I 
112TH CONGRESS 
1ST SESSION H. R. 1578 
To amend the Public Health Service Act to improve the health care system’s 
assessment and response to domestic violence, dating violence, sexual 
assault, and stalking, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 15, 2011 
Ms. SLAUGHTER (for herself, Mrs. LOWEY, Ms. ROYBAL-ALLARD, Ms. 
MOORE, Ms. NORTON, Ms. SCHAKOWSKY, Ms. HANABUSA, Mr. HASTINGS 
of Florida, Mr. HOLDEN, and Ms. DELAURO) introduced the following 
bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to improve the 
health care system’s assessment and response to domes-
tic violence, dating violence, sexual assault, and stalking, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Violence Against Women Health Initiative Act of 2011’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
Sec. 3. Purpose. 
TITLE I—COORDINATED PUBLIC HEALTH INITIATIVE TO END 
VIOLENCE AGAINST WOMEN 
Sec. 101. Grants to foster public health responses to intimate partner violence 
and sexual assault. 
Sec. 102. Training and education of health professionals. 
TITLE II—RESEARCH ON EFFECTIVE PUBLIC HEALTH 
APPROACHES TO END VIOLENCE AGAINST WOMEN 
Sec. 201. Research on effective interventions to end domestic violence, sexual 
assault, and stalking against women in the health care setting. 
SEC. 2. FINDINGS. 
The Congress finds the following: 
(1) Domestic violence and sexual violence are 
public health problems and among the most signifi-
cant social determinants of health for women and 
girls. 
(2) Nearly one in four women in the United 
States reports experiencing violence by a current or 
former spouse or boyfriend at some point in her life, 
and one in six women reported experiencing a com-
pleted sexual assault. 
(3) Violence and abuse can affect health in 
many ways from physical injuries sustained during 
violent episodes, trauma symptoms including depres-
sion and thoughts of suicide, and harmful health 
coping behaviors such as alcohol and substance 
abuse. 
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(4) Research published in the Journal of Wom-
en’s Health in 2007 found that women who are vic-
tims of violence have 17 percent more primary care 
doctor visits, 14 percent more specialist visits, and 
27 percent more prescription refills than non-abused 
women. 
(5) Women who have experienced violence and 
abuse are 80 percent more likely to have a stroke, 
70 percent more likely to have heart disease, and 60 
percent more likely to have asthma than non-abused 
women. 
(6) In addition to utilizing the health system at 
higher rates, victims are more likely to experience a 
wide range of reproductive health problems including 
unintended pregnancies, sexually transmitted dis-
ease/HIV transmission, miscarriages, and more. 
Abuse increases the likelihood of teen pregnancy; ad-
olescent girls in abusive relationships are 3.5 times 
more likely to become pregnant than their non- 
abused peers. 
(7) The Centers for Disease Control and Pre-
vention (CDC) have also linked childhood exposure 
to violence with long-term, chronic health conditions 
including obesity, arthritis, stroke, and heart dis-
ease. 
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(8) The CDC conservatively estimates that inti-
mate partner rape, physical assault, and stalking 
costs the health system and employers $8.3 billion 
annually from direct injuries and services and lost 
productivity from work. 
(9) Most professional health organizations, in-
cluding the American Medical Association, American 
Nurses Association, American College of Obstetri-
cians and Gynecologists, American Psychological As-
sociation, American Academy of Pediatrics, and the 
Joint Commission on the Accreditation of Health 
Care Organizations, endorse routine assessment for 
domestic violence. 
(10) The health system provides an important 
entry point to reduce violence and abuse and can im-
prove the health status of women, but without train-
ing and support on how to assess and respond, pro-
viders are not routinely assessing and responding to 
abuse, missing an important opportunity to help vic-
tims and prevent more serious abuse. 
SEC. 3. PURPOSE. 
It is the purpose of this Act to develop a public health 
response to abuse by— 
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(1) strengthening the health care system’s as-
sessment of and response to domestic violence, dat-
ing violence, sexual assault, and stalking; 
(2) increasing the number of victims identified 
and assisted in health or public health settings; and 
(3) expanding research on effective interven-
tions in health settings. 
