I 

116TH CONGRESS 

2D SESSION H. R. 8544 

To amend the Public Health Service Act to support the development and 

implementation of programs using data analysis to identify and facilitate 

strategies to improve outcomes for children in geographic areas with 

a high prevalence of trauma from exposure to adverse childhood experiences, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 6, 2020 

Ms. PRESSLEY (for herself and Mrs. CAROLYN B. MALONEY of New York) 

introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to support the 

development and implementation of programs using data 

analysis to identify and facilitate strategies to improve 

outcomes for children in geographic areas with a high 

prevalence of trauma from exposure to adverse childhood 

experiences, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Services and Trauma5 informed Research of Outcomes in Neighborhoods Grants 


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1 for Support for Children Act of 2020’’ or the ‘‘STRONG 

2 Support for Children Act of 2020’’. 

3 SEC. 2. FINDINGS. 

4 Congress finds that— 

5 (1) childhood trauma is a pervasive public 

6 health issue with long-term negative effects that 

7 costs the United States thousands of lives and bil8 lions of dollars; 

9 (2) addressing childhood and adolescent trauma 

10 requires a comprehensive Federal approach that rec11 ognizes its severe impact and prioritizes trauma-in12 formed prevention and treatment that is reparative, 

13 healing-centered, gender-responsive, culturally spe14 cific, and community-based; 

15 (3) adults who have suffered from adverse 

16 childhood experiences are at much greater risk of 

17 death, including as the result of heart disease, lung 

18 disease, cancer, substance use disorder, and suicide; 

19 (4) childhood and adolescent exposures to ad20 verse childhood experiences are generational and 

21 persistent and can lead to complex trauma and toxic 

22 stress impacting brain development and triggering 

23 epigenetics; 

24 (5) any Federal effort to prevent and treat 

25 trauma must acknowledge and address the impact of 


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1 historic and systemic causal factors, which include, 

2 but are not limited to, the trauma of— 

3 (A) historical and ongoing systemic racism, 

4 sexism, xenophobia, homophobia, transphobia, 

5 and ableism that have led to generations of vio6 lence and injustice and have robbed commu7 nities of their health, freedom, and peace of 

8 mind; 

9 (B) police brutality, racial profiling, and 

10 criminalization, as well as heightened police ac11 tivity and surveillance in some areas with high12 er police-reported crime, whether as a result of 

13 community violence or of racial profiling; 

14 (C) poverty and other systemic inequities, 

15 including lack of health care, housing insta16 bility, poor housing conditions, hunger and food 

17 instability and the accompanying malnutrition, 

18 and environmental injustice resulting from gen19 erations of racist policies, historic redlining, 

20 lending discrimination, and workplace discrimi21 nation; 

22 (D) gender-based violence, including sexual 

23 harassment and assault and discriminatory 

24 school discipline policies, especially for Black 

25 girls and girls of color; 


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1 (E) western colonization and systemic di2 vestment in native communities; 

3 (F) family separation policies, including 

4 ‘‘zero-tolerance’’ immigration enforcement poli5 cies that have resulted in the deportation or the 

6 threat of deportation for countless immigrant 

7 families and have led to community mistrust 

8 and fear of reporting injustices; and 

9 (G) war and military presence, including 

10 the increased militarization of local, State, and 

11 Federal law enforcement agencies; and 

12 (6) the COVID–19 global health pandemic has 

13 increased and exacerbated the trauma inflicted on 

14 young people, specifically young people who— 

15 (A) live in communities with higher rates 

16 of infection and mortality; 

17 (B) have parents who are essential workers 

18 or first responders; 

19 (C) have parents who have lost their 

20 sources of income; 

21 (D) have witnessed death; 

22 (E) have had their education interrupted; 

23 (F) are living without access to green 

24 space and space for physical exercise; 


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1 (G) have become housing insecure and lack 

2 access to nutritious food; and 

3 (H) are isolated amidst increased domestic 

4 violence and sexual assault. 

5 SEC. 3. DATA ANALYSIS AND STRATEGY IMPLEMENTATION 

6 TO PREVENT AND MITIGATE CHILDHOOD 

7 TRAUMA. 

8 Title XXXI of the Public Health Service Act (42 

9 U.S.C. 300kk) is amended by adding at the end the fol10 lowing: 

11 ‘‘SEC. 3102. DATA ANALYSIS AND STRATEGY IMPLEMENTA12 TION TO PREVENT AND MITIGATE CHILD13 HOOD TRAUMA. 

14 ‘‘(a) IN GENERAL.—The Secretary shall establish a 

15 program— 

16 ‘‘(1) to support the development and implemen17 tation of programs that use data analysis methods 

18 to identify and facilitate strategies for early inter19 vention and prevention, in order to prevent and miti20 gate childhood trauma and support communities and 

21 families, including— 

22 ‘‘(A) improving connections through care 

23 coordination; 

24 ‘‘(B) aligning community initiatives in tar25 geted areas of need; and 


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1 ‘‘(C) expanding community capacity 

2 through cross-sector collaboration; and 

3 ‘‘(2) to evaluate the effectiveness of these pro4 grams in improving outcomes for children. 

5 ‘‘(b) GRANTS.—The Secretary shall award grants to 

6 up to 5 eligible entities to carry out the activities described 

7 in subsection (a). 

