[Senate Report 109-250]
[From the U.S. Government Publishing Office]
Calendar No. 412
109th Congress Report
SENATE
2d Session 109-250
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INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT ACT OF 2006
_______
April 24, 2006.--Ordered to be printed
_______
Mr. McCain, from the Committee on Indian Affairs,submitted the
following
R E P O R T
[To accompany S. 2245]
The Committee on Indian Affairs, to which was referred the
bill (S. 2245) to establish an Indian youth telemental health
demonstration project, having considered the same, reports
favorably thereon without amendment and recommends that the
bill do pass.
PURPOSE
S. 2245 would authorize the Indian Youth Telemental Health
Demonstration Project, under which the Secretary of Health and
Human Services would award grants to five tribes and tribal
organizations with telehealth capabilities to use in youth
suicide prevention, intervention and treatment. The
demonstration project authorized under S. 2245 would permit the
use of telemental health for psychotherapy, psychiatric
assessments and diagnostic interviews of Indian youth; the
provision of clinical expertise and other medical advice to
frontline health care providers working with Indian youth;
training and related support for community leaders, family
members and health and education workers who work with Indian
youth; the development of culturally-relevant educational
materials on suicide prevention and intervention; and data
collection and reporting.
BACKGROUND
Several American Indian and Alaska Native communities
around the country have experienced clusters of youth suicide
completions and suicide attempts in recent years, including the
Standing Rock Sioux Tribe in North and South Dakota, the
Confederated Tribes of Grand Ronde of Oregon, the Cheyenne
River Sioux Tribe of South Dakota, the White Mountain Apache
Tribe of Arizona, the Jicarilla Apache Tribe of New Mexico, and
Native villages in western Alaska.
According to statistics collected by the Substance Abuse
and Mental Health Services Administration, suicide is the
second leading cause of death for American Indian and Alaska
Native youth between the ages of 15 and 24, following
unintentional injury and accidents. The rate of Indian youth
suicide on reservations is two and a half times higher than for
the rest of the country, with a rate that is 10 times higher
than the national average in the Northern Great Plains. More
than one-half of all persons who commit suicide in Indian
Country have never been seen by a mental health services
provider. In addition to the risk factors for completed suicide
of substance abuse and mental health disorders is the economic
depression and poverty of many reservation communities, the
lack of education and other opportunity, and the breakdown of
traditional family and community structures.
The Committee held two hearings on Indian youth suicide in
2005, including a field hearing in Bismarck, ND, and received
testimony from the Surgeon General of the United States, the
Director of the Indian Health Service, tribal elected
officials, Indian psychologists and health professionals, and
Indian parents and students, among others. The issue of Indian
youth suicide has also been discussed at Committee hearings on
Indian health services, child abuse prevention, and
methamphetamine use, production and distribution in Indian
Country. The suggested use of telecommunications technologies
to support such possible services as psychotherapy and
diagnostic interviews of Indian youth, and medical advice to
frontline health care providers working with Indian youth was
one of the several recommendations that came out of these
hearings.
LEGISLATIVE HISTORY
S. 2245 was introduced on February 6, 2006, by Senators
Dorgan, Conrad, Bingaman, Murkowski, McCain, Johnson and Smith,
and was referred to the Committee on Indian Affairs. On March
29, 2006, the Committee on Indian Affairs Committee convened a
business meeting to consider S. 2245 and other measures that
had been referred to it, and on that date ordered the bill
favorably reported.
SECTION-BY-SECTION ANALYSIS
Section 1. Short title
Section 1 states that the Act may be cited as the ``Indian
Youth Telemental Health Demonstration Project Act of 2006.''
Section 2. Findings and purpose
Section 2 sets forth seven findings about youth suicide for
Indians and Alaska Natives and its impact on tribal communities
which provide the reasons for this legislation. This section
also states that the purpose of this Act is to authorize the
Secretary to carry out a demonstration project to test the use
of telemental health services in suicide prevention,
intervention, and treatment of Indian youth.
Section 3. Definitions
Section 3 provides definitions for various terms used in
the Act.
Section 4. Indian Youth Telemental Health Demonstration Project
Section 4 authorizes the Secretary of Health and Human
Services to carry out a demonstration project to award grants
for the provision of telemental health services to Indian youth
who have expressed suicidal ideas; have attempted suicide; or
have mental health conditions that increase or could increase
the risk of suicide.
Subsection (a) provides that grants are to be awarded to
Indian tribes and tribal organizations that operate one or more
facilities located in Alaska and part of the Alaska Federal
Health Care Access Network; that report active clinical
telehealth capabilities; or that offer school-based telemental
health services relating to psychiatry to Indian youth.
