II 

112TH CONGRESS 

1ST SESSION S. 1765 

To amend the Public Health Service Act to provide grants to strengthen 

the healthcare system’s response to domestic violence, dating violence, 

sexual assault, and stalking. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 31, 2011 

Mrs. HAGAN introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to provide grants 

to strengthen the healthcare system’s response to domestic violence, dating violence, sexual assault, and stalking. 

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 ‘‘Consolidation of 

5 Grants to Strengthen the Healthcare System’s Response 

6 to Domestic Violence, Dating Violence, Sexual Assault, 

7 and Stalking Act’’. 


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1 SEC. 2. STRENGTHENING THE HEALTHCARE SYSTEM’S RE2 SPONSE TO DOMESTIC VIOLENCE, DATING VI3 OLENCE, SEXUAL ASSAULT, AND STALKING. 

4 (a) IN GENERAL.—Section 399P of the Public 

5 Health Service Act (42 U.S.C. 280g–4) is amended to 

6 read as follows: 

7 ‘‘SEC. 399A. GRANTS TO STRENGTHEN THE HEALTHCARE 

8 SYSTEM’S RESPONSE TO DOMESTIC VIO9 LENCE, DATING VIOLENCE, SEXUAL ASSAULT, 

10 AND STALKING. 

11 ‘‘(a) IN GENERAL.—The Secretary, acting through 

12 the Office of Women’s Health, shall award grants for— 

13 ‘‘(1) the development or enhancement, and im14 plementation of interdisciplinary training for health 

15 professionals, public health staff, and allied health 

16 professionals; 

17 ‘‘(2) the development or enhancement, and im18 plementation of education programs for medical, 

19 nursing, dental, and other health professions stu20 dents and residents to prevent and respond to do21 mestic violence, dating violence, sexual assault, and 

22 stalking; and 

23 ‘‘(3) the development or enhancement, and im24 plementation of comprehensive Statewide strategies 

25 to improve the response of clinics, public health fa26 cilities, hospitals, and other health settings (includVerDate Mar 15 2010 02:43 Nov 01, 2011 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1765.IS S1765

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1 ing behavioral and mental health programs) to do2 mestic violence, dating violence, sexual assault, and 

3 stalking. 

4 ‘‘(b) USE OF FUNDS.— 

5 ‘‘(1) REQUIRED USES.—Amounts provided 

6 under a grant under subsection (a) shall be used 

7 to— 

8 ‘‘(A) fund interdisciplinary training and 

9 education programs under paragraphs (1) and 

10 (2) of subsection (a) that— 

11 ‘‘(i) are designed to train medical, 

12 psychology, dental, social work, nursing, 

13 and other health professions students, in14 terns, residents, fellows, or current health 

15 care providers to identify and provide 

16 health care services (including mental or 

17 behavioral health care services and refer18 rals to appropriate community services) to 

19 individuals who are or who have been vic20 tims of domestic violence, dating violence, 

21 sexual assault, or stalking; and 

22 ‘‘(ii) plan and develop culturally com23 petent clinical training components for in24 tegration into approved internship, resi25 dency, and fellowship training or conVerDate Mar 15 2010 02:43 Nov 01, 2011 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1765.IS S1765

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1 tinuing medical or other health education 

2 training that address physical, mental, and 

3 behavioral health issues, including protec4 tive factors, related to domestic violence, 

5 dating violence, sexual assault, stalking, 

6 and other forms of violence and abuse, 

7 focus on reducing health disparities and 

8 preventing violence and abuse, and include 

9 the primacy of victim safety and confiden10 tiality; and 

11 ‘‘(B) design and implement comprehensive 

12 strategies to improve the response of the health 

13 care system to domestic or sexual violence in 

14 clinical and public health settings, hospitals, 

15 clinics, and other health settings (including be16 havioral and mental health), under subsection 

17 (a)(3) through— 

18 ‘‘(i) implementation, dissemination, 

19 and evaluation of policies and procedures 

20 to guide health professionals and public 

21 health staff in identifying and responding 

22 to domestic violence, dating violence, sex23 ual assault, stalking, including strategies 

24 to ensure that health information is main25 tained in a manner that protects the paVerDate Mar 15 2010 02:43 Nov 01, 2011 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1765.IS S1765

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1 tient’s privacy and safety, and safely uses 

2 health information technology to improve 

3 documentation, identification, assessment, 

4 treatment, and follow-up care; 

5 ‘‘(ii) development of on-site access to 

6 services to address the safety, medical, and 

7 mental health needs of patients by increas8 ing the capacity of existing health care 

9 professionals and public health staff to ad10 dress domestic violence, dating violence, 

