II 

Calendar No. 336 

111TH CONGRESS 

2D SESSION S. 1635 

[Report No. 111–166] 

To establish an Indian youth telemental health demonstration project, to 

enhance the provision of mental health care services to Indian youth, 

to encourage Indian tribes, tribal organizations, and other mental health 

care providers serving residents of Indian country to obtain the services 

of predoctoral psychology and psychiatry interns, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 6, 2009 

Mr. DORGAN (for himself, Mr. JOHANNS, Mr. BAUCUS, Mr. JOHNSON, Mr. 

THUNE, Mr. TESTER, Mr. UDALL of New Mexico, Mr. CONRAD, Ms. 

MURKOWSKI, and Mr. BEGICH) introduced the following bill; which was 

read twice and referred to the Committee on Indian Affairs 

MARCH 25, 2010 

Reported by Mr. DORGAN, with amendments and an amendment to the title 

[Omit the part struck through and insert the part printed in italic] 

A BILL 

To establish an Indian youth telemental health demonstration 

project, to enhance the provision of mental health care 

services to Indian youth, to encourage Indian tribes, 

tribal organizations, and other mental health care providers serving residents of Indian country to obtain the 

services of predoctoral psychology and psychiatry interns, 

and for other purposes. 


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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 ‘‘7th Generation Prom5 ise: Indian Youth Suicide Prevention Act of 2009’’. 

6 SEC. 2. FINDINGS AND PURPOSE. 

7 (a) FINDINGS.—Congress finds that— 

8 (1)(A) the rate of suicide of American Indians 

9 and Alaska Natives is 1.9 times higher than the na10 tional average rate; and 

11 (B) the rate of suicide of Indian and Alaska 

12 Native youth aged 15 through 24 is— 

13 (i) 3.5 times the national average rate; and 

14 (ii) the highest rate of any population 

15 group in the United States; 

16 (2) many risk behaviors and contributing fac17 tors for suicide are more prevalent in Indian country 

18 than in other areas, including— 

19 (A) history of previous suicide attempts; 

20 (B) family history of suicide; 

21 (C) history of depression or other mental 

22 illness; 

23 (D) alcohol or drug abuse; 

24 (E) health disparities; 

25 (F) stressful life events and losses; 


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1 (G) easy access to lethal methods; 

2 (H) exposure to the suicidal behavior of 

3 others; 

4 (I) isolation; and 

5 (J) incarceration; 

6 (3) according to national data for 2005, suicide 

7 was the second-leading cause of death for Indians 

8 and Alaska Natives of both sexes aged 10 through 

9 34; 

10 (4)(A) the suicide rates of Indians and Alaska 

11 Natives aged 15 through 24, as compared to suicide 

12 rates of any other racial group, are— 

13 (i) for males, up to 4 times greater; and 

14 (ii) for females, up to 11 times greater; 

15 and 

16 (B) data demonstrates that, over their lifetimes, 

17 females attempt suicide 2 to 3 times more often 

18 than males; 

19 (4)(A) the suicide rates of Indian and Alaska 

20 Native males aged 15 through 24 are— 

21 (i) as compared to suicide rates of males of 

22 any other racial group, up to 4 times greater; 

23 and 


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1 (ii) as compared to suicide rates of females 

2 of any other racial group, up to 11 times great3 er; and 

4 (B) data demonstrates that, over their lifetimes, 

5 females attempt suicide 2 to 3 times more often than 

6 males; 

7 (5)(A) Indian tribes, especially Indian tribes lo8 cated in the Great Plains, have experienced epidemic 

9 levels of suicide, up to 10 times the national aver10 age; and 

11 (B) suicide clustering in Indian country affects 

12 entire tribal communities; 

13 (6) death rates for Indians and Alaska Natives 

14 are statistically underestimated because many areas 

15 of Indian country lack the proper resources to iden16 tify and monitor the presence of disease; 

17 (7)(A) the Indian Health Service experiences 

18 health professional shortages, with physician vacancy 

19 rates of approximately 17 percent, and nursing va20 cancy rates of approximately 18 percent, in 2007; 

21 (B) 90 percent of all teens who die by suicide 

22 suffer from a diagnosable mental illness at time of 

23 death; 


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(C) more than 1 1 ⁄2 of teens who commitdie by 

2 suicide have never been seen by a mental health pro3 vider; and 

(D) 1 4 ⁄3 of health needs in Indian country relate 

5 to mental health; 

