Amended in Assembly April 4, 2013

Amended in Assembly March 19, 2013

California Legislature—2013–14 Regular Session

Assembly BillNo. 174

Introduced by Assembly Member Bonta

January 24, 2013

An act to add Section 124174.7 to the Health and Safety Code, relating to public health.


AB 174, as amended, Bonta. Public school health centers.

Existing law establishes the Public School Health Center Support Program, pursuant to which the State Department of Public Health, in collaboration with the State Department of Education, provides, among otherbegin delete dutiesend deletebegin insert thingsend insert, technical assistance to school health centers on effective outreach and enrollment strategies to identify children who are eligible for, but not enrolled in, the Medi-Cal program, the Healthy Families Program, or any other applicable program andbegin delete providesend delete technical assistance to facilitate and encourage the establishment, retention, or expansion of school health centersbegin delete, among other dutiesend delete.

This bill would require the State Department of Public Health to establish a grant program within the Public School Health Center Support Program that would be known as Promoting Resilience: Offering Mental Health Interventions to Support Education (PROMISE). The program would provide resources to eligible applicants, including local education agencies, nonprofit organizations, and community health centers, to fund activities and services to directly address the mental health and related needs of students who are impacted by trauma, as specified. The bill would require the department to implement these provisions only to the extent that funding is made available,begin delete upon appropriation by the Legislature, for these purposes from public and private sources,end delete as specified. The bill would also include legislative findings and declarations.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1


begin delete(a)end deletebegin deleteend deletebegin insertThe Legislature finds and declares all of the
2following:end insert

3begin insert(a)end insertbegin insertend insertTrauma has serious short- and long-term consequences for
4health, educational achievement, and well-being. Trauma has been
5defined as experiences or situations that are emotionally painful
6and distressing, and that overwhelm an individual’s ability to cope,
7and as chronic adversity, including, but not limited to,
8discrimination, racism, oppression, and poverty.

9(b) Children and youth who are neglected or abused, or who
10feel unsafe in their homes, schools, or communities, experience
11trauma that can have lasting negative impacts.

12(c) Children and youth in low-income neighborhoods are
13disproportionately impacted by trauma, including, but not limited
14to, violence. For example, 20 percent of California childrenbegin delete with
15familyend delete
begin insert from families with annualend insert incomes belowbegin delete $25,000end delete
16begin insert twenty-five thousand dollars ($25,000)end insert feel somewhat unsafe or
17very unsafe in their neighborhoods, versus just 2 percent of
18California children begin deletewith familyend deletebegin insert from families with annualend insert incomes
19abovebegin delete $125,000end deletebegin insert one hundred twenty-five thousand dollars
20($125,000)end insert

21(d) Children and youth of color are disproportionately impacted
22by violence. Compared to Caucasians, African American children
23and youth are three times more likely, and Latino children and
24youth are two times more likely, to be exposed to shootings, bombs,
25and riots.

26(e) Boys and young men of color are particularly likely to be
27impacted by trauma. For example, compared to rates among
28Caucasians, boys and young men of color have more than twice
29the risk of witnessing domestic violence, being abused and
30neglected, or having an incarcerated parent. Homicide is the leading
P3    1cause of death among male African American adolescents,
2occurring at a rate 15 times greater than among Caucasians.

3(f) The likelihood of boys and young men suffering from
4post-traumatic stress disorder is two and one-half times greater
5among African American boys and young men and four and
6one-tenth times greater among Latino boys and young men, as
7compared to among Caucasians.

8(g) Mental health services can have a positive and significant
9impact on life outcomes for children and adolescents impacted by

11(h) However, of the almost 13 percent of adolescents who report
12needing help for emotional or mental health problems, over 60
13percent do not receive counseling. Among adolescents living below
14 the poverty line, 92 percent of those who report needing help for
15emotional or mental health problems did not receive counseling
16in the past year. The percentage of adolescents who report needing
17help for emotional or mental health problems is widely assumed
18to be less than the percentage who would benefit from these

20(i) Adolescents are less likely than almost all other age groups
21to have a usual source of health care. Male adolescents, and
22particularly male adolescents of color, are even less likely to have
23a usual place to go when they are sick or need health advice.