TITLE I—COORDINATED PUBLIC 
HEALTH INITIATIVE TO END 
VIOLENCE AGAINST WOMEN 
SEC. 101. GRANTS TO FOSTER PUBLIC HEALTH RESPONSES 
TO INTIMATE PARTNER VIOLENCE AND SEX-
UAL ASSAULT. 
Section 399P of the Public Health Service Act (42 
U.S.C. 280g–4) is amended— 
(1) in subsection (a)— 
(A) by amending paragraph (1) to read as 
follows: 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the Office on Women’s 
Health in the Office of the Secretary, and in con-
sultation with the Director of the Family Violence 
Prevention and Services Office, shall award grants 
to eligible State, tribal, territorial, or local entities to 
strengthen the response of State, tribal, territorial, 
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or local health care systems to domestic violence, 
dating violence, sexual assault, and stalking and pre-
vent and respond to physical and sexual violence 
across the lifespan.’’; 
(B) in paragraph (2), by amending sub-
paragraph (A) to read as follows: 
‘‘(A) be— 
‘‘(i) a State department (or other divi-
sion) of health, a State, tribal, or terri-
torial domestic violence or sexual assault 
coalition or victim services program, a 
State law enforcement task force, or any 
other nonprofit, nongovernmental State, 
tribal, or territorial entity with a history of 
effective work in the fields of domestic vio-
lence, dating violence, sexual assault, or 
stalking, and health care, including phys-
ical or mental health care; or 
‘‘(ii) a local victim services program, a 
local department (or other division) of 
health, a local health clinic, hospital, or 
health system, or any other community- 
based organization with a history of effec-
tive work in the field of domestic violence, 
dating violence, sexual assault, or stalking, 
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and health care, including physical or men-
tal health care;’’; and 
(C) in paragraph (3), by striking ‘‘2 
years’’ and by inserting ‘‘36 months’’; and 
(2) in subsection (b)— 
(A) by amending paragraph (1) to read as 
follows: 
‘‘(1) 
IN
GENERAL.—An 
entity 
shall 
use 
amounts received under a grant under this section to 
design or enhance and implement comprehensive 
strategies to improve the response of the health care 
system to domestic violence, dating violence, sexual 
assault, or stalking in clinical, public health, hos-
pital, managed care (including behavioral and men-
tal health), and other health settings.’’; 
(B) by amending paragraph (2) to read as 
follows: 
‘‘(2) MANDATORY STRATEGIES.—Strategies im-
plemented under paragraph (1) shall include the fol-
lowing: 
‘‘(A) The implementation, dissemination, 
and evaluation of policies and procedures to 
guide health professionals and public health 
staff in responding to domestic violence, dating 
violence, sexual assault, and stalking, including 
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strategies to ensure that health information is 
maintained in a manner that protects the pa-
tient’s privacy and safety and health informa-
tion technology is used to improve documenta-
tion, identification, assessment, treatment, and 
follow-up care. 
‘‘(B) The development of on-site access to 
services to address the safety, medical, mental 
health, and economic needs of patients who are 
victims of domestic violence, dating violence, 
sexual assault, or stalking, either by increasing 
the capacity of existing health professionals and 
public health staff to address domestic violence, 
dating violence, sexual assault, and stalking, or 
by contracting with or hiring victim service pro-
viders to provide the services or to model other 
services appropriate to the geographic and cul-
tural needs of a site. 
‘‘(C) The provision of training and fol-
lowup technical assistance to health profes-
sionals, public health staff, and allied health 
professionals to identify, assess, treat, and refer 
clients who are victims of domestic violence, 
dating violence, sexual assault, or stalking. 
