**National Steering Committee for the **

**Reauthorization of the**

**Indian Health Care Improvement Act, P.L. 94-437**

**TITLE VII \-- BEHAVIORAL HEALTH ~~SUBSTANCE ABUSE ~~PROGRAMS **

**DRAFT 1**

**For Review and Comment Only**

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| +----------------------------------------------------------------------+ |
| | **Indian Health Care Improvement Act (with DRAFT proposed            | |
| | amendments, if any)**                                                | |
| +----------------------------------------------------------------------+ |
|                                                                          |
| ***Comments and **Options***                                             |
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|                                                                          |
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**TITLE VII -- [BEHAVIORAL HEALTH]{.underline} ~~SUBSTANCE ABUSE~~
PROGRAMS**

  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --
  *This Title has been substantially rewritten to combine Mental Health (formerly Sec. 209), Alcohol and Substance Abuse (originally in Title VII) and several behavioral health sections which were formerly in Title VIII. Throughout, provisions have ben added to clarify that programs are subject to contracting and compacting by tribes and tribal organizations. Similarly, consultation requirements have been added. Urban Indian organizations are not included in the provisions of this title except in regard to planning and consultation functions.*   
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --

**~~\[NOTE: P.L. 101-630 included a free-standing provision affecting
section 209, ~~~~Indian Mental Health provisions. This language has been
provided below for ~~~~easy reference\]~~**

**{MENTAL HEALTH PREVENTION AND TREATMENT SERVICES**

**(a) PURPOSES.--The purposes of this section are to--**

**(1) authorize and direct the [Secretary, acting through the
]{.underline}Indian Health Service[, tribes, and tribal and Indian
organizations]{.underline} to develop a comprehensive ~~mental~~
[behavioral ]{.underline}health prevention and treatment program [which
emphasizes collaboration between alcohol and substance abuse, social
]{.underline}[services, and]{.underline} [mental health]{.underline};**

**(2) provide direction and guidance relating to mental illness and
dysfunction and self-destructive behavior, including child abuse and
family violence, to those Federal, tribal, State and local agencies
responsible for programs in Indian communities in areas of health care,
education, social services, child and family welfare, alcohol and
substance abuse, law enforcement and judicial services;**

**(3) assist Indian tribes to identify services and resources available
to address mental illness and dysfunctional and self-destructive
behavior;**

**(4) provide authority and opportunities for Indian tribes to develop
and implement, and coordinate with, community-based ~~mental health
~~programs which include identification, prevention, education,
referral, and treatment services, including through multi-disciplinary
resource teams;**

**(5) ensure that Indians, as citizens of the United States and of the
States in which they reside, have the same access to ~~mental~~
[behavioral]{.underline} health services to which all citizens have
access; and**

  ----------------------------------------------------------------------------------------------------------- --
  **(6) modify or supplement existing programs and authorities in the areas identified in paragraph (2).}**   
                                                                                                              
  ----------------------------------------------------------------------------------------------------------- --

**BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES**

**Sec. [701]{.underline} ~~209~~. **(a) **[BEHAVIORAL HEALTH
PLANNING]{.underline}** ~~National Plan for Indian Mental Health
Services~~.---

\(1\) ~~Not later than 120 days after the date of enactment of this
section, t~~ [T]{.underline}he Secretary, acting through the Service[,
tribes and tribal organizations, and urban Indian
organizations]{.underline}, shall [encourage tribes and tribal
organizations to develop tribal plans, and urban Indian organizations to
develop local plans and for all such groups to participate in developing
Area-wide]{.underline} ~~develop and publish in the Federal Register, a
final national~~ plan[s]{.underline} for Indian [Behavioral]{.underline}
~~Mental~~ Health Services. The plan[s]{.underline} shall include[, to
the extent feasible, the following components]{.underline} --

\(A\) an assessment of the scope of the problem of [alcohol and/or other
substance abuse,]{.underline} mental illness[,]{.underline} ~~and~~
dysfunctional and self-destructive behavior, including [suicide
and]{.underline} child abuse and family violence, among Indians,
including--

\(i\) the number of Indians served ~~by the Service~~ who are directly
or indirectly affected by such illness or behavior, and

\(ii\) an estimate of the financial and human cost attributable to such
illness or behavior;

\(B\) an assessment of the existing and additional resources necessary
for the prevention and treatment of such illness and behavior[,
including an assessment of the progress toward achieving the
availability of the full continuum of care described in (b) of this
section]{.underline}; and

\(C\) an estimate of the additional funding needed by the Service[,
tribes, and tribal organizations and urban Indian
organizations]{.underline} to meet ~~its~~ [their]{.underline}
responsibilities under the plan[s]{.underline}.

[(2) The Secretary shall establish a national clearinghouse of plans and
reports on the outcomes of such plans developed by tribes, tribal
organizations and by Areas relating to Behavioral Health. The Secretary
shall ensure access to these plans and outcomes by any Indian tribe,
tribal organization, urban organization or the Service.]{.underline}

~~(2) The Secretary shall submit a copy of the national plan to the
Congress by January 2, 2001.~~

\(3\) [The Secretary shall provide technical assistance to tribes and
tribal and Indian organizations in preparation of their plans and in
developing standards of care that may be utilized and adopted
locally]{.underline}.

~~(3) The Secretary shall submit an evaluation of the national plan,
based on the health status goals and outcome measures identified in
section 3(b), to the Congress every three years following the enactment
of this Act.~~

+----------------------------------------------------------------------+
|   --                                                                 |
|   --                                                                 |
|                                                                      |
| *This section has been broadened to include all behavioral health    |
| disciplines. The National Plan has been deleted as too costly and    |
| ineffective, and local tribal and Area plans have been encouraged in |
| its place. In lieu of the National Plan, the Secretary is required   |
| to establish a national clearinghouse for local and Area plans and   |
| their outcomes which will be available to all tribes. This section   |
| also sets out a lengthy list or definition of the continuum of care  |
| that should be available.*                                           |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**[(b) CONTINUUM OF CARE.]{.underline}[---]{.underline}**[ The
Secretary, acting through the Service, tribes and tribal organizations,
shall provide, to the extent feasible and funding is available, programs
including---]{.underline}

[(1) a comprehensive continuum of behavioral health care which
provides:]{.underline}

[(A) community based prevention, intervention, outpatient and behavioral
health aftercare;]{.underline}

[(B) detoxification (social and medical);]{.underline}

[(C) acute hospitalization;]{.underline}

[(D) intensive outpatient/day treatment;]{.underline}

[(E) residential treatment;]{.underline}

[(F) transitional living for those needing a temporary stable living
environment that is supportive of treatment/recovery goals;]{.underline}

[(G) emergency shelter.]{.underline}

[(2) behavioral health services by the following services and
populations:]{.underline}

[(A) Child Behavioral Health Services for persons through age 17,
including:]{.underline}

[(i) Pre-school and school age fetal alcohol disorders services,
including assessment and behavioral intervention);]{.underline}

[(ii) Mental health/substance abuse services (emotional, alcohol, drug,
inhalant and tobacco);]{.underline}

[(iii) Co-occurring disorders (dual diagnosis);]{.underline}

[(iv) Prevention focused on ages 5 -- 10 (alcohol, drug, inhalant and
tobacco);]{.underline}

[(v) Early intervention, treatment and aftercare focused on ages 11 --
17;]{.underline}

[(vi) Healthy choices/life style (related to STD's, domestic violence,
sexual abuse; suicide, teen pregnancy, obesity, and other risk/safety
issues);]{.underline}

[(vii) Co-morbidity.]{.underline}

[(B) Adult Behavioral Health Services (age 18 -- 55);]{.underline}

[(i) Early intervention, treatment and aftercare]{.underline}

[(ii) Mental health/Substance abuse services (emotional, alcohol, drug,
inhalant and tobacco)]{.underline}

[(iii) Co-occurring disorders (dual diagnosis) and
coo-morbidity;]{.underline}

[(iv) Healthy choices/Life style (related to parenting, partners,
domestic violence, sexual abuse, suicide, obesity, and other risk
related behavior)]{.underline}

[(v) Women specific:]{.underline}

[(I) Treatment services for women at risk of giving birth to an Alcohol
Related Birth Defect (ARBD) child;]{.underline}

[(II) Treatment for substance abuse requiring sex specific
services;]{.underline}

[(III) Treatment for sexual assault and domestic violence;]{.underline}

[(IV) Healthy choices/Life style (parenting, partners, obesity, suicide
and other related behavioral risk);]{.underline}

[(vi) Men specific:]{.underline}

[(I) Treatment for substance abuse requiring sex specific
services;]{.underline}

[(II) Treatment for sexual assault and domestic violence;]{.underline}

[(III) Healthy choices/Life style (parenting, partners, obesity, suicide
and other risk related behavior);]{.underline}

[(C) Family Behavioral Health Services:]{.underline}

[(i) Early intervention, treatment and aftercare for effected
families;]{.underline}

[(ii) Treatment for sexual assault and domestic violence;]{.underline}

[(iii) Healthy choices/Life style (related to parenting, partners,
domestic violence and other abuse issues);]{.underline}

