HR 1578 IHCommentsClose CommentsPermalink

112th CONGRESSCommentsClose CommentsPermalink

1st SessionCommentsClose CommentsPermalink

H. R. 1578CommentsClose CommentsPermalink

To amend the Public Health Service Act to improve the health care system’s assessment and response to domestic violence, dating violence, sexual assault, and stalking, and for other purposes.CommentsClose CommentsPermalink

IN THE HOUSE OF REPRESENTATIVESCommentsClose CommentsPermalink

April 15, 2011CommentsClose CommentsPermalink

Ms. SLAUGHTER (for herself, Mrs. LOWEY, Ms. ROYBAL-ALLARD, Ms. MOORE, Ms. NORTON, Ms. SCHAKOWSKY, Ms. HANABUSA, Mr. HASTINGS of Florida, Mr. HOLDEN, and Ms. DELAURO) introduced the following bill; which was referred to the Committee on Energy and CommerceCommentsClose CommentsPermalink

A BILLCommentsClose CommentsPermalink

To amend the Public Health Service Act to improve the health care system’s assessment and response to domestic violence, dating violence, sexual assault, and stalking, and for other purposes.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the ‘Violence Against Women Health Initiative Act of 2011’.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink





Sec. 2. Findings.CommentsClose CommentsPermalink





Sec. 3. Purpose.CommentsClose CommentsPermalink

TITLE I--COORDINATED PUBLIC HEALTH INITIATIVE TO END VIOLENCE AGAINST WOMEN

Sec. 101. Grants to foster public health responses to intimate partner violence and sexual assault.CommentsClose CommentsPermalink





Sec. 102. Training and education of health professionals.CommentsClose CommentsPermalink

TITLE II--RESEARCH ON EFFECTIVE PUBLIC HEALTH APPROACHES TO END VIOLENCE AGAINST WOMEN

Sec. 201. Research on effective interventions to end domestic violence, sexual assault, and stalking against women in the health care setting.CommentsClose CommentsPermalink

SEC. 2. FINDINGS.

The Congress finds the following:CommentsClose CommentsPermalink





(1) Domestic violence and sexual violence are public health problems and among the most significant social determinants of health for women and girls.CommentsClose CommentsPermalink





(2) Nearly one in four women in the United States reports experiencing violence by a current or former spouse or boyfriend at some point in her life, and one in six women reported experiencing a completed sexual assault.CommentsClose CommentsPermalink





(3) Violence and abuse can affect health in many ways from physical injuries sustained during violent episodes, trauma symptoms including depression and thoughts of suicide, and harmful health coping behaviors such as alcohol and substance abuse.CommentsClose CommentsPermalink





(4) Research published in the Journal of Women’s Health in 2007 found that women who are victims of violence have 17 percent more primary care doctor visits, 14 percent more specialist visits, and 27 percent more prescription refills than non-abused women.CommentsClose CommentsPermalink





(5) Women who have experienced violence and abuse are 80 percent more likely to have a stroke, 70 percent more likely to have heart disease, and 60 percent more likely to have asthma than non-abused women.CommentsClose CommentsPermalink





(6) In addition to utilizing the health system at higher rates, victims are more likely to experience a wide range of reproductive health problems including unintended pregnancies, sexually transmitted disease/HIV transmission, miscarriages, and more. Abuse increases the likelihood of teen pregnancy; adolescent girls in abusive relationships are 3.5 times more likely to become pregnant than their non-abused peers.CommentsClose CommentsPermalink





(7) The Centers for Disease Control and Prevention (CDC) have also linked childhood exposure to violence with long-term, chronic health conditions including obesity, arthritis, stroke, and heart disease.CommentsClose CommentsPermalink





(8) The CDC conservatively estimates that intimate partner rape, physical assault, and stalking costs the health system and employers $8.3 billion annually from direct injuries and services and lost productivity from work.CommentsClose CommentsPermalink





(9) Most professional health organizations, including the American Medical Association, American Nurses Association, American College of Obstetricians and Gynecologists, American Psychological Association, American Academy of Pediatrics, and the Joint Commission on the Accreditation of Health Care Organizations, endorse routine assessment for domestic violence.CommentsClose CommentsPermalink





(10) The health system provides an important entry point to reduce violence and abuse and can improve the health status of women, but without training and support on how to assess and respond, providers are not routinely assessing and responding to abuse, missing an important opportunity to help victims and prevent more serious abuse.CommentsClose CommentsPermalink

SEC. 3. PURPOSE.

