I 
116TH CONGRESS 
1ST SESSION H. R. 1109 
To amend the Public Health Service Act to revise and extend projects relating 
to children and to provide access to school-based comprehensive mental 
health programs. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 8, 2019 
Mrs. NAPOLITANO (for herself, Mr. KATKO, Mr. LOWENTHAL, Ms. DELBENE, 
Mr. TONKO, Mr. CICILLINE, Mr. PAYNE, Mr. LUJA´N, Mr. DOGGETT, Ms. 
MCCOLLUM, Mr. MOULTON, Mr. SCHIFF, Mr. WELCH, Mr. HECK, Mr. 
GRIJALVA, Ms. HILL of California, Ms. JUDY CHU of California, Mr. 
KILMER, Ms. WILSON of Florida, Ms. KELLY of Illinois, Miss RICE of 
New York, Mr. RYAN, Mr. KHANNA, Mr. REED, Mr. LARSEN of Wash-
ington, Ms. JACKSON LEE, Ms. MOORE, Mr. DESAULNIER, Ms. PINGREE, 
Mrs. LAWRENCE, Ms. SPEIER, Mr. PANETTA, Mr. SOTO, Ms. ROYBAL- 
ALLARD, 
Mrs. 
WATSON
COLEMAN, 
Mr. 
RUPPERSBERGER, 
Mr. 
CA´RDENAS, Mr. AGUILAR, Mr. GOMEZ, Mr. DEFAZIO, Mr. MCGOVERN, 
Mr. BLUMENAUER, Ms. OMAR, Mrs. MURPHY, Mr. SABLAN, Mr. 
GALLEGO, Mr. SUOZZI, Mr. COHEN, Mr. CISNEROS, Ms. MATSUI, Ms. 
SA´NCHEZ, Ms. KUSTER of New Hampshire, Mrs. CAROLYN B. MALONEY 
of New York, Ms. JOHNSON of Texas, Mr. RASKIN, Mr. CARBAJAL, Ms. 
CASTOR of Florida, and Mr. MCNERNEY) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to revise and extend 
projects relating to children and to provide access to 
school-based comprehensive mental health programs. 
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 ‘‘Mental Health Services 
for Students Act of 2019’’. 
SEC. 2. PURPOSES. 
The purposes of this Act are to— 
(1) revise, increase funding for, and expand the 
scope of the Project AWARE State Educational 
Agency Grant Program carried out by the Secretary 
of Health and Human Services, in order to provide 
access to more comprehensive school-based mental 
health services and supports; 
(2) provide for comprehensive staff development 
for school and community service personnel working 
in the school; 
(3) provide for comprehensive training to im-
prove health and academic outcomes for children 
with, or at risk for, mental health disorders, for par-
ents or guardians, siblings, and other family mem-
bers of such children, and for concerned members of 
the community; 
(4) provide for comprehensive, universal, evi-
dence-based screening to identify children and ado-
lescents with potential mental health disorders or 
unmet emotional health needs; 
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(5) recognize best practices for the delivery of 
mental health care in school-based settings, includ-
ing school-based health centers; 
(6) provide for comprehensive training for par-
ents or guardians, siblings, other family members, 
and concerned members of the community on behalf 
of children and adolescents experiencing mental 
health trauma, disorder, or disability; and 
(7) establish formal working relationships be-
tween health, human service, and educational enti-
ties that support the mental and emotional health of 
children and adolescents in the school setting. 
SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 
ACT. 
(a) TECHNICAL AMENDMENTS.—The second part G 
(relating to services provided through religious organiza-
tions) of title V of the Public Health Service Act (42 
U.S.C. 290kk et seq.) is amended— 
(1) by redesignating such part as part J; and 
(2) by redesignating sections 581 through 584 
as sections 596 through 596C, respectively. 
(b) SCHOOL-BASED MENTAL HEALTH AND CHIL-
DREN.—Section 581 of the Public Health Service Act (42 
U.S.C. 290hh) (relating to children and violence) is 
amended to read as follows: 
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‘‘SEC. 581. SCHOOL-BASED MENTAL HEALTH; CHILDREN 
AND ADOLESCENTS. 
