thank you all, very much. [applause] ...

back here to test iv for about the work of the substance abuse administration is doing to help our needs. the 21st century cures act

was based on those with a mental health crisis from 2016 with pat by a vote 422/two hired to conclusion this legislative effort has significant reforms to the mental health and more than a decade. the first provision within the mental health provision strengthen the leadership including establishing that the position that dr. mccance-katz hold on her duties is to develop a strategic plan at the end of the year. also to strengthen the existing programs including the community health block grant and the substance lot grant that each state and

community is differences law provides flexibility to state for unique dental health needs. additionally to authorize that national mental health policy laboratory to carry out existing and new activities until the mental health policy umbrella including awarding grants for promising service delivery model with evidence-based programs. access to mental health disorder care with the overall health of our nation according to the national alliance one out of five adults experienced mental illness. of those who suffering only a little more than 40% received services. title ix of 21st century cures act focuses access on the care this is authorized to strengthen several existing programs that were not in the

statute. provide mental health and substance abuse disorder the jail version programs additionally it authorized a program with my maryland -- primary care through a demonstration project notably the 21st century cures act act that the target population to include additional populations such as certain qualifying children and adolescents. cdc recently released a vital signs report showing arising suicide rate across united states. in 2016 we lost nearly 45000 lives to suicide. twenty-first century cures act aims to give additional resources by codifying the national suicide hotline to authorize the suicide

prevention resource center and use suicide eight grant the existence of all these programs would be far less impactful if we could not have an adequate workforce to provide services therefore the entire subtitle directed to strengthening the mental behavioral healthcare workforce training grants and immigration programs and other needs. tears establish several programs to address mental health needs such as mothers and children to provide grants to statewide or regional pediatric mental health care access programs. such programs could be especially helpful in early identification of the mental health issues of school age children this is especially critical because 50% of all chronic illness begins by 1421st century cures act long thought reforms as a result of thoughtful bipartisan

legislation created over the course of several years while this reflects our diligence and commitment to improving the overall mental health there is work that remains to be done. i yelled back that balance of my time and i recognize the ranking member for an opening statement. >> thank you mr. chairman for holding today's hearing on the t century cures act we are examining division c focusing on mental health programs and activities administered by the t5 and thank you to dr. mccance-katz for her joining us this morning the enactment of 21st century cures act december 2016 was a great achievement at a time of sharp partisanship and gridlock but the work hard and long before 2016 led by colleagues and all

of us on the committee were participants and in 2014 we set out to do something positive to boost medical research and innovation to accelerate the discovery and development of new cures and treatment. after countless hours with the white papers and hearings and drafts to enjoy bipartisan support endorsements from 700 organization representing the full spectrum of the stakeholders. the investment and new authorities are intended to go for far too small the problems given new treatment from the table to the bedside to strengthen the nation's public health infrastructure. the cures act made several changes to mental health authorities and programs implemented by samsa with several existing mental health programs for example the cures act established a chief

medical officer within samsa to assist in evaluating programs within the agency to promote best practices. the law further requires samsa to have a strategic plan every four years to identify priorities putting a strategy to improve recruitment training and retention of the mental health workforce it also created a national mental health policy laboratory and interdepartment serious coordinated committee issuing reporting to congress last december for the needs suffering those of serious mental illness and emotional distress across federal agencies one of the most important actions of the federal government can take to help american suffering from mental illness and emotional disturbances to ensure they have access to care. medicaid is a single largest payer for mental health services and in 2015 medicaid covered 21% of adults and 26%

of adults with serious mental illness i am concerned when that action is taken by the trump administration to make it more difficult medicaid and reducing coverage by suspending patent and i'll make it more difficult for american suffering from mental illness to receive the treatment to live in a full and healthy life. before we close with the ongoing mental health crisis with the trump administration with the separation of children from their parents american academy of pediatrics has emphasized family separation can cause irreparable harm to disrupted child's brain and architecture to affect short and long-term health and this type of prolonged exposure with this toxic stress can lead to lifelong consequences for the children currently there are over 3000 children children

forcibly separated from parents by federal authorities. we must hear how these separations are impacting the mental health of the children and what action samsa is taking to help them recover from the trauma. thank you mr. chairman i'm glad to yield my last-minute someone who would like a minute. >> thank you very much i just want to thank you doctor for coming today and i look forward to hearing what samsa is doing to implement the 21st century cures act it really takes the mental health aspect of the bill with the issues that this committee worked on for many years to get it right i'm not sure we yet have it right but we are working in that direction. thank you i also want to echo what my colleagues are saying about these kids at the border i think we are making progress with uniting them with

families that we need to double our efforts and also need to make sure they are getting adequate mental health counseling and i yield. >> there is a vote on the floor but we will finish with opening statements before returning that i recognize the gentleman from oregon two thank you very much i appreciate that we appreciate you convening this hearing it is important to do oversight on how 21st century cures act and bipartisan changes are now implemented. i also want to think our colleagues on the committee now and doctor murphy was a real leader in congress for his work on this as well this is a multiyear multimember bipartisan congressional effort based largely to help mental health crisis act

passing july 2016 by a sleeping vote it is always important for the authorizing committee once he passed legislation we come back and review is a working or can we improve for what is not working? that is why we are here today ultimately these were in the cures signed into law decembe december 13, 2016 division b authorize landmark reforms and they were long overdue when the committee first found this error 112 federal programs spread across eight federal agencies designed to address mental. they cost taxpayers $130 billion annually. 112 programs eight agencies and many had not been updated or reauthorized in years. with 21st century cures act with our committee at the time we streamline the programs

