BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    AB 580    
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          |AUTHOR:        |O'Donnell                                      |
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          |VERSION:       |June 24, 2015                                  |
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          |HEARING DATE:  |July 8, 2015   |               |               |
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          |CONSULTANT:    |Reyes Diaz                                     |
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           SUBJECT  :  Pupil mental health: model referral protocols.

           SUMMARY  :  Requires the Department of Education (CDE), upon receiving  
          funding, to develop model referral protocols, as specified, for  
          addressing pupil mental health concerns. Specifies that the  
          protocols are to be used on a voluntary basis by specified  
          educational institutions. Requires CDE to post the protocols on  
          its Internet Web site.

          Existing federal law:
          1)Establishes the Individuals with Disabilities Education Act,  
            which provides that students with exceptional needs, who are  
            identified as having emotional disturbance, may be eligible to  
            receive mental health (MH) services, including counseling,  
            psychological services, parent counseling and training, and  
            residential placement.
              
          2)Specifies that schools have the responsibility for  
            educationally related MH services. 
             
          3)Requires local educational agencies (LEAs) to update the  
            Individualized Education Plan (IEP) of each child that will  
            experience a change in services.

          4)Requires the provision of a free, appropriate public education  
            to all disabled students in the least restrictive environment.

          Existing state law: 
          1)Establishes school districts as the responsible agency for MH  
            services for students with IEPs.  

          2)Requires all services identified in a student's IEP to be  
            provided, whether directly by LEA employees or through  







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            contract with outside providers, such as county MH agencies.   
            Requires LEAs to ensure services are provided to students  
            regardless of who provides or pays for those services.  
          
          This bill:
          1)Requires CDE to develop model referral protocols for  
            addressing pupil MH concerns, and to consult with the  
            following:

                  a)        The Student MH Policy Workgroup;
                  b)        LEAs that have served as state or regional  
                    leaders in state or federal pupil MH initiatives;
                  c)        County MH programs;
                  d)        Current classroom teachers and administrators;
                  e)        Current schoolsite classified staff;
                  f)        Current schoolsite staff who hold pupil  
                    personnel services credentials;
                  g)        Current school nurses; and,
                  h)        Current school counselors.
                  i)        Other professionals involved in pupil MH as  
                    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, state special schools for the  
            blind and deaf; teacher, administrator, school counselor,  
            pupil personnel services; and, school nurse preparation  
            programs operated by institutions of higher learning.

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

                  a)        Address the appropriate and timely referral by  
                    school staff of pupils with MH concerns;
                  b)        Reflect a multitiered system of support  
                    processes and positive behavioral interventions and  
                    supports;
                  c)        Be adaptable to varied local service  
                    arrangements for MH services;
                  d)        Reflect evidence-based and culturally  
                    appropriate approaches to pupil MH 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  








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                    pupils 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. Specifies the provisions in  
                    this bill do not authorize or encourage school  
                    employees to diagnose or treat MH illness unless they  
                    are specifically licensed and employed to do so; and,
                  i)        Be consistent with state activities conducted  
                    by CDE in the administration of federally funded MH  
                    programs.

          4)Requires CDE to post the protocols on its Internet Web site  
            for access by schools and institutions of higher learning.

          5)Specifies that the provisions in this bill are contingent upon  
            funds being appropriated to CDE in the annual Budget Act or  
            other legislation, or state, federal, or private funds being  
            allocated for this purpose.

          6)Requires the protocols to be completed and made available  
            within two years of the date funds are received or allocated  
            to implement the provisions in this bill.

           FISCAL  
          EFFECT  :  According to the Assembly Appropriations Committee,  
          this bill has one-time costs in the range of $135,000 to  
          $145,000 for CDE and a designated county office of education to  
          jointly develop a model referral protocol for addressing pupil  
          MH concerns.
           PRIOR  
          VOTES  :  
          
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          |Assembly Floor:                     |77 - 0                      |
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          |Assembly Appropriations Committee:  |15 - 0                      |
          |------------------------------------+----------------------------|
          |Assembly Education Committee:       |6 - 0                       |
          |                                    |                            |
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          COMMENTS  :
          1)Author's statement. According to the author, numerous studies  
            point to a strong connection between mental wellness and  








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            academic achievement, behavior in school, and attendance.  
            Research indicates that while 20% of children have MH issues,  
            80% of those issues are undiagnosed and untreated, and that MH  
            challenges disproportionately impact students who face  
            stressors, such as violence, trauma, and poverty. In spite of  
            the significant impact of MH on academic and life outcomes,  
            many schools lack the information they need to make  
            appropriate and timely referrals for MH concerns. CDE has  
            identified inadequate identification and service referral, as  
            well as inconsistent student MH policies, as major factors  
            contributing to this problem. Currently, there is no state  
            guidance on best practices for student MH referral. This bill  
            provides schools a vital tool for addressing the needs of  
            their students by requiring CDE to develop evidence-based  
            model referral protocols for student MH concerns, for  
            voluntary use by schools. These protocols would be adaptable  
            to varied service arrangements and culturally appropriate, and  
            would in no way authorize school staff to diagnose or treat MH  
            conditions. 
            