[(D) Elder Behavioral Health Services (age 56 and above):]{.underline}

[(i) Early intervention, treatment and aftercare;]{.underline}

[(I) Mental health/Substance abuse services (emotional, alcohol, drug,
inhalant and tobacco)]{.underline}

[(II) Co-occurring disorders (dual diagnosis) and
co-morbidity;]{.underline}

[(III) Healthy choices/Life style (managing conditions related to
aging);]{.underline}

[(ii) Elder women specific:]{.underline}

[(I) Treatment for substance abuse requiring sex specific
services]{.underline}

[(II) Treatment for sexual assault, domestic violence and
neglect;]{.underline}

[(iii) Elder men specific:]{.underline}

[(I) Treatment for substance abuse requiring sex specific
services;]{.underline}

[(II) Treatment for sexual assault, domestic violence and
neglect;]{.underline}

  ---------------------------------------------------
  [(iv) Dimentias regardless of cause.]{.underline}
  ---------------------------------------------------

*Section 209(b), \[Mental Health\] Memorandum of Agreement, has been
merged into the amended former Section 701 \[Substance Abuse\] Indian
Health Services Responsibilities, now Section 702.*

  ---------------------------------------------------------------------------------
  *Issue: should we include language about extent to which funding is available?*
  ---------------------------------------------------------------------------------

**(c) COMMUNITY [BEHAVIORAL]{.underline} ~~MENTAL~~ HEALTH PLAN.\--**
(1) The governing body of any Indian tribe [or tribal organization or
urban Indian organization]{.underline} may, at its discretion, adopt a
resolution for the establishment of a community [behavioral]{.underline}
~~mental~~ health plan providing for the identification and coordination
of available resources and programs to identify, prevent, or treat
[alcohol and other substance abuse,]{.underline} mental illness or
dysfunctional and self-destructive behavior, including child abuse and
family violence, among its members [and/or its service
population]{.underline}. [This plan should include, but not be limited
to, behavioral health services, social services, intensive outpatient
services, and continuing after care.]{.underline}

\(2\) In furtherance of a plan established pursuant to paragraph (1) and
at the request of a tribe, the appropriate agency, service unit, or
other officials of the Bureau of Indian Affairs and the Service shall
cooperate with, and provide technical assistance to, the tribe[ or
tribal organization]{.underline} in the development of such plan. Upon
the establishment of such a plan and at the request of the tribe[ or
tribal organization]{.underline}, such officials~~, as directed by the
memorandum of agreement developed pursuant to subsection (c),~~ shall
cooperate with the tribe [or tribal organization]{.underline} in the
implementation of such plan.

~~(3) Two or more Indian tribes may form a coalition for the adoption of
resolutions and the establishment and development of a joint community
[behavioral]{.underline} mental health plan under this subsection [and
such a tribal organization shall be ]{.underline}[entitled to support
that would otherwise be made available to an Indian tribe under
]{.underline}[paragraph (2)]{.underline}.~~

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| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
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| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | -------- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | ----- -- |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | |          |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | *Section |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | 209(d),  |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | Mental   |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | Health   |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | Training |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | and      |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | C        |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | ommunity |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | E        |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | ducation |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | P        |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | rograms, |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | has been |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | moved to |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | Title I  |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | as new   |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | section  |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | | 125.*    |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | +----------+   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | |          |   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | +----------+   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | |                |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | **[(d)         |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | COORDINATED    |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | PLANNING.]{    |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | .underline}**[ |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | The Secretary, |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | acting through |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | the Service,   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | tribes and     |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | tribal         |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | organizations, |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | shall          |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | coordinate     |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | behavioral     |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | health         |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | planning, to   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | the extent     |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | feasible, with |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | other Federal  |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | agencies and   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | with State     |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | agencies, to   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | encourage      |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | comprehensive  |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | behavioral     |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | health         |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | services are   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | available to   |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | Indians        |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | without regard |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | to their place |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | of             |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | residence      |   |   |   |   |   |   |   |   |   |
| | | | | | | | | | .]{.underline} |   |   |   |   |   |   |   |   |   |
| | | | | | | | | +----------------+   |   |   |   |   |   |   |   |   |
| | | | | | | | |                      |   |   |   |   |   |   |   |   |
| | | | | | | | | *Section 814, Infant |   |   |   |   |   |   |   |   |
| | | | | | | | | and Maternal         |   |   |   |   |   |   |   |   |
| | | | | | | | | Mortality; Fetal     |   |   |   |   |   |   |   |   |
| | | | | | | | | Alcohol Syndrome,    |   |   |   |   |   |   |   |   |
| | | | | | | | | also required        |   |   |   |   |   |   |   |   |
| | | | | | | | | planning to achieve  |   |   |   |   |   |   |   |   |
| | | | | | | | | certain health       |   |   |   |   |   |   |   |   |
| | | | | | | | | objectives. It has   |   |   |   |   |   |   |   |   |
| | | | | | | | | been deleted in      |   |   |   |   |   |   |   |   |
| | | | | | | | | favor of the         |   |   |   |   |   |   |   |   |
| | | | | | | | | national health      |   |   |   |   |   |   |   |   |
| | | | | | | | | objectives in        |   |   |   |   |   |   |   |   |
| | | | | | | | | Section 3 and the    |   |   |   |   |   |   |   |   |
| | | | | | | | | other planning       |   |   |   |   |   |   |   |   |
| | | | | | | | | processes required   |   |   |   |   |   |   |   |   |
| | | | | | | | | by Section 701.*     |   |   |   |   |   |   |   |   |
| | | | | | | | +----------------------+   |   |   |   |   |   |   |   |
| | | | | | | | |                      |   |   |   |   |   |   |   |   |
| | | | | | | | +----------------------+   |   |   |   |   |   |   |   |
| | | | | | | |                            |   |   |   |   |   |   |   |
| | | | | | | | *Sections 209(e) Staffing, |   |   |   |   |   |   |   |
| | | | | | | | (f) Staff Recruitment and  |   |   |   |   |   |   |   |
| | | | | | | | Retention, and (g) Mental  |   |   |   |   |   |   |   |
| | | | | | | | Health Technician Program, |   |   |   |   |   |   |   |
| | | | | | | | have been moved to Title I |   |   |   |   |   |   |   |
| | | | | | | | as a new section 126.*     |   |   |   |   |   |   |   |
| | | | | | | +----------------------------+   |   |   |   |   |   |   |
| | | | | | | |                            |   |   |   |   |   |   |   |
| | | | | | | +----------------------------+   |   |   |   |   |   |   |
| | | | | | |                                  |   |   |   |   |   |   |
| | | | | | | *Section 209(h), Mental Health   |   |   |   |   |   |   |
| | | | | | | Research, has been moved within  |   |   |   |   |   |   |
| | | | | | | this Title as a new section.*    |   |   |   |   |   |   |
| | | | | | +----------------------------------+   |   |   |   |   |   |
| | | | | | |                                  |   |   |   |   |   |   |
| | | | | | +----------------------------------+   |   |   |   |   |   |
| | | | | |                                        |   |   |   |   |   |
| | | | | | **[(e) ]{.underline}~~(i)~~ FACILITIES |   |   |   |   |   |
| | | | | | ASSESSMENT.--** Within one year after  |   |   |   |   |   |
| | | | | | the date of enactment of this section, |   |   |   |   |   |
| | | | | | the Secretary, acting through the      |   |   |   |   |   |
| | | | | | Service, shall make an assessment of   |   |   |   |   |   |
| | | | | | the need for inpatient mental health   |   |   |   |   |   |
| | | | | | care among Indians and the             |   |   |   |   |   |
| | | | | | availability and cost of inpatient     |   |   |   |   |   |
| | | | | | mental health facilities which can     |   |   |   |   |   |
| | | | | | meet such need. In making such         |   |   |   |   |   |
| | | | | | assessment, the Secretary shall        |   |   |   |   |   |
| | | | | | consider the possible conversion of    |   |   |   |   |   |
| | | | | | existing, under-utilized service       |   |   |   |   |   |
| | | | | | hospital beds into psychiatric units   |   |   |   |   |   |
| | | | | | to meet such need.                     |   |   |   |   |   |
| | | | | +----------------------------------------+   |   |   |   |   |
| | | | |                                              |   |   |   |   |
| | | | | *Section 209(i) Facilities Assessment is     |   |   |   |   |
| | | | | incorporated in this section as subsection   |   |   |   |   |
| | | | | (e)*                                         |   |   |   |   |
| | | | +----------------------------------------------+   |   |   |   |
| | | | |                                              |   |   |   |   |
| | | | +----------------------------------------------+   |   |   |   |
| | | |                                                    |   |   |   |
| | | | *Section 209(j) Annual Report, has been merged     |   |   |   |
| | | | into a new section regarding other reports.*       |   |   |   |
| | | +----------------------------------------------------+   |   |   |
| | | |                                                    |   |   |   |
| | | +----------------------------------------------------+   |   |   |
| | |                                                          |   |   |
| | | *Section 209(k), Mental Health Demonstration Grant       |   |   |
| | | Program, has been made into its own new section.*        |   |   |
| | +----------------------------------------------------------+   |   |
| | |                                                          |   |   |
| | +----------------------------------------------------------+   |   |
| |                                                                |   |
| | *Section 209(l), Licensing Requirement for Mental Health Care  |   |
| | Workers, has been moved to Title I as a new section 128.*      |   |
| +----------------------------------------------------------------+   |
| |                                                                |   |
| +----------------------------------------------------------------+   |
|                                                                      |
| *Section 209(m), Intermedicate Adolescent Mental Health Services,    |
| has been moved to a new section 705(c).*                             |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

