BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 174
AUTHOR: Bonta
AMENDED: June 24, 2013
HEARING DATE: July 3, 2013
CONSULTANT: Robinson-Taylor
SUBJECT : Public school health centers.
SUMMARY : Requires the Department of Public Health to establish
a pilot grant program in Alameda County, 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.
Existing law:
1.Requires Department of Public Health (DPH) to establish the
Public School Health Center Support Program (PSHCSP), in
collaboration with the Department of Education, 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.
This bill:
1.Requires DPH to establish a pilot grant program within PSHCSP
to fund activities and services to directly address the mental
health and related needs of students who are impacted by
trauma.
2.Defines "trauma" or "trauma exposure" as experiencing or being
witness to community violence, terrorism, disaster, sexual
abuse, or other violent acts. Specifies that the effects of
trauma or trauma exposure include emotional, cognitive,
physical, or interpersonal reactions as a result of the event
witnessed or experienced.
Continued---
AB 174 | Page 2
3.Names the grant program Promoting Resilience: Offering Mental
Health Interventions to Support Education (PROMISE).
4.Requires DPH to establish the pilot grant program in the
County of Alameda in up to 10 facilities that meet specified
requirements. Authorizes DPH to delegate administrative
duties relating to the program to the County of Alameda.
5.Requires the pilot grant program to operate for the 2015-16
school year.
6.Requires DPH, within 60 days following completion of the
program, to review and compile the results of the summary
reports prepared by participating facilities and submit that
information to the appropriate policy and fiscal committees of
the Legislature.
7.Requires grant funds to be used by eligible applicants to
directly address the mental health and related needs of
students who are impacted by trauma.
8.Authorizes grant funds to be used for the following activities
and services, including but not limited to:
a. individual, family, and group counseling;
b. targeted outreach and education; school-wide violence
prevention and response efforts;
c. youth development programming related to trauma and
violence; and,
d. staff training and consultation on supporting students'
trauma-related needs.
9.Authorizes the individual, family, and group counseling in 8
a) above to be provided by specified mental health
professionals licensed by: the Board of Behavioral Sciences
(BBS), the Board of Psychology (BOP); the Board of Registered
Nursing; or, the Medical Board of California. Also authorizes
a school social worker credentialed by the State of
California; and, 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.
10.Requires that other activities and services, including
school-wide violence prevention efforts, to be provided or
overseen by a mental health professional as described in 9)
AB 174 | Page
3
above.
11.Authorizes grant funds to be used to provide referrals to
evidence-based mental health treatment services in the
community.
12.Requires eligible applicants for grant funds to include local
education agencies, nonprofit organizations, community health
centers, and the county mental health department.
13.Requires applicants to comply with a number of specified
program requirements in their grant applications to address
the mental health and other related needs of students who are
impacted by trauma, and to foster a positive school climate,
including, but not limited to:
a. Individual, family and group counseling;
b. Youth development programming related to
trauma and violence;
c. School-wide violence prevention and response
efforts, including, at a minimum, training for staff
on trauma and their roles in preventing and responding
to it;
d. Coordination between school-based and
community trauma; 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;
e. Demonstration that 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; and,
f. 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.
14.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.
AB 174 | Page 4
15.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 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, within 30 days
following the completion of the program that contains
specified information.
16.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.
17.Requires administrative costs incurred by DPH in implementing
this bill to be reimbursed through federal funding, in-kind
assistance, private funding, foundation support, and any other
non-state funds.
18.Sunsets the provisions of this bill on January 1, 2019.
FISCAL EFFECT : This version of the bill has not yet been
analyzed by a fiscal committee.
PRIOR VOTES :
Assembly Health: 13- 5
Assembly Appropriations:12- 0
Assembly Floor: 52- 24
COMMENTS :
1.Author's statement. All forms of violence, including gun
violence, have become a tragic fact of life for children in
districts throughout the state. In particular, communities of
color are disproportionately affected by violence and exposure
to trauma. According to the author, growing up in violent
environments can cause serious complications for children,
AB 174 | Page
5
including depression and post-traumatic stress disorder. The
author maintains, unfortunately, out of the approximately 13
percent of adolescents who report needing help for emotional
or mental health problems, over 60 percent do not receive
counseling. The author argues there is currently a lack of
services to help students who have been exposed to trauma.
