42 U.S.C. § 280g–4 — Grants to strengthen the healthcare system’s response to domestic violence, dating violence, sexual assault, and stalking

(a) In general: The Secretary must award grants for (1) developing or enhancing, and running, interdisciplinary training for health professionals, public health staff, community health workers, violence-prevention advocates who work with health providers, and allied health professionals; (2) developing or enhancing, and running, education programs for medical, psychology, dental, social work, nursing, and other health profession students, interns, residents, fellows, or current providers, including midwives and doulas; (3) developing or enhancing, and running, comprehensive statewide strategies to improve clinics', public health facilities', hospitals', and other health settings' (including behavioral and mental health programs') capacity to prevent and respond to domestic violence, dating violence, sexual assault, and stalking; (4) developing or enhancing, and running, training programs to improve early childhood programs' capacity to address these issues among the families they serve; and (5) developing or enhancing, and running, comprehensive statewide strategies for health and violence-prevention programs to work together to promote primary prevention of these issues. (b) Use of funds: (1) Required uses -- grant money must fund (A) interdisciplinary training and education under (a)(1)-(2) that (i) trains students, interns, residents, fellows, and current providers to give universal education on healthy relationships and trauma-informed health care, including mental or behavioral health services and referrals, to people who are or were victims; (ii) is planned and developed with culturally specific individuals and American Indian and Alaska Native communities, includes practices like doulas, midwives, and traditional healers, covers physical, mental, and behavioral health issues including protective factors related to these forms of violence and abuse (including labor and sex trafficking), focuses on reducing health inequities and preventing violence, and puts victim safety and confidentiality first; (iii) is designed to include the experiences of all individuals, including LGBT individuals, and covers improving equity and reducing disparities in access to care and prevention resources; and (iv) trains on a universal prevention education approach to both prevent and respond to these issues in health care settings; (B) comprehensive strategies under (a)(3) to improve the health system's capacity to prevent and respond to domestic or sexual violence, through (i) implementing, spreading, and evaluating policies and procedures guiding health professionals and public health staff to identify, respond to, and prevent these issues during in-person or virtual visits, protecting patient privacy and safety and using health IT to improve documentation while maximizing victim choice over their health information; (ii) developing services addressing patients' safety, medical, and mental health needs by (I) growing the capacity of existing providers -- including those specializing in trauma or substance use disorders -- community health workers, and public health staff to address these issues and children exposed to violence; (II) contracting with or hiring victim advocates to provide such services; or (III) funding State domestic and sexual violence coalitions to help them coordinate and support health advocates and system partnerships; (iii) developing measures and methods to evaluate prevention, intervention, and documentation practices during visits, matching the quality-measurement processes in section 1395aaa(b)(7)-(8) and section 1395aaa-1 of this title; (iv) giving training and follow-up technical assistance to providers, public health staff, and allied health professionals to identify, assess, treat, and refer victims, and to promote prevention during visits, using existing tools and materials; (v) developing, running, spreading, and evaluating best practices, tools, and training -- including culturally relevant ones -- for mental health, behavioral health, and substance use disorder professionals to identify and respond to these forms of violence; and (vi) developing and providing culturally relevant training and follow-up technical assistance to providers, public health staff, and allied health professionals to identify, assess, treat, and refer victims from culturally specific communities and promote prevention, using materials developed by and for those communities, prioritizing trainings from culturally specific organizations; and (C) comprehensive strategies to prevent domestic or sexual violence, including through universal education, in clinical and public health settings. (2) Permissible uses -- a grantee may (A) as part of a comprehensive program, address child abuse and abuse in later life; (B) under (a)(1)-(2), use funds to offer rural areas community-based training, including distance learning, for students and residents; and (C) under (a)(3), fund (i) training modules and policies addressing how child abuse, domestic violence, dating violence, sexual assault, stalking, and abuse in later life overlap, and childhood exposure to violence; (ii) sexual-assault prevention programs and forensic exam or nurse-examiner programs; (iii) folding lifetime and cross-generational exposure to violence, and related risk and protective factors, into health professional school curricula; (iv) integrating this knowledge into health care accreditation and licensing exams; (v) funding culturally