in the country. it focuses on a fellow named edmond ross who was credited with capturing the vote that saved johnson's tail and it calls ross' vote the most heroic moment in american history. i actually think it was bought that, his vote was purchased and saving johnson i think was not a heroic moment. >> david stewart, sunday night, 8 eastern on c-span's q and a. up next a look at access to mental healthcare programs under the 21st century cures act. we'll hear about what the health and human services department is doing to help immigrant families and children separated the u.s. southern border held by a house congress subcommittee. this is about 90 minutes. >> we'll now come to order. the chair recognizes himself five minutes for purposes of an opening statement.

today we convene and hold an oversight hearing on the mental health division on the 21st century cures act which was signed into law in december, 2016. on the anniversary of the house passage of 21st century cures this subcommittee held a hearing on the sections of the law that the national institute of health and food and drug administration are implementing. today we have dr. eleanor mccann 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. some mental health titleful 21st century -- the mental health title of 21st century cures was based upon the mental health reform act of 2014 which passed the house by a vote of 422-2 prior to its inclusion in

the cures bill. this legislative effort represents the most significant reforms in the mental health system in more than a decade. the first provision within the mental health division strengthens the leadership and accountability including establishing the position that dr. mccann now holds. one of her duties as the assistant secretary is to develop the strategic plan by the end of this fiscal year. cures also strengthened existing programs including the two biggest programs, the community 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 flexibility to states to address their unique mental health needs. additionally, the law authorized the national mental health policy laboratory to carry out 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 abuse disorder care is vital to the overall health of our nation. according to the national alliance on mental illness, approximately one in five adults in the united states experienced mental illness for a year. of those adults suffering from mental illness only a little more than 40% received mental health services in the past year. title 9 of the 21st century cures act focused on promoting axe sis to mental health and substance abuse -- axis to mental health and substance abuse disorders. some of these programs provide grants to eligible entries that provide mental health substance abuse disorder services to homeless individuals and jail diversion programs. additionally, the title

authorized the program to further integrate primary care and behavioral health services through demonstration projects, notably the 21st century cures act expanded 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 the vital signs report which showed a rising suicide rate across the united states. in 2016 we lost nearly 45,000 lives to suicide. 21st century cures aims 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 grant. the existence of all these programs would be far less impactful if we did not have an adequate workforce to provide services. therefore, there was an entire

subtitle directed to strengthening the mental and behavioral healthcare workforce through training grants, demonstration programs and other means. several new grant programs have been established to address mental health needs in populations such as mothers and children. one program provides grants to support statewide or regional pediatric mental health aired telehealth access programs. such programs could be especially helpful in early identification and dream of mental health issues in school age children. this is especially critical because 50% of all chronic mental illness begins by age 14. 21st century cures made meaningful long sought reforms to our mental health system and is the result of thoughtful bipartisan legislation created over the course of several years. while this law reflects on our diligence and commitment to improving america's overall mental health, there is work that remains to be done. i'll yield back the balance of my time and recognize ranking

member of the subcommittee, mr. green, five minutes for an opening statement, please. >> thank you, mr. chairman, for holding today's hearing on the implementation of the 21st century cures act. today we will be examining division c of the law which focuses on mental health programs and activities administered by the substance abuse and mental health service administration. i want to thank the assistant secretary for mental health for joining us this morning. the enactment of the 21st century cures in december, 2016 was a great achievement, particularly at a team of sharp partisanship and gridlock, but the work started long before 2016 led by our colleagues fred upton and diane degette, but all of us on the committee were participants. in 2014 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 devoted to roundtables, white papers, hearings and drafts, peers enjoyed bipartisan endorsements from over 700 organizations representing a full spectrum and stakeholders. this is to strengthen our nation's public health infrastructure. the cures act made several changes to mental health authorities and programs implemented preauthorizing several existing mental health grant programs and creating new programs. for example, the cures act established a chief medical officer to assist and evaluate an organizing program within the agency and promote best practices. the law further requires the association to develop a strategic plan every four years to identify priorities including a strategy for

