II 

108TH CONGRESS 

2D SESSION S. 2175

To amend the Public Health Service Act to support the planning, implementation, and evaluation of organized activities involving statewide youth 

suicide early intervention and prevention strategies, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 8, 2004

Mr. DODD (for himself, Mr. DEWINE, Mr. SMITH, and Mr. REID) 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 support the 

planning, implementation, and evaluation of organized 

activities involving statewide youth suicide early intervention and prevention strategies, 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 ‘‘Youth Suicide Early 

5 Intervention and Prevention Expansion Act of 2004’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 
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1 (1) More children and young adults die from 

2 suicide each year than from cancer, heart disease, 

3 AIDS, birth defects, stroke, and chronic lung disease 

4 combined. 

5 (2) Over 4,000 children and young adults trag6 ically take their lives every year, making suicide the 

7 third overall cause of death between the ages of 10 

8 and 24. According to the Centers for Disease Con9 trol and Prevention suicide is the third overall cause 

10 of death among college-age students. 

11 (3) According to the National Center for Injury 

12 Prevention and Control of the Centers for Disease 

13 Control and Prevention, children and young adults 

14 accounted for 15 percent of all suicides completed in 

15 2000. 

16 (4) From 1952 to 1995, the rate of suicide in 

17 children and young adults has tripled. 

18 (5) From 1980 to 1997, the rate of suicide 

19 among young adults ages 15 to 19 increased 11 per20 cent. 

21 (6) From 1980 to 1997, the rate of suicide 

22 among children ages 10 to 14 increased 109 percent. 

23 (7) According to the National Center of Health 

24 Statistics, suicide rates among Native Americans 

25 range from 1.5 to 3 times the national average for 
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1 other groups, with young people ages 15 to 34 mak2 ing up 64 percent of all suicides. 

3 (8) Congress has recognized that youth suicide 

4 is a public health tragedy linked to underlying men5 tal health problems and that youth suicide early 

6 intervention and prevention activities are national 

7 priorities. 

8 (9) Youth suicide early intervention and preven9 tion have been listed as urgent public health prior10 ities by the President’s New Freedom Commission in 

11 Mental Health (2002), the Institute of Medicine’s 

12 Reducing Suicide: A National Imperative (2002), the 

13 National Strategy for Suicide Prevention: Goals and 

14 Objectives for Action (2001), and the Surgeon Gen15 eral’s Call to Action To Prevent Suicide (1999). 

16 (10) Many States have already developed com17 prehensive youth suicide early intervention and pre18 vention strategies that seek to provide effective early 

19 intervention and prevention services. 

20 SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICES 

21 ACT. 

22 Part P of title III of the Public Health Service Act 

23 (42 U.S.C. 280g et seq.) is amended by adding at the end 

24 the following: 
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1 ‘‘SEC. 399O. SUICIDE PREVENTION FOR CHILDREN AND 

2 ADOLESCENTS. 

3 ‘‘(a) YOUTH SUICIDE EARLY INTERVENTION AND

4 PREVENTION STRATEGIES.—

5 ‘‘(1) IN GENERAL.—The Secretary shall award 

6 grants or cooperative agreements to eligible entities 

7 to—

8 ‘‘(A) develop and implement statewide 

9 youth suicide early intervention and prevention 

10 strategies in schools, educational institutions, 

11 juvenile justice systems, substance abuse pro12 grams, mental health programs, foster care sys13 tems, and other child and youth support organi14 zations; 

15 ‘‘(B) collect and analyze data on statewide 

16 youth suicide early intervention and prevention 

17 services that can be used to monitor the effec18 tiveness of such services and for research, tech19 nical assistance, and policy development; and 

20 ‘‘(C) assist States, through statewide youth 

21 suicide early intervention and prevention strate22 gies, in achieving their targets for youth suicide 

23 reductions under title V of the Social Security 

24 Act (42 U.S.C. 701 et seq.). 

25 ‘‘(2) ELIGIBLE ENTITY DEFINED.—In this sub26 section, the term ‘eligible entity’ means a State, po-
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1 litical subdivision of a State, federally-recognized In2 dian tribe, tribal organization, public organization, 

3 or private nonprofit organization actively involved in 

4 youth suicide early intervention and prevention ac5 tivities and in the development and continuation of 

6 statewide youth suicide early intervention and pre7 vention strategies. 