specific organizations to partner with providers to support victims and meet referrals; (vi) a State-level pilot to improve substance use disorder treatment and harm reduction programs' response to and capacity to serve these victims, and improve violence programs' capacity to serve survivors with substance use histories; or (vii) developing and using existing technical assistance to help substance use disorder and harm reduction programs address these issues among patients they serve. (c) Requirements for grantees: (1)(A) Grantees must make sure programs address confidentiality and patient safety and comply with confidentiality rules under title 34, section 12291(b)(2) and the Family Violence Prevention and Services Act, that staff are fully trained to protect patients' and staff's ongoing security and confidentiality, and must consult outside experts on confidentiality and safety procedures and document that consultation. (B) Grantees must give patients advance notice of circumstances where information may be disclosed, such as mandatory reporting laws, and let patients get information and referrals without having to disclose abuse. (2) A grantee may use no more than 10 percent of its grant for administrative expenses. (3)(A) The Secretary must prefer applicants with strong evaluation strategies, prioritizing outcome-based evaluations, culturally and population-specific organizations, and community-driven programs. (B) Applicants for (a)(1)-(2) grants must document they represent a collaborating team including at least one accredited school of medicine, psychology, nursing, dentistry, social work, or another health field; one health care facility or system; and one government or nonprofit entity (including culturally specific or community-based organizations) with a history of effective work on these issues; and must give strategies for sharing curricula and materials with other health professions schools and national resource repositories. (C) Applicants for (a)(3) grants must submit an application including (i) documentation that all training, screening, services, and care will be informed by understanding of victimization and trauma-specific approaches; (ii) strategies (I) for policies preventing and addressing these issues across the lifespan and generations, and (II) addressing primary prevention, including social determinants of health, economic justice, equity, and LGBT-inclusiveness; (iii) a plan to consult State and tribal domestic violence or sexual assault coalitions, national victim advocacy organizations, and culturally and population-specific organizations; (iv) if the grantee will have patient contact, a referral plan built with local victim service providers, including culturally specific organizations, and documentation of an ongoing collaborative relationship with one; and (v) for grants funding programs under (b)(2)(C)(ii), a certification that forensic exam and nurse-examiner programs will follow Attorney General guidelines. (d) Eligible entities: (1) For funding under (a)(1) or (2), an entity must be (A) a nonprofit with a history of effective work training health professionals on these issues; (B) an accredited school of medicine, psychology, nursing, dentistry, social work, or allied health; (C) a health care provider membership or professional organization, or a health care system; or (D) a State, tribal, territorial, or local entity. (2) For funding under (a)(3), an entity must be (A) a State health (or mental health or substance abuse) department, a State, tribal, or territorial coalition or victim service provider, or another nonprofit with a history of effective work on these issues and health care; or (B) a local victim service provider, local health department, clinic, hospital, behavioral health or health system, or a community-based organization with relevant experience or a history of partnership on these issues and health care. (e) Technical assistance: (1) The Secretary may grant or contract for technical assistance on planning, developing, and running programs under this section, using no more than 8 percent of a fiscal year's appropriated funds. (2) The Secretary must make grantees' materials on training, best practices, research, and evaluation publicly available. (3) The Secretary must publish a report every two years on how funds were distributed and what programs and activities they supported. (f) Research and evaluation: (1) The Secretary may use no more than 20 percent of a fiscal year's funds to grant or contract for research and evaluation of (A) grants awarded under this section; and (B) other provider training and effective health-care-setting interventions that prevent these forms of violence across the lifespan, prevent their health effects, and improve the safety and health of people currently being victimized. (2) That research may cover (A) how these forms of violence and childhood exposure to them affect health behaviors, conditions, and status of individuals, families, and populations, including underserved populations; (B) which health care interventions effectively respond to and prevent these issues; (C) how they affect the health care system, health care use, costs, and status; and (D) how adverse childhood experiences affect adult experience of these issues and adult health outcomes, including how to reduce that impact through the health care setting. (g) Authorization of appropriations: Congress may spend $20,000,000 each year from 2023 through 2027. (h) Definitions: Except as otherwise provided, the definitions in title 34, section 12291 apply to this section.