11 sexual assault, and stalking, or by con12 tracting with or hiring domestic or sexual 

13 assault advocates to provide such services 

14 or to model other services appropriate to 

15 the geographic and cultural needs of a site; 

16 ‘‘(iii) development of measures and 

17 methods for the identification of risk and 

18 protective factors and evaluation of identi19 fication, intervention, and documentation 

20 regarding victims of domestic violence, dat21 ing violence, sexual assault, sexual coer22 cion, and stalking, including the develop23 ment and testing of quality improvement 

24 measurements; and 


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1 ‘‘(iv) provision of training and follow2 up technical assistance to health care pro3 fessionals, and public health staff, and al4 lied health professionals to identify, assess, 

5 treat, and refer clients who are victims of 

6 domestic violence, dating violence, sexual 

7 assault, sexual coercion, or stalking, in8 cluding using tools and training materials 

9 already developed. 

10 ‘‘(2) PERMISSIBLE USES.— 

11 ‘‘(A) CHILD AND ELDER ABUSE.—To the 

12 extent consistent with the purpose of this sec13 tion, a grantee under this section may address, 

14 as part of a comprehensive programmatic ap15 proach implemented under a grant under this 

16 section, issues relating to child or elder abuse. 

17 ‘‘(B) OTHER USES OF FUNDS.—With re18 spect to— 

19 ‘‘(i) grants awarded under paragraphs 

20 (1) and (2) of subsection (a), grant funds 

21 may be used to— 

22 ‘‘(I) offer to rural areas commu23 nity-based training opportunities, 

24 which may include the use of distance 

25 learning networks and other available 


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1 technologies needed to reach isolated 

2 rural areas, for medical, nursing, and 

3 other health professions students and 

4 residents on domestic violence, dating 

5 violence, sexual assault, stalking, and, 

6 as appropriate, other forms of violence 

7 and abuse; or 

8 ‘‘(II) provide stipends to students 

9 who are underrepresented in the 

10 health professions as necessary to pro11 mote and enable their participation in 

12 clerkships, internships, or other offsite 

13 training experiences that are designed 

14 to develop health care clinical skills 

15 related to domestic violence, dating vi16 olence, sexual assault, stalking; and 

17 ‘‘(ii) grants awarded under subsection 

18 (a)(1), grant funds may be used for— 

19 ‘‘(I) development of training 

20 modules and policies that document 

21 and address the overlap of child 

22 abuse, domestic violence, dating vio23 lence, sexual assault, sexual coercion, 

24 and stalking and elder abuse, as well 


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1 as childhood exposure to domestic and 

2 sexual violence; 

3 ‘‘(II) development, expansion, 

4 and implementation of sexual assault 

5 forensic medical examination or sexual 

6 assault nurse examiner programs; 

7 ‘‘(III) inclusion of the health ef8 fects of lifetime exposure to violence 

9 and abuse as well as related protective 

10 factors and behavioral risk factors in 

11 health professional training schools in12 cluding medical, dental, nursing, so13 cial work, and mental and behavioral 

14 health curricula, and allied health 

15 service training courses; or 

16 ‘‘(IV) integration of knowledge of 

17 domestic violence, dating violence, sex18 ual assault, sexual coercion, and stalk19 ing into health care accreditation and 

20 professional licensing examinations, 

21 such as medical, dental, social work, 

22 and nursing boards, and where appro23 priate, other allied health exams. 

24 ‘‘(c) REQUIREMENTS FOR GRANTEES.— 

25 ‘‘(1) CONFIDENTIALITY AND SAFETY.— 


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1 ‘‘(A) IN GENERAL.—Grantees under this 

2 section shall ensure that all programs developed 

3 with grant funds address issues of confiden4 tiality and patient safety and comply with appli5 cable confidentiality and nondisclosure require6 ments under section 40002(b)(2) of the Vio7 lence Against Women Act of 1994 (42 U.S.C. 

8 13925(b)(2)) and the Family Violence Preven9 tion and Services Act (42 U.S.C. 10401 et 

10 seq.), and that faculty and staff associated with 

11 delivering educational components are fully 

12 trained in procedures that will protect the im13 mediate and ongoing security and confiden14 tiality of the patients, patient records, and 

15 staff. Such grantees shall consult entities with 

16 demonstrated expertise in the confidentiality 

17 and safety needs of victims of domestic violence, 

18 dating violence, sexual assault, and stalking on 

19 the development and adequacy of confidentially 

20 and security procedures, and provide docu21 mentation of such consultation. 

