BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON EDUCATION
                              Senator Carol Liu, Chair
                                2015 - 2016  Regular 

          Bill No:              AB 580            
           ----------------------------------------------------------------- 
          |Author:    |O'Donnell                                            |
          |-----------+-----------------------------------------------------|
          |Version:   |June 24, 2015                                Hearing |
          |           |Date:    July 1, 2015                                |
           ----------------------------------------------------------------- 
           ----------------------------------------------------------------- 
          |Urgency:   |No                      | Fiscal:    |Yes            |
           ----------------------------------------------------------------- 
           ----------------------------------------------------------------- 
          |Consultant:|Lynn Lorber                                          |
          |           |                                                     |
           ----------------------------------------------------------------- 
          
          Subject:  Pupil mental health:  model referral protocols

            SUMMARY
          
          This bill requires the California Department of Education (CDE)  
          to develop model referral protocols for voluntary use by schools  
          to address the appropriate and timely referral by school staff  
          of students with mental health concerns.

          BACKGROUND
          
          The federal Individuals with Disabilities Education Act provides  
          that students with exceptional needs identified as having  
          "emotional disturbance" may be eligible to receive mental health  
          services.  Mental health services are considered "related  
          services" and include counseling, psychological services, parent  
          counseling and training, and residential placement, among  
          others.  (United States Code, Title 20,  1400 et seq. and Code  
          of Federation Regulations, Title 34,  300.34)  

          AB 114 (Committee on Budget, Chapter 43, Statutes of 2011),  
          shifted responsibility for mental health services for students  
          from counties to local educational agencies (LEAs).  Any and all  
          services identified in a student's individualized education  
          program (IEP) must be provided, whether directly by LEA  
          employees or through contract with outside providers such as  
          county mental health agencies.  LEAs are required to ensure  
          services are provided to students regardless of who provides or  
          pays for those services.  (Education Code  56139)








          AB 580 (O'Donnell)                                      Page 2  
          of ?
          
          
          ANALYSIS
          
          This bill requires the CDE to develop model referral protocols  
          for voluntary use by schools to address the appropriate and  
          timely referral by school staff of students with mental health  
          concerns.

       1)Requires the CDE to consult with the members of the Student  
            Mental Health Policy Workgroup, LEAs that have served as state  
            or regional leaders in student mental health initiatives,  
            county mental health programs, and current classroom teachers  
            and administrators, classified staff, staff who hold student  
            personnel services credentials, school nurses, school  
            counselors and other professionals involved in student mental  
            health as the CDE deems appropriate.

       2)Requires the protocols to be designed for use, on a voluntary  
            basis, by schoolsites, school districts, county offices of  
            education, charter schools, and the State Special 
            Schools, and by preparation programs for teachers,  
            administrators, school counselors, student personnel services,  
            and school nurses.

       3)Requires the protocols to do all of the following:

             a)   Address the appropriate and timely referral by school  
               staff of students with mental health concerns.

             b)   Reflect a multitiered system of support processes and  
               positive behavioral interventions and supports.

             c)   Be adaptable to varied local service arrangements for  
               mental health services.

             d)   Reflect evidence-based and culturally appropriate  
               approaches to student mental health referral.

             e)   Address the inclusion of parents and guardians in the  
               referral process.

             f)   Be written to ensure clarity and ease of use by  
               certificated and classified school employees.

             g)   Reflect differentiated referral processes for students  








          AB 580 (O'Donnell)                                      Page 3  
          of ?
          
          
               with disabilities and other populations for whom the  
               referral process may be distinct.

             h)   Be written to ensure that school employees act only  
               within the authorization or scope of their credential or  
               license. 

             i)   Be consistent with state activities conducted by the  
               California Department of Education (CDE) in the  
               administration of federally funded mental health programs.

       4)Requires the CDE to post the model referral protocols on its  
            website.

       5)Provides that nothing in this bill is to be construed as  
            authorizing or encouraging school employees to diagnose or  
            treat mental illness unless they are specifically licensed and  
            employed to do so.

       6)Provides that the implementation of this bill is contingent upon  
            funds being appropriated for its purpose, and requires the  
            model referral protocols to be completed and made available  
            within two years of the date funds are received or allocated  
            to implement the provisions of this bill.

