I 
112TH CONGRESS 
2D SESSION 
H. R. 5841 
To implement demonstration projects at federally qualified community health 
centers to promote universal access to family centered, evidence-based 
behavioral health interventions that prevent child maltreatment and pro-
mote family well-being by addressing parenting practices and skills for 
families from diverse socioeconomic, cultural, racial, ethnic, and other 
backgrounds, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 18, 2012 
Ms. FUDGE (for herself, Mrs. CHRISTENSEN, Ms. HANABUSA, Ms. LEE of 
California, Ms. WILSON of Florida, Mr. RANGEL, and Ms. NORTON) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
A BILL 
To implement demonstration projects at federally qualified 
community health centers to promote universal access 
to family centered, evidence-based behavioral health 
interventions that prevent child maltreatment and pro-
mote family well-being by addressing parenting practices 
and skills for families from diverse socioeconomic, cul-
tural, racial, ethnic, and other backgrounds, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Supporting Child Mal-
treatment Prevention Efforts in Community Health Cen-
ters Act of 2012’’. 
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress finds as follows: 
(1) Child abuse and neglect are serious public 
health problems in this country. During Federal fis-
cal year (FFY) 2010, an estimated 3,300,000 refer-
rals, involving the alleged maltreatment of approxi-
mately 5,900,000 children, were received by child 
protective services agencies. 
(2) The most recent data show 754,000 sub-
stantiated cases of child abuse and neglect in FFY 
2010. Approximately 1,560 children in the United 
States, nearly 3⁄4 of whom were under 4 years of 
age, died as a result of abuse or neglect. More than 
47 percent were under the age of one. 
(3) Early childhood experiences may have life-
long effects. Severe and chronic childhood stress, in-
cluding from maltreatment and exposure to violence, 
is associated with persistent effects and can lead to 
enduring health, behavior, and learning problems. 
(4) Child maltreatment has— 
(A) psychological and behavioral con-
sequences such as depression, anxiety, suicide, 
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aggressive behavior, delinquency, posttraumatic 
stress disorder, and criminal behavior; 
(B) health consequences, including injuries 
and death, chronic obstructive pulmonary dis-
ease, smoking, heart disease, liver disease, and 
drug use; and 
(C) developmental consequences that can 
compromise brain development and learning. 
(5) Child maltreatment has significant financial 
consequences, including the short-term costs associ-
ated with case handling by child protective services 
and investigations, hospitalization or emergency 
room visits for medical treatment of injuries, out-of- 
home placement alternatives, services to address 
mental health and substance abuse problems, loss of 
productivity, and poor physical health requiring mul-
tiple treatments. 
(6) Child maltreatment can be prevented. Given 
that parents and caregivers are responsible for the 
majority of the abuse and neglect, caregiver-focused 
strategies and interventions that address parenting 
skills and parental risk factors such as depression, 
substance abuse, and intimate partner violence, as 
well as strategies and interventions that promote 
family well-being are critical. Parenting practices are 
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amenable to change, given reasonable efforts, and 
the building of safe, stable, nurturing parent-child 
relationships is a scientifically proven strategy for 
the prevention of child maltreatment. 
(7) Prevention of child maltreatment should 
have a focus on primary prevention (before any mal-
treatment), emphasizing community-centered and 
population-based strategies. 
(8) Prevention of child maltreatment should 
focus on promoting healthy parent-child relation-
ships and an environment that provides safe, stable, 
nurturing relationships for children. 
(9) Primary health care is an existing and wide-
ly accessed system in which a range of prevention 
strategies can be implemented, and there is growing 
evidence that primary health care settings are prom-
ising venues in which to conduct child maltreatment 
prevention and behavioral health promotion pro-
grams. 
(10) Community health centers (referred to in 
this Act as ‘‘CHCs’’) serve more than 18,000,000 
individuals in the United States annually, including 
individuals who are poor, uninsured, hard-to-reach, 
and at-risk for child maltreatment. 
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(11) One in 5 low-income children in the United 
States receives health care at a CHC. 
(12) CHCs are an existing network of neighbor-
hood health clinics widely and regularly accessed by 
families in need that can serve as a fitting venue for 
child maltreatment prevention initiatives. 
