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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO HEALTH AND SAFETY - DEPARTMENT OF HEALTH

     

     Introduced By: Representatives Ajello, McNamara, Donovan, Regunberg, and Walsh

     Date Introduced: January 27, 2017

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

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     SECTION 1. Legislative findings. – It is found and declared that:

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     (1) Contemporary science recognizes that being lesbian, gay, bisexual, or transgender is

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part of the natural spectrum of human identity and is not a disease, disorder, or illness;

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     (2) The American Psychological Association convened a Task Force on Appropriate

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Therapeutic Responses to Sexual Orientation. The task force conducted a systematic review of

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peer-reviewed journal literature on sexual orientation change efforts, and issued a report in 2009.

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The task force concluded that sexual orientation change efforts can pose critical health risks to

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lesbian, gay, and bisexual people, including confusion, depression, guilt, helplessness,

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hopelessness, shame, social withdrawal, suicidality, substance abuse, stress, disappointment, self-

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blame, decreased self-esteem and authenticity to others, increased self-hatred, hostility and blame

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toward parents, feelings of anger and betrayal, loss of friends and potential romantic partners,

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problems in sexual and emotional intimacy, sexual dysfunction, high-risk sexual behaviors, a

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feeling of being dehumanized and untrue to self, a loss of faith, and a sense of having wasted time

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and resources;

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     (3) The American Psychological Association issued a resolution on Appropriate

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Affirmative Responses to Sexual Orientation Distress and Change Efforts in 2009, which states:

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"[T]he [American Psychological Association] advises parents, guardians, young people, and their

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families to avoid sexual orientation change efforts that portray homosexuality as a mental illness

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or developmental disorder and to seek psychotherapy, social support, and educational services

 

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that provide accurate information on sexual orientation and sexuality, increase family and school

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support, and reduce rejection of sexual minority youth";

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     (4) The American Psychiatric Association published a position statement in March 2000

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in which it stated:

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     (i) "Psychotherapeutic modalities to convert or 'repair' homosexuality are based on

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developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports

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of 'cures' are counterbalanced by anecdotal claims of psychological harm. In the last four decades,

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'reparative' therapists have not produced any rigorous scientific research to substantiate their

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claims of cure. Until there is such research available, [the American Psychiatric Association]

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recommends that ethical practitioners refrain from attempts to change individuals' sexual

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orientation, keeping in mind the medical dictum to first, do no harm";

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     (ii) "The potential risks of reparative therapy are great, including depression, anxiety and

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self-destructive behavior, since therapist alignment with societal prejudices against

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homosexuality may reinforce self-hatred already experienced by the patient. Many patients who

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have undergone reparative therapy relate that they were inaccurately told that homosexuals are

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lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the

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person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian

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is not presented, nor are alternative approaches to dealing with the effects of societal

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stigmatization discussed"; and

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     (iii) "Therefore, the American Psychiatric Association opposes any psychiatric treatment

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such as reparative or conversion therapy which is based upon the assumption that homosexuality

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per se is a mental disorder or based upon the a priori assumption that a patient should change his

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or her sexual homosexual orientation";

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     (5) The American Academy of Pediatrics in 1993 published an article in its journal,

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Pediatrics, stating: "Therapy directed at specifically changing sexual orientation is

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contraindicated, since it can provoke guilt and anxiety while having little or no potential for

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achieving changes in orientation";

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     (6) The American Medical Association Council on Scientific Affairs prepared a report in

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1994 in which it stated: "Aversion therapy (a behavioral or medical intervention which pairs

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unwanted behavior, in this case, homosexual behavior, with unpleasant sensations or aversive

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consequences) is no longer recommended for gay men and lesbians. Through psychotherapy, gay

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men and lesbians can become comfortable with their sexual orientation and understand the

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societal response to it";

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     (7) The National Association of Social Workers prepared a 1997 policy statement in

 

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which it stated: "Social stigmatization of lesbian, gay, and bisexual people is widespread and is a

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primary motivating factor in leading some people to seek sexual orientation changes. Sexual

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orientation conversion therapies assume that homosexual orientation is both pathological and

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freely chosen. No data demonstrates that reparative or conversion therapies are effective, and, in

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fact, they may be harmful";

