I 

111TH CONGRESS 

1ST SESSION H. R. 2691 

To provide assistance to adolescents and young adults with serious mental 

health disorders as they transition to adulthood. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 3, 2009 

Mr. STARK (for himself, Mr. CAMP, and Mrs. BONO MACK) introduced the 

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

A BILL 

To provide assistance to adolescents and young adults with 

serious mental health disorders as they transition to 

adulthood. 

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 ‘‘Healthy Transition 

5 Act of 2009’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds the following: 

8 (1) According to a June 2008 Government Ac9 countability Office (GAO) report to Congress there 

10 were at least 2,400,000 young adults aged 18 to 26 


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1 with a serious mental illness (SMI) in 2006, and an 

2 additional 9.3 million who experienced mild or mod3 erate mental illness. GAO also found that in 2006— 

4 (A) 46 percent to 63 percent of homeless 

5 young adults experienced mental health prob6 lems; 

7 (B) 63 percent to 71 percent of incarcer8 ated young adults experienced mental health 

9 problems; and 

10 (C) close to 32 percent of young adults 

11 with SMI had a co-occurring diagnosis of alco12 hol or drug abuse or dependence along with at 

13 least one other mental disorder. 

14 (2) A July 2008 American Psychological Asso15 ciation (APA) report found that more than 60 per16 cent of transition youth with SMI do not complete 

17 high school, leaving many of these young adults un18 employed, unable to benefit from continuing edu19 cation (32 percent rate of postsecondary continu20 ation versus 51 percent for youth without mental ill21 ness), and without the skills needed to live independ22 ently. 

23 (3) The 2003 President’s New Freedom Com24 mission on Mental Health found that only 1 in 3 


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1 persons with a disability resulting from mental ill2 ness is employed— 

3 (A) about 186,000 young adults with SMI 

4 received disability benefits in 2006 because 

5 their illness was severe enough to prevent sus6 tainable employment; and 

7 (B) youth centers often lack the expertise 

8 to find employment for young adults because 

9 they do not generally have the capacity to suit 

10 individual mental health needs. 

11 (4) The Substance Abuse and Mental Health 

12 Services Administration (SAMHSA) recommends 

13 supportive housing—which would include job train14 ing and mental health services—to young adults 

15 with SMI. State officials, however, cite a lack of 

16 availability of such housing and the Department of 

17 Housing and Urban Development (HUD) reports 

18 that the median age of HUD supportive housing re19 cipients is 47 years old. 

20 (5) During the transition to adulthood, youth 

21 with SMI are also at risk of losing free or low-cost 

22 services they received as children, but may not qual23 ify for as adults. The difference in eligibility criteria 

24 between child and adult benefits from the Social Se25 curity Administration (SSA) can result in a loss of 


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1 benefits during the redetermination stage at age 18. 

2 For example, Medicaid income requirements are 

3 more stringent for an adult, even though an appli4 cant may have received benefits as a child. 

5 (6) GAO found critical gaps in mental health 

6 and housing services for foster youth— 

7 (A) the report found that States were serv8 ing less than half of their eligible foster care 

9 population through existing programs such as 

10 Chafee Foster Care Independence and Med11 icaid; and 

12 (B) a separate national survey from 2006 

13 found that foster youth were 4 times more like14 ly to have attempted suicide in the preceding 

15 year when compared to those never placed in 

16 foster care. 

17 (7) Public service provision for young adults 

18 with SMI is fragmented and these individuals can 

19 struggle to locate services that aid in their transition 

20 to adulthood— 

21 (A) GAO found that there are currently no 

22 Federal programs to specifically target this 

23 population; 

24 (B) directors of programs providing serv25 ices to youth aged 14 to 21 have difficulty findVerDate Nov 24 2008 05:32 Jun 04, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691

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1 ing adequate age-appropriate mental health 

2 services for their clients partly due to lack of 

3 proper training; and 

4 (C) group therapy in mental health serv5 ices is often not age appropriate and as a re6 sult, SAMHSA reported in 2007 that young 

7 adults with SMI have the lowest ‘‘help-seeking 

8 behavior’’ of any age group. 

9 SEC. 3. HEALTHY TRANSITIONING FOR YOUTH. 

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

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

12 adding at the end the following: 

13 ‘‘SEC. 520K. HEALTHY TRANSITIONING FOR YOUTH. 