          STAFF COMMENTS
          
       1)Need for the bill.  According to the author, "In surveys,  
            California educators report their lack of preparedness in  
            addressing pupil mental health challenges as a major barrier  
            to instruction.  According to the CDE's Student Mental Health  
            Policy Workgroup, most educators and staff lack training to  
            identify pupils who may be in need of support, and to make  
            referrals to help students manage mental health issues and  
            succeed in school.  In particular, the CDE has identified  
            inadequate 

            identification and service referral, and inconsistent student  
            mental health policies, as major factors contributing to  
            students' lack of access to support for mental health  
            concerns."

       2)What does school staff do now?  Statutes are silent with regard  
            to the process followed by school employees to refer students  








          AB 580 (O'Donnell)                                      Page 4  
          of ?
          
          
            for mental health assessments and services.  Teachers are  
            specifically authorized to make a referral for assessment for  
            special education and related services, but mental health  
            needs may not necessitate special education.  It is likely  
            that schools notify the school or school district counselor,  
            psychologist or nurse of mental health concerns.  

       3)Existing statewide student mental health initiatives.  The state  
            is currently engaged in a number of initiatives aimed at  
            improving support for student mental health needs.  Among them  
            are:

       Student Mental Health Policy Workgroup.  In 2012, the  
            Superintendent of Public Instruction and the California Mental  
            Health Services Act (CalMHSA) convened a Student Mental Health  
            Policy Workgroup (workgroup) to develop policy recommendations  
            that promote early identification, referral, coordination, and  
            access to quality mental health services for students.  The  
            workgroup is comprised of teachers, school counselors, school  
            social workers, school psychologists, school nurses, and  
            school administrators, as well as state and county mental  
            health professionals.  

       The workgroup has noted the connection between mental wellness and  
            academic achievement, attendance, and behavior.  It has also  
            noted that California's educators acknowledge their lack of  
            preparedness in addressing pupil mental health challenges as a  
            major barrier to instruction.  The workgroup found that "most  
            educators and staff lack training to identify pupils who may  
            be in need of support, make referrals, and, as appropriate, to  
            help pupils overcome or manage mental health barriers and  
            succeed in school."  They also noted that mental health  
            challenges disproportionately impact students who face  
            stressors such as violence, trauma, and poverty.  

       Regional K-12 Student Mental Health training.  Since 2011, CalMHSA  
            has funded a Student Mental Health Initiative through the  
            California County Superintendents Educational Services  
            Association.  This project is designed to build capacity and  
            cross-system collaboration to develop and sustain school-based  
            mental health programs addressing prevention and early  
            identification strategies.

       One of the goals of this project is the training of school staff.   








          AB 580 (O'Donnell)                                      Page 5  
          of ?
          
          
            Since 2011 this project has used a train-the-trainer model to  
            provide educators with tools for the early identification and  
            prevention of mental health problems.  Two thousand trainings  
            have been conducted, with over 140,000 participants.  The  
            estimated total reach of this project is two million students,  
            or one third of the state's enrollment.  

       The major program topics were school climate and culture, bullying  
            prevention, mental health and wellness, youth development.  
            Participants included school staff, students, parents, mental  
            health staff and providers, community organizations, and law  
            enforcement.  According to evaluation responses, these  
            trainings have significantly increased educators' awareness of  
            mental health issues and knowledge of referral processes.   
            California County Superintendents Educational Services  
            Association (CCSESA) estimates that this program cost an  
            average of $2.25 per student per year.  Since 2014 this  
            project has declined significantly in size as a result of  
            decreased funding.
       
       California Department of Education's training project.  California  
            Mental Health Services Act (CalMHSA) has also funded mental  
            health training through the California Department of Education  
            (CDE), Training Educators through Recognition and  
            Identification Strategies (TETRIS), Eliminating Barriers to  
            Learning (EBL) project.  This statewide K-12 Mental Health  
            Program promotes school and student wellness and academic  
            achievement by increasing capacity for all school and  
            administrative staff to identify students who are experiencing  
            mental health issues early on.  To accomplish this goal, the  
            CDE subcontracted with the Placer County Office of Education  
            to deliver 11 TETRIS EBL workshops annually through 2019.  The  
            curriculum used for the TETRIS EBL workshops was developed by  
            the United States Department of Health and Human Services'  
            Substance Abuse and Mental Health Services Administration  
            (SAMHSA).  Kognito Interactive Online Simulation Program is  
            also used as an outside source to help support school staff in  
            initiating conversations with students around the subject of  
            mental health and suicidal ideation.