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     (8) The American Counseling Association Governing Council issued a position statement

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in April of 1999 and in it the council states: "We oppose the promotion of 'reparative therapy' as a

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'cure' for individuals who are homosexual";

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     (9) The American School Counselor Association issued a position statement in 2014

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which states that: "It is not the role of the professional school counselor to attempt to change a

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student's sexual orientation or gender identity. Professional school counselors do not support

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efforts by licensed mental health professionals to change a student's sexual orientation or gender

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as these practices have been proven ineffective and harmful";

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     (10) The American Psychoanalytic Association issued a position statement in June 2012

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on attempts to change sexual orientation, gender identity, or gender expression, and in it the

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association states: "As with any societal prejudice, bias against individuals based on actual or

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perceived sexual orientation, gender identity or gender expression negatively affects mental

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health, contributing to an enduring sense of stigma and pervasive self-criticism through the

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internalization of such prejudice"; and

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     "Psychoanalytic technique does not encompass purposeful attempts to 'convert', 'repair',

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change or shift an individual's sexual orientation, gender identity or gender expression. Such

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directed efforts are against fundamental principles of psychoanalytic treatment and often result in

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substantial psychological pain by reinforcing damaging internalized attitudes";

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     (11) The American Academy of Child and Adolescent Psychiatry in 2012 published an

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article in its journal, Journal of the American Academy of Child and Adolescent Psychiatry,

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stating: "Clinicians should be aware that there is no evidence that sexual orientation can be

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altered through therapy, and that attempts to do so may be harmful. There is no empirical

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evidence adult homosexuality can be prevented if gender nonconforming children are influenced

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to be more gender conforming. Indeed, there is no medically valid basis for attempting to prevent

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homosexuality, which is not an illness. On the contrary, such efforts may encourage family

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rejection and undermine self-esteem, connectedness and caring, important protective factors

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against suicidal ideation and attempts. Given that there is no evidence that efforts to alter sexual

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orientation are effective, beneficial or necessary, and the possibility that they carry the risk of

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significant harm, such interventions are contraindicated";

 

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     (12) The Pan American Health Organization, a regional office of the World Health

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Organization, issued a statement in 2012 stating: "These supposed conversion therapies constitute

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a violation of the ethical principles of health care and violate human rights that are protected by

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international and regional agreements." The organization also noted that reparative therapies

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"lack medical justification and represent a serious threat to the health and well-being of affected

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people";

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     (13) The American Association of Sexuality Educators, Counselors, and Therapists

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issued a statement in 2014 stating: "[S]ame sex orientation is not a mental disorder and we

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oppose any 'reparative' or conversion therapy that seeks to 'change' or 'fix' a person's sexual

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orientation. AASECT does not believe that sexual orientation is something that needs to be 'fixed'

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or 'changed'. The rationale behind this position is the following: Reparative therapy (for minors,

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in particular) is often forced or nonconsensual. Reparative therapy has been proven harmful to

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minors. There is no scientific evidence supporting the success of these interventions. Reparative

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therapy is grounded in the idea that non-heterosexual orientation is "disordered." Reparative

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therapy has been shown to be a negative predictor of psychotherapeutic benefit";

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     (14) The American College of Physicians wrote a position paper in 2015 stating: "The

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College opposes the use of 'conversion,' 'reorientation,' or 'reparative' therapy for the treatment of

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LGBT persons .... Available research does not support the use of reparative therapy as an

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effective method in the treatment of LGBT persons. Evidence shows that the practice may

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actually cause emotional or physical harm to LGBT individuals, particularly adolescents or young

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persons";

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     (15) Minors who experience family rejection based on their sexual orientation face

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especially serious health risks. In one study, lesbian, gay, and bisexual young adults who reported

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higher levels of family rejection during adolescence were 8.4 times more likely to report having

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attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely

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to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual

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intercourse compared with peers from families that reported no or low levels of family rejection.

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This is documented by Caitlin Ryan et al., in their article entitled Family Rejection as a Predictor

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of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults

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(2009) 123 Pediatrics 346; and

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     (16) Rhode Island has a compelling interest in protecting the physical and psychological

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well-being of minors, including lesbian, gay, bisexual, and transgender youth, and in protecting

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its minors against exposure to serious harms caused by conversion therapy.