improving the recruitment, training and retention of a mental health workforce. the cures act also created a national mental health policy laboratory and interdepartment serious mental illness coordinating committee which issued a report to congress last december to address the needs of americans suffering from serious mental illness and emotional disturbance across federal agencies. one of the most important acts to help americans helping from mental illness and emotional disturbance is ensuring they have access to care. medicaid is the single largest payer for mental health services in the united states. in 2015 medicaid covered 21% of adults with mental health illness and 26% of adults with serious mental illness. i'm concerned that actions taken by the trump administration to make it more difficult to receive medicaid and increase the cost of health coverage will suspend adjustment payments to insure

high cost patients will make it more difficult for americans suffering from mental illness and emotional disturbance to receive treatment they need to live in a full and healthy life. before i close i must note that on the ongoing mental health crisis created by the trump administration regarding the separation of children from their parents. the american academy of pediatrics has emphasized in highly stressful experiences like family separation can cause irreparable harm disrupting 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 3,000 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 we are taking to help these children recover from the

trauma of family situations. thank you, mr. chairman, and i'd be glad to yield my last minute to someone who would like a minute. i'll yield to my colleague from colorado. >> thank you very much. i just want to thank you, doctor, for coming today. i really look forward to hearing what the organization is doing to implement the reforms in 21st century cures, particularly the mental health aspect of the bill were issues this committee worked on many years trying to get it right and i'm not sure we yet have it right. i yield back. >> there is a vote on the floor, but with the committee's

permission we'll finish with our opening staples before adjourning for the vote and i'll recognize the gentleman from oregon. >> thank you very much. we appreciate that. we appreciate your convening this hearing. it's really important we do oversight on how 21st century cures and the one of the bipartisan changes incorporated therein are now being implemented. i want to thank our colleagues on the committee here now and certainly dr. tim 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 a multi-year multi-member bipartisan congressional effort and they're based largely off the healthy families mental health crisis act which passed in july, 2016 by a sweeping vote of 422-2. i think it's always important once we pass legislation, we come back and review is it working? where can we improve? what's not working? that's why we're here today.

these provisions were ultimately folded into cures signed into law on december 13th, 2016. division b marked the landmark reforms to our mental health laws and were long overdue. when our committee first took on this, there were 112 federal programs spread across eight federal agencies trying to address mental illness and cost taxpayers $130 billion annually, 112 programs, eight agencies, 130 billion and many of the programs had not been updated or reauthorized in years. under the leadership of fred upton and ms. degette and others we streamlined these programs. we prioritized access to evidence-based programs and best access to make them available to providers across the nation, granted states additional flexibility and mental health block grants to

address needs of the patient population and increased oversight, transparency and accountability for these programs. there's been important progress in boosting resources for suicide prevention. too many of us have friends who lost loved ones to suicide. my dear friend and colleague, senator gordon smith from oregon, tragically lost his son garrett lee smith to suicide one day before his son's 22nd birthday. worked hard with senator smith to authorize the original garrett lee smith memorial act which provides information and training for suicide prevention and i was proud to see this important program reauthorized in cures. in a march funding bill which is now law, congress provided critical funding for nearly 30 sections of the provisions within cures and these programs include the national child traumatic stress network, national child traumatic stress initiative, mental and behavioral health training grant, assisted outpatient

treatment and the national suicide prevention lifeline. in addition, the bill also appropriated 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 and behavioral healthcare included in cures. in the northeast part of my district and other areas across rural oregon, i've heard the success stories of providers who have been able now to integrate their community health center and behavioral health services. we know it works. we also know there can be barriers to full integration. i'd appreciate hearing from our witness today about what you're seeing at the federal level in this space of integration of service. finally i'd like to note the section in cures devoted to substance abuse disorder and just last month the house passed hr6, the support for patients and communities act. that's the biggest legislative package to address a drug

crisis in american history. that bill started in this very subcommittee and our work on substance abuse disorder, however, goes much further back to the leadup of the comprehensive addiction recovery act and the cures legislation. so this intersection between mental health issues and substance abuse disorder is clearer now more than ever and the grants and 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're doing. your position was created under the very law that we're examining today. i know we're eager to learn more about your work to coordinate critical mental health services programs across the federal government. chairman, i'll yield back. >> thanks. the chair recognizes the gentleman from new jersey, ranking member of the full committee, five minutes. >> thank you, mr. chairman. it's the critical function of this committee to conduct oversight and insure the legislation we pass is working as intended. that's why i think it's important to hold hearings like