It is the purpose of this Act to develop a public health response to abuse by--CommentsClose CommentsPermalink





(1) strengthening the health care system’s assessment of and response to domestic violence, dating violence, sexual assault, and stalking;CommentsClose CommentsPermalink





(2) increasing the number of victims identified and assisted in health or public health settings; andCommentsClose CommentsPermalink





(3) expanding research on effective interventions in health settings.CommentsClose CommentsPermalink

TITLE I--COORDINATED PUBLIC HEALTH INITIATIVE TO END VIOLENCE AGAINST WOMENCommentsClose CommentsPermalink

SEC. 101. GRANTS TO FOSTER PUBLIC HEALTH RESPONSES TO INTIMATE PARTNER VIOLENCE AND SEXUAL ASSAULT.

Section 399P of the Public Health Service Act (42 U.S.C. 280g-4) is amended--CommentsClose CommentsPermalink





(1) in subsection (a)--CommentsClose CommentsPermalink





(A) by amending paragraph (1) to read as follows:CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary, acting through the Director of the Office on Women’s Health in the Office of the Secretary, and in consultation with the Director of the Family Violence Prevention and Services Office, 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 and prevent and respond to physical and sexual violence across the lifespan.’;CommentsClose CommentsPermalink





(B) in paragraph (2), by amending subparagraph (A) to read as follows:CommentsClose CommentsPermalink





‘(A) be--CommentsClose CommentsPermalink





‘(i) a State department (or other division) of health, a State, tribal, or territorial domestic violence or sexual assault coalition or victim services program, a State law enforcement task force, or any other nonprofit, nongovernmental State, tribal, or territorial entity with a history of effective work in the fields of domestic violence, dating violence, sexual assault, or stalking, and health care, including physical or mental health care; orCommentsClose CommentsPermalink





‘(ii) a local victim services program, a local department (or other division) of health, a local health clinic, hospital, or health system, or any other community-based organization with a history of effective work in the field of domestic violence, dating violence, sexual assault, or stalking, and health care, including physical or mental health care;’; andCommentsClose CommentsPermalink





(C) in paragraph (3), by striking ‘2 years’ and by inserting ‘36 months’; andCommentsClose CommentsPermalink





(2) in subsection (b)--CommentsClose CommentsPermalink





(A) by amending paragraph (1) to read as follows:CommentsClose CommentsPermalink





‘(1) IN GENERAL- An entity shall use amounts received under a grant under this section to design or enhance and implement comprehensive strategies to improve the response of the health care system to domestic violence, dating violence, sexual assault, or stalking in clinical, public health, hospital, managed care (including behavioral and mental health), and other health settings.’;CommentsClose CommentsPermalink





(B) by amending paragraph (2) to read as follows:CommentsClose CommentsPermalink





‘(2) MANDATORY STRATEGIES- Strategies implemented under paragraph (1) shall include the following:CommentsClose CommentsPermalink





‘(A) The implementation, dissemination, and evaluation of policies and procedures to guide health professionals 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 health information technology is used to improve documentation, identification, assessment, treatment, and follow-up care.CommentsClose CommentsPermalink





‘(B) The development of on-site access to services to address the safety, medical, mental health, and economic needs of patients who are victims of domestic violence, dating violence, sexual assault, or stalking, either by increasing the capacity of existing health professionals and public health staff to address domestic violence, dating violence, sexual assault, and stalking, or by contracting with or hiring victim service providers to provide the services or to model other services appropriate to the geographic and cultural needs of a site.CommentsClose CommentsPermalink





‘(C) The provision of training and followup technical assistance to health professionals, public health staff, and allied health professionals to identify, assess, treat, and refer clients who are victims of domestic violence, dating violence, sexual assault, or stalking.CommentsClose CommentsPermalink





‘(D) The development, replication, refinement, and testing of model strategies in adolescent health settings to prevent and respond to violence and abuse.’;CommentsClose CommentsPermalink





(C) in paragraph (3)--CommentsClose CommentsPermalink





(i) by amending subparagraph (A) to read as follows:CommentsClose CommentsPermalink





‘(A) The development of training modules and policies that address domestic violence, dating violence, sexual assault, and stalking over the lifespan, including child abuse, childhood exposure to domestic and sexual violence, and elder abuse.’;CommentsClose CommentsPermalink





(ii) in subparagraph (B), by striking ‘and stalking prevention’ and by inserting ‘, stalking prevention, and healthy relationships’;CommentsClose CommentsPermalink





