I 

108TH CONGRESS 

1ST SESSION H. R. 1359

To increase the number of well-trained mental health service professionals 

(including those based in schools) providing clinical mental health care 

to children and adolescents, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 19, 2003

Mr. KENNEDY of Rhode Island (for himself, Ms. ROS-LEHTINEN, Ms. NORTON, Mr. KILDEE, Mr. PLATTS, Mr. OWENS, Ms. KILPATRICK, Mr. LANTOS, Mr. SERRANO, Mr. DEUTSCH, Mr. STARK, and Mr. MARIO DIAZBALART of Florida) introduced the following bill; which was referred to 

the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined 

by the Speaker, in each case for consideration of such provisions as fall 

within the jurisdiction of the committee concerned 

A BILL

To increase the number of well-trained mental health service 

professionals (including those based in schools) providing 

clinical mental health care to children and adolescents, 

and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Child Healthcare Crisis 

5 Relief Act’’. 
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1 SEC. 2. FINDINGS. 

2 The Congress finds the following: 

3 (1) The Center for Mental Health Services esti4 mates that 20 percent or 13,700,000 of the Nation’s 

5 children and adolescents have a diagnosable mental 

disorder, and about 2 6 ⁄3 of these children and adoles7 cents do not receive mental health care. 

8 (2) According to ‘‘Mental Health: A Report of 

9 the Surgeon General’’ in 1999, there are approxi10 mately 6,000,000 to 9,000,000 children and adoles11 cents in the United States (accounting for 9 to 13 

12 percent of all children and adolescents in the United 

13 States) who meet the definition for having a serious 

14 emotional disturbance. 

15 (3) According to the Center for Mental Health 

16 Services, approximately 5 to 9 percent of United 

17 States children and adolescents meet the definition 

18 for extreme functional impairment. 

19 (4) According to the Surgeon General’s Report, 

20 there are particularly acute shortages in the num21 bers of mental health service professionals serving 

22 children and adolescents with serious emotional dis23 orders. 

24 (5) According to the National Center for Edu25 cation Statistics in the Department of Education, 

26 there are approximately 513 students for each school 
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1 counselor in United States schools, which ratio is 

2 more than double the recommended ratio of 250 stu3 dents for each school counselor. 

4 (6) According to the Bureau of Health Profes5 sions in 2000, the demand for the services of child 

6 and adolescent psychiatry is projected to increase by 

7 100 percent by 2020. 

8 (7) The development and application of knowl9 edge about the impact of disasters on children, ado10 lescents, and their families has been impeded by crit11 ical shortages of qualified researchers and practi12 tioners specializing in this work. 

13 (8) According to the Bureau of the Census, the 

14 population of children and adolescents in the United 

15 States under the age of 18 is projected to grow by 

16 more than 40 percent in the next 50 years from 70 

17 million to more than 100 million by 2050. 

18 SEC. 3. LOAN REPAYMENTS, SCHOLARSHIPS, AND GRANTS 

19 TO IMPROVE CHILD AND ADOLESCENT MEN20 TAL HEALTH CARE. 

21 Part B of title VII of the Public Health Service Act 

22 (42 U.S.C. 293 et seq.) is amended by adding at the end 

23 the following: 
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1 ‘‘SEC. 742. LOAN REPAYMENTS, SCHOLARSHIPS, AND 

2 GRANTS TO IMPROVE CHILD AND ADOLES3 CENT MENTAL HEALTH CARE. 

4 ‘‘(a) LOAN REPAYMENTS FOR CHILD AND ADOLES5 CENT MENTAL HEALTH SERVICE PROFESSIONALS.—

6 ‘‘(1) ESTABLISHMENT.—The Secretary, acting 

7 through the Administrator of the Health Resources 

8 and Services Administration, may establish a pro9 gram of entering into contracts on a competitive 

10 basis with eligible individuals (as defined in para11 graph (2)) under which—

12 ‘‘(A) the eligible individual agrees to be 

13 employed full-time for a specified period (which 

14 shall be at least 2 years) in providing mental 

15 health services to children and adolescents; and 

16 ‘‘(B) the Secretary agrees to make, during 

17 the period of employment described in subpara18 graph (A), partial or total payments on behalf 

19 of the individual on the principal and interest 

20 due on the undergraduate and graduate edu21 cational loans of the eligible individual. 

