---
kind: "diff"
citation: "S. 689"
bill: "113-s-689"
heading: "Mental Health Awareness and Improvement Act of 2013"
from: "is"
from_label: "Introduced in Senate"
to: "rs"
to_label: "Reported in Senate"
sections_amended: 4
sections_added: 0
sections_removed: 0
url: "https://uscodex.org/bills/113/s/689/changes/rs"
---

# S. 689 — what changed

S. 689, Mental Health Awareness and Improvement Act of 2013 — 4 sections amended between Introduced in Senate and Reported in Senate.

Edits are marked `<del>struck</del>` and `<ins>inserted</ins>`.

## Sec. 103 Amendments to the Elementary and Secondary Education Act of 1965

- (a) Title I State plans— Section 1111(b) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6311(b)) is amended by adding at the end the following:
  - “(11) Positive behavioral interventions and supports—In the case of a State that proposes to use funds under this part to support positive behavioral interventions and supports, the State plan shall describe how the State educational agency will—
  - “(A) assist local educational agencies in implementing positive behavioral interventions and supports in schools served by the local educational agency on a whole-school basis;
  - “(B) provide technical assistance and training to local educational agencies to improve and support the development, implementation, and coordination of comprehensive positive behavioral interventions and supports carried out under this Act with activities carried out under the Individuals with Disabilities Education Act; and
  - “(C) evaluate the effects of providing positive behavioral interventions and supports for all students, including improvement of the learning environment, academic achievement, disciplinary problems such as incidents of suspensions, expulsions, referrals to law enforcement, and other actions that remove students from instruction, and any other effects the State chooses to evaluate.
  - “(12) Early intervening services—In the case of a State that proposes to use funds under this part to support early intervening services, the State plan shall describe how the State educational agency will—
  - “(A) assist local educational agencies in implementing early intervening services in schools served by the local educational agency to reduce the need to label children as children with disabilities in order to address the learning and behavioral needs of such children;
  - “(B) provide technical assistance and training to local educational agencies to improve coordination of early intervening services provided under this Act with early intervening services carried out under the Individuals with Disabilities Education Act; and
  - “(C) evaluate the effects of providing early intervening services.
  - “(13) Crisis management plans—In the case of a State that proposes to use funds under this part to assist local educational agencies in the State in periodically updating the crisis management plans, as described in section 4114(d)(7)(D), of such local educational agencies, the State plan shall describe how the State educational agency will assist local educational agencies in updating such crisis management plans.”
- (b) Title I State reports— Section 1111(h)(1)(C) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6311(h)(1)(C)) is amended—
  - (1) in clause (vii), by striking “and” after the semicolon;
  - (2) in clause (viii), by striking the period and inserting a semicolon; and
  - (3) by adding at the end the following:
    - “(ix) the number of local educational agencies in the State that implement positive behavioral interventions and supports;
    - “(x) the number of students—
    - “(I) who are served through the use of early intervening services; and
    - “(II) who, in the preceding 2-year period, received early intervening services and who, after receiving such services, have been identified as eligible for, and receive, special education and related services under part B of the Individuals with Disabilities Education Act; and
    - “(xi) the number of local educational agencies in the State that implement school-based mental health programs.”
- (c) Title I local educational agency plans— Section 1112(b)(1) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6312(b)(1)) is amended—
  - (1) in subparagraph (P), by striking “and” after the semicolon;
  - (2) in subparagraph (Q), by striking the period and inserting a semicolon; and
  - (3) by adding at the end the following:
    - “(R) if the local educational agency proposes to use subgrant funds under this part for positive behavioral interventions and supports, a description of the actions the local educational agency will take to provide positive behavioral interventions and supports and coordinate those activities with activities carried out under the Individuals with Disabilities Education Act;
    - “(S) if the local educational agency proposes to use subgrant funds under this part for early intervening services, a description of the actions the local educational agency will take to provide early intervening services and coordinate those services with early intervening services carried out under the Individuals with Disabilities Education Act;
    - “(T) if the local educational agency proposes to use subgrant funds under this part for school-based mental health programs, a description of the actions the local educational agency will take to provide school-based mental health programs and coordinate those activities with activities carried out under the Individuals with Disabilities Education Act; and