(iii) by amending subparagraph (D) to read as follows:CommentsClose CommentsPermalink





‘(D) The inclusion of the health effects of lifetime exposure to violence and abuse as well as related behavioral risk factors in health professional training schools including medical, dental, nursing, social work, and mental health curricula, and allied health service training courses.’;CommentsClose CommentsPermalink





(iv) by amending subparagraph (E) to read as follows:CommentsClose CommentsPermalink





‘(E) The integration of knowledge 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, and where appropriate, other allied health exams.’; andCommentsClose CommentsPermalink





(v) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(F) The development, expansion, and implementation of sexual assault forensic medical examination programs.’; andCommentsClose CommentsPermalink





(D) by adding at the end the following:CommentsClose CommentsPermalink





‘(4) BUILDING EVIDENCE OF MODEL PROGRAMS- Strategies implemented under paragraph (1) may include research and evaluation of programs funded under this section to build evidence of model programs to be disseminated. As a condition on receipt of a grant for such research and evaluation, an applicant shall agree to release any findings resulting from the research and evaluation to the general public no later than 90 days after the findings are available. The Secretary shall facilitate the wide dissemination of such findings by means of multiple media, including the Internet.’; andCommentsClose CommentsPermalink





(3) by striking subsections (c) and (d) and inserting the following:CommentsClose CommentsPermalink





‘(c) Preference- In selecting grant recipients under this section, the Secretary shall give preference to applicants based on the strength of their evaluation strategies, with outcome-based evaluations prioritized.CommentsClose CommentsPermalink





‘(d) Technical Assistance-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary may provide technical assistance with respect to the planning, development, and operation of any program or service carried out pursuant to this section. The Secretary may provide such technical assistance directly or through grants or contracts.CommentsClose CommentsPermalink





‘(2) AVAILABILITY OF MATERIALS- The Secretary shall make materials on training, best practices, evaluation, and other subjects developed by grantees under this section publicly available to the extent feasible, including through the use of electronic media, replication of materials, and tailoring of materials to meet varying geographic and jurisdictional needs.CommentsClose CommentsPermalink





‘(e) Reporting- The Secretary shall publish a biennial report on--CommentsClose CommentsPermalink





‘(1) the distribution of funds under this section; andCommentsClose CommentsPermalink





‘(2) the programs and activities supported by such funds.CommentsClose CommentsPermalink





‘(f) Definitions- Except as inconsistent with this section, the definitions in section 40002 of the Violence Against Women Act of 1994 shall apply to this section.CommentsClose CommentsPermalink





‘(g) Authorization of Appropriations-CommentsClose CommentsPermalink





‘(1) IN GENERAL- There is authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2012 through 2016, to remain available until expended.CommentsClose CommentsPermalink





‘(2) ALLOCATION OF FUNDS-CommentsClose CommentsPermalink





‘(A) ADMINISTRATIVE COSTS- Of the funds made available to carry out this section for any fiscal year, the Secretary shall not use more than 2.5 percent for administration and monitoring of grants awarded under this section.CommentsClose CommentsPermalink





‘(B) RESEARCH AND EVALUATION- Of the funds made available to carry out this section for any fiscal year, the Secretary shall not use more than 15 percent to award funds for research and evaluation under subsection (b)(4).’.CommentsClose CommentsPermalink

SEC. 102. TRAINING AND EDUCATION OF HEALTH PROFESSIONALS.

Section 758 of the Public Health Service Act (42 U.S.C. 294h) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 758. INTERDISCIPLINARY TRAINING AND EDUCATION ON DOMESTIC VIOLENCE, SEXUAL ASSAULT, AND OTHER TYPES OF VIOLENCE AND ABUSE.

‘(a) Grants- The Secretary, acting through the Director of the Office on Women’s Health in the Office of the Secretary, and in consultation with the Administrator of the Health Resources and Services Administration and the Director of the Family Violence Prevention and Services Office, shall award grants to eligible entities to develop interdisciplinary training for health professionals, public health staff, and allied health professionals, and education programs that provide undergraduate, graduate, or postgraduate medical, psychology, and nursing (including advanced practice nursing) students, and current health professionals, with an understanding of, and clinical skills pertinent to, domestic violence, dating violence, sexual assault, and stalking across the lifespan.CommentsClose CommentsPermalink





