BILL ANALYSIS Ó
AB 174
Page 1
Date of Hearing: April 9, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 174 (Bonta) - As Amended: April 4, 2013
SUBJECT : Public school health centers.
SUMMARY : Requires the Department of Public Health (DPH) to
establish a grant program, to the extent that funding is made
available, to provide resources to eligible applicants for
activities and services that directly address the mental health
and related needs of students impacted by trauma. Specifically,
this bill :
1)Makes a number of legislative findings and declarations
relating to the short- and long-term consequences of trauma on
adolescents and the role that school-based mental health
programs focused on trauma play in reducing post-traumatic
stress disorder, depression, and psychosocial dysfunction.
2)Directs DPH to establish a grant program within its Public
School Health Center Support Program (PSHCSP) to fund
activities and services to directly address the mental health
and related needs of students who are impacted by trauma.
3)Authorizes grant funds to be used for the following purposes:
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; and,
j) Oversight, coordination, and evaluation of the items
specified in a) through i) above.
4)Authorizes the individual, family, and group counseling in 3a)
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above to be provided by any of the following mental health
professionals:
a) A mental health clinician licensed by the Board of
Behavioral Sciences (BBS);
b) A clinical psychologist licensed by the Board of
Psychology (BOP);
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; and,
f) An unlicensed mental health professional who is
registered by either the BBS or BOP, and who is receiving
clinical supervision as prescribed by that entity.
5)Requires eligible applicants for grant funds to include local
education agencies, nonprofit organizations, community health
centers, and county mental health departments.
6)Requires applicants to comply with a number of specified
requirements in their grant applications, including
requirements to describe their program to address the mental
health and other related needs of students who are impacted by
trauma; demonstrate their ability to provide a dedicated space
located on the school campus that will serve as the hub of the
program; and, 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.
7)Provides that priority for awarding a grant must be given to
eligible applicants that demonstrate one or more specified
factors as detailed in the request for applications.
8)Requires eligible applicants that receive grant funds to
commit to all of the following:
a) Establish a written memorandum of understanding, as
specified, 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, as
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specified, between involved entities;
b) Make services available to all students in the school,
regardless of ability to pay; and,
c) Submit an annual report to DPH that contains specified
information.
9)Directs DPH to implement this bill only to the extent that
funding is made available from public sources, upon
appropriation by the Legislature, as applicable, to the extent
permitted by law, and from other resources, including federal
funding, in-kind assistance, private funding, and foundation
support for the operation and distribution of grants for this
program.
EXISTING LAW :
1)Requires DPH to establish the PSHCSP to perform specified
functions relating to the establishment, retention, or
expansion of school health centers (SHCs) in California.
2)Establishes a grant program administered by the PSHCSP to
provide technical assistance and funding to SHCs, to the
extent funds are appropriated for implementation of the
PSHCSP. To date, this grant program has not been funded.
3)Defines a SHC, for purposes of the PSHCSP, as a center or
program that provides age-appropriate health care services at
the program site or through referrals, and may be located on
or at a local educational agency.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . The author states that it is well
documented that appropriate mental health services can have a
positive and lasting impact on short- and long-term outcomes
for children and adolescents impacted by trauma. However, the
author notes that many children and youth in California lack
access to the health and mental health services they need and
California's 200 SHCs address this gap by putting medical,
mental health, and/or dental care on school grounds. The
author states that these centers are predominantly located in
low income communities where students are disproportionately
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impacted by trauma in their neighborhoods and cites research
showing that adolescents with SHC access are 10 times more
likely to access mental health or substance abuse services
than those without such access. The author points out that
SHCs do not currently have sufficient funding to reach all of
the students who would benefit from mental health services
focused on trauma and this bill will provide additional
resources to enable school-based mental health providers and
other student support personnel to provide trauma-informed
services on their campuses.
2)TRAUMA . According to the National Child Traumatic Stress
Network (Network), a collaborative of academic and
community-based trauma service centers established by Congress
in 2000 and funded by the federal Substance Abuse and Mental
Health Services Administration, child trauma is a painfully
common problem both domestically and internationally.
Although some children are at greater risk of being exposed to
trauma than others, traumatic events happen to children of all
ages, from all socioeconomic strata, racial and ethnic groups,
and geographic regions in the US. The Network estimates that,
each year, among US children aged two to 17, 50% are victims
of a physical assault; one in eight experiences child abuse;
one in 12 experiences sexual victimization; and one in three
witnesses violence.
The Network states that child traumatic stress occurs when
children and adolescents are exposed to traumatic events or
situations that overwhelm their ability to cope. Usually such
events threaten the life or physical integrity of the child,
or of someone close to the child, or involve the child's
witnessing a similar threat to someone else. Traumatic events
can evoke powerful psychological and emotional reactions such
as an overwhelming sense of terror, helplessness, and horror,
as well as physical sensations such as a racing heart,
trembling, dizziness, and loss of bowel or bladder control.
