II 

116TH CONGRESS 

1ST SESSION S. 1122 

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 SENATE OF THE UNITED STATES 

APRIL 10, 2019 

Ms. SMITH (for herself, Ms. HASSAN, Mr. MURPHY, Mr. WHITEHOUSE, and 

Mr. WYDEN) 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 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, 

3 SECTION 1. SHORT TITLE. 

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

5 for Students Act of 2019’’. 

6 SEC. 2. PURPOSES. 

7 The purposes of this Act are to— 

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

9 scope of the Project AWARE State Educational 


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1 Agency Grant Program carried out by the Secretary 

2 of Health and Human Services, in order to provide 

3 access to more comprehensive school-based mental 

4 health services and supports; 

5 (2) provide for comprehensive staff development 

6 for school and community service personnel working 

7 in the school; 

8 (3) provide for comprehensive training to im9 prove health and academic outcomes for children 

10 with, or at risk for, mental health disorders, for par11 ents or guardians, siblings, and other family mem12 bers of such children, and for concerned members of 

13 the community; 

14 (4) provide for comprehensive, universal, evi15 dence-based screening to identify children and ado16 lescents with potential mental health disorders or 

17 unmet emotional health needs; 

18 (5) recognize best practices for the delivery of 

19 mental health care in school-based settings, includ20 ing school-based health centers; 

21 (6) provide for comprehensive training for par22 ents or guardians, siblings, other family members, 

23 and concerned members of the community on behalf 

24 of children and adolescents experiencing mental 

25 health trauma, disorder, or disability; and 


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1 (7) establish formal working relationships be2 tween health, human service, and educational enti3 ties that support the mental and emotional health of 

4 children and adolescents in the school setting. 

5 SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 

6 ACT. 

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

8 (relating to services provided through religious organiza9 tions) of title V of the Public Health Service Act (42 

10 U.S.C. 290kk et seq.) is amended— 

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

12 (2) by redesignating sections 581 through 584 

13 as sections 596 through 596C, respectively. 

14 (b) SCHOOL-BASED MENTAL HEALTH AND CHIL15 DREN.—Section 581 of the Public Health Service Act (42 

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

17 amended to read as follows: 

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

19 AND ADOLESCENTS. 

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

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

22 grants, contracts, or cooperative agreements awarded to 

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

24 communities and schools (including schools funded by the 

25 Bureau of Indian Education) in applying a public health 


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1 approach to mental health services both in schools and in 

2 the community. Such approach shall provide comprehen3 sive developmentally appropriate services and supports 

4 that are linguistically and culturally appropriate and trau5 ma-informed, and incorporate developmentally appropriate 

6 strategies of positive behavioral interventions and sup7 ports. A comprehensive school-based mental health pro8 gram funded under this section shall assist children in 

9 dealing with traumatic experiences, grief, bereavement, 

10 risk of suicide, and violence. 

11 ‘‘(b) ACTIVITIES.—Under the program under sub12 section (a), the Secretary may— 

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

14 communities to implement a comprehensive cul15 turally and linguistically appropriate, trauma-in16 formed, and developmentally appropriate, school17 based mental health program that— 

18 ‘‘(A) builds awareness of individual trauma 

19 and the intergenerational, continuum of impacts 

20 of trauma on populations; 

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

22 and screen for, signs of trauma exposure, men23 tal health disorders, or risk of suicide; and 

24 ‘‘(C) incorporates positive behavioral inter25 ventions, family engagement, student treatment, 


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1 and multigenerational supports to foster the 

2 health and development of children, prevent 

3 mental health disorders, and ameliorate the im4 pact of trauma; 

5 ‘‘(2) provide technical assistance to local com6 munities with respect to the development of pro7 grams described in paragraph (1); 

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

9 the development of policies to address child and ado10 lescent trauma and mental health issues and violence 

11 when and if it occurs; 

12 ‘‘(4) facilitate community partnerships among 

13 families, students, law enforcement agencies, edu14 cation agencies, mental health and substance use 

15 disorder service systems, family-based mental health 

16 service systems, child welfare agencies, health care 

17 providers (including primary care physicians, mental 

18 health professionals, and other professionals who 

19 specialize in children’s mental health such as child 

20 and adolescent psychiatrists), institutions of higher 

21 education, faith-based programs, trauma networks, 

22 and other community-based systems; and 

23 ‘‘(5) establish mechanisms for children and ado24 lescents to report incidents of violence or plans by 


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1 other children, adolescents, or adults to commit vio2 lence. 