    - “(U) if the local educational agency proposes to use subgrant funds under this part for periodically updating the crisis management plan of the local educational agency, as described in section 4114(d)(7)(D), a description of the actions the local educational agency will take to develop and implement an updated crisis management plan.”
- (d) Title I schoolwide programs—
  - (1) Schoolwide programs— Section 1114(b)(1)(B)(iii)(I) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6314(b)(1)(B)(iii)(I)) is amended—
    - (A) in item (aa), by inserting “and school-based mental health programs” after “services”;
    - (B) by redesignating items (bb) and (cc) as items (dd) and (ee), respectively; and
    - (C) by inserting after item (aa) the following:
      - “(bb) implementation of schoolwide positive behavioral interventions and supports, including through coordination with activities carried out under the Individuals with Disabilities Education Act, in order to improve academic outcomes for students and reduce the need for suspensions, expulsions, and other actions that remove students from instruction;
      - “(cc) implementation of early intervening services, including through coordination with early intervening services carried out under the Individuals with Disabilities Education Act;”
  - (2) Technical assistance— Section 1116(b)(4)(B) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6316(b)(4)(B)) is amended—
    - (A) by redesignating clauses (iii) and (iv) as clauses (iv) and (v), respectively; and
    - (B) by inserting after clause (ii) the following:
      - “(iii) shall include assistance in the implementation of schoolwide positive behavior supports, school-based mental health programs, and other approaches with evidence of effectiveness for improving the learning environment in the school and reducing the need for suspensions, expulsions, and other actions that remove students from instruction, including effective strategies for improving coordination of community resources;”
- (e) Title I assessments and school improvement—
  - (1) School improvement plan— Section 1116(b)(3)(A) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6316(b)(3)(A)) is amended—
    - (A) in clause (ix), by striking “and” after the semicolon;
    - (B) in clause (x), by striking the period and inserting a semicolon; and
    - (C) by adding at the end the following:
      - “(xi) specify whether the local educational agency or the school will adopt and implement policies or practices to implement or improve positive behavioral interventions and supports and enhance coordination with activities carried out under the Individuals with Disabilities Education Act;
      - “(xii) specify whether the local educational agency or the school will adopt and implement policies or practices to implement or improve early intervening services and coordinate with early intervening services carried out under such Act; and
      - “(xiii) specify whether the local educational agency or school will adopt and implement school-based mental health programs and coordinate with programs carried out under such Act.”
  - (2) Local educational agency improvement plans— Section 1116(c)(10) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6316(c)(10)) is amended—
    - (A) in subparagraph (B), by striking “subparagraph (E)” and inserting “subparagraph (F)”;
    - (B) by redesignating subparagraphs (D) through (F) as subparagraphs (E) through (G), respectively; and
    - (C) by inserting after subparagraph (C) the following:
      - “(D) Additional activities—In addition to carrying out 1 or more of the corrective actions required under subparagraph (C) for a local educational agency, the State educational agency may also carry out 1 or more of the following activities:
      - “(i) Improving or expanding positive behavioral interventions and supports and enhancing coordination with activities under the Individuals with Disabilities Education Act.
      - “(ii) Improving or expanding early intervening services and coordinating such services with early intervening services carried out under the Individuals with Disabilities Education Act.”
- (f) Title I school support and recognition—
  - (1) Regional centers— Section 1117(a)(3) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6317(a)(3)) is amended—
    - (A) by striking “of 2002 and comprehensive” and inserting “of 2002, comprehensive”;
    - (B) by striking “and the comprehensive” and inserting “, the comprehensive”; and
    - (C) by inserting “and any technical assistance center on schoolwide positive behavioral interventions and supports funded under section 665(b) of the Individuals with Disabilities Education Act,” after “2002),”.
  - (2) Statewide systems for support— Section 1117(a)(5)(B) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6317(a)(5)(B)) is amended—
    - (A) in clause (i), by striking the semicolon at the end and inserting the following: “, including by improving or expanding the use of positive behavioral interventions and supports aligned with activities carried out under the Individuals with Disabilities Education Act;”;
    - (B) in clause (iii), by striking “and” after the semicolon;
    - (C) in clause (iv), by striking the period and inserting a semicolon; and
    - (D) by adding at the end the following:
      - “(v) review and analyze the school’s efforts to identify and assist students with poor academic achievement and students who are children with disabilities, and assist the school in developing or improving early intervening services that are coordinated with activities carried out under the Individuals with Disabilities Education Act;
      - “(vi) review and analyze the school’s efforts to address behavioral or disciplinary problems, and assist the school in developing or improving schoolwide positive behavioral interventions and supports that are coordinated with activities carried out under the Individuals with Disabilities Education Act;
