BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 174
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          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