California Legislature—2015–16 Regular Session

Assembly BillNo. 1644

Introduced by Assembly Member Bonta

January 11, 2016

An act to amend Section 4372 of, and to add and repeal Chapter 4 (commencing with Section 4391) of Part 4 of Division 4 of, the Welfare and Institutions Code, relating to mental health.


AB 1644, as introduced, Bonta. School-based early mental health intervention and prevention services.

Existing law, the School-based Early Mental Health Intervention and Prevention Services for Children Act of 1991, authorizes the Director of Health Care Services, in consultation with the Superintendent of Public Instruction, to provide matching grants to local educational agencies to pay the state share of the costs of providing school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, subject to the availability of funding each year. Existing law defines “eligible pupil” for this purpose as a pupil who attends a publicly funded elementary school and who is in kindergarten or grades 1 to 3, inclusive. Existing law also defines “local educational agency” as a school district or county office of education or a state special school.

This bill would expand the definition of an eligible pupil to include a pupil who attends a preschool program at a publicly funded elementary school and a pupil who is in transitional kindergarten, thereby extending the application of the act to those persons. The bill would also include charter schools in the definition of local educational agency, thereby extending the application of the act to those entities. The bill would require the State Public Health Officer, in consultation with the Superintendent of Public Schools and the Director of Health Care Services, to establish a 4-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 schoolsites. The bill would require the State Department of Public Health to submit specified reports after 2 and 4 years. The bill would repeal these provisions as of January 1, 2022.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1


The Legislature finds and declares all of the

3(a) California’s communities and systems are currently facing
4challenges to prevent and address the far-reaching impacts of
5childhood adversity, such as Adverse Childhood Experiences
6(ACEs) and childhood trauma, which can result in negative
7educational, health, social, and economic outcomes for children,
8youth, families, and communities across the state.

9(b) ACEs are traumatic experiences that can have a profound
10impact on a child’s developing brain and body and lasting impacts
11on a person’s health and livelihood across their lifetime. ACEs
12include physical, emotional, and sexual abuse; physical and
13emotional neglect; and household dysfunction, such as substance
14abuse by a household member; and witnessing domestic violence.
15Other traumatic experiences can include placement instability for
16foster youth, homelessness, and witnessing violence against family
17and community members.

18(c) In California, 61.7 percent of adults have experienced at
19least one ACE and 16.7 percent have experienced four or more
20ACEs. Compared to an individual who has not experienced an
21ACE, an individual with four or more ACEs is more likely to
22experience chronic disease and engage in negative health behaviors.
23For example, based on results of the California Behavioral Risk
24Factor Surveillance Survey, a person in California with four or
25more ACEs is 1.6 times as likely to have diabetes, 1.9 times as
26likely to have cancer, 2.4 times as likely to suffer from chronic
P3    1obstructive pulmonary disease, 2.9 times as likely to smoke, 4.2
2times as likely to be diagnosed with Alzheimer’s disease or
3dementia, 5.1 times as likely to suffer from depression, 7.4 times
4as likely to be an alcoholic, and 12.2 times as likely to attempt
5suicide. Individuals are similarly impacted by ACEs, regardless
6of race and ethnicity.

7(d) The State of California has long recognized the mental health
8needs of California’s children and the value of addressing these
9needs by supporting the provision of evidence-based mental health
10services in publicly funded preschools and elementary schools, as
11evidenced by the creation in 1981 of the Primary Prevention
12Project, now named the Primary Intervention Program, and the
13creation in 1991 of the School-based Early Mental Health
14Intervention and Prevention Services for Children Program, known
15as the Early Mental Health Initiative (EMHI).

16(e) From the 1992-93 fiscal year to the 2011-12 fiscal year,
17inclusive, the State Department of Mental Health awarded funds
18each year in matching grants to local educational agencies to fund
19prevention and early intervention programs, including the Primary
20Intervention Program, for students experiencing mild to moderate
21school adjustment difficulty through the EMHI. In the 2011-12
22fiscal year, the EMHI received $15 million in state funds.

23(f) School adjustment difficulties that can impede learning, such
24as anxiety, withdrawal, and aggressive behaviors, are common
25symptoms of chronic or traumatic stress resulting from exposure
26to ACEs and childhood trauma.

27(g) Authorizing legislation specified that the EMHI would be
28deemed successful if at least 75 percent of the children who
29complete the program show an improvement in at least one of the
30following four areas: learning behaviors, attendance, school
31adjustment, and school-related competencies.