      - “(vii) review the number of discipline incidents in the school and use that information to assist the school to implement schoolwide positive behavioral interventions and supports or other early intervening services, or both; and
      - “(viii) review and analyze the school's efforts to address mental health needs among students and assist the school in developing or improving school-based mental health programs that are coordinated with activities carried out under the Individuals with Disabilities Education Act.”
- (g) Title I parental involvement— Section 1118(e) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6318(e)) is amended—
  - (1) by redesignating paragraphs (6) through (14) as paragraphs (7) through (15), respectively; and
  - (2) by inserting after paragraph (5) the following:
    - “(6) shall provide information to school personnel, students, and parents about the school’s use of positive behavioral interventions and supports, school-based mental health programs, and the expectations of school personnel, students, and parents in supporting a safe learning environment for all students;”
- (h) Prevention and intervention programs— Section 1414(c)(8) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6434(c)(8)) is amended by inserting “, including coordinating the use of positive behavioral interventions and supports, early intervening services, and school-based mental health programs to improve academic achievement and reduce disciplinary actions” before the semicolon at the end.
- (i) Technical assistance— Section 1419 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6439) is amended—
  - (1) in paragraph (1), by striking “and” after the semicolon;
  - (2) in paragraph (2), by striking the period and inserting “; and”; and
  - (3) by adding at the end the following:
    - “(3) to provide technical assistance in implementing positive behavior interventions and supports, early intervening services, and school-based mental health programs in order to improve academic achievement and reduce disciplinary actions.”
- (j) Title II mental health professional development— Section 2123 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6223) is amended—
  - (1) in subsection (a), by inserting after paragraph (8) the following:
    - “(9) Carrying out in-service training for school personnel in—
    - “(A) the techniques and supports needed to identify children with trauma histories, and children with, or at risk of, mental illness, early;
    - “(B) the use of referral mechanisms that effectively link such children to appropriate treatment and intervention services in the school and in the community where appropriate; and
    - “(C) forming partnerships between school-based mental health programs and public or private mental health organizations.”
  - (2) by redesignating subsection (b) as subsection (c); and
  - (3) by inserting after subsection (a) the following:
    - “(b) Liability protection for school personnel—Section 2366 shall apply to school personnel who received in-service training under subsection (a)(9), and who are carrying out activities related to such training, in the same manner as such section applies to teachers.”
- (k) <del>School-Based </del><ins>School-based </ins>mental health services partnership programs— Section 4121 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7131) is amended—
  - (1) in subsection (a)—
    - (A) in the matter preceding paragraph (1), by inserting “, health (including mental health),” after “promote safety”;
    - (B) by redesignating paragraphs (3) through (8) and (9) as paragraphs (4) through (9) and (11), respectively;
    - (C) by inserting after paragraph (2) the following:
      - “(3) the development and implementation of school-based mental health services partnership programs under subsection (c);”
    - (D) by striking paragraph (7), as redesignated by subparagraph (B), and inserting the following:
      - “(7)
      - “(A) assistance to school systems that have particularly severe drug and violence problems or assistance to support appropriate response efforts to crisis situations, including—
      - “(i) hiring drug prevention and school safety coordinators; and
      - “(ii) making available to students mental health services, conflict resolution programs, and other school-based violence prevention strategies;”
    - (E) in paragraph (9), as redesignated by subparagraph (B), by striking “and” after the semicolon; and
    - (F) by inserting after such paragraph (9) the following:
      - “(10) assistance to States to help local educational agencies develop and implement comprehensive emergency management plans; and”
  - (2) by adding at the end the following:
    - “(c) <del>School-Based </del><ins>School-based </ins>mental health services partnership programs
    - “(1) In general—Each grant, contract, or cooperative agreement awarded or entered into under subsection (a)(3) shall meet the requirements of this subsection.
    - “(2) Eligibility
    - “(A) In general—To be eligible to receive a grant, contract, or cooperative agreement under this subsection, a local educational agency shall enter into a school-based mental health partnership that—
    - “(i) shall include a public or private mental health entity or health care entity; and
    - “(ii) may include a child welfare agency, family-based mental health entity, family organization, trauma network, or other community-based entity.