6 (8) often, the lack of resources of Indian tribes 

7 and the remote nature of Indian reservations make 

8 it difficult to meet the requirements necessary to ac9 cess Federal assistance, including grants; 

10 (9) the Substance Abuse and Mental Health 

11 Services Administration and the Service have estab12 lished specific initiatives to combat youth suicide in 

13 Indian country and among Indians and Alaska Na14 tives throughout the United States, including the 

15 National Suicide Prevention Initiative of the Service, 

16 which has worked with Service, tribal, and urban In17 dian health programs since 2003; 

18 (10) the National Strategy for Suicide Preven19 tion was established in 2001 through a Department 

20 of Health and Human Services collaboration 

21 among— 

22 (A) the Substance Abuse and Mental 

23 Health Services Administration; 

24 (B) the Service; 


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1 (C) the Centers for Disease Control and 

2 Prevention; 

3 (D) the National Institutes of Health; and 

4 (E) the Health Resources and Services Ad5 ministration; and 

6 (11) the Service and other agencies of the De7 partment of Health and Human Services use infor8 mation technology and other programs to address 

9 the suicide prevention and mental health needs of 

10 Indians and Alaska Natives. 

11 (b) PURPOSES.—The purposes of this Act are— 

12 (1) to authorize the Secretary to carry out a 

13 demonstration project to test the use of telemental 

14 health services in suicide prevention, intervention, 

15 and treatment of Indian youth, including through— 

16 (A) the use of psychotherapy, psychiatric 

17 assessments, diagnostic interviews, therapies for 

18 mental health conditions predisposing to sui19 cide, and alcohol and substance abuse treat20 ment; 

21 (B) the provision of clinical expertise to, 

22 consultation services with, and medical advice 

23 and training for frontline health care providers 

24 working with Indian youth; 


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1 (C) training and related support for com2 munity leaders, family members, and health 

3 and education workers who work with Indian 

4 youth; 

5 (D) the development of culturally relevant 

6 educational materials on suicide; and 

7 (E) data collection and reporting; 

8 (2) to encourage Indian tribes, tribal organiza9 tions, and other mental health care providers serving 

10 residents of Indian country to obtain the services of 

11 predoctoral psychology and psychiatry interns; and 

12 (3) to enhance the provision of mental health 

13 care services to Indian youth through existing grant 

14 programs of the Substance Abuse and Mental 

15 Health Services Administration. 

16 SEC. 3. DEFINITIONS. 

17 In this Act: 

18 (1) ADMINISTRATION.—The term ‘‘Administra19 tion’’ means the Substance Abuse and Mental 

20 Health Services Administration. 

21 (2) DEMONSTRATION PROJECT.—The term 

22 ‘‘demonstration project’’ means the Indian youth 

23 telemental health demonstration project authorized 

24 under section 4(a). 


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1 (3) INDIAN.—The term ‘‘Indian’’ means any in2 dividual who is— 

3 (A) a member of an Indian tribe; or 

4 (B) eligible for health services under the 

5 Indian Health Care Improvement Act (25 

6 U.S.C. 1601 et seq.). 

7 (4) INDIAN COUNTRY.—The term ‘‘Indian coun8 try’’ has the meaning given the term in section 1151 

9 of title 18, United States Code. 

10 (5)(4) INDIAN TRIBE.—The term ‘‘Indian tribe’’ 

11 has the meaning given the term in section 4 of the 

12 Indian Self-Determination and Education Assistance 

13 Act (25 U.S.C. 450b). 

14 (6)(5) SECRETARY.—The term ‘‘Secretary’’ 

15 means the Secretary of Health and Human Services. 

16 (7)(6) SERVICE.—The term ‘‘Service’’ means 

17 the Indian Health Service. 

18 (8)(7) TELEMENTAL HEALTH.—The term ‘‘tele19 mental health’’ means the use of electronic informa20 tion and telecommunications technologies to support 

21 long-distance mental health care, patient and profes22 sional-related education, public health, and health 

23 administration. 

24 (9)(8) TRIBAL ORGANIZATION.—The term 

25 ‘‘tribal organization’’ has the meaning given the 


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1 term in section 4 of the Indian Self-Determination 

2 and Education Assistance Act (25 U.S.C. 450b). 

3 SEC. 4. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRA4 TION PROJECT. 

5 (a) AUTHORIZATION.— 

6 (1) IN GENERAL.—The Secretary, acting 

7 through the Service, is authorized to carry out a 

8 demonstration project to award grants for the provi9 sion of telemental health services to Indian youth 

10 who— 

11 (A) have expressed suicidal ideas; 

12 (B) have attempted suicide; or 

13 (C) have mental health conditions that in14 crease or could increase the risk of suicide. 