22 ‘‘(B) ADVANCE NOTICE OF INFORMATION

23 DISCLOSURE.—Grantees under this section shall 

24 provide to patients advance notice about any 

25 circumstances under which information may be 


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1 disclosed, such as mandatory reporting laws, 

2 and shall give patients the option to receive in3 formation and referrals without affirmatively 

4 disclosing abuse. 

5 ‘‘(2) APPLICATION.— 

6 ‘‘(A) PREFERENCE.—In selecting grant re7 cipients under this section, the Secretary shall 

8 give preference to applicants based on the 

9 strength of their evaluation strategies, with out10 come based evaluations, broadly defined and 

11 prioritized. 

12 ‘‘(B) GRANTS UNDER SUBSECTION (a) (1) 

13 OR (2).—An entity desiring a grant under para14 graph (1) or (2) of subsection (a) shall submit 

15 an application to the Secretary at such time, in 

16 such a manner, and containing such informa17 tion and assurances as the Secretary may re18 quire, including— 

19 ‘‘(i) documentation that the applicant 

20 represents a team of entities, including 

21 someone with evaluation or research exper22 tise, working collaboratively to strengthen 

23 the response of the health care system to 

24 domestic violence, dating violence, sexual 


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1 assault, or stalking, and which includes at 

2 least one of each of— 

3 ‘‘(I) an accredited school of 

4 allopathic or osteopathic medicine, 

5 psychology, nursing, dental, social 

6 work, or other health field; or a health 

7 care facility or system; and 

8 ‘‘(II) a government or nonprofit 

9 entity with a history of effective work 

10 in the fields of domestic violence, dat11 ing violence, sexual assault, or stalk12 ing; and 

13 ‘‘(ii) strategies for the dissemination 

14 and sharing of curricula and other edu15 cational materials developed under the 

16 grant, if any, with other interested health 

17 professions schools and national resource 

18 repositories for materials on domestic vio19 lence, dating violence, sexual assault, and 

20 stalking; 

21 ‘‘(C) GRANTS UNDER SUBSECTION

22 (a)(3).—An entity desiring a grant under sub23 section (a)(3) shall submit an application to the 

24 Secretary at such time, in such a manner, and 


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1 containing such information and assurances as 

2 the Secretary may require, including— 

3 ‘‘(i) documentation that all training, 

4 education, screening, assessment, services, 

5 treatment, and any other approach to pa6 tient care will be informed by an under7 standing and dynamics of violence and 

8 abuse victimization and trauma-specific ap9 proaches and these approaches will be inte10 grated into research, prevention, interven11 tion, and treatment activities; 

12 ‘‘(ii) strategies for the development 

13 and implementation of policies to prevent 

14 and address domestic violence, dating vio15 lence, sexual assault, and stalking over the 

16 lifespan in health care settings; 

17 ‘‘(iii) a plan for consulting with State 

18 and tribal domestic violence or sexual as19 sault coalitions, national nonprofit victim 

20 advocacy organizations, State or tribal law 

21 enforcement task forces (where appro22 priate), and culturally specific organiza23 tions with demonstrated expertise in do24 mestic violence, dating violence, sexual as25 sault, or stalking; and 


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1 ‘‘(iv) with respect to an application 

2 for a grant— 

3 ‘‘(I) under which the grantee will 

4 have contact with patients, a plan, de5 veloped in collaboration with local vic6 tim service providers, to respond ap7 propriately to and make correct refer8 rals for individuals who disclose that 

9 they are victims of domestic violence, 

10 dating violence, sexual assault, stalk11 ing, or other types of violence (such 

12 grantees shall provide documentation 

13 of an ongoing collaborative relation14 ship with a local victim service pro15 vider); or 

16 ‘‘(II) proposing to fund a pro17 gram described in subsection 

18 (b)(2)(B)(ii)(II), a certification that 

19 any sexual assault forensic medical ex20 amination and sexual assault nurse 

21 examiner programs supported with 

22 such grant funds will adhere to the 

23 guidelines set forth in the Attorney 

24 General’s National Protocol for SexVerDate Mar 15 2010 02:43 Nov 01, 2011 Jkt 019200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S1765.IS S1765

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1 ual Assault Medical Forensic Exami2 nations (Adults/Adolescents). 

3 ‘‘(d) ELIGIBLE ENTITIES.— 

4 ‘‘(1) GRANTS UNDER SUBSECTION (a) (1) OR

5 (2).—To be eligible to receive funding under para6 graph (1) or (2) of subsection (a), an entity shall 

7 be— 

8 ‘‘(A) a nonprofit organization with a his9 tory of effective work in the field of training 

10 health professionals with an understanding of, 

11 and clinical skills pertinent to, domestic vio12 lence, dating violence, sexual assault, or stalk13 ing, and lifetime exposure to violence and 

14 abuse; 

15 ‘‘(B) an accredited school of allopathic or 

16 osteopathic medicine, psychology, nursing, den17 tal, social work, or allied health; 

18 ‘‘(C) a health care provider membership or 

19 professional organization, or a health care sys20 tem; or 

21 ‘‘(D) a State, tribal, territorial, or local en22 tity. 