‘(b) Eligibility-CommentsClose CommentsPermalink





‘(1) IN GENERAL- To be eligible to receive a grant under this section, an entity shall be--CommentsClose CommentsPermalink





‘(A) an accredited school of allopathic or osteopathic medicine, psychology, nursing, social work, or allied health;CommentsClose CommentsPermalink





‘(B) a health care provider membership or professional organization, or a health care system;CommentsClose CommentsPermalink





‘(C) a nonprofit organization with a history of effective work in the field of training health professionals with an understanding of, and clinical skills pertinent to, domestic violence, dating violence, sexual assault, or stalking, and lifetime exposure to violence and abuse; orCommentsClose CommentsPermalink





‘(D) a State, tribal, territorial, or local entity.CommentsClose CommentsPermalink





‘(2) ADDITIONAL REQUIREMENTS- To be eligible to receive a grant under this section, an entity shall prepare and submit an application to the Secretary including at a minimum--CommentsClose CommentsPermalink





‘(A) strategies for the dissemination and sharing of curricula and other educational materials developed under the grant to other interested medical, psychology, social work, and nursing schools and national resource repositories for materials on domestic violence, dating violence, sexual assault, and stalking; andCommentsClose CommentsPermalink





‘(B) a plan for consulting with domestic violence or sexual assault coalitions, or national nonprofit organizations or racial and ethnic minority-specific organizations with demonstrated experience and expertise in domestic violence, dating violence, sexual assault, or stalking.CommentsClose CommentsPermalink





‘(3) PREFERENCE- In selecting grant recipients under this section, the Secretary shall give preference to applicants based on the strength of their evaluation strategies, with outcome-based evaluations prioritized.CommentsClose CommentsPermalink





‘(c) Use of Funds-CommentsClose CommentsPermalink





‘(1) REQUIRED USES- Amounts provided under a grant under this section shall be used--CommentsClose CommentsPermalink





‘(A) to plan and develop--CommentsClose CommentsPermalink





‘(i) interdisciplinary health training and education for medical, psychology, social work, nursing, and other health professions students, interns, residents, fellows, or current health care providers to identify and provide health care services (including mental or behavioral health care services and referrals to appropriate community services) to individuals who are victims of domestic violence, dating violence, sexual assault, or stalking; andCommentsClose CommentsPermalink





‘(ii) culturally and linguistically competent clinical components for integration into approved internship, residency, and fellowship training or continuing medical education training that address physical and mental health issues related to domestic violence, dating violence, sexual assault, and stalking, along with other forms of violence as appropriate, and include the primacy of victim safety and confidentiality; orCommentsClose CommentsPermalink





‘(B) in the case of a grant recipient described in subsection (b)(1)(B), to--CommentsClose CommentsPermalink





‘(i) develop and provide guidance to members, constituents, institutions, and stakeholders to increase assessment and referral to services; andCommentsClose CommentsPermalink





‘(ii) facilitate cross-training and provide collaborative opportunities between partners and public health agencies.CommentsClose CommentsPermalink





‘(2) PERMISSIVE USES- Amounts provided under a grant under this section may be used to--CommentsClose CommentsPermalink





‘(A) offer community-based training opportunities in rural areas, which may include the use of distance learning networks and other available technologies needed to reach isolated rural areas to train health professions students, interns, residents, and fellows on domestic violence, dating violence, sexual assault, stalking, and other forms of violence and abuse;CommentsClose CommentsPermalink





‘(B) provide stipends to students who are underrepresented in the health professions as necessary to promote and enable their participation in offsite training experiences designed to develop health care clinical skills related to domestic violence, dating violence, sexual assault, and stalking;CommentsClose CommentsPermalink





‘(C) provide clinical research fellowships to explore the relationship between victimization or exposure to abuse, and physical and mental health status; orCommentsClose CommentsPermalink





‘(D) evaluate innovative curricula, training models, or programs.CommentsClose CommentsPermalink





‘(3) BUILDING EVIDENCE OF MODEL PROGRAMS- Amounts provided under a grant under this section may be used to conduct research and evaluation of programs funded under this section to build evidence of model programs to be disseminated. As a condition on receipt of a grant for such research and evaluation, an applicant shall agree to release any findings resulting from the research and evaluation to the general public no later than 90 days after the findings are available. The Secretary shall facilitate the wide dissemination of such findings by means of multiple media, including the Internet.CommentsClose CommentsPermalink





