Amended in Assembly May 24, 2013

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 BillNo. 174

Introduced by Assembly Member Bonta

January 24, 2013

An act to addbegin insert and repealend insert Section 124174.7begin delete toend deletebegin insert ofend insert 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 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 establishbegin insert, within the County of Alameda,end insert a grantbegin insert pilotend insert program within the Public School Health Center Support Program that would be known as Promoting Resilience: Offering Mental Health Interventions to Support Education (PROMISE).begin insert The program would operate from September 1, 2014, to August 31, 2015.end insert 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 define trauma for these purposes.begin insert The bill would require the department, within 60 days following the completion of the program, to submit specified information on the program to the appropriate policy and fiscal committees of the Legislature.end insert The bill would require the department to implement these provisions only to the extent that funding is made available, asbegin delete specified. The bill would also include legislative findings and declarations.end deletebegin insert specified, and would require any administrative costs to the department to be paid through nonstate funds. The bill would repeal these provisions on January 1, 2017.end insert

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

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

begin delete
P2    1


The Legislature finds and declares all of the

3(a) Trauma 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 children from
15families with annual incomes below twenty-five thousand dollars
16($25,000) feel somewhat unsafe or very unsafe in their
17neighborhoods, versus just 2 percent of California children from
18families with annual incomes above one hundred twenty-five
19thousand dollars ($125,000).

20(d) Children and youth of color are disproportionately impacted
21by violence. Compared to Caucasians, African American children
P3    1and youth are three times more likely, and Latino children and
2youth are two times more likely, to be exposed to shootings, bombs,
3and riots.

4(e) Boys and young men of color are particularly likely to be
5impacted by trauma. For example, compared to rates among
6Caucasians, boys and young men of color have more than twice
7the risk of witnessing domestic violence, being abused and
8neglected, or having an incarcerated parent. Homicide is the leading
9cause of death among male African American adolescents,
10occurring at a rate 15 times greater than among Caucasians.

11(f) The likelihood of boys and young men suffering from
12post-traumatic stress disorder is two and one-half times greater
13among African American boys and young men and four and
14one-tenth times greater among Latino boys and young men, as
15compared to among Caucasians.

16(g) Mental health services can have a positive and significant
17impact on life outcomes for children and adolescents impacted by

19(h) However, of the almost 13 percent of adolescents who report
20needing help for emotional or mental health problems, over 60
21percent do not receive counseling. Among adolescents living below
22 the poverty line, 92 percent of those who report needing help for
23emotional or mental health problems did not receive counseling
24in the past year. The percentage of adolescents who report needing
25help for emotional or mental health problems is widely assumed
26to be less than the percentage who would benefit from these

28(i) Adolescents are less likely than almost all other age groups
29to have a usual source of health care. Male adolescents, and
30particularly male adolescents of color, are even less likely to have
31a usual place to go when they are sick or need health advice.

32(j) California’s 200 school health centers are predominantly
33located in low-income communities, where students are
34disproportionately impacted by trauma. For example, 80 percent
35of school health center clients seen in the County of Alameda in
36the 2010-11 school year had witnessed violence or been a victim
37 of violence during their lifetime.

38(k) Among adolescents in managed care plans, those with access
39to a school health center are 10 times more likely to access mental
P4    1health or substance abuse services than those without access to a
2school health center.

3(l) School health centers see higher proportions of adolescent
4males than other care settings, including community clinics or
5private practices.

6(m) Research shows that students receiving mental health
7services at school health centers have significant improvements
8in their presenting problems and that school-based mental health
9services can be more efficacious than those provided in community

11(n) School-based mental health programs focused specifically
12on trauma have been shown to reduce post-traumatic stress
13disorder, depression, and psychosocial dysfunction.

14(o) Schools and school health centers do not currently have
15access to sufficient funding to reach more than a fraction of the
16students impacted by trauma and who would benefit from mental
17health services. The many barriers to securing sufficient funding
18include, but are not limited to, high proportions of uninsured
19students and restrictions on the services that are reimbursable
20through programs such as the California Victim Compensation
21Program and the Medi-Cal program.