8 ‘‘(c) USE OF FUNDS.—A grant for activities under 

9 this section shall be used to support the development and 

10 implementation of programs that use data analysis meth11 ods to identify and facilitate strategies for early interven12 tion and prevention, in order to prevent and mitigate 

13 childhood trauma and support communities and families, 

14 including as follows: 

15 ‘‘(1) Utilize data analysis methods to— 

16 ‘‘(A) identify specific geographic areas, 

17 such as census tracts, with a high prevalence of 

18 adverse childhood experiences and significant 

19 risk factors for poor outcomes for children 

20 (such as increased risk of experiencing adverse 

21 childhood experiences), including areas with 

22 high rates of— 

23 ‘‘(i) poor public health outcomes in24 cluding illness, disease, suicide, and mor25 tality; 


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1 ‘‘(ii) exclusionary discipline practices, 

2 including suspensions, expulsions, and re3 ferrals to law enforcement, as well as low 

4 graduation rates; 

5 ‘‘(iii) substance use disorders; 

6 ‘‘(iv) poverty; 

7 ‘‘(v) foster system involvement or re8 ferrals; 

9 ‘‘(vi) housing instability and homeless10 ness; 

11 ‘‘(vii) food insecurity; 

12 ‘‘(viii) inequity, including disparities 

13 in income, wealth, employment, educational 

14 attainment, health care access, and public 

15 health outcomes, along lines of race, sex, 

16 sexuality and gender identity, ethnicity, or 

17 nationality; 

18 ‘‘(ix) incarceration rates; or 

19 ‘‘(x) other indicators of adversity as 

20 defined by the Secretary; and 

21 ‘‘(B) identify strategies to improve out22 comes for children aged 0 through 17 that build 

23 on strengths in communities that could be fur24 ther supported, including— 


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1 ‘‘(i) existing support networks for 

2 families; and 

3 ‘‘(ii) enhanced connections to commu4 nity-based organizations. 

5 ‘‘(2) Implement strategies identified pursuant 

6 to paragraph (1)(B) to facilitate outreach and in7 volvement of children and their caregivers in Fed8 eral, State, or local programs that provide repar9 ative, gender-responsive, culturally specific, and 

10 trauma-informed prevention services, and for which 

11 children and their caregivers are eligible, including— 

12 ‘‘(A) home visiting programs; 

13 ‘‘(B) training and education on parenting 

14 skills; 

15 ‘‘(C) substance use disorder prevention and 

16 treatment that is voluntary and noncoercive; 

17 ‘‘(D) mental health supports and care that 

18 is voluntary and noncoercive; 

19 ‘‘(E) family and intimate partner violence 

20 prevention services; 

21 ‘‘(F) child advocacy center programming; 

22 ‘‘(G) economic and nutrition support serv23 ices; 

24 ‘‘(H) housing support services, including 

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1 periencing homelessness and housing insecurity, 

2 as well as stable, long-term housing; 

3 ‘‘(I) voluntary, noncoercive, gender-respon4 sive, and culturally specific mental health sup5 ports in school and early childhood education 

6 center-based settings; 

7 ‘‘(J) wraparound programs for 

8 transitioning youth and youth currently in the 

9 foster system; 

10 ‘‘(K) programming to support the health 

11 and well-being of lesbian, gay, bisexual, 

12 transgender, and intersex children and their 

13 families; and 

14 ‘‘(L) family resource center services. 

15 ‘‘(d) SPECIAL RULES.— 

16 ‘‘(1) PRIMARY PAYER RESTRICTION.—The Sec17 retary may not award a grant under this section to 

18 an eligible entity for a service if the service to be 

19 provided is available pursuant to the State plan ap20 proved under title XIX of the Social Security Act for 

21 the State in which the program funded by the grant 

22 is being conducted unless the State and all eligible 

23 subdivisions involved— 


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1 ‘‘(A) will enter into agreements with public 

2 or nonprofit private entities under which the 

3 entities will provide the service; and 

4 ‘‘(B) demonstrate that the State and all el5 igible subdivisions will ensure that the entities 

6 providing the service— 

7 ‘‘(i) will seek payment for each such 

8 service rendered in accordance with the 

9 usual payment schedule under the State 

10 plan; and 

11 ‘‘(ii) the entities have entered into a 

12 participation agreement and are qualified 

13 to receive payments under such plan. 

14 ‘‘(2) IMPLEMENTATION.—An eligible entity that 

15 receives a grant under this section may use— 

16 ‘‘(A) not more than 25 percent of the 

17 amounts made available through the grant for 

18 the first 24 months of the grant period to uti19 lize data analysis methods to— 

20 ‘‘(i) identify specific geographic areas 

21 where care coordination, prevention and 

22 early intervention, and facilitation services 

23 will be provided; and 

24 ‘‘(ii) identify support and intervention 

25 services to improve outcomes for children 


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1 located in a geographic area identified 

2 under subsection (c)(1)(A); and 

3 ‘‘(B) not more than 10 percent of the 

4 grant in each subsequent year to continue data 

5 analysis activities. 

6 ‘‘(3) ADMINISTRATION.—An eligible entity that 

7 receives a grant under this section may not use more 

8 than 5 percent of amounts received through the 

9 grant for administration, reporting, and program 

10 oversight functions, including the development of 

11 systems to improve data collection and data sharing 

12 for the purposes of improving services and the provi13 sion of care. 

14 ‘‘(4) PRIORITY.— 

15 ‘‘(A) IN GENERAL.—In awarding grants 

16 under this section, the Secretary shall give pri17 ority, to the extent practical, to eligible entities 

18 that use community-based system dynamic 

19 modeling as the primary data analysis method. 