3 ‘‘(c) REQUIREMENTS.— 

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

5 contract, or cooperative agreement under subsection 

6 (a), an entity shall— 

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

8 ‘‘(i) a State educational agency, as de9 fined in section 8101 of the Elementary 

10 and Secondary Education Act of 1965, in 

11 coordination with one or more local edu12 cational agencies, as defined in section 

13 8101 of the Elementary and Secondary 

14 Education Act of 1965, or a consortium of 

15 any entities described in subparagraph 

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

17 of such Act; and 

18 ‘‘(ii) in accordance with paragraph 

19 (2)(A)(i), appropriate public or private en20 tities that employ interventions that are 

21 evidence-based, as defined in section 8101 

22 of the Elementary and Secondary Edu23 cation Act of 1965; and 


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1 ‘‘(B) submit an application, that is en2 dorsed by all members of the partnership, 

3 that— 

4 ‘‘(i) specifies which member will serve 

5 as the lead partner; and 

6 ‘‘(ii) contains the assurances described 

7 in paragraph (2). 

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

9 under paragraph (1) shall contain assurances as fol10 lows: 

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

12 carrying out activities under this section, the el13 igible entity will enter into a memorandum of 

14 understanding— 

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

16 mental health provider, including a public 

17 or private mental health entity, health care 

18 entity, family-based mental health entity, 

19 trauma network, or other community-based 

20 entity, as determined by the Secretary 

21 (and which may include additional entities 

22 such as a human services agency, law en23 forcement or juvenile justice entity, child 

24 welfare agency, an institution of higher 


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1 education, or another entity, as determined 

2 by the Secretary); and 

3 ‘‘(ii) that clearly states— 

4 ‘‘(I) the responsibilities of each 

5 partner with respect to the activities 

6 to be carried out, including how fam7 ily engagement will be incorporated in 

8 the activities; 

9 ‘‘(II) how school-employed and 

10 school-based or community-based 

11 mental health professionals will be uti12 lized for carrying out such responsibil13 ities; 

14 ‘‘(III) how each such partner will 

15 be accountable for carrying out such 

16 responsibilities; and 

17 ‘‘(IV) the amount of non-Federal 

18 funding or in-kind contributions that 

19 each such partner will contribute in 

20 order to sustain the program. 

21 ‘‘(B) The comprehensive school-based men22 tal health program carried out under this sec23 tion supports the flexible use of funds to ad24 dress— 


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1 ‘‘(i) universal prevention, through the 

2 promotion of the social, emotional, mental, 

3 and behavioral health of all students in an 

4 environment that is conducive to learning; 

5 ‘‘(ii) selective prevention, through the 

6 reduction in the likelihood of at-risk stu7 dents developing social, emotional, mental, 

8 behavioral health problems, suicide, or sub9 stance use disorders; 

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

11 identification of, social, emotional, mental, 

12 behavioral problems, suicide risk, or sub13 stance use disorders and the provision of 

14 early intervention services; 

15 ‘‘(iv) the treatment or referral for 

16 treatment of students with existing social, 

17 emotional, mental, behavioral health prob18 lems, or substance use disorders; 

19 ‘‘(v) the development and implementa20 tion of evidence-based programs to assist 

21 children who are experiencing or have been 

22 exposed to trauma and violence, including 

23 program curricula, school supports, and 

24 after-school programs; and 


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1 ‘‘(vi) the development and implemen2 tation of evidence-based programs to assist 

3 children who are grieving, which may in4 clude training for school personnel on the 

5 impact of trauma and bereavement on chil6 dren, and services to provide support to 

7 grieving children. 

8 ‘‘(C) The comprehensive school-based men9 tal health program carried out under this sec10 tion will provide for in-service training of all 

11 school personnel, including ancillary staff and 

12 volunteers, in— 

13 ‘‘(i) the techniques and supports need14 ed to promote early identification of chil15 dren with trauma histories, children who 

16 are grieving, and children with a mental 

17 health disorder or at risk of developing a 

18 mental health disorder, or who are at risk 

19 of suicide; 

20 ‘‘(ii) the use of referral mechanisms 

21 that effectively link such children to appro22 priate prevention, treatment, and interven23 tion services in the school and in the com24 munity and to follow-up when services are 

25 not available; 


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1 ‘‘(iii) strategies that promote a school2 wide positive environment, including strat3 egies to prevent bullying, which includes 

4 cyber-bullying; 

5 ‘‘(iv) strategies for promoting the so6 cial, emotional, mental, and behavioral 

7 health of all students; and 

8 ‘‘(v) strategies to increase the knowl9 edge and skills of school and community 

10 leaders about the impact of trauma and vi11 olence and on the application of a public 

12 health approach to comprehensive school13 based mental health programs. 