    - “(B) Flexibility for certain local educational agencies—Notwithstanding subparagraph (A), a local educational agency that is eligible for services under subpart 1 or 2 of part B of title VI, as determined by the Secretary, and that is unable to partner with a public or private mental health entity or health care entity shall be eligible for a grant under this subsection if the local educational agency can demonstrate to the Secretary, in its application for a grant under this subsection, that the local educational agency can otherwise build the capacity to carry out the requirements of this subsection.
    - “(3) Application—A local educational agency that desires a grant, contract, or cooperative agreement under this subsection shall include, in the application required by the Secretary, a description of how the local educational agency will—
    - “(A) assist schools served by the local educational agency to provide, through the school-based mental health services partnership program, comprehensive school-based mental health services and supports and comprehensive staff development for school and community service personnel working in the school;
    - “(B) provide technical assistance and training to improve and support the development, implementation, and coordination of school-based mental health programs and ensure such programs are coordinated with activities carried out under the Individuals with Disabilities Education Act; and
    - “(C) evaluate the effects of providing school-based mental health programs.
    - “(4) Use of funds—A local educational agency receiving a grant, contract, or cooperative agreement under this subsection shall use funds provided under such grant, contract, or cooperative agreement to provide school-based mental health services and supports that—
    - “(A) may include—
    - “(i) the early identification of social, emotional, or behavioral problems, or substance use disorders, and the provision of early intervening services;
    - “(ii) not withstanding section 4154, the treatment or referral for treatment of students with social, emotional, or behavioral health problems, or substance use disorders;
    - “(iii) the development and implementation of programs to assist children in dealing with trauma and violence; and
    - “(iv) the development of mechanisms, based on best practices, for children to report incidents of violence or plans by other children or adults to commit violence;
    - “(B) are based on trauma-informed and evidence-based practices;
    - “(C) are coordinated, where appropriate, with early intervening services carried out under the Individuals with Disabilities Education Act; and
    - “(D) are provided by qualified mental and behavioral health professionals who are certified or licensed by the State involved and practicing within their area of expertise.
    - “(5) General requirements
    - “(A) Parental consent
    - “(i) In general—Each local educational agency receiving a grant, contract, or cooperative agreement under this subsection shall obtain prior written, informed consent from the parent of each child who is under 18 years of age to participate in any assessment service, program, activity, or treatment that is—
    - “(I) funded under this subsection; and
    - “(II) conducted in connection with an elementary school or secondary school under the grant, contract, or cooperative agreement.
    - “(ii) Exception—Notwithstanding clause (i), the written, informed consent described in such clause shall not be required in—
    - “(I) an emergency, where it is necessary to protect the immediate health and safety of the student, other students, or school personnel; or
    - “(II) other instances where parental consent cannot reasonably be obtained, as defined by the Secretary.
    - “(B) Prohibition on mandatory medication—No child shall be required to obtain a prescription for a substance covered by the Controlled Substances Act (21 U.S.C. 801 et seq.) as a condition of receiving an evaluation under this subsection, receiving services under this subsection, or attending a school receiving assistance under this subsection.
    - “(C) Privacy—Each eligible entity receiving a grant under this subsection shall ensure that student mental health records are accorded the privacy protections provided under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191; 110 Stat. 2033) and section 444 of the General Education Provisions Act (20 U.S.C. 1232g) (commonly referred to as the “Federal Educational Rights and Privacy Act of 1974”).
    - “(6) Liability protection for school personnel—Section 2366 shall apply to school personnel providing services under a grant, contract, or cooperative agreement under this subsection in the same manner as such section applies to teachers.
    - “(7) Prohibition against Federal mandates, direction, or control or Federal regulation—In addition to the prohibition of Federal Government control of a State, local educational agency, or school's curriculum or program of instruction that is provided under section 9527(a), nothing in this subsection shall be construed to authorize an officer or employee of the Federal Government to mandate, direct, or control a State, local educational agency, or school's specific instructional content or academic achievement standards and assessments.”
- (l) Definition— Section 9101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801) is amended—
  - (1) by redesignating paragraphs (17) through (43) as paragraphs (18) through (44), respectively; and
  - (2) by inserting after paragraph (16) the following:
    - “(17) Early intervening services—The term early intervening services means early intervening services described in section 613(f)(1) of the Individuals with Disabilities Education Act.”