14 ‘‘(a) PLANNING GRANTS.— 

15 ‘‘(1) IN GENERAL.—The Secretary, in consulta16 tion with the agencies described in subsection (c)(3), 

17 shall award grants or cooperative agreements to 

18 States to develop plans for the statewide coordina19 tion of services to assist adolescents and young 

20 adults with a serious mental health disorder in ac21 quiring the skills, knowledge, and resources nec22 essary to ensure their healthy transition to success23 ful adult roles and responsibilities. 

24 ‘‘(2) APPLICATION.—To be eligible for a grant 

25 or cooperative agreement under this subsection, a 


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1 State shall submit to the Secretary an application, 

2 at such time, in such manner, and containing such 

3 information as the Secretary may require. 

4 ‘‘(3) PLAN.—Not later than 18 months after 

5 the receipt of a grant or cooperative agreement 

6 under this subsection, a State shall submit to the 

7 Secretary a State plan that shall include— 

8 ‘‘(A) reliable estimates on the number of 

9 adolescents and young adults with serious men10 tal health disorders in the State; 

11 ‘‘(B) information on the youth targeted 

12 under this Act, including— 

13 ‘‘(i) the number of adolescents and 

14 young adults with serious mental health 

15 disorders in the State and the number of 

16 such individuals who are currently being 

17 served in the State; 

18 ‘‘(ii) the number of such individuals 

19 who are receiving mental health services 

20 provided by State agencies other than the 

21 agency responsible for mental health serv22 ices in the State; 

23 ‘‘(iii) the number of youth with seri24 ous mental health disorders who are inVerDate Nov 24 2008 05:32 Jun 04, 2009 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691

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1 volved in the juvenile justice system in the 

2 State; 

3 ‘‘(iv) the number of youth with seri4 ous mental health disorders who are in5 volved in the child protection system in the 

6 State; 

7 ‘‘(v) the number of youth with serious 

8 mental health disorders who have plans in 

9 effect under the Individuals with Disabil10 ities Education Act in the State; 

11 ‘‘(vi) the number of youth with seri12 ous mental health disorders who are in13 volved in vocational rehabilitation in the 

14 State; 

15 ‘‘(vii) the range of ages served by the 

16 programs described in clauses (i) through 

17 (vi); and 

18 ‘‘(viii) a description of the overall 

19 transition coordination that is currently 

20 provided by the State or local authorities 

21 and programs in the State; 

22 ‘‘(C) an identification of the skills, knowl23 edge, and resources that adolescents and young 

24 adults with serious mental health disorders in 

25 the State will need to ensure their successful 


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1 and healthy transition into adult roles and re2 sponsibilities; 

3 ‘‘(D) an identification of the obstacles that 

4 adolescents and young adults with serious men5 tal health disorders in the State encounter while 

6 transitioning into adult roles and responsibil7 ities, including breaks in service or programs 

8 caused by eligibility and program criteria dif9 ferences between the child and adult mental 

10 health systems, the lack of culturally and lin11 guistically appropriate mental and behavioral 

12 health and transition services, and the lack of 

13 local access to mental health and transition 

14 services; 

15 ‘‘(E) an identification of the current level, 

16 type, quality, effectiveness, and availability of 

17 services, including evidence-based practices, 

18 available in the State that are uniquely de19 signed for adolescents and young adults with a 

20 serious mental health disorder to ensure a 

21 healthy transition to successful adult roles and 

22 responsibilities; 

23 ‘‘(F) an identification of adolescents and 

24 young adults with a serious emotional disorder 

25 who have a low likelihood of a healthy and sucVerDate Nov 24 2008 05:32 Jun 04, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2691.IH H2691

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1 cessful transition due to the severity of their ill2 ness, and an identification of how the State will 

3 provide treatment and other support services to 

4 this population; 

5 ‘‘(G) an analyses of the strengths, weak6 nesses, and gaps of the current system in the 

7 State, including the availability of lack of men8 tal and behavioral health professionals trained 

9 to treat adolescents and young adults with a se10 rious mental health disorder, as well as bar11 riers, to address the needs of adolescents and 

12 young adults with a serious mental health dis13 order with an appropriate array of effective 

14 services and supports; 

15 ‘‘(H) a description of how the State will 

16 improve the system of care to ensure successful 

17 and healthy transitions; 

18 ‘‘(I) a description of how the State will en19 sure that services and systems of care are cul20 turally and linguistically competent; 

21 ‘‘(J) a description of how the State will co22 ordinate the services of State and non-State 

23 agencies that serve adolescents and young 

24 adults with a serious mental health disorder; 


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1 ‘‘(K) a description of how the State will 