20 ‘‘(B) SYSTEM DYNAMIC MODELING DE21 FINED.—The term ‘system dynamic modeling’ 

22 means a method of data analysis and predictive 

23 modeling that includes— 

24 ‘‘(i) utilization of community-based 

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1 ing community in the process of under2 standing and changing systems and evalu3 ating outcomes of grants; 

4 ‘‘(ii) consideration of a multitude of 

5 environmental risk factors and ascertain6 ment of the significance of contributing 

7 community risk factors for purposes of 

8 identifying strategies to reduce adverse 

9 child outcomes, including— 

10 ‘‘(I) maltreatment cases; 

11 ‘‘(II) involvement with the juve12 nile criminal legal system or foster 

13 system; 

14 ‘‘(III) exclusionary school dis15 cipline; or 

16 ‘‘(IV) exposure to violence; and 

17 ‘‘(iii) identification of cross-sector re18 sponses involving reparative, trauma-in19 formed, culturally specific, gender-respon20 sive, and community-based organizations 

21 to reduce adverse child outcomes. 

22 ‘‘(5) SUBGRANT.— 

23 ‘‘(A) IN GENERAL.—An eligible entity that 

24 receives a grant under this section shall use at 

25 least 25 percent of the total amount of the 


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1 grant to make subgrants to organizations that 

2 aide in implementing the strategy identified 

3 under subsection (c)(1)(B) for preventing and 

4 mitigating childhood trauma and supporting 

5 communities and families. 

6 ‘‘(B) ELIGIBILITY.—To be eligible to re7 ceive a subgrant under this paragraph, an orga8 nization shall prepare and submit to the eligible 

9 entity an application in such form, and con10 taining such information, as the eligible entity 

11 may require, including evidence that the— 

12 ‘‘(i) needs of the population to be 

13 served are urgent and are not met by the 

14 services currently available in the geo15 graphic area; and 

16 ‘‘(ii) the organization has the capacity 

17 to provide the services listed in subsection 

18 (c)(2). 

19 ‘‘(C) SUPPLEMENT NOT SUPPLANT.— 

20 Subgrant funds received pursuant to this para21 graph by an organization shall be used to sup22 plement and not supplant State or local funds 

23 provided to the partnership organization for 

24 services listed in subsection (c)(2). 


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1 ‘‘(e) APPLICATION.—To be eligible to receive a grant 

2 under this section, an eligible entity shall submit to the 

3 Secretary an application in such form, and containing 

4 such information, as the Secretary may require, to include 

5 the following: 

6 ‘‘(1) A demonstration that— 

7 ‘‘(A) the applicant utilizes trauma-in8 formed, culturally specific, and gender-respon9 sive practices, including a demonstration of the 

10 extent to which the applicant has trained staff 

11 in these practices; 

12 ‘‘(B) the applicant has the capacity to ad13 minister the grant, including conducting all re14 quired data analysis activities; and 

15 ‘‘(C) services will be provided to children 

16 and families in an accessible, culturally rel17 evant, and linguistically specific manner con18 sistent with local needs. 

19 ‘‘(2) A preliminary analysis of how the appli20 cant will use the grant to— 

21 ‘‘(A) identify the geographic area or areas 

22 to be served using data analysis methods; 

23 ‘‘(B) utilize data analysis methods to iden24 tify strategies to improve outcomes for children 

25 in the geographic area; 


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1 ‘‘(C) facilitate strategies identified through 

2 care coordination efforts; and 

3 ‘‘(D) track data for evaluation of out4 comes. 

5 ‘‘(3) A detailed project plan for the use of the 

6 grant that includes anticipated technical assistance 

7 needs. 

8 ‘‘(4) Additional funding sources, including State 

9 and local funds, supporting the prevention and miti10 gation of adverse childhood experiences. 

11 ‘‘(f) GRANT AMOUNT.—The amount of a grant under 

12 this section shall not exceed $9,500,000. 

13 ‘‘(g) PERIOD OF A GRANT.—The period of a grant 

14 under this section shall not exceed 7 years. 

15 ‘‘(h) SERVICE PROVISION WITHOUT REGARD TO

16 ABILITY TO PAY.—As a condition on receipt of a grant 

17 under this section, an eligible entity shall agree that any 

18 assistance provided to an individual through the grant will 

19 be provided without regard to— 

20 ‘‘(1) the ability of the individual to pay for such 

21 services; 

22 ‘‘(2) the current or past health condition of the 

23 individual to be served; 

24 ‘‘(3) the immigration status of the individual to 

25 be served; 


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1 ‘‘(4) the sexual orientation and gender identity 

2 of the individual to be served; and 

3 ‘‘(5) any prior involvement of the individual in 

4 the criminal legal system. 

5 ‘‘(i) PROHIBITIONS.—In addition to any other prohi6 bitions determined by the Secretary, an eligible entity may 

7 not use a grant under this section to— 

8 ‘‘(1) use data analysis methods to inform indi9 vidual case decisions, including child removal or 

10 placement decisions, or to target services at certain 

11 individuals or families; 

12 ‘‘(2) require any individual or family to partici13 pate in any service or program as a condition of re14 ceipt of a benefit to which the individual or family 

15 is otherwise eligible; 

16 ‘‘(3) increase the presence or funding of law en17 forcement surveillance, involvement, or activity in 

18 implementing the strategies identified under sub19 section (c)(1)(B); or 

20 ‘‘(4) enable the practice of conversion therapy. 

21 ‘‘(j) EVALUATION.— 

22 ‘‘(1) DATA MODEL EVALUATION.—Not later 

23 than 36 months after the date of enactment of this 

24 section, the Assistant Secretary for Planning and 

25 Evaluation of the Department of Health and Human 


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1 Services, in coordination with the grantees receiving 

2 a grant under this section, shall complete an evalua3 tion of the effectiveness of the data model accuracy 

4 of the grant program under this section to address 

5 each of the following: 

6 ‘‘(A) Determining the effectiveness of the 

7 grantees’ use of data analysis methods to iden8 tify geographic areas pursuant to subsection 

9 (c)(1). 

