109th CONGRESS
1st Session
H. R. 4367
To improve the health care system's response to domestic violence,
dating violence, sexual assault, and stalking through the training and education
of health care providers, developing comprehensive public health responses
to violence.
IN THE HOUSE OF REPRESENTATIVES
November 17, 2005
Mrs. CAPPS (for herself, Mr. LATOURETTE, Mr. WAXMAN, and Mrs. LOWEY) introduced
the following bill; which was referred to the Committee on Energy and Commerce
A BILL
To improve the health care system's response to domestic violence,
dating violence, sexual assault, and stalking through the training and education
of health care providers, developing comprehensive public health responses
to violence.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Domestic Violence Screening, Treatment, and
Prevention Act'.
SEC. 2. PURPOSE.
It is the purpose of this Act to improve the health care system's response
to domestic violence, dating violence, sexual assault, and stalking through
the training and education of health care providers, developing comprehensive
public health responses to violence.
SEC. 3. TRAINING AND EDUCATION OF HEALTH PROFESSIONALS IN DOMESTIC AND
SEXUAL VIOLENCE.
Part D of title VII of the Public Health Service Act (42 U.S.C. 294 et seq.)
is amended by adding at the end the following:
`SEC. 758. INTERDISCIPLINARY TRAINING AND EDUCATION ON DOMESTIC VIOLENCE
AND OTHER TYPES OF VIOLENCE AND ABUSE.
`(a) Grants- The Secretary, acting through the Director of the Health Resources
and Services Administration, shall award grants under this section to develop
interdisciplinary training and education programs that provide undergraduate,
graduate, post-graduate medical, nursing (including advanced practice nursing
students), and other health professions students with an understanding of,
and clinical skills pertinent to, domestic violence, sexual assault, stalking,
and dating violence.
`(b) Eligibility- To be eligible to receive a grant under this section an
entity shall--
`(1) be an accredited school of allopathic or osteopathic medicine;
`(2) prepare and submit to the Secretary an application at such time,
in such manner, and containing such information as the Secretary may require,
including--
`(A) information to demonstrate that the applicant includes the meaningful
participation of a school of nursing and at least one other school of
health professions or graduate program in public health, dentistry,
social work, midwifery, or behavioral and mental health;
`(B) strategies for the dissemination and sharing of curricula and other
educational materials developed under the grant to other interested
medical and nursing schools and national resource repositories for materials
on domestic violence and sexual assault; and
`(C) a plan for consulting with, and compensating community-based coalitions
or individuals who have experience and expertise in issues related to
domestic violence, sexual assault, dating violence, and stalking for
services provided under the program carried out under the grant.
`(1) REQUIRED USES- Amounts provided under a grant under this section
shall be used to--
`(A) fund interdisciplinary training and education projects that are
designed to train medical, nursing, and other health professions students
and residents to identify and provide health care services (including
mental or behavioral health care services and referrals to appropriate
community services) to individuals who are or who have experienced domestic
violence, sexual assault, and stalking or dating violence; and
`(B) plan and develop culturally competent clinical components for integration
into approved residency training programs that address health issues
related to domestic violence, sexual assault, dating violence, and stalking,
along with other forms of violence as appropriate, and include the primacy
of victim safety and confidentiality.
`(2) PERMISSIVE USES- Amounts provided under a grant under this section
may be used to--
`(A) offer community-based training opportunities in rural areas for
medical, nursing, and other students and residents on domestic violence,
sexual assault, stalking, and dating violence, and other forms of violence
and abuse, which may include the use of distance learning networks and
other available technologies needed to reach isolated rural areas; or
`(B) provide stipends to students from racial and ethnic population
groups who are underrepresented in the health professions as necessary
to promote and enable their participation in clerkships, preceptorships,
or other offsite training experiences that are designed to develop health
care clinical skills related to domestic violence, sexual assault, dating
violence, and stalking.
`(A) CONFIDENTIALITY AND SAFETY- Grantees under this section shall ensure
that all educational programs developed with grant funds address issues
of confidentiality and patient safety, and that faculty and staff associated
with delivering educational components are fully trained in procedures
that will protect the immediate and ongoing security of the patients,
patient records, and staff. Advocacy-based coalitions or other expertise
available in the community shall be consulted on the development and
adequacy of confidentially and security procedures, and shall be fairly
compensated by grantees for their services.
`(B) RURAL PROGRAMS- Rural training programs carried out under paragraph
(2)(A) shall reflect adjustments in protocols and procedures or referrals
that may be needed to protect the confidentiality and safety of patients
who live in small or isolated communities and who are currently or have
previously experienced violence or abuse.
`(4) CHILD AND ELDER ABUSE- Issues related to child and elder abuse may
be addressed as part of a comprehensive programmatic approach implemented
under a grant under this section.
