance.--
            ``(1) In general.--The Secretary may provide technical 
        assistance with respect to the planning, development, and 
        operation of any program or service carried out pursuant to 
        this section. The Secretary may provide such technical 
        assistance directly or through grants or contracts.
            ``(2) Availability of materials.--The Secretary shall make 
        materials on training, best practices, evaluation and other 
        subjects developed by grantees under this section publicly 
        available to the extent feasible, including through the use of 
        electronic media, replication of materials, and tailoring of 
        materials to meet varying geographic and jurisdictional needs.
    ``(e) Reporting.--The Secretary shall publish a biennial report 
on--
            ``(1) the distribution of funds under this section; and
            ``(2) the programs and activities supported by such funds.
    ``(f) Definitions.--Except as inconsistent with this section, the 
definitions in section 40002 of the Violence Against Women Act of 1994 
shall apply to this section.
    ``(g) Authorization of Appropriations.--
            ``(1) In general.--There is authorized to be appropriated 
        to carry out this section $3,000,000 for each of fiscal years 
        2012 through 2016, to remain available until expended.
            ``(2) Allocation of funds.--
                    ``(A) Administrative costs.--Of the funds made 
                available to carry out this section for any fiscal 
                year, the Secretary shall not use more than 2.5 percent 
                for administration and monitoring of grants awarded 
                under this section.
                    ``(B) Research and evaluation.--Of the funds made 
                available to carry out this section for any fiscal 
                year, the Secretary shall not use more than 15 percent 
                to award funds for research and evaluation under 
                subsection (c)(3).''.

    TITLE II--RESEARCH ON EFFECTIVE PUBLIC HEALTH APPROACHES TO END 
                         VIOLENCE AGAINST WOMEN

SEC. 201. RESEARCH ON EFFECTIVE INTERVENTIONS TO END DOMESTIC VIOLENCE, 
              SEXUAL ASSAULT, AND STALKING AGAINST WOMEN IN THE HEALTH 
              CARE SETTING.

    Section 40297 of the Violence Against Women Act of 1994 (42 U.S.C. 
13973) is amended--
            (1) in the section heading, by inserting after ``effective 
        interventions'' the following: ``to end domestic violence, 
        sexual assault, and stalking against women'';
            (2) in subsection (b)(1)--
                    (A) in subparagraph (B)--
                            (i) by striking ``and'' after the 
                        semicolon; and
                            (ii) by inserting before the semicolon ``, 
                        including evaluating programs using evidence-
                        based process and outcome indicators'';
                    (B) in subparagraph (C), by striking the period at 
                the end and inserting a semicolon; and
                    (C) by adding at the end the following new 
                subparagraphs:
                    ``(D) research on effective health care 
                interventions to domestic and sexual violence and 
                sexual coercion, including evaluating programs using 
                evidence-based process and outcome indicators; or
                    ``(E) research into factors that increase 
                resiliency for children exposed to dating violence, 
                sexual assault, stalking, or individuals who have a 
                lifetime exposure to violence and abuse.'';
            (3) in subsection (b)(2)(B)--
                    (A) by striking ``within primary care and emergency 
                health care settings'' and inserting ``within community 
                health centers and primary care, emergency health care, 
                or adolescent health settings''; and
                    (B) by striking ``domestic violence'' and inserting 
                ``dating violence, sexual assault, or stalking''; and
            (4) in subsection (d)--
                    (A) by striking ``2007 through 2011'' and inserting 
                ``2012 through 2016''; and
                    (B) by inserting ``, to remain available until 
                expended'' before the period.
                                 <all>