23 ‘‘(2) GRANTS UNDER SUBSECTION (a)(3).—To 

24 be eligible to receive funding under subsection 

25 (a)(3), an entity shall be— 


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1 ‘‘(A) a State department (or other divi2 sion) of health, a State, tribal, or territorial do3 mestic violence or sexual assault coalition or 

4 victim services program, or any other nonprofit, 

5 nongovernmental organization with a history of 

6 effective work in the fields of domestic violence, 

7 dating violence, sexual assault, or stalking, and 

8 health care, including physical or mental health 

9 care; or 

10 ‘‘(B) a local victim service provider, a local 

11 department (or other division) of health, a local 

12 health clinic, hospital, or health system, or any 

13 other community-based organization with a his14 tory of effective work in the field of domestic vi15 olence, dating violence, sexual assault, or stalk16 ing and health care, including physical or men17 tal health care. 

18 ‘‘(e) TECHNICAL ASSISTANCE.— 

19 ‘‘(1) IN GENERAL.—Of the funds made avail20 able to carry out this section for any fiscal year, the 

21 Secretary may make a grant or enter into a contract 

22 to provide technical assistance with respect to the 

23 planning, development, and operation of any pro24 gram, activity, or service carried out pursuant to 

25 this section. Not to exceed 8 percent of the funds 


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1 appropriated under this section for a fiscal year may 

2 be used to fund technical assistance, unless the Sec3 retary has previously set aside amounts greater than 

4 8 percent for technical assistance and training relat5 ing to grant programs authorized under this section. 

6 ‘‘(2) AVAILABILITY OF MATERIALS.—The Sec7 retary shall make publicly available materials devel8 oped by grantees under this section, including mate9 rials on training, best practices, and research and 

10 evaluation. 

11 ‘‘(3) REPORTING.—The Secretary shall publish 

12 a biennial report on— 

13 ‘‘(A) the distribution of funds under this 

14 section; and 

15 ‘‘(B) the programs and activities supported 

16 by such funds. 

17 ‘‘(f) RESEARCH AND EVALUATION.— 

18 ‘‘(1) IN GENERAL.—Of the funds made avail19 able to carry out this section for any fiscal year, the 

20 Secretary may use not to exceed 20 percent to make 

21 a grant or enter into a contract for research and 

22 evaluation of— 

23 ‘‘(A) grants awarded under this section; 

24 and 


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1 ‘‘(B) other training for health professionals 

2 and effective interventions in the health care 

3 setting that prevent domestic violence, dating 

4 violence, and sexual assault across the lifespan, 

5 prevent the health effects of such violence, and 

6 improve the safety and health of individuals 

7 who are currently being victimized. 

8 ‘‘(2) RESEARCH.—Research authorized in para9 graph (1) may include— 

10 ‘‘(A) research on the effects of domestic vi11 olence, dating violence, sexual assault, and 

12 childhood exposure to domestic, dating or sex13 ual violence on health behaviors, health condi14 tions, and health status of individuals, families, 

15 and populations; 

16 ‘‘(B) research to determine effective health 

17 care interventions to respond to and prevent do18 mestic violence, dating violence, sexual assault, 

19 and sexual coercion; 

20 ‘‘(C) research on the impact of domestic, 

21 dating and sexual violence, childhood exposure 

22 to such violence, and stalking on the health care 

23 system, health care utilization, health care 

24 costs, and health status; and 


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1 ‘‘(D) research on the impact of adverse 

2 childhood experiences on adult experience with 

3 domestic violence, dating violence, sexual as4 sault, stalking and adult health outcomes, in5 cluding how to reduce or prevent the impact of 

6 adverse childhood experiences through the 

7 health care setting. 

8 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

9 is authorized to be appropriated to carry out this section 

10 $10,000,000 for each of fiscal years 2012 through 2016. 

11 ‘‘(h) DEFINITIONS.—Except as otherwise provided, 

12 the definitions in section 40002 of the Violence Against 

13 Women Act of 1994 (42 U.S.C. 13925) shall apply to this 

14 section.’’. 

15 (b) REPEALS.—The following provisions are repealed: 

16 (1) Section 758 of the Public Health Service 

17 Act (42 U.S.C. 294h). 

18 (2) Section 40297 of the Violence Against 

19 Women Act of 1994 (42 U.S.C. 13973). 

Æ 


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