>> a house, suddenly her testimony recently on infamous mental health programs under the 21st century choose act. members are testimony from the assistant secretary of health and human services for substance abuse and mental health. many of the questions focus on immigrant parents separated from children at the u.s. southern border. subcommittee will come to order. the chair recognizes himself five minutes for an opening statement. so today we convene and hold an oversight hearing on the mental health division of the 21st century cures act which was signed into law on december december 2016. on the anniversary of the house passed away for century cures, this subcommittee held a hearing on the sections of the law that the national institutes of health and the fda are

implementing. today we have dr. mccance-katz here to testify before us about the work that the substance abuse and mental health services administration is doing to address our country's mental health needs a mental health title and 21st century cures was based upon the helping families and mental health crisis reform act of 2016 which was passed, which passed the house by vote of 422-two. prior to its inclusion in the cures bill. this legislative effort represents the most significant reforms to the mental health system in more than a decade. the first provision within the mental health division strengthened the leadership and the cannes film of samhsa, including establishing the position that dr. mccance-katz now holds. one of her duties as the

assistant secretary is to develop a strategic plan by the end of this fiscal year. cures also strengthen existing programs including sanchez to because programs from the committee mental health services block grant and the substance abuse prevention and treatment block grant, given that each state and community is different, this law provides lexically to states to address their unique mental health needs. additionally a lot authorized the national mental health policy laboratory to gary at existing and new activities under the mental health policy umbrella, including awarding grants for promising service delivery models and expanding evidence-based programs. access to mental health and substance use disorder care is a vital to the overall health of our nation. according to the national alliance on mental illness approximate one in five adults in the united states experience mental illness per year.

of those adults suffering from mental illness, only a little more than 40% receive mental health services in the past year. highlight of the 21st century cures act focused on promoting access to mental health substance use disorder care. the programs included in this title authorized and strengthen some existing programs that produce have not been in statute pics of these programs provide grants to eligible entry that provide mental health and substance use disorder services to homeless individuals and jail diversion programs. additionally the title authorized the program to further integrate primary care behavioral health services through demonstration projects. notably the 21st century cures act expand the target population of this integration to include additional populations such as certain qualifying children and adolescents. the center for disease control and prevention recently released

a vital signs report that showed a rising suicide rate across the united states. in 2016 we lost nearly 45,000 lives to suicide. 21st century cures act inc. to provide additional suicide prevention resources by codifying the national suicide prevention hotline and authorizing the garrett lee smith suicide prevention resource center and youth suicide prevention state grants. the existence of all of these programs would be far less impactful if we didn't have an adequate workforce to provide services, therefore, there was an entire subtitle directed to strengthening the mental and behavioral health care workforce through training grants, demonstration programs and other means. she was established several new grant programs to address mental health needs a population such as mothers and children. one program provides grants to support statewide or regional pediatric mental health care, telehealth access programs.

such programs could be especially helpful in the identification and treatment of mental health issues in school age children. this is especially critical because 80% of all chronic mental illness begins by age 144 to 21st century cures made meaningful long sought reforms are mental health system and as a result of powerful bipartisan legislation created over the course of several years while the slot reflects on our diligence and our commitment to improving america's overall mental health, there is work that remains to be done. i would use back the balance of my time and recognize the ranking of the subcommittee mr. green five minutes for an opening statement, please. >> thank you, mr. chairman,, probably today's hearing of the implementation of the 21st century cures act. today we'll be examining division c of a law which focuses on mental health programs and activities administered by the substance abuse and mental health services administration, sam shapira what

you think dr. mccance-katz, the assistant secretary for mental health and substance abuse of samhsa are joining us this with the enactment of the 20% features in december 2016 was a great achievement, particularly and a type of sharp person ship and gridlock. the work started long before 2016 led by our colleagues at upton and congressman diane to get but all of us on the committee were participants. in 2016 we set out on a mission to do something positive to boost medical research and innovation, accelerate the discovery and development of new cures and treatment and improve public health. after countless hours white papers, hearings and traps enjoyed bipartisan support and endorsement from over 700 organizations representing the full spectrum of the stakeholders. the investment in new buzzword created by cures are intended to go far in solving today's complex scientific problems,

given new treatments in the lab table to the bedside and strengthening our nation's public health infrastructure. the cures act made several changes to mental health authorities and programs implemented by samhsa, reauthorizing several existing mental health grant programs and creating new programs. for example, the cures act established the chief medical officer in samhsa to assist in evaluating and organizing programs within the agency and promote best practices. the law for the required center to develop a strategic plan every four years to identify priorities including a strategy for improving a recruitment, training and retention of the mental health workforce. the cures act also triggered a national mental health policy laboratory and enter department serious mental illness for dating committee which issued a report to congress last december to address the needs of america's suffering from serious mental illness and suffering

emotional disturbance across federal agencies. one of the most important actions of the federal government can take help americans suffer from mental illness and emotional disturbances and to get the access to care. medicaid is the single largest buyer for mental health services in the united states. in 2015 medicaid, 21% of adults with mental health illness, and 26% of adults with serious mental illness. i'm concern that actions taken by the trump administration to make more difficult to receive medicaid at the increased cost of health coverage more recently by suspending risk adjustment payments to insurers covering high-cost patients will make it more difficult for americans suffering from mental illness and emotional disturbance to receive treatment they need to live and a full and healthy life. before i close i must note that on ongoing mental health crisis created by the trump administration regarding the separation of children from their parents. the american academy of pediatrics has emphasized that

highly stressful occurrences like, separation can cause irreparable harm disrupting a a child's brain, architecture and affecting his or her short and long-term health. this type of prolonged exposure is serious stress known as toxic stress, can lead to lifelong consequences for these children. currently there are over 3000 children who are forcibly separated from their parents by federal authorities. we must hear how these family separations are impacting the mental and emotional health of these children and what action samhsa is taken to help these children recover from the trauma of family situation. thank you, mr. chairman, and i'd be glad to yield my last minute to someone who would like a minute. nobody? diane? i yield to my calling from,. >> thank you very much. i just want to thank you, doctor, for come today. i really look forward to hearing what samhsa is doing to implement the forms of 21st

