Amended in Assembly April 14, 2016

Amended in Assembly March 8, 2016

California Legislature—2015–16 Regular Session

Assembly BillNo. 1644


Introduced by Assembly Member Bonta

(Principal coauthor: Assembly Member Achadjian)

(Coauthor: Assembly Member McCarty)

(Coauthor: Senator Beall)

January 11, 2016


An act to amend Sections 4370, 4371, 4372, and 4380 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.

LEGISLATIVE COUNSEL’S DIGEST

AB 1644, as amended, 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 (1991 act), 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 rename the 1991 act the Healing from Early Adversity to Level the Impact (HEAL) of Trauma in Schools Act or the HEAL Trauma in Schools Act. The bill would expand the definition of an eligible pupil to include a pupil who attends a preschool program at abegin delete publicly funded elementary schoolend deletebegin insert contracting agency of the California state preschool programend insertbegin insert end insertbegin insertor a local educational agency,end insert 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, the Director of Health Care Services, and the Attorney General to establish a 4-yearbegin delete pilotend delete program, thebegin delete School-Based Early Mental Health Intervention and Prevention Servicesend deletebegin insert HEAL Trauma in Schoolsend insert 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 make the implementation of thebegin delete pilotend delete program contingent upon an appropriation in the annual budget act. 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

SECTION 1.  

The Legislature finds and declares all of the
2following:

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) In California, 61.7 percent of adults have experienced at
10least one ACE and 16.7 percent have experienced four or more
11ACEs. Compared to an individual who has not experienced an
12ACE, an individual with four or more ACEs is more likely to
P3    1experience chronic disease and engage in negative health behaviors.
2For example, based on results of the California Behavioral Risk
3Factor Surveillance Survey, a person in California with four or
4more ACEs is 1.6 times as likely to have diabetes, 1.9 times as
5likely to have cancer, 2.4 times as likely to suffer from chronic
6obstructive pulmonary disease, 2.9 times as likely to smoke, 4.2
7times as likely to be diagnosed with Alzheimer’s disease or
8dementia, 5.1 times as likely to suffer from depression, 7.4 times
9as likely to be an alcoholic, and 12.2 times as likely to attempt
10suicide. Individuals are similarly impacted by ACEs, regardless
11of race and ethnicity.

12(c) From the 1992-93 fiscal year to the 2011-12 fiscal year,
13inclusive, the State Department of Mental Health awarded funds
14each year in matching grants to local educational agencies to fund
15prevention and early intervention programs, including the Primary
16Intervention Program, for students experiencing mild to moderate
17school adjustment difficulty through the School-based Early Mental
18Health Intervention and Prevention Services for Children Program
19of 1991, known as the Early Mental Health Initiative (EMHI). In
20the 2011-12 fiscal year, the EMHI received $15 million in state
21funds.

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

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

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

3(g) The 2010-11 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(h) 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(i) Multitiered systems and supports, which integrate mental
20health, special education, and school climate interventions, have
21been developed as a model framework within which to implement
22these services. Pilot programs in the Counties of San Bernardino
23and Alameda are demonstrating that implementing these services
24as part of a multitiered system is cost effective because the cost
25of the services is more than fully offset by the reduction in the
26need for high-cost, nonpublic school placements.

27(j) The evidence-based, cost-effective services provided by the
28EMHI support the “Triple Aim” of better health, better care, and
29lower costs. By helping children early on, evidence-based,
30cost-effective services also support the recommendations of the
31Let’s Get Healthy California Task Force, which used the “Triple
32Aim” as its foundation and articulated Healthy Beginnings: Laying
33the Foundation for a Healthy Life, as a goal that includes reducing
34childhood trauma, improving early learning, and improving mental
35health and well-being as priorities.

36(k) Providing early mental health service for children exposed
37to childhood adversity, such as ACEs and childhood trauma,
38additionally furthers the goal of the California Defending
39Childhood State Policy Initiative, which is to more effectively
40align, integrate, and mobilize multisectoral resources to equitably
P5    1prevent, identify, and heal the impacts of violence and trauma on
2children and youth.

