,i #aafth ,,congress #ast ,session ,h4 ,r4 #igc ,,in ,,the ,,house ,,of ,,representatives ,february #e1 #bjai,mrs4 ,dingell 7for herself1 ,mr4 ,katko1 ,ms4 ,clarke of ,new ,york1 ,ms4 ,castor of ,florida1 ,mrs4 ,rodgers of ,washington1 ,ms4 ,eshoo1 ,ms4 ,stefanik1 ,ms4 ,roybal-,allard1 ,mr4 ,crdenas1 ,ms4 ,wilson of ,florida1 ,miss ,gonzlez-,coln of ,puerto ,rico1 and ,mr4 ,marshall7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend the ,public ,health ,service ,act to provide for additional programs funded by grants to strengthen the healthcare system's response to domestic violence1 dating violence1 sexual assault1 and stalking1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,violence ,against ,women ,health ,act of #bjai4 #b4 ,findings ,congress finds that-- 7#a7 millions of ,americans continue to experience domestic or sexual violence each year with more than three women murdered by their partners each day2 7#b7 this type of violence and abuse results in short-term and chronic physical and behavioral health consequences that have a significant economic burden to victims and communities2 7#c7 new ,,cdc data found the lifetime per-victim cost of intimate partner violence was #ajc1gfg for women victims with #ei percent going to medical costs and public funding paid #cg percent of this total cost2 7#d7 victims are also at a higher risk for developing addictions to tobacco1 alcohol1 or drugs2 for example1 #ca percent to #fg percent of women in substance use disorder treatment programs report experiencing domestic violence within the past year2 7#e7 over #ej percent of survivors of domestic violence have experienced depression1 post-traumatic stress disorder1 and substance use and #bc percent have experienced suicidality2 7#f7 a study conducted by the ,national ,domestic ,violence ,hotline1 in conjunction with the ,national ,center on ,domestic ,violence1 ,trauma ,mental ,health practice mental health and substance use coercion where abusers intentionally undermine their partners' sanity or sobriety1 control their access to medication1 and sabotage their treatment and recovery efforts among other coercion tactics2 7#g7 researchers have also found that exposure to multiple childhood traumas such as sexual abuse and domestic violence can cause long-term negative physical and emotional health outcomes such as heart disease1 cancer and depression2 7#h7 health care providers can identify survivors of violence and interventions can decrease risk for violence and improve health outcomes1 but health providers need training and systems level support in order to do so2 7#i7 ,congress authorized a public health response to victims of domestic and sexual violence in the ,violence ,against ,women ,act of #bjje2 7#aj7 since its enactment1 the ,,vawa ,health program has trained more than #ac1jjj health care providers to assess for and respond to domestic and sexual violence in over #bcj clinical settings serving more than #a4c million patients2 7#aa7 last year1 the ,health ,resources ,services ,administration made this issue a priority across all of its bureaus and released the ,,hrsa ,strategy to ,address ,intimate ,partner ,violence #bjag-bjbj with four key priorities3 7,a7 ,train the ,nation's health care and public health workforce to address intimate partner violence 7,,ipv7 at the community and health systems levels4 7,b7 ,develop partnerships to raise awareness about ,,ipv within ,,hrsa and ,,hhs4 7,c7 ,increase access to quality ,,ipv-informed health care services across all populations4 7,d7 ,address gaps in knowledge about ,,ipv risks1 impacts1 and interventions42 and 7#ab7 a strong public health response can prevent and address the immediate and long-term health impacts of this type of violence and abuse4 #c4 ,grants to strengthen the health care system's response to domestic violence1 dating violence1 sexual assault1 and stalking1 and for other purposes ,section #cii,p of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g-#d7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#b71 by striking and at the end2 7,b7 in paragraph 7#c71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following3 7#d7 development or enhancement and implementation of training programs to improve the capacity of early childhood programs to address domestic violence1 dating violence1 sexual assault1 and stalking among families they serve4 2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,a77ii71 by inserting after and other forms of violence and abuse the following3 7including labor and sex trafficking72 and 7ii7 in subparagraph 7,b7-- 7,i7 in clause 7ii7-- 7aa7 by striking on-site access to2 and 7bb7 by striking or to model other services appropriate to the geographic and cultural needs of a site and inserting the following3 or by