22 ‘‘(2) ELIGIBLE INDIVIDUAL.—For purposes of 

23 this section, the term ‘eligible individual’ means an 

24 individual who—

25 ‘‘(A) is receiving specialized training or 

26 clinical experience in child and adolescent men-
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1 tal health in psychiatry, psychology, school psy2 chology, psychiatric nursing, social work, school 

3 social work, marriage and family therapy, 

4 school counseling, or professional counseling 

5 and has less than 1 year remaining before com6 pletion of such training or clinical experience; 

7 or 

8 ‘‘(B)(i) has a license in a State to practice 

9 allopathic medicine, osteopathic medicine, psy10 chology, school psychology, psychiatric nursing, 

11 social work, school social work, marriage and 

12 family therapy, school counseling, or profes13 sional counseling; and 

14 ‘‘(ii)(I) is a mental health service profes15 sional who completed (but not before the end of 

16 the calendar year in which this Act is enacted) 

17 specialized training or clinical experience in 

18 child and adolescent mental health described in 

19 subparagraph (A); or 

20 ‘‘(II) is a physician who graduated from 

21 (but not before the end of the calendar year in 

22 which this Act is enacted) an accredited child 

23 and adolescent psychiatry residency or fellow24 ship program in the United States.
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1 ‘‘(3) ADDITIONAL ELIGIBILITY REQUIRE2 MENTS.—The Secretary may not enter into a con3 tract under this subsection with an eligible indi4 vidual unless the individual—

5 ‘‘(A) is a United States citizen or a perma6 nent legal United States resident; and 

7 ‘‘(B) if enrolled in a graduate program (in8 cluding a medical residency or fellowship), has 

9 an acceptable level of academic standing (as de10 termined by the Secretary). 

11 ‘‘(4) PRIORITY.—In entering into contracts 

12 under this subsection, the Secretary shall give pri13 ority to applicants who—

14 ‘‘(A) are or will be working with high pri15 ority populations; 

16 ‘‘(B) have familiarity with evidence-based 

17 methods in child and adolescent mental health 

18 services; 

19 ‘‘(C) demonstrate financial need; and 

20 ‘‘(D) are or will be working in the publicly 

21 funded sector. 

22 ‘‘(5) MEANINGFUL LOAN REPAYMENT.—If the 

23 Secretary determines that funds appropriated for a 

24 fiscal year to carry out this subsection are not suffi25 cient to allow a meaningful loan repayment to all ex-
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1 pected applicants, the Secretary shall limit the num2 ber of contracts entered into under paragraph (1) to 

3 ensure that each such contract provides for a mean4 ingful loan repayment. 

5 ‘‘(6) AMOUNT.—

6 ‘‘(A) MAXIMUM.—For each year that an 

7 eligible individual agrees under a contract 

8 under paragraph (1) to be employed, the Sec9 retary may agree under that contract to pay 

10 not more than $35,000 on behalf of the indi11 vidual. 

12 ‘‘(B) CONSIDERATION.—In determining 

13 the amount of payments to be made on behalf 

14 of an eligible individual under a contract to be 

15 entered into under paragraph (1), the Secretary 

16 shall consider the eligible individual’s income 

17 and debt load. 

18 ‘‘(7) APPLICABILITY OF CERTAIN PROVI19 SIONS.—The provisions of sections 338E and 338F 

20 shall apply to the program established under para21 graph (1) to the same extent and in the same man22 ner as such provisions apply to the National Health 

23 Service Corps Loan Repayment Program established 

24 in subpart III of part D of title III. 
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1 ‘‘(8) AUTHORIZATION OF APPROPRIATIONS.—

2 There is authorized to be appropriated to carry out 

3 this subsection $10,000,000 for each of fiscal years 

4 2004 through 2008. 

5 ‘‘(b) SCHOLARSHIPS FOR STUDENTS STUDYING TO

6 BECOME CHILD AND ADOLESCENT MENTAL HEALTH

7 SERVICE PROFESSIONALS.—

8 ‘‘(1) ESTABLISHMENT.—The Secretary, acting 

9 through the Administrator of the Health Resources 

10 and Services Administration, may establish a pro11 gram to award scholarships on a competitive basis to 

12 eligible students (as defined in paragraph (2)) who 

13 agree to enter into full-time employment (as de14 scribed in paragraph (4)(C)) as a child and adoles15 cent mental health service professional after gradua16 tion or completion of a residency or fellowship. 

