BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 766
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|AUTHOR: |Ridley-Thomas |
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|VERSION: |April 27, 2015 |
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|HEARING DATE: |July 1, 2015 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Public School Health Center Support Program.
SUMMARY : Requires the Department of Public Health to give grant funding
preference, as specified, to schools with a high percentage of
children and youth who receive free or low-cost insurance
through Medi-Cal.
Existing law:
1)Requires the Department of Public Health (DPH) to establish
the Public School Health Center Support Program (PSHCSP), in
collaboration with the Department of Education (CDE), to
perform specified functions relating to the establishment,
retention, or expansion of school-based health centers (SBHCs)
in California.
2)Establishes a grant program administered by DPH to provide
technical assistance and funding to SBHCs, to the extent funds
are appropriated for implementation of the PSHCSP. Provides
for planning, facilities and startup, sustainability, and
technical assistance grants, as specified.
3)Requires grant funding preference to be given to the following
schools:
a) Those located in areas designated as federally
medically underserved areas or in areas with medically
underserved populations;
b) Those with a high percentage of low-income and
uninsured children and youth;
c) Those with large numbers of limited
English-proficient students;
d) Those in areas with a shortage of health
professionals; and,
AB 766 (Ridley-Thomas) Page 2 of ?
e) Those that are low-performing with Academic
Performance Index rankings in the deciles of three and
below of the state.
4)Defines an SBHC, for purposes of the PSHCSP, as a center or
program located at or near a local educational agency that
provides age-appropriate health care services at the program
site or through referrals. Defines a "local educational
agency" as a school, school district, charter school, or
county office of education, as specified.
5)Establishes the Medi-Cal program, administered by Department
of Health Care Services, under which qualified low-income
individuals receive health care services.
This bill: Requires DPH to also give grant funding preference to
schools with a high percentage of children and youth who receive
free or low-cost insurance through Medi-Cal.
FISCAL
EFFECT : According to the Assembly Appropriations Committee,
this bill would have negligible state fiscal effect. The PSHCSP
grant program is currently not funded.
PRIOR
VOTES :
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|Assembly Floor: |79 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Health Committee: |19 - 0 |
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COMMENTS :
1)Author's statement. According to the author, children from
lower socioeconomic backgrounds have poorer health outcomes.
These health disparities are due, in part, to barriers in
accessing medical care and using primary care services. Recent
expansions in insurance coverage under the Affordable Care
Act, Medi-Cal, and Children's Health Insurance Program have
improved access to health care for this population. Yet, even
AB 766 (Ridley-Thomas) Page 3 of ?
with the expansion of health insurance, children from
low-income households are not guaranteed access to health care
services. Low-income children who have insurance through a
public health program still face problems with gaining access
to health care services and finding providers. Low-income
children who have private insurance have problems finding
providers that accept their insurance, and face unaffordable
medical costs. Additionally, some parents feel unwelcome at
medical practices, are unable to take time off work for health
care appointments, or are unable to travel long distances to
seek care for their children. SBHCs provide a health care
delivery model that can help to address some of the barriers
to health care services that insured children from low-income
households face. SBHCs provide improved access to medical care
because they are conveniently located and provide a
patient-friendly environment.
2)SBHCs. According to the National School-Based Health Alliance
(NSBHA), SBHCs 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; dental
screenings; and mental health assessments, crisis
intervention, brief and long-term therapy, and other services.
SBHC staff offer small group and classroom health promotion
and outreach, which help increase the number of students
exposed to programs and activities that discourage potentially
harmful behaviors including alcohol, tobacco, and drug abuse,
and violence and bullying. These programs also serve to help
promote healthy eating and active living. SBHCs work to ensure
that adolescents, a hard-to-reach population, have access to
the services they need to stay on a path to success. SBHCs are
the primary, and occasionally only, available health care for
many children and adolescents who otherwise would have no
access. The NSBHA states that Congress recognized the
importance of SBHCs 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 SBHCs in the ACA.
