I 

116TH CONGRESS 

1ST SESSION H. R. 1109 

To amend the Public Health Service Act to revise and extend projects relating 

to children and to provide access to school-based comprehensive mental 

health programs. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 8, 2019 

Mrs. NAPOLITANO (for herself, Mr. KATKO, Mr. LOWENTHAL, Ms. DELBENE, 

Mr. TONKO, Mr. CICILLINE, Mr. PAYNE, Mr. LUJA ́N, Mr. DOGGETT, Ms. 

MCCOLLUM, Mr. MOULTON, Mr. SCHIFF, Mr. WELCH, Mr. HECK, Mr. 

GRIJALVA, Ms. HILL of California, Ms. JUDY CHU of California, Mr. 

KILMER, Ms. WILSON of Florida, Ms. KELLY of Illinois, Miss RICE of 

New York, Mr. RYAN, Mr. KHANNA, Mr. REED, Mr. LARSEN of Washington, Ms. JACKSON LEE, Ms. MOORE, Mr. DESAULNIER, Ms. PINGREE, 

Mrs. LAWRENCE, Ms. SPEIER, Mr. PANETTA, Mr. SOTO, Ms. ROYBALALLARD, Mrs. WATSON COLEMAN, Mr. RUPPERSBERGER, Mr. 

CA ́RDENAS, Mr. AGUILAR, Mr. GOMEZ, Mr. DEFAZIO, Mr. MCGOVERN, 

Mr. BLUMENAUER, Ms. OMAR, Mrs. MURPHY, Mr. SABLAN, Mr. 

GALLEGO, Mr. SUOZZI, Mr. COHEN, Mr. CISNEROS, Ms. MATSUI, Ms. 

SA ́NCHEZ, Ms. KUSTER of New Hampshire, Mrs. CAROLYN B. MALONEY

of New York, Ms. JOHNSON of Texas, Mr. RASKIN, Mr. CARBAJAL, Ms. 

CASTOR of Florida, and Mr. MCNERNEY) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to revise and extend 

projects relating to children and to provide access to 

school-based comprehensive mental health programs. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Mental Health Services 

3 for Students Act of 2019’’. 

4 SEC. 2. PURPOSES. 

5 The purposes of this Act are to— 

6 (1) revise, increase funding for, and expand the 

7 scope of the Project AWARE State Educational 

8 Agency Grant Program carried out by the Secretary 

9 of Health and Human Services, in order to provide 

10 access to more comprehensive school-based mental 

11 health services and supports; 

12 (2) provide for comprehensive staff development 

13 for school and community service personnel working 

14 in the school; 

15 (3) provide for comprehensive training to im16 prove health and academic outcomes for children 

17 with, or at risk for, mental health disorders, for par18 ents or guardians, siblings, and other family mem19 bers of such children, and for concerned members of 

20 the community; 

21 (4) provide for comprehensive, universal, evi22 dence-based screening to identify children and ado23 lescents with potential mental health disorders or 

24 unmet emotional health needs; 


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1 (5) recognize best practices for the delivery of 

2 mental health care in school-based settings, includ3 ing school-based health centers; 

4 (6) provide for comprehensive training for par5 ents or guardians, siblings, other family members, 

6 and concerned members of the community on behalf 

7 of children and adolescents experiencing mental 

8 health trauma, disorder, or disability; and 

9 (7) establish formal working relationships be10 tween health, human service, and educational enti11 ties that support the mental and emotional health of 

12 children and adolescents in the school setting. 

13 SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 

14 ACT. 

15 (a) TECHNICAL AMENDMENTS.—The second part G 

16 (relating to services provided through religious organiza17 tions) of title V of the Public Health Service Act (42 

18 U.S.C. 290kk et seq.) is amended— 

19 (1) by redesignating such part as part J; and 

20 (2) by redesignating sections 581 through 584 

21 as sections 596 through 596C, respectively. 