24(j) California’s 200 school health centers are predominantly
25located in low-income communities, where students are
26disproportionately impacted by trauma. For example, 80 percent
27of school health center clients seen in the County of Alameda in
28the 2010-11 school year had witnessed violence or been a victim
29 of violence during their lifetime.

30(k) Among adolescents in managed care plans, those with access
31to a school health center are 10 times more likely to access mental
32health or substance abuse services than those without access to a
33school health center.

34(l) School health centers see higher proportions of adolescent
35males than other care settings, including community clinics or
36private practices.

37(m) Research shows that students receiving mental health
38services at school health centers have significant improvements
39in their presenting problems and that school-based mental health
P4    1services can be more efficacious than those provided in community

3(n) School-based mental health programs focused specifically
4on trauma have been shown to reduce post-traumatic stress
5disorder, depression, and psychosocial dysfunction.

6(o) Schools and school health centers do not currently have
7access to sufficient funding to reach more than a fraction of the
8students impacted by trauma and who would benefit from mental
9health services. The many barriers to securing sufficient funding
10include, but are not limited to, high proportions of uninsured
11students and restrictions on the services that are reimbursable
12through programs such as the California Victim Compensation
13Programbegin delete (CalVCP)end delete andbegin insert theend insert Medi-Calbegin insert programend insert.

14(p) The Early and Periodic Screening, Diagnosis and Treatment
15begin delete (EPSDT)end delete Program, a Medi-Cal program that is a major source of
16funding for school-based mental health services, excludes many
17of the young people who need its services. Barriers include, but
18are not limited to, Medi-Cal eligibility, low provider participation,
19restrictive diagnostic and medical necessity criteria, and the
20requirement that a parent or guardian consent for services.


SEC. 2.  

Section 124174.7 is added to the Health and Safety
, to read:



(a) The State Department of Public Health shall
24establish a grant program within the Public School Health Center
25Support Program to fund activities and services to directly address
26the mental health and related needs of students who are impacted
27by trauma. This grant program shall be named Promoting
28Resilience: Offering Mental Health Interventions to Support
29Education (PROMISE).

30(b) Grant funds shall be used according to the following

32(1) Grant funds shall be used by eligible applicants to directly
33address the mental health and related needs of students who are
34impacted by trauma.

35(2) Grant funds may be used for the following activities and

37(A) Individual, family, and group counseling.

38(B) Targeted outreach and education.

39(C) Risk screening, triage, and referral to campus-based services.

40(D) Schoolwide violence prevention and response efforts.

P5    1(E) Youth development programming related to trauma and

3(F) Crisis response coordination and services.

4(G) Case management services.

5(H) Coordination with off-campus mental health and support

7(I) Staff training and consultation on supporting students’
8trauma-related needs.

9(J) Oversight, coordination, and evaluation of the above
10activities and services.

11(3) Individual, family, and group counseling funded by a grant
12awarded pursuant to this section may be provided by any of the

14(A) A mental health clinician licensed by the Board of
15Behavioral Sciences, including a licensed marriage and family
16therapist, a licensed clinical social worker, or a licensed educational

18(B) A clinical psychologist licensed by the Board of Psychology.

19(C) A psychiatric nurse practitioner licensed by the Board of
20 Registered Nursing.

21(D) A psychiatrist licensed by the Medical Board of California.

22(E) A school social worker credentialed by the State of

24(F) An unlicensed mental health professional who is registered
25by either the Board of Behavioral Sciences or the Board of
26Psychology, and who is receiving clinical supervision as prescribed
27by that entity.

28(4) Other activities and services, including schoolwide violence
29prevention efforts, shall be provided or overseen by a mental health
30professional as described in subparagraphs (A) through (F),
31inclusive, of paragraph (3).

32(c) Grant funds shall be awarded according to the following

34(1) Eligible applicants shall include:

35(A) Local education agencies.

36(B) Nonprofit organizations.

37(C) Community health centers.

38(D) County mental health departments.

39(2) Grant applications shall comply with all of the following:

P6    1(A) Applicants shall describe their program to address the mental
2health and other related needs of students who are impacted by
3trauma, and to foster a positive school climate. At a minimum, the
4program described in the application shall include:

5(i) Individual, family, and group counseling.

