1.This Act may be cited as
the Supporting Child Maltreatment
Prevention Efforts in Community Health Centers Act of
2011
.
2.
(a)Congress
finds as follows:
(1)Child abuse and
neglect are serious public health problems in this country. During 2007,
approximately 3,200,000 referrals, involving the alleged maltreatment of
approximately 5,800,000 children, were sent to child protective services
agencies.
(2)The most recent
data show 794,000 substantiated cases of child abuse and neglect in 2007, and
child maltreatment-related deaths rose 15.5 percent in 2007. Approximately
1,760 children in the United States, nearly 3/4 of whom
were under 4 years of age, died as a result of abuse or neglect.
(3)Early childhood
experiences may have lifelong effects. Severe and chronic childhood stress,
including from maltreatment and exposure to violence, is associated with
persistent effects and can lead to enduring health, behavior, and learning
problems.
(4)Child
maltreatment has—
(A)psychological and
behavioral consequences such as depression, anxiety, suicide, aggressive
behavior, delinquency, posttraumatic stress disorder, and criminal
behavior;
(B)health
consequences, including injuries and death, chronic obstructive pulmonary
disease, smoking, heart disease, liver disease, and drug use; and
(C)developmental
consequences that can compromise brain development and learning.
(5)Child
maltreatment has significant financial consequences, including the short-term
costs associated with case handling by child protective services and
investigations, hospitalization or emergency room visits for medical treatment
of injuries, out-of-home placement alternatives, services to address mental
health and substance abuse problems, loss of productivity, and poor physical
health requiring multiple treatments.
(6)Child
maltreatment can be prevented. Given that parents and caregivers are
responsible for the majority of the abuse and neglect, caregiver-focused
strategies and interventions that address parenting skills and parental risk
factors such as depression, substance abuse, and intimate partner violence, as
well as strategies and interventions that promote family well-being are
critical. Parenting practices are amenable to change, given reasonable efforts,
and the building of safe, stable, nurturing parent-child relationships is a
scientifically proven strategy for the prevention of child maltreatment.
(7)Prevention of
child maltreatment should have a focus on primary prevention (before any
maltreatment), emphasizing community-centered and population-based
strategies.
(8)Prevention of
child maltreatment should focus on promoting healthy parent-child relationships
and an environment that provides safe, stable, nurturing relationships for
children.
(9)Primary health
care is an existing and widely accessed system in which a range of prevention
strategies can be implemented, and there is growing evidence that primary
health care settings are promising venues in which to conduct child
maltreatment prevention and behavioral health promotion programs.
(10)Community health
centers (referred to in this Act as CHCs
) serve more than
18,000,000 individuals in the United States annually, including individuals who
are poor, uninsured, hard-to-reach, and at-risk for child maltreatment.
(11)One in 5
low-income children in the United States receives health care at a CHC.
(12)CHCs are an
existing network of neighborhood health clinics widely and regularly accessed
by families in need that can serve as a fitting venue for child maltreatment
prevention initiatives.
(13)In the last
decade, behavioral issues have had an expanding presence in the portfolio of
services of CHCs. Seventy percent of CHCs have some, if minimal, on-site mental
health and substance abuse services. When demand exceeds capacity or on-site
services do not exist, CHCs refer individuals to off-site options.
(14)The integration
of behavioral health services in primary care settings is a promising
framework. Evaluation results of integrated care have shown—
(A)improvement in
service utilization, such as shorter waiting time and fewer sessions to
complete treatment;
(B)reduction in the
stigma related to mental health services; and
(C)improvement in
access to services.
(b)The
purposes of this Act are as follows:
(1)To fund the
implementation of a minimum of 10 demonstration projects of evidence-based and
promising parenting programs at federally qualified health centers.
(2)To provide
universal access to a family centered integrated and voluntary services model
that prevents child maltreatment and promotes family well-being and which may
include:
(A)implementation of
evidence-based preventive parenting skills training programs at health centers
or permanent or temporary residences of caregivers to strengthen the capacity
of parents to care for their children’s health and well-being and promote their
own ability to create safe, stable, nurturing family environments that protect
children and youth from abuse and neglect and its consequences and support
children’s optimal social, emotional, physical, and academic
development;
(B)screening to
identify parental risk factors such as depression, substance abuse, and
intimate partner violence that are associated with the likelihood that parents
will abuse or neglect their children, and to further develop screening methods
and instruments; and
(C)linkage with, and
referral to, on-site individualized quality mental health services provided by
trained mental health professionals for parents and caregivers screening
positive for child maltreatment risk factors to help them overcome the
impediments to effective parenting and change their behaviors toward child
rearing and parenting.