century particularly the mental health aspects of the bill were issues that this would work on for many years trying to get it right and i'm not sure we yet have it right but we are sorely working in that direction so thank you to also want to echo what my colleagues are saying about these kids at the boarded i think we're making progress reuniting them with their families but we need to double our efforts down and we also need to make sure they get adequate mental health to counseling. i yield back. >> jump from texas yields back. there is a vote on the floor but with the committee's permission we will finish with our opening statements before adjourning for the vote and directors adjustment from oregon, the chairman of the full committee. >> thank you thank you very muc, dr. burgess. appreciate that and we appreciate your continued this ring. it's really important we do oversight on out 21st century cures and the wonderful bipartisan changes incorporated therein are now being

implemented. i want to thank our colleagues on the committee who are here now and certainly dr. jim murphy who is a real leader in the congress on mental health reform for his work on this as well. these policies were the result of multi-gear, , multimember bipartisan congressional effort and their based largely off the crisis act which passed the house in july 2016 by a sweeping photo 422-two back. it's important as an authorized committee that once we pass legislation we come back and review, is it working? reckon we improve? what's not working? that's why we're here today. these provisions ultimately folded into cheers which was signed into law on december 13 december 132016. division be authorized these landmark reforms to our nation's mental health laws and they were long overdue. when a committee first took on december 112 federal programs spread across eight federal agencies designed to address

mental illness. they cost taxers $130 $130 biln annually to wonder 12 programs, eight agencies, 130 billion. many of the programs have not been updated for reauthorized in years. in cures, under the leadership of fred upton are chairman of the committee at the time and ms. degette and others we streamlined these programs and brought them into the 21st century. we prioritize access evidence-based programs and best practices to make them available to provide across the nation. red states additional flexibly at nursing mental health block to address the specific needs of the patient population and we increase oversight, transparency and accountability for these programs. cheers made important progress in boosting resources for suicide prevention. to too many of us have friends o have lost loved ones suicide. my different and colleague senator gordon smith of oregon tragically lost his son to suicide one day before his sons

22nd birthday. worked hard with senator smith to authorize the original dear ms. smith memorial act which provides information attorney for suicide prevention surveillance and intervention strategies for all ages and is proud to see this important program reauthorized in cures. march funding to which is now law congress provided critical funding for nearly 30 sections of the provisions within cures, these programs include the national charter medics stress network, national childhood stress initiative come mental and behavioral health training grants come assisted outpatient treatment at the national suicide prevention lifeline. in addition, the bill also appropriate more than $2.3 billion in new funding for mental health programs and other training. these are resources that can mean the difference literally between life and death. it's also worth noting the promotion of integration of primary behavioral health care included in cures, in the

northeast part of my district and other areas across rural or can i for the success stories of providers have been able to integrate their achievement helped send and the behavioral health services. we know it works but we also know there can be barriers to full integration. i'd appreciate hearing from our witness today about what you sing at the federal level in this space of integration of service. finally i would like to note the section enters the foot to use disorder, just last month the house passed hr6, the support support for patients and communities act, the biggest legislative package to address a drug crisis in american history. that bill started in this for a subcommittee and substance use disorder however goes much further back come back to the leader of the company to addiction recovery act and the cures legislation. this intersection between mental health issues and substance abuse disorder is clear now more than ever and the grants programs authorized by cures

have set the table for our work to combat the opioid crisis. i'd like to thank our witness for joining us today and the work that you are doing. your physique was great under the very law that we are examining today at the nowhere all eager to learn more about your work. mr. chairman, i will yield back the balance of attempts. >> the chair thinks adjustment of regulus adjustment from new jersey, ranking member of the full committee for five minutes. >> thank you, mr. chairman. it's a critical function of this committee to conduct oversight and ensure the legislation we pass is working as intended and that's why think it's important to hold hearings like these the low student directed from the administration how policies are being implemented. in december 2016 president obama signed a landmark 21st century cures cures act into law which was truly a product of hard work of bipartisan members of this committee. as an of the cures act address the wide range of issues facing health care system. however today would be focusing on the provision of religion mental health and i'd like to

thank dr. mccance-katz for joining us today to test and important work happening at samhsa. the health incomes of mental health crisis act which was ultimately passed as part of the cures act within a four step was apparent our country broken mental health system. i was physically to highlight a revision that i worked hard with my colleagues to include in this legislation that expanded and importance that the medicaid benefits to children receiving inpatient psychiatric treatment. despite what was accomplished through this law i think we all agree our work on this issue is far from complete and more needs to be done to improve access to affordable health treatment. unfortunately in the times since we pass the cures act republican party has been fixated on repealing the dr. mccance-katz and cutting medicaid which is the single largest payer of mental health services in the country. many people medicaid provide the only chance they have a getting treatment for mental health disorder and i continued with any progress made by the helping families and mental health crisis act would be completed

reverse if republicans ever succeed in the radical plan to repeal the affordable care act and drastically cut medicaid benefits from low income individuals. these actions could cause catastrophic harm to people with mental illness. speaking of helping them see crisis i'm reminded that this committee has to look back to the thousands of them is currently in crisis because of the trump administration cruel family separation policy. the administration recklessly moved ahead with this inhumane policy with little thought on how to address long-term health implications for the children torn away from the parents or how to reunite them with their family. this is a man-made disaster by the trump administration. public health advocates and health care providers have already would have devastating forceful separation can be to a child's mental health and overall development. according to the american academy of pediatrics, quoting, highly stressful experiences like family separation can cause irreparable harm, to something a