The Secretary shall award grants under this section for a
period of up to 4 years, and not more than 5 grants shall be
provided. Priority consideration shall be given in the awarding
of grants to Indian tribes and tribal organizations that serve
a particular community or geographic area in which there is a
demonstrated need to address Indian youth suicide; enter into
collaborative partnerships with Indian Health Service (IHS) or
other tribal health programs or facilities to provide services
under this demonstration project; serve an isolated community
or geographic area which has limited or no access to behavioral
health services; or operate a detention facility at which
Indian youth are detained.
The bill is intended to provide services for counseling,
medical advice and training, and educational materials under
this new demonstration project to Indian youth living on
reservations and in Native villages, which are generally in
remote locations and quite isolated, and which experience much
more limited access to mental health services than are
available in the nation's cities.
Subsection (b) authorizes the specific use of funds. An
Indian tribe or tribal organization may use a grant to (1)
provide telemental health services to Indian youth, including
the provision of psychotherapy; psychiatric assessments and
diagnostic interviews, therapies for mental health conditions
predisposing to suicide, and treatment; and alcohol and
substance abuse treatment; (2) provide clinician-interactive
medical advice, guidance and training, assistance in diagnosis
and interpretation, crisis counseling and intervention, and
related assistance to IHS or tribal clinicians and health
services providers working with youth being served under the
demonstration project; (3) assist, educate, and train community
leaders, health education professionals and paraprofessionals,
tribal outreach workers, and family members who work with the
youth receiving telemental health services under the
demonstration project, including with identification of
suicidal tendencies, crisis intervention and suicide
prevention, emergency skill development, and building and
expanding networks among those individuals and with state and
local health services providers; (4) develop and distribute
culturally-appropriate community educational materials on
suicide prevention, suicide education, suicide screening,
suicide intervention, and ways to mobilize communities with
respect to the identification of risk factors for suicide; or
(5) conduct data collection and reporting relating to Indian
youth suicide prevention efforts.
Subsection (c) sets forth the application requirements and
information which must be submitted in order for an Indian
tribe or tribal organization to be eligible to receive a grant.
Subsection (d) requires the Secretary to ensure that the
demonstration project involves the use and promotion of the
traditional health care practices of the Indian tribes of the
youth to be served.
Subsection (e) directs the Secretary to encourage grantee
Indian tribes and tribal organizations to collaborate to enable
comparisons about best practices across projects.
Subsection (f) directs each grant recipient to submit to
the Secretary an annual report that describes the number of
telemental health services provided, and includes any other
information that the Secretary may require.
Subsection (g) directs the Secretary to submit a final
report to Congress not later than 270 days after the date of
termination of the demonstration project. That report will
describe the results of the projects funded by grants awarded
under this section, including any data available that indicate
the number of attempted suicides; evaluate the impact of the
telemental health services funded by the grants in reducing the
number of completed suicides among Indian youth; evaluate
whether the demonstration project should be expanded to provide
more than five grants and made a permanent program; and
evaluate the benefits of expanding the demonstration project to
include urban Indian health organizations.
Subsection (h) authorizes $1.5 million for each of fiscal
years 2007 through 2010 for the demonstration program.
COST AND BUDGETARY CONSIDERATIONS
The following cost estimate, as provided by the
Congressional Budget Office, dated April 18, 2006, was prepared
for S. 2245:
S. 2245--Indian Youth Telemental Health Demonstration Project Act of
2006
S. 2245 would direct the Indian Health Service to conduct a
demonstration project to examine the feasibility of using
information and communications technology to improve the
provision of suicide prevention services to Indian youths. As
many as five tribes or tribal organizations would be able to
participate in the project, with priority given to those tribes
or tribal organizations that have a demonstrated need to
address youth suicide or are located in remote areas. The bill
would authorize the appropriation of $1.5 million annually for
fiscal years 2007 through 2010 for the project.
CBO estimates that implementing S. 2245 would cost less
than $500,000 in 2007 and about $6 million over the 2007-2011
period, assuming the appropriation of the authorized amounts.
Enacting this bill would have no effect on direct spending or
revenues.
This legislation contains no intergovernmental or private-
sector mandates as defined in the Unfunded Mandates Reform Act
and would impose no costs on State, local, or tribal
governments.
The CBO staff contact for this estimate is Eric Rollins.
This estimate was approved by Peter H. Fontaine, Deputy
Assistant Director for Budget Analysis.
EXECUTIVE COMMUNICATIONS
The Committee has not received any executive communications
on S. 2245.
REGULATORY AND PAPERWORK IMPACT STATEMENT
Paragraph 11(b) of rule XXVI of the Standing Rules of the
Senate requires each report accompanying a bill to evaluate the
regulatory and paperwork impact that would be incurred in
carrying out the bill. The Committee believes that S. 2245 will
have a minimal impact on regulatory or paperwork requirements.
CHANGES IN EXISTING LAW
In compliance with subsection 12 of rule XXVI of the
Standing Rules of the Senate, the Committee states that the
enactment of S. 2245 will not result in changes in existing
law.