Services and Trauma-informed Research of Outcomes in Neighborhoods Grants for Support for Children Act of 2021 or the STRONG Support for Children Act of 2021
This bill establishes two grant programs for governmental health departments to prevent and mitigate childhood trauma and adverse childhood experiences.
For the first program, the Department of Health and Human Services (HHS) must award grants to health departments to use data analysis methods to identify interventions to prevent and mitigate childhood trauma. Grant activities include using data analysis to identify geographic areas with a high prevalence of adverse childhood experiences and to implement strategies to improve outcomes for infants, children, and adolescents.
For the second program, HHS must award grants to local or tribal governments to establish or expand early childhood trauma-informed care coordination services, including by instituting risk and needs assessments to respond to adverse childhood experiences.
For both grants, the bill prohibits the use of funds for certain purposes, such as using the data analysis methods to inform individual case decisions, including child removals, or increasing the presence of law enforcement.
In addition, HHS must evaluate and report on these programs and make findings and recommendations publicly available on its website.
To amend the Public Health Service Act to support the development and 
    implementation of programs using data analysis to identify and 
 facilitate strategies to improve outcomes for children in geographic 
    areas with a high prevalence of trauma from exposure to adverse 
             childhood experiences, and for other purposes.

    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 ``Services and Trauma-informed 
Research of Outcomes in Neighborhoods Grants for Support for Children 
Act of 2021'' or the ``STRONG Support for Children Act of 2021''.

SEC. 2. FINDINGS.

    Congress finds that--
            (1) childhood trauma is a pervasive public health issue 
        with long-term negative effects that costs the United States 
        thousands of lives and billions of dollars;
            (2) addressing childhood and adolescent trauma requires a 
        comprehensive Federal approach that recognizes its severe 
        impact and prioritizes trauma-informed prevention and treatment 
        that is reparative, healing-centered, gender-responsive, 
        culturally specific, and community-based;
            (3) adults who have suffered from adverse childhood 
        experiences are at much greater risk of death, including as the 
        result of heart disease, lung disease, cancer, substance use 
        disorder, and suicide;
            (4) childhood and adolescent exposures to adverse childhood 
        experiences are generational and persistent and can lead to 
        complex trauma and toxic stress impacting brain development and 
        triggering epigenetics;
            (5) any Federal effort to prevent and treat trauma must 
        acknowledge and address the impact of historic and systemic 
        causal factors, which include, but are not limited to, the 
        trauma of--
                    (A) historical and ongoing systemic racism, sexism, 
                xenophobia, homophobia, transphobia, and ableism that 
                have led to generations of violence and injustice and 
                have robbed communities of their health, freedom, and 
                peace of mind;
                    (B) police brutality, racial profiling, and 
                criminalization, as well as heightened police activity 
                and surveillance in some areas with higher police-
                reported crime, whether as a result of community 
                violence or of racial profiling;
                    (C) poverty and other systemic inequities, 
                including lack of health care, housing instability, 
                poor housing conditions, hunger and food instability 
                and the accompanying malnutrition, and environmental 
                injustice resulting from generations of racist 
                policies, historic redlining, lending discrimination, 
                and workplace discrimination;
                    (D) gender-based violence, including sexual 
                harassment and assault and discriminatory school 
                discipline policies, especially for Black girls and 
                girls of color;
                    (E) western colonization and systemic divestment in 
                native communities;
                    (F) family separation policies, including ``zero-
                tolerance'' immigration enforcement policies that have 
                resulted in the deportation or the threat of 
                deportation for countless immigrant families and have 
                led to community mistrust and fear of reporting 
                injustices; and
                    (G) war and military presence, including the 
                increased militarization of local, State, and Federal 
                law enforcement agencies; and
            (6) the COVID-19 global health pandemic has increased and 
        exacerbated the trauma inflicted on young people, specifically 
        young people who--
                    (A) live in communities with higher rates of 
                infection and mortality;
                    (B) have parents who are essential workers or first 
                responders;
                    (C) have parents who have lost their sources of 
                income;
                    (D) have witnessed death;
                    (E) have had their education interrupted;
                    (F) are living without access to green space and 
                space for physical exercise;
                    (G) have become housing insecure and lack access to 
                nutritious food; and
                    (H) are isolated amidst increased domestic violence 
                and sexual assault.

SEC. 3. DATA ANALYSIS AND STRATEGY IMPLEMENTATION TO PREVENT AND 
              MITIGATE CHILDHOOD TRAUMA.

    Title XXXI of the Public Health Service Act (42 U.S.C. 300kk) is 
amended by adding at the end the following:

``SEC. 3102. DATA ANALYSIS AND STRATEGY IMPLEMENTATION TO PREVENT AND 
              MITIGATE CHILDHOOD TRAUMA.