~~(b)~~ **MEMORAND[A]{.underline} ~~UM~~ OF AGREEMENT [WITH THE
DEPARTMENT OF ]{.underline}[THE INTERIOR]{.underline} ~~.~~~~--~~**

**[Sec. 702.]{.underline}** [(a)]{.underline}Not later than 180 days
after the date of enactment of this section, the Secretary and the
Secretary of the Interior shall develop and enter into ~~a~~
memorand[a]{.underline} ~~um~~ of agreement[, or review and update any
existing memoranda of agreement, as required by section 4205 of the
Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986
(25 U.S.C. 2411) and]{.underline} under which the Secretaries
[address]{.underline} ~~shall, among other things~~-

\(1\) ~~determine and define~~ the scope and nature of mental illness
and dysfunctional and self-destructive behavior, including child abuse
and family violence, among Indians;

\(2\) ~~make an assessment of~~ the existing Federal, tribal, State,
local, and private services, resources, and programs available to
provide mental health services for Indians;

\(3\) ~~make an initial determination of~~ the unmet need for additional
services, resources, programs necessary to meet the needs identified
pursuant to paragraph (1);

(4)(A) [the right of]{.underline} ~~ensure that~~ Indians, as citizens
of the United States and of the States in which they reside,
[to]{.underline} have access to mental health services to which all
citizens have access;

\(B\) ~~determine~~ the right of Indians to participate in, and receive
the benefit of, such services; and

\(C\) take actions necessary to protect the exercise of such right;

\(5\) ~~delineate~~ the responsibilities of the Bureau of Indian Affairs
and the Service, including mental health identification, prevention,
education, referral, and treatment services (including services through
multi disciplinary resource teams), at the central, area, and agency and
service unit levels to address the problems identified in paragraph (1);

\(6\) ~~provide~~ a strategy for the comprehensive coordination of the
mental health services provided by the Bureau of Indian Affairs an the
Service to meet the needs identified pursuant to paragraph (1),
including--

\(A\) the coordination of alcohol and substance abuse programs of the
Service, the Bureau of Indian Affairs, and the various tribes (developed
under the Indian Alcohol and Substance Abuse Prevention and Treatment
Act of 1986) with the mental health initiatives pursuant to this Act,
particularly with respect to the referral and treatment of
dually-diagnosed individuals requiring mental health and substance abuse
treatment; and

\(B\) ensuring that the Bureau of Indian Affairs and Service programs
and services (including multi-disciplinary resource teams) addressing
child abuse and family violence are coordinated with such non-Federal
programs and services;

\(7\) direct appropriate officials of the Bureau of Indian Affairs and
the Service, particularly at the agency and service unit levels to
cooperate fully with tribal requests made pursuant to [community
behavioral health plans adopted under section 701(c)]{.underline}
~~subsection (d)~~ [and Section 4206 of the Indian Alcohol and Substance
Abuse Prevention and Treatment Act of 1986 (25 U.S.C. §
2412)]{.underline}; and

+----------------------------------------------------------------------+
|   ----------                                                         |
| -------------------------------------------------------------------- |
|   \(8\) pr                                                           |
| ovide for an annual review of such agreement by the two Secretaries. |
|   ----------                                                         |
| -------------------------------------------------------------------- |
|                                                                      |
| *This section merges subsection (b) of Section 209, Mental Health    |
| Prevention and Treatment Services, with former Section 701, Indian   |
| Health Services Responsibilities. The objective of the amendment is  |
| to combine these requirements and to ensure that the agencies update |
| their Agreements. The specific requirements of former Section 701    |
| are found in the new Section 702(b).*                                |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**~~INDIAN HEALTH SERVICE RESPONSIBILITIES~~ **

** ~~SEC. 701.~~** [(b)]{.underline} The Memorand[a]{.underline} ~~um~~
of Agreement [updated or]{.underline} entered into pursuant to
[sub]{.underline}section [(a)]{.underline} ~~4205 of the Indian Alcohol
and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C.
2411)~~ shall include specific provisions pursuant to which the Service
shall assume responsibility for\--

\(1\) the determination of the scope of the problem of alcohol and
substance abuse among Indian people, including the number of Indians
within the jurisdiction of the Service who are directly or indirectly
affected by alcohol and substance abuse and the financial and human
cost;

\(2\) an assessment of the existing and needed resources necessary for
the prevention of alcohol and substance abuse and the treatment of
Indians affected by alcohol and substance abuse; and

  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --
  \(3\) an estimate of the funding necessary to adequately support a program of prevention of alcohol and substance abuse and treatment of Indians affected by alcohol and substance abuse.   
                                                                                                                                                                                              
  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --

**[(c) CONSULTATION.]{.underline}[---]{.underline}[ ]{.underline}**[The
Secretary and the Secretary of the Interior shall in developing the
Memoranda of Agreement under subsection (a) of this section consult with
and solicit the comments of---]{.underline}

[(1) interested Indian tribes and tribal organizations,]{.underline}

[(2) Indian individuals;]{.underline}

[(3) Indian organizations;]{.underline}

[(4) behavioral health service providers.]{.underline}

+----------------------------------------------------------------------+
|   ------                                                             |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   **[(                                                               |
| d) PUBLICATION.]{.underline}[---]{.underline}**[ The Memoranda of Ag |
| reement under subsection (a) of this section shall be published in t |
| he Federal Register not later than one year after the enactment of t |
| his Act. At the same time as publication in the Federal Register, th |
| e Secretary of the Interior shall provide a copy of such Memoranda t |
| o each Indian tribe and tribal and Indian organization.]{.underline} |
|   ------                                                             |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *These subsections are modeled after subsections (c) and (d) of the  |
| Indian Alcohol and Substance Abuse Prevention and Treatment Act of   |
| 1986.*                                                               |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**~~INDIAN HEALTH SERVICE PROGRAM~~ **

**COMPREHENSIVE [BEHAVIORAL HEALTH]{.underline} PREVENTION **

** AND TREATMENT PROGRAM.\--**

**SEC. [703]{.underline} ~~702~~.** (a)(1) The Secretary, acting through
the Service[, tribes and tribal organizations]{.underline}, [consistent
with Section 701,]{.underline} shall provide a program of comprehensive
[behavioral health]{.underline} ~~alcohol and substance abuse~~
prevention and treatment[, including Traditional practices,
]{.underline}which shall include\--

\(A\) prevention, through educational intervention, in Indian
communities;

\(B\) acute detoxification and[/or psychiatric hospitalization
and]{.underline} treatment [(residential and intensive
outpatient)]{.underline};

\(C\) community-based rehabilitation;

\(D\) community education and involvement, including extensive training
of health care, educational, and community-based personnel; and

\(E\) [specialized]{.underline} residential treatment programs for [high
risk populations, including but not limited to ]{.underline}pregnant and
post partum women and their children.

\(2\) The target population of such program shall be members of Indian
tribes. Efforts to train and educate key members of the Indian community
shall target employees of health, education, judicial, law enforcement,
legal, and social service programs.

\(b\) **CONTRACT HEALTH SERVICES.\--**(1) The Secretary, acting through
the Service [(with the consent of the tribe to be served)]{.underline},
[tribes and tribal organizations,]{.underline} may[,]{.underline} enter
into contracts with public or private providers of ~~alcohol and
substance abuse~~ [behavioral health ]{.underline} treatment services
for the purpose of assisting the Service in carrying out the program
required under subsection (a).

+----------------------------------------------------------------------+
| +----------------------------------------------------------------+   |
| |   -------------------------------------------------            |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| |   \(2\) In carrying out this subsection, the Secr              |   |
| | etary shall provide assistance to Indian tribes [and tribal or |   |
| | ganizations]{.underline} to develop criteria for the certifica |   |
| | tion of alcohol and substance abuse service providers and accr |   |
| | editation of service facilities which meet minimum standards f |   |
| | or such services and facilities as may be determined pursuant  |   |
| | to section 4205(a)(3) of the Indian Alcohol and Substance Abus |   |
| | e Prevention and Treatment Act of 1986 (25 U.S.C. 2411(a)(3)). |   |
| |   -------------------------------------------------            |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| |                                                                |   |
| | *Revisions have been made to clarify that tribes and tribal    |   |
| | organizations can provide these services and to include        |   |
| | Traditional health practices. The section has been expanded to |   |
| | include functions which tribes believe are necessary as part   |   |
| | of this program.*                                              |   |
| +----------------------------------------------------------------+   |
| |                                                                |   |
| +----------------------------------------------------------------+   |
|                                                                      |
| *Section 702(c), Grants for Model Program (Standing Rock Sioux       |
| Tribe), is moved to a new section in this Title.*                    |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**INDIAN WOMEN TREATMENT PROGRAMS **

**SEC. [704]{.underline} ~~703~~. **(a) The Secretary[, consistent with
Section 701, shall]{.underline} ~~may~~ make [funding
available]{.underline} ~~grants~~ to Indian tribes and tribal
organizations to develop and implement a comprehensive [behavioral
health]{.underline} ~~alcohol and substance abuse~~ program of
prevention, intervention, treatment, and relapse prevention services
that specifically addresses the [spiritual,]{.underline} cultural,
historical, social, and child care needs of Indian women, regardless of
age.