15 (2) ELIGIBILITY FOR GRANTS.—Grants under 

16 paragraph (1) shall be awarded to Indian tribes and 

17 tribal organizations that operate 1 or more facili18 ties— 

19 (A) located in an area with documented 

20 disproportionately high rates of suicide; 

21 (B) reporting active clinical telehealth ca22 pabilities; or 

23 (C) offering school-based telemental health 

24 services to Indian youth. 


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1 (3) GRANT PERIOD.—The Secretary shall 

2 award grants under this section for a period of up 

3 to 4 years. 

4 (4) MAXIMUM NUMBER OF GRANTS.—Not more 

5 than 5 grants shall be provided under paragraph 

6 (1), with priority consideration given to Indian tribes 

7 and tribal organizations that— 

8 (A) serve a particular community or geo9 graphic area in which there is a demonstrated 

10 need to address Indian youth suicide; 

11 (B) enter into collaborative partnerships 

12 with Service or other tribal health programs or 

13 facilities to provide services under this dem14 onstration project; 

15 (C) serve an isolated community or geo16 graphic area that has limited or no access to 

17 behavioral health services; or 

18 (D) operate a detention facility at which 

19 Indian youth are detained. 

20 (5) CONSULTATION WITH ADMINISTRATION.— 

21 In developing and carrying out the demonstration 

22 project under this subsection, the Secretary shall 

23 consult with the Administration as the Federal agen24 cy focused on mental health issues, including suicide. 

25 (b) USE OF FUNDS.— 


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1 (1) IN GENERAL.—An Indian tribe or tribal or2 ganization shall use a grant received under sub3 section (a) for the following purposes: 

4 (A) To provide telemental health services 

5 to Indian youth, including the provision of— 

6 (i) psychotherapy; 

7 (ii) psychiatric assessments and diag8 nostic interviews, therapies for mental 

9 health conditions predisposing to suicide, 

10 and treatment; and 

11 (iii) alcohol and substance abuse 

12 treatment. 

13 (B) To provide clinician-interactive medical 

14 advice, guidance and training, assistance in di15 agnosis and interpretation, crisis counseling and 

16 intervention, and related assistance to Service 

17 or tribal clinicians and health services providers 

18 working with youth being served under the 

19 demonstration project. 

20 (C) To assist, educate, and train commu21 nity leaders, health education professionals and 

22 paraprofessionals, tribal outreach workers, and 

23 family members who work with the youth re24 ceiving telemental health services under the 

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1 tion of suicidal tendencies, crisis intervention 

2 and suicide prevention, emergency skill develop3 ment, and building and expanding networks 

4 among those individuals and with State and 

5 local health services providers. 

6 (D) To develop and distribute culturally 

7 appropriate community educational materials 

8 regarding— 

9 (i) suicide prevention; 

10 (ii) suicide education; 

11 (iii) suicide screening; 

12 (iv) suicide intervention; and 

13 (v) ways to mobilize communities with 

14 respect to the identification of risk factors 

15 for suicide. 

16 (E) To conduct data collection and report17 ing relating to Indian youth suicide prevention 

18 efforts. 

19 (2) TRADITIONAL HEALTH CARE PRACTICES.— 

20 In carrying out the purposes described in paragraph 

21 (1), an Indian tribe or tribal organization may use 

22 and promote the traditional health care practices of 

23 the Indian tribes of the youth to be served. 

24 (c) APPLICATIONS.— 


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1 (1) IN GENERAL.—Subject to paragraph (2), to 

2 be eligible to receive a grant under subsection (a), 

3 an Indian tribe or tribal organization shall prepare 

4 and submit to the Secretary an application, at such 

5 time, in such manner, and containing such informa6 tion as the Secretary may require, including— 

7 (A) a description of the project that the 

8 Indian tribe or tribal organization will carry out 

9 using the funds provided under the grant; 

10 (B) a description of the manner in which 

11 the project funded under the grant would— 

12 (i) meet the telemental health care 

13 needs of the Indian youth population to be 

14 served by the project; or 

15 (ii) improve the access of the Indian 

16 youth population to be served to suicide 

17 prevention and treatment services; 

18 (C) evidence of support for the project 

19 from the local community to be served by the 

20 project; 

21 (D) a description of how the families and 

22 leadership of the communities or populations to 

23 be served by the project would be involved in 

24 the development and ongoing operations of the 

25 project; 


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1 (E) a plan to involve the tribal community 

2 of the youth who are provided services by the 

3 project in planning and evaluating the mental 

4 health care and suicide prevention efforts pro5 vided, in order to ensure the integration of com6 munity, clinical, environmental, and cultural 

7 components of the treatment; and 

8 (F) a plan for sustaining the project after 

9 Federal assistance for the demonstration 

10 project has terminated. 