10 ‘‘(B) Examining the grantees’ development 

11 and utilization of data analysis methods. 

12 ‘‘(C) Examining the grantees’ ability to ef13 fectively utilize data analysis methods in future 

14 prevention work. 

15 ‘‘(D) Establishing a method for rigorously 

16 evaluating the activities of grantees and com17 paring the reduction of child and family expo18 sure to adverse experiences in other commu19 nities with similar demographics. 

20 ‘‘(E) Examining the grantees’ utilization of 

21 community-based system dynamics modeling 

22 methods and other community engagement 

23 methods. 

24 ‘‘(2) PROGRAM EVALUATION.—Not later than 6 

25 years after the date of enactment of this section, the 


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1 Assistant Secretary for Planning and Evaluation of 

2 the Department of Health and Human Services, in 

3 coordination with eligible entities receiving grants 

4 under this section, shall complete an evaluation of 

5 the effectiveness of the grant program under this 

6 section. 

7 ‘‘(3) DATA COLLECTION.— 

8 ‘‘(A) IN GENERAL.—The Assistant Sec9 retary for Planning and Evaluation of the De10 partment of Health and Human Services and 

11 each eligible entity receiving a grant under this 

12 section shall collect any relevant data necessary 

13 to complete the evaluations required by para14 graphs (1) and (2) to include— 

15 ‘‘(i) the activities funded by the grant 

16 under this section, including development 

17 and implementation data analysis methods; 

18 ‘‘(ii) the number of children and of 

19 families receiving coordination and facilita20 tion of care and services; and 

21 ‘‘(iii) the effect of activities supported 

22 by the grant under this section on the local 

23 area serviced by the program, including 

24 such effects on— 


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1 ‘‘(I) children and adolescents’ 

2 health and well-being; 

3 ‘‘(II) the number of children who 

4 enter into or depart from foster serv5 ices; and 

6 ‘‘(III) homelessness and housing 

7 insecurity. 

8 ‘‘(B) STUDY.— 

9 ‘‘(i) IN GENERAL.—Not later than 7 

10 years after the date of enactment of this 

11 section, the Assistant Secretary for Plan12 ning and Evaluation of the Department of 

13 Health and Human Services shall— 

14 ‘‘(I) complete a study on the re15 sults of the grant program under this 

16 section using the community-based 

17 participatory action research method, 

18 which focuses on social, structural, 

19 and physical environmental inequities 

20 through active involvement of commu21 nity members, clients, organizational 

22 representatives, and researchers in all 

23 aspects of the research process; and 

24 ‘‘(II) submit a report on the re25 sults of the study to the Congress. 


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1 ‘‘(ii) PARTNERS.—In conducting the 

2 study under clause (i), the Assistant Sec3 retary for Planning and Evaluation of the 

4 Department of Health and Human Serv5 ices shall ensure that partners and persons 

6 that have participated in the grant pro7 gram under this section on every level, es8 pecially those such partners or persons re9 ceiving services and support through the 

10 program, have an opportunity to contribute 

11 their expertise to evaluating the strategy 

12 and outcomes. 

13 ‘‘(k) REPORT.—Not later than three months after the 

14 completion of the evaluation required by subsection (j)(2), 

15 the Assistant Secretary for Planning and Evaluation of 

16 the Department of Health and Human Services shall sub17 mit to Congress and make available to the public on the 

18 internet website of the Department of Health and Human 

19 Services a report based upon the evaluation under sub20 section (j)(2), to include— 

21 ‘‘(1) the impact of the program under this sec22 tion on homelessness and housing insecurity, sub23 stance use disorder and drug deaths, incarceration, 

24 foster system involvement, and other child and fam25 ily outcomes as identified by the Assistant Secretary 


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1 for Planning and Evaluation of the Department of 

2 Health and Human Services; 

3 ‘‘(2) an analysis of which elements of the pro4 gram should be replicated and scaled by govern5 mental or non-governmental entities; and 

6 ‘‘(3) such recommendations for legislation and 

7 administrative action as the Secretary determines 

8 appropriate. 

9 ‘‘(l) DEFINITION.—In this section: 

10 ‘‘(1) The term ‘adverse childhood experience’ 

11 means a potentially traumatic experience that occurs 

12 in childhood and can have a tremendous impact on 

13 the child’s lifelong health and opportunity outcomes, 

14 such as any of the following: 

15 ‘‘(A) Abuse, such as any of the following: 

16 ‘‘(i) Emotional and psychological 

17 abuse. 

18 ‘‘(ii) Physical abuse. 

19 ‘‘(iii) Sexual abuse. 

20 ‘‘(B) Household challenges such as any of 

21 the following: 

22 ‘‘(i) A household member is treated 

23 violently. 

24 ‘‘(ii) A household member has a sub25 stance use disorder. 


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1 ‘‘(iii) A household member has a men2 tal health condition. 

3 ‘‘(iv) Parental separation or divorce. 

4 ‘‘(v) A household member is incarcer5 ated, placed in immigrant detention, or has 

6 been deported. 

7 ‘‘(vi) A household member has a life8 threatening illness such as COVID–19. 

9 ‘‘(C) Neglect. 

10 ‘‘(D) Living in— 

11 ‘‘(i) impoverished communities that 

12 lack access to human services; 

13 ‘‘(ii) areas of high unemployment 

14 neighborhoods; or 

15 ‘‘(iii) communities experiencing de 

16 facto segregation. 

17 ‘‘(E) Experiencing food insecurity and 

18 poor nutrition. 

19 ‘‘(F) Witnessing violence. 