    ``(a) In General.--The Secretary shall establish a program--
            ``(1) to support the development and implementation of 
        programs that use data analysis methods to identify and 
        facilitate strategies for early intervention and prevention, in 
        order to prevent and mitigate childhood trauma and support 
        communities and families, including--
                    ``(A) improving connections through care 
                coordination;
                    ``(B) aligning community initiatives in targeted 
                areas of need; and
                    ``(C) expanding community capacity through cross-
                sector collaboration; and
            ``(2) to evaluate the effectiveness of these programs in 
        improving outcomes for children.
    ``(b) Grants.--The Secretary shall award grants to up to 5 eligible 
entities to carry out the activities described in subsection (a).
    ``(c) Use of Funds.--A grant for activities under this section 
shall be used to support the development and implementation of programs 
that use data analysis methods to identify and facilitate strategies 
for early intervention and prevention, in order to prevent and mitigate 
childhood trauma and support communities and families, including as 
follows:
            ``(1) Utilize data analysis methods to--
                    ``(A) identify specific geographic areas, such as 
                census tracts, with a high prevalence of adverse 
                childhood experiences and significant risk factors for 
                poor outcomes for children (such as increased risk of 
                experiencing adverse childhood experiences), including 
                areas with high rates of--
                            ``(i) poor public health outcomes including 
                        illness, disease, suicide, and mortality;
                            ``(ii) exclusionary discipline practices, 
                        including suspensions, expulsions, and 
                        referrals to law enforcement, as well as low 
                        graduation rates;
                            ``(iii) substance use disorders;
                            ``(iv) poverty;
                            ``(v) foster system involvement or 
                        referrals;
                            ``(vi) housing instability and 
                        homelessness;
                            ``(vii) food insecurity;
                            ``(viii) inequity, including disparities in 
                        income, wealth, employment, educational 
                        attainment, health care access, and public 
                        health outcomes, along lines of race, sex, 
                        sexuality and gender identity, ethnicity, or 
                        nationality;
                            ``(ix) incarceration rates; or
                            ``(x) other indicators of adversity as 
                        defined by the Secretary; and
                    ``(B) identify strategies to improve outcomes for 
                children aged 0 through 17 that build on strengths in 
                communities that could be further supported, 
                including--
                            ``(i) existing support networks for 
                        families; and
                            ``(ii) enhanced connections to community-
                        based organizations.
            ``(2) Implement strategies identified pursuant to paragraph 
        (1)(B) to facilitate outreach and involvement of children and 
        their caregivers in Federal, State, or local programs that 
        provide reparative, gender-responsive, culturally specific, and 
        trauma-informed prevention services, and for which children and 
        their caregivers are eligible, including--
                    ``(A) home visiting programs;
                    ``(B) training and education on parenting skills;
                    ``(C) substance use disorder prevention and 
                treatment that is voluntary and noncoercive;
                    ``(D) mental health supports and care that is 
                voluntary and noncoercive;
                    ``(E) family and intimate partner violence 
                prevention services;
                    ``(F) child advocacy center programming;
                    ``(G) economic and nutrition support services;
                    ``(H) housing support services, including emergency 
                and temporary shelter for those experiencing 
                homelessness and housing insecurity, as well as stable, 
                long-term housing;
                    ``(I) voluntary, noncoercive, gender-responsive, 
                and culturally specific mental health supports in 
                school and early childhood education center-based 
                settings;
                    ``(J) wraparound programs for transitioning youth 
                and youth currently in the foster system;
                    ``(K) programming to support the health and well-
                being of lesbian, gay, bisexual, transgender, and 
                intersex children and their families; and
                    ``(L) family resource center services.
    ``(d) Special Rules.--
            ``(1) Primary payer restriction.--The Secretary may not 
        award a grant under this section to an eligible entity for a 
        service if the service to be provided is available pursuant to 
        the State plan approved under title XIX of the Social Security 
        Act for the State in which the program funded by the grant is 
        being conducted unless the State and all eligible subdivisions 
        involved--
                    ``(A) will enter into agreements with public or 
                nonprofit private entities under which the entities 
                will provide the service; and
                    ``(B) demonstrate that the State and all eligible 
                subdivisions will ensure that the entities providing 
                the service--
                            ``(i) will seek payment for each such 
                        service rendered in accordance with the usual 
                        payment schedule under the State plan; and
                            ``(ii) the entities have entered into a 
                        participation agreement and are qualified to 
                        receive payments under such plan.
            ``(2) Implementation.--An eligible entity that receives a 
        grant under this section may use--
                    ``(A) not more than 25 percent of the amounts made 
                available through the grant for the first 24 months of 
                the grant period to utilize data analysis methods to--
                            ``(i) identify specific geographic areas 
                        where care coordination, prevention and early 
                        intervention, and facilitation services will be 
                        provided; and
                            ``(ii) identify support and intervention 
                        services to improve outcomes for children 
                        located in a geographic area identified under 
                        subsection (c)(1)(A); and
                    ``(B) not more than 10 percent of the grant in each 
                subsequent year to continue data analysis activities.