(3)To coordinate the
design and implementation of an evaluation plan to assess the impact and
feasibility of integrated services model implementation at each federally
qualified health center participating in the demonstration project for health
outcomes, cost effectiveness, patient satisfaction, program local adaptation,
reduction of child maltreatment and injuries, and improvement of parenting
behaviors and family functioning.
(4)To implement
critical system factors for successful implementation of the integrated
services model to prevent child maltreatment. Such factors include training of
a culturally and linguistically competent workforce, use of best available
technology, establishment of cooperation among FQHCs participating in the
demonstration project, and building internal and external buy-in and support
for the project.
(5)To coordinate the
design and implementation of the cross-site system-wide evaluation plan to
assess the impact and feasibility of an integrated services model on the
reduction of child maltreatment and injuries, to increase a family’s access to
services, to evaluate the effectiveness of the response of FQHCs organizational
systems to the model implemented, and to identify lessons learned and outline
recommendations for system-wide areas for improvement and changes.
3.In this Act:
(1)Federally
qualified health center or FQHCThe term federally
qualified health center or FQHC means an entity receiving a
grant under section 330 of the Public Health Service Act (42 U.S.C.
254b).
(2)The
term caregiver means an adult who is the primary caregiver,
including biological, adoptive, or foster parents, grandparents or other
relatives, and non-custodial parents who have an ongoing relationship, and
provides physical care for, 1 or more children under the age of 10. Caregivers
may be individuals who were born in, or outside of, the United States and
individuals whose main language is not English, including American Indians and
Alaska Natives. Caregivers may be heterosexual or homosexual, and may have
learning, physical, and other disabilities.
(3)Center-based
evidence-based preventive parenting skills programThe term
center-based evidence-based preventative parenting skills program
means research-based and proven, promising interventions provided and located
at a health center that—
(A)have the
potential for broad impact across multiple types of maltreatment, including
physical and psychological abuse and neglect;
(B)are associated
with effective parent behaviors and parenting practices and with reducing child
behavior problems;
(C)may be expected
to reduce child maltreatment rates; and
(D)may be
implemented at the FQHCs.
(4)The term home visitation program means an
evidence-based program in which trained professionals visit a caregiver in the
permanent or temporary residence of the caregiver, and provide a combination of
information, support, or training regarding child development, parenting
skills, and health-related issues.
(5)The term mental health services means
psychotherapeutic interventions offered at health centers, or off-site
locations in partnership with health centers, by mental health professionals to
caregivers that screen for or are referred for child maltreatment.
(6)The
term screening means a form of triage, using valid, culturally
sensitive tools such as scales or questionnaires applied universally by trained
professionals to identify caregivers who are at-risk for maltreating or
neglecting children. Screening assesses parental risks for child maltreatment
such as depression, substance abuse, and intimate partner violence.
4.Grants for
demonstration projects on integrated family centered preventive
services
(a)Demonstration
project grantsThe Secretary of Health and Human Services, acting
through the Director of the National Center for Injury Prevention and Control
of the Centers for Disease Control and Prevention, shall award competitive
grants to eligible federally qualified health centers to fund a minimum of 10
demonstration projects to promote—
(1)universal access
to family centered, evidence-based interventions in the FQHCs that prevent
child maltreatment by addressing parenting practices and skills; and
(2)behavioral health
and family well-being for families from diverse socioeconomic, cultural,
racial, and ethnic backgrounds, including addressing issues related to sexual
orientation and individuals with disabilities.
(b)To
be eligible to receive a grant under subsection (a), an entity shall—
(1)be a federally
qualified community health center; and
(2)submit to the
Secretary an application at such time, in such manner, and containing such
information as the Secretary may require.