       SAMHSA "Now is the Time" pilot projects.  Following the school  
            shooting at Sandy Hook Elementary in Connecticut in December  
            2012, President Obama established a grant program to increase  
            students' access to mental health services.  California  








          AB 580 (O'Donnell)                                      Page 6  
          of ?
          
          
            received $9.7 million from the "Now is the Time Project  
            Advancing Wellness and Resilience in Education" (NITT AWARE)  
            grant last fall.  According to the CDE, the grant has two  
            components.  Three local educational agencies (LEAs), Garden  
            Grove Unified School District, Santa Rosa City Schools, and  
            the San Diego County Office of Education, were selected to  
            participate in the first component of the grant.  The LEAs  
            will establish a process for referring and connecting children  
            to mental health services.  If successful, the models  
            developed by these LEAs can be shared statewide.  The second  
            component utilizes a training program called Youth Mental  
            Health First Aid.  The training teaches school staff how to  
            help youth experiencing mental health or addictions  
            challenges, or are in crisis. 

       4)Audit request.  Senator Beall requested an audit of mental health  
            services for students, which was approved by the Joint  
            Legislative Audit Committee on April 22, 2015.  The request  
            asks for the audit to, among other things:

          a)   Provide the following information for pre- and post- AB 114  
               disaggregated by students for whom an individualized  
               education plan (IEP) identifies them as emotionally  
               disturbed, for students whose IEP may also call for mental  
               health services, and for students who qualify or do not  
               qualify for Med-Cal services:

               i)     Compare the number of students each special  
                 education local plan area (SELPA) served under AB 3632 to  
                 the number served under AB 114.

               ii)    Determine whether the type of frequency of service,  
                 and the providers of services, changed under the  
                 transition from AB 3632 to AB 114.

               iii)   For a selection of students served under AB 3632,  
                 determine whether their individualized education plans  
                 (IEP) were changed during the special education local  
                 plan areas (SELPA) transition to AB 114.

          a)   Determine whether changes in treatment were made by service  
               providers as a result of the transition from AB 3632 to AB  
               114.









          AB 580 (O'Donnell)                                      Page 7  
          of ?
          
          
          b)   Identify the state and federal funding sources for mental  
               health services for students with disabilities, for the  
               past five fiscal years.

          c)   Identify the number of students with mental health issues  
               in California and compare that to the number of students  
               actually receiving services.
          
       1)Fiscal impact.  According to the Assembly Appropriations  
            Committee, this bill would result in one-time costs in the  
            range of $135,000 to $145,000 for the California Department of  
            Education (CDE) to develop model referral protocols for  
            addressing student mental health concerns.  

       2)Related legislation.  AB 104 (Committee on Budget, Ch. 13, 2015)  
            appropriates $10 million to the Superintendent of Public  
            Instruction to provide technical assistance and develop  
            statewide resources to assist local educational agencies to  
            establish and align systems of learning and behavioral  
            supports.

       AB 1133 (Achadjian, 2015 ) establishes a four year pilot program,  
            the School-Based Early Mental Health Intervention and  
            Prevention Services Support Program to provide outreach, free  
            regional training, and technical assistance for local  
            educational agencies in providing mental health services at  
            school sites.  AB 1133 was held on the Assembly Appropriations  
            Committee's suspense file.

       AB 1018 (Cooper, 2015) requires the CDE and the Department of  
            Health Care Services (DHCS) to convene a task force to examine  
            the delivery of mental health services through the Early and  
            Periodic Screening, Diagnosis, and Treatment services.  AB  
            1018 is pending in the Senate Health Committee.

       AB 1299 (Ridley-Thomas, 2015) requires the California Health and  
            Human Services Agency to coordinate with DHCS and the  
            Department of Social Services to facilitate the receipt of  
            medically necessary specialty mental health services by foster  
            youth.  AB 1299 is pending in the Senate Human Services  
            Committee.

          SUPPORT
          








          AB 580 (O'Donnell)                                      Page 8  
          of ?
          
          
          California Association of School Counselors
          California Medical Association
          California School Nurses Organization
          Mental Health America of California
          Santa Clara County Office of Education

          OPPOSITION
           
           None received.
                                      -- END --