2 provide a system of coordinated service delivery 

3 under the grant or cooperative agreement that 

4 will address the effective services, supports, and 

5 unique needs of adolescents and young adults 

6 with a serious mental disorder, including those 

7 who have been placed in out of home settings 

8 such as the juvenile justice system or those who 

9 are or were involved in the child protection sys10 tems; 

11 ‘‘(L) a description of how the State will co12 ordinate efforts under the grant or cooperative 

13 agreement with existing services and systems in 

14 the State that focus on life skills necessary for 

15 a healthy transition including health, employ16 ment and pre-employment training, transpor17 tation, housing, recreation, mental health serv18 ices, substance use, vocational rehabilitation 

19 services for persons with disabilities, and train20 ing for adolescents, young adults and adults, 

21 consumers and their families; 

22 ‘‘(M) a description of how the State will 

23 work to build workforce capacity to serve the 

24 population described in subparagraph (J); 


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1 ‘‘(N) a description of how the State will 

2 reach out to the target population pre-transi3 tion, during transition, and post-transition; 

4 ‘‘(O) a description of how the State is cur5 rently utilizing and leveraging (and how the 

6 State will use and leverage) Federal funding 

7 streams to care for the target population, in8 cluding funding through Medicaid, the Depart9 ment of Housing and Urban Development, the 

10 Department of Labor though supported employ11 ment, the Early and Periodic Screening, Diag12 nosis, and Treatment Program, and other pro13 grams, and including an outline of the barriers 

14 the State faces in making Federal funding flow 

15 to the targeted population in a coordinated 

16 manner; 

17 ‘‘(P) a description of how the State will in18 volve adolescents and young adults with serious 

19 mental health disorders and their families and 

20 guardians in the service design, planning, and 

21 implementation of the plan under the grant or 

22 cooperative agreement; 

23 ‘‘(Q) an implementation subplan that shall 

24 be designed to recognize the challenges of im25 plementing a program between communities at 


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1 a statewide level and how the State will over2 come those challenges; 

3 ‘‘(R) a description of how the State plans 

4 to evaluate outcomes under the program funded 

5 under the grant or cooperative agreement; 

6 ‘‘(S) a designation of the State office that 

7 will be the lead agency responsible for admin8 istering the program under the grant or cooper9 ative agreement; 

10 ‘‘(T) a description of how the State will en11 sure that the activities planned under the grant 

12 or cooperative agreement will remain sustain13 able at the end of the cycle of Federal funding 

14 under this section; and 

15 ‘‘(U) any other information determined ap16 propriate by the Secretary. 

17 ‘‘(4) DURATION OF SUPPORT.—The duration of 

18 a grant or cooperative agreement under this sub19 section shall be at least 1 fiscal year, but shall not 

20 exceed 2 fiscal years. 

21 ‘‘(5) TECHNICAL ASSISTANCE.—The Secretary 

22 shall provide technical assistance and training in the 

23 development of the plan under paragraph (3), in24 cluding convening a meeting of potential applicants 


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1 for grants or cooperative agreement under this sub2 section. 

3 ‘‘(6) AUTHORIZATION OF APPROPRIATIONS.— 

4 ‘‘(A) IN GENERAL.—There is authorized to 

5 be appropriated to carry out this subsection, 

6 $4,500,000 for fiscal year 2011, and such sums 

7 as may be necessary for each of fiscal years 

8 2012 through 2015. 

9 ‘‘(B) TECHNICAL ASSISTANCE.—The Sec10 retary shall make available up to 15 percent of 

11 the amount appropriated under subparagraph 

12 (A), or $1,000,000, whichever is greater, in 

13 each fiscal year for technical assistance under 

14 paragraph (5). 

15 ‘‘(b) IMPLEMENTATION GRANTS.— 

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

17 grants or cooperative agreement to eligible States 

18 for the coordination of services to assist adolescents 

19 and young adults with serious mental health dis20 orders in acquiring the services, skills, and knowl21 edge necessary to ensure their healthy transition to 

22 successful adult roles and responsibilities. 

23 ‘‘(2) ELIGIBILITY.—To be eligible for a grant 

24 or cooperative agreement under paragraph (1), a 

25 State shall— 


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1 ‘‘(A) be a State that has received a grant 

2 or cooperative agreement under subsection (a) 

3 and submitted a plan that meets the require4 ments of paragraph (3) of such subsection; or 

5 ‘‘(B) be a State that has not received such 

6 a grant or cooperative agreement but that has 

7 a plan that is equivalent to the plan required 

8 under subsection (a)(3). 