## Sec. 203 Children's recovery from trauma

- Section 582 of the Public Health Service Act (42 U.S.C. 290hh–1) is amended—
- (1) in subsection (a), by striking “developing programs” and all that follows and inserting “developing and maintaining programs that provide for—
  - “(1) the continued operation of the National Child Traumatic Stress Initiative (referred to in this section as the <del>NCTSI), </del><ins>“NCTSI”), </ins>which includes a coordinating center, that focuses on the mental, behavioral, and biological aspects of psychological trauma response; and
  - “(2) the development of knowledge with regard to evidence-based practices for identifying and treating mental, behavioral, and biological disorders of children and youth resulting from witnessing or experiencing a traumatic event.”
- (2) in subsection (b)—
  - (A) by striking “subsection (a) related” and inserting “subsection (a)(2) (related”;
  - (B) by striking “treating disorders associated with psychological trauma” and inserting “treating mental, behavioral, and biological disorders associated with psychological trauma)”; and
  - (C) by striking “mental health agencies and programs that have established clinical and basic research” and inserting “universities, hospitals, mental health agencies, and other programs that have established clinical expertise and research”;
- (3) by redesignating subsections (c) through (g) as subsections (g) through (k), respectively;
- (4) by inserting after subsection (b), the following:
  - “(c) Child outcome data—The NCTSI coordinating center shall collect, analyze, and report NCTSI-wide child treatment process and outcome data regarding the early identification and delivery of evidence-based treatment and services for children and families served by the NCTSI grantees.
  - “(d) Training—The NCTSI coordinating center shall facilitate the coordination of training initiatives in evidence-based and trauma-informed treatments, interventions, and practices offered to NCTSI grantees, providers, and partners.
  - “(e) Dissemination—The NCTSI coordinating center shall, as appropriate, collaborate with the Secretary in the dissemination of evidence-based and trauma-informed interventions, treatments, products and other resources to appropriate stakeholders.
  - “(f) Review—The Secretary shall, consistent with the peer review process, ensure that NCTSI applications are reviewed by appropriate experts in the field as part of a consensus review process. The Secretary shall include review criteria related to expertise and experience in child trauma and evidence-based practices.”
- (5) in subsection (g) (as so redesignated), by striking “with respect to centers of excellence are distributed equitably among the regions of the country” and inserting “are distributed equitably among the regions of the United States”;
- (6) in subsection (i) (as so redesignated), by striking “recipient may not exceed 5 years” and inserting “recipient shall not be less than 4 years, but shall not exceed 5 years”; and
- (7) in subsection (j) (as so redesignated), by striking “$50,000,000” and all that follows through “2006” and inserting “$45,713,000 for each of fiscal years 2014 through 2018”.

