[House Report 116-540]
[From the U.S. Government Publishing Office]


116th Congress   }                                     {        Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                     {       116-540

======================================================================



 
             BEHAVIORAL INTERVENTION GUIDELINES ACT OF 2020

                                _______
                                

 September 29, 2020.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 3539]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3539) to amend the Public Health Service Act to 
direct the Secretary of Health and Human Services to develop 
best practices for the establishment and use of behavioral 
intervention teams at schools, and for other purposes, having 
considered the same, reports favorably thereon with an 
amendment and recommends that the bill as amended do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary..............................................3
 II. Background and Need for the Legislation..........................3
III. Committee Hearings...............................................4
 IV. Committee Consideration..........................................5
  V. Committee Votes..................................................5
 VI. Oversight Findings...............................................5
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures5
VIII.Federal Mandates Statement.......................................5

 IX. Statement of General Performance Goals and Objectives............6
  X. Duplication of Federal Programs..................................6
 XI. Committee Cost Estimate..........................................6
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......6
XIII.Advisory Committee Statement.....................................6

XIV. Applicability to Legislative Branch..............................6
 XV. Section-by-Section Analysis of the Legislation...................6
XVI. Changes in Existing Law Made by the Bill, as Reported............7

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Behavioral Intervention Guidelines Act 
of 2020''.

SEC. 2. BEST PRACTICES FOR BEHAVIORAL INTERVENTION TEAMS.

  The Public Health Service Act is amended by inserting after section 
520G of such Act (42 U.S.C. 290bb-38) the following new section:

``SEC. 520H. BEST PRACTICES FOR BEHAVIORAL INTERVENTION TEAMS.

  ``(a) In General.--The Secretary, acting through the Assistant 
Secretary, shall develop and periodically update--
          ``(1) best practices to assist elementary schools, secondary 
        schools, and institutions of higher education in establishing 
        and using behavioral intervention teams; and
          ``(2) a list of evidence-based threat assessment training 
        providers to assist personnel in elementary schools, secondary 
        schools, and institutions of higher education in implementing 
        such best practices, including with respect to training 
        behavioral intervention teams.
  ``(b) Elements.--The best practices under subsection (a)(1) shall 
include guidance on the following:
          ``(1) How behavioral intervention teams can operate 
        effectively from an evidence-based, objective perspective while 
        protecting the constitutional and civil rights of individuals, 
        including any individual of concern.
          ``(2) The use of behavioral intervention teams to identify 
        individuals of concern, implement interventions, and manage 
        risk through the framework of the school's or institution's 
        rules or code of conduct, as applicable.
          ``(3) How behavioral intervention teams can, when assessing 
        an individual of concern--
                  ``(A) seek training on evidence-based, threat-
                assessment rubrics;
                  ``(B) ensure that such teams--
                          ``(i) have adequately trained, diverse 
                        stakeholders with varied expertise; and
                          ``(ii) use cross validation by a wide-range 
                        of individual perspectives on the team; and
                  ``(C) use violence risk assessment.
          ``(4) How behavioral intervention teams can avoid--
                  ``(A) attempting to predict future behavior by the 
                concept of pre-crime;
                  ``(B) inappropriately using a mental health 
                assessment;
                  ``(C) inappropriately limiting or restricting law 
                enforcement's jurisdiction over criminal matters;
                  ``(D) attempting to substitute the behavioral 
                intervention process in place of a criminal process, or 
                impede a criminal process, when an individual of 
                concern's behavior has potential criminal implications;
                  ``(E) endangering an individual's privacy by failing 
                to ensure that all applicable Federal and State privacy 
                laws are fully complied with; or
                  ``(F) creating school-to-prison pipelines.
  ``(c) Consultation.--In carrying out subsection (a)(1), the Secretary 
shall consult with--
          ``(1) the Secretary of Education;
          ``(2) the Director of the National Threat Assessment Center 
        of the Department of Homeland Security;
          ``(3) the Attorney General of the United States; and
          ``(4) as appropriate, relevant stakeholders including--
                  ``(A) teachers and other educators, principals, 
                school administrators, school board members, school 
                psychologists, mental health professionals, and parents 
                of elementary school and secondary school students;
                  ``(B) local law enforcement agencies and campus law 
                enforcement administrators;
                  ``(C) mental health mobile crisis providers;
                  ``(D) child and adolescent psychiatrists; and
                  ``(E) other education and mental health 
                professionals.
  ``(d) Publication.--Not later than 2 years after the date of 
enactment of this section, the Secretary shall publish the best 
practices under subsection (a)(1) and the list under subsection (a)(2) 
on a publicly accessible website of the Department of Health and Human 
Services.
  ``(e) Technical Assistance.--The Secretary shall provide technical 
assistance to institutions of higher education, elementary schools, and 
secondary schools to assist such institutions and schools in 
implementing the best practices under subsection (a).
  ``(f) Definitions.--In this section:
          ``(1) The term `behavioral intervention team' means a team of 
        qualified individuals who--
                  ``(A) are responsible for identifying and assessing 
                individuals of concern; and
                  ``(B) develop and facilitate implementation of 
                evidence-based interventions to mitigate the threat of 
                harm to self or others posed by individuals of concern 
                and address the mental and behavioral health needs of 
                individuals of concern to reduce such threat.
          ``(2) The terms `elementary school', `parent', and `secondary 
        school' have the meanings given to such terms in section 8101 
        of the Elementary and Secondary Education Act of 1965 (20 
        U.S.C. 7801).
          ``(3) The term `individual of concern' means an individual 
        whose behavior indicates a potential threat to self or others.
          ``(4) The term `institution of higher education' has the 
        meaning given to such term in section 102 of the Higher 
        Education Act of 1965 (20 U.S.C. 1002).
          ``(5) The term `mental health assessment' means an 
        evaluation, primarily focused on diagnosis, determining the 
        need for involuntary commitment, medication management, and on-
        going treatment recommendations.
          ``(6) The term `pre-crime' means law-enforcement efforts and 
        strategies to deter crime by predicting when and where criminal 
        activity will occur.
          ``(7) The term `violence risk assessment' refers to a broad 
        determination of the potential risk of violence based on 
        evidence-based literature.''.