bring them into the 21st century to prioritize with best practices to make them available to providers across the nation granted states additional flexibility to administer the block grant to address specific needs of the patient population and increased oversight transparency and accountability. it also made progress to boost resources for suicide conventions to many of us have friends or lost loved ones to suicide and my dear friend and colleague from oregon tragically lost his son to suicide one day before his 22nd birthday. we have worked hard with senator smith to half the original that is training for suicide prevention and strategies for all ages i was proud to see this program was reauthorized in 21st century cures act in the march funding bill now law congress provided critical funding for 30

section of those provisions within cures and this includes the national dramatic dress network and the traumatic stress initiative behavioral health training grants and outpatient treatment in the national suicide prevention lifeline. in addition it also appropriated more than $2.3 billion of new funding for mental health programs and other training these are resources that make a difference literally between life and death. it's also worth noting primary behavioral healthcare included in cures in the northeast part of my district and other areas across rural oregon i have for the success stories of providers able to integrate the community health center and behavioral health services. it works but there can also be barriers. so i appreciate hearing from our witnesses today what you see at the federal level in the face of integration of

service and finally the sections in cures devoted to substance abuse disorder last month the house was the support for patients and communities act had the biggest legislative package to address the drug crisis in american history that started in this very subcommittee and our work goes much further back to the lead up of the comprehensive act and cures legislations of this intersection is clearer more now than ever and now we have set the table for the work to combat the opioid crisis i would like to thank the witnesses for joining us today in the work you're doing when this was created under the very law we are examining today i know we are eager to learn more about your work and your programs with the federal government i yield back the balance of my time. >> the gentleman from new

jersey for your opening statement. >> it is a critical function of the committee to conduct oversight to make sure the legislation we passed is working as intended that is why we hold hearings like these to learn directly from the ministration how policies are implemented in december 2016 president obama signed the landmark 21st century cures act into law which is truly a product of hard work and bipartisan members of the committee and it addressed a wide range of issues facing the healthcare system however today we are focused on the provision needed to mental health i would like to think dr. mccance-katz for joining us today to testify on what is happening with samsa. the cures act was an important to repair the broken mental health system would like to highlight a provision i worked hard to include legislation with an banded that medicaid

benefits but despite what was accomplished i think we all agree to work on this issue is far from complete and more needs to be done for treatment unfortunately in the time since we passed 21st century cures act the republican party has been fixated on repealing the affordable care act and cutting medicaid which is the single largest of health services in the country and many people medicaid has the only chance to get treatment for mental health disorder and any progress made by that mental health crisis act would be completely reversed if republicans ever succeed in a radical plan feel the affordable care act and drastically cut medicaid benefits from low income individuals they could have catastrophic harm to people with mental illness. helping families in crisis i reminded by this committee is still not acted to help the thousands of families in crisis because of the family

separation policy administration recklessly moved ahead with the incoming policy with little thought on how to address the long-term health implications for the children he torn away from their parents or how to unite them with your family and a man-made disaster made by the trump administration public health advocates and providers worn how devastating forceful separation can be to a child's mental health and overall development according to care academy of pediatrics highly stressful dreams is like family separation does reparable harm changing the brain architecture affecting short and long-term health prolonged exposure him the two lifelong consequences for children and as i said at the outset oversight is the critical function of the committee so far the chairman has not been willing to hold an oversight hearing on the family separation crisis which

i think we should have before the august recess and that told me the republican majority is not as troubled as some of them claim to be. you must get to the bottom of how this happened to ensure it doesn't happen again we must reunite the families immediately fell we cannot undo the trauma they have endured the ministration must take every step possible to prevent further harm and with that i yield back. >> there is under five minutes left in the vote series that should take a little less than one hour to complete and the committee is in recess until immediately after. the five the five

[inaudible conversations] all members of the opening statements are part of the record we want to thank our witness to be here today and stay with us through votes and taking time to testify before the subcommittee and give an opportunity of an opening statement followed by questions by members we will hear from dr. mccance-katz assistant hhs secretary for substance abuse and mental health services. we appreciate you being here with us today and you are recognized for five minutes for your opening mac chairman and ranking member and members of the house energy subcommittee on helsinki for inviting me to justify this hearing in decembe december 20, 1621 century cures act was signed into law and i want to thank you for your vision and leadership on addressing the needs of americans living with mental health disorders with the

departments of hhs have been actively implementing this loss was passed was the first assistant secretary the physician created by 21st century cures act i take three see my duties outlined including leadership with evidence-based program and coordination across government part of strengthening leadership and accountability includes a strong clinical perspective of the agency to codify the role of the chief medical officer and we are taking further to establish the beginning of the office to include two additional psychiatrist is clinical psychologist and a nurse practitioner and samsa is created from the policy laboratory to promote evidence-based practices in service delivery to evaluation of models to benefit from further development of expansion replication policy laboratory also gave

leadership of coordinating policies and programs including the needed policy changes. the departmental series coordinating committee was established by the cures act to ensure better coordination across the federal government and children and youth with serious disturbances in their family working within five key areas to strengthen federal court nation to care closing the gap tween what works and what is offered to involve care for those who are involved and to make it easier to obtain evidence-based healthcare in developing finance strategies to increase availability and affordability. twenty-first century cures act we authorize the lot and codified the first set to set aside if we can intervene early with this services

individuals they can manage similar to other chronic health conditions and in 201,644,965 americans died by suicide and according to the national survey over 1.3 million american have died and 21st century cures act authorized the five existing national suicide prevention lifeline data shows following use of the lifeline reported interventions stop them from completing and help to keep them safe and at the same time the highest rate of suicide in america is among adults age 45 through 65 years old and samsa is grateful for the adult suicide prevention program the purpose of the program to implement suicide prevention