these to allow us to learn from the administration how policies are implemented. in 2016 president obama signed the 21st century cures act into law which was truly a product of the hard work of bipartisan members of this committee. as we know, the cures act addressed the wide range of issues facing our healthcare system. however, today we'll be focusing on the provisions related to mental health and i'd like to thank dr. mccann for joining us today to testify on the important work happening at samsa. helping families and mental health crisis act which was ultimately passed as part of the cures act is an important step towards repairing our country's broken mental health system. i'd like to highlight a provision i worked hard with my colleagues to include in this legislation that expanded an important set of medicaid benefits to children receiving inpatient psychiatric treatment. i think we agree our work is far from complete and more needs to be done to improve access to affordable mental health treatment. unfortunately in the time since

we've passed the cures act the republican party has been fixated on repealing the affordable care act and cutting medicaid, which is the single largest payer of mental health services in the country. for many people medicaid provides the only chance they have at getting treatment for a mental health disorder and i continue to believe any progress made by the helping families and mental health crisis act would be completely reversed if the republicans ever succeed in their radical plan to repeal the affordable care act and drastically cut medicaid benefits to low income individuals. these actions could cause catastrophic harm to people with mental illness. speaking of helping families in crisis, i'm reminded that this committee has still not acted to help the thousands of families currently in crisis because of the trump administration's cruel family separation policy. the administration recklessly moved ahead with this inhumane policy with little thought how to address the long term health implications for the children torn away from their parents or how to reunite them with their family and this is a manmade

disaster by the trump administration. public health advocates and healthcare providers have already warned how devastating forcible separation can be to a child's mental health and overall development. according to the american academy of pediatrics and i'm quoting, "highly stressful experiences like family separation can cause irreparable harm affecting his or her short and long term health. this type of prolonged exposure to serious stress leads to lifelong consequences for children." as i said at the outset of my remarks, oversight is a critical funk of this committee and -- function of this committee and so far chairman weldon has not been willing to hold an oversight committee which i think we should have before the august recess and that tells me 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 it never happens again. we must reunite these families immediately and while we can't

undo the trauma these children have already endured, the administration must take every step possible to prevent further harm. with that i yield back, mr. chairman. >> the gentleman yields back. under five minutes left in this vote series. my understanding is there are four votes in this series. that should take us a little less than one hour to complete and the committee will stand in recess until immediately after votes. >> as we recessed, we had just concluded with opening statements. all opening statements will be part of the record. we want to thank our witness for being here today, staying with us through votes and taking time to testify before the subcommittee. our witness will have the opportunity to give an opening

statement followed by questions from members. today we're going to hear from dr. eleanor mccann, assistant secretary for mental health and substance abuse, united states department of health and human services. we appreciate you being with us today, doctor. you are recognized for five minutes for an opening statement, please. >> chairman burgess, ranking member green and members on the subcommittee on health, thank you for inviting many he to testify at this important hearing. december, 2016 the 21st century cures acquisition was signed into law. i -- act was signed into law. i thank you for your vision and leadership on addressing the needs of americans living with substance abuse and mental disorders. we have actively implemented this law since enactment. as the first assistant secretary created by the cures act, i take seriously my duties

including leadership and accountability for behavioral health, evidence-based program coordination across government. part of strengthening leadership and accountability includes a strong clinical perspective at the agency. it codifies the role of the chief medical officer and we have expanded the office of the chief medical officer to include two additional psychiatrists, a clinical psychologist and a nurse practitioner. a new component of samsa is a national health and substance abuse policy laboratory. the policy lab promotes evidence-based practices and service delivery through evaluation of models that would benefit through further development, expansion or replication. policy laboratory also provides leadership in identifying and coordinating policies and programs related to mental and substance abuse disorders including needed policy changes. the interdepartmental serious mental illness coordinating committee was established by the cures act to insure better

