S. 2204
A BILL
Be it enacted by the Senate and
House of Representatives of the United States of America in Congress assembled,
This Act may be cited as the `Women
in Trauma Act of 2002'.
Congress finds as follows:
(1) Researchers have concluded
that women may experience significant adverse mental health consequences
relating to trauma exposure, often the result of sexual or domestic violence.
(2) The majority of women
suffering from both substance abuse and mental health problems have been
victims of rape, incest, or physical or emotional abuse and hundreds of
thousands of these same women are also severely beaten by their husbands or a
significant male intimate. Surveys have indicated that approximately 1,500,000
children are physically abused each year and 700,000 are victims of sexual
abuse.
(3) Women with serious mental
illnesses are over-represented in samples that experienced trauma, including
physical, sexual, and emotional abuse. Between 50 and 70 percent of women
hospitalized for psychiatric disorders have a history of trauma.
(4) Even for people whose mental
health problems are caused by other factors, a history of early physical or sexual
abuse leads to the earlier onset of their illness, a more severe course of
illness, and a greater likelihood of suicide and other poor outcomes.
(5) Trauma exposure is generally
prevalent in people who suffer from mental health and substance abuse problems,
and can worsen the course and overall impact of these illnesses.
(6) In a recent study, 97 percent
of homeless women with mental illness were found to have experienced severe
physical or sexual abuse and 87 percent experienced this abuse both as children
and as adults.
(7) Of women in prisons and jails,
80 to 100 percent have been victims of physical and sexual abuse.
(8) The prevalence of violence-
and trauma-related problems among women with mental health and substance abuse
problems is not adequately addressed by most treatment practices.
(9) There is an urgent need to
provide services that directly address the issue of trauma for women suffering
from mental health and substance abuse problems.
(10) To improve mental health and
substance abuse services for women, further research to expand the development
and implementation of trauma-sensitive services is needed as well as additional
services to improve access to comprehensive therapeutic interventions and to
the support needed to overcome barriers to recovery.
Subpart 3 of part B of title V of
the Public Health Service Act (42 U.S.C. 290bb-31 et seq.) is amended by adding
at the end the following:
`(a) RESEARCH GRANTS-
`(1) GRANTS AUTHORIZED-
`(A) IN GENERAL- The Secretary,
acting through the Director of the National Institute of Mental Health and in
consultation with the Administrator of the Substance Abuse and Mental Health
Services Administration, shall award grants, contracts, or cooperative
agreements to public and nonprofit private entities, as well as Indian tribes
and tribal organizations, for the purpose of building the evidence base for new
treatment interventions that simultaneously address trauma, substance abuse,
and psychiatric disorders, including depression and anxiety disorders
(including post-traumatic stress disorder, psychotic and dissociative
disorders) and the integration of existing interventions for the treatment of
trauma, substance abuse, and psychiatric disorders, including depression and
anxiety disorders (including post-traumatic stress disorder, psychotic and
dissociative disorders).
`(B) GEOGRAPHICAL DISTRIBUTION-
The Secretary shall ensure that grants, contracts, or cooperative agreements
awarded pursuant to this paragraph are distributed equitably among regions of
the country and among urban and rural areas.
`(C) DURATION OF AWARDS- Grants,
contracts, or cooperative agreements awarded pursuant to this paragraph may not
exceed 5 years. Such grants, contracts, or agreements may be renewed.
`(2) APPLICATION-
`(A) IN GENERAL- Each entity
desiring a grant under this subsection shall submit an application to the
Secretary at such time, in such manner, and accompanied by such information as
the Secretary may reasonably require.
`(B) CONTENTS- Each application
submitted pursuant to subparagraph (A) shall--
`(i) describe the activities for
which assistance under this subsection is sought; and
`(ii) demonstrate that the testing
of treatment interventions will be carried out through community-based
treatment programs.
`(3) AUTHORIZATION OF
APPROPRIATIONS- There is authorized to be appropriated to carry out this
subsection, $50,000,000 for fiscal year 2003, and such sums as may be necessary
for each fiscal year thereafter.
`(b) TREATMENT GRANTS-
`(1) GRANTS AUTHORIZED-
`(A) IN GENERAL- The Secretary,
acting through the Administrator of the Substance Abuse and Mental Health
Services Administration, shall make grants to public and nonprofit private
entities, including Indian tribes and tribal organizations, for the purpose of
providing comprehensive community-based mental health and substance abuse
services to women who have experienced a history of physical or sexual abuse,
or other types of trauma.
`(B) GRANTMAKING CONSIDERATIONS-
The Secretary shall ensure that--
`(i) grants awarded pursuant to
this paragraph are distributed equitably among the regions of the country and
among urban and rural areas; and
`(ii) preference is given to
applicants with strong ties to minority communities and those that offer
services that are culturally and linguistically appropriate.
`(C) DURATION- The Secretary shall
award grants under this paragraph for a period not to exceed 5 years. Such
grants may be renewed.
`(2) TECHNICAL ASSISTANCE- The
Secretary, acting through the Administrator of the Substance Abuse and Mental
Health Services Administration, shall provide technical assistance to entities
awarded grants pursuant to paragraph (1) with respect to the implementation of
programs described in paragraph (3).
`(3) USE OF FUNDS- An entity
awarded a grant pursuant to paragraph (1) shall--
`(A) establish and operate 1 or
more multidisciplinary integrated systems of community-based care--
`(i) to include medical, social,
and behavioral services for the simultaneous and coordinated treatment of
trauma, substance abuse, and psychiatric disorders, including depression and
anxiety disorders (including post-traumatic stress disorder, psychotic, and
dissociative disorders);
`(ii) that specifically addresses
the impact of trauma on the lives of women receiving services through the
grant; and
`(iii) that may include services
for children of women who are survivors of trauma;
`(B) establish avenues for the
involvement of women who access the services described in subparagraph (A), in
all phases of service delivery and design including in the development of
individualized treatment plans;
`(C) offer specialized and
structured treatment components addressing trauma that are culture- and
gender-specific;
`(D) implement collaboration among
public and private nonprofit entities likely to serve women with histories of
trauma including rape and domestic violence programs, hospital emergency rooms,
appropriate branches of the criminal justice system, low-income housing
authorities, substance abuse and mental health service providers, consolidated
health centers, battered women's shelters, and churches and other
community-based organizations;
`(E) undertake aggressive outreach
efforts to encourage women from minority communities, in particular, to
participate; and
`(F) offer educational materials
or training, through subparagraph (D) or other avenues, to agencies and
community-based organizations that serve women with histories of trauma to
increase awareness of the devastating impact of chronic exposures to traumatic
experiences on women's mental health and of the need to address this impact in
the context of mental health and substance abuse treatment.
`(4) ACCESS TO CHILD CARE- An
entity awarded a grant pursuant to paragraph (1) may use grant funds to provide
child care, either directly or through an off site, licensed child care
provider, to women offered services under such grant to facilitate
participation and address a primary barrier to care.
`(5) APPLICATION-
`(A) IN GENERAL- Each entity
desiring a grant under this subsection shall submit an application to the
Secretary at such time, in such manner, and accompanied by such information as
the Secretary may reasonably require.
`(B) CONTENTS- Each application
submitted pursuant to subparagraph (A) shall--
`(i) describe the activities for
which assistance under this subsection is sought; and
`(ii) describe a plan for the
rigorous evaluation of such activities, including both process and outcome
evaluation, and the submission of the evaluation at the end of the project
period.
`(6) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to carry out this subsection, $100,000,000 for fiscal year 2003, and such sums as may be necessary for each fiscal year thereafter.'.