6(ii) Youth development programming related to trauma and

8(iii) Schoolwide violence prevention and response efforts,
9including, at a minimum, training for staff on trauma and their
10roles in preventing and responding to it.

11(iv) Coordination between school-based and community

13(v) A discussion of any components of the program for which
14funding does not yet exist or is currently insufficient and for which
15they are seeking grant funding.

16(B) Demonstrate the applicant’s ability to provide a dedicated
17space located on the school campus that will serve as the hub of
18the program, that will be youth friendly, and, for middle and high
19schools, that will be regularly accessible to students on a drop-in

21(C) Provide evidence of a strong partnership and commitment
22to collaboration between the school and any agencies or
23organizations that will provide mental health, medical, or other
24related services on the school campus, whether funded by this
25grant or another funding source. Specific mechanisms by which
26applicants shall provide this evidence shall be detailed in the
27request for applications, but may include letters of agreement or
28support, memoranda of understanding, or draft, signed

30(3) begin deletePriority end deletebegin insertAs detailed in the request for applications, priority end insert
31for awarding a grant shall be given to eligible applicants that
32demonstratebegin delete allend deletebegin insert one or moreend insert of the following:

33(A) High levels of exposure to trauma and violence among the
34target population.

35(B) Limited access to mental health services among the target

37(C) An ability to meet the cultural and linguistic needs of the
38target population.

P7    1(D) An ability to engage and serve subgroups of students within
2the target population who are disproportionately impacted by
3trauma and violence.

4(E) A plan to hire staff with similar backgrounds and experiences
5to the target population and who can therefore enhance program

7(F) A plan to obtain additional sources of funding or third-party
8reimbursement to create a robust and sustainable school-based
9mental health program.

10(G) A plan to integrate mental health and related services with
11primary medical care.

12(d) An eligible applicant that receives grant funds shall commit
13to all of the following:

14(1) Establish a written memorandum of understanding (MOU)
15between the school, the school district, and other agencies or
16organizations providing grant-funded mental health, medical, or
17other related services, in an effort to develop a strong collaborative
18partnership between involved entities.

19(A) The collaborative partnership shall do all of the following:

20(i) Include local education agency-employed personnel,
21including school administrators, teachers, and staff, and any school
22health personnel, including school nurses or social workers.

23(ii) Include personnel employed by other agencies or
24 organizations, including community health centers, who provide
25relevant services on campus.

26(iii) Establish and implement regular communication protocols
27between the school and agencies or organizations.

28(iv) Engage all relevant personnel in identifying students who
29would benefit from mental health or other related services and
30linking them to those services.

31(v) Promote the integration of funded services into the overall
32school environment.

33(B) The MOU shall do both of the following:

34(i) Describe how services are coordinated on the campus and
35how services will be integrated into the overall school environment.

36(ii) Ensure the confidentiality and privacy of both education
37and health information, consistent with applicable federal and state

39(2) Make services available to all students in the school,
40regardless of ability to pay.

P8    1(3) Submit an annual report, including a discussion of all of the

3(A) The activities and services funded through the grant award.

4(B) The number of students served through specific activities
5and services.

6(C) The roles and credentials of personnel funded through the
7grant award.

8(D) Any additional funding sources that are available to enhance
9or sustain activities and services. To the extent possible, grant
10reporting requirements shall be consistent with those required by
11other funding mechanisms that support the program.

12(e) The department shall implement this section only to the
13extent that funding is madebegin delete available, upon appropriation by the
14Legislature,end delete
begin insert availableend insert from the following sources:

15(1) From funding made available through public sources,begin insert upon
16appropriation by the Legislature, as applicable, andend insert
to the extent
17permitted bybegin delete law, including, but not limited to, the Early and
18Periodic Screening, Diagnosis, and Treatment Program and local
19education agency Medi-Cal billingend delete
begin insert lawend insert.

20(2) Frombegin delete privateend deletebegin insert otherend insert resources, includingbegin insert federal funding,end insert
21 in-kind assistance,begin delete federalend deletebegin insert private end insert funding, and foundation support
22for the operation and distribution of grants for this program.