3

SEC. 2.  

Section 4370 of the Welfare and Institutions Code is
4amended to read:

5

4370.  

Thisbegin delete articleend deletebegin insert partend insert shall be known and may be cited as the
6Healing from Early Adversity to Level the Impact (HEAL) of
7Trauma in Schools Act or the HEAL Trauma in Schools Act.

8

SEC. 3.  

Section 4371 of the Welfare and Institutions Code is
9amended to read:

10

4371.  

The Legislature finds and declares all of the following:

11(a) Each year in California over 65,000 teenagers become
12adolescent mothers and 230 teenagers commit suicide. Each year
13more than 20 percent of California’s teenagers drop out of high
14school.

15(b) Thirty percent of California’s elementary school pupils
16experience school adjustment problems, many of which are evident
17the first four years of school, that is, kindergarten and grades 1 to
183, inclusive.

19(c) Problems that our children experience, whether in school or
20at home, that remain undetected and untreated grow and manifest
21themselves in all areas of their later lives.

22(d) There is a clear relationship between early adjustment
23problems and later adolescent problems, including, but not limited
24to, poor school attendance, low achievement, delinquency, drug
25abuse, and high school dropout rates. In many cases, signs of these
26problems can be detected in the early grades.

27(e) It is in California’s best interest, both in economic and human
28terms, to identify and treat the minor difficulties that our children
29are experiencing before those difficulties become major barriers
30to later success. It is far more humane and cost-effective to make
31a small investment in early mental health intervention and
32prevention services now and avoid larger costs, including, but not
33limited to, foster care, group home placement, intensive special
34education services, mental health treatment, or probation supervised
35care.

36(f) Programs like the Primary Intervention Program and the San
37Diego Unified Counseling Program for Children have proven very
38effective in helping children adjust to the school environment and
39learn more effective coping skills that in turn result in better school
40achievement, increased attendance, and increased self-esteem.

P6    1(g) To create the optimum learning environment for our children,
2schools, teachers, parents, public and private service providers,
3and community-based organizations must enter into locally
4appropriate cooperative agreements to ensure that all pupils will
5receive the benefits of school-based early mental health
6intervention and prevention services that are designed to meet their
7personal, social, and educational needs.

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

17(i) The State of California has long recognized the mental health
18needs of California’s children and the value of addressing these
19needs by supporting the provision of evidence-based mental health
20services in publicly funded preschools and elementary schools, as
21evidenced by the creation in 1981 of the Primary Prevention
22Project, now named the Primary Intervention Program, and the
23creation in 1991 of the School-Based Early Mental Health
24Intervention and Prevention Services for Children Program, known
25as the Early Mental Health Initiative (EMHI).

26(j) It is in the interest of California’s children, families, schools,
27and communities that the State of California support local decisions
28to provide funding for evidence-based services in publicly funded
29preschools and elementary schools to address the mental health
30needs of children who have been exposed to childhood adversity.

31(k) In addressing these needs, priority should be given to
32children, youth, and communities that experience childhood
33adversity more severely and profoundly, including those that
34experience socioeconomic disadvantage and historical and
35contemporary injustices, vulnerable communities, communities
36of color, and culturally, linguistically, and geographically isolated
37communities.

38

SEC. 4.  

Section 4372 of the Welfare and Institutions Code is
39amended to read:

P7    1

4372.  

For the purposes of this part, the following definitions
2shall apply:

3(a) “Cooperating entity” means a federal, state, or local, public
4or private nonprofit agency providing school-based early mental
5health intervention and prevention services that agrees to offer
6services at a schoolsite through a program assisted under this part.