child's brain architecture affecting his or her short want to know. it can lead to lifelong consequences for children. as i sit at the outset of my remarks oversight is a critical function of this committee and so far chairman walden has not been willing to hold an oversight hearing on a family separation crisis which i think we should have before we leave for the august recess and that tells me that the republican majority are really not as troubled by this crisis as some of them claim to be. we must get to the bottom of how this happened so we can sure it never happens again. we must reignite these families immediately and while we can't undo the trauma the children only endured the administration must take every step possible to prevent further harm. with that i just back, mr. chairman. >> the chair thinks the gentleman. the chair notes that are under five minutes left of this boat series. my extent is the or for mac boats industries as i should take us a little less than one hour to complete, and the committee will stand in recess

until immediately after votes. [inaudible conversations] call the committee back to order. as we recess which we just cone with member opening statements. the chair will remind members pursuant to committee rules all members of a status will be part of the record. we do what you think our witness for being here today and stay with us through boats and taking them to testify before the subcommittee. what is one the opportunity to give an opening statement followed by questions from members and today we're going to hear from dr. elinore mccance-katz, the assistant secretary for mental health and substance use in our other stas department of health and human services. we appreciate you being here with us today, dr. mccance-katz, angela recognized for five minutes for an opening statement, please. >> chairman burgess, ranking

member green and members of house energy and commerce subcommittee on health, thank you for inviting me to testify at this important hearing. december 2016 the 21st century cures act was signed into law and want to thank you for your vision and leadership on addressing the needs of americans living with mental and substance use disorders. .. i take seriously my duties outlined including leadership and accountability for behavioral health, and coordination across government, part of strengthening leadership and accountability includes a strong clinical perspective at the agency that codifies and we have taken this further by establishing and expanding the office of chief

medical officer to include additional psychiatrists like clinical psychologists and nurse practitioner. and it is a national mental health and substitute policy laboratory, and evidence-based practices in service delivery for evaluation of models that benefit further development, expansion or replication and provide leadership in identifying and coordinating policies and programs for substance abuse disorders included needed policy. and to ensure better coordination across the federal government to address needs of adults with serious mental illness in children and youth with serious disturbances and their families. we have been working with 5 key areas of focus, strengthening federal coordination, closing the gap between what works and what is offered, reducing

involvement in care for those who are just as involve making it easier to obtain evidence-based and finance strategies, for affordability of care. and mental health services for block grants to be satisfied. to intervene in psychosocial services, individuals are better able first similar chronic health conditions. and 44,960 americans died by suicide. and for drug use and health statistics over 1.3 million americans attempted suicide. the cures act authorized

national suicide prevention lifeline, recent evaluation data shows the majority of individuals serve in an interview following use of the lifeline reporting intervention stops them from completing suicide it helps keep them safe. at the same time the highest rate of suicide in america is among adults age 45 to 64 years old. nafta is grateful for authorization of the suicide prevention program and cures. this is to implement suicide prevention intervention programs focused on training healthcare professionals to ask about suicidal ideation, make safety plans and assist treatment if they endorse thoughts of wanting to end their lives. we implement the implantation of 44, regulation governing confidentiality and substance abuse records. we made substantive updates since 2017-18. in compliance with the cures act, there was a listening session attended by 1200 people in january 2018 for implementation.

these include 44, the need for technical assistance and training, importance of integrated care and use of electronic health records. this demonstrates congress's commitment to the opioids crisis to implementation of yours awarded to $500 million in 2017-18, in the targeted response grant funding to states and communities around the country and supporting approaches to addressing the opioid crisis through intervention, treatment and recovery services. i feel we need to assure the direction provided by congress is followed with fidelity and the highest quality service delivery possible. to achieve this i have reconfigured the technical assistance approach from a grant approach to one which supports robust national and regional technical assistance strategy emphasizing evidence-based and effective practices with communities

across the country as much work has been undertaken across hhs implement the cures act but we know this is far from over. i look forward to continuing a strong partnership with congress to help americans for their families. and answer questions today. >> thank you, elinor mccance-katz, thank you for your testimony. that concludes the opening statement. we moved to member questions. i recognize myself for five minutes for questions and i begin by asking unanimous consent to place into the record statement for the record by doctor phillips from texas tech university health science center, professor of family and community medicine, professor of public health and executive vice president for rural and community health at texas tech university, describing their program of wellness intervention, triage and referral.

without objection so ordered. i went to submit the statement, let me pull a couple pieces out of this. doctor phillips says this provide school-based screening assessment and referral services to students that are typically struggling with behavioral and mental health issues and currently active in independent school districts using telemedicine technology to link, promote schools that are without sufficient counselors, psychiatrists and other mental health service providers that comprise -- provides recognition and training services to educators and school resource officers to promote greater recognition and prompt referral, it described in some detail how the program runs and coordination that occurs in the staff and staff of the school. this provides statistics, how

we have impacted an annual enrollment of 40,000 students in ten school districts in loving, texas, where students are empowered to create a safe learning environment. of that number only a small fraction, 414 total referred by teachers and we recognize those referred to the larger program. we have screened out, 250,000 students, 25 have been removed to a school population by hospitalizations and they believe they ever did tragic outcomes that started others on a path toward healing so interesting program they developed for school safety in rural school district in west texas and i would be interested in your thoughts how this integrates with the work we did in cures and cures

implementation. >> thank you for bringing that forward. this is an important part not only in securing that and focusing the school safety commission and so we had the opportunity to speak to a number of districts across the country, texas being one of them. these innovative programs are what we need to better ensure two things, a safe environment, a nurturing environment where they can learn and thanking being one where they identify children only who may have mental health issues that need to be addressed and there are a number of ways to address those mental health service needs, within the school systems or through a close relationship with other types of programs and some of the things that

directly affect those programs, reauthorize certain types of mental health programs oriented toward children, and samsung continues to implement those programs. things like project aware which provides infrastructure of these types of services within schools in states and programs that teach about mental health, psychological, mental health, first-aid type programs, help to identify youth early so we can get them the care and services they need, we are in the process right now of making more awards through granting system. in addition when we talk about integration of care, the certified community behavioral health centers congress established for us represent a

model that can be used who would be referred from this. >> i understand this program has been funded in texas tech university itself but they set up a telemedicine portal and secure connections and encrypting that is necessary to have those secure connections but i look forward to working with you on this and the white house as well. i think you are onto something that is very important. i will recognize you for questions. >> welcome. the 21st century care act was a landmark allowing important visions and substance abuse disorder care for women, children and adolescents.