According to the California School-Based Health Alliance
(CSBHA), 40% of SBHCs are in high schools, 25% are in
elementary schools, 10% are in middle schools, and 25% are
"school-linked" or mobile medical vans. CSBHA states that many
SBHCs are located on school campuses that serve some of the
AB 766 (Ridley-Thomas) Page 4 of ?
state's most vulnerable children, with about 70% of students
receiving free or reduced-price meals. SBHCs 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 various sources, including
grants from state, local, and private sources; reimbursements
from public programs, such as the Child Health and Disability
Prevention Program and Medi-Cal; partnerships with local
community clinics and nonprofits; and fundraising efforts by
their school districts. According to CSBHA, more than half of
SBHCs recover less than 50% of their operating costs from
billing sources, as many of them provide health education,
case management, parent support, and teacher consultation,
much of which is not reimbursable. CSBHA states that research
shows investments in SBHCs generate savings through reduced
high-cost services, reduced inappropriate emergency room use,
and immunization initiatives that prevent disease.
CSBHA believes that schools are a natural place to identify
health problems and offer solutions, as children spend six to
eight hours per day at school, and school-based interventions
eliminate transportation barriers faced by other obesity
prevention programs. CSBHA cites cases in which SBHCs have
implemented strategies, such as reducing television viewing,
increasing physical activity, and increasing fruit and
vegetable intake. Studies showed that school-based nutrition
and fitness programs were generally effective in improving
health behaviors, and one study found that 50% fewer children
in the intervention schools became overweight compared to the
study's control schools. CSBHA found that one such SBHC's
interventions compared favorably with other public health
campaigns, costing less per quality-adjusted life years than
programs such as adult hypertension prevention and adult
diabetes screening.
3)Integrated Student Supports (ISS). In a white paper issued in
February 2014, Child Trends (a national non-profit research
center) looked at the benefits of ISS, which are a
school-based approach to promoting students' academic success
by developing, securing, and coordinating supports that target
academic and non-academic barriers to achievement. To date,
ISS programs have served more than 1.5 million students in
nearly 3,000 schools across the US, and Child Trends estimates
that Hispanic and black students account for more than 75%of
AB 766 (Ridley-Thomas) Page 5 of ?
the students enrolled in ISS programs. Research cited by Child
Trends indicates that the likelihood of academic success,
especially for disadvantaged students, is enhanced by a more
comprehensive set of supports at the individual, family, and
school levels, which implies that providing an array of
academic and non-academic supports in a coordinated fashion is
a more effective strategy than focusing on one or a small set
of supports. Child Trends found that generally the return on
investment for ISS programs ranged from $4 to almost $15 for
every dollar invested, which suggests that the ISS approach
yields a positive return on investment.
4)Related legislation. SB 118 (Liu), renames the PSHCSP the
School-Based Health and Education Partnership Program and
makes changes to the requirements and funding levels. Creates
a new type of grant to fund interventions related to obesity,
asthma, alcohol and substance abuse, and mental health. SB 118
is pending in the Assembly Education Committee.
AB 1025 (Thurmond), would require CDE to establish a
three-year pilot program to encourage inclusive practices that
integrate mental health, special education, and school climate
interventions following a multitiered framework. AB 1025 is
set for hearing in the Senate Education Committee on July 8,
2015.
AB 1133 (Achadjian), would make technical changes to existing
law regarding grants to local educational agencies to pay the
state share of costs of providing school-based early mental
health intervention and prevention services to eligible
students. AB 1133 was held under submission in the Assembly
Appropriations Committee.
5)Prior legislation. SB 1055 (Liu, 2014), was identical to SB
118. SB 1055 died in the Senate Rules Committee.
SB 596 (Yee, 2014), would have required CDE to establish a
three-year pilot program in four schools to provide
school-based mental health services that leverage cross-system
resources and offer comprehensive multitiered interventions;
allocated a total of $600,000 in start-up funding to each
school selected to participate in the program; and required
CDE to submit a report to the Legislature evaluating the
success of the program. SB 596 was held at the Assembly Desk.
AB 766 (Ridley-Thomas) Page 6 of ?
AB 1955 (Pan, 2014), would have required the SPI to establish
the Healthy Kids, Healthy Minds Demonstration, which would
provide grants to local educational agencies for the purpose
of employing one full-time school nurse and one full-time
mental health professional, and ensured that the schools'
libraries were open one hour before and three hours after the
regular school day. AB 1955 was held on the Assembly
Appropriations Committee's suspense file.