‘‘(a) IN GENERAL.—The Secretary, in collaboration 
with the Secretary of Education, shall, directly or through 
grants, contracts, or cooperative agreements awarded to 
eligible entities described in subsection (c), assist local 
communities and schools (including schools funded by the 
Bureau of Indian Education) in applying a public health 
approach to mental health services both in schools and in 
the community. Such approach shall provide comprehen-
sive developmentally appropriate services and supports 
that are linguistically and culturally appropriate and trau-
ma-informed, and incorporate developmentally appropriate 
strategies of positive behavioral interventions and sup-
ports. A comprehensive school-based mental health pro-
gram funded under this section shall assist children in 
dealing with traumatic experiences, grief, bereavement, 
risk of suicide, and violence. 
‘‘(b) ACTIVITIES.—Under the program under sub-
section (a), the Secretary may— 
‘‘(1) provide financial support to enable local 
communities to implement a comprehensive cul-
turally and linguistically appropriate, trauma-in-
formed, and developmentally appropriate, school- 
based mental health program that— 
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‘‘(A) builds awareness of individual trauma 
and the intergenerational, continuum of impacts 
of trauma on populations; 
‘‘(B) trains appropriate staff to identify, 
and screen for, signs of trauma exposure, men-
tal health disorders, or risk of suicide; and 
‘‘(C) incorporates positive behavioral inter-
ventions, family engagement, student treatment, 
and multigenerational supports to foster the 
health and development of children, prevent 
mental health disorders, and ameliorate the im-
pact of trauma; 
‘‘(2) provide technical assistance to local com-
munities with respect to the development of pro-
grams described in paragraph (1); 
‘‘(3) provide assistance to local communities in 
the development of policies to address child and ado-
lescent trauma and mental health issues and violence 
when and if it occurs; 
‘‘(4) facilitate community partnerships among 
families, students, law enforcement agencies, edu-
cation agencies, mental health and substance use 
disorder service systems, family-based mental health 
service systems, child welfare agencies, health care 
providers (including primary care physicians, mental 
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health professionals, and other professionals who 
specialize in children’s mental health such as child 
and adolescent psychiatrists), institutions of higher 
education, faith-based programs, trauma networks, 
and other community-based systems; and 
‘‘(5) establish mechanisms for children and ado-
lescents to report incidents of violence or plans by 
other children, adolescents, or adults to commit vio-
lence. 
‘‘(c) REQUIREMENTS.— 
‘‘(1) IN GENERAL.—To be eligible for a grant, 
contract, or cooperative agreement under subsection 
(a), an entity shall— 
‘‘(A) be a partnership that includes— 
‘‘(i) a State educational agency, as de-
fined in section 8101 of the Elementary 
and Secondary Education Act of 1965, in 
coordination with one or more local edu-
cational agencies, as defined in section 
8101 of the Elementary and Secondary 
Education Act of 1965, or a consortium of 
any entities described in subparagraph 
(B), (C), (D), or (E) of section 8101(30) 
of such Act; and 
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‘‘(ii) in accordance with paragraph 
(2)(A)(i), appropriate public or private en-
tities that employ interventions that are 
evidence-based, as defined in section 8101 
of the Elementary and Secondary Edu-
cation Act of 1965; and 
‘‘(B) submit an application, that is en-
dorsed by all members of the partnership, 
that— 
‘‘(i) specifies which member will serve 
as the lead partner; and 
‘‘(ii) contains the assurances described 
in paragraph (2). 