9 ‘‘(3) APPLICATION.—To be eligible for a grant 

10 or cooperative agreement under this subsection, a 

11 State shall submit to the Secretary an application, 

12 at such time, in such manner, and containing such 

13 information as the Secretary requires, including— 

14 ‘‘(A) a copy of the plan submitted under 

15 subsection (a)(3), or in the case of a State de16 scribed in paragraph (2)(B), a plan that is 

17 equivalent to the plan required under subsection 

18 (a)(3); 

19 ‘‘(B) a list of the State agencies that will 

20 participate in the program to be funded under 

21 the grant or cooperative agreement along with 

22 written verification as to the commitment of 

23 such agencies to the program; 

24 ‘‘(C) an assurance that the State will de25 velop a coordinating committee composed of 


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1 representatives of the participating State agen2 cies, as well as consumers and families of con3 sumers; 

4 ‘‘(D) a description of the role of such co5 ordinating committee; and 

6 ‘‘(E) the names of at least two local com7 munities that will implement the program at 

8 the local level and how those communities will 

9 implement the State plan. 

10 ‘‘(4) USE OF FUNDS.—Funds provided under a 

11 grant or cooperative agreement under this sub12 section shall be used to implement the State plan, 

13 including— 

14 ‘‘(A) facilitating a youth ombudsman or 

15 other advocacy program; 

16 ‘‘(B) facilitating peer support programs 

17 and networks within the State; 

18 ‘‘(C) facilitating access to independent liv19 ing and life skills supports; 

20 ‘‘(D) developing infrastructure to support 

21 access to necessary health, mental health, em22 ployment, education, and housing supports; and 

23 ‘‘(E) facilitating the training of support 

24 providers and workforce capacity to serve the 

25 target population. 


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1 ‘‘(5) DURATION OF SUPPORT.—The duration of 

2 a grant or cooperative agreement under this sub3 section shall not exceed 5 fiscal years. 

4 ‘‘(6) MATCHING REQUIREMENT.— 

5 ‘‘(A) IN GENERAL.—To be eligible for a 

6 grant or cooperative agreement under this sub7 section, the State shall agree that, with respect 

8 to the costs to be incurred by the State in car9 rying out activities under the grant or coopera10 tive agreement, the State will make available 

11 (directly or through donations from public or 

12 private entities) non-Federal contributions to13 ward such costs in an amount that— 

14 ‘‘(i) for the first fiscal year for which 

15 the State receives payments under the 

16 grant or cooperative agreement, is not less 

17 than $1 for each $3 of Federal funds pro18 vided under the grant or cooperative agree19 ment; 

20 ‘‘(ii) for any second or third such fis21 cal year, is not less than $1 for each $2 of 

22 Federal funds provided under the grant or 

23 cooperative agreement; 

24 ‘‘(iii) for any fourth such fiscal year, 

25 is not less than $1 for each $1 of Federal 


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1 funds provided under the grant or coopera2 tive agreement; and 

3 ‘‘(iv) for any fifth such fiscal year, is 

4 not less than $2 for each $1 of Federal 

5 funds provided under the grant or coopera6 tive agreement. 

7 ‘‘(B) DETERMINATION OF AMOUNT CON8 TRIBUTED.— 

9 ‘‘(i) IN GENERAL.—Non-Federal con10 tributions required under subparagraph 

11 (A) may be in cash or in kind, fairly evalu12 ated, including plant, equipment, or serv13 ices. Amounts provided by the Federal 

14 Government, or services assisted or sub15 sidized to any significant extent by the 

16 Federal Government, may not be included 

17 in determining the amount of such non18 Federal contributions. 

19 ‘‘(ii) NON-FEDERAL CONTRIBU20 TIONS.—In making a determination of the 

21 amount of non-Federal contributions for 

22 purposes of clause (i), the Secretary may 

23 include only non-Federal contributions in 

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1 volved toward the purpose of the grant or 

2 cooperative agreement under this sub3 section for the 2-year period preceding the 

4 first fiscal year for which the State re5 ceives a grant or cooperative agreement 

6 under such subsection. 

7 ‘‘(7) TECHNICAL ASSISTANCE.—The Secretary 

8 shall provide technical assistance and training to re9 cipients of grants or cooperative agreements under 

10 this subsection, including convening meetings each 

11 year to identify ways of improving State programs. 