coordination across the federal government to address the needs of adults with serious mental illness and children and youth with serious emotional disturbances and their families. the committee has worked in five key areas of focus, strengthening federal coordination to improve care, closing the gap between what works and what is offered, reducing justice involvement and involving care for those -- improving care for those who are justice involved, making it easier to obtain evidence-based healthcare for mental and substance abuse disorders and developing finance strategies and increased availability. the cures act reauthorized the block grant and codified the first set aside. if we can intervene early with needed treatment in psychosocial services, individuals are better able to manage their serious mental illnesses, similar to other chronic health conditions. in 2016 44,965 americans died

by suicide. according to samsa's national survey on drug use and health statistics, over 1.3 million americans attempted suicide. the cures act authorized samsa's existing national suicide prevention lifeline. recent evaluation data show the majority of individuals served and then interviewed following use of lifeline reported the intervention stopped them from completing suicide and helped to keep them safe. at the same time the highest rate of suicide in america is among adults aged 45 to 64 years old. samsa is grateful to the organization of the adult suicide prevention program. the purpose of this program is to implement suicide prevention intervention programs focused on training of healthcare professionals, asked about suicide ideation, make safety plans and assist people with treatment who have thoughts of wanting to end their lives. one of samsa's roles is the

implementation governing patient records. samsa updated these regulations. in january, 2018 input was obtained about part 2 information. the need for technical assistance and training, the importance of integrated care and use of electronic health records were addressed. the cures act demonstrates congress' commitment to addressing the opioid crisis awarding $500 million in 2017 and 2018 in the state targeted response great funding to states and communities around the country. these funds support comprehensive addresses in the opioid crisis. i feel strongly we need to insure the direction provided by congress in cures is

followed with fidelity and the highest quality service delivery possible. in order to achieve this goal, i have reconfigured samsa technical assistant approach from a grantee-based approach to one which 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 at sams a and across hhs to inch mountain the cures action, but we know this work is -- implement the cures act, but we know this work is far from over. i'm pleased to answer your questions today. thank you. >> thank you, dr. mccann. thank you for your testimony. this concludes the witness opening statement portion of the hearing. we'll move to member questions. i recognize myself, five minutes for questions. i want to begin by asking consent to place into the record a statement for the record by dr. billy phillips

from texas tech university health science center. the professor of family community medicine, professor of public health and executive vice president for rural and community health at texas tech university describing their program of telemedicine, wellness, triage and referral. without objection so ordered. dr. mccann, let me just pull a couple of pieces out of this. dr. phillips tells us this program provides school-based screening assessment and referral services to students that are typically struggling with behavioral mental health issues and is currently active in 10 west texas independent school districts. this project uses telemedicine technology to link remote rural schools without sufficient counselors, psychiatrists and other mental health service providers. it also provides mental health recognition and training services to educators and school resource officers to

promote a greater recognition and prompt referral. it then goes on to describe in some detail how the program runs and the coordination that occurs between their staff and the staff of the school. interesting he provides some statistics. the impact area has an annual enrollment of 42,000 students who attend mostly rural school districts around lubbock, texas, creating a environment where students are empowered to help create a safe learning environment and better morale. of that number only a small fraction, 414 total, have been referred by teachers and we've been trained to recognize those who will need to be referred to the larger program. the team has screened out and prelaunched by telemedicine 215 students. 25 have been removed from the school population, most by

hospitalizations, a few by arrests. they believe they've averted tragic outcomes and started others on a path toward healing. a very interesting program that they've developed for school safety in their rural school district in west texas and i'd just be interested in your thoughts as to how this integrates with the work we did in cures and what you're doing now with cures implementation. >> yes. thank you for bringing that forward because this is a very important part not only of the cures act, but also a focus of the president's federal school safety commission and so we've had the opportunity to speak to a number of districts across the country, texas being one of them, and these kinds of innovative programs are exactly what we need to better insure two things, one, a safe environment for students, anarch rick environment where they can learn -- a nurturing environment where they can learn, and the second being one where we identify children early who may have emotional or mental health issues that need