\(b\) [Funding]{.underline} ~~Grants~~ made [available]{.underline}
pursuant to this section may be used to\--

(1)develop and provide community training, education, and prevention
programs for Indian women relating to [behavioral health issues,
including]{.underline} ~~alcohol and substance abuse issues, including~~
fetal alcohol [disorders]{.underline} ~~syndrome and fetal alcohol
effect~~;

(2)identify and provide ~~appropriate~~ counseling, advocacy, support,
and relapse prevention to Indian women and their families; and

(3)develop prevention and intervention models for Indian women which
incorporate Traditional ~~[healers]{.underline}~~[
practices]{.underline}, cultural values, and community and family
involvement.

+----------------------------------------------------------------------+
|   ----------------------------------------                           |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   \(c\) The Secretary[, in consultation                              |
| with tribes and tribal organizations]{.underline}, shall establish c |
| riteria for the review and approval of applications [and proposals]{ |
| .underline} for [funding]{.underline} ~~grants~~ under this section. |
|   ----------------------------------------                           |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *This section has been revised to make funding available under the   |
| ISDEAA and to focus on behavioral health which is broader in scope   |
| than just alcohol and substance abuse. Traditional practices have    |
| also been included.*                                                 |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

(d)(1) There are authorized to be appropriated to carry out this section
~~\$10,000,000 for fiscal year 1993 and~~ such sums as are necessary for
each of the fiscal years ~~1994, 1995, 1996, 1997, 1998, 1999, and~~
2000 through [2012]{.underline}.

  ------------------------------------------------------------------------------------------------------------------------------------------------------------- --
  \(2\) Twenty percent of the funds appropriated pursuant to this subsection shall be used to make grants to urban Indian organizations funded under title V.   
                                                                                                                                                                
  ------------------------------------------------------------------------------------------------------------------------------------------------------------- --

**INDIAN ~~HEALTH SERVICE~~ YOUTH PROGRAM **

+----------------------------------------------------------------------+
|   -----------------------------------------------------------        |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   ** SEC. [705]{.underline} ~~704~~.** (a)** DETOXIFICATION          |
|  AND REHABILITATION.**\--The Secretary[ consistent with Section 701, |
| ]{.underline} shall develop and implement a program for acute detoxi |
| fication and treatment for Indian youth ~~who are alcohol and substa |
| nce abusers~~. The program shall include regional treatment centers  |
| designed to include detoxification and rehabilitation for both sexes |
|  on a referral basis [and programs developed and implemented by trib |
| es or tribal organizations at the local level under the Indian Self- |
| Determination and Education Assistance Act]{.underline}. ~~These r~~ |
|  [R]{.underline}egional centers shall be integrated with the intake  |
| and rehabilitation programs based in the referring Indian community. |
|   -----------------------------------------------------------        |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *The programs for Indian Youth are to include at least one YRTC in   |
| each Area, and at least two in California where networks may be      |
| established. Tuscon and Phoenix are no longer considered on Area for |
| the purpose of these provisions.*                                    |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

(b)** [ALCOHOL AND SUBSTANCE ABUSE]{.underline} TREATMENT CENTERS OR
FACILITIES.**\--(1) The Secretary[, acting through the Service, tribes
or tribal organizations]{.underline}, shall construct, renovate, or, as
necessary, purchase, and appropriately staff and operate, [at least
one]{.underline} ~~a~~ youth regional treatment center [or treatment
network ]{.underline}in each area under the jurisdiction of an area
office. For the purposes of this subsection,~~ the area offices of the
Service in Tucson and Phoenix, Arizona, shall be considered one area
office and ~~the area office in California shall be considered to be two
area offices, one office whose jurisdiction shall be considered to
encompass the northern area of the State of California, and one office
whose jurisdiction shall be considered to encompass the remainder of the
State of California [for the purpose of implementing California
treatment networks]{.underline}.

\(2\) For the purpose of staffing and operating such centers or
facilities, funding shall be pursuant to the Act of November 2, 1921 (25
U.S.C. 13).

\(3\) A youth treatment center constructed or purchased under this
subsection shall be constructed or purchased at a location within the
area described in paragraph (1) agreed upon (by appropriate tribal
resolution) by a majority of the tribes to be served by such center.

~~ (4)(A) Notwithstanding any other provision of this title, the
Secretary may, from amounts authorized to be appropriated for the
purposes of carrying out this section, make funds available to\-- ~~

~~(i) the Tanana Chiefs Conference, Incorporated, for purpose of
leasing, constructing, renovating, operating and maintaining a
residential youth treatment facility in Fairbanks, Alaska; and ~~

~~(ii) the Southeast Alaska Regional Health Corporation to staff and
operate a residential youth treatment facility without regard to the
proviso set forth in section 4(l) of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450b(l))~~

+----------------------------------------------------------------------+
|   -------------------------------------                              |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   \(B\) Until additional residential                                 |
| youth treatment facilities are established ~~in Alaska pursuant to t |
| his section~~, the facilities specified in subparagraph (~~A~~[1]{.u |
| nderline}) shall make every effort to provide services to all eligib |
| le Indian youth residing in ~~such State~~[ each Area.]{.underline}. |
|   -------------------------------------                              |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *It was decided to eliminate the programs which were specifically    |
| named in this section because they were already funded and the       |
| programs continue under their recurring base funding. However, due   |
| to concerns about availability of services the provision which       |
| formerly encouraged tribal programs in Alaska to serve all eligible  |
| Indians has been expanded to all Areas. The requirements for         |
| consultation have also been expanded throughout.*                    |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

([c]{.underline} ~~m~~) **INTERMEDIATE ADOLESCENT ~~MENTAL~~ [BEHAVIORAL
]{.underline}HEALTH SERVICES. -- **(1) The Secretary, acting through the
Service, [tribes and tribal organizations]{.underline} may[, consistent
with Section 701,]{.underline} make [funding]{.underline} ~~grants~~
[available]{.underline} to Indian tribes and tribal organizations to
provide intermediate mental health services [which may incorporate
Traditional practices,]{.underline} to Indian children and adolescents,
including--

\(A\) pre-treatment assistance;

(~~A~~[B]{.underline}) inpatient[,]{.underline} ~~and~~ outpatient[, and
after-care]{.underline} services;

(~~B~~[C]{.underline}) emergency care;

(~~C~~[D]{.underline}) suicide prevention and crisis intervention; and

(~~D~~[E]{.underline}) prevention and treatment of mental illness, and
dysfunctional and self-destructive behavior, including child abuse and
family violence.

\(2\) Funds provided under this subsection may be used--

\(A\) to construct or renovate an existing health facility to provide
intermediate ~~mental~~ [behavioral]{.underline} health services;

\(B\) to hire ~~mental~~ [behavioral]{.underline} health professionals;

\(C\) to staff, operate, and maintain an intermediate mental health
facility, group home, [sober housing,]{.underline} [transitional housing
or similar facilities,]{.underline} or youth shelter where intermediate
~~mental~~ [behavioral ]{.underline}health services are being provided;
and

+----------------------------------------------------------------------+
|   -------------------------------------------------------            |
| -------------------------------------------------------------------- |
|   \(D\) to make renovations and hire appropriate staff               |
| to convert existing hospital beds into adolescent psychiatric units. |
|   -------------------------------------------------------            |
| -------------------------------------------------------------------- |
|                                                                      |
| *This was subsection (m), Intermediate Adolescent Mental Health      |
| Services, of Section 209, Mental Health Prevention and Treatment     |
| Services. It's focus has been changed from mental health to          |
| behavioral health. *                                                 |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

\(3\) ~~Funds provided under this subsection may not be used for the
purposes described in section 216(b)(1).~~

~~ (4) An Indian tribe or tribal organization receiving
[funding]{.underline} a grant under this subsection shall ensure that
intermediate adolescent mental [behavioral]{.underline} health services
are coordinated with other tribal, Service, and Bureau of Indian Affairs
mental health, alcohol and substance abuse, and social services programs
on the reservation of such tribe or tribal organization.~~

