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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1404 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1404

 To implement demonstration projects at federally qualified community 
    health centers to promote universal access to family centered, 
   evidence-based behavioral health interventions that prevent child 
  maltreatment and promote family well-being by addressing parenting 
practices and skills for families from diverse socioeconomic, cultural, 
     racial, ethnic, and other backgrounds, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              July 7, 2009

  Mr. Inouye introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
 To implement demonstration projects at federally qualified community 
    health centers to promote universal access to family centered, 
   evidence-based behavioral health interventions that prevent child 
  maltreatment and promote family well-being by addressing parenting 
practices and skills for families from diverse socioeconomic, cultural, 
     racial, ethnic, and other backgrounds, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Supporting Child Maltreatment 
Prevention Efforts in Community Health Centers Act of 2009''.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--Congress finds as follows:
            (1) Child abuse and neglect are serious public health 
        problems in this country. During 2007, approximately 3,200,000 
        referrals, involving the alleged maltreatment of approximately 
        5,800,000 children, were sent to child protective services 
        agencies.
            (2) The most recent data show 794,000 substantiated cases 
        of child abuse and neglect in 2007, and child maltreatment-
        related deaths rose 15.5 percent in 2007. Approximately 1,760 
        children in the United States, nearly \3/4\ of whom were under 
        4 years of age, died as a result of abuse or neglect.
            (3) Early childhood experiences may have lifelong effects. 
        Severe and chronic childhood stress, including from 
        maltreatment and exposure to violence, is associated with 
        persistent effects and can lead to enduring health, behavior, 
        and learning problems.
            (4) Child maltreatment has--
                    (A) psychological and behavioral consequences such 
                as depression, anxiety, suicide, aggressive behavior, 
                delinquency, posttraumatic stress disorder, and 
                criminal behavior;
                    (B) health consequences, including injuries and 
                death, chronic obstructive pulmonary disease, smoking, 
                heart disease, liver disease, and drug use; and
                    (C) developmental consequences that can compromise 
                brain development and learning.
            (5) Child maltreatment has significant financial 
        consequences, including the short-term costs associated with 
        case handling by child protective services and investigations, 
        hospitalization or emergency room visits for medical treatment 
        of injuries, out-of-home placement alternatives, services to 
        address mental health and substance abuse problems, loss of 
        productivity, and poor physical health requiring multiple 
        treatments.
            (6) Child maltreatment can be prevented. Given that parents 
        and caregivers are responsible for the majority of the abuse 
        and neglect, caregiver-focused strategies and interventions 
        that address parenting skills and parental risk factors such as 
        depression, substance abuse, and intimate partner violence, as 
        well as strategies and interventions that promote family well-
        being are critical. Parenting practices are amenable to change, 
        given reasonable efforts, and the building of safe, stable, 
        nurturing parent-child relationships is a scientifically proven 
        strategy for the prevention of child maltreatment.
            (7) Prevention of child maltreatment should have a focus on 
        primary prevention (before any maltreatment), emphasizing 
        community-centered and population-based strategies.
            (8) Prevention of child maltreatment should focus on 
        promoting healthy parent-child relationships and an environment 
        that provides safe, stable, nurturing relationships for 
        children.
            (9) Primary health care is an existing and widely accessed 
        system in which a range of prevention strategies can be 
        implemented, and there is growing evidence that primary health 
        care settings are promising venues in which to conduct child 
        maltreatment prevention and behavioral health promotion 
        programs.
            (10) Community health centers (referred to in this Act as 
        ``CHCs'') serve more than 18,000,000 individuals in the United 
        States annually, including individuals who are poor, uninsured, 
        hard-to-reach, and at-risk for child maltreatment.
            (11) One in 5 low-income children in the United States 
        receives health care at a CHC.
            (12) CHCs are an existing network of neighborhood health 
        clinics widely and regularly accessed by families in need that 
        can serve as a fitting venue for child maltreatment prevention 
        initiatives.
            (13) In the last decade, behavioral issues have had an 
        expanding presence in the portfolio of services of CHCs. 
        Seventy percent of CHCs have some, if minimal, on-site mental 
        health and substance abuse services. When demand exceeds 
        capacity or on-site services do not exist, CHCs refer 
        individuals to off-site options.