22(p) The Early and Periodic Screening, Diagnosis and Treatment
23Program, a Medi-Cal program that is a major source of funding
24for school-based mental health services, excludes many of the
25young people who need its services. Barriers include, but are not
26limited to, Medi-Cal eligibility, low provider participation,
27restrictive diagnostic and medical necessity criteria, and the
28requirement that a parent or guardian consent for services.

end delete

begin deleteSEC. 2.end delete
30begin insertSECTION 1.end insert  

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



(a) begin insert(1)end insertbegin insertend insert The State Department of Public Health
33shall establish a grantbegin insert pilotend insert program within the Public School
34Health Center Support Program to fund activities and services to
35directly address the mental health and related needs of students
36who are impacted by trauma. This grantbegin insert pilotend insert program shall be
37named Promoting Resilience: Offering Mental Health Interventions
38to Support Education (PROMISE).

begin insert

P5    1(2) The department shall establish the pilot program in the
2County of Alameda, and up to 10 facilities that meet the
3requirements in this section may participate in the program.

end insert
begin insert

4(3) The program shall operate for one year, beginning
5September 1, 2014, and ending on August 31, 2015.

end insert
begin insert

6(4) Within 60 days following completion of the program, the
7department shall review and compile the results of the summary
8reports prepared by participating facilities pursuant to paragraph
9(3) of subdivision (d) and submit that information to the
10appropriate policy and fiscal committees of the Legislature.

end insert

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

13(1) Grant funds shall be used by eligible applicants to directly
14address the mental health and related needs of students who are
15impacted by trauma.

16(2) Grant funds may be used for the following activities and

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

19(B) Targeted outreach and education.

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

21(D) Schoolwide violence prevention and response efforts.

22(E) Youth development programming related to trauma and

24(F) Crisis response coordination and services.

25(G) Case management services.

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

28(I) Staff training and consultation on supporting students’
29trauma-related needs.

30(J) Oversight, coordination, and evaluation of the above
31activities and services.

32(3) Individual, family, and group counseling funded by a grant
33awarded pursuant to this section may be provided by any of the

35(A) A mental health clinician licensed by the Board of
36Behavioral Sciences, including a licensed marriage and family
37therapist, a licensed clinical social worker, or a licensed educational

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

P6    1(C) A psychiatric nurse practitioner licensed by the Board of
2 Registered Nursing.

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

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

6(F) An unlicensed mental health professional who is registered
7by either the Board of Behavioral Sciences or the Board of
8Psychology, and who is receiving clinical supervision as prescribed
9by that entity.

10(4) Other activities and services, including schoolwide violence
11prevention efforts, shall be provided or overseen by a mental health
12professional as described in subparagraphs (A) through (F),
13inclusive, of paragraph (3).

begin insert

14(5) Grant funds may be used to provide referrals to
15evidence-based mental health treatment services in the community.

end insert

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

18(1) Eligible applicants shall include:

19(A) Local education agencies.

20(B) Nonprofit organizations.

21(C) Community health centers.

22(D) begin deleteCounty end deletebegin insertThe county end insertmental health begin deletedepartments.end deletebegin insert department.end insert

23(2) Grant applications shall comply with all of the following:

24(A) Applicants shall describe their program to address the mental
25health and other related needs of students who are impacted by
26trauma, and to foster a positive school climate. At a minimum, the
27program described in the application shall include:

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

29(ii) Youth development programming related to trauma and

31(iii) Schoolwide violence prevention and response efforts,
32including, at a minimum, training for staff on trauma and their
33roles in preventing and responding to it.

34(iv) Coordination between school-based and community

36(v) A discussion of any components of the program for which
37funding does not yet exist or is currently insufficient and for which
38they are seeking grant funding.