providing funding to national1 ,state1 ,tribal1 or territorial domestic and sexual violence coalitions to improve their capacity to coordinate and support health advocates and health system partnerships2 7,,ii7 in clause 7iii71 by striking and at the end2 7,,iii7 in clause 7iv71 by striking the period at the end and inserting 1 with priority given to programs administered through the ,health ,resources and ,services ,administration1 ,office of ,women's ,health2 and2 and 7,,iv7 by adding at the end the following3 7v7 the development1 dissemination1 and evaluation of best practices1 tools and training materials for behavioral health professionals to identify and respond to domestic violence1 sexual violence1 stalking1 and dating violence4 2 and 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,a71 to read as follows3 7,a7 ,child abuse and abuse in later life ,to the extent consistent with the purpose of this section1 a grantee may address1 as part of a comprehensive programmatic approach implemented under a grant under this section1 issues relating to child abuse or abuse in later life4 2 and 7ii7 in subparagraph 7,c7-- 7,i7 in clause 7i71 by striking elder abuse and inserting abuse in later life2 7,,ii7 in clause 7iv7-- 7aa7 by inserting 1 mental health after dental2 7bb7 by inserting and certification after exams2 and 7cc7 by striking the period at the end and inserting 2 and2 and 7,,iii7 by adding at the end the following3 7v7 development of a state-level pilot program to improve the response of substance use disorder treatment programs and systems to domestic violence1 dating violence1 sexual assault1 and stalking and the capacity of domestic violence1 dating violence1 sexual assault1 and stalking to serve survivors dealing with substance use disorder2 and 7vi7 development and utilization of existing technical assistance and training resources to improve the capacity of substance use disorder treatment programs to address domestic violence1 dating violence1 sexual assault1 and stalking among patients they serve4 2 7#c7 in subsection 7d77#b7-- 7,a7 in subparagraph 7,a7-- 7i7 by inserting or behavioral health1 after a ,state department 7or other division7 of health12 and 7ii7 by striking mental health care and inserting behavioral health care2 and 7,b7 in subparagraph 7,b7-- 7i7 by striking or health system and inserting behavioral health treatment system2 and 7ii7 by striking mental health care and inserting behavioral health care2 7#d7 in subsection 7f71 to read as follows3 7f7 ,research1 and evaluation1 and data collection 7#a7 ,in general ,of the funds made available to carry out this section for any fiscal year1 the ,secretary may use not more than #bj percent to make a grant or enter into a contract for research1 and evaluation1 or data collection of-- 7,a7 grants awarded under this section2 and 7,b7 other training for health professionals and effective interventions in the health care or behavioral health setting that prevent domestic violence1 dating violence1 and sexual assault across the lifespan1 prevent the health effects of such violence1 and improve the safety and health of individuals who are currently being victimized4 7#b7 ,research and ,data ,collection ,research or data collection authorized in paragraph 7#a7 may include-- 7,a7 research on the effects of domestic violence1 dating violence1 sexual assault1 and childhood exposure to domestic1 dating or sexual violence on health behaviors1 health conditions1 and health status of individuals1 families1 and populations1 including underserved populations2 7,b7 research to determine effective health care interventions to respond to and prevent domestic violence1 dating violence1 sexual assault1 and stalking2 7,c7 research on the impact of domestic1 dating and sexual violence1 childhood exposure to such violence1 and stalking on the health care system1 health care utilization1 health care costs1 and health status2 7,d7 research on the impact of adverse childhood experiences on adult experience with domestic violence1 dating violence1 sexual assault1 stalking and adult health outcomes1 including how to reduce or prevent the impact of adverse childhood experiences through the health care setting2 7,e7 research on the intersection of substance use disorder and domestic violence1 dating violence1 sexual assault1 and stalking1 including effect of coerced use and efforts by an abusive partner or other to interfere with substance use disorder treatment and recovery2 and 7,f7 improved data collection using existing federal surveys by including questions about domestic violence1 dating violence1 sexual assault1 or stalking and substance use disorder1 coerced use1 and mental health4 2 and 7#e7 in subsection 7g71 by striking #bjad through #bjah and inserting #bjai through #bjbc4