11 (2) EFFICIENCY OF GRANT APPLICATION PROC12 ESS.—The Secretary shall carry out such measures 

13 as the Secretary determines to be necessary to maxi14 mize the time and workload efficiency of the process 

15 by which Indian tribes and tribal organizations apply 

16 for grants under paragraph (1). 

17 (d) COLLABORATION.—The Secretary, acting 

18 through the Service, shall encourage Indian tribes and 

19 tribal organizations receiving grants under this section to 

20 collaborate to enable comparisons regarding best practices 

21 across projects. 

22 (e) ANNUAL REPORT.—Each grant recipient shall 

23 submit to the Secretary an annual report that— 

24 (1) describes the number of telemental health 

25 services provided; and 


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1 (2) includes any other information that the Sec2 retary may require. 

3 (f) REPORTS TO CONGRESS.— 

4 (1) INITIAL REPORT.— 

5 (A) IN GENERAL.—Not later than 2 years 

6 after the date on which the first grant is award7 ed under this section, the Secretary shall sub8 mit to the Committee on Indian Affairs of the 

9 Senate and the Committee on Natural Re10 sources and the Committee on Energy and 

11 Commerce of the House of Representatives a 

12 report that— 

13 (i) describes each project funded by a 

14 grant under this section during the pre15 ceding 2-year period, including a descrip16 tion of the level of success achieved by the 

17 project; and 

18 (ii) evaluates whether the demonstra19 tion project should be continued during the 

20 period beginning on the date of termi21 nation of funding for the demonstration 

22 project under subsection (g) and ending on 

23 the date on which the final report is sub24 mitted under paragraph (2). 


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1 (B) CONTINUATION OF DEMONSTRATION

2 PROJECT.—On a determination by the Sec3 retary under clause (ii) of subparagraph (A) 

4 that the demonstration project should be con5 tinued, the Secretary may carry out the dem6 onstration project during the period described 

7 in that clause using such sums otherwise made 

8 available to the Secretary as the Secretary de9 termines to be appropriate. 

10 (2) FINAL REPORT.—Not later than 270 days 

11 after the date of termination of funding for the dem12 onstration project under subsection (g), the Sec13 retary shall submit to the Committee on Indian Af14 fairs of the Senate and the Committee on Natural 

15 Resources and the Committee on Energy and Com16 merce of the House of Representatives a final report 

17 that— 

18 (A) describes the results of the projects 

19 funded by grants awarded under this section, 

20 including any data available that indicate the 

21 number of attempted suicides; 

22 (B) evaluates the impact of the telemental 

23 health services funded by the grants in reducing 

24 the number of completed suicides among Indian 

25 youth; 


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1 (C) evaluates whether the demonstration 

2 project should be— 

3 (i) expanded to provide more than 5 

4 grants; and 

5 (ii) designated as a permanent pro6 gram; and 

7 (D) evaluates the benefits of expanding the 

8 demonstration project to include urban Indian 

9 organizations. 

10 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

11 authorized to be appropriated to carry out this section 

12 $1,500,000 for each of fiscal years 2010 through 2013. 

13 SEC. 5. SUBSTANCE ABUSE AND MENTAL HEALTH SERV14 ICES ADMINISTRATION GRANTS. 

15 (a) GRANT APPLICATIONS.— 

16 (1) EFFICIENCY OF GRANT APPLICATION PROC17 ESS.—The Secretary, acting through the Adminis18 tration, shall carry out such measures as the Sec19 retary determines to be necessary to maximize the 

20 time and workload efficiency of the process by which 

21 Indian tribes and tribal organizations apply for 

22 grants under any program administered by the Ad23 ministration, including by providing methods other 

24 than electronic methods of submitting applications 

25 for those grants, if necessary. 


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1 (2) PRIORITY FOR CERTAIN GRANTS.— 

2 (A) IN GENERAL.—To fulfill the trust re3 sponsibility of the United States to Indian 

4 tribes, in awarding relevant grants pursuant to 

5 a program described in subparagraph (B), the 

6 Secretary shall give priority consideration to the 

7 applicationstake into consideration the needs of 

8 Indian tribes or tribal organizations, as applica9 ble, that serve populations with documented 

10 high suicide rates, regardless of whether those 

11 Indian tribes or tribal organizations possess 

12 adequate personnel or infrastructure to fulfill 

13 all applicable requirements of the relevant pro14 gram. 