+----------------------------------------------------------------------+
| +----------------------------------------------------------------+   |
| |   ----------------------------                                 |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| |   The Secretary shall, [ in                                    |   |
| | consultation with tribes and tribal organizations]{.underline} |   |
| | , establish criteria for the review and approval of applicatio |   |
| | ns [or proposals]{.underline} for [funding]{.underline} ~~gran |   |
| | ts~~ made [available]{.underline} pursuant to this subsection. |   |
| |   ----------------------------                                 |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| |                                                                |   |
| | *Paragraph (3) was deleted because the requirement that        |   |
| | existed under section 216(b)(1) for matching funds has been    |   |
| | eliminated in the proposed amendment found at the new          |   |
| | subsection (h) of this section.*                               |   |
| +----------------------------------------------------------------+   |
| |                                                                |   |
| +----------------------------------------------------------------+   |
|                                                                      |
| *Paragraph (6) (regarding appropriations) of subsection (m),         |
| Intermediate Adolescent Mental Health Services, of Section 209,      |
| Mental Health Prevention and Treatment Services was moved to be a    |
| new subsection of this new Section 705 to have general application   |
| to the entire section regarding Youth Programs. *                    |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

([d]{.underline} ~~c~~) **FEDERALLY OWNED STRUCTURES.\-- **

\(1\) The Secretary, acting through the Service, shall, in consultation
with Indian tribes [and tribal organizations]{.underline}---

(A)identify and use, where appropriate, federally owned structures
suitable [for]{.underline} ~~as~~ local residential or regional
[behavioral health]{.underline} ~~alcohol and substance abuse~~
treatment ~~centers~~ for Indian youth; and

(B)establish guidelines[, in consultation with tribes and tribal
organizations,]{.underline} for determining the suitability of any such
federally owned structure to be used [for]{.underline} ~~as a~~ local
residential or regional [behavioral health]{.underline} ~~alcohol and
substance abuse~~ treatment ~~center~~ for Indian youth.

  -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --
  \(2\) Any structure described in paragraph (1) may be used under such terms and conditions as may be agreed upon by the Secretary and the agency having responsibility for the structure [and any tribe or tribal organization operating the program]{.underline}.   
                                                                                                                                                                                                                                                                       
  -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --

([e]{.underline} ~~d~~)** REHABILITATION AND AFTERCARE SERVICES.\-- **

\(1\) The Secretary[, tribes or tribal organizations]{.underline}, in
cooperation with the Secretary of the Interior, shall develop and
implement within each Service, service unit community-based
rehabilitation and follow-up services for Indian youth who are [having
significant behavioral health problems, and require]{.underline}
~~alcohol or substance abusers which are designed to integrate~~
long-term treatment[, community reintegration]{.underline} and ~~to~~
monitor[ing to]{.underline} ~~and~~ support the Indian youth after their
return to their home community.

\(2\) Services under paragraph (1) shall be administered within each
service unit [ or tribal program ]{.underline}by trained staff within
the community who can assist the Indian youth in continuing development
of self-image, positive problem-solving skills, and nonalcohol or
substance abusing behaviors. Such staff shall include alcohol and
substance abuse counselors, mental health professionals, and other
health professionals and paraprofessionals, including community health
representatives.

  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --
  ([f]{.underline} ~~e~~) **INCLUSION OF FAMILY IN YOUTH TREATMENT PROGRAM.**\--In providing the treatment and other services to Indian youth authorized by this section, the Secretary[, tribes and tribal organizations]{.underline} shall provide for the inclusion of family members of such youth in the treatment programs or other services as may be appropriate. Not less than 10 percent of the funds appropriated for the purposes of carrying out subsection ([e]{.underline} ~~d~~) shall be used for outpatient care of adult family members related to the treatment of an Indian youth under that subsection.   
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --

([g]{.underline} ~~f~~) **MULTIDRUG ABUSE [PROGRAM]{.underline}
~~STUDY~~.**\--(1) The Secretary[, acting through the Service, tribes
and tribal and Indian organizations, shall provide, consistent with
Section 701, programs and services to prevent and treat]{.underline}
~~conduct a study to determine the incidence and prevalence of~~ the
abuse of multiple forms of [substances]{.underline} ~~drugs,~~
including, but not limited to, alcohol, [drugs, inhalants and
tobacco,]{.underline} among Indian youth residing [in Indian
communities,]{.underline} on Indian reservations and in urban areas and
[provide appropriate mental health services to address]{.underline}
~~the interrelationship of such abuse with~~ the incidence of mental
illness among such youth.

~~(2) The Secretary shall submit a report detailing the findings of such
study, together with recommendations based on such findings, to the
Congress no later than two years after the date of the enactment of this
section. ~~

+-----------------------------------------------------------------------+---+
|   --                                                                  |   |
|   --                                                                  |   |
|                                                                       |   |
| *This provision has been changed from a study to an ongoing program.* |   |
+-----------------------------------------------------------------------+---+
|                                                                       |   |
+-----------------------------------------------------------------------+---+
|                                                                       |   |
+-----------------------------------------------------------------------+---+
|                                                                       |   |
+-----------------------------------------------------------------------+---+

**[INPATIENT AND COMMUNITY-BASED MENTAL HEALTH]{.underline} FACILITIES
[DESIGN, CONSTRUCTION ]{.underline}**

**[AND STAFFING]{.underline} ~~ASSESSMENT~~.\--**

+----------------------------------------------------------------------+
|                                                                      |
|  ------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   **[Sec. 706 ]{.underline}~~[316]{.underline}~~** Within one year   |
| after the date of enactment of this section, the Secretary, acting t |
| hrough the Service[, tribes and tribal organizations]{.underline}, s |
| hall [provide , in each area of the Service, ]{.underline}~~make an  |
| assessment of the need for~~ [not less than one]{.underline} inpatie |
| nt mental health care [facility]{.underline} ~~among~~ [for]{.underl |
| ine} Indians [with behavioral health problems]{.underline}. [For the |
|  purposes of this subsection, California shall be considered to be t |
| wo area offices, one office whose location shall be considered to en |
| compass the northern are of the State of California and one office w |
| hose jurisdiction shall be considered to encompass the remainder of  |
| the state of California ]{.underline}~~ and the availability and cos |
| t of inpatient mental health facilities which can meet such need. In |
|  making such assessment,~~ ~~[t]{.underline}~~[T]{.underline}he Secr |
| etary shall consider the possible conversion of existing, under-util |
| ized service hospital beds into psychiatric units to meet such need. |
|                                                                      |
|  ------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *This section has been moved from Title III and expanded to provide  |
| authorization to establish inpatient mental health facilities in     |
| each Area for Indians with behavioral health problems. The           |
| allocation of facilities is to be the same as for YRTC's.*           |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**TRAINING AND COMMUNITY EDUCATION **

** SEC. [707]{.underline} ~~705~~.** (a) **COMMUNITY EDUCATION.**\--The
Secretary, in cooperation with the Secretary of the Interior, shall
develop and implement [or provide funding for tribes and tribal
organizations to develop and implement]{.underline} within each service
unit [or tribal program]{.underline} a program of community education
and involvement which shall be designed to provide concise and timely
information to the community leadership of each tribal community. Such
program shall include education [about behavioral health
issues]{.underline} ~~in alcohol and substance abuse~~ to political
leaders, tribal judges, law enforcement personnel, members of tribal
health and education boards, health care providers including Traditional
practitioners, and other critical members of each tribal community.
[Community based training (oriented toward local capacity development)
shall also include village/tribal community provider training (designed
for adult learners from the communities receiving services for
prevention, intervention, treatment and aftercare).]{.underline}

\(b\) **TRAINING.**\--The Secretary shall, either directly or [through
tribes and tribal organizations]{.underline} ~~by contract~~, provide
instruction in the area of ~~alcohol and substance abuse~~ [behavioral
health issues,]{.underline} including instruction in crisis intervention
and family relations in the context of alcohol and substance abuse,
[child sexual abuse, ]{.underline}youth alcohol and substance abuse, and
the causes and effects of fetal alcohol ~~syndrome~~
[disorders]{.underline} to appropriate employees of the Bureau of Indian
Affairs and the Service, and to personnel in schools or programs
operated under any contract with the Bureau of Indian Affairs or the
Service, including supervisors of emergency shelters and halfway houses
described in section 4213 of the Indian Alcohol and Substance Abuse
Prevention and Treatment Act of 1986 (25 U.S.C. 2433).