20 ‘‘(G) Involvement with the foster system. 

21 ‘‘(H) Experiencing discrimination. 

22 ‘‘(I) Dealing with historical and ongoing 

23 traumas due to systemic and interpersonal rac24 ism. 


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1 ‘‘(J) Dealing with historical and ongoing 

2 traumas regarding systemic and interpersonal 

3 sexism, homophobia, biphobia, and transphobia. 

4 ‘‘(K) Dealing with the threat of deporta5 tion or detention as a result of immigration sta6 tus. 

7 ‘‘(L) The impacts of multigenerational pov8 erty resulting from limited educational and eco9 nomic opportunities. 

10 ‘‘(M) Living through natural disasters 

11 such as earthquakes, forest fires, floods, or hur12 ricanes. 

13 ‘‘(2) The term ‘eligible entity’ means a State or 

14 local health department. 

15 ‘‘(3) The term ‘practice of conversion ther16 apy’— 

17 ‘‘(A) means any practice or treatment by 

18 any person that seeks to change another indi19 vidual’s sexual orientation or gender identity, 

20 including efforts to change behaviors or gender 

21 expressions, or to eliminate or reduce sexual or 

22 romantic attractions or feelings toward individ23 uals of the same gender, if such person receives 

24 monetary compensation in exchange for any 

25 such practice or treatment; and 


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1 ‘‘(B) does not include any practice or 

2 treatment that does not seek to change sexual 

3 orientation or gender identity and— 

4 ‘‘(i) provides assistance to an indi5 vidual undergoing a gender transition; or 

6 ‘‘(ii) provides acceptance, support, 

7 and understanding of a client or facilita8 tion of a client’s coping, social support, 

9 and identity exploration and development. 

10 ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.—There 

11 is authorized to be appropriated to carry out this section 

12 for the period of fiscal years 2020 through 2027— 

13 ‘‘(1) to carry out subsection (a)(1) through the 

14 award of grants under subsection (b)— 

15 ‘‘(A) $47,500,000 for grants; and 

16 ‘‘(B) such sums as may be necessary for 

17 the administrative costs of carrying out such 

18 subsection; and 

19 ‘‘(2) $7,500,000 to carry out the evaluation 

20 under subsection (a)(2).’’. 

21 SEC. 4. CARE COORDINATION GRANTS. 

22 Part E of title XII of the Public Health Service Act 

23 (42 U.S.C. 300d–51 et seq.) is amended by adding at the 

24 end the following new section: 


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1 ‘‘SEC. 1255. CARE COORDINATION GRANTS. 

2 ‘‘(a) IN GENERAL.—The Secretary shall award 

3 grants to eligible entities to establish or expand trauma4 informed care coordination services to support— 

5 ‘‘(1) children aged 0 through 5 at risk of ad6 verse childhood experiences; and 

7 ‘‘(2) their caregivers, including prenatal people 

8 of any age. 

9 ‘‘(b) NUMBER OF GRANTS.—Subject to the avail10 ability of appropriations, the Secretary shall award not 

11 fewer than 9 and not more than 40 grants under this sec12 tion. 

13 ‘‘(c) AMOUNT OF GRANTS.—Subject to the avail14 ability of appropriations, the amount of a grant under this 

15 section for a fiscal year shall be— 

16 ‘‘(1) not less than $250,000; and 

17 ‘‘(2) not more than $1,000,000. 

18 ‘‘(d) ELIGIBLE ENTITIES.—To be eligible to receive 

19 a grant under this section, an entity shall be a local gov20 ernment or Indian Tribe, acting through the public health 

21 department thereof if such government or Tribe has a 

22 public health department. 

23 ‘‘(e) PRIORITY.— 

24 ‘‘(1) IN GENERAL.—In awarding grants under 

25 this section, the Secretary shall give priority to eligi26 ble entities proposing to serve communities with a 


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1 high need for trauma-informed care coordination 

2 services, as demonstrated by indicators such as— 

3 ‘‘(A) pregnant people who face barriers to 

4 prenatal care; 

5 ‘‘(B) mortality or morbidity of people giv6 ing birth or infants; 

7 ‘‘(C) caretakers and parents who are living 

8 with a mental health condition or substance use 

9 disorder; 

10 ‘‘(D) a high prevalence of community vio11 lence, including domestic violence, as dem12 onstrated by instances of homicide and public 

13 health statistics, including treatment of injury 

14 or trauma; 

15 ‘‘(E) high proportions of low-income chil16 dren; 

17 ‘‘(F) a high prevalence of child fatalities or 

18 near fatalities related to child abuse and ne19 glect; 

20 ‘‘(G) significant disparities in health out21 comes for people giving birth and infants; 

22 ‘‘(H) a high rate of exclusionary discipline 

23 and referrals to law enforcement; and 

24 ‘‘(I) a high rate of homelessness and hous25 ing instability. 


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1 ‘‘(2) DATA FROM TRIBAL AREAS.—The Sec2 retary, acting through the Director of the Indian 

3 Health Service, shall consult with Indian Tribes to 

4 establish criteria to measure indicators of need, for 

5 purposes of paragraph (1), with respect to Tribal 

6 areas. 

7 ‘‘(f) USE OF FUNDS.— 

8 ‘‘(1) REQUIRED USES.— 

9 ‘‘(A) IN GENERAL.—A grant received 

10 under this section shall be used to establish or 

11 expand gender-responsive, culturally specific, 

12 trauma-informed care coordination services, in13 cluding by instituting and conducting risk and 

14 needs assessments including— 

15 ‘‘(i) using strengths-based approaches 

16 focused on protective factors for children 

17 and their caregivers, including prenatal 

18 people of any age; and 

19 ‘‘(ii) inputting screening results into a 

20 centralized intake system to promote a sin21 gle point of access system across providers 

22 and services. 