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     SECTION 2. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

 

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amended by adding thereto the following chapter:

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CHAPTER 94

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PREVENTION OF CONVERSION THERAPY FOR CHILDREN

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     23-94-1. Short title.

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     This chapter shall be known and may be cited as the "Prevention of Conversion Therapy

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for Children Act."

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     23-94-2. Definitions.

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     As used in this chapter:

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     (1) "Conversion therapy" means any practices or treatments that seek to change an

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individual's sexual orientation or gender identity, including efforts to change behaviors or gender

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expressions or to eliminate or reduce sexual or romantic attractions or feelings toward individuals

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of the same gender. Conversion therapy shall not include counseling that provides assistance to a

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person undergoing gender transition, or counseling that provides acceptance, support, and

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understanding of a person or facilitates a person's coping, social support, and identity exploration

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and development, including sexual-orientation-neutral interventions to prevent or address

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unlawful conduct or unsafe sexual practices, as long as such counseling does not seek to change

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an individual's sexual orientation or gender identity.

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     (i) "Conversion therapy" shall include any practice by any licensed professional that

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seeks or purports to impose change of an individual's sexual orientation or gender identity,

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practices which attempt or purport to change behavioral expression of an individual's sexual

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orientation or gender identity or attempt or purport to eliminate or reduce sexual or romantic

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attractions or feelings toward individuals of the same sex;

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     (ii) "Conversion therapy" shall not include practices which:

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     (A) Provide acceptance, support, and understanding of an individual's sexual orientation,

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gender identity, or gender expression and the facilitation of an individual's coping, social support,

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and identity exploration and development, including interventions to prevent or address unlawful

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conduct or unsafe sexual practices; or

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     (B) Provide acceptance, support, or understanding of an individual's gender expression or

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the facilitation of an individual's coping, social support, and identity exploration and

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development.

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     (2) "Department" means the Rhode Island department of health.

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     (3) "Licensed professional" means any licensed medical, mental health, or human service

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professional licensed pursuant to title 5 including, but not limited to, any psychologist,

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psychiatrist, social worker, nurse, mental health professional, human services professional, under

 

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any provisions of the general law, rule or regulation to the contrary.

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     23-94-3. Conversion therapy efforts for minors prohibited – Violations and

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enforcement.

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     (a) No licensed professional shall advertise for or engage in conversion therapy efforts

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with or relating to a patient(s) under the age of eighteen (18).

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     (b) Any conversion therapy practiced by a licensed professional, as defined in §23-94-2,

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on a patient under the age of eighteen (18) shall be considered unprofessional conduct and shall

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subject them to discipline by the department, which discipline may include suspension and

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revocation of the professional's license.

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     (c) The department is hereby authorized to initiate proceedings for violations of this

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section.

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     (d) The department shall promulgate rules in accordance with the provisions of this

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section. These rules and regulations shall include, but not be limited to, a clear distinction

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between conversion therapy and other types of medically or clinically recognized therapies and

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practices, including, but not limited to, those practices referenced in §23-94-2(1)(ii) of this

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section.

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     23-94-4. Prohibition on state funding for conversion therapy.

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     No state funds, nor any funds belonging to a municipality, agency, or political

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subdivision of this state, shall be expended for the purpose of conducting conversion therapy,

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referring a person for conversion therapy, health benefits coverage for conversation therapy, or a

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grant or contract with any entity that conducts conversion therapy or refers individuals for

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conversion therapy.

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     23-94-5. Severability.

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     If any provision of this chapter or of any rule or regulation made under this chapter, or its

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application to any person or circumstance is held invalid by a court of competent jurisdiction, the

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remainder of the chapter, rule, or regulation and the application of the provision to other persons

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or circumstances shall not be affected by this invalidity. The invalidity of any section or sections

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or parts of any section or sections shall not affect the validity of the remainder of the chapter.

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     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY - DEPARTMENT OF HEALTH

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     This act would prohibit "conversion therapy" by licensed health care professionals with

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respect to children under eighteen (18) years of age. Violations of this act would subject the

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health care professional to disciplinary action and/or suspension and revocation of the license by

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the director of the department of health.

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     This act would take effect upon passage.

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