\(c\) **COMMUNITY-BASED TRAINING MODELS.**\--In carrying out the
education and training programs required by this section, the Secretary,
acting through the Service and in consultation with tribes[, tribal
organizations]{.underline} and Indian alcohol and substance abuse
prevention experts, shall develop and provide community-based training
models. Such models shall address\--

\(1\) the elevated risk of alcohol and ~~substance abuse~~ [behavioral
health problems]{.underline} faced by children of alcoholics;

\(2\) the cultural[, spiritual]{.underline} and multigenerational
aspects of [behavioral health problem]{.underline} ~~alcohol and
substance abuse~~ prevention and recovery; and

+--------------------------------------------------------------------------+
| +----------------------------------------------------------------------+ |
| |   -------------------                                                | |
| | -------------------------------------------------------------------- | |
| | -------------------------------------------------------------------- | |
| |   (3)community-base                                                  | |
| | d and multidisciplinary strategies for preventing and treating [beha | |
| | vioral health problems]{.underline} ~~alcohol and substance abuse~~. | |
| |   -------------------                                                | |
| | -------------------------------------------------------------------- | |
| | -------------------------------------------------------------------- | |
| |                                                                      | |
| | *This section has been revised to allow tribes and tribal            | |
| | organizations to operate these programs.*                            | |
| +----------------------------------------------------------------------+ |
| |                                                                      | |
| +----------------------------------------------------------------------+ |
|                                                                          |
| *The former Section 707, Reports, is now Section 710 .*                  |
+--------------------------------------------------------------------------+
|                                                                          |
+--------------------------------------------------------------------------+

**[BEHAVIORAL]{.underline} ~~MENTAL~~ HEALTH DEMONSTRATION **

**~~GRANT ~~PROGRAM.**

** Sec. 708 ~~209~~**~~ (k)~~(1) The Secretary, acting through the
Service, [consistent with Section 701,]{.underline} is authorized to
make [funding]{.underline} ~~grants~~ [available]{.underline} to Indian
tribes and ~~inter-~~tribal [organizations]{.underline} ~~consortia to
pay 75 percent of~~ [for]{.underline} the cost of planning, developing,
~~and~~ implementing [and carrying out]{.underline} programs to deliver
innovative community-based [behavioral]{.underline} ~~mental~~ health
services to Indians. ~~The 25 percent tribal share of such cost may be
provided in cash or through the provision of property or services.~~

\(2\) The Secretary may award [such funding]{.underline} ~~a grant~~ for
a project under paragraph (1) to an Indian tribe or ~~inter-~~tribal
[organization]{.underline} ~~consortium~~ [and may consider the
]{.underline}~~which meets~~ the following criteria:

\(A\) The project will address significant unmet
[behavioral]{.underline} ~~mental~~ health needs among Indians.

\(B\) The project will serve a significant number of Indians.

\(C\) The project has the potential to deliver services in an efficient
and effective manner.

\(D\) The tribe or [tribal organization]{.underline} ~~consortium~~ has
the administrative and financial capability to administer the project.

\(E\) The project ~~will~~ [may]{.underline} deliver services in a
manner consistent with traditional Indian healing and treatment
practices.

\(F\) The project is coordinated with, and avoids duplication of,
existing services.

\(3\) For purposes of this subsection, the Secretary shall, in
evaluating applications [or proposals]{.underline} for
[funding]{.underline} ~~grants~~ for projects to be operated under any
[funding agreement]{.underline} ~~contract~~ entered into with the
Service under the Indian Self-Determination Act [and Education
Assistance Act]{.underline}, use the same criteria that the Secretary
uses in evaluating any other application [or proposal]{.underline} for
such [funding]{.underline} ~~a grant~~.

~~(4) The Secretary may only award one grant under this subsection with
respect to a service area until the Secretary has awarded grants for all
service areas with respect to which the Secretary receives applications
during the application period, as determined by the Secretary, which
meet the criteria specified in paragraph (2).~~

~~(5) Not later than 180 days after the close of the term of the last
grant awarded pursuant to this subsection, the Secretary shall submit to
the Congress a report evaluating the effectiveness of the innovative
community-based projects demonstrated pursuant to this subsection. Such
report shall include findings and recommendations, if any, relating to
the reorganization of the programs of the Service for delivery of mental
health service to Indians.~~

+----------------------------------------------------------------------+
|   ----------------------                                             |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   ~~(6) Grants made pu                                               |
| rsuant to this section may be expended over a period of three years  |
| and no grant may exceed \$1,000,000 for the fiscal years involved.~~ |
|   ----------------------                                             |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *This section was subsection (k) of Section 209, Mental Health       |
| Prevention and Treatment Services. It has been revised to authorize  |
| funding for development of community-based behavioral health         |
| services. The requirement for matching funds has been eliminated.    |
| It's intent is to fund innovative demonstration projects.*           |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**FETAL ALCOHOL [DISORDER]{.underline} ~~SYNDROME AND FETAL ~~**

**~~ALCOHOL EFFECT~~ ~~GRANTS ~~[FUNDING]{.underline}**

** SEC. 709. ~~708~~** (a)(1) The Secretary[, consistent with Section
701, shall]{.underline} ~~may~~ make [funding available]{.underline}
~~grants~~ to Indian tribes and tribal [and Indian]{.underline}
organizations to establish [and operate]{.underline} fetal alcohol
[disorders]{.underline} ~~syndrome and fetal alcohol effect~~ programs
as provided in this section for the purposes of meeting the health
status objectives specified in section 3(b).

\(2\) [Funding]{.underline} ~~Grants~~ ~~made~~ [provided
]{.underline}pursuant to this section shall be used to\--

\(A\) develop and provide community and in-school training, education,
and prevention programs relating to [fetal alcohol
disorders]{.underline} ~~FAS and FAE~~;

\(B\) identify and provide [behavioral health]{.underline} ~~alcohol and
substance abuse~~ treatment to high-risk women;

\(C\) identify and provide appropriate educational and vocational
support, counseling, advocacy, and information to [fetal alcohol
disorder]{.underline} ~~FAS and FAE~~ affected persons and their
families or caretakers;

\(D\) develop and implement counseling and support programs in schools
for [fetal alcohol disorder]{.underline} ~~FAS and FAE~~ affected
children;

(E)develop prevention and intervention models which incorporate
Traditional ~~healers~~ [practitioners]{.underline}, cultural [and
spiritual]{.underline} values and community involvement;

\(F\) develop, print, and disseminate education and prevention materials
on [fetal alcohol disorders]{.underline} ~~FAS and FAE~~; and

\(G\) develop and implement, through the tribal consultation process,
culturally sensitive assessment and diagnostic tools [including
dysmorphology clinics]{.underline} for use in tribal and urban Indian
communities.

\(3\) The Secretary shall establish criteria for the review and approval
of applications for [funding]{.underline} ~~grants~~ under this section.

\(b\) The Secretary, acting through the Service, [tribes and tribal
organizations,]{.underline} shall\--

\(1\) develop [and provide services]{.underline} ~~an annual plan~~ for
the prevention, intervention, treatment, and aftercare for those
affected by [fetal alcohol disorders]{.underline} ~~FAS and FAE~~ in
Indian communities; [and]{.underline}

\(2\) [provide suppotive services directly or through a tribe or tribal
organization, including, but not limited to, ]{.underline}~~conduct a
study, directly or by contract with any organization, entity, or
institution of higher education with significant knowledge of [fetal
alcohol disorders]{.underline} FAS and FAE and Indian communities, of
the~~ [meeting the ]{.underline}special educational, vocational,
school-to-work transition, and independent living needs of adolescent
and adult Indians and Alaska Natives with [fetal alcohol
disorders.]{.underline} ~~FAS or FAE; and ~~

~~(3) establish a national clearinghouse for prevention and educational
materials and other information on [the effect of fetal alcohol
disorders]{.underline} FAS and FAE effect in Indian and Alaska Native
communities and ensure access to clearinghouse materials by any Indian
tribe[, tribal organization]{.underline} or urban Indian organization.
~~

\(c\) The Secretary shall establish a task force to be known as the
[Fetal Alcohol Disorders]{.underline} ~~FAS/FAE~~ Task Force to advise
the Secretary in carrying out subsection (b). Such task force shall be
composed of representatives from the National Institute on Drug Abuse,
the National Institute on Alcohol and Alcoholism, the Office of
Substance Abuse Prevention, the National Institute of Mental Health, the
Service, the Office of Minority Health of the Department of Health and
Human Services, the Administration for Native Americans, the Bureau of
Indian Affairs, Indian tribes, tribal organizations, urban Indian
communities, and Indian [fetal alcohol disorders]{.underline}
~~FAS/FAE~~ experts.

+----------------------------------------------------------------------+
|   ---                                                                |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   \                                                                  |
| (d\) The Secretary, acting through the Substance Abuse and Mental He |
| alth Services Administration, shall make [funding available]{.underl |
| ine} ~~grants~~ to Indian tribes, tribal organizations, ~~universiti |
| es working with Indian tribes [and tribal organizations]{.underline} |
|  on cooperative projects,~~ and urban Indian organizations for appli |
| ed research projects which propose to elevate the understanding of m |
| ethods to prevent, intervene, treat, or provide [rehabilitation and  |
| behavioral health]{.underline} aftercare for Indians and urban India |
| ns affected by [fetal alcohol disorders]{.underline} ~~FAS or FAE~~. |
|   ---                                                                |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *All of the types of fetal alcohol problems, including FAS, partial  |
| FAS, and Alcohol Related Neurodevelopmental Disorders, have been     |
| grouped in the definitions under Fetal Alcohol Disorders. Each of    |
| these terms also is defined separately as well. This construct is    |
| based on the most current material from the National Institute of    |
| Health. Revisions have been made to allow these programs to be       |
| funded under the ISDEAA rather than solely under grants. Reporting   |
| requirements have been eliminated.*                                  |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

~~ (e)(1) The Secretary shall submit to the President, for inclusion in
each report required to be transmitted to the Congress under section
801, a report on the status of [fetal alcohol disorders]{.underline} FAS
and FAE in the Indian population. Such report shall include, in addition
to the information required under section 3(d) with respect to the
health status objective specified in section 3(b)(27), the following: ~~

~~(A) The progress of implementing a uniform assessment and diagnostic
methodology in Service and tribally service delivery systems. ~~