                         I. Purpose and Summary

    H.R. 3539, the ``Behavioral Intervention Guidelines Act of 
2020'', introduced by Representatives A. Drew Ferguson IV (R-
GA), Michael C. Burgess (R-TX), Joseph P. Kennedy III (D-MA), 
and Jimmy Panetta (D-CA) on June 27, 2019, requires the 
Substance Abuse and Mental Health Administration (SAMHSA) to 
develop best practices for schools to establish behavioral 
intervention teams and properly train them on how to intervene 
and avoid inappropriate use of mental health assessments and 
law enforcement. Not later than one year after enactment, those 
best practices shall be made publicly available on a website at 
the Department of Health and Human Services (HHS). The HHS 
Secretary (the Secretary) is also instructed to provide 
technical assistance to educational entities to assist in 
implementing such best practices.

              II. Background and Need for the Legislation

    According to the Centers for Disease Control and Prevention 
(CDC), about three in four children aged three to 17 years with 
depression also have anxiety and almost half have behavioral 
problems.\1\ Additionally, suicide is the second leading cause 
of death for young Americans between the age of 10 and 34.\2\ 
Recent data also show that among young people with mental 
health needs, more than 80 percent did not receive needed 
care.\3\ For those who did receive services, just 15 percent 
say they received mental health services in a school 
setting.\4\
---------------------------------------------------------------------------
    \1\Centers for Disease Control and Prevention, Children's Mental 
Health Data & Statistics (www.cdc.gov/childrensmentalhealth/data.html) 
(accessed September 18, 2020).
    \2\National Center for Health Statistics, Leading Causes of Death 
Reports, 1981-2018 (accessed September 19, 2020).
    \3\Substance Abuse and Mental Health Services Administration. Key 
substance use and mental health indicators in the United States: 
Results from the 2019 National Survey on Drug Use and Health (2020).
    \4\Id.
---------------------------------------------------------------------------
    The need to address mental health services and prevent 
suicide or other self-harm was raised in the testimony before 
the Committee of Arriana Gross, a high school student from 
Covington, Georgia, who said, ``[i]n our school, a year doesn't 
go by without a student dying by suicide. I've even known of 
elementary kids who died by suicide. I am concerned that youth 
suicide has become so common that my school community and our 
Nation is stuck in a pattern of mourning and accepting these 
deaths as something that is normal, instead of seeing them as 
preventable and tragic.''\5\ In addition to elementary and 
secondary school students, those in higher education are also 
experiencing high levels of emotional distress. The American 
College Health Association found in 2019 that over the past 
year, 87 percent of college students felt overwhelmed by all 
they had to do, 66 percent experienced severe anxiety, 56 
percent experienced feelings of hopelessness and 13 percent 
seriously considered suicide.\6\
---------------------------------------------------------------------------
    \5\House Committee on Energy and Commerce, Testimony of Arriana 
Gross, National Youth Advisory Board Member, Sandy Hook Promise 
Students Against Violence Everywhere (SAVE) Promise Club, Hearing on 
High Anxiety and Stress: Legislation to Improve Mental Health During 
Crisis, 116th Cong. (June 30, 2020).
    \6\American College Health Association, National College Health 
Assessment II (2019) (www.acha.org/documents/ncha/NCHA-