22 (b) SCHOOL-BASED MENTAL HEALTH AND CHIL23 DREN.—Section 581 of the Public Health Service Act (42 

24 U.S.C. 290hh) (relating to children and violence) is 

25 amended to read as follows: 


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1 ‘‘SEC. 581. SCHOOL-BASED MENTAL HEALTH; CHILDREN 

2 AND ADOLESCENTS. 

3 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

4 with the Secretary of Education, shall, directly or through 

5 grants, contracts, or cooperative agreements awarded to 

6 eligible entities described in subsection (c), assist local 

7 communities and schools (including schools funded by the 

8 Bureau of Indian Education) in applying a public health 

9 approach to mental health services both in schools and in 

10 the community. Such approach shall provide comprehen11 sive developmentally appropriate services and supports 

12 that are linguistically and culturally appropriate and trau13 ma-informed, and incorporate developmentally appropriate 

14 strategies of positive behavioral interventions and sup15 ports. A comprehensive school-based mental health pro16 gram funded under this section shall assist children in 

17 dealing with traumatic experiences, grief, bereavement, 

18 risk of suicide, and violence. 

19 ‘‘(b) ACTIVITIES.—Under the program under sub20 section (a), the Secretary may— 

21 ‘‘(1) provide financial support to enable local 

22 communities to implement a comprehensive cul23 turally and linguistically appropriate, trauma-in24 formed, and developmentally appropriate, school25 based mental health program that— 


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1 ‘‘(A) builds awareness of individual trauma 

2 and the intergenerational, continuum of impacts 

3 of trauma on populations; 

4 ‘‘(B) trains appropriate staff to identify, 

5 and screen for, signs of trauma exposure, men6 tal health disorders, or risk of suicide; and 

7 ‘‘(C) incorporates positive behavioral inter8 ventions, family engagement, student treatment, 

9 and multigenerational supports to foster the 

10 health and development of children, prevent 

11 mental health disorders, and ameliorate the im12 pact of trauma; 

13 ‘‘(2) provide technical assistance to local com14 munities with respect to the development of pro15 grams described in paragraph (1); 

16 ‘‘(3) provide assistance to local communities in 

17 the development of policies to address child and ado18 lescent trauma and mental health issues and violence 

19 when and if it occurs; 

20 ‘‘(4) facilitate community partnerships among 

21 families, students, law enforcement agencies, edu22 cation agencies, mental health and substance use 

23 disorder service systems, family-based mental health 

24 service systems, child welfare agencies, health care 

25 providers (including primary care physicians, mental 


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1 health professionals, and other professionals who 

2 specialize in children’s mental health such as child 

3 and adolescent psychiatrists), institutions of higher 

4 education, faith-based programs, trauma networks, 

5 and other community-based systems; and 

6 ‘‘(5) establish mechanisms for children and ado7 lescents to report incidents of violence or plans by 

8 other children, adolescents, or adults to commit vio9 lence. 

10 ‘‘(c) REQUIREMENTS.— 

11 ‘‘(1) IN GENERAL.—To be eligible for a grant, 

12 contract, or cooperative agreement under subsection 

13 (a), an entity shall— 

14 ‘‘(A) be a partnership that includes— 

15 ‘‘(i) a State educational agency, as de16 fined in section 8101 of the Elementary 

17 and Secondary Education Act of 1965, in 

18 coordination with one or more local edu19 cational agencies, as defined in section 

20 8101 of the Elementary and Secondary 

21 Education Act of 1965, or a consortium of 

22 any entities described in subparagraph 

23 (B), (C), (D), or (E) of section 8101(30) 

24 of such Act; and 


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1 ‘‘(ii) in accordance with paragraph 

2 (2)(A)(i), appropriate public or private en3 tities that employ interventions that are 

4 evidence-based, as defined in section 8101 

5 of the Elementary and Secondary Edu6 cation Act of 1965; and 

7 ‘‘(B) submit an application, that is en8 dorsed by all members of the partnership, 

9 that— 

10 ‘‘(i) specifies which member will serve 

11 as the lead partner; and 

12 ‘‘(ii) contains the assurances described 

13 in paragraph (2). 