7(b) “Eligible pupil” means a pupil who attends a preschool
8programbegin delete at a publicly funded elementary school,end deletebegin insert at a contracting
9agency of the California state preschool program, as established
10by Article 7 (commencing with Section 8235) of Chapter 2 of Part
116 of Division 1 of Title 1 of the Education Code, or a local
12educational agency,end insert
or who attends a publicly funded elementary
13school and who is in kindergarten, transitional kindergarten, or
14grades 1 to 3, inclusive.

15(c) “Local educational agency” means any school district or
16county office of education, state special school, or charter school.

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

18(e) “Director” means the State Public Health Officer.

19(f) “Supportive service” means a service that will enhance the
20mental health and social-emotional development of children.

21

SEC. 5.  

Section 4380 of the Welfare and Institutions Code is
22amended to read:

23

4380.  

Subject to the availability of funding each year, the
24Legislature authorizes the director, in consultation with the
25Superintendent of Public Instruction, to award matching grants to
26local educational agencies to pay the state share of the costs of
27providing programs that provide school-based early mental health
28intervention and prevention services to eligible pupils at schoolsites
29of eligible pupils, as follows:

30(a) The director shall award matching grants pursuant to this
31chapter to local educational agencies throughout the state.

32(b) Matching grants awarded under this part shall be awarded
33for a period of not more than three years and no single schoolsite
34shall be awarded more than one grant, except for a schoolsite that
35received a grant prior to July 1, 1992.

36(c) The director shall pay to each local educational agency
37having an application approved pursuant to requirements in this
38part the state share of the cost of the activities described in the
39application.

P8    1(d) Commencing July 1, 1993, the state share of matching grants
2shall be a maximum of 50 percent in each of the three years.

3(e) Commencing July 1, 1993, the local share of matching grants
4shall be at least 50 percent, from a combination of school district
5and cooperating entity funds.

6(f) The local share of the matching grant may be in cash or
7payment in-kind.

8(g) Priority shall be given to those applicants that demonstrate
9the following:

10(1) The local educational agency will serve the greatest number
11of eligible pupils from low-income families.

12(2) The local educational agency will provide a strong parental
13involvement component.

14(3) The local educational agency will provide supportive services
15with one or more cooperating entities.

16(4) The local educational agency will provide services at a low
17cost per child served in the project.

18(5) The local educational agency will provide programs and
19services that are based on adoption or modification, or both, of
20existing programs that have been shown to be effective.

21(6) The local educational agency will provide services to
22children who are in out-of-home placement or who are at risk of
23being in out-of-home placement.

24(7) The local educational agencybegin delete shallend deletebegin insert willend insert prioritize for receipt
25of services children who have been exposed to childhood trauma,
26including, but not limited to, foster youth, as defined in subdivision
27(b) of Section 42238.01 of the Education Code, and homeless
28children and youth, as defined in Section 11434a(2) of the federal
29McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301
30et seq.).

31(h) Eligible supportive services may include the following:

32(1) Individual and group intervention and prevention services.

33(2) Parent involvement through conferences or training, or both.

34(3) Teacher and staff conferences and training related to meeting
35project goals.

36(4) Referral to outside resources when eligible pupils require
37additional services.

38(5) Use of paraprofessional staff, who are trained and supervised
39by credentialed school psychologists, school counselors, or school
40social workers, to meet with pupils on a short-term weekly basis,
P9    1in a one-on-one setting as in the primary intervention program
2established pursuant to Chapter 4 (commencing with Section 4343)
3of Part 3. begin delete A minimum of 80 percent of the grants awarded by the
4director shall include the basic components of the primary
5intervention program.end delete

6(6) Any other service or activity that will improve the mental
7health of eligible pupils, particularly evidence-based interventions
8and promising practices intended to mitigate the consequences of
9childhood adversity and cultivate resilience and protective factors.

10Prior to participation by an eligible pupil in either individual or
11group services, consent of a parent or guardian shall be obtained.

12(i) Each local educational agency seeking a grant under this
13chapter shall submit an application to the director at the time, in
14a manner, and accompanied by any information the director may
15reasonably require.