and intervention programs focus on training of healthcare professionals to ask about suicide and make safety plans and people with treatment should they endorse thoughts of wanting to end their life one of samsa role is to implement the regulation confidentiality and substance abuse disorder records we made updates to the regulations in 2017 and 2018 in compliance with 21st century cures act to hold a listening session attended by over 1200 people to obtain input about part two implementation and included the need to align hip and that technical assistance and training important for integrated care and chronic health records also demonstrating the opioid-to award $500 million in each year 2017 and 2017 and 2018 and a targeted response grant

funding to those duties around the country. these have a comprehensive approach through prevention and treatment. i feel strongly we need to assure the direction provided by congress as the strongest fidelity and the highest quality service delivery possible in order to achieve this goal every configured samsa technical assistance approach to one that supports a robust national and regional technical assistance strategy emphasizing training on evidence-based and effective practices to communities across the country. much work has been undertaken across hhs and samsa implement t century cures act but this is far from over look forward to continuing a strong partnership with congress to help americans living with mental and substance abuse disorders and family. i am pleased to answer questions today. >> thank you dr. mccance-katz for your testimony this concludes witness opening

statement portion now we move to questions that i recognized myself for five minutes. i want to begin by asking unanimous consent to place into the record statement for the record from texas tech university health science center the hall professor family community medicine and professor of public health and executive vice president for rural and community health at texas tech university. to describe their program of telemedicine wellness intervention and referral without objection so ordered. so to submit global statement for the record.couple of pieces out of to provide school-based screening assessment and referral services for those who are struggling with behavior mental health issues is currently active in the school districts using telemedicine

technology to link remote tool tools -- schools and other providers and also mental health recognition and trainings services to promote a greater recognition and then it goes on to describe in detail how the program runs and the coordination that occurs between their staff and the staff of the school. interesting he provides statistics we have impacted area has an annual enrollment of 42000 students and rural school districts creating the environment where students are empowered to them safe learning environment and of that number of small faction 414 total total have been referred by teachers in your train to recognize those to be

referred to the larger program but those that were screened out and triaged by telemedicine 215 students and 25 have been removed from the school population most by hospitalization a few by arrests and they believe they have averted tragic outcomes started others on a path to healing so that is a very interesting program they have developed for school safety in the rural school district in west texas i'm interested in your thoughts how to integrate with the work we did with 21st century cures act and what you are doing with the implementation. >> yes. thank you for bringing that forward because this is a very important part that only 21st century cures act but to focus on the have the opportunity districts across the country texas was one of them and with those innovative programs are exactly what we

need to better ensure two things a safe environment in a nurturing environment where they can learn for those that need to be addressed either through integration directly within the school system with a close relationship with other types of programs. but what the cures act does to affect those programs he authorizes certain types of mental health programs oriented to children and samsa continues to implement those programs. like project aware which provides for infrastructure of these types of services within schools in the state and programs that teach about mental health psychological

and first-aid type of programs to identify use early to get them the services that they need and operations programs and we are in the process right now of making more award granting system and in addition we start talking about integration of care, the community behavioral health centers that congress established or us represents a model that can be used to provide those needed services to children who would be referred from the school system. >> certainly use of that model will be important but this program has been funded entirely out of funds from within texas tech university itself but they have set up telemedicine portals with secure connections and the encrypting and all that is to

have a secure connections. i look forward to working with you and your office because they do think they're onto something that is very important. i will yield back for questions. >> welcome dr. mccance-katz 21st century cures act was a landmark law and carries vision for the substance -- care for women children and adolescents initiative that supports the national network of child, centers to focus on increasing access to effective, focus so can you explain how the national child traumatic stress network operates and the impact it has improved the lives of children impacted by traumatic stress? the initiative program that has been established in a large number of states

provides national technical services around issues of traumatic stress in children. this is a program not only trained practitioners and providers of these services but also will be consultation within communities to help them address traumatic issues. this is a very highly regarded and valuable program. >> do you know of any grantees in the state of texas off the top of your head? >> i don't have those dedicated to memory that we can get you that very quickly. >> children that are impacted by traumatic stress receive early intervention the long-term health effects can be mitigated in any way? >> yes they can. there is a fair amount of literature on this in terms of how trauma affects children

and the ability to address those traumatic event in a therapeutic environment can mitigate the effect later. >> i'm interested how the national child traumatic stress network is responding to the family separation that border as a result of the trump administration zero tolerance is the network utilized to coordinate services for children that do are this trauma as a result of family separation policy? >> what i would say is that samsa itself is not involved in those issues those are dealt with by a different part of hhs. the office for refugee resettlement. any provider within the jurisdiction can go to a samsa national program and after

resources that samsa itself is not. >> hhs is responsible for the children and if you happen to find information on what is done with hhs and the network for the children, my concern is that they have a document on their website that is noted children could recover from traumatic separation developmentally trauma services for their families including evidence-based and i hope that would be part of the process and obviously samsa without effort. in the coordinating committee report reached by last december is five areas of focus including increasing availability and affordability

and could a patient suffering from a serious mental illness be denied health coverage by health insurance to have a pre-existing condition? >> that is not my area of expertise at all feel comfortable commenting on the deed health health insurance. what i would say in that medicaid is one of the largest providers of mental health services their insurance programs and they serve millions of americans at this very momen moment. >> thank you mr. chairman i would also like to ask unanimous consent to place into the record a statement by the american had yet to idea psychiatric association