23 ‘‘(B) TRAINING.—A grant received under 

24 this section shall be used to ensure that individ25 uals employed through the grant funds, in 


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1 whole or in part, have received sufficient and 

2 up-to-date training on trauma-informed care 

3 and strategies that are reparative, culturally 

4 sensitive, gender-responsive, and healing-cen5 tered. 

6 ‘‘(2) PERMISSIBLE USES.—A grant received 

7 under this section may be used for any of the fol8 lowing: 

9 ‘‘(A) Employing care coordinators, case 

10 managers, community health workers, certified 

11 infant mental health specialists, and outreach 

12 and engagement specialists to work with chil13 dren and their caregivers, including prenatal in14 dividuals, to prevent and respond to adverse 

15 childhood experiences by connecting clients with 

16 culturally specific, trauma-informed care treat17 ment services, including economic, social, food, 

18 and housing supports. 

19 ‘‘(B) Providing training described in para20 graph (1)(B) to community health providers 

21 and community partners. 

22 ‘‘(C) Expanding, enhancing, modifying, 

23 and connecting the existing network of commu24 nity programs and services to achieve a more 


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1 comprehensive and coordinated system of care 

2 approach, including— 

3 ‘‘(i) developing local infrastructure to 

4 bolster and shape community support sys5 tems and map and build access to services 

6 in a coordinated and comprehensive way; 

7 and 

8 ‘‘(ii) creating infrastructure to con9 duct outreach to children and families, in10 cluding those experiencing homelessness 

11 and housing instability, so they acquire ac12 cess to the services and supports they need 

13 and the benefits to which they are entitled. 

14 ‘‘(D) Compiling information on resources 

15 (including any referral services) available 

16 through community-based organizations and 

17 local, State, and Federal agencies, such as— 

18 ‘‘(i) programs addressing social deter19 minants of health, including— 

20 ‘‘(I) emergency, temporary, and 

21 long-term housing; 

22 ‘‘(II) programs that offer free or 

23 affordable and nutritious food; 

24 ‘‘(III) vocational and workforce 

25 development; and 


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1 ‘‘(IV) transportation supports; 

2 ‘‘(ii) home visiting programs for new 

3 parents and their infants; 

4 ‘‘(iii) workforce development programs 

5 to support caregivers in skill building; 

6 ‘‘(iv) trauma-responsive, parenting 

7 skills-building programs; 

8 ‘‘(v) the continuum of substance use 

9 prevention, intervention, and treatment 

10 programs and mental health support pro11 grams, including programs with trauma-in12 formed, gender-responsive, and culturally 

13 specific counseling; and 

14 ‘‘(vi) childcare support and early 

15 childhood education, including Head Start 

16 and Early Head Start programs. 

17 ‘‘(E) Subject to subsection (g)(2), estab18 lishing or updating a database that compiles 

19 data used to track the effectiveness of the care 

20 coordination services funded through the grant. 

21 ‘‘(F) Developing and implementing referral 

22 partnership agreements with community-based 

23 organizations, parent organizations, substance 

24 use disorder treatment providers and facilities, 

25 housing and shelter providers, health care proVerDate Sep 11 2014 00:07 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H8544.IH H8544

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1 viders, mental health care providers, and Fed2 eral and State offices and programs that imple3 ment practices to support children ages 0 

4 through 5 who are at risk of adverse childhood 

5 experiences and their caregivers, including pre6 natal people. Such practices shall include— 

7 ‘‘(i) a bilateral ‘warm handoff’ system 

8 whereby a grantee understands the needs 

9 of the children and their families, and fam10 ilies are involved in addressing these needs; 

11 and 

12 ‘‘(ii) an active service connection 

13 whereby the children and families are each 

14 actively connected with a resource in a 

15 well-coordinated way that ensures avail16 ability and direct contact. 

17 ‘‘(G) Supporting cross-system planning 

18 and collaboration among employees who may 

19 work in emergency medical services, health care 

20 services, public health, early childhood edu21 cation, and substance use disorder treatment 

22 and recovery support. 

23 ‘‘(H) Providing or subsidizing services to 

24 address barriers that children, prenatal individ25 uals, and caregivers face to utilizing community 


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1 resources and services, such as by providing or 

2 subsidizing transportation or childcare costs as 

3 applicable and within reasonable amounts. 

4 ‘‘(I) Creating or expanding infrastructure 

5 and investing in technology, including the provi6 sion of communications technology and internet 

7 service to children and their caregivers, to en8 able increased telemedicine capabilities to reach 

9 participants. 

10 ‘‘(3) INDIAN TRIBES.—In the case of an eligible 

11 entity that is an Indian tribe, the Secretary may 

12 waive such provisions of this subsection as the Sec13 retary determines appropriate. 

14 ‘‘(4) PROHIBITIONS.—In addition to any other 

15 prohibitions determined by the Secretary, an eligible 

16 entity may not use a grant under this section to— 

17 ‘‘(A) use data analysis methods to inform 

18 individual case decisions, including child re19 moval or placement decisions, or to target serv20 ices at certain individuals or families; 

21 ‘‘(B) require any individual or family to 

22 participate in any service or program as a con23 dition of receipt of a benefit to which the indi24 vidual or family is otherwise eligible; or 


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1 ‘‘(C) increase the presence or funding of 

2 law enforcement surveillance, involvement, or 

3 activity in connection with trauma-informed 

4 care coordination services supported pursuant 

5 to this section. 