to be addressed and there are a number of ways to address those kinds of mental health service needs by either integration directly within these school systems or through a close relationship with other types of programs. some of the things that the cures act do that directly affect those kinds of programs is that cures reauthorized certain types of mental health programs that are oriented toward children and samsa continues to implement those programs. so things 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 mental health and mental health first aid type programs that help to identify youth early so that we can get them the care and services that they need. we reauthorized those programs and we are in the process right

now of making more awards through our granting system. in addition, when we start talking about integration of care, the certified community behavioral health centers that congress established for us represent a model that can be used to provide those needed services to children who would be referred from the school system. >> certainly i think use of that model will be important. as i understand, this program has been funded entirely out of funds from within texas tech university itself, but they have set up a telemedicine portals and secure connections and encrypting and all that is necessary to have those secure connections, but i actually look forward to working with you on this and perhaps the white house as well. i think they're onto something that is very important. i'm going to yield back, mr.

green, and recognize you for five questions. >> thank you. the 21st century cures act was landmark law that included important provisions to strengthen mental and substance abuse care for men, women and adolescents and the national child traumatic stress initiative which supports a national network of child trauma centers and focuses on increasing access to trauma focused interventions. can you explain how the national child traumatic stress network operates and what effect it has improving the lives of children impacted by traumatic stress? >> yes. the national child traumatic stress initiatives is a program that was established in a large number of states but provides national technical assistance services around issues of traumatic stress in children. this is a program that not only trains practitioners and providers of services, but also

will do consultation within communities to help them to address traumatic issues. so this is a very highly regarded and valuable program. >> following the chairman, do you know of any grantees in the state of texas off the top of your head? >> i don't have the grantees dedicated to memory, but i will tell you this. we can get you that very quickly. >> thank you. if children impacted by traumatic stress receive early interventions and the trauma care they need, can the long term effects of trauma be mitigated in any way? >> yes, they can. there is a fair amount of literature on this in terms of how trauma effects children and the ability to -- affects children and the ability to address those traumatic events in therapeutic violence can mitigate the effects later in life. >> i'm interested in how the

network is responding to recent events relating to family separations at the border as a result of the trump administration's zero tolerance. is the network being utilized to coordinate services for children that have endured this trauma as a result of the family separation policy? >> what i would say, congressman green, is that samsa itself is not involved in those issues. those issues are being dealt with by a different part of hhs, the administration for children and families, and the office for refugee resettlement. any provider within a jurisdiction can go to a samsa national program and ask for resources, but samsa itself is not directly involved in that. >> i was wondering, hhs is responsible for those children and if you happen to find any information on what's being

done with hhs and the network for these children, my concern is the fact the national children for traumatic stress has a document on its website that notes children can recover from traumatic separation and other traumatic experiences with development be culturally and linguistically appropriate trauma services for these children and their families including evidence-based and trauma focused treatment. i would hope that would be part of the process and obviously samsa in that effort. in the interdepartmental series of mental illness coordinating report last december mentioned five areas of focus including increasing availability and affordability of the care. could a patient suffering from a serious mental illness, an smi or serious emotional disturbance be denied health coverage by health insurers as having a preexisting condition?

>> that's not my area of expertise. i really don't feel comfortable commenting on the details of health insurance. what i would say is that medicaid is one of the largest providers of mental health services through their insurance program and they serve millions of americans at the very moment. >> thank you, mr. chairman. i'd like to ask consent to place into the record a statement by the american academy of pediatrics opposing separation of children at the border, the american psychiatric association opposing separation of children from their parents, the american psychological association regarding traumatic effects of separating families and again the national child traumatic stress network and

key points on the traumatic separation of refugee children and immigrant children. i ask unanimous consent to place into the record. >> no objection, so ordered. the gentleman yields back. the chair recognizes the gentleman from kentucky, mr. guthrie. five minutes for questions. >> thank you, mr. chairman and thank you for being here, dr. mccann. the cdc has found less than half of substance abuse disorder patients with multiple mental health issues have received dream for their mental health issue. the commission suggests -- treatment for their mental health issue. the commission suggests this is a lack of motivation to seek treatment. would you discuss how you plan to encourage states using the state targeted response opioid money to help treat patients with untreated mental health disorders. i'm from kentucky and we have a very large portion of the population in need of these services and the general public needs to be aware of these services.