opposing separation of children (and psychological association regarding the dramatic effects separate family and the national child traumatic stress network in those key points on that traumatic separation from refugee childre children. >> without objection so ordered your time expired the gentleman from kentucky 54 question and i thank you for being here dr. mccance-katz so the cdc found that less than half of the abuse disorder patient with multiple mental health issues ever received treatment for mental health the commission suggests this is due to lack of access and discrimination and lack of motivation to seek treatment would you describe how you plan to encourage with the state using the state targeted response opioid money to help

those with untreated disorders we have a very large population with the general public who needs awareness of the services. >> thank you for that question because we are very much engaged on that issue. the state targeted response to opioid provides funding for technical assistance training within the state now that we have done it samsa and to put in place in february was to have a grantees whose requirement was to establish a routine with every state multiple teams those with larger geographic areas that they had to have addiction experts and other types of mental health for and physical healthcare expertise available so they could go into communities in those providers

let the state know what kind of services and training and technical assistance they need and they provide that on the spot. we believe that will be way to establish evidence-based practice and we know the whole occurring rate is quite high so somebody has a substance abuse disorder they must be screened and treating one and not the other will not solve those problems as are professionals, they are license within there's date and certified by the board to provide that technical assistance and training and they are doing that now in our communities. >> the new tv show that's out several characters seem to

have addiction but at the very end of the show they have a public service announcement for tee5 i don't know if you knew about that so you getting any response from that? i was pleased they were trying to show people how to reach out if they have addiction issues. so for guidance issues with the 21st century cures act samsa has released extensive guidance for consumers on how they can report. the concern does samsa have plans to offer additional pathways to address potential parity violations or concerns? >> we are very pleased he has a portal that consumers can you that they believe could have violations and getting

for their mental health or substance problems. that portal will get them to the appropriate federal agency through treasury and we are about that. we also provide guidance. samsa last summer did a 38 policy where he trained on issues related to. he and how state can make sure appropriate attention is paid to the people of their states can get the services that they need to make those are my two questions i appreciate you being here and i yield back in the gentleman from new jersey. five minutes for questions.

>> 21st century cures act included provision that physically addressed child, and as i noted in my opening statement i continue to have great concerns about the children forcibly separated from their parents or guardians as a result of the trump administration zero tolerance policy. so now whether those information of refugee settlement care have experienced trauma and my resolution of inquiry last week to request the documents of the long-term health implications of the family separation policy on the children. as hhs leader on mental health issue samsa is qualified to speak to the impact of the long-term health implication so my question not just me raising concern about the health impact of this policy but this is been a goodbye numerous public health organization and child health advocate putting the american academy of pediatrics trust for america's health and national sensation of

officials so the fact national child traumatic stress network says that separation from parents or primary figures is one of the most potent traumatic stressors a child can experience especially under frightening sudden chaotic or prolonged circumstances. what is traumatic or toxic stress you don't mind? >> traumatic course toxic stress could be any number of things that an individual would experience as emotionally distressing in various individuals have different types of responses to that. in fact as you mentioned that has been reported to be separation but i would suggest to you there are lots of stressors these children have experienced in their travels to the united states not

having indoor attributes with their distress might be about it is hard to say exactly what epidemiology of these individuals might be. >> but could you comment how the circumstances of separation increase the likelihood of toxic stress? can i get is hard to say but if you were to look at the literature on pneumatic stress you would see depending on the study that you look at 43% will experience a experience a traumatic stress in her lifetime most of them do not go one to develop major mental disorders. when you mitigate that stressors need to recover people have an amazing amount of resilience that is why all of us who are exposed to some type of stressed-out developmental disorders but we cannot predict with

reliability will. >> all the more reason to get the kids back together with their parents so they can recover. >> in our department is working very hard on that as secretary has spoken to that issue they are addressing it every single day. >> i guess the problem that i have is you mention that samsa is not involved in the child separation issue but it is from zero tolerance policy. but the problem is that 21st century cures act requires to coordinate those services across the federal government do you think samsa as a leader of mental health care should play role to respond to this crisis at the border? samsa has defined responsibilities. one of those as you have mentioned in 21st century cures act is the national traumatic network and we do implement that work to make

sure they are providing the services needed to serve those who are experiencing traumatic stress. it is also a decision by others as to what agencies are specifically are specifically involved in the day-to-day activities of any particular so samsa does what it is required to do by the cure is actively standby to give additional assistance if requested to make it sounds like you are willing to help that nobody is asking you to you don't have to respond. i think it's clear these families must be reunited immediately and to ensure that they have access to the trauma prevention in order to recover to mitigate that experience as result of this policy in my time has run out.

>> the gentleman from virginia for five minutes. >> thank you for being here today with a very important topic with 21st century cures act and mental health that is also important. i will ask questions that probably are not answerable in the five minutes that we have i will give you an opportunity that recognize i would like you to come up with answers if you can and send them to acetylene or date in your testimony discussed concerns of the enforcement of parity protection of mental health and other medicines or treatment. meeting there was similar concerns from the department of labor they have horsemen's authority --em-dash enforcement authority but have difficulty on the enforcement side that so what tools are

necessary? what suggestions would you have ensure compliance and the two are being treated. that is probably an hour lecture. in my quick answer to that question is important that i would want to use the legal counsel he will be happy to give an answer. >> i would like the extended answer because they are all complex. in a world school and to say

we can identify a child has issues and send him for evaluation with the current state of the privacy laws they cannot tell us what is going on we don't need to know everything that if there are some things we need to know like do they have a violent with that emotional or mental issues? we could pay more attention or stop by the office to look in their bookbag every day to see if they are bringing in contraband and so the question is is there some way we can experience the knowledge base? we pass some bills that it still would not cover.