            (14) The integration of behavioral health services in 
        primary care settings is a promising framework. Evaluation 
        results of integrated care have shown--
                    (A) improvement in service utilization, such as 
                shorter waiting time and fewer sessions to complete 
                treatment;
                    (B) reduction in the stigma related to mental 
                health services; and
                    (C) improvement in access to services.
    (b) Purposes.--The purposes of this Act are as follows:
            (1) To fund the implementation of a minimum of 10 
        demonstration projects of evidence-based and promising 
        parenting programs at federally qualified health centers.
            (2) To provide universal access to a family centered 
        integrated and voluntary services model that prevents child 
        maltreatment and promotes family well-being and which may 
        include:
                    (A) implementation of evidence-based preventive 
                parenting skills training programs at health centers or 
                permanent or temporary residences of caregivers to 
                strengthen the capacity of parents to care for their 
                children's health and well-being and promote their own 
                ability to create safe, stable, nurturing family 
                environments that protect children and youth from abuse 
                and neglect and its consequences and support children's 
                optimal social, emotional, physical, and academic 
                development;
                    (B) screening to identify parental risk factors 
                such as depression, substance abuse, and intimate 
                partner violence that are associated with the 
                likelihood that parents will abuse or neglect their 
                children, and to further develop screening methods and 
                instruments; and
                    (C) linkage with, and referral to, on-site 
                individualized quality mental health services provided 
                by trained mental health professionals for parents and 
                caregivers screening positive for child maltreatment 
                risk factors to help them overcome the impediments to 
                effective parenting and change their behaviors toward 
                child rearing and parenting.
            (3) To coordinate the design and implementation of an 
        evaluation plan to assess the impact and feasibility of 
        integrated services model implementation at each federally 
        qualified health center participating in the demonstration 
        project for health outcomes, cost effectiveness, patient 
        satisfaction, program local adaptation, reduction of child 
        maltreatment and injuries, and improvement of parenting 
        behaviors and family functioning.
            (4) To implement critical system factors for successful 
        implementation of the integrated services model to prevent 
        child maltreatment. Such factors include training of a 
        culturally and linguistically competent workforce, use of best 
        available technology, establishment of cooperation among FQHCs 
        participating in the demonstration project, and building 
        internal and external buy-in and support for the project.
            (5) To coordinate the design and implementation of the 
        cross-site system-wide evaluation plan to assess the impact and 
        feasibility of an integrated services model on the reduction of 
        child maltreatment and injuries, to increase a family's access 
        to services, to evaluate the effectiveness of the response of 
        FQHCs organizational systems to the model implemented, and to 
        identify lessons learned and outline recommendations for 
        system-wide areas for improvement and changes.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) Federally qualified health center or fqhc.--The term 
        ``federally qualified health center'' or ``FQHC'' means an 
        entity receiving a grant under section 330 of the Public Health 
        Service Act (42 U.S.C. 254b).
            (2) Caregivers.--The term ``caregiver'' means an adult who 
        is the primary caregiver, including biological, adoptive, or 
        foster parents, grandparents or other relatives, and non-
        custodial parents who have an ongoing relationship, and 
        provides physical care for, 1 or more children under the age of 
        10. Caregivers may be individuals who were born in, or outside 
        of, the United States and individuals whose main language is 
        not English, including American Indians and Alaska Natives. 
        Caregivers may be heterosexual or homosexual, and may have 
        learning, physical, and other disabilities.
            (3) Center-based evidence-based preventive parenting skills 
        program.--The term ``center-based evidence-based preventative 
        parenting skills program'' means research-based and proven, 
        promising interventions provided and located at a health center 
        that--
                    (A) have the potential for broad impact across 
                multiple types of maltreatment, including physical and 
                psychological abuse and neglect;
                    (B) are associated with effective parent behaviors 
                and parenting practices and with reducing child 
                behavior problems;
                    (C) may be expected to reduce child maltreatment 
                rates; and
                    (D) may be implemented at the FQHCs.
