BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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          |SENATE RULES COMMITTEE            |                        AB 174|
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                                    THIRD READING


          Bill No:  AB 174
          Author:   Bonta (D)
          Amended:  9/3/13 in Senate
          Vote:     21

           
           SENATE HEALTH COMMITTEE  :  7-2, 7/3/13
          AYES:  Hernandez, Beall, De León, DeSaulnier, Monning, Pavley,  
            Wolk
          NOES:  Anderson, Nielsen

           SENATE APPROPRIATIONS COMMITTEE  :  6-1, 8/30/13
          AYES:  De León, Gaines, Hill, Lara, Padilla, Steinberg
          NOES:  Walters

           ASSEMBLY FLOOR  :  52-24, 5/29/13 - See last page for vote


           SUBJECT  :    Public school health centers

           SOURCE  :     California Pan-Ethnic Health Network
                      California School Health Centers Association 


           DIGEST  :    This bill requires the Department of Public Health  
          (DPH) 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.

           ANALYSIS  :    

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          Existing law:

          1.Requires 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.

           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.  

           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  

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             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.

           1. Authorizes the individual, family, and group counseling in  
             #8A 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.

           2. 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  
             above.

           3. Authorizes grant funds to be used to provide referrals to  
             evidence-based mental health treatment services in the  
             community.

           4. Requires eligible applicants for grant funds to include  
             local education agencies, nonprofit organizations, community  
             health centers, and the county mental health department.

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           5. 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.

           1. 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.

           2. 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  

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               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.

           1. Directs DPH to implement this bill only to the extent that  
             funding is made available from nonstate resources, including  
             federal funding, in-kind assistance, private funding,  
             foundation support for the operation and distribution of  
             grants for this program, and for administrative costs  
             incurred by DPH in implementing these provisions.

           2. Establishes a sunset date of January 1, 2019.

           Comments
           
           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 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.

           SHCs  .  According to the National Assembly on School-Based Care,  
          SHCs provide a broad array of primary care and preventive  
          services, including comprehensive health 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,  

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          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.  

          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, 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.  

           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 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 200 SHCs located in California are located in  
          Alameda County.

           Prior Legislation
          
          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.

          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.

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          AB 2560 (Ridley-Thomas, Chapter 334, Statutes of 2006) requires  
          the Department of Health Services (DHS), now DPH, to establish  
          the PSHCSP. 

          SB 566 (Escutia, 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.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

          According to the Senate Appropriations Committee:

               Unknown costs to provide grants (federal funds or private  
              funds).  The bill specifies that the program would be  
              limited to a one-year pilot project in Alameda County at up  
              to ten facilities.  However, the bill does not specify the  
              total amount of funding or the potential fund source.

               Unknown costs to administer the program (federal funds or  
              private funds).  Typically, the cost to administer a grant  
              program is about 5% of total grant spending.  

           SUPPORT  :   (Verified  8/30/13)

          California Pan-Ethnic Health Network (co-sponsor)
          California School Health Centers Association (co-sponsor)
          AFSCME
          Alameda County Board of Supervisors
          Asian Health Services
          Bienvenidos
          California Academy of Family Physicians
          California Alliance of Child and Family Services
          California Black Health Network
          California Immigrant Policy Center
          California Latino School Boards Association
          California Medical Association

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          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
          Catholic Charities of the East Bay
          Children Now
          Children's Defense Fund - California
          Children's Hospital & Research Center Oakland
          City of Oakland
          Compton Unified School District
          East Bay Agency for Children
          Fight Crime:  Invest in Kids California
          Hundreds of Individuals
          James Morehouse Project
          Kaiser Permanente
          Latino Coalition for a Healthy California
          Lifelong Medical Care
          Lincoln Child Center
          Los Angeles Trust for Children's Health
          Native American Health Center
          Oakland Unified School District
          Partnership for Children and Youth
          PICO California
          Policy Link
          Street Level Health Project
          The Children's Partnership
          The Greenlining Institute
          The Los Angeles County Education Foundation
          United Way of the Bay Area
          Urban Strategies Council
          Youth ALIVE!

           OPPOSITION  :    (Verified  8/30/13)

          California Right to Life Committee, Inc.

           ARGUMENTS IN SUPPORT  :    According to the author's office, 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.  The author argues there is  
          currently a lack of services to help students who have been  

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          exposed to trauma.

          According to the author's office, 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 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 Association,  
          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 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.
          
           ARGUMENTS IN 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.  
           
           ASSEMBLY FLOOR  :  52-24, 05/29/13
          AYES: Alejo, Ammiano, Atkins, Bloom, Blumenfield, Bocanegra,  
            Bonilla, Bonta, Bradford, Brown, Buchanan, Ian Calderon,  
            Campos, Chau, Chesbro, Cooley, Daly, Dickinson, Fong, Fox,  
            Frazier, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gray, Hall,  
            Roger Hernández, Jones-Sawyer, Levine, Lowenthal, Medina,  
            Mitchell, Mullin, Muratsuchi, Nazarian, Pan, Perea, V. Manuel  
            Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner, Stone,  
            Ting, Weber, Wieckowski, Williams, Yamada, John A. Pérez
          NOES: Achadjian, Allen, Bigelow, Chávez, Conway, Dahle,  
            Donnelly, Beth Gaines, Gorell, Grove, Hagman, Harkey, Jones,  
            Logue, Maienschein, Mansoor, Melendez, Morrell, Nestande,  
            Olsen, Patterson, Wagner, Waldron, Wilk
          NO VOTE RECORDED: Eggman, Holden, Linder, Vacancy

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          JL:nl  9/3/13   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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