17 ‘‘(2) ELIGIBLE STUDENT.—For purposes of 

18 this subsection, the term ‘eligible student’ means a 

19 United States citizen or a permanent legal United 

20 States resident who—

21 ‘‘(A) is enrolled or accepted to be enrolled 

22 in a graduate program that includes specialized 

23 training or clinical experience in child and ado24 lescent mental health in psychology, school psy25 chology, psychiatric nursing, social work, school 
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1 social work, marriage and family therapy, 

2 school counseling, or professional counseling; or 

3 ‘‘(B) is enrolled or accepted to be enrolled 

4 in an accredited graduate training program of 

5 allopathic or osteopathic medicine in the United 

6 States and intends to complete an accredited 

7 residency or fellowship in child and adolescent 

8 psychiatry. 

9 ‘‘(3) PRIORITY.—In awarding scholarships 

10 under this subsection, the Secretary shall give—

11 ‘‘(A) highest priority to applicants who 

12 previously received a scholarship under this 

13 subsection and satisfy the criteria described in 

14 subparagraph (B); and 

15 ‘‘(B) second highest priority to applicants 

16 who—

17 ‘‘(i) demonstrate a commitment to 

18 working with high priority populations; 

19 ‘‘(ii) have familiarity with evidence20 based methods in child and adolescent 

21 mental health services; 

22 ‘‘(iii) demonstrate financial need; and 

23 ‘‘(iv) are or will be working in the 

24 publicly funded sector. 
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1 ‘‘(4) REQUIREMENTS.—The Secretary may 

2 award a scholarship to an eligible student under this 

3 subsection only if the eligible student agrees—

4 ‘‘(A) to complete any graduate training 

5 program, internship, residency, or fellowship 

6 applicable to that eligible student under para7 graph (2); 

8 ‘‘(B) to maintain an acceptable level of 

9 academic standing (as determined by the Sec10 retary) during the completion of such graduate 

11 training program, internship, residency, or fel12 lowship; and 

13 ‘‘(C) to be employed full-time after gradua14 tion or completion of a residency or fellowship, 

15 for at least the number of years for which a 

16 scholarship is received by the eligible student 

17 under this subsection, in providing mental 

18 health services to children and adolescents. 

19 ‘‘(5) USE OF SCHOLARSHIP FUNDS.—A scholar20 ship awarded to an eligible student for a school year 

21 under this subsection may be used only to pay for 

22 tuition expenses of the school year, other reasonable 

23 educational expenses (including fees, books, and lab24 oratory expenses incurred by the eligible student in 

25 the school year), and reasonable living expenses, as
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1 such tuition expenses, reasonable educational ex2 penses, and reasonable living expenses are deter3 mined by the Secretary. 

4 ‘‘(6) AMOUNT.—The amount of a scholarship 

5 under this subsection shall not exceed the total 

6 amount of the tuition expenses, reasonable edu7 cational expenses, and reasonable living expenses de8 scribed in paragraph (5). 

9 ‘‘(7) APPLICABILITY OF CERTAIN PROVI10 SIONS.—The provisions of sections 338E and 338F 

11 shall apply to the program established under para12 graph (1) to the same extent and in the same man13 ner as such provisions apply to the National Health 

14 Service Corps Scholarship Program established in 

15 subpart III of part D of title III. 

16 ‘‘(8) AUTHORIZATION OF APPROPRIATIONS.—

17 There is authorized to be appropriated to carry out 

18 this subsection $5,000,000 for each of fiscal years 

19 2004 through 2008. 

20 ‘‘(c) CLINICAL TRAINING GRANTS FOR PROFES21 SIONALS.—

22 ‘‘(1) ESTABLISHMENT.—The Secretary, acting 

23 through the Administrator of the Health Resources 

24 and Services Administration, in cooperation with the 

25 Administrator of the Substance Abuse and Mental 
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1 Health Services Administration, may establish a pro2 gram to award grants on a competitive basis to ac3 credited institutions of higher education to establish 

4 or expand internships or other field placement pro5 grams for students receiving specialized training or 

6 clinical experience in child and adolescent mental 

7 health in psychiatry, psychology, school psychology, 

8 psychiatric nursing, social work, school social work, 

9 marriage and family therapy, school counseling, or 

10 professional counseling. 