6 ‘‘(g) REQUIREMENTS.—As a condition on receipt of 

7 a grant under this section, an eligible entity shall agree 

8 to each of the following funding conditions: 

9 ‘‘(1) RESTRICTION OF FUNDING ALLOCATION.— 

10 The eligible entity will not use more than 30 percent 

11 of the funds made available to the entity through the 

12 grant (for the total grant period) to establish or up13 date a database pursuant to subsection (f)(2)(E). 

14 ‘‘(2) ACCESSIBLE SETTING.— 

15 ‘‘(A) IN GENERAL.—The eligible entity will 

16 ensure that all care coordination services pro17 vided through the grant are provided in a set18 ting that is accessible, including through mobile 

19 settings, to— 

20 ‘‘(i) low-income or no-income individ21 uals, including individuals experiencing 

22 homelessness or housing instability; and 

23 ‘‘(ii) individuals in rural areas. 

24 ‘‘(B) COMMUNITY OUTREACH.—In com25 plying with subparagraph (A), the eligible entity 


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1 will ensure that at least 50 percent of the care 

2 coordination services provided through the 

3 grant occur in community settings that are con4 venient to the children and caregivers who are 

5 being served, such as homes, schools, and shel6 ters, whether for initial outreach or as part of 

7 long-term care. 

8 ‘‘(3) SUPPLEMENT NOT SUPPLANT.—The grant 

9 will be used to supplement not supplant other Fed10 eral, State, or local funds available for care coordi11 nation services. 

12 ‘‘(4) CONFIDENTIALITY.—The eligible entity 

13 will maintain the confidentiality of individuals receiv14 ing services through the grant in a manner con15 sistent with applicable law. 

16 ‘‘(5) PARTNERING; RISK STRATIFICATION.—In 

17 providing care coordination services through the 

18 grant, the eligible entity will— 

19 ‘‘(A) partner with community-based orga20 nizations with experience serving child popu21 lations prenatally through age 5; 

22 ‘‘(B) coordinate with the local agency re23 sponsible for administering the State plan ap24 proved under title XIX of the Social Security 

25 Act; and 


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1 ‘‘(C) employ risk stratification to develop 

2 different effective models of care for different 

3 populations based on their needs. 

4 ‘‘(h) APPLICATION.— 

5 ‘‘(1) IN GENERAL.—To seek a grant under this 

6 section, an eligible entity shall submit an application 

7 to the Secretary at such time, in such manner, and 

8 containing such information, as the Secretary may 

9 require. 

10 ‘‘(2) CONTENTS.—An application under para11 graph (1) shall, at a minimum, contain each of the 

12 following: 

13 ‘‘(A) Goals to be achieved through the 

14 grant, including the activities that will be un15 dertaken to achieve those goals. 

16 ‘‘(B) The number of individuals likely to 

17 be served through the grant, including demo18 graphic data on the populations to be served. 

19 ‘‘(C) Existing programs and services that 

20 can be used to significantly increase the propor21 tion of children and families who receive needed 

22 supports and services. 

23 ‘‘(D) A plan for expanding, coordinating, 

24 or modifying the existing network of programs 

25 and services to meet the needs of children and 


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1 families for preventing and mitigating the trau2 matic impact of adverse childhood experiences. 

3 ‘‘(E) A demonstration of the ability of the 

4 eligible entity to reach the individuals to be 

5 served, including by partnering with local stake6 holders. 

7 ‘‘(F) An indication of how the personnel 

8 involved are reflective of the communities to be 

9 served. 

10 ‘‘(G) A list of stakeholders with whom the 

11 entity plans to partner or consult. 

12 ‘‘(i) REPORTING BY GRANTEES.—Not later than 4 

13 years after the date of enactment of this section, an eligi14 ble entity receiving a grant under this section shall submit 

15 to the Secretary a report on the activities funded through 

16 the grant. Such report shall include, at a minimum, a de17 scription of— 

18 ‘‘(1) the number of individuals served through 

19 activities funded through the grant, including demo20 graphics as applicable; 

21 ‘‘(2) the number of referrals made through the 

22 grant and the rate of such referrals successfully 

23 linked or closed; 


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1 ‘‘(3) a qualitative analysis or number of collabo2 rative partnerships with other organizations in car3 rying out the activities funded through the grant; 

4 ‘‘(4) the number of services provided to individ5 uals through the grant; 

6 ‘‘(5) aggregated and de-identified outcomes ex7 perienced by individuals served through the grant 

8 such as— 

9 ‘‘(A) the rate of successful service connec10 tions; 

11 ‘‘(B) any increases in development of pro12 tective factors for children; 

13 ‘‘(C) any increase in development of pro14 tective factors for the caregivers; 

15 ‘‘(D) any mitigation of the negative out16 comes associated with adverse childhood experi17 ences or decreased likelihood of children experi18 encing an adverse childhood experience as evi19 denced by— 

20 ‘‘(i) decreased presence of law en21 forcement or other punitive State surveil22 lance in the community; 

23 ‘‘(ii) a parent completing substance 

24 use treatment; 


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1 ‘‘(iii) a parent receiving voluntary 

2 treatment for mental health-related condi3 tions; 

4 ‘‘(iv) a family entering into or main5 taining a stable housing situation; 

6 ‘‘(v) a family achieving or maintaining 

7 economic security; 

8 ‘‘(vi) a parent achieving or maintain9 ing job stability; or 

10 ‘‘(vii) a child meeting developmental 

11 markers for school readiness; and 

12 ‘‘(E) reports of satisfaction with the co13 ordination of care by people served; and 

14 ‘‘(6) any other information required by the Sec15 retary. 