          2)Background. Current law is silent on how school employees  
            should refer students for MH assessments and services.  
            Teachers are specifically authorized to make a referral for  
            assessment for special education and related services, but MH  
            needs may not necessitate special education. It is likely that  
            employees notify the school or school district counselor,  
            psychologist, or nurse of students' MH concerns. The state is  
            currently engaged in a number of initiatives aimed at  
            improving support for student MH needs, such as:

               a)     Student Mental Health Policy Workgroup.  In 2012,  
                 the Superintendent of Public Instruction and the  
                 California Mental Health Services Authority (CalMHSA)  
                 convened a Student Mental Health Policy Workgroup to  
                 develop policy recommendations that promote early  
                 identification, referral, coordination, and access to  
                 quality MH 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 MH  
                 professionals.  

               b)     Regional K-12 Student Mental Health training.  Since  
                 2011, CalMHSA has funded a Student Mental Health  
                 Initiative through the California County Superintendents  








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                 Educational Services Association. This project is  
                 designed to build capacity and cross-system collaboration  
                 to develop and sustain school-based MH programs  
                 addressing prevention and early identification  
                 strategies. One of the goals of this project is the  
                 training of school staff. Since 2011, this project has  
                 used a train-the-trainer model to provide educators with  
                 tools for the early identification and prevention of MH  
                 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. According to evaluation  
                 responses, these trainings have significantly increased  
                 educators' awareness of MH issues and knowledge of  
                 referral processes. The California County Superintendents  
                 Educational Services Association estimates that this  
                 program costs an average of $2.25 per student per year.  
                 Since 2014, this project has declined significantly in  
                 size as a result of decreased funding.

               c)     CDE training project. CalMHSA has also funded MH  
                 training through the 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 MH issues early  
                 on. 

               d)     Federal "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 MH  
                 services. California received $9.7 million from the "Now  
                 is the Time Project Advancing Wellness and Resilience in  
                 Education" grant last fall. Three 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 MH services. If successful, the models  
                 developed by these LEAs can be shared statewide. Another  
                 component of the grant utilizes a training program called  
                 Youth Mental Health First Aid. The training teaches  








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                 school staff how to help youth experiencing MH or  
                 substance abuse challenges, or who are in crisis. 

          3)Audit request. Senator Beall requested an audit of MH services  
            for students, which was approved by the Joint Legislative  
            Audit Committee on April 22, 2015. The audit request covers MH  
            services more broadly than EPSDT services. Specifically, the  
            request asks for the audit to, among other things:

               a)     Provide the following information for pre- and  
                 post-AB 114 (Committee on Budget, Chapter 43, Statutes of  
                 2011) disaggregated by students for whom an IEP  
                 identifies them as emotionally disturbed, for students  
                 whose IEP may also call for MH services, and for students  
                 who qualify or do not quality 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; and,

                     iii.        For a selection of students served under  
                      AB 3632, determine whether their IEPs were changed  
                      during the SELPA's transition to AB 114.

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

               c)     Identify the state and federal funding sources for  
                 MH services for students with disabilities for the past  
                 five fiscal years.

               d)     Identify the number of students with MH issues in  
                 California and compare that to the number of students  
                 actually receiving services.

          4)Double referral. This bill was heard in the Senate Education  
            Committee and passed out on a 7-0 vote.

          5)Related legislation. AB 104 (Committee on Budget, Chapter 13,  
            Statutes of 2015) appropriates $10 million to the  








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            Superintendent of Public Instruction to provide technical  
            assistance and develop statewide resources to assist LEAs to  
            establish and align systems of learning and behavioral  
            supports.


            AB 1018 (Cooper), requires the CDE and the Department of  
            Health Care Services (DHCS) to convene a task force to examine  
            the delivery of MH services through the Early and Periodic  
            Screening, Diagnosis, and Treatment (EPSDT) services. AB 1018  
            was heard in the Senate Health Committee on July 1, 2015, and  
            passed out on a 7-0 vote.

            AB 1025 (Thurmond), requires the CDE to establish additional  
            pilot programs to encourage inclusive practices that integrate  
            MH, special education, and school climate interventions  
            following a multi-tiered framework. AB 1025 is set for hearing  
            in the Senate Education Committee on July 8, 2015. 


            AB 1133 (Achadjian), 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 MH services at school sites.  
            AB 1133 was held on the Assembly Appropriations Committee's  
            suspense file.

            AB 1299 (Ridley-Thomas), 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 MH services by foster youth. AB  
            1299 is set for hearing in the Senate Human Services Committee  
            on July 14, 2015.

          6)Prior legislation. AB 2212 (Gray, 2014), required DHCS to  
            allow county MH plans to contract with LEAs to provide EPSDT  
            services. AB 2212 was held on the Assembly Appropriations  
            Committee's suspense file.

            AB 114 shifted responsibility for MH services for students  
            from counties to LEAs. 

          7)Support.  Supporters argue that the protocols required in this  
            bill will greatly assist in addressing the MH and academic  








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            needs of students, as educators and school counselors  
            sometimes express feeling unprepared to address pupil MH  
            challenges. 

           SUPPORT AND OPPOSITION  :
          Support:  California Association of School Counselors
                    California Medical Association 
                    California School Employees Association
                    California School Nurses Organization
                    Mental Health America of California
                    Santa Clara County Office of Education
          
          Oppose:   None received.
          


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