the national stress initiative supports a national network of child trauma centers and focuses on increasing access to affected trauma focused interventions. explain how the national challenge operates and what impact it has on improving the lives of children impacted by traumatic stress. >> the national traumatic stress initiative program established in a large number of states provide national technical assistance services around issues of traumatic stress, that normally trained practitioners and provide services but also will do consultation in communities to help them address dramatic issues. this is a highly regarded and valuable program. >> the chairman, do you know of anything in the state of texas off the top of your head? >> i don't have a dedicated to

memory. >> i appreciate it. you see early intervention and trauma informed care. the health effects of trauma to be mitigated in any way. >> they can. there is a fair amount of literature on this, the ability to address those traumatic events. a therapeutic environment to mitigate the effects later in life. >> i'm interested in how the stress network response to recent events related to family separation at the border. the network is utilized to facilitate services that endured the trauma as a result of family separation.

>> what i would say, sam's the itself is not involved in those issues. they are dealt with by a different part of hhs, the administration for children and families and the office for refugee resettlement. any provider in the jurisdiction can go to a national program and ask for resources but sam's the itself is not directly involved in that. >> hhs is responsible for those children and if you happen to find any information on what is done, the network for these children, we have a document on the website that notes children can recover from traumatic separation and other experiences with development culturally and linguistically appropriate trauma services for

these children and families including evidence-based and trauma focused treatment. i hope that would be part of the process and sam's the in that effort. in the interdepartmental memo coordinating committee report it listed 5 areas of focus including increasing availability and affordability of care. a patient suffering a serious mental illness or emotional disturbance could be denied health coverage by health insurance as having a preexisting condition? >> that is not my area of expertise and i don't feel comfortable commenting on the details of health insurance. what i would say is medicaid is one of the largest providers of mental health services through their insurance program and

they serve millions of americans at the moment. >> thank you, i would like to ask unanimous consent to place into the record a statement by american academy of pediatrics opposing separation at the border, and the separation of children from their parents, american psychological association and families, the national traumatic stress network and key points on the traumatic separation of refugee children and immigrant children, unanimous consent to place into the record. >> so ordered, the gentleman's time is expired, the chair recognizes the gentleman from kentucky for questions. >> thanks for being here, elinor mccance-katz.

the cdc found less than half of substance abuse disorder patients with multiple mental health issues ever received treatment for mental health issues. the commission suggests this is due to fear of shame and discrimination, lack of motivation to seek treatment. would you discuss how you plan to encourage and work the states using state targeted response on opioid money to help patients with untreated mental health disorders. we have a large population, they need education awareness of these services. >> thank you for that question because we are very much engaged on that issue. the state targeted response to opioids, part of the cures act provides funding for technical assistance training within the state. what we have now done, what we have put in place in february was to have a grantee whose

requirement was to establish teams within every state, states with larger geographic areas that had to have addiction experts and other types of mental health expertise and physical healthcare expertise available so they could go into communities, providers and communities let their states know what services and training and technical assistance can provide that on the spot. we believe that is a way to establish evidence-based practice. if someone has a substance abuse, treating one and not treating the other, would not solve both problems and these

teams are professionals, they are licensed within their states and certified by various regulatory boards to provide that training as part of clinical practices and they are doing that in our communities. >> i was watching a new tv show, amy adams, the actress, several characters seem to have addictions. but at the very end of the show they had a public service announcement that says if you have any issues please call. have you gotten any response from that? that, i was pleased they were trying to show people how to reach out who have addiction issues. for guidance issues via the care act sam's the released guidance for consumers on how to report parity concerns and tools for health plans.

are there future plans to offer providers additional pathways for addressing potential -- additional pathways were addressing potential parity violations? >> we are pleased we have a portal that consumers can use where they can report what they believe may be difficulties with getting coverage for their mental health or substance abuse problems. that portal will give them to the appropriate federal agency, be it labor or cms or treasury. we are pleased about that. we provide guidance, sam's a provided a 30 state parity policy academy where we train on issues related to parity and how states can make sure

appropriate attention is paid to people of their states to get those services that they need. >> those are my two questions and i appreciate you being here and i yield back. >> the chair recognizes the ranking member of the full committee to answer questions. >> thank you. the cures act included provisions that address child trauma. i noted in my opening statement i continue to have grave concerns about children forcibly separated from parents or guardians as a result of the trump administration's 0-tolerance policy. i thought at information on whether children in the office of refugee settlements may have experienced trauma and my resolution of inquiry was debated by the committee last week specifically requesting documents on long-term health implications of the family separation policy on the children.

the leader on mental health issues, sam's the speaks to the impact of trauma and long-term health implications. my questions focus on this. not just me who raised concerns, this has been echoed by child health advocates. and the trust for america's health and national association of health officials. the national child traumatic stress network administered by sam's the notes that separation from parents or primary caregivers is the most potent traumatic stressor a child can experience especially under chaotic or prolonged circumstances. what is traumatic or toxic stress if you don't mind? >> it can be any of a number of things that an individual would

experience as emotionally distressing. various individuals have different responses to that. as you mentioned, one was reported to be separation, i would suggest to you lots of stressors these children have experienced in their travel to the united states, not having seen these kids or attributes what their distress might be about, it is hard to say exactly what the ideology of any particular individual problem might be. >> could you comment on how circumstances of separation increase the likelihood of traumatic or toxic stress? >> hard to say. i will say if you look at the literature on traumatic stress, depending on the study, 43% of

individuals, some traumatic stress in their lifetime, both of them do not going to develop major mental disorders and when you mitigate, when you relieve that stressor people recover. people have amazing resilience and that is why all of us who are opposed to some stress don't developmental disorders. we can't predict with reliability who will. >> all the more reason if you have had separation, to try to get kids back together with their parents so they can recover. >> our department is working hard on that, our secretary has spoken to that issue and they are addressing it every single day. >> the problem i have is you mentioned sam's the is not involved in the child separation issue that resulted from the 0-tolerance policy.