(13) In the last decade, behavioral issues have 
had an expanding presence in the portfolio of serv-
ices of CHCs. Seventy percent of CHCs have some, 
if minimal, on-site mental health and substance 
abuse services. When demand exceeds capacity or 
on-site services do not exist, CHCs refer individuals 
to off-site options. 
(14) The integration of behavioral health serv-
ices in primary care settings is a promising frame-
work. Evaluation results of integrated care have 
shown— 
(A) improvement in service utilization, 
such as shorter waiting time and fewer sessions 
to complete treatment; 
(B) reduction in the stigma related to 
mental health services; and 
(C) improvement in access to services. 
(b) PURPOSES.—The purposes of this Act are as fol-
lows: 
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(1) To fund the implementation of a minimum 
of 10 demonstration projects of evidence-based and 
promising parenting programs at federally qualified 
health centers. 
(2) To provide universal access to a family cen-
tered integrated and voluntary services model that 
prevents child maltreatment and promotes family 
well-being and which may include— 
(A) implementation of evidence-based pre-
ventive parenting skills training programs at 
health centers or permanent or temporary resi-
dences of caregivers to strengthen the capacity 
of parents to care for their children’s health 
and well-being and promote their own ability to 
create safe, stable, nurturing family environ-
ments that protect children and youth from 
abuse and neglect and its consequences and 
support children’s optimal social, emotional, 
physical, and academic development; 
(B) screening to identify parental risk fac-
tors such as depression, substance abuse, and 
intimate partner violence that are associated 
with the likelihood that parents will abuse or 
neglect their children, and to further develop 
screening methods and instruments; and 
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(C) linkage with, and referral to, on-site 
individualized quality mental health services 
provided by trained mental health professionals 
for parents and caregivers screening positive for 
child maltreatment risk factors to help them 
overcome the impediments to effective parenting 
and change their behaviors toward child rearing 
and parenting. 
(3) To coordinate the design and implementa-
tion of an evaluation plan to assess the impact and 
feasibility of integrated services model implementa-
tion at each federally qualified health center partici-
pating in the demonstration project for health out-
comes, cost effectiveness, patient satisfaction, pro-
gram local adaptation, reduction of child maltreat-
ment and injuries, and improvement of parenting be-
haviors and family functioning. 
(4) To implement critical system factors for 
successful implementation of the integrated services 
model to prevent child maltreatment. Such factors 
include training of a culturally and linguistically 
competent workforce, use of best available tech-
nology, establishment of cooperation among FQHCs 
participating in the demonstration project, and 
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building internal and external buy-in and support for 
the project. 
(5) To coordinate the design and implementa-
tion of the cross-site system-wide evaluation plan to 
assess the impact and feasibility of an integrated 
services model on the reduction of child maltreat-
ment and injuries, to increase a family’s access to 
services, to evaluate the effectiveness of the response 
of FQHCs organizational systems to the model im-
plemented, and to identify lessons learned and out-
line recommendations for system-wide areas for im-
provement and changes. 
SEC. 3. DEFINITIONS. 
In this Act: 
(1) FEDERALLY
QUALIFIED
HEALTH
CENTER 
OR FQHC.—The term ‘‘federally qualified health cen-
ter’’ or ‘‘FQHC’’ means an entity receiving a grant 
under section 330 of the Public Health Service Act 
(42 U.S.C. 254b). 
(2) CAREGIVERS.—The term ‘‘caregiver’’ means 
an adult who is the primary caregiver, including bio-
logical, adoptive, or foster parents, grandparents or 
other relatives, and non-custodial parents who have 
an ongoing relationship, and provides physical care 
for one or more children under the age of 10. Care-
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givers may be individuals who were born in, or out-
side of, the United States and individuals whose 
main language is not English, including American 
Indians and Alaska Natives. Caregivers may be het-
erosexual or homosexual, and may have learning, 
physical, and other disabilities. 
(3) CENTER-BASED EVIDENCE-BASED PREVEN-
TIVE
PARENTING
SKILLS
PROGRAM.—The term 
‘‘center-based evidence-based preventative parenting 
skills program’’ means research-based and proven, 
promising interventions provided and located at a 
health center that— 
(A) have the potential for broad impact 
across multiple types of maltreatment, including 
physical and psychological abuse and neglect; 
(B) are associated with effective parent be-
haviors and parenting practices and with reduc-
ing child behavior problems; 
(C) may be expected to reduce child mal-
treatment rates; and 
(D) may be implemented at the FQHCs. 