            ``(3) Administration.--An eligible entity that receives a 
        grant under this section may not use more than 5 percent of 
        amounts received through the grant for administration, 
        reporting, and program oversight functions, including the 
        development of systems to improve data collection and data 
        sharing for the purposes of improving services and the 
        provision of care.
            ``(4) Priority.--
                    ``(A) In general.--In awarding grants under this 
                section, the Secretary shall give priority, to the 
                extent practical, to eligible entities that use 
                community-based system dynamic modeling as the primary 
                data analysis method.
                    ``(B) System dynamic modeling defined.--The term 
                `system dynamic modeling' means a method of data 
                analysis and predictive modeling that includes--
                            ``(i) utilization of community-based 
                        participatory research methods for involving 
                        community in the process of understanding and 
                        changing systems and evaluating outcomes of 
                        grants;
                            ``(ii) consideration of a multitude of 
                        environmental risk factors and ascertainment of 
                        the significance of contributing community risk 
                        factors for purposes of identifying strategies 
                        to reduce adverse child outcomes, including--
                                    ``(I) maltreatment cases;
                                    ``(II) involvement with the 
                                juvenile criminal legal system or 
                                foster system;
                                    ``(III) exclusionary school 
                                discipline; or
                                    ``(IV) exposure to violence; and
                            ``(iii) identification of cross-sector 
                        responses involving reparative, trauma-
                        informed, culturally specific, gender-
                        responsive, and community-based organizations 
                        to reduce adverse child outcomes.
            ``(5) Subgrant.--
                    ``(A) In general.--An eligible entity that receives 
                a grant under this section shall use at least 25 
                percent of the total amount of the grant to make 
                subgrants to organizations that aide in implementing 
                the strategy identified under subsection (c)(1)(B) for 
                preventing and mitigating childhood trauma and 
                supporting communities and families.
                    ``(B) Eligibility.--To be eligible to receive a 
                subgrant under this paragraph, an organization shall 
                prepare and submit to the eligible entity an 
                application in such form, and containing such 
                information, as the eligible entity may require, 
                including evidence that the--
                            ``(i) needs of the population to be served 
                        are urgent and are not met by the services 
                        currently available in the geographic area; and
                            ``(ii) the organization has the capacity to 
                        provide the services listed in subsection 
                        (c)(2).
                    ``(C) Supplement not supplant.--Subgrant funds 
                received pursuant to this paragraph by an organization 
                shall be used to supplement and not supplant State or 
                local funds provided to the partnership organization 
                for services listed in subsection (c)(2).
    ``(e) Application.--To be eligible to receive a grant under this 
section, an eligible entity shall submit to the Secretary an 
application in such form, and containing such information, as the 
Secretary may require, to include the following:
            ``(1) A demonstration that--
                    ``(A) the applicant utilizes trauma-informed, 
                culturally specific, and gender-responsive practices, 
                including a demonstration of the extent to which the 
                applicant has trained staff in these practices;
                    ``(B) the applicant has the capacity to administer 
                the grant, including conducting all required data 
                analysis activities; and
                    ``(C) services will be provided to children and 
                families in an accessible, culturally relevant, and 
                linguistically specific manner consistent with local 
                needs.
            ``(2) A preliminary analysis of how the applicant will use 
        the grant to--
                    ``(A) identify the geographic area or areas to be 
                served using data analysis methods;
                    ``(B) utilize data analysis methods to identify 
                strategies to improve outcomes for children in the 
                geographic area;
                    ``(C) facilitate strategies identified through care 
                coordination efforts; and
                    ``(D) track data for evaluation of outcomes.
            ``(3) A detailed project plan for the use of the grant that 
        includes anticipated technical assistance needs.
            ``(4) Additional funding sources, including State and local 
        funds, supporting the prevention and mitigation of adverse 
        childhood experiences.
    ``(f) Grant Amount.--The amount of a grant under this section shall 
not exceed $9,500,000.
    ``(g) Period of a Grant.--The period of a grant under this section 
shall not exceed 7 years.
    ``(h) Service Provision Without Regard to Ability To Pay.--As a 
condition on receipt of a grant under this section, an eligible entity 
shall agree that any assistance provided to an individual through the 
grant will be provided without regard to--
            ``(1) the ability of the individual to pay for such 
        services;
            ``(2) the current or past health condition of the 
        individual to be served;
            ``(3) the immigration status of the individual to be 
        served;
            ``(4) the sexual orientation and gender identity of the 
        individual to be served; and
            ``(5) any prior involvement of the individual in the 
        criminal legal system.
    ``(i) Prohibitions.--In addition to any other prohibitions 
determined by the Secretary, an eligible entity may not use a grant 
under this section to--
            ``(1) use data analysis methods to inform individual case 
        decisions, including child removal or placement decisions, or 
        to target services at certain individuals or families;
            ``(2) require any individual or family to participate in 
        any service or program as a condition of receipt of a benefit 
        to which the individual or family is otherwise eligible;
            ``(3) increase the presence or funding of law enforcement 
        surveillance, involvement, or activity in implementing the 
        strategies identified under subsection (c)(1)(B); or
            ``(4) enable the practice of conversion therapy.