14 ‘‘(2) REQUIRED ASSURANCES.—An application 

15 under paragraph (1) shall contain assurances as fol16 lows: 

17 ‘‘(A) The eligible entity will ensure that, in 

18 carrying out activities under this section, the el19 igible entity will enter into a memorandum of 

20 understanding— 

21 ‘‘(i) with at least 1 community-based 

22 mental health provider, including a public 

23 or private mental health entity, health care 

24 entity, family-based mental health entity, 

25 trauma network, or other community-based 


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1 entity, as determined by the Secretary 

2 (and which may include additional entities 

3 such as a human services agency, law en4 forcement or juvenile justice entity, child 

5 welfare agency, agency, an institution of 

6 higher education, or another entity, as de7 termined by the Secretary); and 

8 ‘‘(ii) that clearly states— 

9 ‘‘(I) the responsibilities of each 

10 partner with respect to the activities 

11 to be carried out, including how fam12 ily engagement will be incorporated in 

13 the activities; 

14 ‘‘(II) how school-employed and 

15 school-based or community-based 

16 mental health professionals will be uti17 lized for carrying out such responsibil18 ities; 

19 ‘‘(III) how each such partner will 

20 be accountable for carrying out such 

21 responsibilities; and 

22 ‘‘(IV) the amount of non-Federal 

23 funding or in-kind contributions that 

24 each such partner will contribute in 

25 order to sustain the program. 


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1 ‘‘(B) The comprehensive school-based men2 tal health program carried out under this sec3 tion supports the flexible use of funds to ad4 dress— 

5 ‘‘(i) universal prevention, through the 

6 promotion of the social, emotional, mental, 

7 and behavioral health of all students in an 

8 environment that is conducive to learning; 

9 ‘‘(ii) selective prevention, through the 

10 reduction in the likelihood of at risk stu11 dents developing social, emotional, mental, 

12 behavioral health problems, suicide, or sub13 stance use disorders; 

14 ‘‘(iii) the screening for, and early 

15 identification of, social, emotional, mental, 

16 behavioral problems, suicide risk, or sub17 stance use disorders and the provision of 

18 early intervention services; 

19 ‘‘(iv) the treatment or referral for 

20 treatment of students with existing social, 

21 emotional, mental, behavioral health prob22 lems, or substance use disorders; 

23 ‘‘(v) the development and implementa24 tion of evidence-based programs to assist 

25 children who are experiencing or have been 


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1 exposed to trauma and violence, including 

2 program curricula, school supports, and 

3 after-school programs; and 

4 ‘‘(vi) the development and implemen5 tation of evidence-based programs to assist 

6 children who are grieving, which may in7 clude training for school personnel on the 

8 impact of trauma and bereavement on chil9 dren, and services to provide support to 

10 grieving children. 

11 ‘‘(C) The comprehensive school-based men12 tal health program carried out under this sec13 tion will provide for in-service training of all 

14 school personnel, including ancillary staff and 

15 volunteers, in— 

16 ‘‘(i) the techniques and supports need17 ed to promote early identification of chil18 dren with trauma histories, children who 

19 are grieving, and children with a mental 

20 health disorder or at risk of developing a 

21 mental health disorder, or who are at risk 

22 of suicide; 

23 ‘‘(ii) the use of referral mechanisms 

24 that effectively link such children to appro25 priate prevention, treatment, and intervenVerDate Sep 11 2014 23:38 Feb 20, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1109.IH H1109

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1 tion services in the school and in the com2 munity and to follow-up when services are 

3 not available; 

4 ‘‘(iii) strategies that promote a school5 wide positive environment, including strat6 egies to prevent bullying, which includes 

7 cyber-bullying; 

8 ‘‘(iv) strategies for promoting the so9 cial, emotional, mental, and behavioral 

10 health of all students; and 

11 ‘‘(v) strategies to increase the knowl12 edge and skills of school and community 

13 leaders about the impact of trauma and vi14 olence and on the application of a public 

15 health approach to comprehensive school16 based mental health programs. 