and to get some answers back on that. so this is a topic that the president has asked us to look at and i will further but part of this problem is that is that providers and teachers and administrators don't understand when they can communicate and if there is a threat already hipaa allows communication but this is not well understood what we have to do is we have to work very hard to get that information out for what they allow. >> my time has run out but here is the dilemma if there

is a child who could be harmful if you think it is a developing problem don't think it covers now and then tumor further with issues of mental illness that they have violent tendencies. they don't have a clue and then to flip one more. to deal with adult children and how the written get to be

interacting if there's something we need to do in the code we want to help fix the problem but we don't want to give up those privacy rights. >> that gentleman yields back. >> i guess i will ask the question. given samsa leadership on dramatic care and practice and the office of refugee settlement ensure the children held in their custody are receiving trauma and care? >> i can say two things about that.

the office of refugee settlement ensures that they are getting both physical healthcare and regularly. >> quite frankly i was pretty shocked by your attitude that they would get over to have congressman greene enter into the record those professional health organizations the psychiatric association american public health association, american academy of pediatrics, and the concern

of the trauma. to add into the record some articles of people that that weighs in from long ago and those atrocities and so i ask unanimous consent not separated me from my trauma lasts a lifetime and an article on anti-defamation league quotes hitting children of the holocaust open up about border situation and separating migrant children from parents and they are talking about the lifelong

effect. >> i have an objection to article seven to compare what the nazis did to the current u.s. government policy in the united states with certification i may remove my objection but to compare the nazi to united states of america i will not allow those to be submitted. >> and in defense of the anti-defamation league they issued a statement of a group of hidden children of the holocaust felt strongly compelled to propose the expanded zero-tolerance policy. >> i object to mr. chairman. >> i will ask for the yeas and

in long nays will you recognize there is no comparison between united states government and the nazi? >> i recognize there isn't but this is to separating children from their parents and the long-term effects. >> i read my objection. >> i appreciate that. >> i want to ask you about the no touching policy. i am having a hard time pinning down exactly what that is. is this a policy or his son with those particular staff

and if it is a firm policy that i have heard of places for example with those articles that his sister was not able to embrace her younger brother. they were told they cannot touch each other and that may not children in great distress. i wonder if those decisions are trauma informed? >> it's really not possible for me to comment i am not only with those details. >> you don't know about touching your physical comfort coming to mental health? >> what i'm not familiar with

is the agency. >> i am asking a more general question of psychological study and positive touch in with if administered regularly. and then to have detrimental effects as a maturity you agree with that? >> that is out of context. >> really? i am asking generally. and that you are and next for don? trauma informed care and so.

>> deal agrees connect will the witness answer the question your time is expired. >> thanks for being here first of all and i just want to say i am opposed to separating children from families in all of the sample size are but i wasn't going to bring up this subject but it seems like my colleagues are staying on message and everyone will talk about that i feel i would also. i am also concerned about the thousands of children coming in accompanied tracking thousands of miles bring bought when -- brought by the coyotes and drug cartels.

many of whom have been assaulted or abused. i am concerned about them also. and it is a tragic circumstance. and currently adult meals with children and then we are releasing them with ankle bracelets two or 300 of these people per day. because the cartel and the coyote helps to follow the law. or when we do follow a lot any

with the past failed policies and with catch and release to send children thousands of miles by themselves. . . . . neglected and suffering traumatic problems and we all know that is a difficult circumstance. that is all i'm going to say on that. section 605 requires a

strategic plan every four years identifying priorities including a strategy for improving the mental health of the workforce.additionally the testimony mentionsengaging subject matter from across the country.macadamia hospitals , state consumers and for members to formal complex problems and it is a compass problem. such as workforce challenges among other things. can you expand a little on what they are doing to address the workforce challenges? particularly in rural areas? related to mental health and let me just say this, i know because i was a healthcare provider before, one of the big challenges is financial support for this type of services. but can you expand on that a little bit? >> i can. and thank you, for the question. we have developed a new program that will be in place by september 30 through the end of the fiscal year. that sets up both specialized program around issues related

to mental and substance abuse disorders. things like the teams dimension for the opioid crisis. we caught the state targeted response. we have one for veterans. with the national child traumatic stress initiative. we have a number of different types of topic related special national programs. we have to do clinical support systems for serious mental illness that will address issues around serious mental illness. we also are establishing technical assistance and training programs within each of the 10 hhs regions. those, again, focused on localized needs of communities because we know every community is different. we also recently have established a relationship with the department of agriculture that does a lot of rural work and so, we are expanding our technical assistance to some of their initiatives into rural areas. telehealth is a big issue for the department of health and

human services. we have behavioral health coordinating committee which includes the operating divisions and telehealth is a specific issue we are working on to provide additional guidance to states to try to expand the reach of practitioners that we have into rural areas. >> thank you for that answer. i yelled back. >> the gentleman yells back to the chair recognizes the gentlewoman. >> thank you for joining us today. i'm pleased your hosting is hearing to discuss the mental health in the 21st century cures. i look forward to having an oversight hearing of the final section of the 21st century cures including health it and in operability. before i asked my questions about mental health, and curious. have to make a comment about the mental health of children separated from the family due to the presidents zero-tolerance policy.

public health, mental health and pediatric experts including the american academy of pediatrics, american nurses association was concerned about the harm caused by the stress and trauma incurred by children. and forcibly separated from parents by the stress not only has immediate impact but it is also damaging long-term impact on child housing development. the dr. knows that the impact of traumatic stress can last far beyond childhood and child trauma survivors or more likely to have long-term health problems including behavioral health and substance abuse disorders pay that is why this committee must act immediately to ensure that hhs is reunited children with their parents and to ensure that hhs long-term plans to mitigate the impact of trauma on these children. now, moving on to my legislative priorities of the 21st century cures. i also have title 11 the compassionate medication hipaa section of the bill.