~~(B) The incidence of [fetal alcohol disorders]{.underline} FAS and FAE
babies born for all births by reservation and urban-based sites.~~

~~(C) The prevalence of [fetal alcohol disorders]{.underline} FAS and
FAE affected Indian persons in Indian communities, their primary means
of support, and recommendations to improve the support system for these
individuals and their families or caretakers. ~~

~~(D) The level of support received from the entities specified in
subsection (c) in the area of [fetal alcohol disorders]{.underline} FAS
and FAE. ~~

~~(E) The number of inpatient and outpatient substance abuse treatment
resources which are specifically designed to meet the unique needs of
Indian women, and the volume of care provided to Indian women through
these means. ~~

~~(F) Recommendations regarding the prevention, intervention, and
appropriate vocational, educational and other support services for
[fetal alcohol ]{.underline}[disorders]{.underline} FAS and FAE affected
individuals in Indian communities. ~~

~~(2) The Secretary may contract the production of this report to a
national organization specifically addressing [fetal alcohol
disorders]{.underline} FAS and FAE in Indian communities. ~~

~~ (f)(1) There are authorized to be appropriated to carry out this
section \$22,000,000 for fiscal year 1993 and such sums as may be
necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998,
1999, and 2000 [through 2012]{.underline}. ~~

+----------------------------------------------------------------------+
|   ------------------                                                 |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   ~~(2) Ten percen                                                   |
| t of the funds appropriated pursuant to this section shall be used t |
| o make grants to urban Indian organizations funded under title V. ~~ |
|   ------------------                                                 |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *Reporting provisions should be included in the general section on   |
| reports.*                                                            |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**CHILD SEXUAL ABUSE [AND PREVENTION ]{.underline}~~DEMONSTRATION~~
[TREATMENT]{.underline} PROGRAMS**

**Sec. [710]{.underline} .**~~ ~~**~~[Sec. 717.]{.underline}~~**~~ The
Secretary and the Secretary of the Interior shall, for each fiscal year
through fiscal year 1995, continue the demonstration programs involving
treatment for child sexual abuse provided through the Hopi Tribe and the
Assiniboine and Sioux Tribes of the Fort Peck Reservation.~~ ~~(b)~~
~~Beginning October 1, 1995, ~~(1) [T]{.underline}he Secretary and the
Secretary of the Interior[, acting through the Service, tribes and
tribal organizations, shall]{.underline} ~~may~~ establish[, consistent
with Section 701]{.underline}, in ~~any~~ [every]{.underline} service
area, ~~demonstration~~ programs involving treatment for [(a) victims of
child sexual abuse; and, (b) perpetrators of child sexual
abuse.]{.underline}~~, except that the Secretaries may not establish a
greater number of such programs in one service area than in any other
service area until there is an equal number of such programs established
with respect to all service areas from which the Secretary receives
qualified applications during the application period (as determined by
the Secretary). ~~

[ (2) Funding provided pursuant to this section shall be used to
--]{.underline}

[(A) Develop and provide community education and prevention programs
related to child sexual abuse;]{.underline}

[(B) Identify and provide behavioral health treatment to children who
are victims of sexual abuse and to their families who are affected by
sexual abuse;]{.underline}

[(C) Develop prevention and intervention models which incorporate
Traditional practitioners, cultural and spiritual values, and community
involvement; ]{.underline}

[(D) Develop and implement, though the tribal consultation process,
culturally sensitive assessment and diagnostic tools for use in tribal
and urban Indian communities.]{.underline}

[(E) Identify and provide behavioral health treatment to
perpetrators.]{.underline}

[(1) Effort will be made to begin treatment while the perpetrator is
incarcerated, and]{.underline}

[(2) Treatment should be provided afer release to the community, until
it is determined that the perpetrator is not a threat to
children.]{.underline}

+----------------------------------------------------------------------+
|   --                                                                 |
|   --                                                                 |
|                                                                      |
| *This section has been revised to provide for a program to treat     |
| both the victims and the perpetrators of child sexual abuse, and to  |
| provide general guidelines for programs established relating to      |
| child sexual abuse.*                                                 |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**[BEHAVIORAL]{.underline} ~~MENTAL~~ HEALTH RESEARCH.\--**

**[Sec. 711]{.underline}** **~~209(h).~~** The Secretary, acting through
the Service and in consultation with the National Institute of Mental
Health, shall [provide funding to tribes or tribal organizations and
Urban Indian organizations or, through]{.underline} ~~enter into~~
contracts ~~with,~~ or ~~make~~ grants[,]{.underline} to~~,~~
appropriate institutions for the conduct of research on the incidence
and prevalence of ~~mental disorders ~~[behavioral health
problems]{.underline} among Indians [served by the Service, tribes or
tribal organizations]{.underline} ~~on Indian reservations~~ and [among
Indians]{.underline} in urban areas. Research priorities under this
~~sub~~section shall include--

\(1\) the inter-relationship and inter-dependance of ~~mental
disorders~~ [behavioral health problems]{.underline} with alcoholism
[and other substance abuse]{.underline}, suicide, homicides, [other
injuries]{.underline} ~~accidents~~, and the incidence of family
violence, and

\(2\) the development of models of prevention techniques.

+----------------------------------------------------------------------+
|   ---------                                                          |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   The eff                                                            |
| ect of the inter-relationships and interdependencies referred to in  |
| paragraph (1) on children, and the development of prevention techniq |
| ues under paragraph (2) applicable to children, shall be emphasized. |
|   ---------                                                          |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *This Section was a subsection of Section 209, Mental Health         |
| Prevention and Treatment Services. It has been expanded to allow     |
| tribes and tribal organizations to obtain funding for this           |
| research.*                                                           |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**~~REPORTS ~~**

**~~ ~~~~Sec. 707. (a) COMPILATION OF DATA.\--~~**~~The Secretary, with
respect to the administration of any health program by a service unit,
directly or through contract, including a contract under the Indian
Self-Determination Act, shall require the compilation of data relating
to the number of cases or incidents in which any Service personnel or
services were involved and which were related, either directly or
indirectly, to alcohol or substance abuse. Such report shall include the
type of assistance provided and the disposition of these cases. ~~

~~ (b) ~~**~~REFERRAL OF DATA.\--~~**~~The data compiled under
subsection (a) shall be provided annually to the affected Indian tribe
and Tribal Coordinating Committee to assist them in developing or
modifying a Tribal Action Plan under section 4206 of the Indian Alcohol
and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2471
et seq.). ~~

~~ (c) ~~**~~COMPREHENSIVE REPORT.\--~~**~~Each service unit director
shall be responsible for assembling the data compiled under this section
and section 4214 of the Indian Alcohol and Substance Abuse Prevention
and Treatment Act of 1986 (25 U.S.C. 2434) into an annual tribal
comprehensive report. Such report shall be provided to the affected
tribe and to the Director of the Service who shall develop and publish a
biennial national report based on such tribal comprehensive reports.~~

+----------------------------------------------------------------------+
| +----------------------------------------------------------------+   |
| | +----------------------------------------------------------+   |   |
| | | +----------------------------------------------------+   |   |   |
| | | |   --                                               |   |   |   |
| | | |   --                                               |   |   |   |
| | | |                                                    |   |   |   |
| | | | *This section should be deleted and all reports    |   |   |   |
| | | | covered in Sec. 801.*                              |   |   |   |
| | | +----------------------------------------------------+   |   |   |
| | | |                                                    |   |   |   |
| | | +----------------------------------------------------+   |   |   |
| | |                                                          |   |   |
| | | ~~ [(d)]{.underline} (j) ~~**~~ANNUAL REPORT.\--         |   |   |
| | | ~~**~~The Service[ ]{.underline}shall develop methods    |   |   |
| | | for analyzing and evaluating the overall status of       |   |   |
| | | mental health programs and services for Indians and      |   |   |
| | | shall submit to the President, for inclusion in each     |   |   |
| | | report required to be transmitted to the Congress under  |   |   |
| | | section 801, a report on the mental health status of     |   |   |
| | | Indians which shall describe the progress being made to  |   |   |
| | | address mental [behavioral]{.underline} health problems  |   |   |
| | | of Indian communities.~~                                 |   |   |
| | +----------------------------------------------------------+   |   |
| |                                                                |   |
| | *This subsection was moved from Section 209, Mental Health     |   |
| | Prevention and Treatment Services. It should likewise be       |   |
| | deleted and covered in Section 801.*                           |   |
| +----------------------------------------------------------------+   |
| |                                                                |   |
| +----------------------------------------------------------------+   |
|                                                                      |
| *Section 711, Substance Abuse Counselor Education Demonstration      |
| Project, has been moved to Title I.*                                 |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

** ~~GALLUP ALCOHOL AND SUBSTANCE ABUSE TREATMENT CENTER ~~**

**~~ ~~~~SEC. 706.~~**~~ (a) ~~**~~GRANTS FOR RESIDENTIAL
TREATMENT.~~**~~\--The Secretary shall make grants to the Navajo Nation
for the purpose of providing residential treatment for alcohol and
substance abuse for adult and adolescent members of the Navajo Nation
and neighboring tribes. ~~