            (4) Home visitation program.--The term ``home visitation 
        program'' means an evidence-based program in which trained 
        professionals visit a caregiver in the permanent or temporary 
        residence of the caregiver, and provide a combination of 
        information, support, or training regarding child development, 
        parenting skills, and health-related issues.
            (5) Mental health services.--The term ``mental health 
        services'' means psychotherapeutic interventions offered at 
        health centers, or off-site locations in partnership with 
        health centers, by mental health professionals to caregivers 
        that screen for or are referred for child maltreatment.
            (6) Screening.--The term ``screening'' means a form of 
        triage, using valid, culturally sensitive tools such as scales 
        or questionnaires applied universally by trained professionals 
        to identify caregivers who are at-risk for maltreating or 
        neglecting children. Screening assesses parental risks for 
        child maltreatment such as depression, substance abuse, and 
        intimate partner violence.

SEC. 4. GRANTS FOR DEMONSTRATION PROJECTS ON INTEGRATED FAMILY CENTERED 
              PREVENTIVE SERVICES.

    (a) Demonstration Project Grants.--The Secretary of Health and 
Human Services, acting through the Director of the National Center for 
Injury Prevention and Control of the Centers for Disease Control and 
Prevention, shall award competitive grants to eligible federally 
qualified health centers to fund a minimum of 10 demonstration projects 
to promote--
            (1) universal access to family centered, evidence-based 
        interventions in the FQHCs that prevent child maltreatment by 
        addressing parenting practices and skills; and
            (2) behavioral health and family well-being for families 
        from diverse socioeconomic, cultural, racial, and ethnic 
        backgrounds, including addressing issues related to sexual 
        orientation and individuals with disabilities.
    (b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            (1) be a federally qualified community health center; and
            (2) submit to the Secretary an application at such time, in 
        such manner, and containing such information as the Secretary 
        may require.
    (c) Use of Grant Funds.--A federally qualified health center 
receiving a grant under subsection (a) may use such funds to--
            (1) conduct a needs assessment for the demonstration 
        project, including the need for proposed integrated services, 
        the number of caregivers involved, an organizational 
        assessment, workforce capacity and needs, and technological 
        needs;
            (2) use available technologies to collect, organize, and 
        provide access to health and mental health information of 
        patients, and to provide referrals, train staff, monitor 
        service delivery and outcomes, and create networking 
        opportunities for on-site providers and others in the 
        community;
            (3) adapt and implement evidence-based parenting skills 
        training programs for caregivers from all backgrounds who use 
        the health center for health care and child well-visits, 
        through on-site programs or programs operated at permanent or 
        temporary residences and administered, supervised, and 
        monitored by trained professionals employed by the FQHC;
            (4) adapt instruments and screen caregivers for child 
        maltreatment risk factors such as depression, substance abuse, 
        and intimate partner violence, provided that such screening is 
        conducted by trained professionals employed by the FQHC;
            (5) provide access to mental health services to caregivers 
        screened positive for child maltreatment risk factors, which 
        may include services offered at the health centers or at off-
        site locations in partnership with the health centers, and 
        which shall be conducted by mental health professionals;
            (6) promote models of integrated care that involve 
        behavioral health specialists and primary care providers 
        working collaboratively in integrated teams to deliver services 
        that prevent child maltreatment and promote family well-being;
            (7) develop public education campaigns to increase 
        community awareness of the integrated services offered by the 
        health centers; and
            (8) evaluate patient satisfaction, project cost 
        effectiveness, results of the integrated services model, and 
        effectiveness of evidence-based parenting programs in improving 
        parenting practices and reducing child abuse and neglect.
    (d) Duration of Grant.--A grant under subsection (a) shall be 
awarded for a period not to exceed 5 years.
    (e) Technical Assistance and Project Coordination.--
            (1) In general.--The Secretary shall award a contract to 1 
        or more eligible entities to provide--
                    (A) technical assistance and project coordination 
                for the recipients of grants under subsection (a);
                    (B) training for health care professionals, 
                including mental health care professionals, at FQHCs 
                that receive grants under subsection (a); and
                    (C) cross-site evaluation of the demonstration 
                projects under subsection (a).