passed into law. these provisions seek to clarify confusion about the privacy rules as applies in mental health scenarios. the confusion for patients families, doctors and even administrators and lawyers about what information can and cannot be shared remains. they require that they coordinate with relevant agencies to develop and periodically update programs to train healthcare providers, lawyers, patients and families on the permitted use and disclosure of the health information of individual seeking and receiving treatment for mental health or substance use disorders.doctor, as you know they released additional guidance on the topic back in december. what progress has been made to develop training programs? >> well, i have a few things to tell you. one is that we are working very

hard with the civil rights office to coordinate those efforts and one of the things that we did just last week was to train attorneys, healthcare attorneys on issues around hipaa and in fact, i brought a copy of the training and i will be happy to leave it if you like. >> that will be great, thank you. >> made a thousand attorneys on that webinar. that is the most that you can have in the american bar association which has possession of this and is continuing to disseminate it. the american bar association says they thought that we would have had 4000 because they have a committed everybody that wanted to learn about this topic. we also using this to develop something that i will just say will be a little simpler language for people like me who are practitioners. to do special training for practitioners on the privacy issues. but the thing that i think is most exciting is that

yesterday, we were able to publish a funding announcement. will have a national center on privacy. hipaa and 42cfr and i think it will make a huge difference. >> help the other stakeholders and clinicians? will you be bringing them in too as you develop this programs? >> absolutely. we will have a single grantee whose job it will be to train clinicians, to train administrators and often comedies will be lawyers that are involved in healthcare systems. but the other requirement that i put into the funding announcement is that we must put up materials for families and patients. >> that is very important because many times it is misunderstood. and so, if we set up this programs if we don't have a communication to even have some

patients come in and parents coming to understand what the process is, because when a family gets into a certain kind. and i would hope that we would keep these training sessions going because just because we have a certain set training does not mean that it is all done. >> that is correct. and this will be a multiyear initiative. >> okay, thank you. -- >> thank you, mr. chairman. and thank you elinore mccance-katz for being here. as the first assistant secretary focused on these issues in this way and every answer you have given, your portfolio is so large about so many issues that our constituents care about and i'm having hard to figure out where to focus.

but i have to tell you, as an attorney who practice criminal defense in the courts, as a former u.s. attorney someone has been very involved in criminal justice system, we know that the 21st century cure reauthorized programs regarding the job diversion grant programs. our jails are often just ovand are often the largest institutions in many ways and counties that have those with mental illness. can you give us any updates on the successes that you've seen in the program so far? that we can have our local county jails and state prisons and so forth deal with this problem. >> yes. and this is really a great benefit of the act that these kinds of resources have been made available. what we have done is to fund

mental health both for adults and youth who are experiencing mental illness from sometimes for the first time but it involves them in the justice system. we also are starting programs that divert people prior to arrest. this is really very important because people who have serious mental illnesses suffer from a great deal of stigma and these things, when you have an arrest it makes it so much more difficult for you to be able to navigate in communities without problems. it makes it more difficult to get insurance, more difficult to get a job, more difficult to get housing. and so, we like the idea of pre-diversion programs and we have funding for some of those again, through the abilities given to us. >> and i apologize and i also

think we just mentioned, the national center on privacy and the fact that many lawyers got on a call, i want to applaud the american bar association for encouraging that and i believe that many lawyers will participate in that kind of training. i want to encourage you getting the word out on that as well as my colleagues across the aisle. we talked about, what is the best way for our constituents to learn about all of these grant opportunities which seem to be either so many new grants, so many new programs and quite frankly, we are having a hard time trying to direct all of our constituents. we had a school shooting in my district on may 25. we talk about teachers and educators wanting to learn more, that is one thing i have heard is that our teachers and educators are so concerned about learning more about whether mental health first aid

you talked about, whether it is about identifying as congressman griffith brought up, how can, what can you share with us as the best mechanism we can provide our constituents to be educated or to pursue grant programs, particularly for mental health in the schools. mental health in the communities. what are the best ways we should be communicating this? instead of just going to the website. i mean, how can we have better access to the tools to provide our constituents? >> and so, i would say that the website has the information and it is -- >> extensive. >> excuse me? >> extensive. >> and we are trying to make it easier to find things. we are also working on developing webinars on specific programs to talk to the public about what the programs are and about the funding opportunities

available. the other thing that we will be using, the system of regionalized training is for these kinds of opportunities as well to make it easier for those who are taking advantage of those regional programs who know more about what the opportunities are. so, if you have a transfer center for example in region one, the northeast. the technology transfer center also can make it easier for the communities and individuals in the communities to find out what the resources are. as it relates to addiction. will have one for substance abuse prevention and will also have one for mental health issues. we also are will be supplementing the mental health technology transfer centers to specifically work on issues related to school and

children's needs. i'll be happening in the next fiscal year. and so, we hope that by regional lysing the programs that we can get down to the community level and communicate better because you are so right. it is very difficult. >> thank you. i applaud all the work your office is doing. it is so critically important. i look forward to helping you with that. i yield back to request that your lady. >> doctor elinore mccance-katz, thank you for being here today. you have a very significant responsibility. as assistant secretary for mental health and substance use. anna want to thank you for taking on this very important assignment. i reviewed your bio. you have great experience and a number of degrees. from outstanding institutions. i think your expertise is going to be, it is needed here in

this area. i want to ask you about the long-term mental health implications of child traumatic stress. caused by the family separation. you heard the concern from colleagues here today. we are reflecting the concern that we hurry back home across the country. i would like to ask you about child traumatic stress caused by the family separation policy. the children that have been forcibly separated from their families. i know you cannot get into specifics. but based upon your extensive expertise i would like you to comment in general. at this point, many public health organizations have stressed that quote - the practice of separating children from their loved ones, and caregivers for an extensive period of time as a threat to public health inflicting serious trauma and threatening long-term, irreversible health effects. do you agree? >> this is a form of trauma.