32(h) The EMHI succeeded in meeting these legislative
33requirements. According to the 2010-2011 Early Mental Health
34Initiative Statewide Evaluation Report, of the 15,823 students
35located in 424 elementary schools across 66 school districts
36participating in EMHI-funded services during the 2010-11 school
37year, 79 percent exhibited positive social competence and school
38adjustment behaviors more frequently after completing services.
39Furthermore, the magnitude of the improvements was exceptional
40in comparison to evaluations of other programs, especially given
P4    1the short-term and cost-effective nature of the intervention, and
2improvements were evident across all demographic subgroups.

3(i) The 2010-2011 Early Mental Health Initiative Statewide
4Evaluation Report described an unmet demand for EMHI-funded
5services at participating schoolsites, as only 37 percent of the
6students that scored in the appropriate school adjustment difficulty
7range were served with EMHI-funded services due to program
8capacity and funding constraints. Based on demographic
9considerations, similar demand would be expected at schools that
10did not receive EMHI grants.

11(j) The Governor’s realignment for the 2011-12 fiscal year
12renamed the State Department of Mental Health as the State
13Department of State Hospitals and limited that department’s
14mission. The Budget Act of 2012 disbursed Proposition 98 funds,
15which had been used to fund the EMHI, directly to local
16educational agencies in order to provide local schools with
17enhanced flexibility to manage their finances and give greater
18control of local decisions.

19(k) It is in the interest of California’s children, families, schools,
20and communities that the State of California support local decisions
21to provide funding for evidence-based services to address the
22mental health needs of children who have been exposed to
23childhood adversity in publicly funded preschools and elementary

25(l) In addressing these needs, priority should be given to
26children, youth, and communities that experience childhood
27adversity, more severely and profoundly, including those that
28experience socioeconomic disadvantage and historical and
29contemporary injustices, vulnerable communities, communities
30of color, and culturally, linguistically, and geographically isolated

32(m) Multitiered systems and supports, which integrate mental
33health, special education, and school climate interventions, have
34been developed as a model framework within which to implement
35these services. Pilot programs in the Counties of San Bernardino
36and Alameda are demonstrating that implementing these services
37as part of a multitiered system is cost effective because the cost
38of the services is more than fully offset by the reduction in the
39need for high-cost, nonpublic school placements.

P5    1(n) The evidence-based, cost-effective services provided by the
2EMHI support the “Triple Aim” of better health, better care, and
3lower costs. By helping children early on, evidence-based,
4cost-effective services also support the recommendations of the
5Let’s Get Healthy California Task Force, which used the “Triple
6Aim” as its foundation and articulated Healthy Beginnings: Laying
7the Foundation for a Healthy Life, as a goal that includes reducing
8childhood trauma, improving early learning, and improving mental
9health and well-being as priorities.

10(o) Providing early mental health service for children exposed
11to childhood adversity, such as ACEs and childhood trauma,
12additionally furthers the goal of the California Defending
13Childhood State Policy Initiative, which is to more effectively
14align, integrate, and mobilize multisectoral resources to equitably
15prevent, identify, and heal the impacts of violence and trauma on
16children and youth.


SEC. 2.  

Section 4372 of the Welfare and Institutions Code is
18amended to read:



For the purposes of this part, the following definitions
20shall apply:

21(a) “Cooperating entity” meansbegin delete anyend deletebegin insert aend insert federal, state, or local,
22public or private nonprofit agency providing school-based early
23mental health intervention and prevention services that agrees to
24offer services at a schoolsite through a program assisted under this

26(b) “Eligible pupil” means a pupil who attends abegin insert preschool
27program at aend insert
publicly funded elementarybegin insert school, or who attends
28a publicly funded elementaryend insert
school and who is inbegin delete kindergartenend delete
29begin insert kindergarten, transitional kindergarten,end insert or grades 1 to 3, inclusive.

30(c) “Local educational agency” means any school district or
31county office of education,begin delete orend delete state specialbegin insert school, or charterend insert
32 school.

begin insert

33(d) “Department” means the State Department of Public Health.

end insert
begin delete


end delete

35begin insert(e)end insert “Director” means the Statebegin delete Director of Mental Health.end deletebegin insert Public
36Health end insert
begin insertOfficer.end insert

begin delete


end delete

38begin insert(f)end insert “Supportive service” means a service that will enhance the
39mental health andbegin delete socialend deletebegin insert social-emotionalend insert development of children.

P6    1

SEC. 3.  

Chapter 4 (commencing with Section 4391) is added
2to Part 4 of Division 4 of the Welfare and Institutions Code, to


5Chapter  4. School-Based Early Mental Health
6Intervention and Prevention Services Support Program




(a) The State Public Health Officer shall establish a
9four-year pilot program, in consultation with the Superintendent
10of Public Instruction and the Director of Health Care Services, to
11encourage and support local decisions to provide funding for the
12eligible support services as provided in this section.

13(b) The department shall provide outreach to local educational
14agencies and county mental health agencies to inform individuals
15responsible for local funding decisions of the program established
16pursuant to this section.