39(B) Demonstrate the applicant’s ability to provide a dedicated
40space located on the school campus that will serve as the hub of
P7    1the program, that will be youth friendly, and, for middle and high
2schools, that will be regularly accessible to students on a drop-in

4(C) Provide evidence of a strong partnership and commitment
5to collaboration between the school and any agencies or
6organizations that will provide mental health, medical, or other
7related services on the school campus, whether funded by this
8grant or another funding source. Specific mechanisms by which
9applicants shall provide this evidence shall be detailed in the
10request for applications, but may include letters of agreement or
11support, memoranda of understanding, or draft, signed

13(3) As detailed in the request for applications, priority for
14awarding a grant shall be given to eligible applicants that
15demonstrate the following:

16(A) High levels of exposure to trauma and violence among the
17target population.

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

20(C) An ability to meet the cultural and linguistic needs of the
21target population.

22(D) An ability to engage and serve subgroups of students within
23the target population who are disproportionately impacted by
24trauma and violence.

25(E) An ability to hire staff with similar backgrounds and
26experiences to the target population and who can therefore enhance
27program impact.

28(F) An ability to obtain additional sources of funding or
29third-party reimbursement to create a robust and sustainable
30school-based mental health program.

31(G) An ability to integrate mental health and related services
32with primary medical care.

33(d) An eligible applicant that receives grant funds shall commit
34to all of the following:

35(1) Establish a written memorandum of understanding (MOU)
36between the school, the school district, and other agencies or
37organizations providing grant-funded mental health, medical, or
38other related services, in an effort to develop a strong collaborative
39partnership between involved entities.

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

P8    1(i) Include local education agency-employed personnel,
2 including school administrators, teachers, and staff, and any school
3health personnel, including school nurses or social workers.

4(ii) Include personnel employed by other agencies or
5 organizations, including community health centers, who provide
6relevant services on campus.

7(iii) Establish and implement regular communication protocols
8between the school and agencies or organizations.

9(iv) Engage all relevant personnel in identifying students who
10would benefit from mental health or other related services and
11linking them to those services.

12(v) Promote the integration of funded services into the overall
13school environment.

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

15(i) Describe how services are coordinated on the campus and
16how services will be integrated into the overall school environment.

17(ii) Ensure the confidentiality and privacy of both education
18and health information, consistent with applicable federal and state

20(2) Make services available to all students in the school,
21regardless of ability to pay.

22(3) Submitbegin delete an annualend deletebegin insert a summaryend insert reportbegin insert to the departmentend insert,
23begin delete includingend deletebegin insert within 30 days following the completion of the program,
24that includesend insert
a discussion of all of the following:

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

26(B) The number of students served through specific activities
27and services.

28(C) The roles and credentials of personnel funded through the
29grant award.

30(D) Any additional funding sources that are available to enhance
31or sustain activities and services. To the extent possible, grant
32reporting requirements shall be consistent with those required by
33other funding mechanisms that support the program.

begin insert

34(E) An analysis of the effects of the program on the surrounding

end insert

36(e) begin insert(1)end insertbegin insertend insert The department shall implement this section only to
37the extent that funding is made available from the following

begin delete


end delete

P9    1begin insert(end insertbegin insertA)end insert From funding made available through public sources, upon
2appropriation by the Legislature, as applicable, and to the extent
3permitted by law.

begin delete


end delete

5begin insert(end insertbegin insertB)end insert From other resources, including federal funding, in-kind
6assistance, private funding, and foundation support for the
7operation and distribution of grants for this program.

begin insert

8(2) Administrative costs to the department for the establishment
9and maintenance of this program shall be paid through federal
10funding, in-kind assistance, private funding, foundation support,
11and any other nonstate funds.

end insert

12(f) For purposes of this section, “trauma” or “trauma exposure”
13is defined as experiencing or being witness to community violence,
14terrorism, disaster, sexual abuse, or other violent acts. The effects
15of trauma or trauma exposure include emotional, cognitive,
16physical, or interpersonal reactions as a result of the event
17witnessed or experienced.

begin insert

18(g) This section shall remain in effect only until January 1, 2017,
19and as of that date is repealed, unless a later enacted statute, that
20is enacted before January 1, 2017, deletes or extends that date.

end insert