>> what are some of the serious long-term irreversible health effects that could result from family separation? >> so, i cannot speak to family separation per se. i do not know who might develop a mental disorder that will health-- that will have long-term implications. >> that is counter to things we hearing from the little mental health organizations and public health organizations from across the country.>> the president has directed the families not be separated further. secretary -- these facilities. >> you would not recommend this would you?

>> the -- >> if they came to as assistant secretary would you have recommended these policies? or did they ask you? were you asked? were you consulted? >> there are a number of different policy implications. and i am -- >> i am just curious. i note secretary azar, i believe he said he was not consulted. were you asked as the assistant secretary for substance use and mental health? >> asked what? >> before the family separation policy was implemented? >> i was not consulted on that. >> we know there is a significant body of evidence detailing the public health implications of adverse childhood experiences. would you consider the forceful separation of children from their parents to be an adverse childhood experience? >> i would consider separation from parents to be an adverse experience. and i would also remind you that these children are getting

physical healthcare and mental health care and they are getting that very regularly. >> thank you. it is likely that this forcible separation already compounds upon other adverse childhood experiences these children have faced in their home countries. such as witnessing domestic violence or gun violence. do these experiences have a cumulative effect? >> depending on the individual. reality is, and the reality is that most people have a great deal of resiliency. and when they can get their mental health issues addressed, and these children are getting mental health care in the facilities, then we hope that they will not go on -- >> the cdc and kaiser permanente adverse childhood expenses study found many long-term health impact of

adverse childhood experience. including the risk of disrupting neurodevelopment, social, emotional and cognitive impairment and heightened risk for disease, disability and social problems. can you explain some of the specific physical and mental health problems that can come from adverse childhood experience? >> there are a variety of different types of mental disorders. that can be a result of adverse experiences. >> and their risk factors for behavioral health and substance use disorders. typically, correct? >> that is true. >> there was a recent news report. >> i believe the time has expired. >> i would ask courtesy most members have gone an additional 30 seconds. i just want to ask about -- there is a recent report that hhs has quietly dipped into tens of millions of dollars to

pay for what has happened through family separation and the department has burned through at least 40 million in the past two months. i'm just wondering, has it impacted your shop at samsa? have you been asked to shift any monies out that were previously directed towards samsa? >> samsa has not had any direct effect. >> the response is negative and the gentle lady yields back. you have five minutes. >> i'm sorry. thank you, very much. appreciate that mr. chairman. dr. elinore mccance-katz in accordance with section 13002 of cures, i understand that samsa last year conducted a public listening session on mental health. involving 15 and person groups with an additional 40 comments submitted via email and in writing. can you provide us with a

summary of the comments, how were the comments addressed and samsa's action plan and do plan to host another meeting with industry stakeholders? >> the -- yes, we did hold that listening session. the comments that we received were around need for education around the parity act. and how individuals experience what they believe to be. violations will get assistant they need and what are the responsibility of states and insurers around the issues. samsa is an issue of developing a guidance on that and that should be out before the end of this calendar year. that is what i was told before the meeting. i give me the information i have available to me. >> thank you, very much. in your testimony you mentioned over 7.4 million children and youth in the nation have a

serious mental health disorder but only a certain percentage received treatment which leaves a vast majority untreated. the 41 percent are the ones that were identified. it could be even more than that. again, this is a serious issue and i'm glad that the chairman is holding this hearing and we are taking this issue very seriously. it really is an epidemic and in addition to supporting systems of care, how is samsa working with industry to address workforce shortage issues? >> we are addressing -- when you think about what type or probably have, leave an urgent problem, we have an urgent need to get more services to americans living with these kinds of conditions. what is the fastest way to do that? by the way, it will not be by opening more medical schools. that will take too long. and when i think about this i

have to think about, how can i get services to americans? i can do it by training and providing technical assistance that will prepare practitioners to intervene and to provide care and treatment for mental and substance use disorders. that is why i, so much attention since i have come to samsa -- >> me talk about practitioners, ice, psychologist, psychologist or primary care physicians that would get additional training? >> all of the above. and so, we are setting up programs of regional training and technical assistance. we also have specialty programs.we are working very hard to disseminate this so clinicians and practitioners, psychologists, psychologist, nurse practitioner, physician assistants, counselors, social workers. and primary care doctors will be able to take advantage of these kinds of trainings. that allows him to get specialized kinds of skills.

and provide service to their clients. the other thing i would say is that we are working to set up programs through our grants funded organization that will provide ways that practical assistance can be provided. for example, in the state target response fund, that cures provided, the states can contract providers that provide specialized treatment services to also be grant program at samsa which is medication assistance. a way of fomenting medical assistant treatment. those programs provide practical experience. with the ability to provide classroom style webinar web based training. but then, the ability within regions of the country where people can go see this in practice. and we think that that is the way to better assure that

practitioners will feel confident enough and able to use a new skill set to provide care when americans need it. we also continue to support programs called expert screening briefs and referral treatment. we also encourage primary care to continue -- >> how does that work now? in the schools? how can we identify the kids that have these issues and is the burden going to be always on the teacher? and where you go next once they are diagnosed? i know it is very expensive. treatment centers and a lot of the insurance companies do not cover -- even if they do, the co-pays are so very high. the deductibles. i'm sorry. >> the genre from georgia has been waiting very patiently all day. perhaps this can be responded to in writing.

