BILL ANALYSIS                                                                                                                                                                                                    






                             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)  




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            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.





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          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,  




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            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  




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            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  




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            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  




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            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




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                    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.






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