(4) HOME
VISITATION
PROGRAM.—The term 
‘‘home visitation program’’ means an evidence-based 
program in which trained professionals visit a care-
giver in the permanent or temporary residence of the 
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caregiver, and provide a combination of information, 
support, or training regarding child development, 
parenting skills, and health-related issues. 
(5) MENTAL
HEALTH
SERVICES.—The term 
‘‘mental health services’’ means psychotherapeutic 
interventions offered at health centers, or off-site lo-
cations in partnership with health centers, by mental 
health professionals to caregivers that screen for or 
are referred for child maltreatment. 
(6) SCREENING.—The term ‘‘screening’’ means 
a form of triage, using valid, culturally sensitive 
tools such as scales or questionnaires applied univer-
sally by trained professionals to identify caregivers 
who are at-risk for maltreating or neglecting chil-
dren. Screening assesses parental risks for child 
maltreatment such as depression, substance abuse, 
and intimate partner violence. 
SEC. 4. GRANTS FOR DEMONSTRATION PROJECTS ON INTE-
GRATED 
FAMILY 
CENTERED 
PREVENTIVE 
SERVICES. 
(a) DEMONSTRATION PROJECT GRANTS.—The Sec-
retary of Health and Human Services, acting through the 
Director of the National Center for Injury Prevention and 
Control of the Centers for Disease Control and Preven-
tion, shall award competitive grants to eligible federally 
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qualified health centers to fund a minimum of 10 dem-
onstration projects to promote— 
(1) universal access to family centered, evi-
dence-based interventions in the FQHCs that pre-
vent child maltreatment by addressing parenting 
practices and skills; and 
(2) behavioral health and family well-being for 
families from diverse socioeconomic, cultural, racial, 
and ethnic backgrounds, including addressing issues 
related to sexual orientation and individuals with 
disabilities. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
(1) be a federally qualified community health 
center; and 
(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
(c) USE OF GRANT FUNDS.—A federally qualified 
health center receiving a grant under subsection (a) may 
use such funds to— 
(1) conduct a needs assessment for the dem-
onstration project, including the need for proposed 
integrated services, the number of caregivers in-
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volved, an organizational assessment, workforce ca-
pacity and needs, and technological needs; 
(2) use available technologies to collect, orga-
nize, and provide access to health and mental health 
information of patients, and to provide referrals, 
train staff, monitor service delivery and outcomes, 
and create networking opportunities for on-site pro-
viders and others in the community; 
(3) adapt and implement evidence-based par-
enting skills training programs for caregivers from 
all backgrounds who use the health center for health 
care and child well-visits, through on-site programs 
or programs operated at permanent or temporary 
residences and administered, supervised, and mon-
itored by trained professionals employed by the 
FQHC; 
(4) adapt instruments and screen caregivers for 
child maltreatment risk factors such as depression, 
substance abuse, and intimate partner violence, pro-
vided that such screening is conducted by trained 
professionals employed by the FQHC; 
(5) provide access to mental health services to 
caregivers screened positive for child maltreatment 
risk factors, which may include services offered at 
the health centers or at off-site locations in partner-
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ship with the health centers, and which shall be con-
ducted by mental health professionals; 
(6) promote models of integrated care that in-
volve behavioral health specialists and primary care 
providers working collaboratively in integrated teams 
to deliver services that prevent child maltreatment 
and promote family well-being; 
(7) develop public education campaigns to in-
crease community awareness of the integrated serv-
ices offered by the health centers; and 
(8) evaluate patient satisfaction, project cost ef-
fectiveness, results of the integrated services model, 
and effectiveness of evidence-based parenting pro-
grams in improving parenting practices and reducing 
child abuse and neglect. 
(d) DURATION
OF GRANT.—A grant under sub-
section (a) shall be awarded for a period not to exceed 
5 years. 
(e) TECHNICAL ASSISTANCE AND PROJECT COORDI-
NATION.— 
(1) IN GENERAL.—The Secretary shall award a 
contract to one or more eligible entities to provide— 
(A) technical assistance and project coordi-
nation for the recipients of grants under sub-
section (a); 
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(B) training for health care professionals, 
including mental health care professionals, at 
FQHCs that receive grants under subsection 
(a); and 
(C) cross-site evaluation of the demonstra-
tion projects under subsection (a). 
