Amended in Assembly April 17, 2013

Amended in Assembly April 4, 2013

Amended in Assembly March 19, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 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.

LEGISLATIVE COUNSEL’S DIGEST

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 other things, 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 and technical assistance to facilitate and encourage the establishment, retention, or expansion of school health centers.

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. begin insert The bill would define trauma for these purposes. end insert The bill would require the department to implement these provisions only to the extent that funding is made available, 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:

SECTION 1.  

The Legislature finds and declares all of the
following:

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

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

(c) Children and youth in low-income neighborhoods are
disproportionately impacted by trauma, including, but not limited
to, violence. For example, 20 percent of California children from
families with annual incomes below twenty-five thousand dollars
($25,000) feel somewhat unsafe or very unsafe in their
neighborhoods, versus just 2 percent of California children from
families with annual incomes above one hundred twenty-five
thousand dollars ($125,000).

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

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

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

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

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

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

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

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

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

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

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

(o) Schools and school health centers do not currently have
access to sufficient funding to reach more than a fraction of the
students impacted by trauma and who would benefit from mental
health services. The many barriers to securing sufficient funding
include, but are not limited to, high proportions of uninsured
students and restrictions on the services that are reimbursable
through programs such as the California Victim Compensation
Program and the Medi-Cal program.

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

SEC. 2.  

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

124174.7.  

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

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

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

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

(A) Individual, family, and group counseling.

(B) Targeted outreach and education.

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

(D) Schoolwide violence prevention and response efforts.

(E) Youth development programming related to trauma and
violence.

(F) Crisis response coordination and services.

(G) Case management services.

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

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

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

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

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

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

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

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

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

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

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

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

(1) Eligible applicants shall include:

(A) Local education agencies.

(B) Nonprofit organizations.

(C) Community health centers.

(D) County mental health departments.

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

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

(i) Individual, family, and group counseling.

(ii) Youth development programming related to trauma and
violence.

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

(iv) Coordination between school-based and community
services.

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

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

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

(3) As detailed in the request for applications, priority for
awarding a grant shall be given to eligible applicants that
demonstrate begin delete one or more of end delete the following:

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

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

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

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

(E)  begin delete A plan end delete begin insert An ability end insert to hire staff with similar backgrounds and
experiences to the target population and who can therefore enhance
program impact.

(F)  begin delete A plan end delete begin insert An ability end insert to obtain additional sources of funding or
third-party reimbursement to create a robust and sustainable
school-based mental health program.

(G)  begin delete A plan end delete begin insert An ability end insert to integrate mental health and related
services with primary medical care.

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

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

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

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

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

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

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

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

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

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

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

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

(3) Submit an annual report, including a discussion of all of the
following:

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

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

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

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

(e) The department shall implement this section only to the
extent that funding is made available from the following sources:

(1) From funding made available through public sources, upon
appropriation by the Legislature, as applicable, and to the extent
permitted by law.

(2) From other resources, including federal funding, in-kind
assistance, private funding, and foundation support for the
operation and distribution of grants for this program.

begin insert

(f) For purposes of this section, “trauma” or “trauma exposure”
is defined as experiencing or being witness to community violence,
terrorism, disaster, sexual abuse, or other violent acts. The effects
of trauma or trauma exposure include emotional, cognitive,
physical, or interpersonal reactions as a result of the event
witnessed or experienced.

end insert