BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: AB 580 --------------------------------------------------------------- |AUTHOR: |O'Donnell | |---------------+-----------------------------------------------| |VERSION: |June 24, 2015 | --------------------------------------------------------------- --------------------------------------------------------------- |HEARING DATE: |July 8, 2015 | | | --------------------------------------------------------------- --------------------------------------------------------------- |CONSULTANT: |Reyes Diaz | --------------------------------------------------------------- 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 AB 580 (O'Donnell) Page 2 of ? 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 AB 580 (O'Donnell) Page 3 of ? 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 : ----------------------------------------------------------------- |Assembly Floor: |77 - 0 | |------------------------------------+----------------------------| |Assembly Appropriations Committee: |15 - 0 | |------------------------------------+----------------------------| |Assembly Education Committee: |6 - 0 | | | | ----------------------------------------------------------------- COMMENTS : 1)Author's statement. According to the author, numerous studies point to a strong connection between mental wellness and AB 580 (O'Donnell) Page 4 of ? 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 AB 580 (O'Donnell) Page 5 of ? 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 AB 580 (O'Donnell) Page 6 of ? 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 AB 580 (O'Donnell) Page 7 of ? 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 AB 580 (O'Donnell) Page 8 of ? 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. -- END --