‘‘(2) REQUIRED ASSURANCES.—An application 
under paragraph (1) shall contain assurances as fol-
lows: 
‘‘(A) The eligible entity will ensure that, in 
carrying out activities under this section, the el-
igible entity will enter into a memorandum of 
understanding— 
‘‘(i) with at least 1 community-based 
mental health provider, including a public 
or private mental health entity, health care 
entity, family-based mental health entity, 
trauma network, or other community-based 
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entity, as determined by the Secretary 
(and which may include additional entities 
such as a human services agency, law en-
forcement or juvenile justice entity, child 
welfare agency, agency, an institution of 
higher education, or another entity, as de-
termined by the Secretary); and 
‘‘(ii) that clearly states— 
‘‘(I) the responsibilities of each 
partner with respect to the activities 
to be carried out, including how fam-
ily engagement will be incorporated in 
the activities; 
‘‘(II) how school-employed and 
school-based 
or 
community-based 
mental health professionals will be uti-
lized for carrying out such responsibil-
ities; 
‘‘(III) how each such partner will 
be accountable for carrying out such 
responsibilities; and 
‘‘(IV) the amount of non-Federal 
funding or in-kind contributions that 
each such partner will contribute in 
order to sustain the program. 
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‘‘(B) The comprehensive school-based men-
tal health program carried out under this sec-
tion supports the flexible use of funds to ad-
dress— 
‘‘(i) universal prevention, through the 
promotion of the social, emotional, mental, 
and behavioral health of all students in an 
environment that is conducive to learning; 
‘‘(ii) selective prevention, through the 
reduction in the likelihood of at risk stu-
dents developing social, emotional, mental, 
behavioral health problems, suicide, or sub-
stance use disorders; 
‘‘(iii) the screening for, and early 
identification of, social, emotional, mental, 
behavioral problems, suicide risk, or sub-
stance use disorders and the provision of 
early intervention services; 
‘‘(iv) the treatment or referral for 
treatment of students with existing social, 
emotional, mental, behavioral health prob-
lems, or substance use disorders; 
‘‘(v) the development and implementa-
tion of evidence-based programs to assist 
children who are experiencing or have been 
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exposed to trauma and violence, including 
program curricula, school supports, and 
after-school programs; and 
‘‘(vi) the development and implemen-
tation of evidence-based programs to assist 
children who are grieving, which may in-
clude training for school personnel on the 
impact of trauma and bereavement on chil-
dren, and services to provide support to 
grieving children. 
‘‘(C) The comprehensive school-based men-
tal health program carried out under this sec-
tion will provide for in-service training of all 
school personnel, including ancillary staff and 
volunteers, in— 
‘‘(i) the techniques and supports need-
ed to promote early identification of chil-
dren with trauma histories, children who 
are grieving, and children with a mental 
health disorder or at risk of developing a 
mental health disorder, or who are at risk 
of suicide; 
‘‘(ii) the use of referral mechanisms 
that effectively link such children to appro-
priate prevention, treatment, and interven-
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tion services in the school and in the com-
munity and to follow-up when services are 
not available; 
‘‘(iii) strategies that promote a school- 
wide positive environment, including strat-
egies to prevent bullying, which includes 
cyber-bullying; 
‘‘(iv) strategies for promoting the so-
cial, emotional, mental, and behavioral 
health of all students; and 
‘‘(v) strategies to increase the knowl-
edge and skills of school and community 
leaders about the impact of trauma and vi-
olence and on the application of a public 
health approach to comprehensive school- 
based mental health programs. 
‘‘(D) The comprehensive school-based men-
tal health program carried out under this sec-
tion will include comprehensive training for par-
ents or guardians, siblings, and other family 
members of children with mental health dis-
orders, and for concerned members of the com-
munity in— 
‘‘(i) the techniques and supports need-
ed to promote early identification of chil-
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dren with trauma histories, children who 
are grieving, children with a mental health 
disorder or at risk of developing a mental 
health disorder, and children who are at 
risk of suicide; 
‘‘(ii) the use of referral mechanisms 
that effectively link such children to appro-
priate prevention, treatment, and interven-
tion services in the school and in the com-
munity and follow-up when such services 
are not available; and 
‘‘(iii) strategies that promote a school- 
wide positive environment, including strat-
egies to prevent bullying, including cyber- 
bullying. 
‘‘(E) The comprehensive school-based men-
tal health program carried out under this sec-
tion will demonstrate the measures to be taken 
to sustain the program (which may include 
seeking funding for the program under a State 
Medicaid plan under title XIX of the Social Se-
curity Act or a waiver of such a plan, or under 
a State plan under subpart 1 of part B or part 
E of title IV of the Social Security Act). 
