I
107TH CONGRESS
2D SESSION
H. R. 5078
To increase the number of well-trained mental health service professionals
(including those based in schools) providing clinical mental health care
to children and adolescents, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JULY 9, 2002
Mr. KENNEDY of Rhode Island (for himself, Ms. ROS-LEHTINEN, Ms. KAP-
TUR, Mr. SERRANO, Ms. MILLENDER-MCDONALD, Ms. RIVERS, Mr.
OWENS, Mr. FROST, Mr. STARK, Mr. CONYERS, Mr. HOLT, Mr. LANTOS,
Mr. DEUTSCH, Mr. BALDACCI, Ms. LEE, and Mr. DEFAZIO) introduced
the following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for
a period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned
A BILL
To increase the number of well-trained mental health service
professionals (including those based in schools) providing
clinical mental health care to children and adolescents,
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.
This Act may be cited as the ‘‘Children’s Mental
Health Service Expansion Act’’.
SEC. 2. FINDINGS.
The Congress finds the following:
(1) The Center for Mental Health Services esti-
mates that 20 percent or 13,700,000 of the Nation’s
children and adolescents have a diagnosable mental
disorder, and about 2⁄3 of these children and adoles-
cents do not receive mental health care.
(2) According to ‘‘Mental Health: A Report of
the Surgeon General’’ in 1999, there are approxi-
mately 6,000,000 to 9,000,000 children and adoles-
cents in the United States (accounting for 9 to 13
percent of all children and adolescents in the United
States) who meet the definition for having a serious
emotional disturbance.
(3) According to the Center for Mental Health
Services, approximately 5 to 9 percent of United
States children and adolescents meet the definition
for extreme functional impairment.
(4) According to the Surgeon General’s Report,
there are particularly acute shortages in the num-
bers of mental health service professionals serving
children and adolescents with serious emotional dis-
orders.
(5) According to the National Center for Edu-
cation Statistics in the Department of Education,
there are approximately 513 students for each school
counselor in United States schools, which ratio is
more than double the recommended ratio of 250 stu-
dents for each school counselor.
(6) According to the Bureau of Health Profes-
sions in 2000, the demand for the services of child
and adolescent psychiatry is projected to increase by
100 percent by 2020.
(7) The development and application of knowl-
edge about the impact of disasters on children, ado-
lescents, and their families has been impeded by crit-
ical shortages of qualified researchers and practi-
tioners specializing in this work.
(8) According to the Bureau of the Census, the
population of children and adolescents in the United
States under the age of 18 is projected to grow by
more than 40 percent in the next 50 years from 70
million to more than 100 million by 2050.
SEC. 3. LOAN REPAYMENTS, SCHOLARSHIPS, AND GRANTS
TO IMPROVE CHILD AND ADOLESCENT MEN-
TAL HEALTH CARE.
Part B of title VII of the Public Health Service Act
(42 U.S.C. 293 et seq.) is amended by adding at the end
the following:
‘‘SEC. 
742. 
LOAN 
REPAYMENTS, 
SCHOLARSHIPS, 
AND
GRANTS TO IMPROVE CHILD AND ADOLES-
CENT MENTAL HEALTH CARE.
‘‘(a) LOAN REPAYMENTS FOR CHILD AND ADOLES-
CENT MENTAL HEALTH SERVICE PROFESSIONALS.—
‘‘(1) ESTABLISHMENT.—The Secretary, acting
through the Administrator of the Health Resources
and Services Administration, may establish a pro-
gram of entering into contracts on a competitive
basis with eligible individuals (as defined in para-
graph (2)) under which—
‘‘(A) the eligible individual agrees to be
employed full-time for a specified period (which
shall be at least 2 years) in providing mental
health services to children and adolescents; and
‘‘(B) the Secretary agrees to make, during
the period of employment described in subpara-
graph (A), partial or total payments on behalf
of the individual on the principal and interest
due on the undergraduate and graduate edu-
cational loans of the eligible individual.
‘‘(2) ELIGIBLE INDIVIDUAL.—For purposes of
this section, the term ‘eligible individual’ means an
individual who—
‘‘(A) is receiving specialized training or
clinical experience in child and adolescent men-
tal health in psychiatry, psychology, school psy-
chology, psychiatric nursing, social work, school
social work, marriage and family therapy,
school counseling, or professional counseling
and has less than 1 year remaining before com-
pletion of such training or clinical experience;
or
‘‘(B)(i) has a license in a State to practice
allopathic medicine, osteopathic medicine, psy-
chology, school psychology, psychiatric nursing,
social work, school social work, marriage and
family therapy, school counseling, or profes-
sional counseling; and
‘‘(ii)(I) is a mental health service profes-
sional who completed (but not before the end of
the calendar year in which this Act is enacted)
specialized training or clinical experience in
child and adolescent mental health described in
subparagraph (A); or
‘‘(II) is a physician who graduated from
(but not before the end of the calendar year in
which this Act is enacted) an accredited child
and adolescent psychiatry residency or fellow-
ship program in the United States.