the cures bill required sam's a to coordinate across the federal government. do you think samessay should play a role in responding to this crisis at the border? >> samsa has the national traumatic child stress network and we do implement that and work with grantees to make sure they are providing services needed to serve americans who may experience traumatic stress and their children. it is also a decision by others as to what agencies are specifically involved in the day today activities of any particular event. so samsa does what it is required to do by that yours act and we stand ready to provide additional assistance if requested. >> i don't want to put words in

your mouth it sounds like you would be willing to help but no one in his to permit is asking you to. i just think it is clear families must be reunified immediately and ensure that these kids have access to the trauma of prevention of mental health services in order to republican -- recover and mitigate the experience as a result of this policy. i will leave it at that because my time is running out. >> the gentleman yield back, recognize the gentleman from virginia. >> thank you for being here today, very important topic, mental health, so important and you touched on a number of things that are not answerable in the 5 minutes we have. recognize i would like you to think about them and send them to us at a later date. in your testimony discussed concerns brought up about

enforcement of parity protections, mental health and other medicine for treatment. i was in a meeting with secretary acosta, he brought up similar concerns that they have enforcement authority. but really have difficulty in the enforcement side of that. what tools are necessary? what suggestions would you have as steps that we can taken the federal law, for mental health parity and physical health parity so the two are treated the same in various plans. i will give you an opportunity and recognize this, and our lecture as opposed to a 5-minute segment. >> my quick answer to that would be the question is quite an important one. it is one that i would want to

seek legal counsel about and when that we will be happy to give a written answer to. >> i would like an extended answer. because these issues are complex, switching gears, another complex question, talk to a principal in one of my rural schools, representing the mostly rural district and we are talking school safety and mental health, a major component in that and we can identify a child who has issues and send them off for evaluation. but because of the current state of privacy laws they can't tell us what is going on and we don't need to know everything going on in child's like but if there is things we need to know like are they violent? do they have a tendency to be violent? even if you don't expect something now is there a violent component and emotional or mental issues? we could at least pay more attention, have them checked by the office to look in their

bookbag every day to see if they are bringing in contraband, guns or other weapons or issues we should be aware of, we have no ability to do that so is there some way we can expand the knowledge base of folks, we pass some bills to make it -- that still wouldn't cover with the drug use, wouldn't cover the school personnel who may very well need to know what is going on. if you could give me some answers back, that would be great. >> this is a topic that is part of the federal school safety commission, one of the areas the president has asked us to look at. i will go a little further, we will give you something in writing as well. part of the big problem here is providers, teachers, administrators don't understand when they can communicate and

if there is a threat already, there is communication but this is not well understood. one of the things we really have to do is work very hard to get that information out, what these allow us to do. >> i want to jump in, here's the dilemma you get, is there a direct threat? if you think they are harmful to someone else at the moment, if you just check, there may be a developing problem or i don't think it covers, we can talk about it and look at this, school personnel would like to know what side we should be looking for this person is starting to move further in issues with mental illness that right now they are not a threat but they have violent tendencies, what should we be looking for?

they are with a child every day in most weeks so they are the first people to pick up on that. we don't have time for the answer. we did a lot of work trying to figure out how to deal with adult children even if they have mental health issues, medical issues, and how parents are interactive. we struggled with this. if there's something we need to do in the code this committee on a bipartisan basis wants to help, we don't want to give up privacy rights. i yield back. >> the gentleman yields back. the chair recognizes the gentlelady from illinois. >> doctor elinor mccance-katz, i will ask this question.

given samsa's leadership uninformed care, the office of refugee resettlement worked with samsa to ensure children being held in their custody are receiving trauma informed care? >> i can say two things about that. one is the office of refugee resettlement assures these children are getting physical health care and mental health care and getting it regularly. >> the reason i was going to say i am not going to ask that is quite frankly i was shocked by your attitude that we all have trauma in our lives and most of us get over it and they will probably get over it. you may have heard congressman green entered into the record

statements from a number of professional health organizations, the american psychiatric association, the american psychological association, the american public health association, the american academy of pediatrics. the concern about the trauma, i want to add into the record too a couple of other articles of people who actually -- groups that weighed in that were victims of long-ago atrocities, separation of children so i ask unanimous consent, the first from the guardian not to use -- separating me from my parents, the trauma lasts a lifetime, that is the one article and the

second from the anti-defamation league, quote, hidden children of the holocaust open up about border situations saying policy separating migrant children from parents is unconscionable and in this article, talking about the lifelong effects, maybe it is time they didn't contact you about that. i wonder -- >> i object. i have an objection to submitting articles about the nazis and comparing what the nazis did with the current us policy is in the united states with clarification. i may remove my objection but to compare nazis to the united states of america is something i object to and i won't allow those to be submitted. >> let me comment on that in

defense particularly of the anti-defamation league, issued a statement on behalf of a group of hidden children of the holocaust who felt strongly compelled to oppose the trump administration's expanded, quote, 0-tolerance policy. >> i object, mister chairman. >> i will ask for yeas and days. >> we can resolve this if the gentlelady would recognize there is no comparison between the current united states government and the nazis. >> i recognize that there isn't but this is about a particular issue of separating children from their parents and the long-term effect. >> i remove my objection. >> i appreciate that. i wanted to ask you about no

touching policies. i had a hard time pinning down exactly what that is. if there is a policy, if this is being done by the particular staff in particular places because it is unclear if there is a firm policy but i have heard of places, articles that a sister was not able to embrace her younger brother, they were told children may not touch each other, staff may not come and hold children that are in great distress. i wondered what kind of trauma, if those decisions are trauma informed care.

