59–010 

Calendar No. 108 

110TH CONGRESS REPORT " ! SENATE 1st Session 110–43 

TO ESTABLISH AN INDIAN YOUTH TELEMENTAL HEALTH 

DEMONSTRATION PROJECT 

APRIL 10, 2007.—Ordered to be printed 

Mr. DORGAN, from the Committee on Indian Affairs, 

submitted the following 

R E P O R T 

[To accompany S. 322] 

The Committee on Indian Affairs, to which was referred the bill 

(S. 322), to establish an Indian youth telemental health demonstration project, having considered the same, reports favorably thereon 

and recommends that the bill do pass. 

PURPOSE

S. 322 would authorize the Indian Youth Telemental Health 

Demonstration Project, under which the Secretary of Health and 

Human Services would award grants to five tribes and tribal organizations with telehealth capabilities to use in youth suicide prevention, intervention and treatment. The demonstration project authorized under S. 322 would permit the use of telemental health 

for psychotherapy, psychiatric assessments and diagnostic interviews of Indian youth; the provision of clinical expertise and other 

medical advice to frontline health care providers working with Indian youth; training and related support for community leaders, 

family members and health and education workers who work with 

Indian youth; the development of culturally-relevant educational 

materials on suicide prevention and intervention; and data collection and reporting. 

BACKGROUND

Several American Indian and Alaska Native communities around 

the country have experienced clusters of youth suicide completions 

and suicide attempts in recent years, including the Standing Rock 

Sioux Tribe in North and South Dakota, the Confederated Tribes 


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of Grand Ronde of Oregon, the Cheyenne River Sioux Tribe of 

South Dakota, the White Mountain Apache Tribe of Arizona, the 

Jicarilla Apache Tribe of New Mexico, and Native villages in western Alaska. 

According to statistics collected by the Substance Abuse and 

Mental Health Services Administration, suicide is the second leading cause of death for American Indians and Alaska Natives between the ages of 15 and 24, following unintentional injury and accidents. The rate of Indian youth suicide on reservations is two and 

a half times higher than for the rest of the country, with a rate 

that is 10 times higher than the national average in the Northern 

Great Plains. More than one-half of all persons who commit suicide 

in Indian Country have never been seen by a mental health services provider. Significant risk factors for suicide and suicide ideation exist in Indian communities, such as substance abuse and 

mental health disorders. Compounding these risk factors are other 

circumstances of life in Indian communities, including the economic 

depression and poverty of many reservation communities, the lack 

of education and other opportunities, and the breakdown of traditional family and community structures. 

During the 109th Congress, the Committee held three hearings 

on Indian youth suicide, including a field hearing in Bismarck, ND, 

and received testimony from the Surgeon General of the United 

States, the Administrator of the Substance Abuse and Mental 

Health Services Administration, the Director of the Indian Health 

Service, the Bureau of Indian Affairs’ Deputy Director for Tribal 

Services, tribal elected officials, Indian psychologists and health 

professionals, and Indian parents and students. These hearings 

generated several recommendations, including the suggested use of 

telecommunications technologies to support services such as psychotherapy and diagnostic interviews of Indian youth, and medical 

advice to frontline health care providers working with Indian 

youth. The issue of Indian youth suicide was also discussed at 

Committee hearings in 2005 and 2006 on Indian health services, 

Indian child abuse prevention, and methamphetamine use, production and distribution in Indian Country. 

LEGISLATIVE HISTORY

S. 322 was introduced on January 17, 2007, by Senator Dorgan, 

for himself and Senators Murkowski, McCain, Conrad, Bingaman, 

Baucus, Smith and Inouye, and was referred to the Committee on 

Indian Affairs. Senator Thomas was added as a cosponsor on February 5, 2007. On February 8, 2007, the Committee on Indian Affairs convened a business meeting to consider S. 322 and other 

measures that had been referred to it, and ordered the bill favorably reported. 

COMMITTEE RECOMMENDATION AND TABULATION OF VOTE

On February 8, 2007, the Committee on Indian Affairs convened 

a business meeting to consider S. 322. The Committee voted unanimously to have the measure favorably reported to the full Senate 

with the recommendation that the bill do pass. 


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SECTION-BY-SECTION ANALYSIS

Section 1. Short title 

Section 1 states that the Act may be cited as the ‘‘Indian Youth 

Telemental Health Demonstration Project Act of 2007.’’ 

Section 2. Findings and purpose 

Section 2 sets forth seven findings about youth suicide for Indians and Alaska Natives and its impact on tribal communities 

which provide support for this legislation. This section also states 

that the purpose of this Act is to authorize the Secretary to carry 

out a demonstration project to test the use of telemental health 

services in suicide prevention, intervention, and treatment of Indian youth. 

Section 3. Definitions 

Section 3 provides definitions for various terms used in the Act. 

Section 4. Indian Youth Telemental Health Demonstration Project 

Section 4 authorizes the Secretary of Health and Human Services to carry out a demonstration project to award grants for the 

provision of telemental health services to Indian youth who have 

expressed suicidal ideas; have attempted suicide; or have mental 

health conditions that increase or could increase the risk of suicide. 

Subsection (a) provides that grants are to be awarded to Indian 

tribes and tribal organizations that operate one or more facilities 

located in Alaska and part of the Alaska Federal Health Care Access Network; that report active clinical telehealth capabilities; or 

that offer school-based telemental health services relating to psychiatry for Indian youth. 