17 ‘‘(D) The comprehensive school-based men18 tal health program carried out under this sec19 tion will include comprehensive training for par20 ents or guardians, siblings, and other family 

21 members of children with mental health dis22 orders, and for concerned members of the com23 munity in— 

24 ‘‘(i) the techniques and supports need25 ed to promote early identification of chilVerDate Sep 11 2014 23:38 Feb 20, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1109.IH H1109

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1 dren with trauma histories, children who 

2 are grieving, children with a mental health 

3 disorder or at risk of developing a mental 

4 health disorder, and children who are at 

5 risk of suicide; 

6 ‘‘(ii) the use of referral mechanisms 

7 that effectively link such children to appro8 priate prevention, treatment, and interven9 tion services in the school and in the com10 munity and follow-up when such services 

11 are not available; and 

12 ‘‘(iii) strategies that promote a school13 wide positive environment, including strat14 egies to prevent bullying, including cyber15 bullying. 

16 ‘‘(E) The comprehensive school-based men17 tal health program carried out under this sec18 tion will demonstrate the measures to be taken 

19 to sustain the program (which may include 

20 seeking funding for the program under a State 

21 Medicaid plan under title XIX of the Social Se22 curity Act or a waiver of such a plan, or under 

23 a State plan under subpart 1 of part B or part 

24 E of title IV of the Social Security Act). 


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1 ‘‘(F) The eligible entity is supported by the 

2 State agency with primary responsibility for be3 havioral health to ensure that the comprehen4 sive school-based mental health program carried 

5 out under this section will be sustainable after 

6 funding under this section terminates. 

7 ‘‘(G) The comprehensive school-based men8 tal health program carried out under this sec9 tion will be coordinated with early intervening 

10 activities carried out under the Individuals with 

11 Disabilities Education Act or activities funded 

12 under part A of title IV of the Elementary and 

13 Secondary Education Act of 1965. 

14 ‘‘(H) The comprehensive school-based 

15 mental health program carried out under this 

16 section will be trauma-informed, evidence-based, 

17 and developmentally, culturally, and linguis18 tically appropriate. 

19 ‘‘(I) The comprehensive school-based men20 tal health program carried out under this sec21 tion will include a broad needs assessment of 

22 youth who drop out of school due to policies of 

23 ‘zero tolerance’ with respect to drugs, alcohol, 

24 or weapons and an inability to obtain appro25 priate services. 


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1 ‘‘(J) The mental health services provided 

2 through the comprehensive school-based mental 

3 health program carried out under this section 

4 will be provided by qualified mental and behav5 ioral health professionals who are certified, 

6 credentialed, or licensed in compliance with ap7 plicable Federal and State law and regulations 

8 by the State involved and who are practicing 

9 within their area of expertise. 

10 ‘‘(K) Students will be permitted to self11 refer to the mental health program for mental 

12 health care and self-consent for mental health 

13 crisis care to the extent permitted by State or 

14 other applicable law. 

15 ‘‘(3) COORDINATOR.—Any entity that is a 

16 member of a partnership described in paragraph 

17 (1)(A) may serve as the coordinator of funding and 

18 activities under the grant if all members of the part19 nership agree. 

20 ‘‘(4) COMPLIANCE WITH HIPAA.—A grantee 

21 under this section shall be deemed to be a covered 

22 entity for purposes of compliance with the regula23 tions promulgated under section 264(c) of the 

24 Health Insurance Portability and Accountability Act 


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1 of 1996 with respect to any patient records devel2 oped through activities under the grant. 