(2) ELIGIBLE ENTITIES.—To be eligible to re-
ceive a contract under this section, an entity shall— 
(A) be— 
(i) an institution of higher education 
(as defined in section 101 of the Higher 
Education Act of 1965 (20 U.S.C. 1001)); 
(ii) a nonprofit organization that 
qualifies for tax exempt status under sec-
tion 501(c)(3) of the Internal Revenue 
Code of 1986; or 
(iii) such national and professional or-
ganizations and community-based organi-
zations as the Secretary determines appro-
priate; 
(B) have expertise in parent-child relation-
ships, parenting programs, prevention of child 
maltreatment, the integration of behavioral 
health in primary and community health center 
settings, and coordinating multi-site projects; 
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(C) demonstrate a defined or proposed col-
laboration with purveyors of evidence-based 
child maltreatment prevention interventions; 
and 
(D) submit to the Secretary an application 
that includes— 
(i) an outline of a technical assistance 
and coordination plan and timeline; 
(ii) a description of activities, services, 
and strategies to be used to reach out and 
work with the FQHCs and others involved 
in the demonstration projects under sub-
section (a); and 
(iii) a description of the evaluation 
methods and strategies the entity plans to 
use, and an outline of the progress and 
final reports required under subsection 
(f)(2). 
(3) PRIORITY.—In awarding contracts under 
this subsection, the Secretary shall give priority to 
eligible entities whose applications under paragraph 
(2)(D) demonstrate that the evaluation design of 
such eligible entity uses strong experimental designs 
that capture a range of health and behavioral out-
comes and include feasibility evaluation of the inte-
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grated health-behavioral health services model. Such 
evaluation designs should provide evaluation results 
that identify lessons learned and generate rec-
ommendations for improvements and changes. 
(4) AUTHORIZED ACTIVITIES.—Each recipient 
of a contract under this subsection shall use such 
award to provide technical assistance to the FQHCs 
receiving a grant under subsection (a) and to pro-
vide coordination and cross-site evaluation of such 
demonstration projects to the Secretary. Such tech-
nical assistance and coordination and cross-site eval-
uation may include— 
(A) establishing and implementing uniform 
tracking and monitoring systems across FQHCs 
participating in the demonstration project, 
using the best available, highest level of techno-
logical tools; 
(B) developing and implementing a cross- 
site, multi-level evaluation plan using rigorous 
research and evaluation designs to evaluate the 
demonstration projects across FQHCs; 
(C) ensuring that, in implementing the evi-
dence-based parenting training programs, each 
such FQHC follows standardized manuals and 
protocols, and ensuring effectiveness of the inte-
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grated services of each FQHC in promoting 
positive stable, nurturing parent-child relation-
ships and preventing child maltreatment and in-
juries; 
(D) ensuring an effective and feasible eval-
uation of the outcomes of the demonstration 
projects, including an assessment of— 
(i) improvement of parent knowledge 
of child social, emotional, cognitive devel-
opment; 
(ii) improvement of parent-child rela-
tionships; 
(iii) parental use of positive discipline 
methods 
and 
effective 
communication 
skills; 
(iv) health outcomes for children; 
(v) reduction of incidence of child 
maltreatment; 
(vi) cost-effectiveness of the dem-
onstration projects; 
(vii) 
implementation 
that 
follows 
standardized manuals and protocols; 
(viii) the interdisciplinary collaborative 
model; 
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(ix) cultural sensitivity and local ad-
aptation of the projects; 
(x) any increase in access to services; 
and 
(xi) 
further 
improvements 
and 
changes needed at the FQHCs; 
(E) establishing and coordinating the im-
plementation of a workforce development and 
training plan to ensure that professionals work-
ing at the health centers, including physicians, 
nurses, nurse practitioners, psychologists, social 
workers, physician’s assistants, clinical phar-
macists, and others, are trained to participate 
in interdisciplinary teams and work collabo-
ratively to provide culturally competent and lin-
guistically sensitive integrated services to all 
caregivers coming to such center, with a focus 
on the development and strengthening of— 
(i) knowledge of the public health 
model, child development, family func-
tioning, the problem of child maltreatment, 
and methods of prevention; 
(ii) core attitudes, including the belief 
that child maltreatment is preventable, 
professionals have a role in prevention, 
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families are partners in preventing mal-
treatment, and evaluation is a critical ele-
ment of interventions; 
(iii) ability to conduct screenings, im-
plement evidence-based parenting pro-
grams, provide mental health services, and 
collaborate with evaluation efforts; 
(iv) ability to manage the site project, 
participate in interdisciplinary teams, work 
on integrated efforts, and master tech-
nology for best results; 
(v) the knowledge, skills, and attitude 
to work with individuals from diverse cul-
tural, racial, ethnic, and other back-
grounds; and 
(vi) an understanding of cross-field 
culture and language to effectively partici-
pate in interdisciplinary teams and collabo-
rate in integrated activities; 
(F) educating and involving the governing 
boards of FQHCs participating in the dem-
onstration projects in the integrated service ef-
forts; 
(G) promoting partnerships with State and 
local institutions of higher education, commu-
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nity networks, and professional associations for 
staff training and recruitment; 
(H) promoting collaboration and net-
working among FQHCs participating in the 
demonstration projects; and 
(I) establishing and coordinating child mal-
treatment 
prevention 
collaboratives 
across 
FQHCs participating in the demonstration 
projects and helping such FQHCs partner with 
local departments of child welfare and commu-
nity mental health centers. 