‘(4) REQUIREMENTS-CommentsClose CommentsPermalink





‘(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. Organizations with demonstrated expertise in the confidentiality and safety needs of victims of domestic violence, dating violence, sexual assault, and stalking shall be consulted on the development and adequacy of confidentially and security procedures, and shall be fairly compensated by grantees for their services.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(C) 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.CommentsClose CommentsPermalink





‘(d) Technical Assistance-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary may provide technical assistance with respect to the planning, development, and operation of any program or service carried out pursuant to this section. The Secretary may provide such technical assistance directly or through grants or contracts.CommentsClose CommentsPermalink





‘(2) AVAILABILITY OF MATERIALS- The Secretary shall make materials on training, best practices, evaluation and other subjects developed by grantees under this section publicly available to the extent feasible, including through the use of electronic media, replication of materials, and tailoring of materials to meet varying geographic and jurisdictional needs.CommentsClose CommentsPermalink





‘(e) Reporting- The Secretary shall publish a biennial report on--CommentsClose CommentsPermalink





‘(1) the distribution of funds under this section; andCommentsClose CommentsPermalink





‘(2) the programs and activities supported by such funds.CommentsClose CommentsPermalink





‘(f) Definitions- Except as inconsistent with this section, the definitions in section 40002 of the Violence Against Women Act of 1994 shall apply to this section.CommentsClose CommentsPermalink





‘(g) Authorization of Appropriations-CommentsClose CommentsPermalink





‘(1) IN GENERAL- There is authorized to be appropriated to carry out this section $3,000,000 for each of fiscal years 2012 through 2016, to remain available until expended.CommentsClose CommentsPermalink





‘(2) ALLOCATION OF FUNDS-CommentsClose CommentsPermalink





‘(A) ADMINISTRATIVE COSTS- Of the funds made available to carry out this section for any fiscal year, the Secretary shall not use more than 2.5 percent for administration and monitoring of grants awarded under this section.CommentsClose CommentsPermalink





‘(B) RESEARCH AND EVALUATION- Of the funds made available to carry out this section for any fiscal year, the Secretary shall not use more than 15 percent to award funds for research and evaluation under subsection (c)(3).’.CommentsClose CommentsPermalink

TITLE II--RESEARCH ON EFFECTIVE PUBLIC HEALTH APPROACHES TO END VIOLENCE AGAINST WOMENCommentsClose CommentsPermalink

SEC. 201. RESEARCH ON EFFECTIVE INTERVENTIONS TO END DOMESTIC VIOLENCE, SEXUAL ASSAULT, AND STALKING AGAINST WOMEN IN THE HEALTH CARE SETTING.

Section 40297 of the Violence Against Women Act of 1994 (42 U.S.C. 13973) is amended--CommentsClose CommentsPermalink





(1) in the section heading, by inserting after ‘effective interventions’ the following: ‘to end domestic violence, sexual assault, and stalking against women’;CommentsClose CommentsPermalink





(2) in subsection (b)(1)--CommentsClose CommentsPermalink





(A) in subparagraph (B)--CommentsClose CommentsPermalink





(i) by striking ‘and’ after the semicolon; andCommentsClose CommentsPermalink





(ii) by inserting before the semicolon ‘, including evaluating programs using evidence-based process and outcome indicators’;CommentsClose CommentsPermalink





(B) in subparagraph (C), by striking the period at the end and inserting a semicolon; andCommentsClose CommentsPermalink





(C) by adding at the end the following new subparagraphs:CommentsClose CommentsPermalink





‘(D) research on effective health care interventions to domestic and sexual violence and sexual coercion, including evaluating programs using evidence-based process and outcome indicators; orCommentsClose CommentsPermalink





‘(E) research into factors that increase resiliency for children exposed to dating violence, sexual assault, stalking, or individuals who have a lifetime exposure to violence and abuse.’;CommentsClose CommentsPermalink





(3) in subsection (b)(2)(B)--CommentsClose CommentsPermalink





(A) by striking ‘within primary care and emergency health care settings’ and inserting ‘within community health centers and primary care, emergency health care, or adolescent health settings’; andCommentsClose CommentsPermalink





(B) by striking ‘domestic violence’ and inserting ‘dating violence, sexual assault, or stalking’; andCommentsClose CommentsPermalink





(4) in subsection (d)--CommentsClose CommentsPermalink





(A) by striking ‘2007 through 2011’ and inserting ‘2012 through 2016’; andCommentsClose CommentsPermalink





(B) by inserting ‘, to remain available until expended’ before the period.CommentsClose CommentsPermalink