‘‘(3) 
ADDITIONAL
ELIGIBILITY
REQUIRE-
MENTS.—The Secretary may not enter into a con-
tract under this subsection with an eligible indi-
vidual unless the individual—
‘‘(A) is a United States citizen or a perma-
nent legal United States resident; and
‘‘(B) if enrolled in a graduate program (in-
cluding a medical residency or fellowship), has
an acceptable level of academic standing (as de-
termined by the Secretary).
‘‘(4) PRIORITY.—In entering into contracts
under this subsection, the Secretary shall give pri-
ority to applicants who—
‘‘(A) are or will be working with high pri-
ority populations;
‘‘(B) have familiarity with evidence-based
methods in child and adolescent mental health
services;
‘‘(C) demonstrate financial need; and
‘‘(D) are or will be working in the publicly
funded sector.
‘‘(5) MEANINGFUL LOAN REPAYMENT.—If the
Secretary determines that funds appropriated for a
fiscal year to carry out this subsection are not suffi-
cient to allow a meaningful loan repayment to all ex-
pected applicants, the Secretary shall limit the num-
ber of contracts entered into under paragraph (1) to
ensure that each such contract provides for a mean-
ingful loan repayment.
‘‘(6) AMOUNT.—
‘‘(A) MAXIMUM.—For each year that an
eligible individual agrees under a contract
under paragraph (1) to be employed, the Sec-
retary may agree under that contract to pay
not more than $35,000 on behalf of the indi-
vidual.
‘‘(B) 
CONSIDERATION.—In 
determining
the amount of payments to be made on behalf
of an eligible individual under a contract to be
entered into under paragraph (1), the Secretary
shall consider the eligible individual’s income
and debt load.
‘‘(7) 
APPLICABILITY
OF
CERTAIN
PROVI-
SIONS.—The provisions of sections 338E and 338F
shall apply to the program established under para-
graph (1) to the same extent and in the same man-
ner as such provisions apply to the National Health
Service Corps Loan Repayment Program established
in subpart III of part D of title III.
‘‘(8) AUTHORIZATION
OF
APPROPRIATIONS.—
There is authorized to be appropriated to carry out
this subsection $10,000,000 for each of fiscal years
2003 through 2007.
‘‘(b) SCHOLARSHIPS FOR STUDENTS STUDYING TO
BECOME CHILD
AND ADOLESCENT MENTAL HEALTH
SERVICE PROFESSIONALS.—
‘‘(1) ESTABLISHMENT.—The Secretary, acting
through the Administrator of the Health Resources
and Services Administration, may establish a pro-
gram to award scholarships on a competitive basis to
eligible students (as defined in paragraph (2)) who
agree to enter into full-time employment (as de-
scribed in paragraph (4)(C)) as a child and adoles-
cent mental health service professional after gradua-
tion or completion of a residency or fellowship.
‘‘(2) ELIGIBLE
STUDENT.—For purposes of
this subsection, the term ‘eligible student’ means a
United States citizen or a permanent legal United
States resident who—
‘‘(A) is enrolled or accepted to be enrolled
in a graduate program that includes specialized
training or clinical experience in child and ado-
lescent mental health in psychology, school psy-
chology, psychiatric nursing, social work, school
social work, marriage and family therapy,
school counseling, or professional counseling; or
‘‘(B) is enrolled or accepted to be enrolled
in an accredited graduate training program of
allopathic or osteopathic medicine in the United
States and intends to complete an accredited
residency or fellowship in child and adolescent
psychiatry.
‘‘(3) 
PRIORITY.—In 
awarding 
scholarships
under this subsection, the Secretary shall give—
‘‘(A) highest priority to applicants who
previously received a scholarship under this
subsection and satisfy the criteria described in
subparagraph (B); and
‘‘(B) second highest priority to applicants
who—
‘‘(i) demonstrate a commitment to
working with high priority populations;
‘‘(ii) have familiarity with evidence-
based methods in child and adolescent
mental health services;
‘‘(iii) demonstrate financial need; and
‘‘(iv) are or will be working in the
publicly funded sector.