(c)A federally qualified health center receiving a grant under
subsection (a) may use such funds to—
(1)conduct a needs
assessment for the demonstration project, including the need for proposed
integrated services, the number of caregivers involved, an organizational
assessment, workforce capacity and needs, and technological needs;
(2)use available
technologies to collect, organize, and provide access to health and mental
health information of patients, and to provide referrals, train staff, monitor
service delivery and outcomes, and create networking opportunities for on-site
providers and others in the community;
(3)adapt and
implement evidence-based parenting skills training programs for caregivers from
all backgrounds who use the health center for health care and child
well-visits, through on-site programs or programs operated at permanent or
temporary residences and administered, supervised, and monitored by trained
professionals employed by the FQHC;
(4)adapt instruments
and screen caregivers for child maltreatment risk factors such as depression,
substance abuse, and intimate partner violence, provided that such screening is
conducted by trained professionals employed by the FQHC;
(5)provide access to
mental health services to caregivers screened positive for child maltreatment
risk factors, which may include services offered at the health centers or at
off-site locations in partnership with the health centers, and which shall be
conducted by mental health professionals;
(6)promote models of
integrated care that involve behavioral health specialists and primary care
providers working collaboratively in integrated teams to deliver services that
prevent child maltreatment and promote family well-being;
(7)develop public
education campaigns to increase community awareness of the integrated services
offered by the health centers; and
(8)evaluate patient
satisfaction, project cost effectiveness, results of the integrated services
model, and effectiveness of evidence-based parenting programs in improving
parenting practices and reducing child abuse and neglect.
(d)A grant under subsection (a) shall be awarded for a period
not to exceed 5 years.
(e)Technical
assistance and project coordination
(1)The Secretary shall
award a contract to 1 or more eligible entities to provide—
(A)technical assistance and project
coordination for the recipients of grants under subsection (a);
(B)training for health care professionals,
including mental health care professionals, at FQHCs that receive grants under
subsection (a); and
(C)cross-site evaluation of the demonstration
projects under subsection (a).
(2)To be eligible to receive a contract under this section,
an entity shall—
(A)be—
(i)an
institution of higher education (as defined in section 101 of the Higher
Education Act of 1965 (20 U.S.C. 1001));
(ii)a
nonprofit organization that qualifies for tax exempt status under section
501(c)(3) of the Internal Revenue Code of 1986; or
(iii)such national
and professional organizations and community-based organizations as the
Secretary determines appropriate;
(B)have expertise in
parent-child relationships, parenting programs, prevention of child
maltreatment, the integration of behavioral health in primary and community
health center settings, and coordinating multi-site projects;
(C)demonstrate a
defined or proposed collaboration with purveyors of evidence-based child
maltreatment prevention interventions; and
(D)submit to the
Secretary an application that includes—
(i)an
outline of a technical assistance and coordination plan and timeline;
(ii)a
description of activities, services, and strategies to be used to reach out and
work with the FQHCs and others involved in the demonstration projects under
subsection (a); and
(iii)a
description of the evaluation methods and strategies the entity plans to use,
and an outline of the progress and final reports required under subsection
(f)(2).
(3)In
awarding contracts under this subsection, the Secretary shall give priority to
eligible entities whose applications under paragraph (2)(D) demonstrate that
the evaluation design of such eligible entity uses strong experimental designs
that capture a range of health and behavioral outcomes and include feasibility
evaluation of the integrated health-behavioral health services model. Such
evaluation designs should provide evaluation results that identify lessons
learned and generate recommendations for improvements and changes.