3 ‘‘(5) COMPLIANCE WITH FERPA.—Section 444 

4 of the General Education Provisions Act (commonly 

5 known as the ‘Family Educational Rights and Pri6 vacy Act of 1974’) shall apply to any entity that is 

7 a member of the partnership in the same manner 

8 that such section applies to an educational agency or 

9 institution (as that term is defined in such section). 

10 ‘‘(d) GEOGRAPHICAL DISTRIBUTION.—The Secretary 

11 shall ensure that grants, contracts, or cooperative agree12 ments under subsection (a) will be distributed equitably 

13 among the regions of the country and among urban and 

14 rural areas. 

15 ‘‘(e) DURATION OF AWARDS.—With respect to a 

16 grant, contract, or cooperative agreement under sub17 section (a), the period during which payments under such 

18 an award will be made to the recipient shall be 5 years, 

19 with options for renewal. 

20 ‘‘(f) EVALUATION AND MEASURES OF OUTCOMES.— 

21 ‘‘(1) DEVELOPMENT OF PROCESS.—The Assist22 ant Secretary shall develop a fiscally appropriate 

23 process for evaluating activities carried out under 

24 this section. Such process shall include— 


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1 ‘‘(A) the development of guidelines for the 

2 submission of program data by grant, contract, 

3 or cooperative agreement recipients; 

4 ‘‘(B) the development of measures of out5 comes (in accordance with paragraph (2)) to be 

6 applied by such recipients in evaluating pro7 grams carried out under this section; and 

8 ‘‘(C) the submission of annual reports by 

9 such recipients concerning the effectiveness of 

10 programs carried out under this section. 

11 ‘‘(2) MEASURES OF OUTCOMES.— 

12 ‘‘(A) IN GENERAL.—The Assistant Sec13 retary shall develop measures of outcomes to be 

14 applied by recipients of assistance under this 

15 section, and the Assistant Secretary, in evalu16 ating the effectiveness of programs carried out 

17 under this section. Such measures shall include 

18 student and family measures as provided for in 

19 subparagraph (B) and local educational meas20 ures as provided for under subparagraph (C). 

21 ‘‘(B) STUDENT AND FAMILY MEASURES OF

22 OUTCOMES.—The measures for outcomes devel23 oped under paragraph (1)(B) relating to stu24 dents and families shall, with respect to activi25 ties carried out under a program under this 


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1 section, at a minimum include provisions to 

2 evaluate whether the program is effective in— 

3 ‘‘(i) increasing social and emotional 

4 competency; 

5 ‘‘(ii) improving academic outcomes, 

6 including as measured by proficiency on 

7 the annual assessments under section 

8 1111(b)(2) of the Elementary and Sec9 ondary Education Act of 1965; 

10 ‘‘(iii) reducing disruptive and aggres11 sive behaviors; 

12 ‘‘(iv) improving child functioning; 

13 ‘‘(v) reducing substance use disorders; 

14 ‘‘(vi) reducing rates of suicide; 

15 ‘‘(vii) reducing suspensions, truancy, 

16 expulsions, and violence; 

17 ‘‘(viii) increasing high school gradua18 tion rates, calculated using the four-year 

19 adjusted cohort graduation rate or the ex20 tended-year adjusted cohort graduation 

21 rate (as such terms are defined in section 

22 8101 of the Elementary and Secondary 

23 Education Act of 1965); 

24 ‘‘(ix) improving attendance rates and 

25 rates of chronic absenteeism; 


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1 ‘‘(x) improving access to care for men2 tal health disorders, including access to 

3 mental health services that are trauma-in4 formed, and developmentally, linguistically, 

5 and culturally appropriate; 

6 ‘‘(xi) improving health outcomes; and 

7 ‘‘(xii) decreasing disparities among 

8 vulnerable and protected populations in 

9 outcomes described in clauses (i) through 

10 (viii). 