17(c) The department shall provide free regional training on all
18of the following:

19(1) Eligible support services, which may include any or all of
20the following:

21(A) Individual and group intervention and prevention services.

22(B) Parent engagement through conference or training, or both.

23(C) Teacher and staff conferences and training related to meeting
24project goals.

25(D) Referral to outside resources when eligible pupils require
26additional services.

27(E) Use of paraprofessional staff, who are trained and supervised
28by credentialed school psychologists, school counselors, or school
29social workers, to meet with pupils on a short-term weekly basis,
30in a one-on-one setting as in the primary intervention program
31established pursuant to Chapter 4 (commencing with Section 4343)
32of Part 3.

33(F) Any other service or activity that will improve the mental
34health of eligible pupils, particularly evidence-based interventions
35and promising practices intended to mitigate the consequences of
36childhood adversity and cultivate resilience and protective factors.

37(2) The potential for the eligible support services defined in this
38section to help fulfill state priorities described by the local control
39funding formula and local goals described by local control and
40accountability plans.

P7    1(3) How educational, mental health, and other funds subject to
2local control can be used to finance the eligible support services
3defined in this section.

4(4) External resources available to support the eligible support
5services defined in this section, which may include workshops,
6training, conferences, and peer learning networks.

7(5) State resources available to support student mental health
8and resilience, and positive, trauma-informed learning
9environments, which may include any of the following:

10(A) Foundational aspects of learning, childhood social-emotional
11development, mental health and resilience, toxic stress, childhood
12trauma, and Adverse Childhood Experiences.

13(B) Inclusive multitiered systems of behavioral and academic
14supports, Schoolwide Positive Behavior Interventions and Supports,
15restorative justice or restorative practices, trauma-informed
16practices, social and emotional learning, and bullying prevention.

17(d) The department shall provide technical assistance to local
18educational agencies that provide or seek to provide eligible
19services defined in this section. Technical assistance shall include
20assistance in any of the following:

21(1) Designing programs.

22(2) Training program staff in intervention skills.

23(3) Conducting local evaluations.

24(4) Leveraging educational, mental health, and other funds that
25are subject to local control and assisting in budget development.

26(e) In providing outreach pursuant to subdivision (b), training
27pursuant to subdivision (c), and technical assistance pursuant to
28subdivision (d), the department shall select and support schoolsites
29as follows:

30(1) During the first 18 months of the program, the department
31shall support, strengthen, and expand the provision of eligible
32services at schoolsites that previously received funding pursuant
33to the School-Based Early Mental Health Intervention and
34Prevention Services Matching Grant Program (Chapter 2
35(commencing with Section 4380)) and have continued to provide
36eligible support services. In working with these selected
37schoolsites, the department shall develop methods and standards
38for providing services and practices to new schoolsites.

39(2) During the subsequent 18 months of the program, the
40department shall select new schoolsites that are not providing
P8    1eligible support services but that demonstrate the willingness and
2capacity to participate in the program. The department shall work
3with these schoolsites to deliver eligible support services.

4(3) In selecting schoolsites and providing support, the
5department shall prioritize the following:

6(A) Schoolsites in communities that have experienced high
7levels of childhood adversity, such as Adverse Childhood
8Experiences and childhood trauma.

9(B) Schoolsites that prioritize for receipt of services children
10who have been exposed to childhood trauma, including, but not
11limited to, foster youth, as defined in subdivision (b) of Section
1242238.01 of the Education Code, and homeless children and youth,
13as defined in Section 11434a(2) of the federal McKinney-Vento
14Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.)

15(C) Geographic diversity, program effectiveness, program
16efficiency, and long-term program sustainability.

17(f) The department shall submit, in compliance with Section
189795 of the Government Code, an interim report to the Legislature
19at the end of the second year of the pilot program that details the
20department’s work to support the schoolsites selected pursuant to
21paragraph (1) of subdivision (e) and includes an assessment of the
22demand and impact of funding for the School-Based Early Mental
23Health Intervention and Prevention Services Matching Grant
24Program established pursuant to Chapter 3 (commencing with
25Section 4390). The department shall make the report available to
26the public and shall post the report on the its Internet Web site.

27(g) The department shall develop an evaluation plan to assess
28the impact of the pilot program. The department, in compliance
29with Section 9795 of the Government Code, shall submit a report
30to the Legislature at the end of the four-year period evaluating the
31impact of the pilot program and providing recommendations for
32further implementation. The department shall make the report
33available to the public and shall post the report on its Internet Web



This chapter shall remain in effect only until January 1,
362022, and as of that date is repealed, unless a later enacted statute,
37that is enacted before January 1, 2022, deletes or extends that date.