AB 174 (Bonta, 2013), would have required DPH to establish a
pilot grant program in Alameda County, to the extent that
funding was 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. AB 174 was vetoed by Governor Brown, who stated in his
veto message that, while he supports the efforts of the bill,
Alameda County can establish such a program without state
intervention and may even be able to use existing funds to do
so. In addition, Governor Brown stated that all counties, not
just Alameda, should explore all funding options, including
Mental Health Services Act funds, to tailor programs that best
meet local needs.
AB 1178 (Bocanegra, 2013), would have established the
California Promise Neighborhood Initiative to provide funding
to schools that have formalized partnerships with local
agencies and community organizations to provide a network of
services to improve the health, safety, education, and
economic development of a defined area. AB 1178 failed in the
Assembly Appropriations Committee.
SB 564 (Ridley-Thomas, Chapter 381, Statutes of 2008),
specified that an SBHC may conduct routine physical health,
mental health, and oral health assessments, and provide for
any services not offered onsite or through a referral process.
The bill also required 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 SBHCs,
and the development of new SBHCs, in accordance with specified
procedures.
AB 2560 (Ridley-Thomas, Chapter 334, Statutes of 2006),
required the Department of Health Services (DHS), in
cooperation with CDE, to establish the PSHCSP to perform
AB 766 (Ridley-Thomas) Page 7 of ?
specified functions relating to the establishment, retention,
or expansion of SBHCs; required DHS to establish standardized
data collection procedures and collect specified data from
SBHCs on an ongoing basis; required CDE, in collaboration with
DHS, to coordinate programs within CDE and programs within
other specified departments to support SBHCs and to provide
technical assistance to facilitate and encourage the
establishment, retention, and expansion of SBHCs; and required
the program to provide a biennial update to the appropriate
policy and fiscal committees of the Legislature containing
specified information regarding SBHCs, beginning on or before
January 1, 2009.
AB 2105 (Scott, 2000), would have required the Director of
Mental Health, in consultation with the Secretary of Child
Development and Education and the Superintendent of Public
Instruction, to establish a program to award planning grants
to counties for the provision of school-based mental health
services to children, according to specified criteria, and to
the extent funding was made available for that purpose. This
bill would have also required the director to provide a
preliminary report on the program to the Governor, appropriate
policy and fiscal committees of the Legislature, and the
Legislative Analyst on or before January 1, 2003, and to
provide a final report to these entities on or before January
1, 2007. AB 2105 failed in the Assembly Appropriations
Committee.
SB 566 (Escutia, 1999), would have established the SBHC Grant
Program, to be administered by DHS, to provide grants to
qualifying SBHCs 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 SBHCs and incorporate these
centers into a comprehensive and coordinated health care
system. SB 566 was moved to the inactive file on the Senate
Floor.
6)Support. Supporters of the bill, including health and labor
organizations, argue that children from lower socioeconomic
backgrounds have poorer health outcomes, particularly those
from communities of color who may have issues with accessing
care. Supporters further argue that SBHCs provide a health
care delivery model that can help address some of the barriers
AB 766 (Ridley-Thomas) Page 8 of ?
services that insured children from low-income households
face, including services like primary health and mental health
care, substance abuse counseling, case management, dental
health, and nutrition education.
7)Opposition. The California Right to Life Committee, Inc.
(CRLC) argues that this bill continues to promote health
services that include preventive medical services and
reproductive services. Therefore, CRLC opposes any further
expansion of abortion services to children and youth when
using the public's tax dollars.
8)Policy comment. The PSHCSP has existed in statute for eight
years and has never been implemented due to a lack of funding.
This bill does not include provisions to provide for future
funding, so it is unclear what the impact would be.
SUPPORT AND OPPOSITION :
Support: California Black Health Network
California Chapter of the National Association of
Social Workers
California Federation of Teachers
California Pan-Ethnic Health Network
California School Boards Association
California School Employees Association
California State PTA
Planned Parenthood Affiliates of California
Oppose: California Right to Life Committee, Inc.
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