II_SPRING_2019_US_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf).
---------------------------------------------------------------------------
    This bill would help schools address mental health issues 
or self-harm of students by making available best practices for 
the proper use and implementation of behavioral intervention 
programs to support students and schools across the country. 
Behavioral intervention teams are multi-disciplinary teams that 
support students' mental health and emotional well-being by 
detecting patterns, trends, and disturbances in behavior, and 
by conducting outreach to students who are unable to manage 
distress in healthy and constructive ways. These teams are 
already active in some educational settings, such as at the 
University of California, Los Angeles,\7\ Texas A&M 
University,\8\ and Virginia Tech.\9\
---------------------------------------------------------------------------
    \7\UCLA Campus Human Resources, Behavioral Intervention Team, 
(www.chr.ucla.edu/behavioral-intervention-team) (accessed Sep. 28, 
2020).
    \8\Texas A&M University, Special Situations Team 
(tellsomebody.tamu.edu/sst/?_ga=2.152478009.1448536522.1600872225-
426169545.1600872225&_ga=2.152478009.1448536522.1600872225-
426169545.1600872225) (accessed Sep. 28, 2020).
    \9\Virginia Tech, Threat Assessment Team (threatassessment.vt.edu/) 
(accessed Sep. 28, 2020).
---------------------------------------------------------------------------

                        III. Committee Hearings

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress, the following hearing was used to develop or 
consider H.R. 3539:
    The Subcommittee on Health held a virtual legislative 
hearing on June 30, 2020, entitled, ``High Anxiety and Stress: 
Legislation to Improve Mental Health During Crisis.'' The 
hearing focused on H.R. 3539 and 21 other bills. The 
Subcommittee received testimony from the following witnesses:
           The Honorable Patrick J. Kennedy, Founder of 
        the Kennedy Forum and former Member of Congress
           Arthur C. Evans, Jr., Ph.D., Chief Executive 
        Officer, American Psychological Association;
           Jeffrey L. Geller, M.D., M.P.H., President, 
        American Psychiatric Association, Professor of 
        Psychiatry and Director of Public Sector Psychiatry at 
        the University of Massachusetts Medical School 
        Worcester Recovery Center and Hospital
           Arriana Gross, National Youth Advisory Board 
        Member, Sandy Hook Promise Students Against Violence 
        Everywhere (SAVE) Promise Club

                      IV. Committee Consideration

    Representatives Ferguson (R-GA), Burgess (R-TX), Kennedy 
(D-MA), and Panetta (D-CA) introduced H.R. 3539, the 
``Behavioral Intervention Guidelines Act of 2020'', on June 27, 
2019 and the bill was referred to the Committee on Energy and 
Commerce. The bill was then referred to the Subcommittee on 
Health on June 28, 2019. A legislative hearing was held on the 
bill on June 30, 2020.
    On September 9, 2020, H.R. 3539 was discharged from further 
consideration by the Subcommittee on Health as the bill was 
called up for markup by the full Committee on Energy and 
Commerce. The full Committee met in virtual open markup session 
on September 9, 2020, pursuant to notice, to consider H.R. 
3539. During consideration of the bill, a manager's amendment 
offered by Mr. Bilirakis of Florida was agreed to by a voice 
vote. Upon conclusion of consideration of the bill, the full 
Committee agreed to a motion on final passage by Mr. Pallone, 
Chairman of the committee, to order H.R. 3539 reported 
favorably to the House, amended, by a voice vote, a quorum 
being present.