            (2) Eligible entities.--To be eligible to receive a 
        contract under this section, an entity shall--
                    (A) be--
                            (i) an institution of higher education (as 
                        defined in section 101 of the Higher Education 
                        Act of 1965 (20 U.S.C. 1001));
                            (ii) a nonprofit organization that 
                        qualifies for tax exempt status under section 
                        501(c)(3) of the Internal Revenue Code of 1986; 
                        or
                            (iii) such national and professional 
                        organizations and community-based organizations 
                        as the Secretary determines appropriate;
                    (B) have expertise in parent-child relationships, 
                parenting programs, prevention of child maltreatment, 
                the integration of behavioral health in primary and 
                community health center settings, and coordinating 
                multi-site projects;
                    (C) demonstrate a defined or proposed collaboration 
                with purveyors of evidence-based child maltreatment 
                prevention interventions; and
                    (D) submit to the Secretary an application that 
                includes--
                            (i) an outline of a technical assistance 
                        and coordination plan and timeline;
                            (ii) a description of activities, services, 
                        and strategies to be used to reach out and work 
                        with the FQHCs and others involved in the 
                        demonstration projects under subsection (a); 
                        and
                            (iii) a description of the evaluation 
                        methods and strategies the entity plans to use, 
                        and an outline of the progress and final 
                        reports required under subsection (f)(2).
            (3) Priority.--In awarding contracts under this subsection, 
        the Secretary shall give priority to eligible entities whose 
        applications under paragraph (2)(D) demonstrate that the 
        evaluation design of such eligible entity uses strong 
        experimental designs that capture a range of health and 
        behavioral outcomes and include feasibility evaluation of the 
        integrated health-behavioral health services model. Such 
        evaluation designs should provide evaluation results that 
        identify lessons learned and generate recommendations for 
        improvements and changes.
            (4) Authorized activities.--Each recipient of a contract 
        under this subsection shall use such award to provide technical 
        assistance to the FQHCs receiving a grant under subsection (a) 
        and to provide coordination and cross-site evaluation of such 
        demonstration projects to the Secretary. Such technical 
        assistance and coordination and cross-site evaluation may 
        include--
                    (A) establishing and implementing uniform tracking 
                and monitoring systems across FQHCs participating in 
                the demonstration project, using the best available, 
                highest level of technological tools;
                    (B) developing and implementing a cross-site, 
                multi-level evaluation plan using rigorous research and 
                evaluation designs to evaluate the demonstration 
                projects across FQHCs;
                    (C) ensuring that, in implementing the evidence-
                based parenting training programs, each such FQHC 
                follows standardized manuals and protocols, and 
                ensuring effectiveness of the integrated services of 
                each FQHC in promoting positive stable, nurturing 
                parent-child relationships and preventing child 
                maltreatment and injuries;
                    (D) ensuring an effective and feasible evaluation 
                of the outcomes of the demonstration projects, 
                including an assessment of--
                            (i) improvement of parent knowledge of 
                        child social, emotional, cognitive development;
                            (ii) improvement of parent-child 
                        relationships;
                            (iii) parental use of positive discipline 
                        methods and effective communication skills;
                            (iv) health outcomes for children;
                            (v) reduction of incidence of child 
                        maltreatment;
                            (vi) cost-effectiveness of the 
                        demonstration projects;
                            (vii) implementation that follows 
                        standardized manuals and protocols;
                            (viii) the interdisciplinary collaborative 
                        model;
                            (ix) cultural sensitivity and local 
                        adaptation of the projects;
                            (x) any increase in access to services; and
                            (xi) further improvements and changes 
                        needed at the FQHCs;
                    (E) establishing and coordinating the 
                implementation of a workforce development and training 
                plan to ensure that professionals working at the health 
                centers, including physicians, nurses, nurse 
                practitioners, psychologists, social workers, 
                physician's assistants, clinical pharmacists, and 
                others, are trained to participate in interdisciplinary 
                teams and work collaboratively to provide culturally 
                competent and linguistically sensitive integrated 
                services to all caregivers coming to such center, with 
                a focus on the development and strengthening of--
                            (i) knowledge of the public health model, 
                        child development, family functioning, the 
                        problem of child maltreatment, and methods of 
                        prevention;
                            (ii) core attitudes, including the belief 