11 ‘‘(2) PRIORITY.—In awarding grants under this 

12 subsection, the Secretary shall give priority to appli13 cants that—

14 ‘‘(A) have demonstrated the ability to col15 lect data on the number of students trained in 

16 child and adolescent mental health and the pop17 ulations served by such students after gradua18 tion; 

19 ‘‘(B) have demonstrated familiarity with 

20 evidence-based methods in child and adolescent 

21 mental health services; and 

22 ‘‘(C) have programs designed to increase 

23 the number of professionals serving high pri24 ority populations. 
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1 ‘‘(3) REQUIREMENTS.—The Secretary may 

2 award a grant to an applicant under this subsection 

3 only if the applicant agrees that—

4 ‘‘(A) any internship or other field place5 ment program assisted under the grant will 

6 prioritize cultural competency; 

7 ‘‘(B) students benefiting from any assist8 ance under this subsection will be United States 

9 citizens or permanent legal United States resi10 dents; 

11 ‘‘(C) the institution will provide to the Sec12 retary such data, assurances, and information 

13 as the Secretary may require; and 

14 ‘‘(D) with respect to any violation of the 

15 agreement between the Secretary and the insti16 tution, the institution will pay such liquidated 

17 damages as prescribed by the Secretary by reg18 ulation. 

19 ‘‘(4) APPLICATION.—The Secretary shall re20 quire that any application for a grant under this 

21 subsection include a description of the applicant’s 

22 experience working with child and adolescent mental 

23 health issues. 

24 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.—

25 There is authorized to be appropriated to carry out 
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1 this subsection $10,000,000 for each of fiscal years 

2 2004 through 2008. 

3 ‘‘(d) PROGRESSIVE EDUCATION GRANTS FOR PARA4 PROFESSIONALS.—

5 ‘‘(1) ESTABLISHMENT.—The Secretary, acting 

6 through the Administrator of the Health Resources 

7 and Services Administration, in cooperation with the 

8 Administrator of the Substance Abuse and Mental 

9 Health Services Administration, may establish a pro10 gram to award grants on a competitive basis to 

11 State-licensed mental health nonprofit and for-profit 

12 organizations (including accredited institutions of 

13 higher education) to enable such organizations to 

14 pay for programs for preservice or in-service training 

15 of paraprofessional child and adolescent mental 

16 health workers. 

17 ‘‘(2) DEFINITION.—For purposes of this sub18 section, the term ‘paraprofessional child and adoles19 cent mental health worker’ means an individual who 

20 is not a mental health service professional, but who 

21 works at the first stage of contact with children and 

22 families who are seeking mental health services. 

23 ‘‘(3) PRIORITY.—In awarding grants under this 

24 subsection, the Secretary shall give priority to appli25 cants that—
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1 ‘‘(A) have demonstrated the ability to col2 lect data on the number of paraprofessional 

3 child and adolescent mental health workers 

4 trained by the applicant and the populations 

5 served by these workers after the completion of 

6 the training; 

7 ‘‘(B) have familiarity with evidence-based 

8 methods in child and adolescent mental health 

9 services; and 

10 ‘‘(C) have programs designed to increase 

11 the number of paraprofessional child and ado12 lescent mental health workers serving high pri13 ority populations. 

14 ‘‘(4) REQUIREMENTS.—The Secretary may 

15 award a grant to an organization under this sub16 section only if the organization agrees that—

17 ‘‘(A) any training program assisted under 

18 the grant will prioritize cultural competency; 

19 ‘‘(B) the organization will provide to the 

20 Secretary such data, assurances, and informa21 tion as the Secretary may require; and 

22 ‘‘(C) with respect to any violation of the 

23 agreement between the Secretary and the orga24 nization, the organization will pay such liq-
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1 uidated damages as prescribed by the Secretary 

2 by regulation. 