‘‘(4) REQUIREMENTS.—The Secretary may
award a scholarship to an eligible student under this
subsection only if the eligible student agrees—
‘‘(A) to complete any graduate training
program, internship, residency, or fellowship
applicable to that eligible student under para-
graph (2);
‘‘(B) to maintain an acceptable level of
academic standing (as determined by the Sec-
retary) during the completion of such graduate
training program, internship, residency, or fel-
lowship; and
‘‘(C) to be employed full-time after gradua-
tion or completion of a residency or fellowship,
for at least the number of years for which a
scholarship is received by the eligible student
under this subsection, in providing mental
health services to children and adolescents.
‘‘(5) USE OF SCHOLARSHIP FUNDS.—A scholar-
ship awarded to an eligible student for a school year
under this subsection may be used only to pay for
tuition expenses of the school year, other reasonable
educational expenses (including fees, books, and lab-
oratory expenses incurred by the eligible student in
the school year), and reasonable living expenses, as
such tuition expenses, reasonable educational ex-
penses, and reasonable living expenses are deter-
mined by the Secretary.
‘‘(6) AMOUNT.—The amount of a scholarship
under this subsection shall not exceed the total
amount of the tuition expenses, reasonable edu-
cational expenses, and reasonable living expenses de-
scribed in paragraph (5).
‘‘(7) 
APPLICABILITY
OF
CERTAIN
PROVI-
SIONS.—The provisions of sections 338E and 338F
shall apply to the program established under para-
graph (1) to the same extent and in the same man-
ner as such provisions apply to the National Health
Service Corps Scholarship Program established in
subpart III of part D of title III.
‘‘(8) AUTHORIZATION
OF
APPROPRIATIONS.—
There is authorized to be appropriated to carry out
this subsection $5,000,000 for each of fiscal years
2003 through 2007.
‘‘(c) CLINICAL TRAINING GRANTS
FOR PROFES-
SIONALS.—
‘‘(1) ESTABLISHMENT.—The Secretary, acting
through the Administrator of the Health Resources
and Services Administration, in cooperation with the
Administrator of the Substance Abuse and Mental
Health Services Administration, may establish a pro-
gram to award grants on a competitive basis to ac-
credited institutions of higher education to establish
or expand internships or other field placement pro-
grams for students receiving specialized training or
clinical experience in child and adolescent mental
health in psychiatry, psychology, school psychology,
psychiatric nursing, social work, school social work,
marriage and family therapy, school counseling, or
professional counseling.
‘‘(2) PRIORITY.—In awarding grants under this
subsection, the Secretary shall give priority to appli-
cants that—
‘‘(A) have demonstrated the ability to col-
lect data on the number of students trained in
child and adolescent mental health and the pop-
ulations served by such students after gradua-
tion;
‘‘(B) have demonstrated familiarity with
evidence-based methods in child and adolescent
mental health services; and
‘‘(C) have programs designed to increase
the number of professionals serving high pri-
ority populations.
‘‘(3) REQUIREMENTS.—The Secretary may
award a grant to an applicant under this subsection
only if the applicant agrees that—
‘‘(A) any internship or other field place-
ment program assisted under the grant will
prioritize cultural competency;
‘‘(B) students benefiting from any assist-
ance under this subsection will be United States
citizens or permanent legal United States resi-
dents;
‘‘(C) the institution will provide to the Sec-
retary such data, assurances, and information
as the Secretary may require; and
‘‘(D) with respect to any violation of the
agreement between the Secretary and the insti-
tution, the institution will pay such liquidated
damages as prescribed by the Secretary by reg-
ulation.
‘‘(4) APPLICATION.—The Secretary shall re-
quire that any application for a grant under this
subsection include a description of the applicant’s
experience working with child and adolescent mental
health issues.
‘‘(5) AUTHORIZATION
OF
APPROPRIATIONS.—
There is authorized to be appropriated to carry out
this subsection $10,000,000 for each of fiscal years
2003 through 2007.
‘‘(d) PROGRESSIVE EDUCATION GRANTS FOR PARA-
PROFESSIONALS.—
‘‘(1) ESTABLISHMENT.—The Secretary, acting
through the Administrator of the Health Resources
and Services Administration, in cooperation with the
Administrator of the Substance Abuse and Mental
Health Services Administration, may establish a pro-
gram to award grants on a competitive basis to
State-licensed mental health nonprofit and for-profit
organizations (including accredited institutions of
higher education) to enable such organizations to
pay for programs for preservice or in-service training
of paraprofessional child and adolescent mental
health workers.