`(d) Requirements of Grantees-
`(1) LIMITATION ON ADMINISTRATIVE EXPENSES- A grantee shall not use more
than 10 percent of the amounts received under a grant under this section
for administrative expenses.
`(2) CONTRIBUTION OF FUNDS- A grantee under this section, and any entity
receiving assistance under the grant for training and education, shall
contribute non-Federal funds, either directly or through in-kind contributions,
to the costs of the activities to be funded under the grant in an amount
that is not less than 25 percent of the total cost of such activities.
`(e) Authorization of Appropriations- There is authorized to be appropriated
to carry out this section, $3,000,000 for each of fiscal years 2006 through
2010. Amounts appropriated under this subsection shall remain available
until expended.'.
SEC. 4. GRANTS TO FOSTER PUBLIC HEALTH RESPONSES TO DOMESTIC VIOLENCE,
DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING GRANTS.
Part P of title III of the Public Health Service Act (42 U.S.C. 280g et
seq.) is amended by adding at the end the following:
`SEC. 399P. GRANTS TO FOSTER PUBLIC HEALTH RESPONSES TO DOMESTIC VIOLENCE,
DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING.
`(a) Authority to Award Grants-
`(1) IN GENERAL- The Secretary, acting through the Director of the Centers
for Disease Control and Prevention, shall award grants to eligible State,
tribal, territorial, or local entities to strengthen the response of State,
tribal, territorial, or local health care systems to domestic violence,
dating violence, sexual assault, and stalking.
`(2) ELIGIBLE ENTITIES- To be eligible to receive a grant under this section,
an entity shall--
`(i) a State department (or other division) of health, a State domestic
or sexual assault coalition or service-based program, or any other
nonprofit, nongovernmental, tribal, territorial, or State entity with
a history of effective work in the fields of domestic violence, dating
violence, sexual assault or stalking, and health care; or
`(ii) a nonprofit domestic violence, dating violence, sexual assault,
or stalking service-based program, a local department (or other division)
of health, a local health clinic, hospital, or health system, or any
other nonprofit, tribal, or local entity with a history of effective
work in the field of domestic or sexual violence and health;
`(B) prepare and submit to the Secretary an application at such time,
in such manner, and containing such agreements, assurances, and information
as the Secretary determines to be necessary to carry out the purposes
for which the grant is to be made; and
`(C) demonstrate that the entity is representing a team of organizations
and agencies working collaboratively to strengthen the response of the
health care system involved to domestic violence, dating violence, sexual
assault, or stalking and that such team includes domestic violence,
dating violence, sexual assault or stalking and health care organizations.
`(3) DURATION- A program conducted under a grant awarded under this section
shall not exceed 3 years.
`(1) IN GENERAL- An entity shall use amounts received under a grant under
this section to design and implement comprehensive strategies to improve
the response of the health care system involved to domestic or sexual
violence in clinical and public health settings, hospitals, clinics, managed
care settings (including behavioral and mental health), and other health
settings.
`(2) MANDATORY STRATEGIES- Strategies implemented under paragraph (1)
shall include the following:
`(A) The implementation, dissemination, and evaluation of policies and
procedures to guide health care professionals and behavioral and public
health staff in responding to domestic violence, dating violence, sexual
assault, and stalking, including strategies to ensure that health information
is maintained in a manner that protects the patient's privacy and safety
and prohibits insurance discrimination.
`(B) The development of on-site access to services to address the safety,
medical, mental health, and economic needs of patients either by increasing
the capacity of existing health care professionals and behavioral and
public health staff to address domestic violence, dating violence, sexual
assault, and stalking, by contracting with or hiring domestic or sexual
assault advocates to provide the services, or to model other services
appropriate to the geographic and cultural needs of a site.
`(C) The development or adaptation and dissemination of education materials
for patients and health care professionals and behavioral and public
health staff.
`(D) The evaluation of practice and the institutionalization of identification,
intervention, and documentation including quality improvement measurements.
`(3) PERMISSIVE STRATEGIES- Strategies implemented under paragraph (1)
may include the following:
`(A) Where appropriate, the development of training modules and policies
that address the overlap of child abuse, domestic violence, dating violence,
sexual assault, and stalking and elder abuse as well as childhood exposure
to domestic violence.
`(B) The creation, adaptation, and implementation of public education
campaigns for patients concerning domestic violence, dating violence,
sexual assault, and stalking prevention.
`(C) The development, adaptation, and dissemination of domestic violence,
dating violence, sexual assault, and stalking education materials to
patients and health care professionals and behavioral and public health
staff.
`(D) The promotion of the inclusion of domestic violence, dating violence,
sexual assault, and stalking into health professional training schools,
including medical, dental, nursing school, social work, and mental health
curriculum.