>> yes. thank you for this question. we are very much engaged on that issue. so the state targeted response to opioids as part of the cures act provides for technical assistance and training within the state. what we have now done at samsa, what we've put in place in february was to have a grantee whose requirement was to establish teams within every state, multiple teams for states with larger geographic areas, but these teams had to have addiction experts and other types of mental health expertise and physical healthcare expertise available so they could go into communities and providers within those communities to let their states know what kinds of services and training and technical assistance that these teams can go in and provide that on the spot. so we believe that is going to be a way that we establish

evidence-based practice. we know that the co-occurring rate of mental and substance abuse disorders is quite high. so if someone has a substance abuse disorder, they must be screened for a mental health issue. we know treating one and not the other in a person with co- occurring disorders will not solve both problems and these teams are professionals. they are licensed within their states and certified by their various regulatory boards to provide that kind of technical assistance and training as part of their own clinical practices and they're doing that in our communities now. >> thanks. before my next question i was watching i guess a new tv show that's out, amy adams stars in. several of the characters seem to have addiction. i can't really tell what that show is going at, but at the very end of the show they had a public service announcement for samsa. at the very end it says if you have any issues or know of people with that, please call. i don't know if you're getting any response, but i was pleased

at the end of the show they were trying to show people how to reach out to those with addiction issues. my next question, for guidance to the 21st century cures act, samsa released extensive guidance for consumers how to report concerns and future health plans. does samsa have plans for providing additional pathways for additional parity violations or concerns? >> we're very pleased that we have a portal that consumers can use where they can report what they believe may be parity violations, difficult getting coverage for their mental health or substance abuse problems. that portal will get them to the appropriate federal agency, be it labor, be it cms, be it

treasury. we're pleased about that. we also provide guidance. samsa last summer did a 30 state parity policy academy where we train on issues related to parity and how states can make sure that appropriate attention is paid so people at their states can get the services that they need. >> thank you. those are my two questions and i appreciate you being here and i yield back. >> thanks. the chair recognizes the gentleman from new jersey, ranking member of the full committee. five minutes for questioning. >> thank you, mr. chairman. doctor, the cures act included provisions that specifically addressed child trauma. as i noted in my opening statement, i continue to have grave concerns about the children forcibly separated from their parents or guardians as a result of the trump administration's zero tolerance policy. i've sought information from the administration on whether children in the office of

refugee settlements care may have experienced trauma and my resolution of inquiry that was debated by the committee last week. receiving the requested documents on the long term health implications on the family's separation policy on the children in orr's care, samsa is uniquely qualified to speak to the issue and it's not just me raising these questions. this is by numerous health organizations and child health advocates including the american academy of pediatrics, the american public health association, trust for america's health and national association of county and city health officials. so, in fact, the national child traumatic stress network which is administered by samsa notes and i quote, "that separation from parent or primary caregivers 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 basically, if you don't mind? >> traumatic or toxic stress can be any of a number of things that an individual would experience as emotionally distressing and various individuals will have different types of responses to that. in fact, as you mentioned, one of them has been reported to be separation, but i would suggest to you that there are lots of stressors that these children have probably experienced in their travels to the united states. so not having seen any of these kids, not being able to attribute what their distress might be about, it's hard to say exactly what the etiology of any particular individual's problem might be. >> could you say or could you

comment on how the circumstances of separation increase the likelihood of traumatic or toxic stress? could you comment on that? >> very hard to say. what i will say is if you were to look at the literature on traumatic stress, you would see that somewhere -- depending on the study you look at -- up to 43% of individuals will experience some type of traumatic stress in their lifetime. most of them do not go on to develop major mental disorders and when you mitigate, when you relieve that stressor, they do recover. people have an amazing amount of resilience. that's why all of us who are exposed to some type of stress don't develop mental disorders. some do. we can't predict with reliability who will. >> all the more reason if you've had separation to try to get the kids back together with their parents because maybe they can recover. >> our department is working very hard on that. our secretary has spoken to that issue and they are