    ``(j) Evaluation.--
            ``(1) Data model evaluation.--Not later than 36 months 
        after the date of enactment of this section, the Assistant 
        Secretary for Planning and Evaluation of the Department of 
        Health and Human Services, in coordination with the grantees 
        receiving a grant under this section, shall complete an 
        evaluation of the effectiveness of the data model accuracy of 
        the grant program under this section to address each of the 
        following:
                    ``(A) Determining the effectiveness of the 
                grantees' use of data analysis methods to identify 
                geographic areas pursuant to subsection (c)(1).
                    ``(B) Examining the grantees' development and 
                utilization of data analysis methods.
                    ``(C) Examining the grantees' ability to 
                effectively utilize data analysis methods in future 
                prevention work.
                    ``(D) Establishing a method for rigorously 
                evaluating the activities of grantees and comparing the 
                reduction of child and family exposure to adverse 
                experiences in other communities with similar 
                demographics.
                    ``(E) Examining the grantees' utilization of 
                community-based system dynamics modeling methods and 
                other community engagement methods.
            ``(2) Program evaluation.--Not later than 6 years after the 
        date of enactment of this section, the Assistant Secretary for 
        Planning and Evaluation of the Department of Health and Human 
        Services, in coordination with eligible entities receiving 
        grants under this section, shall complete an evaluation of the 
        effectiveness of the grant program under this section.
            ``(3) Data collection.--
                    ``(A) In general.--The Assistant Secretary for 
                Planning and Evaluation of the Department of Health and 
                Human Services and each eligible entity receiving a 
                grant under this section shall collect any relevant 
                data necessary to complete the evaluations required by 
                paragraphs (1) and (2) to include--
                            ``(i) the activities funded by the grant 
                        under this section, including development and 
                        implementation data analysis methods;
                            ``(ii) the number of children and of 
                        families receiving coordination and 
                        facilitation of care and services; and
                            ``(iii) the effect of activities supported 
                        by the grant under this section on the local 
                        area serviced by the program, including such 
                        effects on--
                                    ``(I) children and adolescents' 
                                health and well-being;
                                    ``(II) the number of children who 
                                enter into or depart from foster 
                                services; and
                                    ``(III) homelessness and housing 
                                insecurity.
                    ``(B) Study.--
                            ``(i) In general.--Not later than 7 years 
                        after the date of enactment of this section, 
                        the Assistant Secretary for Planning and 
                        Evaluation of the Department of Health and 
                        Human Services shall--
                                    ``(I) complete a study on the 
                                results of the grant program under this 
                                section using the community-based 
                                participatory action research method, 
                                which focuses on social, structural, 
                                and physical environmental inequities 
                                through active involvement of community 
                                members, clients, organizational 
                                representatives, and researchers in all 
                                aspects of the research process; and
                                    ``(II) submit a report on the 
                                results of the study to the Congress.
                            ``(ii) Partners.--In conducting the study 
                        under clause (i), the Assistant Secretary for 
                        Planning and Evaluation of the Department of 
                        Health and Human Services shall ensure that 
                        partners and persons that have participated in 
                        the grant program under this section on every 
                        level, especially those such partners or 
                        persons receiving services and support through 
                        the program, have an opportunity to contribute 
                        their expertise to evaluating the strategy and 
                        outcomes.
    ``(k) Report.--Not later than three months after the completion of 
the evaluation required by subsection (j)(2), the Assistant Secretary 
for Planning and Evaluation of the Department of Health and Human 
Services shall submit to Congress and make available to the public on 
the internet website of the Department of Health and Human Services a 
report based upon the evaluation under subsection (j)(2), to include--
            ``(1) the impact of the program under this section on 
        homelessness and housing insecurity, substance use disorder and 
        drug deaths, incarceration, foster system involvement, and 
        other child and family outcomes as identified by the Assistant 
        Secretary for Planning and Evaluation of the Department of 
        Health and Human Services;
            ``(2) an analysis of which elements of the program should 
        be replicated and scaled by governmental or non-governmental 
        entities; and
            ``(3) such recommendations for legislation and 
        administrative action as the Secretary determines appropriate.
    ``(l) Definition.--In this section:
            ``(1) The term `adverse childhood experience' means a 
        potentially traumatic experience that occurs in childhood and 
        can have a tremendous impact on the child's lifelong health and 
        opportunity outcomes, such as any of the following:
                    ``(A) Abuse, such as any of the following:
                            ``(i) Emotional and psychological abuse.
                            ``(ii) Physical abuse.
                            ``(iii) Sexual abuse.
                    ``(B) Household challenges such as any of the 
                following:
                            ``(i) A household member is treated 
                        violently.
                            ``(ii) A household member has a substance 
                        use disorder.
                            ``(iii) A household member has a mental 
                        health condition.
                            ``(iv) Parental separation or divorce.
                            ``(v) A household member is incarcerated, 
                        placed in immigrant detention, or has been 
                        deported.