(4)Each recipient of a contract under this subsection
shall use such award to provide technical assistance to the FQHCs receiving a
grant under subsection (a) and to provide coordination and cross-site
evaluation of such demonstration projects to the Secretary. Such technical
assistance and coordination and cross-site evaluation may include—
(A)establishing and
implementing uniform tracking and monitoring systems across FQHCs participating
in the demonstration project, using the best available, highest level of
technological tools;
(B)developing and
implementing a cross-site, multi-level evaluation plan using rigorous research
and evaluation designs to evaluate the demonstration projects across
FQHCs;
(C)ensuring that, in
implementing the evidence-based parenting training programs, each such FQHC
follows standardized manuals and protocols, and ensuring effectiveness of the
integrated services of each FQHC in promoting positive stable, nurturing
parent-child relationships and preventing child maltreatment and
injuries;
(D)ensuring an
effective and feasible evaluation of the outcomes of the demonstration
projects, including an assessment of—
(i)improvement of
parent knowledge of child social, emotional, cognitive development;
(ii)improvement of
parent-child relationships;
(iii)parental use of
positive discipline methods and effective communication skills;
(iv)health outcomes
for children;
(v)reduction of
incidence of child maltreatment;
(vi)cost-effectiveness
of the demonstration projects;
(vii)implementation
that follows standardized manuals and protocols;
(viii)the
interdisciplinary collaborative model;
(ix)cultural
sensitivity and local adaptation of the projects;
(x)any
increase in access to services; and
(xi)further
improvements and changes needed at the FQHCs;
(E)establishing and
coordinating the implementation of a workforce development and training plan to
ensure that professionals working at the health centers, including physicians,
nurses, nurse practitioners, psychologists, social workers, physician's
assistants, clinical pharmacists, and others, are trained to participate in
interdisciplinary teams and work collaboratively to provide culturally
competent and linguistically sensitive integrated services to all caregivers
coming to such center, with a focus on the development and strengthening
of—
(i)knowledge of the
public health model, child development, family functioning, the problem of
child maltreatment, and methods of prevention;
(ii)core attitudes,
including the belief that child maltreatment is preventable, professionals have
a role in prevention, families are partners in preventing maltreatment, and
evaluation is a critical element of interventions;
(iii)ability to
conduct screenings, implement evidence-based parenting programs, provide mental
health services, and collaborate with evaluation efforts;
(iv)ability to
manage the site project, participate in interdisciplinary teams, work on
integrated efforts, and master technology for best results;
(v)the
knowledge, skills, and attitude to work with individuals from diverse cultural,
racial, ethnic, and other backgrounds; and
(vi)an
understanding of cross-field culture and language to effectively participate in
interdisciplinary teams and collaborate in integrated activities;
(F)educating and
involving the governing boards of FQHCs participating in the demonstration
projects in the integrated service efforts;
(G)promoting
partnerships with State and local institutions of higher education, community
networks, and professional associations for staff training and
recruitment;
(H)promoting
collaboration and networking among FQHCs participating in the demonstration
projects; and
(I)establishing and
coordinating child maltreatment prevention collaboratives across FQHCs
participating in the demonstration projects and helping such FQHCs partner with
local departments of child welfare and community mental health centers.
(5)
(A)Each recipient of a contract under this subsection shall
establish an advisory group. Each such advisory group shall provide feedback
and input to the contract recipient to ensure such recipient's effectiveness in
providing quality services.
(B)Each
such advisory group shall be composed of representatives of—
(i)national
organizations representing community health centers;
(ii)national
professional organizations representing professionals from various fields,
including pediatrics, nursing, psychology, and social work; and
(iii)government
agencies with relevant expertise, as determined by the Director of the National
Center for Injury Prevention and Control of the Centers for Disease Control and
Prevention.
(f)
(1)Demonstration
project reporting
(A)Annual progress
evaluation and financial reportingFor the duration of the grant
under subsection (a), each FQHC shall submit to the Secretary an annual
progress evaluation and financial reporting indicating activities conducted and
the progress of the health center toward achievement of established outcomes,
including cost effectiveness, patient satisfaction, program local adaptation,
reduction of child maltreatment and injuries, and improvement of parenting
behaviors and family functioning.
(B)At the end of the grant period, each FQHC shall submit a
final report with evaluation data analysis and conclusions related to the
outcomes of the demonstration project.
(2)Technical
assistance reporting
(A)Annual progress
and financial reportFor the duration of the contract under
subsection (e), each technical assistance provider shall submit to the
Secretary an annual progress and financial report indicating activities
conducted under such contract.
(B)At the end of the contract period, each recipient of a
technical assistance contract under subsection (e) shall submit to the
Secretary a final report that includes—
(i)an
analysis of comparative data related to effectiveness and feasibility of
projects implemented at the FQHCs, workforce training, and achievement of
outcomes at the FQHCs;
(ii)overall
recommendations for system improvement and changes that would allow the
demonstration projects to be expanded;
(iii)an outline of
the project results; and
(iv)a
plan that outlines opportunities and vehicles for the dissemination of
cross-site evalution results, findings, and recommendations.
(g)Authorization
of appropriations
(1)To carry out the demonstration project grant program
described in subsection (a), there are authorized to be appropriated
$10,000,000 for fiscal year 2012, and such sums as may be necessary for each of
fiscal years 2013 through 2016.
(2)The Secretary shall reserve not less than 10 percent
of the amounts appropriated under paragraph (1) to carry out the technical
assistance program described in subsection (e).