14 ‘‘(D) The comprehensive school-based men15 tal health program carried out under this sec16 tion will include comprehensive training for par17 ents or guardians, siblings, and other family 

18 members of children with mental health dis19 orders, and for concerned members of the com20 munity in— 

21 ‘‘(i) the techniques and supports need22 ed to promote early identification of chil23 dren with trauma histories, children who 

24 are grieving, children with a mental health 

25 disorder or at risk of developing a mental 


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1 health disorder, and children who are at 

2 risk of suicide; 

3 ‘‘(ii) the use of referral mechanisms 

4 that effectively link such children to appro5 priate prevention, treatment, and interven6 tion services in the school and in the com7 munity and follow-up when such services 

8 are not available; and 

9 ‘‘(iii) strategies that promote a school10 wide positive environment, including strat11 egies to prevent bullying, including cyber12 bullying. 

13 ‘‘(E) The comprehensive school-based men14 tal health program carried out under this sec15 tion will demonstrate the measures to be taken 

16 to sustain the program (which may include 

17 seeking funding for the program under a State 

18 Medicaid plan under title XIX of the Social Se19 curity Act or a waiver of such a plan, or under 

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

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

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

23 State agency with primary responsibility for be24 havioral health to ensure that the comprehen25 sive school-based mental health program carried 


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1 out under this section will be sustainable after 

2 funding under this section terminates. 

3 ‘‘(G) The comprehensive school-based men4 tal health program carried out under this sec5 tion will be coordinated with early intervening 

6 activities carried out under the Individuals with 

7 Disabilities Education Act or activities funded 

8 under part A of title IV of the Elementary and 

9 Secondary Education Act of 1965. 

10 ‘‘(H) The comprehensive school-based 

11 mental health program carried out under this 

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

13 and developmentally, culturally, and linguis14 tically appropriate. 

15 ‘‘(I) The comprehensive school-based men16 tal health program carried out under this sec17 tion will include a broad needs assessment of 

18 youth who drop out of school due to policies of 

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

20 or weapons and an inability to obtain appro21 priate services. 

22 ‘‘(J) The mental health services provided 

23 through the comprehensive school-based mental 

24 health program carried out under this section 

25 will be provided by qualified mental and behavVerDate Sep 11 2014 18:33 Apr 19, 2019 Jkt 089200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S1122.IS S1122

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1 ioral health professionals who are certified, 

2 credentialed, or licensed in compliance with ap3 plicable Federal and State law and regulations 

4 by the State involved and who are practicing 

5 within their area of expertise. 

6 ‘‘(K) Students will be permitted to self7 refer to the mental health program for mental 

8 health care and self-consent for mental health 

9 crisis care to the extent permitted by State or 

10 other applicable law. 

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

12 member of a partnership described in paragraph 

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

14 activities under the grant if all members of the part15 nership agree. 

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

17 under this section shall be deemed to be a covered 

18 entity for purposes of compliance with the regula19 tions promulgated under section 264(c) of the 

20 Health Insurance Portability and Accountability Act 

21 of 1996 with respect to any patient records devel22 oped through activities under the grant. 

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

24 of the General Education Provisions Act (commonly 

25 known as the ‘Family Educational Rights and PriVerDate Sep 11 2014 18:33 Apr 19, 2019 Jkt 089200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S1122.IS S1122

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1 vacy Act of 1974’) shall apply to any entity that is 

2 a member of the partnership in the same manner 

3 that such section applies to an educational agency or 

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

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

6 shall ensure that grants, contracts, or cooperative agree7 ments under subsection (a) will be distributed equitably 

8 among the regions of the country and among urban and 

9 rural areas. 

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

11 grant, contract, or cooperative agreement under sub12 section (a), the period during which payments under such 

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

14 with options for renewal. 

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

16 ‘‘(1) DEVELOPMENT OF PROCESS.—The Assist17 ant Secretary shall develop a fiscally appropriate 

18 process for evaluating activities carried out under 

19 this section. Such process shall include— 

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

21 submission of program data by grant, contract, 

22 or cooperative agreement recipients; 

23 ‘‘(B) the development of measures of out24 comes (in accordance with paragraph (2)) to be 


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1 applied by such recipients in evaluating pro2 grams carried out under this section; and 

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

4 such recipients concerning the effectiveness of 

5 programs carried out under this section. 

6 ‘‘(2) MEASURES OF OUTCOMES.— 

7 ‘‘(A) IN GENERAL.—The Assistant Sec8 retary shall develop measures of outcomes to be 

9 applied by recipients of assistance under this 

10 section, and the Assistant Secretary, in evalu11 ating the effectiveness of programs carried out 

12 under this section. Such measures shall include 

13 student and family measures as provided for in 

14 subparagraph (B) and local educational meas15 ures as provided for under subparagraph (C). 