                            ``(vi) A household member has a life-
                        threatening illness such as COVID-19.
                    ``(C) Neglect.
                    ``(D) Living in--
                            ``(i) impoverished communities that lack 
                        access to human services;
                            ``(ii) areas of high unemployment 
                        neighborhoods; or
                            ``(iii) communities experiencing de facto 
                        segregation.
                    ``(E) Experiencing food insecurity and poor 
                nutrition.
                    ``(F) Witnessing violence.
                    ``(G) Involvement with the foster system.
                    ``(H) Experiencing discrimination.
                    ``(I) Dealing with historical and ongoing traumas 
                due to systemic and interpersonal racism.
                    ``(J) Dealing with historical and ongoing traumas 
                regarding systemic and interpersonal sexism, 
                homophobia, biphobia, and transphobia.
                    ``(K) Dealing with the threat of deportation or 
                detention as a result of immigration status.
                    ``(L) The impacts of multigenerational poverty 
                resulting from limited educational and economic 
                opportunities.
                    ``(M) Living through natural disasters such as 
                earthquakes, forest fires, floods, or hurricanes.
            ``(2) The term `eligible entity' means a State or local 
        health department.
            ``(3) The term `practice of conversion therapy'--
                    ``(A) means any practice or treatment by any person 
                that seeks to change another individual's sexual 
                orientation or gender identity, including efforts to 
                change behaviors or gender expressions, or to eliminate 
                or reduce sexual or romantic attractions or feelings 
                toward individuals of the same gender, if such person 
                receives monetary compensation in exchange for any such 
                practice or treatment; and
                    ``(B) does not include any practice or treatment 
                that does not seek to change sexual orientation or 
                gender identity and--
                            ``(i) provides assistance to an individual 
                        undergoing a gender transition; or
                            ``(ii) provides acceptance, support, and 
                        understanding of a client or facilitation of a 
                        client's coping, social support, and identity 
                        exploration and development.
    ``(m) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section for the period of fiscal years 
2021 through 2028--
            ``(1) to carry out subsection (a)(1) through the award of 
        grants under subsection (b)--
                    ``(A) $47,500,000 for grants; and
                    ``(B) such sums as may be necessary for the 
                administrative costs of carrying out such subsection; 
                and
            ``(2) $7,500,000 to carry out the evaluation under 
        subsection (a)(2).''.

SEC. 4. CARE COORDINATION GRANTS.

    Part E of title XII of the Public Health Service Act (42 U.S.C. 
300d-51 et seq.) is amended by adding at the end the following new 
section:

``SEC. 1255. CARE COORDINATION GRANTS.

    ``(a) In General.--The Secretary shall award grants to eligible 
entities to establish or expand trauma-informed care coordination 
services to support--
            ``(1) children aged 0 through 5 at risk of adverse 
        childhood experiences; and
            ``(2) their caregivers, including prenatal people of any 
        age.
    ``(b) Number of Grants.--Subject to the availability of 
appropriations, the Secretary shall award not fewer than 9 and not more 
than 40 grants under this section.
    ``(c) Amount of Grants.--Subject to the availability of 
appropriations, the amount of a grant under this section for a fiscal 
year shall be--
            ``(1) not less than $250,000; and
            ``(2) not more than $1,000,000.
    ``(d) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall be a local government or Indian Tribe, 
acting through the public health department thereof if such government 
or Tribe has a public health department.
    ``(e) Priority.--
            ``(1) In general.--In awarding grants under this section, 
        the Secretary shall give priority to eligible entities 
        proposing to serve communities with a high need for trauma-
        informed care coordination services, as demonstrated by 
        indicators such as--
                    ``(A) pregnant people who face barriers to prenatal 
                care;
                    ``(B) mortality or morbidity of people giving birth 
                or infants;
                    ``(C) caretakers and parents who are living with a 
                mental health condition or substance use disorder;
                    ``(D) a high prevalence of community violence, 
                including domestic violence, as demonstrated by 
                instances of homicide and public health statistics, 
                including treatment of injury or trauma;
                    ``(E) high proportions of low-income children;
                    ``(F) a high prevalence of child fatalities or near 
                fatalities related to child abuse and neglect;
                    ``(G) significant disparities in health outcomes 
                for people giving birth and infants;
                    ``(H) a high rate of exclusionary discipline and 
                referrals to law enforcement; and
                    ``(I) a high rate of homelessness and housing 
                instability.
            ``(2) Data from tribal areas.--The Secretary, acting 
        through the Director of the Indian Health Service, shall 
        consult with Indian Tribes to establish criteria to measure 
        indicators of need, for purposes of paragraph (1), with respect 
        to Tribal areas.
    ``(f) Use of Funds.--
            ``(1) Required uses.--
                    ``(A) In general.--A grant received under this 
                section shall be used to establish or expand gender-
                responsive, culturally specific, trauma-informed care 
                coordination services, including by instituting and 
                conducting risk and needs assessments including--
                            ``(i) using strengths-based approaches 
                        focused on protective factors for children and 
                        their caregivers, including prenatal people of 
                        any age; and
                            ``(ii) inputting screening results into a 
                        centralized intake system to promote a single 
                        point of access system across providers and 
                        services.