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‘‘(F) The eligible entity is supported by the 
State agency with primary responsibility for be-
havioral health to ensure that the comprehen-
sive school-based mental health program carried 
out under this section will be sustainable after 
funding under this section terminates. 
‘‘(G) The comprehensive school-based men-
tal health program carried out under this sec-
tion will be coordinated with early intervening 
activities carried out under the Individuals with 
Disabilities Education Act or activities funded 
under part A of title IV of the Elementary and 
Secondary Education Act of 1965. 
‘‘(H) 
The 
comprehensive 
school-based 
mental health program carried out under this 
section will be trauma-informed, evidence-based, 
and developmentally, culturally, and linguis-
tically appropriate. 
‘‘(I) The comprehensive school-based men-
tal health program carried out under this sec-
tion will include a broad needs assessment of 
youth who drop out of school due to policies of 
‘zero tolerance’ with respect to drugs, alcohol, 
or weapons and an inability to obtain appro-
priate services. 
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‘‘(J) The mental health services provided 
through the comprehensive school-based mental 
health program carried out under this section 
will be provided by qualified mental and behav-
ioral health professionals who are certified, 
credentialed, or licensed in compliance with ap-
plicable Federal and State law and regulations 
by the State involved and who are practicing 
within their area of expertise. 
‘‘(K) Students will be permitted to self- 
refer to the mental health program for mental 
health care and self-consent for mental health 
crisis care to the extent permitted by State or 
other applicable law. 
‘‘(3) COORDINATOR.—Any entity that is a 
member of a partnership described in paragraph 
(1)(A) may serve as the coordinator of funding and 
activities under the grant if all members of the part-
nership agree. 
‘‘(4) COMPLIANCE
WITH
HIPAA.—A grantee 
under this section shall be deemed to be a covered 
entity for purposes of compliance with the regula-
tions promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act 
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of 1996 with respect to any patient records devel-
oped through activities under the grant. 
‘‘(5) COMPLIANCE WITH FERPA.—Section 444 
of the General Education Provisions Act (commonly 
known as the ‘Family Educational Rights and Pri-
vacy Act of 1974’) shall apply to any entity that is 
a member of the partnership in the same manner 
that such section applies to an educational agency or 
institution (as that term is defined in such section). 
‘‘(d) GEOGRAPHICAL DISTRIBUTION.—The Secretary 
shall ensure that grants, contracts, or cooperative agree-
ments under subsection (a) will be distributed equitably 
among the regions of the country and among urban and 
rural areas. 
‘‘(e) DURATION
OF AWARDS.—With respect to a 
grant, contract, or cooperative agreement under sub-
section (a), the period during which payments under such 
an award will be made to the recipient shall be 5 years, 
with options for renewal. 
‘‘(f) EVALUATION AND MEASURES OF OUTCOMES.— 
‘‘(1) DEVELOPMENT OF PROCESS.—The Assist-
ant Secretary shall develop a fiscally appropriate 
process for evaluating activities carried out under 
this section. Such process shall include— 
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section, at a minimum include provisions to 
evaluate whether the program is effective in— 
‘‘(i) increasing social and emotional 
competency; 
‘‘(ii) improving academic outcomes, 
including as measured by proficiency on 
the annual assessments under section 
1111(b)(2) of the Elementary and Sec-
ondary Education Act of 1965; 
‘‘(iii) reducing disruptive and aggres-
sive behaviors; 
‘‘(iv) improving child functioning; 
‘‘(v) reducing substance use disorders; 
‘‘(vi) reducing rates of suicide; 
‘‘(vii) reducing suspensions, truancy, 
expulsions, and violence; 
‘‘(viii) increasing high school gradua-
tion rates, calculated using the four-year 
adjusted cohort graduation rate or the ex-
tended-year adjusted cohort graduation 
rate (as such terms are defined in section 
8101 of the Elementary and Secondary 
Education Act of 1965); 
‘‘(ix) improving attendance rates and 
rates of chronic absenteeism; 
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‘‘(x) improving access to care for men-
tal health disorders, including access to 
mental health services that are trauma-in-
formed, and developmentally, linguistically, 
and culturally appropriate; 
‘‘(xi) improving health outcomes; and 
‘‘(xii) decreasing disparities among 
vulnerable and protected populations in 
outcomes described in clauses (i) through 
(viii). 