According to the Network, if left unaddressed, the lasting
effects of childhood trauma can place a heavy emotional and
economic burden on individuals, families, and communities, and
create challenges for virtually all public institutions and
service systems.
3)SHCs . According to the National Assembly on School-Based Care
(NASBC), SHCs provide a broad array of primary care and
preventive services, including comprehensive health
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assessments; prescriptions for medications; treatment for
acute illness; asthma treatment; oral health education; and
dental screenings. Approximately 75% of SHCs also have mental
health providers on staff to offer mental health assessments,
crisis intervention, brief and long term therapy, and, other
services. SHCs are the primary, and occasionally only,
available health care for many children and adolescents who
otherwise would have no access. The NASBC states that
Congress recognized the importance of SHCs as a key link in
the nation's health care safety net by providing $50 million a
year for four years in one-time funding for construction,
renovation, and equipment for SHCs in the federal Affordable
Care Act and more than 350 applicants from around the nation
are seeking funding through the first round of competitive
grants created under the law.
According to background information provided by a cosponsor of
this bill, the California School Health Centers Association
(CSHCA), there are currently 200 SHCs in California. 44% of
SHCs are in high schools, 31% are in elementary schools, 13%
are in middle schools, and 12% are "school-linked" or mobile
medical vans. CSHCA points out that many SHCs are located in
schools serving some of the state's most vulnerable children
and on campuses with SHCs, about 70% of students receive free
or reduced price meals. Since 2012, CSHCA estimates that
13,500 children have gained access to health care in their
school through the expansion of SHCs. SHCs are administered
by a variety of organizations, including school districts,
Federally Qualified Health Centers, county health departments,
hospitals, community-based agencies, and private physician
groups. They are financed through grants from state, local,
and private sources as well as reimbursements from public
programs, such as the Child Health and Disability Prevention
Program and Medi-Cal. According to CSHCA, more than half of
SHCs recover less than 50% of their operating costs from
billing sources.
4)SUPPORT . The California Pan-Ethnic Health Network, a
cosponsor of this bill, writes in support that too many young
people are not getting culturally appropriate and accessible
mental health care and this bill will begin to address this
growing and unmet need in our communities. Additional
supporters, including individual SHCs, children's advocacy
groups, and health care providers, state that the grant
program in this bill would fund a variety of essential
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school-based services, including counseling, youth
development, and support for teachers and other school staff
in identifying and responding to students' trauma-related
needs. They add that the creation of a grant program aimed at
services for students who have suffered trauma has the
potential to improve the health, academic achievement, and
life outcomes of California's children.
5)PRIOR LEGISLATION .
a) AJR 10 (Brownley), Resolution Chapter 68, Statutes of
2011, urges Congress to include an appropriation to fund
SHCs in the reauthorization of the federal Elementary and
Secondary Education Act.
b) SB 564 (Ridley-Thomas), Chapter 381, Statutes of 2008,
provides a definition of SHCs and requires DPH, to the
extent funds are appropriated for implementation of the
PSHCSP, to establish a grant program to provide technical
assistance and funding for the expansion, renovation, and
retrofitting of existing SHCs and the development of new
SHCs, as specified.
c) AB 2560 (Ridley-Thomas), Chapter 334, Statutes of 2006,
requires the Department of Health Services (DHS), now DPH,
to establish the PSHCSP.
d) SB 566 (Escutia) of 1999 would have established the SHC
Grant Program, to be administered by DHS, to provide grants
to qualifying SHCs in order to assist the centers in
providing health services to students, provided that funds
were appropriated in the annual Budget Act. This bill also
would have required DHS to convene a study group to explore
long-term strategies to support SHCs and incorporate these
centers into a comprehensive and coordinated health care
system. This bill was moved to the inactive file on the
Senate Floor.
6)AUTHOR'S AMENDMENTS . The author intends to offer amendments
in committee to provide a definition of trauma and make other
minor technical changes.
REGISTERED SUPPORT / OPPOSITION :
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Support
California School Health Centers Association (sponsor)
California Pan-Ethnic Health Network (sponsor)
California Immigrant Policy Center
California Medical Association
California Primary Care Association
California State Conference of the National Association for the
Advancement of Colored People
Children Now
Children's Defense Fund - California
Eisher Pediatric & Family Medical Center
Greenlining Institute
James Morehouse Project
Lake County Office of Education
Lakeport Unified School District
Latino Coalition for a Healthy California
Lincoln Child Center
Los Angeles County Education Foundation, Inc.
Los Angeles Trust for Children's Health
National Association of Social Workers, California Chapter
Northeast Valley Health Corporation
Partnership for Children and Youth
Prevention Institute
United Way of the Bay Area
Unity Care Group
Young Minds Advocacy Project
Several individuals
Opposition
None on file.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097