16 ‘‘(B) STUDENT AND FAMILY MEASURES OF

17 OUTCOMES.—The measures for outcomes devel18 oped under paragraph (1)(B) relating to stu19 dents and families shall, with respect to activi20 ties carried out under a program under this 

21 section, at a minimum include provisions to 

22 evaluate whether the program is effective in— 

23 ‘‘(i) increasing social and emotional 

24 competency; 


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1 ‘‘(ii) improving academic outcomes, 

2 including as measured by proficiency on 

3 the annual assessments under section 

4 1111(b)(2) of the Elementary and Sec5 ondary Education Act of 1965; 

6 ‘‘(iii) reducing disruptive and aggres7 sive behaviors; 

8 ‘‘(iv) improving child functioning; 

9 ‘‘(v) reducing substance use disorders; 

10 ‘‘(vi) reducing rates of suicide; 

11 ‘‘(vii) reducing suspensions, truancy, 

12 expulsions, and violence; 

13 ‘‘(viii) increasing high school gradua14 tion rates, calculated using the four-year 

15 adjusted cohort graduation rate or the ex16 tended-year adjusted cohort graduation 

17 rate (as such terms are defined in section 

18 8101 of the Elementary and Secondary 

19 Education Act of 1965); 

20 ‘‘(ix) improving attendance rates and 

21 rates of chronic absenteeism; 

22 ‘‘(x) improving access to care for men23 tal health disorders, including access to 

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1 formed, and developmentally, linguistically, 

2 and culturally appropriate; 

3 ‘‘(xi) improving health outcomes; and 

4 ‘‘(xii) decreasing disparities among 

5 vulnerable and protected populations in 

6 outcomes described in clauses (i) through 

7 (viii). 

8 ‘‘(C) LOCAL EDUCATIONAL OUTCOMES.— 

9 The outcome measures developed under para10 graph (1)(B) relating to local educational sys11 tems shall, with respect to activities carried out 

12 under a program under this section, at a min13 imum include provisions to evaluate— 

14 ‘‘(i) the effectiveness of comprehensive 

15 school mental health programs established 

16 under this section; 

17 ‘‘(ii) the effectiveness of formal part18 nership linkages among child and family 

19 serving institutions, community support 

20 systems, and the educational system; 

21 ‘‘(iii) the progress made in sustaining 

22 the program once funding under the grant 

23 has expired; 

24 ‘‘(iv) the effectiveness of training and 

25 professional development programs for all 


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1 school personnel that incorporate indica2 tors that measure cultural and linguistic 

3 competencies under the program in a man4 ner that incorporates appropriate cultural 

5 and linguistic training; 

6 ‘‘(v) the improvement in perception of 

7 a safe and supportive learning environment 

8 among school staff, students, and parents; 

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

10 of students in need of more intensive serv11 ices and referral of identified students to 

12 prevention, early intervention, and clinical 

13 services; 

14 ‘‘(vii) the improvement in the imme15 diate availability of clinical assessment and 

16 treatment services within the context of 

17 the local community to students posing a 

18 danger to themselves or others; 

19 ‘‘(viii) the increased successful matric20 ulation to postsecondary school; 

21 ‘‘(ix) reduced suicide rates; 

22 ‘‘(x) reduced referrals to juvenile jus23 tice; and 

24 ‘‘(xi) increased educational equity. 


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1 ‘‘(3) SUBMISSION OF ANNUAL DATA.—An eligi2 ble entity described in subsection (c) that receives a 

3 grant, contract, or cooperative agreement under this 

4 section shall annually submit to the Assistant Sec5 retary a report that includes data to evaluate the 

6 success of the program carried out by the entity 

7 based on whether such program is achieving the pur8 poses of the program. Such reports shall utilize the 

9 measures of outcomes under paragraph (2) in a rea10 sonable manner to demonstrate the progress of the 

11 program in achieving such purposes. 

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

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

14 the Assistant Secretary shall annually submit to 

15 Congress a report concerning the results and effec16 tiveness of the programs carried out with assistance 

17 received under this section. 

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

19 not more than 20 percent of amounts received under 

20 a grant under this section to carry out evaluation 

21 activities under this subsection. 

22 ‘‘(g) INFORMATION AND EDUCATION.—The Sec23 retary shall establish comprehensive information and edu24 cation programs to disseminate the findings of the knowlVerDate Sep 11 2014 18:33 Apr 19, 2019 Jkt 089200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S1122.IS S1122

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1 edge development and application under this section to the 

2 general public and to health care professionals. 

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

4 APPROPRIATIONS.— 

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

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

7 $2,000,000 for each of the first 5 fiscal years fol8 lowing the date of enactment of the Mental Health 

9 Services for Students Act of 2019. The Secretary 

10 shall determine the amount of each such grant based 

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

12 area to be served under the grant. 

13 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

14 There is authorized to be appropriated to carry out 

15 this section, $200,000,000 for each of the first 5 fis16 cal years following the date of enactment of the 

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

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

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

20 as amended by subsection (b), is further amended by strik21 ing the part designation and heading and inserting the 

22 following: 

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

Æ 


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