8 ‘‘(3) PREFERENCE.—The Secretary shall give 

9 preference to eligible entities that—

10 ‘‘(A) provide early intervention services to 

11 youth in, and that are integrated with, school 

12 systems, educational institutions, juvenile jus13 tice systems, substance abuse programs, mental 

14 health programs, foster care systems, and other 

15 child and youth support organizations; 

16 ‘‘(B) demonstrate collaboration among 

17 early intervention and prevention services or 

18 certify that entities will engage in future col19 laboration; 

20 ‘‘(C) employ or include in their applica21 tions a commitment to engage in an evaluative 

22 process the best evidence-based or promising 

23 youth suicide early intervention and prevention 

24 practices and strategies adapted to the local 

25 community;
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1 ‘‘(D) provide for the timely assessment of 

2 youth who are at risk for emotional disorders 

3 which may lead to suicide attempts; 

4 ‘‘(E) provide timely referrals for appro5 priate community-based mental health care and 

6 treatment of youth in all child-serving settings 

7 and agencies who are at risk for suicide; 

8 ‘‘(F) provide immediate support and infor9 mation resources to families of youth who are 

10 at risk for emotional behavioral disorders which 

11 may lead to suicide attempts; 

12 ‘‘(G) offer equal access to services and care 

13 to youth with diverse linguistic and cultural 

14 backgrounds; 

15 ‘‘(H) offer appropriate postvention serv16 ices, care, and information to families, friends, 

17 schools, educational institutions, juvenile justice 

18 systems, substance abuse programs, mental 

19 health programs, foster care systems, and other 

20 child and youth support organizations of youth 

21 who recently completed suicide; 

22 ‘‘(I) offer continuous and up-to-date infor23 mation and awareness campaigns that target 

24 parents, family members, child care profes25 sionals, community care providers, and the gen-
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1 eral public and highlight the risk factors associ2 ated with youth suicide and the life-saving help 

3 and care available from early intervention and 

4 prevention services; 

5 ‘‘(J) ensure that information and aware6 ness campaigns on youth suicide risk factors, 

7 and early intervention and prevention services, 

8 use effective communication mechanisms that 

9 are targeted to and reach youth, families, 

10 schools, educational institutions, and youth or11 ganizations; 

12 ‘‘(K) provide a timely response system to 

13 ensure that child-serving professionals and pro14 viders are properly trained in youth suicide 

15 early intervention and prevention strategies and 

16 that child-serving professionals and providers 

17 involved in early intervention and prevention 

18 services are properly trained in effectively iden19 tifying youth who are at risk for suicide; 

20 ‘‘(L) provide continuous training activities 

21 for child care professionals and community care 

22 providers on the latest best evidence-based 

23 youth suicide early intervention and prevention 

24 services practices and strategies; and 
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1 ‘‘(M) work with interested families and ad2 vocacy organizations to conduct annual self3 evaluations of outcomes and activities on the 

4 State level, according to standards established 

5 by the Secretary. 

6 ‘‘(b) TECHNICAL ASSISTANCE, DATA MANAGEMENT, 

7 AND RESEARCH.—

8 ‘‘(1) TECHNICAL ASSISTANCE AND DATA MAN9 AGEMENT.—

10 ‘‘(A) IN GENERAL.—The Secretary shall 

11 award technical assistance grants and coopera12 tive agreements to State agencies to conduct as13 sessments independently or in collaboration 

14 with educational institutions related to the de15 velopment of statewide youth suicide early 

16 intervention and prevention strategies. 

17 ‘‘(B) AUTHORIZED ACTIVITIES.—Grants 

18 awarded under subparagraph (A) shall be used 

19 to establish programs for the development of 

20 standardized procedures for data management, 

21 such as—

22 ‘‘(i) ensuring the quality surveillance 

23 of youth suicide early intervention and pre24 vention strategies; 
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1 ‘‘(ii) providing technical assistance on 

2 data collection and management; 

3 ‘‘(iii) studying the costs and effective4 ness of statewide youth suicide early inter5 vention and prevention strategies in order 

6 to answer relevant issues of importance to 

7 State and national policymakers; 

8 ‘‘(iv) further identifying and under9 standing causes of and associated risk fac10 tors for youth suicide; 

11 ‘‘(v) ensuring the quality surveillance 

12 of suicidal behaviors and nonfatal suicidal 

13 attempts; 

14 ‘‘(vi) studying the effectiveness of 

15 statewide youth suicide early intervention 

16 and prevention strategies on the overall 

17 wellness and health promotion strategies 

18 related to suicide attempts; and 

19 ‘‘(vii) promoting the sharing of data 

20 regarding youth suicide with Federal agen21 cies involved with youth suicide early inter22 vention and prevention, and statewide 

23 youth suicide early intervention and pre24 vention strategies for the purpose of identi25 fying previously unknown mental health 
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1 causes and associated risk-factors for sui2 cide in youth. 

3 ‘‘(2) RESEARCH.—

4 ‘‘(A) IN GENERAL.—The Secretary shall 

5 conduct a program of research and development 

6 on the efficacy of new and existing youth sui7 cide early intervention techniques and tech8 nology, including clinical studies and evalua9 tions of early intervention methods, and related 

10 research aimed at reducing youth suicide and 

11 offering support for emotional and behavioral 

12 disorders which may lead to suicide attempts. 

13 ‘‘(B) DISSEMINATING RESEARCH.—The 

14 Secretary shall promote the sharing of research 

15 and development data developed pursuant to 

16 subparagraph (A) with the Federal agencies in17 volved in youth suicide early intervention and 

18 prevention, and entities involved in statewide 

19 youth suicide early intervention and prevention 

20 strategies for the purpose of applying and inte21 grating new techniques and technology into ex22 isting statewide youth suicide early intervention 

23 and strategies systems. 