(5) ADVISORY GROUPS.— 
(A) IN
GENERAL.—Each recipient of a 
contract under this subsection shall establish an 
advisory group. Each such advisory group shall 
provide feedback and input to the contract re-
cipient to ensure such recipient’s effectiveness 
in providing quality services. 
(B) MEMBERSHIP.—Each such advisory 
group shall be composed of representatives of— 
(i) national organizations representing 
community health centers; 
(ii) national professional organizations 
representing professionals from various 
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fields, including pediatrics, nursing, psy-
chology, and social work; and 
(iii) government agencies with rel-
evant expertise, as determined by the Di-
rector of the National Center for Injury 
Prevention and Control of the Centers for 
Disease Control and Prevention. 
(f) EVALUATION AND REPORTING.— 
(1) DEMONSTRATION PROJECT REPORTING.— 
(A) ANNUAL PROGRESS EVALUATION AND 
FINANCIAL
REPORTING.—For the duration of 
the grant under subsection (a), each FQHC 
shall submit to the Secretary an annual 
progress evaluation and financial reporting indi-
cating activities conducted and the progress of 
the health center toward achievement of estab-
lished outcomes, including cost effectiveness, 
patient satisfaction, program local adaptation, 
reduction of child maltreatment and injuries, 
and improvement of parenting behaviors and 
family functioning. 
(B) FINAL REPORT.—At the end of the 
grant period, each FQHC shall submit a final 
report with evaluation data analysis and conclu-
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sions related to the outcomes of the demonstra-
tion project. 
(2) TECHNICAL ASSISTANCE REPORTING.— 
(A) ANNUAL
PROGRESS
AND
FINANCIAL 
REPORT.—For the duration of the contract 
under subsection (e), each technical assistance 
provider shall submit to the Secretary an an-
nual progress and financial report indicating 
activities conducted under such contract. 
(B) FINAL REPORT.—At the end of the 
contract period, each recipient of a technical as-
sistance contract under subsection (e) shall sub-
mit to the Secretary a final report that in-
cludes— 
(i) an analysis of comparative data re-
lated to effectiveness and feasibility of 
projects implemented at the FQHCs, work-
force training, and achievement of out-
comes at the FQHCs; 
(ii) overall recommendations for sys-
tem improvement and changes that would 
allow the demonstration projects to be ex-
panded; 
(iii) an outline of the project results; 
and 
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(iv) a plan that outlines opportunities 
and vehicles for the dissemination of cross- 
site evaluation results, findings, and rec-
ommendations. 
(g) AUTHORIZATION OF APPROPRIATIONS.— 
(1) IN GENERAL.—To carry out the demonstra-
tion project grant program described in subsection 
(a), there are authorized to be appropriated 
$10,000,000 for fiscal year 2013, and such sums as 
may be necessary for each of fiscal years 2014 
through 2017. 
(2) TECHNICAL
ASSISTANCE.—The Secretary 
shall reserve not less than 10 percent of the 
amounts appropriated under paragraph (1) to carry 
out the technical assistance program described in 
subsection (e). 
Æ 
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H5841
rfrederick on DSK6VPTVN1PROD with BILLS