‘‘(C) LOCAL EDUCATIONAL OUTCOMES.— 
The outcome measures developed under para-
graph (1)(B) relating to local educational sys-
tems shall, with respect to activities carried out 
under a program under this section, at a min-
imum include provisions to evaluate— 
‘‘(i) the effectiveness of comprehensive 
school mental health programs established 
under this section; 
‘‘(ii) the effectiveness of formal part-
nership linkages among child and family 
serving institutions, community support 
systems, and the educational system; 
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‘‘(iii) the progress made in sustaining 
the program once funding under the grant 
has expired; 
‘‘(iv) the effectiveness of training and 
professional development programs for all 
school personnel that incorporate indica-
tors that measure cultural and linguistic 
competencies under the program in a man-
ner that incorporates appropriate cultural 
and linguistic training; 
‘‘(v) the improvement in perception of 
a safe and supportive learning environment 
among school staff, students, and parents; 
‘‘(vi) the improvement in case-finding 
of students in need of more intensive serv-
ices and referral of identified students to 
prevention, early intervention, and clinical 
services; 
‘‘(vii) the improvement in the imme-
diate availability of clinical assessment and 
treatment services within the context of 
the local community to students posing a 
danger to themselves or others; 
‘‘(viii) the increased successful matric-
ulation to postsecondary school; 
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‘‘(ix) reduced suicide rates; 
‘‘(x) reduced referrals to juvenile jus-
tice; and 
‘‘(xi) increased educational equity. 
‘‘(3) SUBMISSION OF ANNUAL DATA.—An eligi-
ble entity described in subsection (c) that receives a 
grant, contract, or cooperative agreement under this 
section shall annually submit to the Assistant Sec-
retary a report that includes data to evaluate the 
success of the program carried out by the entity 
based on whether such program is achieving the pur-
poses of the program. Such reports shall utilize the 
measures of outcomes under paragraph (2) in a rea-
sonable manner to demonstrate the progress of the 
program in achieving such purposes. 
‘‘(4) EVALUATION BY ASSISTANT SECRETARY.— 
Based on the data submitted under paragraph (3), 
the Assistant Secretary shall annually submit to 
Congress a report concerning the results and effec-
tiveness of the programs carried out with assistance 
received under this section. 
‘‘(5) LIMITATION.—An eligible entity shall use 
not more than 20 percent of amounts received under 
a grant under this section to carry out evaluation 
activities under this subsection. 
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‘‘(g) INFORMATION
AND
EDUCATION.—The Sec-
retary shall establish comprehensive information and edu-
cation programs to disseminate the findings of the knowl-
edge development and application under this section to the 
general public and to health care professionals. 
‘‘(h) AMOUNT OF GRANTS AND AUTHORIZATION OF 
APPROPRIATIONS.— 
‘‘(1) AMOUNT OF GRANTS.—A grant under this 
section shall be in an amount that is not more than 
$2,000,000 for each of the first 5 fiscal years fol-
lowing the date of enactment of the Mental Health 
Services for Students Act of 2019. The Secretary 
shall determine the amount of each such grant based 
on the population of children up to age 21 of the 
area to be served under the grant. 
‘‘(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
this section, $200,000,000 for each of the first 5 fis-
cal years following the date of enactment of the 
Mental Health Services for Students Act of 2019.’’. 
(c) CONFORMING AMENDMENT.—Part G of title V of 
the Public Health Service Act (42 U.S.C. 290hh et seq.), 
as amended by subsection (b), is further amended by strik-
ing the part designation and heading and inserting the 
following: 
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‘‘PART G—SCHOOL-BASED MENTAL HEALTH’’. 
Æ 
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