## Sec. 205 Increasing education and awareness of treatments for opioid use disorders

- (a) In general— In order to improve the quality of care delivery and treatment outcomes among patients with opioid use disorders, the Secretary of Health and Human Services (referred to in this section as the <del>Secretary), </del><ins>“Secretary”), </ins>acting through the Administrator for the Substance Abuse and Mental Health Services Administration, may advance, through existing programs as appropriate, the education and awareness of providers, patients, and other appropriate stakeholders regarding all products approved by the Food and Drug Administration to treat opioid use disorders.
- (b) Activities— The activities described in subsection (a) may include—
  - (1) disseminating evidence-based practices for the treatment of opioid use disorders;
  - (2) facilitating continuing education programs for health professionals involved in treating opioid use disorders;
  - (3) increasing awareness among relevant stakeholders of the treatment of opioid use disorders;
  - (4) assessing current barriers to the treatment of opioid use disorders for patients and providers and development and implementation of strategies to mitigate such barriers; and
  - (5) continuing innovative approaches to the treatment of opioid use disorders in various treatment settings, such as prisons, community mental health centers, primary care, and hospitals.
- (c) Report— Not later than 1 year after the date of enactment of this Act, if the Secretary carries out the activities under this section, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that examines—
  - (1) the activities the Substance Abuse and Mental Health Services Administration conducts under this section, including any potential impacts on health care costs associated with such activities;
  - (2) the role of adherence in the treatment of opioid use disorders and methods to reduce opioid use disorders; and
  - (3) recommendations on priorities and strategies to address co-occurring substance use disorders and mental illnesses.

## Sec. 207 Evidence based practices for older adults

- (a) Geriatric substance use disorders treatment— Section 509(e) of the Public Health Service Act (42 U.S.C. <del>290bb–2(e)) </del><ins>290bb-2(e)) </ins>is amended—
  - (1) by striking “The Secretary shall establish” and inserting:
    - “(1) In general—The Secretary shall establish”
  - (2) by adding at the end the following:
    - “(2) Geriatric substance use disorders treatment—The Secretary shall, as appropriate, provide technical assistance to grantees regarding evidence-based practices for the treatment of geriatric substance use disorders, as well as disseminate information about such evidence-based practices to States and nongrantees throughout the United States.”
- (b) Geriatric substance use disorders prevention— Section 516(e) of the Public Health Service Act (42 U.S.C. <del>290bb–22(e)) </del><ins>290bb-22(e)) </ins>is amended—
  - (1) by striking “The Secretary shall establish” and inserting:
    - “(1) In general—The Secretary shall establish”
  - (2) by adding at the end the following:
    - “(2) Geriatric substance use disorders prevention—The Secretary shall, as appropriate, provide technical assistance to grantees regarding evidence-based practices for the prevention of geriatric substance use disorders, as well as disseminate information about such evidence-based practices to States and nongrantees throughout the United States.”
- (c) Geriatric mental health disorders— Section 520A(e) of the Public Health Service Act (42 U.S.C. <del>290bb–32(e)) </del><ins>290bb-32(e)) </ins>is amended by adding at the end the following:
  - “(3) Geriatric mental health disorders—The Secretary shall, as appropriate, provide technical assistance to grantees regarding evidence-based practices for the prevention and treatment of geriatric mental health disorders, as well as disseminate information about such evidence-based practices to States and nongrantees throughout the United States.”