24 ‘‘(c) COORDINATION AND COLLABORATION.—
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1 ‘‘(1) IN GENERAL.—In carrying out this sec2 tion, the Secretary shall collaborate and consult 

3 with—

4 ‘‘(A) other Federal agencies and State and 

5 local agencies, including agencies responsible 

6 for early intervention and prevention services 

7 under title XIX of the Social Security Act (42 

8 U.S.C. 1396 et seq.), the State Children’s 

9 Health Insurance Program under title XXI of 

10 the Social Security Act (42 U.S.C. 1397aa et 

11 seq.), programs funded by grants under title V 

12 of the Social Security Act (42 U.S.C. 701 et 

13 seq.), and programs under part C of the Indi14 viduals with Disabilities Education Act (20 

15 U.S.C. 1431 et seq.), and the National Strategy 

16 for Suicide Prevention Federal Steering Group; 

17 ‘‘(B) local and national organizations that 

18 serve youth at risk for suicide and their fami19 lies; 

20 ‘‘(C) relevant national medical and other 

21 health and education specialty organizations; 

22 ‘‘(D) youth who are at risk for suicide, 

23 who have survived suicide attempts, or who are 

24 currently receiving care from early intervention 

25 services; 
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1 ‘‘(E) families and friends of youth who are 

2 at risk for suicide, who have survived suicide at3 tempts, who are currently receiving care from 

4 early intervention and prevention services, or 

5 who have completed suicide; 

6 ‘‘(F) qualified professionals who possess 

7 the specialized knowledge, skills, experience, 

8 and relevant attributes needed to serve youth at 

9 risk for suicide and their families; and 

10 ‘‘(G) third-party payers, managed care or11 ganizations, and related commercial industries. 

12 ‘‘(2) POLICY DEVELOPMENT.—The Secretary 

13 shall coordinate and collaborate on policy develop14 ment at the Federal and State levels and with the 

15 private sector, including consumer, medical, suicide 

16 prevention advocacy groups, and other health and 

17 education professional-based organizations, with re18 spect to statewide youth suicide early intervention 

19 and prevention strategies. 

20 ‘‘(d) RULE OF CONSTRUCTION; RELIGIOUS ACCOM21 MODATION.—Nothing in this section shall be construed to 

22 preempt any State law, including any State law that does 

23 not require the suicide early intervention for youth whose 

24 parents or legal guardians object to such early interven-
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1 tion based on the parents’ or legal guardians’ religious be2 liefs. 

3 ‘‘(e) EVALUATION.—

4 ‘‘(1) IN GENERAL.—The Secretary shall con5 duct an evaluation to analyze the effectiveness and 

6 efficacy of the activities conducted with grants under 

7 this section. 

8 ‘‘(2) REPORT.—Not later than 2 years after the 

9 date of enactment of this section, the Secretary shall 

10 submit to the appropriate committees of Congress a 

11 report concerning the results of the evaluation con12 ducted under paragraph (1). 

13 ‘‘(f) DEFINITIONS.—In this section: 

14 ‘‘(1) BEST EVIDENCE-BASED.—The term ‘best 

15 evidence-based’ with respect to programs, means 

16 programs that have undergone scientific evaluation 

17 and have proven to be effective. 

18 ‘‘(2) EARLY INTERVENTION.—The term ‘early 

19 intervention’ means a strategy or approach that is 

20 intended to prevent an outcome or to alter the 

21 course of an existing condition. 

22 ‘‘(3) EDUCATIONAL INSTITUTION.—The term 

23 ‘educational institution’ means a high school, voca24 tional school, or an institution of higher education. 
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1 ‘‘(4) PREVENTION.—The term ‘prevention’ 

2 means a strategy or approach that reduces the likeli3 hood or risk of onset, or delays the onset, of adverse 

4 health problems or reduces the harm resulting from 

5 conditions or behaviors. 

6 ‘‘(5) SCHOOL.—The term ‘school’ means a non7 profit institutional day or residential school that pro8 vides an elementary, middle, or secondary education, 

9 as determined under applicable State law, except 

10 that such term does not include any education be11 yond the 12th grade. 

12 ‘‘(6) YOUTH.—The term ‘youth’ means individ13 uals who are between 6 and 24 years of age. 

14 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—

15 ‘‘(1) STATEWIDE YOUTH SUICIDE EARLY

16 INTERVENTION AND PREVENTION STRATEGIES.—

17 For the purpose of carrying out subsection (a), there 

18 are authorized to be appropriated $25,000,000 for 

19 fiscal year 2004, $25,000,000 for fiscal year 2005, 

20 $25,000,000 for fiscal year 2006, and such sums as 

21 may be necessary for each subsequent fiscal year. 

22 ‘‘(2) TECHNICAL ASSISTANCE, DATA MANAGE23 MENT, AND RESEARCH.—For the purpose of car24 rying out subsection (b), there are authorized to be 

25 appropriated $5,000,000 for fiscal year 2003, 
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1 $5,000,000 for fiscal year 2004, $5,000,000 for fis2 cal year 2005, and such sums as may be necessary 

3 for each subsequent fiscal year.’’.

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