‘‘(2) DEFINITION.—For purposes of this sub-
section, the term ‘paraprofessional child and adoles-
cent mental health worker’ means an individual who
is not a mental health service professional, but who
works at the first stage of contact with children and
families who are seeking mental health services.
‘‘(3) PRIORITY.—In awarding grants under this
subsection, the Secretary shall give priority to appli-
cants that—
‘‘(A) have demonstrated the ability to col-
lect data on the number of paraprofessional
child and adolescent mental health workers
trained by the applicant and the populations
served by these workers after the completion of
the training;
‘‘(B) have familiarity with evidence-based
methods in child and adolescent mental health
services; and
‘‘(C) have programs designed to increase
the number of paraprofessional child and ado-
lescent mental health workers serving high pri-
ority populations.
‘‘(4) REQUIREMENTS.—The Secretary may
award a grant to an organization under this sub-
section only if the organization agrees that—
‘‘(A) any training program assisted under
the grant will prioritize cultural competency;
‘‘(B) the organization will provide to the
Secretary such data, assurances, and informa-
tion as the Secretary may require; and
‘‘(C) with respect to any violation of the
agreement between the Secretary and the orga-
nization, the organization will pay such liq-
uidated damages as prescribed by the Secretary
by regulation.
‘‘(5) APPLICATION.—The Secretary shall re-
quire that any application for a grant under this
subsection include a description of the applicant’s
experience working with paraprofessional child and
adolescent mental health workers.
‘‘(6) AUTHORIZATION
OF
APPROPRIATIONS.—
There is authorized to be appropriated to carry out
this subsection $5,000,000 for each of fiscal years
2003 through 2007.
‘‘(e) CHILD
AND ADOLESCENT MENTAL HEALTH
PROGRAM DEVELOPMENT GRANTS.—
‘‘(1) ESTABLISHMENT.—The Secretary, acting
through the Administrator of the Health Resources
and Services Administration, may establish a pro-
gram to increase the number of well-trained child
and adolescent mental health service professionals in
the United States by awarding grants on a competi-
tive basis to accredited institutions of higher edu-
cation to enable the institutions to establish or ex-
pand accredited graduate child and adolescent men-
tal health programs.
‘‘(2) PRIORITY.—In awarding grants under this
subsection, the Secretary shall give priority to appli-
cants that—
‘‘(A) demonstrate familiarity with the use
of evidence-based methods in child and adoles-
cent mental health services;
‘‘(B) provide experience in and collabora-
tion with community-based child and adolescent
mental health services;
‘‘(C) have included normal child develop-
ment curricula; and
‘‘(D) demonstrate commitment to working
with high priority populations.
‘‘(3) USE
OF
FUNDS.—Funds received as a
grant under this subsection may be used to establish
or expand any accredited graduate child and adoles-
cent mental health program in any manner deemed
appropriate by the Secretary, including by improving
the coursework, related field placements, or faculty
of such program.
‘‘(4) REQUIREMENTS.—The Secretary may
award a grant to an accredited institution of higher
education under this subsection only if the institu-
tion agrees that—
‘‘(A) any child and adolescent mental
health program assisted under the grant will
prioritize cultural competency;
‘‘(B) the institution will provide to the Sec-
retary such data, assurances, and information
as the Secretary may require; and
‘‘(C) with respect to any violation of the
agreement between the Secretary and the insti-
tution, the institution will pay such liquidated
damages as prescribed by the Secretary by reg-
ulation.
‘‘(5) AUTHORIZATION
OF
APPROPRIATIONS.—
There is authorized to be appropriated to carry out
this subsection $15,000,000 for each of fiscal years
2003 through 2007.
‘‘(f) DEFINITIONS.—In this section:
‘‘(1) SPECIALIZED TRAINING OR CLINICAL EX-
PERIENCE
IN
CHILD
AND
ADOLESCENT
MENTAL
HEALTH.—The term ‘specialized training or clinical
experience in child and adolescent mental health’
means training and clinical experience that—
(A) is part of or occurs after completion of
an accredited graduate program in the United
States for training mental health service profes-
sionals;
(B) consists of at least 500 hours of train-
ing or clinical experience in treating children
and adolescents; and
(C) is comprehensive, coordinated, develop-
mentally appropriate, and of high quality to ad-
dress the unique ethnic and cultural diversity of
the United States population.
