II 

108TH CONGRESS 

1ST SESSION S. 1810

To amend the Public Health Service Act to improve treatment for the mental 

health and substance abuse needs of women with histories of trauma, 

including domestic and sexual violence. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 31, 2003

Mr. DASCHLE (for Mr. EDWARDS) introduced the following bill; which was 

read twice and referred to the Committee on Health, Education, Labor, 

and Pensions 

A BILL

To amend the Public Health Service Act to improve treatment for the mental health and substance abuse needs 

of women with histories of trauma, including domestic 

and sexual violence.

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 ‘‘Women in Trauma 

5 Act of 2003’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds as follows: 
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1 (1) Researchers have concluded that women 

2 may experience significant adverse mental health 

3 consequences relating to trauma exposure, often the 

4 result of sexual or domestic violence. 

5 (2) The majority of women suffering from both 

6 substance abuse and mental health problems have 

7 been victims of rape, incest, or physical or emotional 

8 abuse and hundreds of thousands of these same 

9 women are also severely beaten by their husbands or 

10 a significant male intimate. Surveys have indicated 

11 that approximately 1,500,000 children are physically 

12 abused each year and 700,000 are victims of sexual 

13 abuse. 

14 (3) Women with serious mental illnesses are 

15 over-represented in samples that experienced trau16 ma, including physical, sexual, and emotional abuse. 

17 Between 50 and 70 percent of women hospitalized 

18 for mental health disorders have a history of trau19 ma. 

20 (4) Even for people whose mental health prob21 lems are caused by other factors, a history of early 

22 physical or sexual abuse leads to the earlier onset of 

23 their illness, a more severe course of illness, and a 

24 greater likelihood of suicide and other poor out25 comes. 
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1 (5) Trauma exposure is generally prevalent in 

2 people who suffer from mental health and substance 

3 abuse problems, and can worsen the course and 

4 overall impact of these illnesses. 

5 (6) In a recent study, 97 percent of homeless 

6 women with mental illness were found to have expe7 rienced severe physical or sexual abuse and 87 per8 cent experienced this abuse both as children and as 

9 adults. 

10 (7) Of women in prisons and jails, 80 to 100 

11 percent have been victims of physical and sexual 

12 abuse. 

13 (8) The prevalence of violence- and trauma-re14 lated problems among women with mental health 

15 and substance abuse problems is not adequately ad16 dressed by most treatment practices. 

17 (9) There is an urgent need to provide services 

18 that directly address the issue of trauma for women 

19 suffering from mental health and substance abuse 

20 problems. 

21 (10) To improve mental health and substance 

22 abuse services for women, further research to ex23 pand the development and implementation of trau24 ma-sensitive services is needed as well as additional 

25 services to improve access to comprehensive thera-
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1 peutic interventions and to the support needed to 

2 overcome barriers to recovery. 

3 SEC. 3. GRANTS TO IMPROVE TREATMENT FOR WOMEN 

4 WITH HISTORIES OF TRAUMA. 

5 Subpart 3 of part B of title V of the Public Health 

6 Service Act (42 U.S.C. 290bb–31 et seq.) is amended by 

7 adding at the end the following: 

8 ‘‘SEC. 520K. GRANTS TO IMPROVE TREATMENT FOR WOMEN 

9 WITH HISTORIES OF TRAUMA. 

10 ‘‘(a) RESEARCH GRANTS.—

11 ‘‘(1) GRANTS AUTHORIZED.—

12 ‘‘(A) IN GENERAL.—The Secretary, acting 

13 through the Director of the National Institute 

14 of Mental Health and in consultation with the 

15 Administrator of the Substance Abuse and 

16 Mental Health Services Administration, shall 

17 award grants, contracts, or cooperative agree18 ments to public and nonprofit private entities, 

19 as well as Indian tribes and tribal organiza20 tions, for the purpose of building the evidence 

21 base for new treatment interventions that si22 multaneously address trauma, substance abuse, 

23 and mental health disorders, including depres24 sion and anxiety disorders (including post-trau25 matic stress disorder), psychotic and dissocia-
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1 tive disorders, and the integration of existing 

2 interventions for the treatment of trauma, sub3 stance abuse, and mental health disorders, in4 cluding depression and anxiety disorders (in5 cluding post-traumatic stress disorder), psy6 chotic and dissociative disorders. 

7 ‘‘(B) GEOGRAPHICAL DISTRIBUTION.—The 

8 Secretary shall ensure that grants, contracts, or 

9 cooperative agreements awarded pursuant to 

10 this paragraph are distributed equitably among 

11 regions of the country and among urban and 

12 rural areas. 

13 ‘‘(C) DURATION OF AWARDS.—Grants, 

14 contracts, or cooperative agreements awarded 

15 pursuant to this paragraph may not exceed 5 

16 years. Such grants, contracts, or agreements 

17 may be renewed. 

18 ‘‘(2) APPLICATION.—

19 ‘‘(A) IN GENERAL.—Each entity desiring a 

20 grant under this subsection shall submit an ap21 plication to the Secretary at such time, in such 

22 manner, and accompanied by such information 

23 as the Secretary may reasonably require. 