3 ‘‘(5) APPLICATION.—The Secretary shall re4 quire that any application for a grant under this 

5 subsection include a description of the applicant’s 

6 experience working with paraprofessional child and 

7 adolescent mental health workers. 

8 ‘‘(6) AUTHORIZATION OF APPROPRIATIONS.—

9 There is authorized to be appropriated to carry out 

10 this subsection $5,000,000 for each of fiscal years 

11 2004 through 2008. 

12 ‘‘(e) CHILD AND ADOLESCENT MENTAL HEALTH

13 PROGRAM DEVELOPMENT GRANTS.—

14 ‘‘(1) ESTABLISHMENT.—The Secretary, acting 

15 through the Administrator of the Health Resources 

16 and Services Administration, may establish a pro17 gram to increase the number of well-trained child 

18 and adolescent mental health service professionals in 

19 the United States by awarding grants on a competi20 tive basis to accredited institutions of higher edu21 cation to enable the institutions to establish or ex22 pand accredited graduate child and adolescent men23 tal health programs. 
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1 ‘‘(2) PRIORITY.—In awarding grants under this 

2 subsection, the Secretary shall give priority to appli3 cants that—

4 ‘‘(A) demonstrate familiarity with the use 

5 of evidence-based methods in child and adoles6 cent mental health services; 

7 ‘‘(B) provide experience in and collabora8 tion with community-based child and adolescent 

9 mental health services; 

10 ‘‘(C) have included normal child develop11 ment curricula; and 

12 ‘‘(D) demonstrate commitment to working 

13 with high priority populations. 

14 ‘‘(3) USE OF FUNDS.—Funds received as a 

15 grant under this subsection may be used to establish 

16 or expand any accredited graduate child and adoles17 cent mental health program in any manner deemed 

18 appropriate by the Secretary, including by improving 

19 the coursework, related field placements, or faculty 

20 of such program. 

21 ‘‘(4) REQUIREMENTS.—The Secretary may 

22 award a grant to an accredited institution of higher 

23 education under this subsection only if the institu24 tion agrees that—
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1 ‘‘(A) any child and adolescent mental 

2 health program assisted under the grant will 

3 prioritize cultural competency; 

4 ‘‘(B) the institution will provide to the Sec5 retary such data, assurances, and information 

6 as the Secretary may require; and 

7 ‘‘(C) with respect to any violation of the 

8 agreement between the Secretary and the insti9 tution, the institution will pay such liquidated 

10 damages as prescribed by the Secretary by reg11 ulation. 

12 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.—

13 There is authorized to be appropriated to carry out 

14 this subsection $15,000,000 for each of fiscal years 

15 2004 through 2008. 

16 ‘‘(f) DEFINITIONS.—In this section: 

17 ‘‘(1) SPECIALIZED TRAINING OR CLINICAL EX18 PERIENCE IN CHILD AND ADOLESCENT MENTAL

19 HEALTH.—The term ‘specialized training or clinical 

20 experience in child and adolescent mental health’ 

21 means training and clinical experience that—

22 (A) is part of or occurs after completion of 

23 an accredited graduate program in the United 

24 States for training mental health service profes25 sionals;
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1 (B) consists of at least 500 hours of train2 ing or clinical experience in treating children 

3 and adolescents; and 

4 (C) is comprehensive, coordinated, develop5 mentally appropriate, and of high quality to ad6 dress the unique ethnic and cultural diversity of 

7 the United States population. 

8 ‘‘(2) HIGH PRIORITY POPULATION.—The term 

9 ‘high priority population’ means a population that 

10 has a high incidence of children and adolescents who 

11 have serious emotional disturbances, are racial and 

12 ethnic minorities, or live in urban or rural areas. 

13 ‘‘(3) MENTAL HEALTH SERVICE PROFES14 SIONAL.—The term ‘mental health service profes15 sional’ means an individual with a graduate or post16 graduate degree from an accredited institution of 

17 higher education in psychiatry, psychology, school 

18 psychology, psychiatric nursing, social work, school 

19 social work, marriage and family counseling, school 

20 counseling, or professional counseling.’’. 