                    ``(B) Training.--A grant received under this 
                section shall be used to ensure that individuals 
                employed through the grant funds, in whole or in part, 
                have received sufficient and up-to-date training on 
                trauma-informed care and strategies that are 
                reparative, culturally sensitive, gender-responsive, 
                and healing-centered.
            ``(2) Permissible uses.--A grant received under this 
        section may be used for any of the following:
                    ``(A) Employing care coordinators, case managers, 
                community health workers, certified infant mental 
                health specialists, and outreach and engagement 
                specialists to work with children and their caregivers, 
                including prenatal individuals, to prevent and respond 
                to adverse childhood experiences by connecting clients 
                with culturally specific, trauma-informed care 
                treatment services, including economic, social, food, 
                and housing supports.
                    ``(B) Providing training described in paragraph 
                (1)(B) to community health providers and community 
                partners.
                    ``(C) Expanding, enhancing, modifying, and 
                connecting the existing network of community programs 
                and services to achieve a more comprehensive and 
                coordinated system of care approach, including--
                            ``(i) developing local infrastructure to 
                        bolster and shape community support systems and 
                        map and build access to services in a 
                        coordinated and comprehensive way; and
                            ``(ii) creating infrastructure to conduct 
                        outreach to children and families, including 
                        those experiencing homelessness and housing 
                        instability, so they acquire access to the 
                        services and supports they need and the 
                        benefits to which they are entitled.
                    ``(D) Compiling information on resources (including 
                any referral services) available through community-
                based organizations and local, State, and Federal 
                agencies, such as--
                            ``(i) programs addressing social 
                        determinants of health, including--
                                    ``(I) emergency, temporary, and 
                                long-term housing;
                                    ``(II) programs that offer free or 
                                affordable and nutritious food;
                                    ``(III) vocational and workforce 
                                development; and
                                    ``(IV) transportation supports;
                            ``(ii) home visiting programs for new 
                        parents and their infants;
                            ``(iii) workforce development programs to 
                        support caregivers in skill building;
                            ``(iv) trauma-responsive, parenting skills-
                        building programs;
                            ``(v) the continuum of substance use 
                        prevention, intervention, and treatment 
                        programs and mental health support programs, 
                        including programs with trauma-informed, 
                        gender-responsive, and culturally specific 
                        counseling; and
                            ``(vi) childcare support and early 
                        childhood education, including Head Start and 
                        Early Head Start programs.
                    ``(E) Subject to subsection (g)(2), establishing or 
                updating a database that compiles data used to track 
                the effectiveness of the care coordination services 
                funded through the grant.
                    ``(F) Developing and implementing referral 
                partnership agreements with community-based 
                organizations, parent organizations, substance use 
                disorder treatment providers and facilities, housing 
                and shelter providers, health care providers, mental 
                health care providers, and Federal and State offices 
                and programs that implement practices to support 
                children ages 0 through 5 who are at risk of adverse 
                childhood experiences and their caregivers, including 
                prenatal people. Such practices shall include--
                            ``(i) a bilateral `warm handoff' system 
                        whereby a grantee understands the needs of the 
                        children and their families, and families are 
                        involved in addressing these needs; and
                            ``(ii) an active service connection whereby 
                        the children and families are each actively 
                        connected with a resource in a well-coordinated 
                        way that ensures availability and direct 
                        contact.
                    ``(G) Supporting cross-system planning and 
                collaboration among employees who may work in emergency 
                medical services, health care services, public health, 
                early childhood education, and substance use disorder 
                treatment and recovery support.
                    ``(H) Providing or subsidizing services to address 
                barriers that children, prenatal individuals, and 
                caregivers face to utilizing community resources and 
                services, such as by providing or subsidizing 
                transportation or childcare costs as applicable and 
                within reasonable amounts.
                    ``(I) Creating or expanding infrastructure and 
                investing in technology, including the provision of 
                communications technology and internet service to 
                children and their caregivers, to enable increased 
                telemedicine capabilities to reach participants.
            ``(3) Indian tribes.--In the case of an eligible entity 
        that is an Indian tribe, the Secretary may waive such 
        provisions of this subsection as the Secretary determines 
        appropriate.
            ``(4) Prohibitions.--In addition to any other prohibitions 
        determined by the Secretary, an eligible entity may not use a 
        grant under this section to--
                    ``(A) use data analysis methods to inform 
                individual case decisions, including child removal or 
                placement decisions, or to target services at certain 
                individuals or families;
                    ``(B) require any individual or family to 
                participate in any service or program as a condition of 
                receipt of a benefit to which the individual or family 
                is otherwise eligible; or
                    ``(C) increase the presence or funding of law 
                enforcement surveillance, involvement, or activity in 
                connection with trauma-informed care coordination 
                services supported pursuant to this section.
