[Senate Report 110-43]
[From the U.S. Government Publishing Office]


                                                       Calendar No. 108
110th Congress                                                   Report
                                 SENATE
 1st Session                                                     110-43

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  TO ESTABLISH AN INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT

                                _______
                                

                 April 10, 2007.--Ordered to be printed

                                _______
                                

           Mr. Dorgan, from the Committee on Indian Affairs, 
                        submitted the following

                              R E P O R T

                         [To accompany S. 322]

    The Committee on Indian Affairs, to which was referred the 
bill (S. 322), to establish an Indian youth telemental health 
demonstration project, having considered the same, reports 
favorably thereon and recommends that the bill do pass.

                                PURPOSE

    S. 322 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. 322 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 Indians and Alaska 
Natives 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. 
Significant risk factors for suicide and suicide ideation exist 
in Indian communities, such as substance abuse and mental 
health disorders. Compounding these risk factors are other 
circumstances of life in Indian communities, including the 
economic depression and poverty of many reservation 
communities, the lack of education and other opportunities, and 
the breakdown of traditional family and community structures.
    During the 109th Congress, the Committee held three 
hearings on Indian youth suicide, including a field hearing in 
Bismarck, ND, and received testimony from the Surgeon General 
of the United States, the Administrator of the Substance Abuse 
and Mental Health Services Administration, the Director of the 
Indian Health Service, the Bureau of Indian Affairs' Deputy 
Director for Tribal Services, tribal elected officials, Indian 
psychologists and health professionals, and Indian parents and 
students. These hearings generated several recommendations, 
including the suggested use of telecommunications technologies 
to support services such as psychotherapy and diagnostic 
interviews of Indian youth, and medical advice to frontline 
health care providers working with Indian youth. The issue of 
Indian youth suicide was also discussed at Committee hearings 
in 2005 and 2006 on Indian health services, Indian child abuse 
prevention, and methamphetamine use, production and 
distribution in Indian Country.

                          LEGISLATIVE HISTORY

    S. 322 was introduced on January 17, 2007, by Senator 
Dorgan, for himself and Senators Murkowski, McCain, Conrad, 
Bingaman, Baucus, Smith and Inouye, and was referred to the 
Committee on Indian Affairs. Senator Thomas was added as a 
cosponsor on February 5, 2007. On February 8, 2007, the 
Committee on Indian Affairs convened a business meeting to 
consider S. 322 and other measures that had been referred to 
it, and ordered the bill favorably reported.

            COMMITTEE RECOMMENDATION AND TABULATION OF VOTE

    On February 8, 2007, the Committee on Indian Affairs 
convened a business meeting to consider S. 322. The Committee 
voted unanimously to have the measure favorably reported to the 
full Senate with the recommendation that the bill do pass.

                      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 2007.''

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 support 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 for 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 Alaska Native villages, which are generally 
in remote locations and quite isolated, and which experience 
much more limited access to mental health services than 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. In carrying out these 
purposes, an Indian tribe or tribal organization may use and 
promote the traditional health care practices of the Indian 
tribes of the youth to be served.
    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) directs the Secretary to encourage grantee 
Indian tribes and tribal organizations to collaborate to enable 
comparisons about best practices across projects.
    Subsection (e) 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 (f) 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 (g) authorizes $1.5 million for each of fiscal 
years 2008 through 2011 for the demonstration program.

                   COST AND BUDGETARY CONSIDERATIONS

    The following cost estimate, as provided by the 
Congressional Budget Office, dated March 1, 2007, was prepared 
for S. 322:

S. 322--Indian Youth Telemental Health Demonstration Project Act of 
        2007

    S. 322 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 2008 through 2011 for the project.
    CBO estimates that implementing S. 322 would cost less than 
$500,000 in 2008 and about $6 million over the 2008-2012 
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. 322.

               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. 322 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. 322 will not result in changes in existing law.

                                  
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