>> really not possible to comment on that because i'm not familiar with the details of it. >> touching children, the issue of touching, are you not informed about the effects of touching or comforting, physical touching when it comes to mental health? >> what i'm not familiar with is the agency. >> i am asking a more general question. according to decades of psychological study, positive touch from adults can not only lower stress levels in the moment but have long-term an official affects if administered regularly and a consistent lack of positive touch is shown to have detrimental effects on kids as they mature. do you agree with that?

>> i don't have an opinion. it is out of context. >> really? i am asking generally about an issue that you are supposedly an expert on. about trauma informed care. >> let me just tell you that touching can have all sorts of implications, good and bad. >> do you agree with the statement -- >> the witnesses answered the question in the gentlelady's time has expired. we go to ms. brooks. doctor bucshon. 5 minutes. >> thank you. thanks for being here, appreciate it. i am opposed to separating children from their families. all of us on both sides of the aisle are. i am also have serious concerns, i wasn't going to bring the subject up but since

it seems like my colleagues on the other side are staying on message on this and every one of them is going to talk about this i feel i will also. i'm also concerned about thousands of children coming unaccompanied and thousands of miles across mexico being brought by coyotes and drug cartels and i have been down there. many of them have been sexually assaulted and abused and so i'm concerned about them also. we have 12,000 children in our custody, 10,000 of which are unaccompanied that came with no adult, no family member. a tragic circumstance as well as families coming and adult males with children because they know we don't have beds for them in the united states and if they come we are

releasing ankle bracelets into the united states 300 of these people per day and that is not my opinion, that is what we are doing, the cartels and coyotes, they know our laws and when we don't follow the law they exploit it or when we do follow the law that needs to be changed and congress's fault to adjust these things. many of these people are coming to my view from the past failed policies, most recently of the obama administration on open borders and sanctuary cities and catch and release, being encouraged to send their children thousands of miles by themselves. and fairness, their countries are in dire circumstances and i can't say what i would do but i do know the situation is much more complicated than is being

portrayed and i'm concerned about millions of us citizen children who are being abused, neglected and suffering traumatic problems. we all know that is a difficult circumstance and that is all i will say. section 605 requires samsa to develop a strategic plan identifying priorities including a strategy for improving the mental health workforce. your testimony mentions engaging subject matter exports. macadamia hospital assures state governments, consumers and family members on the concepts -- complex problems such as workforce challenges. can you expand on what samsa is doing to expand workforce challenges in rural areas related to mental health? let me say this. i was a healthcare provider, one of the big challenges is financial support for these

types of services. can you expand on that a little bit? >> i can, thank you for the question. we have developed a new program in place by september 30th at the end of this fiscal year that set up specialized specialized programs around issues related to mental and substance abuse disorders on things like things i mentioned for the opioid crisis. we call it the state targeted response. we have one of veterans, national child traumatic stress initiative. we have a number of different types of topic related special national programs, clinical support systems for serious mental illness that will address issues around serious mental illness. we also are establishing technical assistance within each of the ten regions, those

are focused on localized needs of communities because every community is different. we recently established a relationship with the government of agriculture that does a lot of rural work and so we are expanding technical assistance through some of their initiatives into rural areas. telehealth is a big issue or the department of health and human services, we have behavioral health coordinating committee which includes operating divisions and telehealth is a specific issue we are working on to provide additional guidance to try to expand the reach of the practitioners in rural areas. >> thank you, i yield back. >> the gentleman yield back, the chair recognizes the gentlelady for questions. >> thank you for joining us today. i'm pleased we are hosting this hearing to discuss mental health provisions and 20% treat

yours and i look forward to oversight hearing, including health it and interoperability. i have to make a comment about the mental health of thousands of children separated from families due to donald trump's 0-tolerance policy, public health, pediatric experts including the american academy of pediatrics and the nurses association voicing concerns about the harm caused through stress and trauma incurred by children forcibly separated from their parents, the stress and from a has immediate harmful effect on these children but also long-term impact on development. elinor mccance-katz, samsa note the impact of childhood traumatic stress can last far beyond childhood and child from a survivors are likely to have

long-term health problems including behavioral health and substance abuse disorders. that is why this committee must act immediately to ensure hhs is reuniting children with parents and to assure that hhs has long-term plans to mitigate the impact of trauma on these children. moving on to my legislative priority in 20% treat yours, title 11, compassionate communication on the hipa -- hipaa section of the bill clarifying confusion about the hipaa privacy bill is -- the confusion for patients, families, doctors and administrators and lawyers about what information can or cannot be shared remains, cures requires hhs office for civil rights to coordinate with samsa and other agencies to develop and update programs to train healthcare providers, and their families on the use and

disclosure of information on individual seeking a receiving treatment for mental health or substance abuse disorders. elinor mccance-katz, hhs released additional guidance in december. what is being developed for model training programs? >> i have a few things to tell you. one is we are working hard to coordinate those efforts and one of the things we did last week was to train attorneys, healthcare attorneys on issues around hipaa and i brought a copy of the training and i will be happy to leave it. we had 1000 attorneys on that webinar, the most you can have in the american bar association

which is continuing to disseminate it. the american bar associations that there would be 4000 to accommodate it. we are also using this to develop something i will say is simpler language for people like me who are practitioners to do special training for practitioners on the privacy issues but the thing that is most exciting is yesterday we were able to publish a funding announcement, we have a national center on privacy. hipaa and 42 cfr will make a huge difference. >> what about other stakeholders? will you be bringing them in too as you develop a training program? >> absolutely. we will have a single grantee whose job it will be to train

clinicians, to train administrators, and often these will be lawyers involved in healthcare systems. the other requirement in the funding announcement is we must put out materials. >> that is important because many times it is misunderstood and we set up these programs. if we don't have a communication, in essence to have patients come in and parents to understand what the process is. a certain kind of situation, people don't know what to do. i would hope we keep these training sessions going. just because we have certain set of training doesn't mean it is all done. >> that is correct and this will be a multi-year initiative. >> i yield back. >> the gentlelady yield back. miss brooks for five minutes.