`(E) The integration of domestic violence, dating violence, sexual assault,
and stalking into health care accreditation and professional licensing
examinations, such as medical, dental, social work, and nursing boards.
`(c) Allocation of Funds- Funds appropriated under this section shall be
distributed equally between State and local programs.
`(d) Authorization of Appropriations- There is authorized to be appropriated
to award grants under this section, $5,000,000 for each of fiscal years
2006 through 2010.'.
SEC. 5. IMPROVING FEDERAL HEALTH PROGRAMS' RESPONSE TO DOMESTIC VIOLENCE,
DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING.
(a) Training Grants Under the Maternal and Child Health Services Block Grant-
(1) PREFERENCE IN CERTAIN FUNDING- Section 502(b)(2) of the Social Security
Act (42 U.S.C. 702(b)(2)) is amended by adding at the end the following:
`(C) Of the amounts retained for projects described in subparagraphs (A)
through (F) of section 501(a)(3), the Secretary shall provide preference
to qualified applicants that demonstrate that the activities to be carried
out with such amounts include training of service providers in how to identify
and treat the health effects of domestic violence, dating violence, sexual
assault, or stalking, including children who have been exposed to domestic
or dating violence. Such training should include--
`(i) identifying patients of clients experiencing domestic violence, dating
violence sexual assault, or stalking;
`(ii) assessing the immediate and short-term safety of the patient or
client, the impact of the abuse on the health of the patient, and assisting
the patient in developing a plan to promote his or her safety;
`(iii) examining and treating such patients or clients within the scope
of the health professional's discipline, training, and practice (including
providing medical advice regarding the dynamics and nature of domestic
violence, dating violence sexual assault, or stalking);
`(iv) maintaining complete medical or forensic records that include the
documentation of the examination, treatment given, and referrals made,
and recording the location and nature of the victim's injuries, and establishing
mechanisms to ensure the privacy and confidentiality of those medical
records;
`(v) referring the patient or client to public and private nonprofit entities
that provide services for such victims; and
`(vi) ensuring that all services are provided in a linguistically and
culturally relevant manner.'.
(2) REQUIREMENT FOR PORTION OF EXPENDITURES ON DOMESTIC VIOLENCE IDENTIFICATION
AND TREATMENT- Section 505(a)(5) of the Social Security Act (42 U.S.C.
705(a)(5)) is amended--
(A) in subparagraph (E), by striking `and' at the end;
(B) in subparagraph (F), by striking the period and inserting `; and';
and
(C) by inserting after subparagraph (F), the following:
`(G) the State will set aside a reasonable portion (based upon the State's
previous use of funds under this title) of the funds provided for domestic
violence, dating violence, sexual assault, or stalking services.'.
(3) REPORTING DATA- Section 506(a)(2) of the Social Security Act (42 U.S.C.
706(a)(2)) is amended by inserting after subparagraph (E) the following:
`(F) Information on how funds provided under this title are used to identify
and treat domestic violence, dating violence, sexual assault, or stalking.'.
(4) SEPARATE PROGRAM FOR DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT,
AND STALKING IDENTIFICATION AND TREATMENT- Title V of the Social Security
Act (42 U.S.C. 701 et seq.) is amended by adding at the end the following:
`SEC. 511. SEPARATE PROGRAM FOR DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL
ASSAULT AND STALKING SCREENING AND TREATMENTS.
`(a) Allotments- For the purpose described in subsection (b), the Secretary
shall, for fiscal year 2006 and each subsequent fiscal year, allot to each
State that has transmitted an application for the fiscal year under section
505(a) an amount equal to the product of--
`(1) the amount appropriated under subsection (d) for the fiscal year;
and
`(2) the percentage determined for the State under section 502(c)(1)(B)(ii).
`(b) Purpose- The purpose of an allotment under subsection (a) with respect
to a State is to enable the State to provide for domestic violence, dating
violence, sexual assault, or stalking identification and treatment, including
the provision of domestic violence, dating violence, sexual assault, or
stalking identification, treatment services, increasing the number of persons
identified, assessed, treated, and referred, and including training of health
care professionals, and behavioral and public health staff, on how to identify
and respond to adult and minor patients experiencing domestic violence,
dating violence, sexual assault, or stalking. Such training shall include--
`(1) identifying patients of clients experiencing domestic violence, dating
violence sexual assault, or stalking;
`(2) assessing the immediate and short-term safety of the patient or client,
the impact of the abuse on the health of the patient, and assisting the
patient in developing a plan to promote his or her safety;
`(3) examining and treating such patients or clients within the scope
of the health professional's discipline, training, and practice (including
providing medical advice regarding the dynamics and nature of domestic
violence, dating violence sexual assault, or stalking);
`(4) maintaining complete medical or forensic records that include the
documentation of the examination, treatment given, and referrals made,
and recording the location and nature of the victim's injuries, and establishing
mechanisms to ensure the privacy and confidentiality of those medical
records;
`(5) referring the patient or client to public and private nonprofit entities
that provide services for such victims; and
`(6) ensuring that all services are provided in a linguistically and culturally
relevant manner.