21 SEC. 4. AMENDMENTS TO SOCIAL SECURITY ACT TO IM22 PROVE CHILD AND ADOLESCENT MENTAL 

23 HEALTH CARE. 

24 (a) INCREASING NUMBER OF CHILD AND ADOLES25 CENT PSYCHIATRY RESIDENTS PERMITTED TO BE PAID
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1 UNDER THE MEDICARE GRADUATE MEDICAL EDUCATION

2 PROGRAM.—Section 1886(h)(4)(F) of the Social Security 

3 Act (42 U.S.C. 1395ww(h)(4)(F)) is amended by adding 

4 at the end the following new clause: 

5 ‘‘(iii) INCREASE ALLOWED FOR TRAIN6 ING IN CHILD AND ADOLESCENT PSYCHI7 ATRY.—In applying clause (i), there shall 

8 not be taken into account such additional 

9 number of full-time equivalent residents in 

10 the field of allopathic or osteopathic medi11 cine who are residents or fellows in child 

12 and adolescent psychiatry as the Secretary 

13 determines reasonable to meet the need for 

14 such physicians as demonstrated by the 

15 1999 report of the Department of Health 

16 and Human Services entitled ‘Mental 

17 Health: A Report of the Surgeon Gen18 eral’.’’. 

19 (b) EXTENSION OF MEDICARE BOARD ELIGIBILITY

20 PERIOD FOR RESIDENTS AND FELLOWS IN CHILD AND

21 ADOLESCENT PSYCHIATRY.—

22 (1) IN GENERAL.—Section 1886(h)(5)(G) of 

23 the Social Security Act (42 U.S.C. 

24 1395ww(h)(5)(G)) is amended—
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1 (A) in clause (i), by striking ‘‘and (v)’’ and 

2 inserting ‘‘(v), and (vi)’’; and 

3 (B) by adding at the end the following new 

4 clause: 

5 ‘‘(vi) CHILD AND ADOLESCENT PSY6 CHIATRY TRAINING PROGRAMS.—In the 

7 case of an individual enrolled in a child 

8 and adolescent psychiatry residency or fel9 lowship program approved by the Sec10 retary, the period of board eligibility and 

11 the initial residency period shall be the pe12 riod of board eligibility for the specialty of 

13 general psychiatry, plus 2 years for the 

14 subspecialty of child and adolescent psychi15 atry.’’. 

16 (2) EFFECTIVE DATE.—The amendments made 

17 by paragraph (1) shall apply to residency training 

18 years beginning on or after July 1, 2003. 

19 SEC. 5. CHILD MENTAL HEALTH PROFESSIONAL REPORT. 

20 (a) STUDY.—The Administrator of the Health Re21 sources and Services Administration (in this section re22 ferred to as the ‘‘Administrator’’) shall study and make 

23 findings and recommendations on the distribution and 

24 need for child mental health service professionals, includ25 ing with respect to specialty certifications, practice charac-
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1 teristics, professional licensure, practice types, locations, 

2 education, and training. 

3 (b) DISAGGREGATION.—The results of the study re4 quired by subsection (a) shall be disaggregated by State. 

5 (c) REPORT.—Not later than 1 year after the date 

6 of the enactment of this Act, the Administrator shall sub7 mit to the Congress and make publicly available a report 

8 on the study, findings, and recommendations required by 

9 subsection (a). 

10 (d) REVISION.—Each year the Administrator shall 

11 revise the report required under subsection (c). 

12 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section 

14 such sums as may be necessary for each of fiscal years 

15 2004 through 2008. 

16 SEC. 6. REPORTS. 

17 (a) TRANSMISSION.—The Secretary of Health and 

18 Human Services shall transmit a report described in sub19 section (b) to the Congress—

20 (1) not later than 3 years after the date of the 

21 enactment of this Act; and 

22 (2) not later than 5 years after the date of the 

23 enactment of this Act. 
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1 (b) CONTENTS.—The reports transmitted to the Con2 gress under subsection (a) shall address each of the fol3 lowing: 

4 (1) The effectiveness of the amendments made 

5 by, and the programs carried out under, this Act in 

6 increasing the number of child and adolescent men7 tal health service professionals and paraprofessional 

8 child and adolescent mental health workers. 

9 (2) The demographics of the individuals served 

10 by such increased number of child and adolescent 

11 mental health service professionals and paraprofes12 sional child and adolescent mental health workers.

Æ