                        that child maltreatment is preventable, 
                        professionals have a role in prevention, 
                        families are partners in preventing 
                        maltreatment, and evaluation is a critical 
                        element of interventions;
                            (iii) ability to conduct screenings, 
                        implement evidence-based parenting programs, 
                        provide mental health services, and collaborate 
                        with evaluation efforts;
                            (iv) ability to manage the site project, 
                        participate in interdisciplinary teams, work on 
                        integrated efforts, and master technology for 
                        best results;
                            (v) the knowledge, skills, and attitude to 
                        work with individuals from diverse cultural, 
                        racial, ethnic, and other backgrounds; and
                            (vi) an understanding of cross-field 
                        culture and language to effectively participate 
                        in interdisciplinary teams and collaborate in 
                        integrated activities;
                    (F) educating and involving the governing boards of 
                FQHCs participating in the demonstration projects in 
                the integrated service efforts;
                    (G) promoting partnerships with State and local 
                institutions of higher education, community networks, 
                and professional associations for staff training and 
                recruitment;
                    (H) promoting collaboration and networking among 
                FQHCs participating in the demonstration projects; and
                    (I) establishing and coordinating child 
                maltreatment prevention collaboratives across FQHCs 
                participating in the demonstration projects and helping 
                such FQHCs partner with local departments of child 
                welfare and community mental health centers.
            (5) Advisory groups.--
                    (A) In general.--Each recipient of a contract under 
                this subsection shall establish an advisory group. Each 
                such advisory group shall provide feedback and input to 
                the contract recipient to ensure such recipient's 
                effectiveness in providing quality services.
                    (B) Membership.--Each such advisory group shall be 
                composed of representatives of--
                            (i) national organizations representing 
                        community health centers;
                            (ii) national professional organizations 
                        representing professionals from various fields, 
                        including pediatrics, nursing, psychology, and 
                        social work; and
                            (iii) government agencies with relevant 
                        expertise, as determined by the Director of the 
                        National Center for Injury Prevention and 
                        Control of the Centers for Disease Control and 
                        Prevention.
    (f) Evaluation and Reporting.--
            (1) Demonstration project reporting.--
                    (A) Annual progress evaluation and financial 
                reporting.--For the duration of the grant under 
                subsection (a), each FQHC shall submit to the Secretary 
                an annual progress evaluation and financial reporting 
                indicating activities conducted and the progress of the 
                health center toward achievement of established 
                outcomes, including cost effectiveness, patient 
                satisfaction, program local adaptation, reduction of 
                child maltreatment and injuries, and improvement of 
                parenting behaviors and family functioning.
                    (B) Final report.--At the end of the grant period, 
                each FQHC shall submit a final report with evaluation 
                data analysis and conclusions related to the outcomes 
                of the demonstration project.
            (2) Technical assistance reporting.--
                    (A) Annual progress and financial report.--For the 
                duration of the contract under subsection (e), each 
                technical assistance provider shall submit to the 
                Secretary an annual progress and financial report 
                indicating activities conducted under such contract.
                    (B) Final report.--At the end of the contract 
                period, each recipient of a technical assistance 
                contract under subsection (e) shall submit to the 
                Secretary a final report that includes--
                            (i) an analysis of comparative data related 
                        to effectiveness and feasibility of projects 
                        implemented at the FQHCs, workforce training, 
                        and achievement of outcomes at the FQHCs;
                            (ii) overall recommendations for system 
                        improvement and changes that would allow the 
                        demonstration projects to be expanded;
                            (iii) an outline of the project results; 
                        and
                            (iv) a plan that outlines opportunities and 
                        vehicles for the dissemination of cross-site 
                        evalution results, findings, and 
                        recommendations.
    (g) Authorization of Appropriations.--
            (1) In general.--To carry out the demonstration project 
        grant program described in subsection (a), there are authorized 
        to be appropriated $10,000,000 for fiscal year 2010, and such 
        sums as may be necessary for each of fiscal years 2011 through 
        2014.
            (2) Technical assistance.--The Secretary shall reserve not 
        less than 10 percent of the amounts appropriated under 
        paragraph (1) to carry out the technical assistance program 
        described in subsection (e).
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