addressing it every single day. >> i guess the problem that i have is you mentioned that samsa is not involved in the child separation issue that resulted from the zero tolerance policy. the problem is that the cures bill required samsa to coordinate into those services across the federal government. do you think that samsa as a leader of mental healthcare for our country should play a role in responding to this crisis at the border? >> samsa has defined responsibilities. one of those is the national child traumatic stress network and we do implement that and we work with our grantees to make sure that they are providing the services needed across this nation to serve americans who may be experiencing traumatic stress and their children. it is also a decision by others

as to what agencies are specifically involved in the day to day activities of any particular event. so samsa does what it is required to do by the cures act and we stand ready to provide additional assistance if it were requested. >> i don't want to put words in your mouth, but it sounds like you'd be willing to help, but maybe nobody in the department is asking you to. you don't have to respond to that. i just think it's clear these families must be reunified immediately and insure these kids have access to the trauma formed prevention and mental health services to recover and mitigate the harm experienced as a result of this policy. i'll leave it at that because my time has run out. thank you. >> the gentleman from virginia, five minutes for questions. >> thank you very much, mr. chairman. thank you for being here today, very important topic, cures, mental health all so important.

i'm going to ask some questions that probably are not unanswerable in the five minutes that we have. so i'll give you an opportunity to answer, but recognize i would like you to think about them and come up with answers, if you can, and send them to us at a later date. the first one is you brought up the enforcement of parity protection, mental health and other medicine or treatment. i was in a meeting where similar concerns were brought up by the department of labor about the fact they have enforcement authority but really have difficulty in the enforcement side of that. so the question is what tools are necessary? what suggestions would you have for us of steps we can take in the federal law to insure compliance with mental health parity and physical health parity so the two are treateds same in our various plan --

treated the same in our various plan. i'll give you an opportunity, but i recognize that's probably an hour lecture as opposed to a five minute segment. >> my quick answer to that would be that the question is quite an important one. it's one that i would want to seek legal counsel about and one that we will be happy to give a written answer to you. >> i would like an extended answer. >> absolutely. >> because these issues are all complex. i'm talking to a principal, switching gears, in one of my rural schools. i represent a mostly rural district and we're talking about school safety and mental health obviously a major component in that and he says look, you know, we can identify a child who has some issues and send them off for evaluation, but because of the current state of the privacy laws they can't tell us what's going on and we don't need to know everything that's going on in the child's life, but if

there's some things we need to know like are they violent? do they have a violent tendency even if you don't expect them to do something now, is there a violent component in their emotional or mental issues? we could at least pay more attention, maybe have them checked by the office so we can look in their book bag every day to see if they're bringing in contraband guns or other weapons or issues we may be able to be aware of. we've got no ability to do that. the question is if there's some way we can expand the knowledge base of folks. when we passed some films here to try to make it more like hitler, but it still wouldn't cover the school personnel who may very well need to know what's going on. if you could get me some answers back on that. if you've got something quick, that's great. >> this is a topic that is part

of the federal safety commission. that is one of the areas the president asked us to look at. i'm just go a little bit further. we'll give you something in writing as well, but part of the big problem here is that providers, teachers, administrators don't understand when they can communicate and if there is a threat, already both hippa allows communication. this is not well understood. one of the things we really have to do is we have to work very hard to get that information out as to just what these laws allow and what they don't allow. >> my time is running out. i want to say here's the dilemma you get. if there is a direct threat, yes, that's true or you think they're going to be harmful to somebody else at that moment, but if you just deck there may be a developing problem and they may be a threat in the future, i don't think it covers. we can certainly sit down and

talk about it. the school personnel would like to know what signs should we be looking for if this person might be starting to move further into their issues with mental illness that -- right now they aren't a threat, but they've got some violent tendencies we need to keep an eye on. what should we be looking for? they don't have a clue and they're with the child every day during the week most weeks. so they're probably the first people who could pick up on that. i'm going to flip to one more and we don't have time for the answer. i apologize. we did a lot of work here trying to figure out how we could deal with adult children even living at home and have mental health issues, also medical issues and how do the parent get to be interactive and i would love to help on that. i know we've struggled with this. if we can be of assistance or there's something you all have we need to do in the code, this committee on a bipartisan basis wants to help. we want to fix the problem, but

we don't want to give up all the privacy rights and balancing the two are tough. i yield back. >> thank you. the gentleman yields back. the chair recognizes the senator from illinois. >> thank you, mr. chairman. dr. mccann, i guess i will ask this question to start. given samsa's leadership on traumatic care and practice, has the refugee resettlement worked with samsa to insure the children held in their custody are receiving trauma informed care? >> i can say two things about that. one is that the office of refugee resettlement assures that these children are getting both physical healthcare and mental helm regularly.