15 (B) DESCRIPTION OF GRANT PROGRAMS.— 

16 A grant program referred to in subparagraph 

17 (A) is a grant program— 

18 (i) administered by the Administration 

19 to fund activities relating to mental health, 

20 suicide prevention, or suicide-related risk 

21 factors; and 

22 (ii) under which an Indian tribe or 

23 tribal organization is an eligible recipient. 

24 (3) CLARIFICATION REGARDING INDIAN TRIBES

25 AND TRIBAL ORGANIZATIONS.—Notwithstanding any 


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1 other provision of law, in applying for a grant under 

2 any program administered by the Administration, no 

3 Indian tribe or tribal organization shall be required 

4 to apply through a State or State agency. 

5 (4) REQUIREMENTS FOR AFFECTED STATES.— 

6 (A) DEFINITIONS.—In this paragraph: 

7 (i) AFFECTED STATE.—The term ‘‘af8 fected State’’ means a State— 

9 (I) the boundaries of which in10 clude 1 or more Indian tribes; and 

11 (II) the application for a grant 

12 under any program administered by 

13 the Administration of which includes 

14 statewide data. 

15 (ii) INDIAN POPULATION.—The term 

16 ‘‘Indian population’’ means the total num17 ber of residents of an affected State who 

18 are members of 1 or more Indian tribes lo19 cated within the affected State.are Indian. 

20 (B) REQUIREMENTS.—As a condition of 

21 receipt of a grant under any program adminis22 tered by the Administration, each affected State 

23 shall— 

24 (i) describe in the grant application— 


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1 (I) the Indian population of the 

2 affected State; and 

3 (II) the contribution of that In4 dian population to the statewide data 

5 used by the affected State in the ap6 plication; and 

7 (ii) demonstrate to the satisfaction of 

8 the Secretary that— 

9 (I) of the total amount of the 

10 grant, the affected State will allocate 

11 for use for the Indian population of 

12 the affected State an amount equal to 

13 the proportion that— 

14 (aa) the Indian population 

15 of the affected State; bears to 

16 (bb) the total population of 

17 the affected State; and 

18 (II) the affected State will offer 

19 to enter into a partnership with each 

20 Indian tribe located within the af21 fected State to carry out youth suicide 

22 prevention and treatment measures 

23 for members of the Indian tribe. 

24 (II) the affected State will take 

25 reasonable efforts to collaborate with 


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1 each Indian tribe located within the af2 fected State to carry out youth suicide 

3 prevention and treatment measures for 

4 members of the Indian tribe. 

5 (C) REPORT.—Not later than 1 year after 

6 the date of receipt of a grant described in sub7 paragraph (B), an affected State shall submit 

8 to the Secretary a report describing the meas9 ures carried out by the affected State to ensure 

10 compliance with the requirements of subpara11 graph (B)(ii). 

12 (b) NO NON-FEDERAL SHARE REQUIREMENT.—Not13 withstanding any other provision of law, no Indian tribe 

14 or tribal organization shall be required to provide a non15 Federal share of the cost of any project or activity carried 

16 out using a grant provided under any program adminis17 tered by the Administration. 

18 (c) OUTREACH FOR RURAL AND ISOLATED INDIAN

19 TRIBES.—Due to the rural, isolated nature of most Indian 

20 reservations and communities (especially those reserva21 tions and communities in the Great Plains region), the 

22 Secretary shall conduct outreach activities, with a par23 ticular emphasis on the provision of telemental health 

24 services, to achieve the purposes of this Act with respect 

25 to Indian tribes located in rural, isolated areas. 


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1 (d) PROVISION OF OTHER ASSISTANCE.— 

2 (1) IN GENERAL.—The Secretary, acting 

3 through the Administration, shall carry out such 

4 measures (including monitoring and the provision of 

5 required assistance) as the Secretary determines to 

6 be necessary to ensure the provision of adequate sui7 cide prevention and mental health services to Indian 

8 tribes described in paragraph (2), regardless of 

9 whether those Indian tribes possess adequate per10 sonnel or infrastructure— 

11 (A) to submit an application for a grant 

12 under any program administered by the Admin13 istration, including due to problems relating to 

14 access to the Internet or other electronic means 

15 that may have resulted in previous obstacles to 

16 submission of a grant application; or 

17 (B) to fulfill all applicable requirements of 

18 the relevant program. 