~~ (b) ~~**~~PURPOSES OF GRANTS.~~**~~\--Grants made pursuant to this
section shall (to the extent appropriations are made available) be used
to\-- ~~

~~(1) provide at least 15 residential beds each year for adult long-term
treatment, including beds for specialized services such as polydrug
abusers, dual diagnosis, and specialized services for women with fetal
alcohol syndrome children; ~~

~~(2) establish clinical assessment teams consisting of a clinical
psychologist, a part-time addictionologist, a master\'s level assessment
counselor, and a certified medical records technician which shall be
responsible for conducting individual assessments and matching Indian
clients with the appropriate available treatment; ~~

~~(3) provide at least 12 beds for an adolescent shelter bed program in
the city of Gallup, New Mexico, which shall serve as a satellite
facility to the Acoma/Canoncito/Laguna Hospital and the adolescent
center located in Shiprock, New Mexico, for emergency crisis services,
assessment, and family intervention; ~~

~~(4) develop a relapse program for the purposes of identifying sources
of job training and job opportunity in the Gallup area and providing
vocational training, job placement, and job retention services to
recovering substance abusers; and ~~

~~(5) provide continuing education and training of treatment staff in
the areas of intensive outpatient services, development of family
support systems, and case management in cooperation with regional
colleges, community colleges, and universities.~~

~~ (c) ~~**~~CONTRACT FOR RESIDENTIAL TREATMENT.\--~~**~~The Navajo
Nation, in carrying out the purposes of this section, shall enter into a
contract with an institution in the Gallup, New Mexico, area which is
accredited by the Joint Commission of the Accreditation of Health Care
Organizations to provide comprehensive alcohol and drug treatment as
authorized in subsection (b). ~~

+----------------------------------------------------------------------+
|                                                                      |
|  ------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   ~~ (d) ~~**~~AUTHORIZATION OF APPROPRIATIONS.\--~~**~~There are a  |
| uthorized to be appropriated\-- for each of fiscal years 1996 throug |
| h 2000, such sums as may be necessary to carry out subsection (b).~~ |
|                                                                      |
|  ------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *This has been funded already and is part of the recurring base, so  |
| no further authorization is necessary. Therefore, it can be deleted  |
| from the Act.*                                                       |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**~~PUEBLO SUBSTANCE ABUSE TREATMENT PROJECT FOR SAN JUAN ~~**

**~~PUEBLO, NEW MEXICO ~~**

+----------------------------------------------------------------------+
|   ----------------------------                                       |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   **~~ ~~~~SEC. 709.~~**~~ T                                         |
| he Secretary, acting through the Service, shall continue to make gra |
| nts, through fiscal year 1995, to the 8 Northern Indian Pueblos Coun |
| cil, San Juan Pueblo, New Mexico, for the purpose of providing subst |
| ance abuse treatment services to Indians in need of such services.~~ |
|   ----------------------------                                       |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *This program and has been funded and is part of the recurring base  |
| funding so can be deleted from the Act.*                             |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**~~THUNDER CHILD TREATMENT CENTER ~~**

**~~ ~~~~SEC. 710.~~**~~ (a) The Secretary, acting through the Service,
shall make a grant to the Intertribal Addictions Recovery Organization,
Inc. (commonly known as the Thunder Child Treatment Center) at Sheridan,
Wyoming, for the completion of construction of a multiple approach
substance abuse treatment center which specializes in the treatment of
alcohol and drug abuse of Indians.~~

+----------------------------------------------------------------------+
|   ------------------------------------------------------             |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   ~~ (b) For the purposes of carrying out subsection (               |
| a), there are authorized to be appropriated \$2,000,000 for fiscal y |
| ears 1993 and 1994. No funding shall be available for staffing or op |
| eration of this facility. None of the funding~~ ~~appropriated to ca |
| rry out subsection (a) shall be used for administrative purposes. ~~ |
|   ------------------------------------------------------             |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *This program and has been funded and is part of the recurring base  |
| funding so can be deleted from the Act.*                             |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**~~[STANDING ROCK SIOUX COMMUNITY-BASED DEMONSTRATION
]{.underline}~~~~[PROJECT]{.underline}~~**

~~ ~~**~~[Sec. 702]{.underline}~~~~ (c)~~**~~ ~~**~~GRANTS FOR MODEL
PROGRAM.\--~~**~~(1) The Secretary, acting through the Service shall
make a grant to the Standing Rock Sioux Tribe to develop a
community-based demonstration project to reduce drug and alcohol abuse
on the Standing Rock Sioux Reservation and to rehabilitate Indian
families afflicted by such abuse. ~~

~~ [(b)]{.underline}(2) Funds shall be used by the Tribe to\-- ~~

~~[(1)]{.underline}(A) develop and coordinate community-based alcohol
and substance abuse prevention and treatment services for Indian
families; ~~

~~[(2)]{.underline}(B) develop prevention and intervention models for
Indian families; ~~

~~[(3)]{.underline}(C) conduct community education on alcohol and
substance abuse; and ~~

~~[(4)]{.underline}(D) coordinate with existing Federal, State, and
tribal services on the reservation to develop a comprehensive alcohol
and substance abuse program that assists in the rehabilitation of Indian
families that have been or are afflicted by alcoholism. ~~

+----------------------------------------------------------------------+
| +----------------------------------------------------------------+   |
| |   -                                                            |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| |                                                                |   |
| |  ~~ [(c)]{.underline}(3) The Secretary shall submit to the Pre |   |
| | sident for inclusion in the report to be transmitted to the Co |   |
| | ngress under section 801 for fiscal year 1995 an evaluation of |   |
| |  the demonstration project established under paragraph (1). ~~ |   |
| |   -                                                            |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| | -------------------------------------------------------------- |   |
| |                                                                |   |
| | *This section was moved from Section 702, Indian Health        |   |
| | Service Program. This program and has been funded and is part  |   |
| | of the recurring base funding so can be deleted from the Act.  |   |
| | *                                                              |   |
| +----------------------------------------------------------------+   |
| |                                                                |   |
| +----------------------------------------------------------------+   |
|                                                                      |
| *Section 711, Substance Abuse Counselor Education Demonstration      |
| Project, has been moved to Title I.*                                 |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**~~GILA RIVER ALCOHOL AND SUBSTANCE ABUSE TREATMENT ~~~~FACILITY ~~**

**~~ ~~~~Sec. 712.~~**~~ (a) The Secretary, acting through the Service,
shall establish a regional youth alcohol and substance abuse prevention
and treatment center in Sacaton, Arizona, on the Gila River Indian
Reservation. The center shall be established within facilities leased,
with the consent of the Gila River Indian Community, by the Service from
such Community. ~~

~~ (b) The center established pursuant to this section shall be known as
the \"Regional Youth Alcohol and Substance Abuse Prevention and
Treatment Center\". ~~

+----------------------------------------------------------------------+
|   ---------------------------------------------------------          |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   ~~ (c) The Secretary, acting through the Service, shall            |
|  establish, as a unit of the regional center, a youth alcohol and su |
| bstance abuse prevention and treatment facility in Fallon, Nevada.~~ |
|   ---------------------------------------------------------          |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *This program and has been funded and is part of the recurring base  |
| funding so can be deleted from the Act.*                             |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**~~ALASKA NATIVE DRUG AND ALCOHOL ABUSE DEMONSTRATION ~~~~PROJECT ~~**

**~~ ~~~~SEC. 713.~~**~~ (a) The Secretary, acting through the Service,
shall make grants to the Alaska Native Health Board for the conduct of a
two-part community-based demonstration project to reduce drug and
alcohol abuse in Alaska Native villages and to rehabilitate families
afflicted by such abuse. Sixty percent of such grant funds shall be used
by the Health Board to stimulate coordinated community development
programs in villages seeking to organize to combat alcohol and drug use.
Forty percent of such grant funds shall be transferred to a qualified
nonprofit corporation providing alcohol recovery services in the village
of St. Mary\'s, Alaska, to enlarge and strengthen a family life
demonstration program of rehabilitation for families that have been or
are afflicted by alcoholism. ~~

+----------------------------------------------------------------------+
|   ------------------------------------                               |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   ~~ (b) The Secretary shall submit                                  |
| to the President for inclusion in the report required to be submitte |
| d to the Congress under section 801 for fiscal year 1995 an evaluati |
| on of the demonstration project established under subsection (a). ~~ |
|   ------------------------------------                               |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *This section has never been implemented. The Alaska Area recommends |
| its deletion in favor of more pressing needs.*                       |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**AUTHORIZATION OF APPROPRIATIONS **

** Sec. [712]{.underline} ~~714~~.** Except as provided in sections 703,
706, 708, 710, and 711, there are authorized to be appropriated such
sums as may be necessary for each fiscal year through fiscal year
~~2000~~ [2012]{.underline} to carry out the provisions of this title.

  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --
  **\[NOTE: Sections 702(B) of P.L. 102-573 repealed Part 6 of the Indian Alcohol and Substance Abuse Prevention and Treatment Act, P.L. 99-570 except for section 4224 which was redesignated as section 4208A and moved to Part II. Title VII above now includes former Part 6 Provisions as amended by P.L. 102-573.\]**   
  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --