(1) IN
GENERAL.—The Comptroller General 
shall conduct a study of the barriers to, and the op-
portunities for increasing, the early identification 
and treatment of children and youth, and their fami-
lies as appropriate, who have experienced or are at 
risk of experiencing trauma. 
(2) CONTENTS.—In conducting the study, the 
Comptroller General shall examine— 
(A) ways in which such identification and 
treatment could be facilitated in early childhood 
education and care settings and elementary and 
secondary schools, such as through improved 
teacher preparation, professional development, 
and curriculum design, and the development of 
the cognitive and social-emotional skills of stu-
dents; 
(B)(i) the extent to which State Medicaid 
plans use early and periodic screening, diag-
nostic, and treatment services (as defined in 
section 1905(r) of the Social Security Act (42 
U.S.C. 1396d(r)) that are provided in accord-
ance 
with 
the 
requirements 
of 
section 
1902(a)(43) 
of 
such 
Act 
(42 
U.S.C. 
1396a(a)(43))) to provide trauma-informed 
services to children and youth, and their fami-
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lies as appropriate, who have experienced or are 
at risk of experiencing trauma; 
(ii) barriers to increased utilization of such 
screening, diagnostic, and treatment services; 
and 
(iii) the impact of State Medicaid plan de-
sign and State regulatory decisions on the pro-
vision of such services; 
(C) the feasibility of, State experiences 
with, and considerations regarding, systematic 
collection and sharing of data that— 
(i) is carried out by health care pro-
viders, State, local, and tribal educational 
agencies, social service providers, law en-
forcement, and any other entity providing 
services in a covered setting (as defined in 
section 101(f)); 
(ii) relies on common data measures, 
fosters communication and coordination 
across covered settings (as so defined), and 
promotes shared accountability for the 
data; and 
(iii) relates to the screening, referral, 
and support of children and youth, and 
their families as appropriate, who have ex-
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perienced or are at risk of experiencing 
trauma; 
(D) privacy and consent issues affecting 
identification and treatment of children and 
youth who have experienced or are at risk of ex-
periencing trauma, including considerations re-
garding information collected and reported by 
providers and regarding parental consent; 
(E)(i) the comprehensive, coordinated, and 
multisector process through which State, local, 
and tribal educational agencies locate, identify, 
and screen infants and toddlers with disabil-
ities, and children with disabilities (including 
such children who are youth), under the Indi-
viduals with Disabilities Education Act (20 
U.S.C. 1400 et seq.); and 
(ii) considerations, strategies, alignment 
opportunities, and applicability for trauma-in-
formed models for conducting such location, 
identification, and screening; 
(F)(i) clinical child and adolescent mental 
health and child- and youth-serving social serv-
ice workforce capacity, including analyzing that 
capacity by setting, geographic distribution, and 
population served; and 
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(ii) barriers that contribute to any short-
ages in professionals in that workforce; and 
(G) the cost-effectiveness and success of 
providing services through school-based health 
centers as a method of— 
(i) addressing the needs of students 
who have experienced or are at risk of ex-
periencing trauma; and 
(ii) improving their academic achieve-
ment. 
(b) REPORT.—The Comptroller General shall submit 
a report containing the results of the study to— 
(1) the Committee on Appropriations, the Com-
mittee on Health, Education, Labor, and Pensions, 
the Committee on Finance, the Committee on Indian 
Affairs, and the Committee on the Judiciary of the 
Senate; and 
(2) the Committee on Appropriations, the Com-
mittee on Energy and Commerce, the Committee on 
Education and the Workforce, the Committee on 
Ways and Means, the Committee on Natural Re-
sources, and the Committee on the Judiciary of the 
House of Representatives. 
(c) DEFINITIONS.—In this section: 
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(1) CHILD
WITH
A
DISABILITY.—The term 
‘‘child with a disability’’ has the meaning given the 
term in section 602 of the Individuals with Disabil-
ities Education Act (20 U.S.C. 1401). 
(2) INFANT
OR
TODDLER
WITH
A
DIS-
ABILITY.—The term ‘‘infant or toddler with a dis-
ability’’ has the meaning given the term in section 
632 of the Individuals with Disabilities Education 
Act (20 U.S.C. 1432). 
SEC. 304. NIH REPORT ON TRAUMA. 
The Director of the National Institutes of Health, not 
later than 1 year after the date of enactment of this Act, 
shall submit to Congress a report on the activities of the 
National Institutes of Health with respect to trauma (in-
cluding trauma that stems from child abuse, exposure to 
violence, and toxic stress) and the implications of trauma 
for children, youth, and adults. Such report shall in-
clude— 
(1) the comprehensive research agenda of the 
National Institutes of Health with respect to trau-
ma; 
(2) the capacity, expertise, and review mecha-
nisms of the National Institutes of Health with re-
spect to the evaluation and examination of research 
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proposals related to child trauma, including coordi-
nation across institutes and centers; 
(3) the relevance of trauma to other diseases, 
outcomes, and domains; 
(4) strategies to link and analyze data from 
multiple independent sources, including child wel-
fare, health care (including mental health care), law 
enforcement, and education systems, to enhance re-
search efforts and improve health outcomes; 
(5) the efficacy of existing interventions, includ-
ing clinical treatment methods, child- and family-fo-
cused prevention models, and community-based ap-
proaches, in mitigating the effects of experiencing 
trauma and improving health and societal outcomes; 
and 
(6) identification of gaps in understanding in 
the field of trauma and areas of greatest need for 
further research related to trauma. 
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TITLE IV—EVALUATION OF NEW 
INTERVENTIONS 
AND 
IM-
PROVING SERVICE DELIVERY 
SEC. 401. CLARIFICATION OF DEFINITION OF MEDICAID 
EPSDT 
SERVICES; 
DEMONSTRATION 
PROJECT TO TEST TRAUMA-INFORMED DE-
LIVERY OF EPSDT SERVICES. 
(a) CLARIFICATION
OF DEFINITION
OF EPSDT 
SERVICES.—Section 1905(r) of the Social Security Act 
(42 U.S.C. 1396d(r)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A)(ii), by inserting 
‘‘(including in the immediate aftermath of expo-
sure to a traumatic event)’’ after ‘‘medically 
necessary’’; and 
(B) in subparagraph (B)(i), by inserting 
‘‘and any past exposure to traumatic events’’ 
after ‘‘health development’’; and 
(2) in paragraph (5), by inserting ‘‘including 
any defects, illnesses, and conditions (including 
symptoms of a possible mental health disorder that 
are not sufficiently acute for a diagnosis of a clinical 
mental health disorder) stemming from exposure to 
traumatic events,’’ after ‘‘screening services,’’. 
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(b) TRAUMA-INFORMED
DELIVERY
OF
EPSDT 
SERVICES DEMONSTRATION PROJECT.— 
(1) IN GENERAL.—The Secretary shall make 
grants to States to conduct demonstration projects 
under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) to test innovative, trauma-in-
formed approaches for delivering early and periodic 
screening, diagnostic, and treatment services (as de-
fined in section 1905(r) of the Social Security Act 
(42 U.S.C. 1396d(r))) to eligible children. 
(2) SCOPE AND DURATION.— 
(A) SCOPE.—The Secretary shall select 10 
States to participate in the demonstration 
project. 
(B) SELECTION.— 
(i) DIVERSITY.—In selecting States to 
participate in the demonstration project, 
the Secretary shall— 
(I) ensure that geographically di-
verse areas, including rural and un-
derserved areas, are included; and 
(II) include at least 2 States in 
which Indian tribes or tribal organiza-
tions (as defined in section 4 of the 
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Indian Health Care Improvement Act 
(25 U.S.C. 1603)) are located. 
(ii) PRIORITY.—In selecting States to 
participate in the demonstration project, 
the Secretary shall give priority to States 
that— 
(I) use a value-based payment 
methodology for paying providers for 
services provided under the State 
Medicaid program, including services 
related to healthy child development; 
(II) use an alternative payment 
model under the State Medicaid pro-
gram that enables cross-sector col-
laboration, provision of trauma-in-
formed services, and supports for 
healthy child development; or 
(III) integrate information tech-
nology between child- and youth-serv-
ing sectors to improve coordination 
and outcomes. 
(C) 
DURATION.—The 
demonstration 
project shall begin not later than 1 year after 
the date of the enactment of this Act, and shall 
be conducted for a period of 4 years. 
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(3) REQUIREMENTS.—To be eligible for a grant 
under this subsection, a State that is participating 
in the demonstration project shall demonstrate that 
it has implemented the following measures with re-
spect to the State Medicaid program: 
(A) The State Medicaid program allows for 
the provision of early and periodic screening, di-
agnostic, and treatment services— 
(i) in a diverse set of settings, includ-
ing schools, hospitals, primary care set-
tings, Federally-qualified health centers (as 
defined in section 1905(l)(2)(B) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1396d(l)(2)(B))), 
and 
tribally-operated 
health facilities, without undue restrictions 
on the settings in which providers are per-
mitted to furnish such services; and 
(ii) by the full scope of providers that 
are licensed or otherwise authorized under 
State law to provide the services, including 
trained peers through eligible peer support 
services, community health workers, or 
subclinical case managers. 
(B) Where necessary to improve or pro-
mote the health of an eligible child, the State 
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Medicaid program provides for payment for 
services provided to the parent of the child. 
(C) The State Medicaid program has pro-
cedures in place to coordinate across settings, 
which may include coordinating with law en-
forcement, juvenile justice agencies, schools (in-
cluding preschools and after-school programs), 
hospitals, primary care providers, tribally-oper-
ated health facilities, mental health and sub-
stance use treatment facilities, and child welfare 
providers, to ensure that eligible children who 
experience trauma receive the appropriate serv-
ices. 
(D) Where appropriate, the State Medicaid 
program coordinates with facilities of the In-
dian Health Service (including a hospital, nurs-
ing facility, or any other type of facility which 
provides services of a type otherwise covered 
under the program) and other tribally-operated 
health facilities to ensure eligible children have 
access to adequate qualified providers that are 
licensed or otherwise authorized under State 
law to furnish the services. 
(4) FUNDING.—Out of any funds in the Treas-
ury not otherwise appropriated, there is appro-
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priated $75,000,000 for the period of fiscal years 
2017 through 2021 to carry out this subsection. 
(5) DEFINITIONS.—In this subsection: 
(A) DEMONSTRATION PROJECT.—The term 
‘‘demonstration project’’ means the demonstra-
tion project established under this subsection. 
(B) ELIGIBLE CHILD.—The term ‘‘eligible 
child’’ means an individual who is under age 21 
and who is enrolled in a State plan under title 
XIX of the Social Security Act (42 U.S.C. 1396 
et seq.). 
(C) SECRETARY.—The term ‘‘Secretary’’ 
means the Secretary of Health and Human 
Services. 
(D) STATE
MEDICAID
PROGRAM.—The 
term ‘‘State Medicaid program’’ means a State 
plan or waiver under title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.). 
SEC. 402. HEALTH PROFESSIONAL SHORTAGE AREAS. 
Section 332(a) of the Public Health Service Act (42 
U.S.C. 254e(a)) is amended— 
(1) in paragraph (2)(A), by inserting ‘‘(includ-
ing a community health center operated in an ele-
mentary or secondary school)’’ after ‘‘community 
health center’’; and 
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(2) in paragraph (3)— 
(A) by striking ‘‘, and residents’’ and in-
serting ‘‘, residents’’; and 
(B) by inserting ‘‘, and a population group 
that the Secretary determines has experienced 
trauma (such as through acute or long-term ex-
posure to substantial discrimination, historical 
or cultural oppression, intergenerational pov-
erty, civil unrest, a high rate of violence, or a 
high rate of drug overdose mortality)’’ before 
‘‘may be’’. 
SEC. 403. TRAINING AND CERTIFICATION GUIDELINES FOR 
COMMUNITY FIGURES. 
The Secretary of Health and Human Services, acting 
through the Administrator of the Agency for Healthcare 
Research and Quality, shall conduct a study on, and estab-
lish guidelines for States to consider with respect to, the 
training and certification of community figures, including 
community mentors, peers with lived experiences, and 
faith-based leaders, to build awareness of trauma and pro-
mote linkages to community services, provide case man-
agement services, and conduct appropriate trauma-in-
formed screening for individuals who have experienced or 
are at risk of experiencing trauma. Such training and cer-
tification guidelines shall include recommendations for ex-
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perience, education, and supervision requirements for, and 
partnerships between, such trained and certified commu-
nity figures and other health care providers such that the 
trained and certified community figures may be reim-
bursed through the State Medicaid plan under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.) for 
furnishing services to individuals enrolled in such plan. 
SEC. 404. TRAINING FOR HEALTH CARE WORKFORCE. 
(a) MENTAL AND BEHAVIORAL HEALTH EDUCATION 
AND TRAINING PROGRAM.—Section 756 of the Public 
Health Service Act (42 U.S.C. 294e–1) is amended— 
(1) in subsection (a)— 
(A) in paragraph (1), by inserting ‘‘, trau-
ma,’’ after ‘‘focus on child and adolescent men-
tal health’’; and 
(B) in paragraphs (2) and (3), by inserting 
‘‘trauma-informed care and’’ before ‘‘substance 
use disorder prevention and treatment serv-
ices’’; and 
(2) in subsection (d)— 
(A) in paragraph (1), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (2), by striking the pe-
riod and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
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‘‘(3) programs with academic study and com-
munity practice related to trauma, its impact on 
mental and behavioral health outcomes, and appro-
priate interventions, which may include best prac-
tices developed under section 101 of the Trauma-In-
formed Care for Children and Families Act of 
2017.’’. 
(b) TRAINING DEMONSTRATION PROGRAM.—Section 
760 of such Act (42 U.S.C. 294k) is amended— 
(1) in subsection (a)— 
(A) in paragraphs (1) and (2), by inserting 
‘‘trauma-informed’’ after ‘‘integrate’’; and 
(B) in paragraph (3)(A), by inserting ‘‘, 
and recognize and address the impacts of expe-
riencing trauma on children, youth, and fami-
lies’’ before the semicolon; 
(2) in subsection (b)— 
(A) in paragraph (1)(A)— 
(i) in clause (i)(II), by inserting 
‘‘trauma-informed’’ after ‘‘integrated’’; and 
(ii) in clause (ii)(III), by inserting 
‘‘trauma-informed’’ 
before 
‘‘treatment’’; 
and 
(B) in paragraph (2)(A), by inserting 
‘‘trauma-informed’’ after ‘‘integrate’’; 
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(3) in subsection (c)(1)(B), by inserting ‘‘trau-
ma-informed’’ after ‘‘integrate’’; and 
(4) in subsection (d)— 
(A) in paragraph (1)— 
(i) in subparagraph (C), by striking 
‘‘or’’ at the end; 
(ii) in subparagraph (D), by striking 
the period and inserting ‘‘; or’’; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(E) provide training with academic study 
and community practice related to trauma, its 
impact on mental health outcomes, and appro-
priate interventions, which may include best 
practices developed under section 101 of the 
Trauma-Informed Care for Children and Fami-
lies Act of 2017.’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (D), by striking 
‘‘or’’ at the end; 
(ii) in subparagraph (E), by striking 
the period and inserting ‘‘; or’’; and 
(iii) by adding at the end the fol-
lowing: 
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‘‘(F) provide training with academic study 
and community practice related to trauma, its 
impact on mental health outcomes, and appro-
priate interventions, which may include best 
practices developed under section 101 of the 
Trauma-Informed Care for Children and Fami-
lies Act of 2017.’’. 
SEC. 405. TRAUMA-RELATED COORDINATING BODIES. 
Part G of title V of the Public Health Service Act 
(42 U.S.C. 290hh et seq.) is amended by adding at the 
end the following: 
‘‘SEC. 583. TRAUMA-RELATED COORDINATING BODIES. 
‘‘(a) GRANTS.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Administrator, shall make not more 
than 20 grants for demonstration projects to State, 
local, or tribal eligible entities to act as trauma-re-
lated coordinating bodies. 
‘‘(2) AMOUNT.—The Secretary shall make such 
a grant in an amount of not more than $4,000,000. 
‘‘(3) DURATION.—The Secretary shall make 
such a grant for a period of 4 years. 
‘‘(b) ELIGIBLE ENTITIES.— 
‘‘(1) IN GENERAL.—To be eligible to receive a 
grant under this section, an entity shall include 1 or 
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more representatives of each of the categories de-
scribed in paragraph (2). 
‘‘(2) COMPOSITION.—The categories referred to 
in paragraph (1) are— 
‘‘(A) agencies, such as public health or 
child welfare agencies, that provide services to 
prevent the impact of trauma among, identify, 
refer for services, or support (including pro-
viding treatment for) children and youth, and 
their families as appropriate, that have experi-
enced or are at risk of experiencing trauma; 
‘‘(B) faculty at an institution of higher 
education, or researchers or experts, in an area 
related to prevention of the impact of, identi-
fication of, referral for services for, or support 
(including treatment) for child and youth trau-
ma; 
‘‘(C) hospitals or other health care institu-
tions, such as mental health and substance use 
treatment facilities; 
‘‘(D) law enforcement; 
‘‘(E) elementary or secondary schools, or 
early childhood education or care programs; 
‘‘(F) community-based faith, human serv-
ices, or social services organizations, including 
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providers of after-school programs, home vis-
iting programs, or programs to prevent or ad-
dress the impact of violence; and 
‘‘(G) the general public, including individ-
uals who have experienced trauma. 
‘‘(3) QUALIFICATIONS.—In order for an entity 
to be eligible to receive the grant, the representatives 
included in the entity shall, collectively, have profes-
sional training and expertise concerning a broad 
range of adverse childhood experiences. 
‘‘(c) APPLICATION.—To be eligible to receive a grant 
under this section, an entity shall submit an application 
to the Secretary at such time, in such manner, and con-
taining such information as the Secretary may require, in-
cluding information describing how the coordinating body 
will continue its activities after the end of the grant pe-
riod. 
‘‘(d) PRIORITY.—In making grants under this sec-
tion, the Secretary shall give priority to entities proposing 
to serve communities that have faced trauma due to sub-
stantial discrimination, historical or cultural oppression, 
intergenerational poverty, civil unrest, a high rate of vio-
lence, or a high rate of drug overdose mortality. 
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‘‘(e) USE OF FUNDS.—An entity that receives a grant 
under this section to act as a coordinating body shall use 
the grant funds— 
‘‘(1) to bring together stakeholders who provide 
or use services in, or have expertise concerning, cov-
ered settings to identify community needs and re-
sources related to services to prevent or address the 
impact of trauma, and to build on any needs assess-
ments conducted by organizations or groups rep-
resented on the coordinating body; 
‘‘(2)(A) to collect data, on indicators specified 
by the Secretary, that covers multiple covered set-
tings; and 
‘‘(B) to use the data to identify unique commu-
nity challenges, gaps in services, and high-need 
areas, related to services to prevent or address the 
impact of trauma; 
‘‘(3) to build awareness, skills, and leadership 
(including through trauma-informed training and 
public outreach campaigns) related to implementing 
the best practices developed under section 101 of the 
Trauma-Informed Care for Children and Families 
Act of 2017 (referred to in this subsection as the 
‘developed best practices’); 
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‘‘(4) to pool resources of the members of the or-
ganizations and groups represented on the coordi-
nating body, related to implementing the developed 
best practices; and 
‘‘(5) to develop a strategic plan that identi-
fies— 
‘‘(A) barriers to and gaps in the provision 
of services to prevent or address the impact of 
trauma; and 
‘‘(B) policy goals and coordination oppor-
tunities (including coordination in applying for 
grants) relating to implementing the developed 
best practices. 
‘‘(f) SUPPLEMENT NOT SUPPLANT.—Amounts made 
available under this section shall be used to supplement 
and not supplant other Federal, State, and local public 
funds and private funds expended to provide trauma-re-
lated coordination activities. 
‘‘(g) EVALUATION.—At the end of the period for 
which grants are made under this section, the Secretary 
shall conduct an evaluation of the activities carried out 
under each grant under this section. In conducting the 
evaluation, the Secretary shall assess the outcomes of the 
grant activities carried out by each grant recipient. 
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‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$80,000,000 for the period of fiscal years 2018 through 
2021. 
‘‘(i) DEFINITION.—In this section, the term ‘covered 
setting’ has the meaning given the term in section 101(f) 
of the Trauma-Informed Care for Children and Families 
Act of 2017.’’. 
SEC. 406. EXPANSION OF PERFORMANCE PARTNERSHIP 
PILOT FOR CHILDREN WHO HAVE EXPERI-
ENCED OR ARE AT RISK OF EXPERIENCING 
TRAUMA. 
Section 526 of the Departments of Labor, Health and 
Human Services, and Education, and Related Agencies 
Appropriations Act, 2014 (42 U.S.C. 12301 note) is 
amended— 
(1) in subsection (a), by adding at the end the 
following: 
‘‘(4) ‘To improve outcomes for children and 
youth, and their families as appropriate, who have 
experienced or are at risk of experiencing trauma’ 
means to increase the rate at which individuals who 
have experienced or are at risk of experiencing trau-
ma, including those who are low-income, homeless, 
in foster care, involved in the juvenile justice system, 
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unemployed, or not enrolled in or at risk of dropping 
out of an educational institution and live in a com-
munity that has faced acute or long-term exposure 
to substantial discrimination, historical oppression, 
intergenerational poverty, civil unrest, or a high rate 
of violence, achieve success in meeting educational, 
employment, health, developmental, community re-
entry, or other key goals.’’; 
(2) in subsection (b)— 
(A) in the subsection heading, by striking 
‘‘FISCAL YEAR 2014’’ and inserting ‘‘FISCAL 
YEARS 2018 THROUGH 2022’’; 
(B) by redesignating paragraphs (1) and 
(2) as subparagraphs (A) and (B), respectively, 
and by moving such subparagraphs, as so re-
designated, 2 ems to the right; 
(C) by striking ‘‘Federal agencies’’ and in-
serting the following: 
‘‘(1) DISCONNECTED YOUTH PILOTS.—Federal 
agencies’’; and 
(D) by adding at the end the following: 
‘‘(2) TRAUMA-INFORMED CARE PILOTS.—Fed-
eral agencies may use Federal discretionary funds 
that are made available in this Act or any Act ap-
propriating funds for any of fiscal years 2018 
VerDate Sep 11 2014 
22:30 Mar 31, 2017
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