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‘‘(D) The development, replication, refine-
ment, and testing of model strategies in adoles-
cent health settings to prevent and respond to 
violence and abuse.’’; 
(C) in paragraph (3)— 
(i) by amending subparagraph (A) to 
read as follows: 
‘‘(A) The development of training modules 
and policies that address domestic violence, dat-
ing violence, sexual assault, and stalking over 
the lifespan, including child abuse, childhood 
exposure to domestic and sexual violence, and 
elder abuse.’’; 
(ii) in subparagraph (B), by striking 
‘‘and stalking prevention’’ and by inserting 
‘‘, stalking prevention, and healthy rela-
tionships’’; 
(iii) by amending subparagraph (D) to 
read as follows: 
‘‘(D) The inclusion of the health effects of 
lifetime exposure to violence and abuse as well 
as related behavioral risk factors in health pro-
fessional training schools including medical, 
dental, nursing, social work, and mental health 
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curricula, and allied health service training 
courses.’’; 
(iv) by amending subparagraph (E) to 
read as follows: 
‘‘(E) The integration of knowledge of do-
mestic violence, dating violence, sexual assault, 
and stalking into health care accreditation and 
professional licensing examinations, such as 
medical, dental, social work, and nursing 
boards, and where appropriate, other allied 
health exams.’’; and 
(v) by adding at the end the following 
new subparagraph: 
‘‘(F) The development, expansion, and im-
plementation of sexual assault forensic medical 
examination programs.’’; and 
(D) by adding at the end the following: 
‘‘(4) BUILDING
EVIDENCE
OF
MODEL
PRO-
GRAMS.—Strategies implemented under paragraph 
(1) may include research and evaluation of programs 
funded under this section to build evidence of model 
programs to be disseminated. As a condition on re-
ceipt of a grant for such research and evaluation, an 
applicant shall agree to release any findings result-
ing from the research and evaluation to the general 
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public no later than 90 days after the findings are 
available. The Secretary shall facilitate the wide dis-
semination of such findings by means of multiple 
media, including the Internet.’’; and 
(3) by striking subsections (c) and (d) and in-
serting the following: 
‘‘(c) PREFERENCE.—In selecting grant recipients 
under this section, the Secretary shall give preference to 
applicants based on the strength of their evaluation strate-
gies, with outcome-based evaluations prioritized. 
‘‘(d) TECHNICAL ASSISTANCE.— 
‘‘(1) IN GENERAL.—The Secretary may provide 
technical assistance with respect to the planning, de-
velopment, and operation of any program or service 
carried out pursuant to this section. The Secretary 
may provide such technical assistance directly or 
through grants or contracts. 
‘‘(2) AVAILABILITY OF MATERIALS.—The Sec-
retary shall make materials on training, best prac-
tices, evaluation, and other subjects developed by 
grantees under this section publicly available to the 
extent feasible, including through the use of elec-
tronic media, replication of materials, and tailoring 
of materials to meet varying geographic and jurisdic-
tional needs. 
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‘‘(e) REPORTING.—The Secretary shall publish a bi-
ennial report on— 
‘‘(1) the distribution of funds under this sec-
tion; and 
‘‘(2) the programs and activities supported by 
such funds. 
‘‘(f) DEFINITIONS.—Except as inconsistent with this 
section, the definitions in section 40002 of the Violence 
Against Women Act of 1994 shall apply to this section. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN GENERAL.—There is authorized to be 
appropriated to carry out this section $5,000,000 for 
each of fiscal years 2012 through 2016, to remain 
available until expended. 
‘‘(2) ALLOCATION OF FUNDS.— 
‘‘(A) ADMINISTRATIVE
COSTS.—Of the 
funds made available to carry out this section 
for any fiscal year, the Secretary shall not use 
more than 2.5 percent for administration and 
monitoring of grants awarded under this sec-
tion. 
‘‘(B) RESEARCH
AND
EVALUATION.—Of 
the funds made available to carry out this sec-
tion for any fiscal year, the Secretary shall not 
use more than 15 percent to award funds for 
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research 
and 
evaluation 
under 
subsection 
(b)(4).’’. 
SEC. 102. TRAINING AND EDUCATION OF HEALTH PROFES-
SIONALS. 
Section 758 of the Public Health Service Act (42 
U.S.C. 294h) is amended to read as follows: 
‘‘SEC. 758. INTERDISCIPLINARY TRAINING AND EDUCATION 
ON DOMESTIC VIOLENCE, SEXUAL ASSAULT, 
AND OTHER TYPES OF VIOLENCE AND ABUSE. 
‘‘(a) GRANTS.—The Secretary, acting through the 
Director of the Office on Women’s Health in the Office 
of the Secretary, and in consultation with the Adminis-
trator of the Health Resources and Services Administra-
tion and the Director of the Family Violence Prevention 
and Services Office, shall award grants to eligible entities 
to develop interdisciplinary training for health profes-
sionals, public health staff, and allied health professionals, 
and education programs that provide undergraduate, 
graduate, or postgraduate medical, psychology, and nurs-
ing (including advanced practice nursing) students, and 
current health professionals, with an understanding of, 
and clinical skills pertinent to, domestic violence, dating 
violence, sexual assault, and stalking across the lifespan. 