                           V. Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
3539, including the motion for final passage of the bill.

                         VI. Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.
    The Committee has requested but not received from the 
Director of the Congressional Budget Office a statement as to 
whether this bill contains any new budget authority, spending 
authority, credit authority, or an increase or decrease in 
revenues or tax expenditures.

                    VIII. Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

       IX. Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to direct 
the Secretary of Health and Human Services to develop best 
practices for the establishment and use of behavioral 
intervention teams at schools, and for other purposes.

                   X. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 3539 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

                      XI. Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

    XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 3539 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                   XIII. Advisory Committee Statement

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                XIV. Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

           XV. Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the short title may be cited as 
the ``Behavioral Intervention Guidelines Act of 2020''.

Sec. 2. Best practice for behavioral intervention teams

    Section 2 amends the Public Health Service Act to create a 
new section 520H. In the new section, the Secretary of Health 
and Human Services, acting through the Assistant Secretary of 
Mental Health and Substance Use, must develop and periodically 
update best practices for establishing and using behavioral 
intervention teams in elementary schools, secondary schools, 
and institutions of higher education. The Secretary must also 
develop and periodically update a list of evidence-based threat 
assessment training providers to assist personnel in 
implementing such best practices and training of behavioral 
health intervention teams.
    The best practices developed by the Secretary must include: 
how behavioral intervention teams can operate effectively; how 
behavioral intervention teams can be appropriately utilized to 
identify individuals of concern, intervene, and manage risk; 
evidence-based training and threat assessment rubrics; and how 
behavioral intervention teams can avoid predicting future 
behavior, inappropriately using a mental health assessment or 
restricting law enforcement's jurisdiction over criminal 
matters, endangering an individual's privacy, or creating 
school-to-prison pipelines.
    The Secretary must consult with the Secretary of Education, 
the Director of the National Threat Assessment Center of the 
Department of Homeland Security, the Attorney General, and 
relevant stakeholders from education, mental health, and law 
enforcement backgrounds. Best practices developed under this 
section must be published not later than two years after 
enactment of this Act on a publicly accessible website. The 
Secretary of HHS is also instructed to provide technical 
assistance to educational entities to assist in implementing 
such best practices.
    The definition of a ``behavioral intervention team'' in 
this section means a team of qualified individuals who are 
responsible for identifying and assessing individuals of 
concern and who develop and facilitate the implementation of 
evidence-based interventions. The terms ``elementary school'', 
``parent'', and ``secondary school'' have the same meanings as 
under section 8101 of the Elementary and Secondary Education 
Act of 1965. The term ``individual of concern'' means an 
individual whose behavior indicates a potential threat to self 
or others. The term ``institution of higher education'' is 
consistent with the meaning under the Higher Education Act of 
1965. The term ``mental health assessment'' means an 
evaluation, primarily focused on diagnosis, determining the 
need for involuntary commitment, medication management, and on-
going treatment recommendations. The term ``pre-crime'' means 
law-enforcement efforts and strategies to deter crime by 
predicting when and where criminal activity will occur. The 
term ``violence risk assessment'' refers to a broad 
determination of the potential risk of violence based on 
evidence-based literature.''

       XVI. Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (new matter is 
printed in italics and existing law in which no change is 
proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT



           *       *       *       *       *       *       *
TITLE V--SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

           *       *       *       *       *       *       *


Part B--Centers and Programs

           *       *       *       *       *       *       *


Subpart 3--Center for Mental Health Services

           *       *       *       *       *       *       *


SEC. 520H. BEST PRACTICES FOR BEHAVIORAL INTERVENTION TEAMS.