>> thank you, elinor mccance-katz, thank you for being here. is the first assistance victory focused on these issues, every answer you have given your portfolio is so large, so many issues constituent care about, i have a hard time figuring out where to focus. as an attorney who practiced -- in the criminal justice system, we know that 21st-century your reauthorized and added some programs regarded the grant programs for mental health, and often overflowing and often the largest, those with mental

illness. any update on successes you've seen in the program so far that we can help local county jails and state prisons deal with this problem? >> this is a great benefit that these resources have been made available. what we have done at samsa is to fund mental health courts for adults and youth who are experiencing mental illness sometimes for the first time but involve them in the justice system. we also are -- our starting programs divers people prior to arrest. they suffer from a great deal of stigma and these things, you have an arrest that makes it more difficult to be able to

navigate in communities without problems, more difficult to get insurance, a job, housing. so we like the idea of diversion programs and we are funding some of those. >> i applaud you for that and what you just mentioned, the national center on privacy and the fact that that many lawyers got our call, i applaud the american bar association for encouraging that and many many lawyers will participate in that kind of training. i want to encourage you getting the word out on that as my colleagues across the aisle. when you talk about what is the best way for our constituents to learn about all these grant opportunities? there seem to be new grants or new programs and we are having a hard time trying to help

direct our constituents. we have a school shooting in my district on may 25th and when you talked about teachers and educators wanting to learn more that is the one thing i heard, our teachers and educators are so concerned about learning more about whether it is the mental health first aid you talked about or identifying as congressman griffith brought up, what can you share with us is the best mechanism we can provide our constituents to be educated or to pursue grant programs particularly for mental health in our schools and communities, what are the best ways we should communicate this instead of just going to samsa's website? how can we better provide our

constituents? >> it is a resource. >> extensive. >> it is. we are working on how to simplify that and find things but we are working on webinars on specific programs, talk to the public about what those programs are and funding opportunities. the other thing we will be using, the system of regionalized training is for these opportunities, to make it easier for those who are taking advantage of those regional programs to know more about the opportunities. if you have addiction transfers center in region one in the northeast, that technology transfer center can make it

easier for the communities and individuals to find out what the resources are. we have one for substance abuse and also have one for mental health issues. we also are supplementing those mental health technology transfer centers to specifically work on issues related to schools and children's needs. that will be happening in the next fiscal year. we hope by regionalized in the programs, we can get down to the community level. it is very difficult. >> i applaud the work your office is doing. look forward to helping with that. i yield back. >> the gentlelady yield back, the gentlelady from florida. >> elinor mccance-katz, thank you for being here today.

you have a significant responsibility as secretary for mental health and substance abuse. i thank you for taking on this important -- i reviewed your bio. you have great experience and a number of degrees from outstanding institutions. i think your expertise is needed in this area. i want to ask you about the long-term mental health implications of child traumatic stress caused by the family separation policy. you heard the concern from colleagues today and we are reflecting the concerns all across the country. and we ask about the family separation policy on those children forcibly separated from their families. i know you cannot get into specific cases but based on your extensive expertise i

would like you to comment in general. many public health organizations have stressed the practice of separating children from their loved ones and caregivers for an extensive period of time is 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? >> i can't speak to family separation per se. i don't know who might develop a mental disorder that will have long-term implications for them. >> that runs counter to everything we are hearing from organizations, leading mental health organizations from across the country. >> the president has directed

the families not be separated further. secretary a's are made it clear our job is to reunite these families. we are working hard to do that. these children are in a safe environment, the practitioners are all licensed in the states that these facilities -- >> you would not have recommended this policy at the outset, would you if they came to us assistance secretary, would you have recommended this policy or did they ask you? where you asked? where you consulted? >> there are a number of policy implications. >> i'm not trying to play gotcha. secretary a's i said he was not consulted, were us assistance secretary for substance abuse and mental health before the family separation policy was implement it?

>> i was not consulted. >> there is a significant body of evidence detailing public health implications, adverse childhood experiences. would you consider forcible 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 health care and mental health care and they are getting it very regularly. >> it is likely that 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, the reality is most people have

a great deal of resiliency and when they can get their mental elf issues addressed and these children are getting mental health care in these facilities we hope they will not go on. >> the cdc adverse childhood experiences study found many long-term health impact of adverse childhood experience including risk of disrupted neurodevelopment, social, emotional and cognitive impairment and heightened risk for disease, disability and social problems. can you explains specific physical and mental health problems that can result from adverse childhood experiences? >> there are a variety of types of mental disorders that can be a result of adverse experiences. >> at risk factors for behavioral health and substance

abuse disorders. >> that is true. >> there was a recent news report. >> the gentlelady have time expired. >> i ask an additional 30 seconds to ask about funding shift that hhs because there's a recent report hhs has dipped into tens of millions of dollars to pay for what has happened through family separation, the department burned through $49 in the past few months. i wonder if that impacted your shop? shipping any money out that was previously directed towards samsara -- samsa? >> samsa has had no direct effect. >> the response was negative. the gentleman from florida five minutes please. i am sorry. >> thank you very much, appreciate it. elinor mccance-katz, in

accordance with section 13002 of cures, i understand last year samsa had a public listening session on mental health parity involving 15 in person groups with an additional 40 comments the a email and in writing. .. that we received around the need for education, around the parity act, and how individuals who experience what they believed to be violations with the assistance they need and what are the responsibilities that states and insurers about these issues. samhsa is in the process of developing a guidance on that,

and that should be out before the end of this calendar year is what i i was told prior to this hearing. so i am giving you the information that i have available to me. >> thank you very much. in your testimony to mention over 7.4 million children and our nation of us to his mental health disorder what only 41% actually receive treatment leaving the vast majority untreated. those are the 41% are the ones that were identified, so it could be even more than that. again this is a serious come as you get assisters issue and i'm glad the chairman is holding this hearing and we're taking this issue very seriously. it really is an epidemic, and in addition to supporting systems of care, how has samhsa worked with industry to address work force short issues.