The Secretary shall award grants under this section for a period 

of up to 4 years, and not more than 5 grants shall be provided. Priority consideration shall be given in the awarding of grants to Indian tribes and tribal organizations that serve a particular community or geographic area in which there is a demonstrated need to 

address Indian youth suicide; enter into collaborative partnerships 

with Indian Health Service (IHS) or other tribal health programs 

or facilities to provide services under this demonstration project; 

serve an isolated community or geographic area which has limited 

or no access to behavioral health services; or operate a detention 

facility at which Indian youth are detained. 

The bill is intended to provide services for counseling, medical 

advice and training, and educational materials under this new 

demonstration project to Indian youth living on reservations and in 

Alaska Native villages, which are generally in remote locations and 

quite isolated, and which experience much more limited access to 

mental health services than the nation’s cities. 

Subsection (b) authorizes the specific use of funds. An Indian 

tribe or tribal organization may use a grant to (1) provide telemental health services to Indian youth, including the provision of 

psychotherapy; psychiatric assessments and diagnostic interviews, 

therapies for mental health conditions predisposing to suicide, and 

treatment; and alcohol and substance abuse treatment; (2) provide 

clinician-interactive medical advice, guidance and training, assistance in diagnosis and interpretation, crisis counseling and interVerDate Mar 15 2010 21:48 Sep 19, 2011 Jkt 059010 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\SR043.XXX SR043

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vention, and related assistance to IHS or tribal clinicians and 

health services providers working with youth being served under 

the demonstration project; (3) assist, educate, and train community 

leaders, health education professionals and paraprofessionals, tribal outreach workers, and family members who work with the youth 

receiving telemental health services under the demonstration 

project, including with identification of suicidal tendencies, crisis 

intervention and suicide prevention, emergency skill development, 

and building and expanding networks among those individuals and 

with state and local health services providers; (4) develop and distribute culturally-appropriate community educational materials on 

suicide prevention, suicide education, suicide screening, suicide 

intervention, and ways to mobilize communities with respect to the 

identification of risk factors for suicide; or (5) conduct data collection and reporting relating to Indian youth suicide prevention efforts. In carrying out these purposes, an Indian tribe or tribal organization may use and promote the traditional health care practices 

of the Indian tribes of the youth to be served. 

Subsection (c) sets forth the application requirements and information which must be submitted in order for an Indian tribe or 

tribal organization to be eligible to receive a grant. 

Subsection (d) directs the Secretary to encourage grantee Indian 

tribes and tribal organizations to collaborate to enable comparisons 

about best practices across projects. 

Subsection (e) directs each grant recipient to submit to the Secretary an annual report that describes the number of telemental 

health services provided, and includes any other information that 

the Secretary may require. 

Subsection (f) directs the Secretary to submit a final report to 

Congress not later than 270 days after the date of termination of 

the demonstration project. That report will describe the results of 

the projects funded by grants awarded under this section, including 

any data available that indicate the number of attempted suicides; 

evaluate the impact of the telemental health services funded by the 

grants in reducing the number of completed suicides among Indian 

youth; evaluate whether the demonstration project should be expanded to provide more than five grants and made a permanent 

program; and evaluate the benefits of expanding the demonstration 

project to include urban Indian health organizations. Subsection (g) authorizes $1.5 million for each of fiscal years 

2008 through 2011 for the demonstration program. 

COST AND BUDGETARY CONSIDERATIONS

The following cost estimate, as provided by the Congressional 

Budget Office, dated March 1, 2007, was prepared for S. 322: 

S. 322—Indian Youth Telemental Health Demonstration Project Act 

of 2007 

S. 322 would direct the Indian Health Service to conduct a demonstration project to examine the feasibility of using information 

and communications technology to improve the provision of suicide 

prevention services to Indian youths. As many as five tribes or tribal organizations would be able to participate in the project, with 

priority given to those tribes or tribal organizations that have a 

demonstrated need to address youth suicide or are located in reVerDate Mar 15 2010 21:48 Sep 19, 2011 Jkt 059010 PO 00000 Frm 00004 Fmt 6659 Sfmt 6602 E:\HR\OC\SR043.XXX SR043

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mote areas. The bill would authorize the appropriation of $1.5 million annually for fiscal years 2008 through 2011 for the project. 

CBO estimates that implementing S. 322 would cost less than $500,000 in 2008 and about $6 million over the 2008–2012 period, 

assuming the appropriation of the authorized amounts. Enacting 

this bill would have no effect on direct spending or revenues. 

This legislation contains no intergovernmental or private-sector 

mandates as defined in the Unfunded Mandates Reform Act and 

would impose no costs on state, local, or tribal governments. 

The CBO staff contact for this estimate is Eric Rollins. This estimate was approved by Peter H. Fontaine, Deputy Assistant Director for Budget Analysis. 

EXECUTIVE COMMUNICATIONS

The Committee has not received any executive communications 

on S. 322. 

REGULATORY AND PAPERWORK IMPACT STATEMENT

Paragraph 11(b) of rule XXVI of the Standing Rules of the Senate requires each report accompanying a bill to evaluate the regulatory and paperwork impact that would be incurred in carrying 

out the bill. The Committee believes that S. 322 will have a minimal impact on regulatory or paperwork requirements. 

CHANGES IN EXISTING LAW

In compliance with subsection 12 of rule XXVI of the Standing 

Rules of the Senate, the Committee states that the enactment of 

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

Æ 


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