  (a) In General.--The Secretary, acting through the Assistant 
Secretary, shall develop and periodically update--
          (1) best practices to assist elementary schools, 
        secondary schools, and institutions of higher education 
        in establishing and using behavioral intervention 
        teams; and
          (2) a list of evidence-based threat assessment 
        training providers to assist personnel in elementary 
        schools, secondary schools, and institutions of higher 
        education in implementing such best practices, 
        including with respect to training behavioral 
        intervention teams.
  (b) Elements.--The best practices under subsection (a)(1) 
shall include guidance on the following:
          (1) How behavioral intervention teams can operate 
        effectively from an evidence-based, objective 
        perspective while protecting the constitutional and 
        civil rights of individuals, including any individual 
        of concern.
          (2) The use of behavioral intervention teams to 
        identify individuals of concern, implement 
        interventions, and manage risk through the framework of 
        the school's or institution's rules or code of conduct, 
        as applicable.
          (3) How behavioral intervention teams can, when 
        assessing an individual of concern--
                  (A) seek training on evidence-based, threat-
                assessment rubrics;
                  (B) ensure that such teams--
                          (i) have adequately trained, diverse 
                        stakeholders with varied expertise; and
                          (ii) use cross validation by a wide-
                        range of individual perspectives on the 
                        team; and
                  (C) use violence risk assessment.
          (4) How behavioral intervention teams can avoid--
                  (A) attempting to predict future behavior by 
                the concept of pre-crime;
                  (B) inappropriately using a mental health 
                assessment;
                  (C) inappropriately limiting or restricting 
                law enforcement's jurisdiction over criminal 
                matters;
                  (D) attempting to substitute the behavioral 
                intervention process in place of a criminal 
                process, or impede a criminal process, when an 
                individual of concern's behavior has potential 
                criminal implications;
                  (E) endangering an individual's privacy by 
                failing to ensure that all applicable Federal 
                and State privacy laws are fully complied with; 
                or
                  (F) creating school-to-prison pipelines.
  (c) Consultation.--In carrying out subsection (a)(1), the 
Secretary shall consult with--
          (1) the Secretary of Education;
          (2) the Director of the National Threat Assessment 
        Center of the Department of Homeland Security;
          (3) the Attorney General of the United States; and
          (4) as appropriate, relevant stakeholders including--
                  (A) teachers and other educators, principals, 
                school administrators, school board members, 
                school psychologists, mental health 
                professionals, and parents of elementary school 
                and secondary school students;
                  (B) local law enforcement agencies and campus 
                law enforcement administrators;
                  (C) mental health mobile crisis providers;
                  (D) child and adolescent psychiatrists; and
                  (E) other education and mental health 
                professionals.
  (d) Publication.--Not later than 2 years after the date of 
enactment of this section, the Secretary shall publish the best 
practices under subsection (a)(1) and the list under subsection 
(a)(2) on a publicly accessible website of the Department of 
Health and Human Services.
  (e) Technical Assistance.--The Secretary shall provide 
technical assistance to institutions of higher education, 
elementary schools, and secondary schools to assist such 
institutions and schools in implementing the best practices 
under subsection (a).
  (f) Definitions.--In this section:
          (1) The term ``behavioral intervention team'' means a 
        team of qualified individuals who--
                  (A) are responsible for identifying and 
                assessing individuals of concern; and
                  (B) develop and facilitate implementation of 
                evidence-based interventions to mitigate the 
                threat of harm to self or others posed by 
                individuals of concern and address the mental 
                and behavioral health needs of individuals of 
                concern to reduce such threat.
          (2) The terms ``elementary school'', ``parent'', and 
        ``secondary school'' have the meanings given to such 
        terms in section 8101 of the Elementary and Secondary 
        Education Act of 1965 (20 U.S.C. 7801).
          (3) The term ``individual of concern'' means an 
        individual whose behavior indicates a potential threat 
        to self or others.
          (4) The term ``institution of higher education'' has 
        the meaning given to such term in section 102 of the 
        Higher Education Act of 1965 (20 U.S.C. 1002).
          (5) The term ``mental health assessment'' means an 
        evaluation, primarily focused on diagnosis, determining 
        the need for involuntary commitment, medication 
        management, and on-going treatment recommendations.
          (6) The term ``pre-crime'' means law-enforcement 
        efforts and strategies to deter crime by predicting 
        when and where criminal activity will occur.
          (7) The term ``violence risk assessment'' refers to a 
        broad determination of the potential risk of violence 
        based on evidence-based literature.

           *       *       *       *       *       *       *


                                  [all]