19 (2) DESCRIPTION OF INDIAN TRIBES.—An In20 dian tribe referred to in paragraph (1) is an Indian 

21 tribe— 

22 (A) the members of which experience— 

23 (i) a high rate of youth suicide; 

24 (ii) low socioeconomic status; and 

25 (iii) extreme health disparity; 


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1 (B) that is located in a remote and isolated 

2 area; and 

3 (C) that lacks technology and communica4 tion infrastructure. 

5 (3) AUTHORIZATION OF APPROPRIATIONS.— 

6 There are authorized to be appropriated to the Sec7 retary such sums as the Secretary determines to be 

8 necessary to carry out this subsection. 

9 (e) EARLY INTERVENTION AND ASSESSMENT SERV10 ICES.— 

11 (1) DEFINITION OF AFFECTED ENTITY.—In 

12 this subsection, the term ‘‘affected entity’’ means 

13 any entity— 

14 (A) that receives a grant for suicide inter15 vention, prevention, or treatment under a pro16 gram administered by the Administration; and 

17 (B) the population to be served by which 

18 includes Indian youth. 

19 (2) REQUIREMENT.—The Secretary, acting 

20 through the Administration, shall ensure that each 

21 affected entity carrying out a youth suicide early 

22 intervention and prevention strategy described in 

23 section 520E(c)(1) of the Public Health Service Act 

24 (42 U.S.C. 290bb–36(c)(1)), or any other youth sui25 cide-related early intervention and assessment activVerDate Nov 24 2008 02:12 Mar 26, 2010 Jkt 089200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S1635.RS S1635

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1 ity, provides training or education to individuals who 

2 interact frequently with the Indian youth to be 

3 served by the affected entity (including parents, 

4 teachers, coaches, and mentors) on identifying warn5 ing signs of Indian youth who are at risk of commit6 ting suicide. 

7 SEC. 6. USE OF PREDOCTORAL PSYCHOLOGY AND PSYCHI8 ATRY INTERNS. 

9 The Secretary shall carry out such activities as the 

10 Secretary determines to be necessary to encourage Indian 

11 tribes, tribal organizations, and other mental health care 

12 providers serving residents of Indian country to obtain the 

13 services of predoctoral psychology and psychiatry in14 terns— 

15 (1) to increase the quantity of patients served 

16 by the Indian tribes, tribal organizations, and other 

17 mental health care providers; and 

18 (2) for purposes of recruitment and retention. 

19 SEC. 7. INDIAN YOUTH LIFE SKILLS DEVELOPMENT DEM20 ONSTRATION PROGRAM. 

21 (a) PURPOSE.—The purpose of this section is to au22 thorize the Secretary, acting through the Administration, 

23 to carry out a demonstration program to test the effective24 ness of a culturally compatible, school-based, life skills curVerDate Nov 24 2008 02:12 Mar 26, 2010 Jkt 089200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6203 E:\BILLS\S1635.RS S1635

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1 riculum for the prevention of Indian and Alaska Native ad2 olescent suicide, including through— 

3 (1) the establishment of tribal partnerships to de4 velop and implement such a curriculum, in coopera5 tion with— 

6 (A) behavioral health professionals, with a 

7 priority for tribal partnerships cooperating with 

8 behavioral health professionals employed by the 

9 Service; 

10 (B) tribal or local school agencies; and 

11 (C) parent and community groups; 

12 (2) the provision by the Administration or the 

13 Service of— 

14 (A) technical expertise; and 

15 (B) clinicians, analysts, and educators, as 

16 appropriate; 

17 (3) training for teachers, school administrators, 

18 and community members to implement the cur19 riculum; 

20 (4) the establishment of advisory councils com21 posed of parents, educators, community members, 

22 trained peers, and others to provide advice regarding 

23 the curriculum and other components of the dem24 onstration program; 


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1 (5) the development of culturally appropriate 

2 support measures to supplement the effectiveness of 

3 the curriculum; and 

4 (6) projects modeled after evidence-based projects, 

5 such as programs evaluated and published in relevant 

6 literature. 

7 (b) DEMONSTRATION GRANT PROGRAM.— 

8 (1) DEFINITIONS.—In this subsection: 

9 (A) CURRICULUM.—The term ‘‘curriculum’’ 

10 means the culturally compatible, school-based, 

11 life skills curriculum for the prevention of In12 dian and Alaska Native adolescent suicide iden13 tified by the Secretary under paragraph (2)(A). 