‘‘(2) HIGH PRIORITY POPULATION.—The term
‘high priority population’ means a population that
has a high incidence of children and adolescents who
have serious emotional disturbances, are racial and
ethnic minorities, or live in urban or rural areas.
‘‘(3) 
MENTAL
HEALTH
SERVICE
PROFES-
SIONAL.—The term ‘mental health service profes-
sional’ means an individual with a graduate or post-
graduate degree from an accredited institution of
higher education in psychiatry, psychology, school
psychology, psychiatric nursing, social work, school
social work, marriage and family counseling, school
counseling, or professional counseling.’’.
SEC. 4. AMENDMENTS TO SOCIAL SECURITY ACT TO IM-
PROVE CHILD AND ADOLESCENT MENTAL
HEALTH CARE.
(a) INCREASING NUMBER OF CHILD AND ADOLES-
CENT PSYCHIATRY RESIDENTS PERMITTED TO BE PAID
UNDER THE MEDICARE GRADUATE MEDICAL EDUCATION
PROGRAM.—Section 1886(h)(4)(F) of the Social Security
Act (42 U.S.C. 1395ww(h)(4)(F)) is amended by adding
at the end the following new clause:
‘‘(iii) INCREASE ALLOWED FOR TRAIN-
ING IN CHILD AND ADOLESCENT PSYCHI-
ATRY.—In applying clause (i), there shall
not be taken into account such additional
number of full-time equivalent residents in
the field of allopathic or osteopathic medi-
cine who are residents or fellows in child
and adolescent psychiatry as the Secretary
determines reasonable to meet the need for
such physicians as demonstrated by the
1999 report of the Department of Health
and Human Services entitled ‘Mental
Health: A Report of the Surgeon Gen-
eral’.’’.
(b) EXTENSION OF MEDICARE BOARD ELIGIBILITY
PERIOD FOR RESIDENTS AND FELLOWS IN CHILD AND
ADOLESCENT PSYCHIATRY.—
(1) IN
GENERAL.—Section 1886(h)(5)(G) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1395ww(d)(5)(G)) is amended—
(A) in clause (i), by striking ‘‘or (v)’’ and
inserting ‘‘(v), or (vi)’’; and
(B) by adding at the end the following new
clause:
‘‘(vi) CHILD AND ADOLESCENT PSY-
CHIATRY
TRAINING
PROGRAMS.—In the
case of an individual enrolled in a child
and adolescent psychiatry residency or fel-
lowship program approved by the Sec-
retary, the period of board eligibility and
the initial residency period shall be the pe-
riod of board eligibility for the specialty of
general psychiatry, plus 2 years for the
subspecialty of child and adolescent psychi-
atry.’’.
(2) EFFECTIVE DATE.—The amendments made
by paragraph (1) shall apply to residency training
years beginning on or after July 1, 2002.
SEC. 5. CHILD MENTAL HEALTH PROFESSIONAL REPORT.
(a) STUDY.—The Administrator of the Health Re-
sources and Services Administration (in this section re-
ferred to as the ‘‘Administrator’’) shall study and make
findings and recommendations on the distribution and
need for child mental health service professionals, includ-
ing with respect to specialty certifications, practice charac-
teristics, professional licensure, practice types, locations,
education, and training.
(b) DISAGGREGATION.—The results of the study re-
quired by subsection (a) shall be disaggregated by State.
(c) REPORT.—Not later than 1 year after the date
of the enactment of this Act, the Administrator shall sub-
mit to the Congress and make publicly available a report
on the study, findings, and recommendations required by
subsection (a).
(d) REVISION.—Each year the Administrator shall
revise the report required under subsection (c).
(e) AUTHORIZATION
OF APPROPRIATIONS.—There
are authorized to be appropriated to carry out this section
such sums as may be necessary for each of fiscal years
2003 through 2007.
SEC. 6. REPORTS.
(a) TRANSMISSION.—The Secretary of Health and
Human Services shall transmit a report described in sub-
section (b) to the Congress—
(1) not later than 3 years after the date of the
enactment of this Act; and
(2) not later than 5 years after the date of the
enactment of this Act.
(b) CONTENTS.—The reports transmitted to the Con-
gress under subsection (a) shall each address the fol-
lowing:
(1) The effectiveness of the amendments made
by, and the programs carried out under, this Act in
increasing the number of child and adolescent men-
tal health service professionals and paraprofessional
child and adolescent mental health workers.
(2) The demographics of the individuals served
by such increased number of child and adolescent
mental health service professionals and paraprofes-
sional child and adolescent mental health workers.
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