    ``(g) Requirements.--As a condition on receipt of a grant under 
this section, an eligible entity shall agree to each of the following 
funding conditions:
            ``(1) Restriction of funding allocation.--The eligible 
        entity will not use more than 30 percent of the funds made 
        available to the entity through the grant (for the total grant 
        period) to establish or update a database pursuant to 
        subsection (f)(2)(E).
            ``(2) Accessible setting.--
                    ``(A) In general.--The eligible entity will ensure 
                that all care coordination services provided through 
                the grant are provided in a setting that is accessible, 
                including through mobile settings, to--
                            ``(i) low-income or no-income individuals, 
                        including individuals experiencing homelessness 
                        or housing instability; and
                            ``(ii) individuals in rural areas.
                    ``(B) Community outreach.--In complying with 
                subparagraph (A), the eligible entity will ensure that 
                at least 50 percent of the care coordination services 
                provided through the grant occur in community settings 
                that are convenient to the children and caregivers who 
                are being served, such as homes, schools, and shelters, 
                whether for initial outreach or as part of long-term 
                care.
            ``(3) Supplement not supplant.--The grant will be used to 
        supplement not supplant other Federal, State, or local funds 
        available for care coordination services.
            ``(4) Confidentiality.--The eligible entity will maintain 
        the confidentiality of individuals receiving services through 
        the grant in a manner consistent with applicable law.
            ``(5) Partnering; risk stratification.--In providing care 
        coordination services through the grant, the eligible entity 
        will--
                    ``(A) partner with community-based organizations 
                with experience serving child populations prenatally 
                through age 5;
                    ``(B) coordinate with the local agency responsible 
                for administering the State plan approved under title 
                XIX of the Social Security Act; and
                    ``(C) employ risk stratification to develop 
                different effective models of care for different 
                populations based on their needs.
    ``(h) Application.--
            ``(1) In general.--To seek a grant under this section, an 
        eligible entity shall submit an application to the Secretary at 
        such time, in such manner, and containing such information, as 
        the Secretary may require.
            ``(2) Contents.--An application under paragraph (1) shall, 
        at a minimum, contain each of the following:
                    ``(A) Goals to be achieved through the grant, 
                including the activities that will be undertaken to 
                achieve those goals.
                    ``(B) The number of individuals likely to be served 
                through the grant, including demographic data on the 
                populations to be served.
                    ``(C) Existing programs and services that can be 
                used to significantly increase the proportion of 
                children and families who receive needed supports and 
                services.
                    ``(D) A plan for expanding, coordinating, or 
                modifying the existing network of programs and services 
                to meet the needs of children and families for 
                preventing and mitigating the traumatic impact of 
                adverse childhood experiences.
                    ``(E) A demonstration of the ability of the 
                eligible entity to reach the individuals to be served, 
                including by partnering with local stakeholders.
                    ``(F) An indication of how the personnel involved 
                are reflective of the communities to be served.
                    ``(G) A list of stakeholders with whom the entity 
                plans to partner or consult.
    ``(i) Reporting by Grantees.--Not later than 4 years after the date 
of enactment of this section, an eligible entity receiving a grant 
under this section shall submit to the Secretary a report on the 
activities funded through the grant. Such report shall include, at a 
minimum, a description of--
            ``(1) the number of individuals served through activities 
        funded through the grant, including demographics as applicable;
            ``(2) the number of referrals made through the grant and 
        the rate of such referrals successfully linked or closed;
            ``(3) a qualitative analysis or number of collaborative 
        partnerships with other organizations in carrying out the 
        activities funded through the grant;
            ``(4) the number of services provided to individuals 
        through the grant;
            ``(5) aggregated and de-identified outcomes experienced by 
        individuals served through the grant such as--
                    ``(A) the rate of successful service connections;
                    ``(B) any increases in development of protective 
                factors for children;
                    ``(C) any increase in development of protective 
                factors for the caregivers;
                    ``(D) any mitigation of the negative outcomes 
                associated with adverse childhood experiences or 
                decreased likelihood of children experiencing an 
                adverse childhood experience as evidenced by--
                            ``(i) decreased presence of law enforcement 
                        or other punitive State surveillance in the 
                        community;
                            ``(ii) a parent completing substance use 
                        treatment;
                            ``(iii) a parent receiving voluntary 
                        treatment for mental health-related conditions;
                            ``(iv) a family entering into or 
                        maintaining a stable housing situation;
                            ``(v) a family achieving or maintaining 
                        economic security;
                            ``(vi) a parent achieving or maintaining 
                        job stability; or
                            ``(vii) a child meeting developmental 
                        markers for school readiness; and
                    ``(E) reports of satisfaction with the coordination 
                of care by people served; and
            ``(6) any other information required by the Secretary.