16 ‘‘(j) CONVENING PARTICIPANTS FOR SHARING LES17 SONS LEARNED.—After the period of all grants awarded 

18 under this section has concluded, the Assistant Secretary 

19 for Planning and Evaluation of the Department of Health 

20 and Human Services shall provide an in-person or online 

21 opportunity for persons participating in the programs 

22 funded through this section to share with each other— 

23 ‘‘(1) lessons learned; 

24 ‘‘(2) challenges experienced; and 

25 ‘‘(3) ideas for next steps and solutions. 


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1 ‘‘(k) COMPILING FINDINGS AND CONCLUSIONS.— 

2 After providing the opportunity required by subsection (j), 

3 the Secretary shall— 

4 ‘‘(1) compile the findings and conclusions of 

5 grantees under this section on the provision of care 

6 coordination services described in subsection (a); 

7 ‘‘(2) submit a report on such findings and con8 clusions to the appropriate congressional commit9 tees; and 

10 ‘‘(3) make such report publicly available. 

11 ‘‘(l) DEFINITIONS.—In this section: 

12 ‘‘(1) ADVERSE CHILDHOOD EXPERIENCE.—The 

13 term ‘adverse childhood experience’ means a poten14 tially traumatic experience that occurs in childhood 

15 and can have a tremendous impact on the child’s 

16 lifelong health and opportunity outcomes, such as 

17 any of the following: 

18 ‘‘(A) Abuse, such as any of the following: 

19 ‘‘(i) Emotional and psychological 

20 abuse. 

21 ‘‘(ii) Physical abuse. 

22 ‘‘(iii) Sexual abuse. 

23 ‘‘(B) Household challenges such as any of 

24 the following: 


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1 ‘‘(i) A household member is treated 

2 violently. 

3 ‘‘(ii) A household member has a sub4 stance use disorder. 

5 ‘‘(iii) A household member has a men6 tal health condition. 

7 ‘‘(iv) Parental separation or divorce. 

8 ‘‘(v) A household member is incarcer9 ated, placed in immigrant detention, or has 

10 been deported. 

11 ‘‘(vi) A household member has a life12 threatening illness such as COVID–19. 

13 ‘‘(C) Neglect. 

14 ‘‘(D) Living in— 

15 ‘‘(i) impoverished communities that 

16 lack access to human services; 

17 ‘‘(ii) areas of high unemployment 

18 neighborhoods; or 

19 ‘‘(iii) communities experiencing de 

20 facto segregation. 

21 ‘‘(E) Experiencing food insecurity and 

22 poor nutrition. 

23 ‘‘(F) Witnessing violence. 

24 ‘‘(G) Involvement with the foster system. 

25 ‘‘(H) Experiencing discrimination. 


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1 ‘‘(I) Dealing with historical and ongoing 

2 traumas due to systemic and interpersonal rac3 ism. 

4 ‘‘(J) Dealing with historical and ongoing 

5 traumas regarding systemic and interpersonal 

6 sexism, homophobia, biphobia, and transphobia. 

7 ‘‘(K) Dealing with the threat of deporta8 tion or detention as a result of immigration sta9 tus. 

10 ‘‘(L) The impacts of multigenerational pov11 erty resulting from limited educational and eco12 nomic opportunities. 

13 ‘‘(M) Living through natural disasters 

14 such as earthquakes, forest fires, floods, or hur15 ricanes. 

16 ‘‘(2) CARE COORDINATION.—The term ‘care co17 ordination’ means an active, ongoing process that— 

18 ‘‘(A) assists children ages 0 through 5 at 

19 risk of, or who have experienced, an adverse 

20 childhood experience, and their caregivers, in21 cluding prenatal people of any age, to identify, 

22 access, and use community resources and serv23 ices; 

24 ‘‘(B) is client-centered and comprehensive 

25 of the services a child or caregiver may need; 


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1 ‘‘(C) ensures a closed loop referral by ob2 taining feedback from the families served; and 

3 ‘‘(D) works across systems and services to 

4 promote collaboration to effectively meet the 

5 needs of community members. 

6 ‘‘(3) INDIAN TRIBE.—The term ‘Indian Tribe’ 

7 has the meaning given such term in section 4 of the 

8 Indian Self-Determination and Education Assistance 

9 Act. 

10 ‘‘(4) PROTECTIVE FACTORS.—The term ‘protec11 tive factors’ refers to any supportive element in a 

12 child or caretaker’s life that helps the child or care13 taker to withstand trauma such as a stable school 

14 environment or supportive peer relationships. 

15 ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.— 

16 ‘‘(1) IN GENERAL.—To carry out this section, 

17 there is authorized to be appropriated $15,000,000 

18 for each of the 5 fiscal years following the fiscal year 

19 in which this section is enacted. 

20 ‘‘(2) GRANTS TO INDIAN TRIBES.—Of the 

21 amount made available to carry out this section for 

22 a fiscal year, the Secretary shall use not less than 

23 10 percent of such amount for grants to eligible en24 tities that are Indian tribes. 


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1 ‘‘(3) ADMINISTRATIVE EXPENSES.—Of the 

2 amount made available to carry out this section for 

3 a fiscal year, the Secretary may use not more than 

4 15 percent of such amount for administrative ex5 penses, including the expenses of the Assistant Sec6 retary for Planning and Evaluation of the Depart7 ment of Health and Human Services for compiling 

8 and reporting information. 

9 ‘‘(4) TECHNICAL ASSISTANCE.—Of the amount 

10 made available to carry out this section for a fiscal 

11 year, the Secretary may reserve up to 5 percent of 

12 such amount to provide technical assistance to eligi13 ble entities in preparing and submitting applications 

14 under this section.’’. 

Æ 


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