12 Such meetings shall include the members of the 

13 Federal Partners Committee under subsection (c). 

14 ‘‘(8) EVALUATION.—The Secretary shall carry 

15 out a cross-site evaluation that— 

16 ‘‘(A) reports on current State efforts to 

17 transition the population involved prior to the 

18 implementation of the State plans under this 

19 section; and 

20 ‘‘(B) evaluates the program carried out by 

21 the State under this section to determine the ef22 fectiveness of such program in meeting its goals 

23 and objectives as compared with current ap24 proaches. 

25 ‘‘(9) AUTHORIZATION OF APPROPRIATIONS.— 


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1 ‘‘(A) IN GENERAL.—There is authorized to 

2 be appropriated to carry out this subsection, 

3 $6,000,000 for each of fiscal years 2011 and 

4 2012, $15,000,000 for fiscal year 2013, 

5 $20,000,000 for fiscal year 2014, and 

6 $25,000,000 for fiscal year 2015. 

7 ‘‘(B) TECHNICAL ASSISTANCE AND EVAL8 UATION.—The Secretary shall make available 

9 up to 15 percent of the amount appropriated 

10 under subparagraph (A), or $2,000,000 which11 ever is greater, in each fiscal year for technical 

12 assistance under paragraph (7) and the evalua13 tion under paragraph (8). 

14 ‘‘(c) FEDERAL PARTNERS.— 

15 ‘‘(1) IN GENERAL.—The Secretary shall des16 ignate an existing Federal entity, or establish a 

17 Committee of Federal Partners, to coordinate service 

18 programs to assist adolescents and young adults 

19 with serious mental health disorders in acquiring the 

20 knowledge and skills necessary for them to transi21 tion into adult roles and responsibilities. 

22 ‘‘(2) EXISTING FEDERAL ENTITY.—If the Sec23 retary elects to utilize an existing Federal entity 

24 under paragraph (1), the Secretary shall ensure 

25 that— 


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1 ‘‘(A) such entity is comprised of represent2 atives of at least the agencies described in para3 graph (3); and 

4 ‘‘(B) such entity shall give special atten5 tion to the knowledge and skills needed by ado6 lescents and young adults with mental health 

7 disorders in coordinating the programs funded 

8 under this section. 

9 ‘‘(3) MEMBERSHIP.—A Federal entity utilized 

10 under this subsection, or a committee established 

11 under paragraph (1), shall include representatives 

12 of— 

13 ‘‘(A) the Department of Education (or any 

14 subagency of the Department); 

15 ‘‘(B) the Department of Health and 

16 Human Services (or any subagency of the De17 partment); 

18 ‘‘(C) the Department of Labor (or any 

19 subagency of the Department); 

20 ‘‘(D) the Department of Transportation 

21 (or any subagency of the Department); 

22 ‘‘(E) the Department of Housing and 

23 Urban Development (or any subagency of the 

24 Department); 


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1 ‘‘(F) the Department of Interior (or any 

2 subagency of the Department); 

3 ‘‘(G) the Department of Justice (or any 

4 subagency of the Department); 

5 ‘‘(H) the Social Security Administration; 

6 ‘‘(I) an organization representing con7 sumers and families of consumers as designated 

8 by the Secretary; and 

9 ‘‘(J) an organization representing mental 

10 health and behavioral health professionals as 

11 designated by the Secretary. 

12 ‘‘(4) ROLE OF ENTITY OR COMMITTEE.—The 

13 Federal entity or committee designated or estab14 lished under paragraph (1) shall review how Federal 

15 programs and efforts that address issues related to 

16 the transition of adolescents and young adults with 

17 serious mental health disorders may be coordinated 

18 to ensure the maximum benefit for the individuals 

19 being served and to provide technical assistance to 

20 the States who are planning or implementing pro21 grams under this section. 

22 ‘‘(5) REPORT.—Not later than 18 months after 

23 the date of enactment of this Act, the Federal entity 

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1 tees of Congress, and make available to the general 

2 public, a report concerning the participation of Fed3 eral agencies and stakeholders in the planning and 

4 operations of the entity or committee. Such report 

5 shall also contain a description of the status of the 

6 efforts of such entity or committee in coordinating 

7 Federal efforts on behalf of the target population. 

8 ‘‘(6) AUTHORIZATION OF APPROPRIATIONS.— 

9 There are authorized to be appropriated to carry out 

10 this subsection, $1,000,000 for fiscal year 2011, and 

11 such sums as may be necessary for each of fiscal 

12 years 2012 through 2015. 

13 ‘‘(d) DEFINITION.—In this section, the term ‘serious 

14 mental health disorder’ has the meaning given the term 

15 ‘serious mental illness’ by the Administrator for purposes 

16 of this title.’’. 

Æ 


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