`(c) Application of Provisions-
`(1) IN GENERAL- Sections 503, 507, and 508 apply to allotments under
subsection (a) to the same extent and in the same manner as such sections
apply to allotments under section 502(c).
`(2) SECRETARIAL DISCRETION- Sections 505 and 506 apply to allotments
under subsection (a) to the extent determined by the Secretary to be appropriate.
`(d) Authorization of Appropriations- For the purpose of making allotments
under subsection (a), there are authorized to be appropriated $4,000,000
for each of fiscal years 2006 through 2010.'.
(b) Domestic Violence, Dating Violence, Sexual Assault, and Stalking Identification
and Treatment Services at Community Health Centers- Part P of title III
of the Public Health Service Act (42 U.S.C. 280g et seq.), as amended by
section 5, is further amended by adding at the end the following:
`SEC. 399P-1. DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT AND STALKING
PREVENTION, IDENTIFICATION, AND TREATMENT GRANTS.
`(a) Grants Authorized- The Secretary is authorized to award grants to eligible
entities to improve the identification and treatment of domestic violence,
dating violence, sexual assault, or stalking.
`(b) Use of Funds- Grants awarded under subsection (a) may be used for activities
such as--
`(1) the implementation, dissemination, and evaluation of policies and
procedures to guide health care and behavioral health care professionals
and other staff responding to domestic violence, dating violence, sexual
assault, or stalking;
`(2) the provision of training and follow-up technical assistance to health
care professionals and staff to identify domestic violence, dating violence,
sexual assault, or stalking, and to appropriately assess, treat, and refer
patients who are victims of domestic violence, dating violence, sexual
assault, or stalking; and
`(3) the development of on-site access to services to address the safety,
medical, mental health, and economic needs of patients either by increasing
the capacity of existing health care professionals and staff to address
these issues or by contracting with or hiring domestic violence or sexual
assault advocates to provide the services, or by developing other models
appropriate to the geographic, cultural, and linguistic needs of a site.
`(c) Eligibility- To be eligible for a grant under this section, an entity
shall--
`(1) be a federally qualified health center as defined in section 1861(aa)(4)
of the Social Security Act (42 U.S.C. 1395x(aa)(4)); and
`(2) prepare and submit to the Secretary an application at such time,
in such manner, and accompanied by such information as the Secretary may
require.
`(d) Authorization of Appropriations- There is authorized to be appropriated
to carry out this section, $4,000,000 for each of fiscal years 2006 through
2010.'.
SEC. 6. RESEARCH ON EFFECTIVE INTERVENTIONS IN THE HEALTHCARE SETTING.
Subtitle B of the Violence Against Women Act of 1994 (Public Law 103-322;
108 Stat. 1902 et seq.), as amended by the Violence Against Women Act of
2000 (114 Stat. 1491 et seq.), and as amended by this Act, is further amended
by adding at the end the following:
`CHAPTER 11--RESEARCH ON EFFECTIVE INTERVENTIONS TO ADDRESS VIOLENCE
AGAINST WOMEN
`SEC. 40297. RESEARCH ON EFFECTIVE INTERVENTIONS IN THE HEALTH CARE SETTING.
`(a) Purpose- The Secretary, acting through the Director of the Centers
for Disease Control and Prevention and the Director of the Agency for Healthcare
Research and Quality, shall award grants and contracts to fund research
on effective interventions in the health care setting that prevent domestic
violence, dating violence, and sexual assault across the lifespan and that
prevent the health effects of such violence and improve the safety and health
of individuals who are currently being victimized.
`(b) Use of Funds- Research conducted with amounts received under a grant
or contract under this section shall include--
`(1) with respect to the authority of the Centers for Disease Control
and Prevention--
`(A) research on the effects of domestic violence, dating violence,
sexual assault, and childhood exposure to domestic, dating, or sexual
violence, on health behaviors, health conditions, and the health status
of individuals, families, and populations; and
`(B) research and testing of best messages and strategies to mobilize
public action concerning the prevention of domestic, dating, or sexual
violence
`(2) with respect to the authority of the Agency for Healthcare Research
and Quality--
`(A) ›research on the impact on the health care system, health
care utilization, health care costs, and health status of domestic and
dating violence and childhood exposure to domestic and dating violence;
and
`(B) research on effective interventions within primary care and emergency
health care settings and with health care settings that include clinical
partnerships within community domestic violence providers for adults
and children exposed to domestic or dating violence.
`(c) Authorization of Appropriations- There is authorized to be appropriated
to carry out this section, $5,000,000 for each of fiscal years 2006 through
2010.'.
END