14 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 

15 entity’’ means— 

16 (i) an Indian tribe; 

17 (ii) a tribal organization; 

18 (iii) any other tribally authorized enti19 ty; and 

20 (iv) any partnership composed of 2 or 

21 more entities described in clause (i), (ii), or 

22 (iii). 

23 (2) ESTABLISHMENT.—The Secretary, acting 

24 through the Administration, may establish and carry 


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1 out a demonstration program under which the Sec2 retary shall— 

3 (A) identify a culturally compatible, school4 based, life skills curriculum for the prevention of 

5 Indian and Alaska Native adolescent suicide; 

6 (B) identify the Indian tribes that are at 

7 greatest risk for adolescent suicide; 

8 (C) invite those Indian tribes to participate 

9 in the demonstration program by— 

10 (i) responding to a comprehensive pro11 gram requirement request of the Secretary; 

12 or 

13 (ii) submitting, through an eligible en14 tity, an application in accordance with 

15 paragraph (4); and 

16 (D) provide grants to the Indian tribes 

17 identified under subparagraph (B) and eligible 

18 entities to implement the curriculum with re19 spect to Indian and Alaska Native youths who— 

20 (i) are between the ages of 10 and 19; 

21 and 

22 (ii) attend school in a region that is at 

23 risk of high youth suicide rates, as deter24 mined by the Administration. 

25 (3) REQUIREMENTS.— 


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1 (A) TERM.—The term of a grant provided 

2 under the demonstration program under this sec3 tion shall be not less than 4 years. 

4 (B) MAXIMUM NUMBER.—The Secretary 

5 may provide not more than 5 grants under the 

6 demonstration program under this section. 

7 (C) AMOUNT.—The grants provided under 

8 this section shall be of equal amounts. 

9 (D) CERTAIN SCHOOLS.—In selecting eligi10 ble entities to receive grants under this section, 

11 the Secretary shall ensure that not less than 1 

12 demonstration program shall be carried out at 

13 each of— 

14 (i) a school operated by the Bureau of 

15 Indian Education; 

16 (ii) a Tribal school; and 

17 (iii) a school receiving payments under 

18 section 8002 or 8003 of the Elementary and 

19 Secondary Education Act of 1965 (20 

20 U.S.C. 7702, 7703). 

21 (4) APPLICATIONS.—To be eligible to receive a 

22 grant under the demonstration program, an eligible 

23 entity shall submit to the Secretary an application, 

24 at such time, in such manner, and containing such 


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1 information as the Secretary may require, includ2 ing— 

3 (A) an assurance that, in implementing the 

4 curriculum, the eligible entity will collaborate 

5 with 1 or more local educational agencies, in6 cluding elementary schools, middle schools, and 

7 high schools; 

8 (B) an assurance that the eligible entity 

9 will collaborate, for the purpose of curriculum 

10 development, implementation, and training and 

11 technical assistance, with 1 or more— 

12 (i) nonprofit entities with dem13 onstrated expertise regarding the develop14 ment of culturally sensitive, school-based, 

15 youth suicide prevention and intervention 

16 programs; or 

17 (ii) institutions of higher education 

18 with demonstrated interest and knowledge 

19 regarding culturally sensitive, school-based, 

20 life skills youth suicide prevention and 

21 intervention programs; 

22 (C) an assurance that the curriculum will 

23 be carried out in an academic setting in con24 junction with at least 1 classroom teacher not 


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1 less frequently than twice each school week for 

2 the duration of the academic year; 

3 (D) a description of the methods by which 

4 curriculum participants will be— 

5 (i) screened for behavioral health at6 risk indicators; and 

7 (ii) if needed and on a case-by-case 

8 basis, referred to a behavioral health clini9 cian for further assessment and treatment 

10 and with crisis response capability; and 

11 (E) an assurance that supportive services 

12 will be provided to curriculum participants 

13 identified as high-risk participants, including 

14 referral, counseling, and follow-up services for— 

15 (i) drug or alcohol abuse; 

16 (ii) sexual or domestic abuse; and 

17 (iii) depression and other relevant be18 havioral health concerns. 