>> okay. the reason i was going to say i'm not going to ask you that is, quite frankly, i was pretty shocked by your attitude well, we all have trauma and most of us get over it and they'll probably get over it. you may have heard congressman green entered into the record statement from a number of the professional health organizations, the american psychiatric association, the american psychological association, the american public health association, the american academy of pediatrics and, you know, the concern about the trauma, i want to add into the record, too, a couple of other articles of people and groups that actually weighed in

that were victims of long ago atrocities about separation of children. i asked unanimous consent to enter into the record two articles, the first from the guardian, nazis separated me from my parents as a child. the trauma lasts a lifetime. that was one article and the second from the anti-defamation league, hidden children of the holocaust open up about border situation saying policies separating migrant children from parents is unconscionable and they have in this article talking about the lifelong effects. so maybe it's fine they didn't contact you about that. i wonder if you do have any -- >> i object. i have an objection to submitting articles about the

nazis and comparing what the nazis did to what the current u.s. government's 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'll object to and i won't allow those to be submitted to the record. >> let me just comment on that and in defense, particularly of the anti-defamation league today 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 "zero tolerance" policy of migrant children. >> i object. i object, mr. chairman. >> i'm going to ask for the yea's and nay's. mr. chairman. >> we can resolve this if the young lady would recognize there's 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 effects. >> okay. i remove my objection. thank you. >> thank you. i appreciate that. i wanted to ask you about no touching policies. i've had a hard time pinning down exactly what that is, if there's a policy, if this is being done by the particular staffs at particular places because it's unclear exactly if there is a firm policy, but i certainly have heard of places, for example, and there's been articles that a sister was not able to embrace her younger brother, that they were told the children may not touch each

other, that 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. >> it's really not possible for me to comment on that because i'm not familiar with the details of it. >> touching children that are -- the issue of touching, are you not informed about the effect of touching or comforting, physical touching when it comes to mental health? >> what i'm not familiar with is the agency and its rules and -- >> no, no. i'm asking a more general question. according to decades of psychological study, positive touch from adults cannot only

lower stress levels in the moment, but can have long term beneficial effects if administered regularly and relatedly a consistent lack of positive touch has been shown to have detrimental effects on kids as they mature. do you agree with that? >> i don't have an opinion on it. it's out of context. >> really? i'm asking it generally about an issue that you're supposedly an expert on, trauma informed care. >> let me just tell you that touching can have all sorts of implications, good and bad, and so i cannot comment. >> do you agree with the state -- >> i think the witness has answered the question and the young lady's time has expired. we'll go to ms. brook from indiana, five minutes for

questions, please. dr. buchon, five minutes. >> first of all, thanks for being here, very much appreciate it. i want to say i'm opposed from separating children from their families. i think all of us on both sides of the aisle are, but i also have serious concerns. i wasn't going to bring this subject up, but since it seems like my colleagues on the other side are staying on message on this, every one of them will talk about this, i feel that i will, also. i'm also concerned about the thousands of children coming unaccompanied from and trekking thousands of miles across mexico being brought by coyotes and drug cartels, approximately 10,000. i've just been down there. so this is information i know, many of whom have been sexually assaulted and abused. so i'm concerned about them, also. just so everyone knows, we have about 12,000 children under our

custody, 10,000 of which approximately are unaccompanied that came with no adult, no family member. it's a tragic circumstance as well as the families who are coming and currently adult males with children because they know that we don't have any beds for them in the united states and if they come, we're releasing them with angle brace lets into the united states, 2 or 300 of these people per day.