    ``(j) Convening Participants for Sharing Lessons Learned.--After 
the period of all grants awarded under this section has concluded, the 
Assistant Secretary for Planning and Evaluation of the Department of 
Health and Human Services shall provide an in-person or online 
opportunity for persons participating in the programs funded through 
this section to share with each other--
            ``(1) lessons learned;
            ``(2) challenges experienced; and
            ``(3) ideas for next steps and solutions.
    ``(k) Compiling Findings and Conclusions.--After providing the 
opportunity required by subsection (j), the Secretary shall--
            ``(1) compile the findings and conclusions of grantees 
        under this section on the provision of care coordination 
        services described in subsection (a);
            ``(2) submit a report on such findings and conclusions to 
        the appropriate congressional committees; and
            ``(3) make such report publicly available.
    ``(l) Definitions.--In this section:
            ``(1) Adverse childhood experience.--The term `adverse 
        childhood experience' means a potentially traumatic experience 
        that occurs in childhood and can have a tremendous impact on 
        the child's lifelong health and opportunity outcomes, such as 
        any of the following:
                    ``(A) Abuse, such as any of the following:
                            ``(i) Emotional and psychological abuse.
                            ``(ii) Physical abuse.
                            ``(iii) Sexual abuse.
                    ``(B) Household challenges such as any of the 
                following:
                            ``(i) A household member is treated 
                        violently.
                            ``(ii) A household member has a substance 
                        use disorder.
                            ``(iii) A household member has a mental 
                        health condition.
                            ``(iv) Parental separation or divorce.
                            ``(v) A household member is incarcerated, 
                        placed in immigrant detention, or has been 
                        deported.
                            ``(vi) A household member has a life-
                        threatening illness such as COVID-19.
                    ``(C) Neglect.
                    ``(D) Living in--
                            ``(i) impoverished communities that lack 
                        access to human services;
                            ``(ii) areas of high unemployment 
                        neighborhoods; or
                            ``(iii) communities experiencing de facto 
                        segregation.
                    ``(E) Experiencing food insecurity and poor 
                nutrition.
                    ``(F) Witnessing violence.
                    ``(G) Involvement with the foster system.
                    ``(H) Experiencing discrimination.
                    ``(I) Dealing with historical and ongoing traumas 
                due to systemic and interpersonal racism.
                    ``(J) Dealing with historical and ongoing traumas 
                regarding systemic and interpersonal sexism, 
                homophobia, biphobia, and transphobia.
                    ``(K) Dealing with the threat of deportation or 
                detention as a result of immigration status.
                    ``(L) The impacts of multigenerational poverty 
                resulting from limited educational and economic 
                opportunities.
                    ``(M) Living through natural disasters such as 
                earthquakes, forest fires, floods, or hurricanes.
            ``(2) Care coordination.--The term `care coordination' 
        means an active, ongoing process that--
                    ``(A) assists children ages 0 through 5 at risk of, 
                or who have experienced, an adverse childhood 
                experience, and their caregivers, including prenatal 
                people of any age, to identify, access, and use 
                community resources and services;
                    ``(B) is client-centered and comprehensive of the 
                services a child or caregiver may need;
                    ``(C) ensures a closed loop referral by obtaining 
                feedback from the families served; and
                    ``(D) works across systems and services to promote 
                collaboration to effectively meet the needs of 
                community members.
            ``(3) Indian tribe.--The term `Indian Tribe' has the 
        meaning given such term in section 4 of the Indian Self-
        Determination and Education Assistance Act.
            ``(4) Protective factors.--The term `protective factors' 
        refers to any supportive element in a child or caretaker's life 
        that helps the child or caretaker to withstand trauma such as a 
        stable school environment or supportive peer relationships.
    ``(m) Authorization of Appropriations.--
            ``(1) In general.--To carry out this section, there is 
        authorized to be appropriated $15,000,000 for each of the 5 
        fiscal years following the fiscal year in which this section is 
        enacted.
            ``(2) Grants to indian tribes.--Of the amount made 
        available to carry out this section for a fiscal year, the 
        Secretary shall use not less than 10 percent of such amount for 
        grants to eligible entities that are Indian tribes.
            ``(3) Administrative expenses.--Of the amount made 
        available to carry out this section for a fiscal year, the 
        Secretary may use not more than 15 percent of such amount for 
        administrative expenses, including the expenses of the 
        Assistant Secretary for Planning and Evaluation of the 
        Department of Health and Human Services for compiling and 
        reporting information.
            ``(4) Technical assistance.--Of the amount made available 
        to carry out this section for a fiscal year, the Secretary may 
        reserve up to 5 percent of such amount to provide technical 
        assistance to eligible entities in preparing and submitting 
        applications under this section.''.
                                 <all>
STRONG Support for Children Act of 2021
To amend the Public Health Service Act to support the development and implementation of programs using data analysis to identify and facilitate strategies to improve outcomes for children in geographic areas with a high prevalence of trauma from exposure to adverse childhood experiences, and for other purposes.
STRONG Support for Children Act of 2021
Services and Trauma-informed Research of Outcomes in Neighborhoods Grants for Support for Children Act of 2021
Rep. Pressley, Ayanna