‘‘(b) ELIGIBILITY.— 
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‘‘(1) IN GENERAL.—To be eligible to receive a 
grant under this section, an entity shall be— 
‘‘(A) an accredited school of allopathic or 
osteopathic medicine, psychology, nursing, so-
cial work, or allied health; 
‘‘(B) a health care provider membership or 
professional organization, or a health care sys-
tem; 
‘‘(C) a nonprofit organization with a his-
tory of effective work in the field of training 
health professionals with an understanding of, 
and clinical skills pertinent to, domestic vio-
lence, dating violence, sexual assault, or stalk-
ing, and lifetime exposure to violence and 
abuse; or 
‘‘(D) a State, tribal, territorial, or local en-
tity. 
‘‘(2) ADDITIONAL REQUIREMENTS.—To be eli-
gible to receive a grant under this section, an entity 
shall prepare and submit an application to the Sec-
retary including at a minimum— 
‘‘(A) strategies for the dissemination and 
sharing of curricula and other educational ma-
terials developed under the grant to other inter-
ested medical, psychology, social work, and 
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nursing schools and national resource reposi-
tories for materials on domestic violence, dating 
violence, sexual assault, and stalking; and 
‘‘(B) a plan for consulting with domestic 
violence or sexual assault coalitions, or national 
nonprofit organizations or racial and ethnic mi-
nority-specific organizations with demonstrated 
experience and expertise in domestic violence, 
dating violence, sexual assault, or stalking. 
‘‘(3) PREFERENCE.—In selecting grant recipi-
ents under this section, the Secretary shall give pref-
erence to applicants based on the strength of their 
evaluation strategies, with outcome-based evalua-
tions prioritized. 
‘‘(c) USE OF FUNDS.— 
‘‘(1) 
REQUIRED
USES.—Amounts 
provided 
under a grant under this section shall be used— 
‘‘(A) to plan and develop— 
‘‘(i) interdisciplinary health training 
and education for medical, psychology, so-
cial work, nursing, and other health profes-
sions students, interns, residents, fellows, 
or current health care providers to identify 
and provide health care services (including 
mental or behavioral health care services 
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and referrals to appropriate community 
services) to individuals who are victims of 
domestic violence, dating violence, sexual 
assault, or stalking; and 
‘‘(ii) culturally and linguistically com-
petent clinical components for integration 
into approved internship, residency, and 
fellowship training or continuing medical 
education training that address physical 
and mental health issues related to domes-
tic violence, dating violence, sexual assault, 
and stalking, along with other forms of vi-
olence as appropriate, and include the pri-
macy of victim safety and confidentiality; 
or 
‘‘(B) in the case of a grant recipient de-
scribed in subsection (b)(1)(B), to— 
‘‘(i) develop and provide guidance to 
members, constituents, institutions, and 
stakeholders to increase assessment and 
referral to services; and 
‘‘(ii) facilitate cross-training and pro-
vide collaborative opportunities between 
partners and public health agencies. 
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‘‘(2) PERMISSIVE
USES.—Amounts provided 
under a grant under this section may be used to— 
‘‘(A) offer community-based training op-
portunities in rural areas, which may include 
the use of distance learning networks and other 
available technologies needed to reach isolated 
rural areas to train health professions students, 
interns, residents, and fellows on domestic vio-
lence, dating violence, sexual assault, stalking, 
and other forms of violence and abuse; 
‘‘(B) provide stipends to students who are 
underrepresented in the health professions as 
necessary to promote and enable their partici-
pation in offsite training experiences designed 
to develop health care clinical skills related to 
domestic violence, dating violence, sexual as-
sault, and stalking; 
‘‘(C) provide clinical research fellowships to 
explore the relationship between victimization or 
exposure to abuse, and physical and mental 
health status; or 
‘‘(D) evaluate innovative curricula, training 
models, or programs. 
‘‘(3) BUILDING
EVIDENCE
OF
MODEL
PRO-
GRAMS.—Amounts provided under a grant under 
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