>> we are addressing, so when you think about how can come with that problem we have, we have an urgent problem, and urgent need to get more services to americans are living with these kinds of conditions. what is the fastest way to do that? it's not going to be by opening for medical schools. that's going to take too long. when you think about this like to think about how can they get service to americans? i can do it by training and providing technical assistance that will prepare practitioners to intervene and to provide care and treatment of mental and substance use disorders. and that's why so much attention since i've come to samhsa -- >> would you talk about practitioners, talk about like psychologist, , psychiatrist or primary care physicians that would get additional training? >> all of the above. and so we are setting up programs of regional trade and technical systems.

we are working hard to disseminate that information so clinicians and practitioners, psychiatrist, psychologist, physicians assistants, social workers would be able to take advantage of these kinds of trainings. that allows them to get specialized kinds of skills and provide that service to their clients. the other thing i would say is working to set up programs to our grant funded organizations that will provide ways that practical assistance can be provided. so, for example, in the state targeted response funds that cures provided, the the states can contract with providers that provide specialist opener treatment services. we also the grant program at

sancho, medication, way medication-assisted treatment. those programs provide practical experience to have the ability to provide a didactic classroom style webinar, web-based training but then the ability within regions of the country where people can go and see this in practice. and we think that is a way to better assure that that practitioners will feel confident enough and able to use new skill set to provide care when americans needed. we also continue to support programs called experts. 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. is a burden always going to be on the teacher? where to go next once they are diagnosed? i know it's very expensive.

treatment centers and a lot of insurance companies do not cover -- >> the time of the gentleman has expired. >> even if they do the co-pays are so very high deductibles. i'm sorry. >> the time of the gentleman has expired. the gentleman from george has been waiting very, very patiently all day. perhaps that question can be responded to in writing. >> thank you, mr. chairman. dr. mccance-katz, thank you for being here and 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 has got a little bit off-base but of what to do we appreciate what you doing for our citizens here. i'm sorry to report to you that george is not doing so good with mental health services. in fact, we rate about 47 out of 50, and that's one of the things that bothers me and, in fact, it's estimated that we have less than 20% 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 can win at 59 counties in the state of george and only 76 have license or 76 do not have a license psychologist we got again one of 59 counties, page two of them have no license social worker. all of these figures are alarming to us and alarming to me in particular, because of the fact in the state of georgia for those children between the ages of 15-19 the second leading cause of death a suicide. for those between ten and 14, the third leading cause of death is suicide. so all of that leads me to ask you, jurors reauthorized the children's mental health initiative and that provide a lot of grants and a lot of assistance that we are very appreciative for. but i just want to ask you, particularly in the george with a lot of rural areas can take on south georgia my district a lot of rural areas and i just

wondering how to begin services to those areas? any suggestions on how we can improve services there? >> so samhsa's has provided two types of integrated care programs. one is where behavioral health providers would be able to be part of a team and eight primary care program such as a qualified health center. the second way is through programs such as are certified community behavioral health clinics that bring primary care directly into a beautiful help setting so that a person can easily access all the care and services that they need in one setting. samhsa 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 at trying to establish those programs on a national level. we talk with our colleagues at the centers for medicare and medicaid services.

>> what about telemedicine? is that something that we should be focusing more on? >> yes. i was just about to get to the. >> i'm sorry. >> so yes, , telehealth is a vey important piece of it, particularly for areas that have a lot of large role communities. >> right. >> telehealth generally extend the reach of a practitioner who may be any more urban area but -- and so the 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 about issues of prescribing so that we can utilize the telehealth providers to the very best extent. >> are there grants specifically for that or are the just concluded in regular grants act you can use for the purpose?

>> we have sancho part of a larger grant program that are telehealth services come from and i believe other parts of hhs have specific funding for telehealth. >> great. nothing want to talk about real quickly is the opioid addiction and the funds that been going there, the grants. we've been very fortunate the georgia department behavioral health and development of disabilities has gotten almost $12 million. i want to report back to because i've been a part of some of these programs. it is working well and is been utilized well. in fact, one of the cities, i want to give them a shout out, the city of pembroke of georgia in my district in brine count has been very active in this and simply a number of programs that have media campaigns, school partnerships, a number of programs that have been very successful can you elaborate just very quickly on what else we might be doing with that?

>> so for the opioid crisis is one of secretaries priorities. >> and this committees priorities. >> yes. and we are very grateful to congress for the increase in funding to address these issues. what we have to do is work very hard to integrate substance abuse treatment, opioid addiction treatment into primary care settings in addition to 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 the care, and to use innovative practices such as telehealth. this is why we working with the drug enforcement administration to make it possible for a clinician of the greater reach and reach americans in those rural areas that had such difficulty accessing. >> thank you again for your work, and i just back.

>> the gentleman yields back. i think all members had the opportunity to ask questions. i will again thank eyewitness of taking time to be with us today. pursuant to give rules i reminder was 15 business days to submit additional question for the record. ask the witness to submit responses within ten business days upon receipt of this questions. without objection the subcommittee is adjourned. [inaudible conversations] [inaudible conversations] [inaudible conversations]

[inaudible conversations] >> coming up on c-span2, c-spak at u.s. policy in southeast asia with assistant defense secretary for asian and pacific security affairs randall schriver. he will stick at the american enterprise institute and that's scheduled for 12:30 p.m. eastern life on c-span2. >> "washington journal"

continues. host: >> for a discussion on security of the us the electrical grid we're joined now by richard kauzlarich, codirector of the center for energy and science policy at george mason university, also a former u.s. ambassador. first, we were talking about the grid, what does that include? >> guest: that kind of the very basic question because my connection to the great is when i come home at night and through the electrical switch and i think most people can think that's the most important part. you've got the production of energy, which may come from coal, gas, nuclear power. you've got its transmission. ultimately he g