the gentleman from georgia is recognized for five minutes. >> thank you, mr. chairman. dr. mccance-katz thank you for being here. thank you for what you do for the children particularly of our citizens. we appreciate that very much. i know a lot of this hearing is got a little bit off base but i want you to know that we appreciate what you are doing for us and our citizens here. i'm sorry to have to report to you that george is not doing so good with mental health services. in fact, route we raised about 47/50 and that is one of the things that bothers me. it is estimated that we have less than 20 percent of the beds that we need for mental health services in the state of georgia as well. particularly when it comes to childhood mental health. we've got 159 counties in the state of georgia and only 76 of them have a license, 76 do not have a licensed psychologist. we've got again, hundred 59 counties. 52 of them have no licensed social worker. all of these figures are

alarming to us and alarming to me in particular. because of the fact that in the state of georgia, for those children between the ages of 15 and 19, the second leading cause of death or suicide. between those of 10 and 14 the third leading cause of death or suicide. all that leads me to ask you, they reauthorized the mental health initiative. it provided a lot of grants and a lot of assistance. and we are very appreciative to them for. i wanted to ask you, particularly in the state of georgia, we have a lot of rural areas between south georgia and my district.i am wondering, how do we get services to those areas?any suggestions on how we can improve services there? >> samsa has supported two types of integrated care programs. one is where behavioral health

providers can participate in certain programs. the second is through programs such as certified community behavioral health clinics. they bring primary care directly into gabriel health setting. so a person can easily access all the care and services that they need in one setting. samsa, as you know, has limited funds. we do demonstrations. we work closely in terms of establishing those demonstrations and then doing more technical assistance and training and trying to establish those on a national level. we talk with our colleagues at the centers for medicare and medicaid services. >> what about family medicine? or telemedicine? is that something we should be focusing more on? >> yes. i was just about to get to that. >> i'm sorry. [laughter] >> yes, telehealth is very important piece of it. particularly for areas that have a lot of large rural

communities.>> right. >> telehealth can really extend the reach of a practitioner who may be in a more urban area but -- and so, department of health and human services has a committee that is working on telehealth guidance for the states. and in addition to that, is working with for example, the drug enforcement administration around issues of prescribing. so that we can utilize the telehealth providers to the very best extent. >> right. other grants specifically for that? or are they included in the regular grants that you can use it for that purpose? >> we have at samsa, part of a larger grant program that our telehealth services come from. and i believe the other parts of hhs have specific funding for telehealth.

>> another thing i want to talk about quickly is the opiate addiction and funds that have been going there, grants that have been going there. we've been very fortunate at the georgia department of health and develop mental disabilities. it has almost $12 million. i want to report back to because i been part of some of these programs. it is working well and being utilized well. in fact i've been, one of the cities, want to give them a shout out, pembroke georgia. in my district. they've been very active in this and implement a number programs that have media campaigns, school partnerships. a number programs that have been very successful. can you elaborate quickly on what else we might be doing with all of that? >> for the opioid crisis, it is one of secretary azar 's parties. >> and this committees parties. >> yes. and we are very grateful to congress for the increase in funding to address these issues.but we have to do is

work hard to integrate substance abuse treatment, opiate addiction treatment into primary care settings. in addition to having specialty care available. we know that people find it very difficult to access care and so, we want to broaden the number of providers that are willing to engage in care. and to use innovative practices such as telehealth. this is why we are working with the dea to make it possible for clinician to have a greater reach and to reach americans in the areas of such difficulty accessing. >> right. thank you again for your work. i yield back. >> thank you. all members have had the opportunity to ask questions. i would think our witness for taking time to be here with us today. pursuant to committee rules i remind members have 10 business days to submit additional questions for the record. i asked our witness to submit responses within 10 business days upon receipt of those

questions. without objections, the subcommittee is adjourned. [inaudible conversations] [inaudible conversations] >> c-span washington journal. live every day with news and policy issues that impact you. coming up friday morning, heritage action for america's tim chapman discussed his groups role in the upcoming midterm elections and supreme

court confirmation hearings. then a look at election security in the upcoming midterms. amid concerns russian interference. with liz kennedy from the center for american progress. and political report editor charlie cook on the outlook for the 2018 elections. be sure to watch c-span washington journal. live at seven eastern friday morning. join the discussion. >> this weekend on american history tv. on c-span3 appears saturday at 6 pm eastern on the civil war. william marble offer of the book lincolns mercenaries, expends economic factors that drove many northerners to volunteer. and at 8 pm on lester's in history. san diego state university professor, -- on the vietnam war from the u.s. military escalation in 1965 to the fall of saigon 10 years later. sunday at 11:00 a.m.

. military history patrick o'donnell and his book, the unknowns, the untold story of america's unknown soldier. and world war i most decorated heroes who brought him home. at 4:30 pm eastern on reel america, part of our alaska weekend. four films about alaska. the 1936 film, alaska silver millions. the 1949 film, eskimo hunters in northwestern alaska. the 1967 film alaska centennial. the 1944 film, alaska highway. watch american history t.v. this weekend on c-span3. >> senator marco rubio gave a speech and discussed deep fake technology that allows faces of people and videos to be replaced with those of other people. talk about the risk of bad actors that could use this for disinformation campaigns to sway elections. his remark at the heritage foundation in washington d.c. ran one hour.