24 ‘‘(B) CONTENTS.—Each application sub25 mitted pursuant to subparagraph (A) shall—
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1 ‘‘(i) describe the activities for which 

2 assistance under this subsection is sought; 

3 and

4 ‘‘(ii) demonstrate that the testing of 

5 treatment interventions will be carried out 

6 through community-based treatment pro7 grams. 

8 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.—

9 There are authorized to be appropriated to carry out 

10 this subsection, such sums as may be necessary. 

11 ‘‘(b) TREATMENT GRANTS.—

12 ‘‘(1) GRANTS AUTHORIZED.—

13 ‘‘(A) IN GENERAL.—The Secretary, acting 

14 through the Administrator of the Substance 

15 Abuse and Mental Health Services Administra16 tion, shall make grants to public and nonprofit 

17 private entities, including Indian tribes and 

18 tribal organizations, for the purpose of pro19 viding comprehensive community-based mental 

20 health and substance abuse services to women 

21 who have experienced a history of physical or 

22 sexual abuse, or other types of trauma. 

23 ‘‘(B) GRANTMAKING CONSIDERATIONS.—

24 The Secretary shall ensure that—
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1 ‘‘(i) grants awarded pursuant to this 

2 paragraph are distributed equitably among 

3 the regions of the country and among 

4 urban and rural areas; and 

5 ‘‘(ii) preference is given to applicants 

6 with strong ties to minority communities 

7 and those that offer services that are cul8 turally and linguistically appropriate. 

9 ‘‘(C) DURATION.—The Secretary shall 

10 award grants under this paragraph for a period 

11 not to exceed 5 years. Such grants may be re12 newed. 

13 ‘‘(2) TECHNICAL ASSISTANCE.—The Secretary, 

14 acting through the Administrator of the Substance 

15 Abuse and Mental Health Services Administration, 

16 shall provide technical assistance to entities awarded 

17 grants pursuant to paragraph (1) with respect to the 

18 implementation of programs described in paragraph 

19 (3). 

20 ‘‘(3) USE OF FUNDS.—An entity awarded a 

21 grant pursuant to paragraph (1) shall—

22 ‘‘(A) establish and operate 1 or more mul23 tidisciplinary integrated systems of community24 based care—
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1 ‘‘(i) to include medical, social, and be2 havioral services for the simultaneous and 

3 coordinated treatment of trauma, sub4 stance abuse, and mental health disorders, 

5 including depression and anxiety disorders 

6 (including post-traumatic stress disorder), 

7 psychotic and dissociative disorders; 

8 ‘‘(ii) that specifically addresses the 

9 impact of trauma on the lives of women re10 ceiving services through the grant; and 

11 ‘‘(iii) that may include services for 

12 children of women who are survivors of 

13 trauma; 

14 ‘‘(B) establish avenues for the involvement 

15 of women who access the services described in 

16 subparagraph (A), in all phases of service deliv17 ery and design including in the development of 

18 individualized treatment plans; 

19 ‘‘(C) offer specialized and structured treat20 ment components addressing trauma that are 

21 culture- and gender-specific; 

22 ‘‘(D) implement collaboration among public 

23 and private nonprofit entities likely to serve 

24 women with histories of trauma including rape 

25 and domestic violence programs, hospital emer-
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1 gency rooms, appropriate branches of the crimi2 nal justice system, low-income housing authori3 ties, substance abuse and mental health service 

4 providers, consolidated health centers, battered 

5 women’s shelters, and churches and other com6 munity-based organizations; 

7 ‘‘(E) undertake aggressive outreach efforts 

8 to encourage women from minority commu9 nities, in particular, to participate; and 

10 ‘‘(F) offer educational materials or train11 ing, through subparagraph (D) or other ave12 nues, to agencies and community-based organi13 zations that serve women with histories of trau14 ma to increase awareness of the devastating im15 pact of chronic exposures to traumatic experi16 ences on women’s mental health and of the 

17 need to address this impact in the context of 

18 mental health and substance abuse treatment. 

19 ‘‘(4) ACCESS TO CHILD CARE.—An entity 

20 awarded a grant pursuant to paragraph (1) may use 

21 grant funds to provide child care, either directly or 

22 through an off site, licensed child care provider, to 

23 women offered services under such grant to facilitate 

24 participation and address a primary barrier to care. 

25 ‘‘(5) APPLICATION.—
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1 ‘‘(A) IN GENERAL.—Each entity desiring a 

2 grant under this subsection shall submit an ap3 plication to the Secretary at such time, in such 

4 manner, and accompanied by such information 

5 as the Secretary may reasonably require. 

6 ‘‘(B) CONTENTS.—Each application sub7 mitted pursuant to subparagraph (A) shall—

8 ‘‘(i) describe the activities for which 

9 assistance under this subsection is sought; 

10 and 

11 ‘‘(ii) describe a plan for the rigorous 

12 evaluation of such activities, including both 

13 process and outcome evaluation, and the 

14 submission of the evaluation at the end of 

15 the project period. 

16 ‘‘(6) AUTHORIZATION OF APPROPRIATIONS.—

17 There are authorized to be appropriated to carry out 

18 this subsection, such sums as may be necessary.’’.

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