11 ‘‘(C) LOCAL EDUCATIONAL OUTCOMES.— 

12 The outcome measures developed under para13 graph (1)(B) relating to local educational sys14 tems shall, with respect to activities carried out 

15 under a program under this section, at a min16 imum include provisions to evaluate— 

17 ‘‘(i) the effectiveness of comprehensive 

18 school mental health programs established 

19 under this section; 

20 ‘‘(ii) the effectiveness of formal part21 nership linkages among child and family 

22 serving institutions, community support 

23 systems, and the educational system; 


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1 ‘‘(iii) the progress made in sustaining 

2 the program once funding under the grant 

3 has expired; 

4 ‘‘(iv) the effectiveness of training and 

5 professional development programs for all 

6 school personnel that incorporate indica7 tors that measure cultural and linguistic 

8 competencies under the program in a man9 ner that incorporates appropriate cultural 

10 and linguistic training; 

11 ‘‘(v) the improvement in perception of 

12 a safe and supportive learning environment 

13 among school staff, students, and parents; 

14 ‘‘(vi) the improvement in case-finding 

15 of students in need of more intensive serv16 ices and referral of identified students to 

17 prevention, early intervention, and clinical 

18 services; 

19 ‘‘(vii) the improvement in the imme20 diate availability of clinical assessment and 

21 treatment services within the context of 

22 the local community to students posing a 

23 danger to themselves or others; 

24 ‘‘(viii) the increased successful matric25 ulation to postsecondary school; 


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1 ‘‘(ix) reduced suicide rates; 

2 ‘‘(x) reduced referrals to juvenile jus3 tice; and 

4 ‘‘(xi) increased educational equity. 

5 ‘‘(3) SUBMISSION OF ANNUAL DATA.—An eligi6 ble entity described in subsection (c) that receives a 

7 grant, contract, or cooperative agreement under this 

8 section shall annually submit to the Assistant Sec9 retary a report that includes data to evaluate the 

10 success of the program carried out by the entity 

11 based on whether such program is achieving the pur12 poses of the program. Such reports shall utilize the 

13 measures of outcomes under paragraph (2) in a rea14 sonable manner to demonstrate the progress of the 

15 program in achieving such purposes. 

16 ‘‘(4) EVALUATION BY ASSISTANT SECRETARY.— 

17 Based on the data submitted under paragraph (3), 

18 the Assistant Secretary shall annually submit to 

19 Congress a report concerning the results and effec20 tiveness of the programs carried out with assistance 

21 received under this section. 

22 ‘‘(5) LIMITATION.—An eligible entity shall use 

23 not more than 20 percent of amounts received under 

24 a grant under this section to carry out evaluation 

25 activities under this subsection. 


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1 ‘‘(g) INFORMATION AND EDUCATION.—The Sec2 retary shall establish comprehensive information and edu3 cation programs to disseminate the findings of the knowl4 edge development and application under this section to the 

5 general public and to health care professionals. 

6 ‘‘(h) AMOUNT OF GRANTS AND AUTHORIZATION OF

7 APPROPRIATIONS.— 

8 ‘‘(1) AMOUNT OF GRANTS.—A grant under this 

9 section shall be in an amount that is not more than 

10 $2,000,000 for each of the first 5 fiscal years fol11 lowing the date of enactment of the Mental Health 

12 Services for Students Act of 2019. The Secretary 

13 shall determine the amount of each such grant based 

14 on the population of children up to age 21 of the 

15 area to be served under the grant. 

16 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

17 There is authorized to be appropriated to carry out 

18 this section, $200,000,000 for each of the first 5 fis19 cal years following the date of enactment of the 

20 Mental Health Services for Students Act of 2019.’’. 

21 (c) CONFORMING AMENDMENT.—Part G of title V of 

22 the Public Health Service Act (42 U.S.C. 290hh et seq.), 

23 as amended by subsection (b), is further amended by strik24 ing the part designation and heading and inserting the 

25 following: 


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1 ‘‘PART G—SCHOOL-BASED MENTAL HEALTH’’. 

Æ 


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