According to the author, this bill seeks to rectify this problem
through the creation of a pilot grant program to support
services to students suffering from trauma exposure, including
individual, group and family counseling; youth development
programming focused on preventing and addressing violence;
school-wide violence prevention programs; and support for
teachers and other staff in identifying and responding to
students' trauma-related needs. The author asserts the state
has a responsibility to protect California's students and
ensure that they are receiving the proper services for
recovery from traumatic events. This bill, the author argues,
is a step in the right direction towards protecting
California's students' well-being and growing stronger
communities.
2.Trauma. According to a 2009 study by United States Department
of Justice (DOJ), children's exposure to violence, whether as
victims or witnesses, is often associated with long-term
physical, psychological, and emotional harm and that children
exposed to violence are also at a higher risk of engaging in
criminal behavior later in life and becoming part of a cycle
of violence. According to the National Child Traumatic Stress
Network (Network), 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. However, according to the Network,
children and youth living in low-income neighborhoods, as well
as children and youth of color, are disproportionately
impacted by trauma. Kidsdata.org reports that 20 percent of
California children with family incomes below $25,000 feel
unsafe in their homes, schools, or communities, versus just 2
percent of California children with family incomes above
$125,000.
3.SHCs. According to the National Assembly on School-Based Care
(NASBC), SHCs provide a broad array of primary care and
AB 174 | Page 6
preventive services, including comprehensive health
assessments; prescriptions for medications; treatment for
acute illness; asthma treatment; oral health education; and
dental screenings. Approximately 75 percent 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.
Forty-four percent of SHCs are in high schools, thirty-one
percent are in elementary schools, thirteen percent are in
middle schools, and twelve percent 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 percent 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 percent of
their operating costs from billing sources.
4.Alameda County. Alameda County is located in northern
California occupying the East Bay region of the San Francisco
Bay Area and its major cities include Oakland, Freemont,
Berkeley and Hayward. According to the California DOJ,
Alameda County has the second highest rate of violence per
100,000 people in the state next to San Joaquin County.
According to a recent CBS news report, Oakland has one of the
AB 174 | Page
7
top five highest violent crime rates in the country. In 2011,
Oakland averaged three street shootings per day, some of which
caused injury or death to innocent bystanders. In addition to
these conditions, the author maintains that Alameda County was
chosen because it has the largest number of SHCs within a
single county. Twenty-two of the two-hundred SHCs located in
California are located in Alameda County.
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.Support. The California Pan-Ethnic Health Network, a
co-sponsor of this bill, writes in support that trauma has
serious short and long-term consequences for health,
educational achievement, and well-being. The California
School Health Centers Assoication, also a co-sponsor, writes
that the PROMISE program has potential to create a model that
could be expanded in the future to the rest of the state and
result in significant costs savings for California. Children
AB 174 | Page 8
Now, Latino Coalition for a Healthy California, Los Angeles
Trust for Children's Health, and a number of other supporting
organizations write that research shows school-based mental
health services are effective and can reduce depression and
post-traumatic stress syndrome.
7.Opposition. The California Right to Life Committee, Inc.
opposes this bill because it expands school health centers and
the services they provide, which include contraceptive
services, abortion referrals or actual abortions to minors
without parental notifications or consent.
8.Policy Comment. Considering trauma and its related impact on
mental health is a problem that impacts students across the
entire state, the Committee may wish to consider whether this
pilot grant program should be conducted only in Alameda County
as opposed to targeted communities across the state
disproportionately impacted by violence.
SUPPORT AND OPPOSITION :
Support: California Pan-Ethnic Health Network (co-sponsor)
California School Health Centers Association
(co-sponsor)
American Federation of State, County and Municipal
Employees, AFL-CIO
Asian Health Services
Bienvenidos
California Alliance of Child and Family Services
California Black Health Network
California Immigrant Policy Center
California Latino School Boards Association
California Medical Association
California Partnership to End Domestic Violence
California Primary Care Association
California School Board Association
California School Employees Association
California School Nurses Organization
California Parent Teachers Association
Children's Defense Fund - California
Children's Hospital & Research Center Oakland
Children Now
Compton Unified School District
East Bay Agency for Children
Fight Crime: Invest in Kids California
The Greenlining Institute
AB 174 | Page
9
Latino Coalition for a Healthy California
Native American Health Center
Partnership for Children and Youth
PICO California
Policy Link
Street Level Health Project
United Way of the Bay Area
Urban Strategies Council
Youth ALIVE!
The Los Angeles County Education Foundation
The Children's Partnership
Hundreds of Individuals
Oppose: California Right to Life Committee, Inc.
-- END --