19 (5) USE OF FUNDS.—An Indian tribe identified 

20 under paragraph (2)(B) or an eligible entity may use 

21 a grant provided under this subsection— 

22 (A) to develop and implement the cur23 riculum in a school-based setting; 

24 (B) to establish an advisory council— 


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1 (i) to advise the Indian tribe or eligible 

2 entity regarding curriculum development; 

3 and 

4 (ii) to provide support services identi5 fied as necessary by the community being 

6 served by the Indian tribe or eligible entity; 

7 (C) to appoint and train a school- and com8 munity-based cultural resource liaison, who will 

9 act as an intermediary among the Indian tribe 

10 or eligible entity, the applicable school adminis11 trators, and the advisory council established by 

12 the Indian tribe or eligible entity; 

13 (D) to establish an on-site, school-based, 

14 MA- or PhD-level behavioral health practitioner 

15 (employed by the Service, if practicable) to work 

16 with tribal educators and other personnel; 

17 (E) to provide for the training of peer coun18 selors to assist in carrying out the curriculum; 

19 (F) to procure technical and training sup20 port from nonprofit or State entities or institu21 tions of higher education identified by the com22 munity being served by the Indian tribe or eligi23 ble entity as the best suited to develop and im24 plement the curriculum; 


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1 (G) to train teachers and school administra2 tors to effectively carry out the curriculum; 

3 (H) to establish an effective referral proce4 dure and network; 

5 (I) to identify and develop culturally com6 patible curriculum support measures; 

7 (J) to obtain educational materials and 

8 other resources from the Administration or other 

9 appropriate entities to ensure the success of the 

10 demonstration program; and 

11 (K) to evaluate the effectiveness of the cur12 riculum in preventing Indian and Alaska Native 

13 adolescent suicide. 

14 (c) EVALUATIONS.—Using such amounts made avail15 able pursuant to subsection (e) as the Secretary determines 

16 to be appropriate, the Secretary shall conduct, directly or 

17 through a grant, contract, or cooperative agreement with 

18 an entity that has experience regarding the development 

19 and operation of successful culturally compatible, school20 based, life skills suicide prevention and intervention pro21 grams or evaluations, an annual evaluation of the dem22 onstration program under this section, including an eval23 uation of— 

24 (1) the effectiveness of the curriculum in pre25 venting Indian and Alaska Native adolescent suicide; 


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1 (2) areas for program improvement; and 

2 (3) additional development of the goals and ob3 jectives of the demonstration program. 

4 (d) REPORT TO CONGRESS.— 

5 (1) IN GENERAL.—Subject to paragraph (2), not 

6 later than 180 days after the date of termination of 

7 the demonstration program, the Secretary shall sub8 mit to the Committee on Indian Affairs and the Com9 mittee on Health, Education, Labor, and Pensions of 

10 the Senate and the Committee on Natural Resources 

11 and the Committee on Education and Labor of the 

12 House of Representatives a final report that— 

13 (A) describes the results of the program of 

14 each Indian tribe or eligible entity under this 

15 section; 

16 (B) evaluates the effectiveness of the cur17 riculum in preventing Indian and Alaska Native 

18 adolescent suicide; 

19 (C) makes recommendations regarding— 

20 (i) the expansion of the demonstration 

21 program under this section to additional el22 igible entities; 

23 (ii) designating the demonstration pro24 gram as a permanent program; and 


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1 (iii) identifying and distributing the 

2 curriculum through the Suicide Prevention 

3 Resource Center of the Administration; and 

4 (D) incorporates any public comments re5 ceived under paragraph (2). 

6 (2) PUBLIC COMMENT.—The Secretary shall pro7 vide a notice of the report under paragraph (1) and 

8 an opportunity for public comment on the report for 

9 a period of not less than 90 days before submitting 

10 the report to Congress. 

11 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

12 authorized to be appropriated to carry out this section 

13 $1,000,000 for each of fiscal years 2010 through 2014. 

Amend the title so as to read: ‘‘A bill to establish 

an Indian youth telemental health demonstration program, to enhance the provision of behavioral health care 

services to Indian youth, to encourage Indian tribes, tribal organizations, and other behavioral health care providers serving residents of Indian country to obtain the 

services of predoctoral psychology and psychiatry interns, 

and for other purposes.’’. 


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Calendar No. 336 

111TH CONGRESS 

2D SESSION S. 1635 

[Report No. 111–166] 

A BILL 

To establish an Indian youth telemental health 

and for other purposes. predoctoral psychology and psychiatry interns, dents of Indian country to obtain the services of other mental health care providers serving resiencourage Indian tribes, tribal organizations, and of mental health care services to Indian youth, to demonstration project, to enhance the provision 

MARCH 25, 2010 

Reported with amendments and an amendment to the 

title 


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