16(j) Each matching grant application submitted shall include all
17of the following:

18(1) Documentation of need for the school-based early mental
19health intervention and prevention services.

20(2) A description of the school-based early mental health
21intervention and prevention services expected to be provided at
22the schoolsite.

23(3) A statement of program goals.

24(4) A list of cooperating entities that will participate in the
25provision of services. A letter from each cooperating entity
26confirming its participation in the provision of services shall be
27included with the list. At least one letter shall be from a cooperating
28entity confirming that it will agree to screen referrals of low-income
29children the program has determined may be in need of mental
30health treatment services and that, if the cooperating entity
31determines that the child is in need of those services and if the
32cooperating entity determines that according to its priority process
33the child is eligible to be served by it, the cooperating entity will
34agree to provide those mental health treatment services.

35(5) A detailed budget and budget narrative.

36(6) A description of the proposed plan for parent involvement
37in the program.

38(7) A description of the population anticipated to be served,
39including number of pupils to be served and socioeconomic
40indicators of sites to receive funds.

P10   1(8) A description of the matching funds from a combination of
2local education agencies and cooperating entities.

3(9) A plan describing how the proposed school-based early
4mental health intervention and prevention services program will
5be continued after the matching grant has expired.

6(10) Assurance that grants would supplement and not supplant
7existing local resources provided for early mental health
8intervention and prevention services.

9(11) A description of an evaluation plan that includes
10quantitative and qualitative measures of school and pupil
11characteristics, and a comparison of children’s adjustment to
12school.

13(k) Matching grants awarded pursuant to this article may be
14used for salaries of staff responsible for implementing the
15school-based early mental health intervention and prevention
16services program, equipment and supplies, training, and insurance.

17(l) Salaries of administrative staff and other administrative costs
18associated with providing services shall be limited to 5 percent of
19the state share of assistance provided under this section.

20(m) No more than 10 percent of each matching grant awarded
21pursuant to this article may be used for matching grant evaluation.

22(n) No more than 10 percent of the moneys allocated to the
23director pursuant to this chapter may be utilized for program
24administration and evaluation.

25Program administration shall include both state staff and field
26staff who are familiar with and have successfully implemented
27school-based early mental health intervention and prevention
28services. Field staff may be contracted with by local school districts
29or community mental health programs. Field staff shall provide
30support in the timely and effective implementation of school-based
31early mental health intervention and prevention services. Reviews
32of each project shall be conducted at least once during the first
33 year of funding.

34(o) Subject to the approval of the director, at the end of the fiscal
35year, a school district may apply unexpended funds to the budget
36for the subsequent funding year.

37(p) Contracts for the program and administration, or ancillary
38services in support of the program, shall be exempt from the
39requirements of the Public Contract Code and the State
P11   1Administrative Manual, and from approval by the Department of
2General Services.

3

SEC. 6.  

Chapter 4 (commencing with Section 4391) is added
4to Part 4 of Division 4 of the Welfare and Institutions Code, to
5read:

6 

7Chapter  4. begin deleteSchool-Based Early Mental Health
8Intervention and Prevention Services end delete
begin insertHEAL Trauma in
9Schoolsend insert
Support Program
10

 

11

4391.  

(a) The director shall establish a four-yearbegin delete pilotend delete program,
12in consultation with the Superintendent of Public Instruction, the
13Director of Health Care Services, and the Attorney General to
14encourage and support local decisions to provide funding for the
15eligible support services as provided in this section.

16(b) The department shall provide outreach to local educational
17agencies and county mental health agencies to inform individuals
18responsible for local funding decisions of the program established
19pursuant to this section.

20(c) The department shall provide free regional training on all
21of the following:

22(1) Eligible support services, which may include any or all of
23the following:

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

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

26(C) Teacher and staff conferences and training related to meeting
27project goals.

28(D) Referral to outside resources when eligible pupils require
29additional services.

30(E) Use of paraprofessional staff, who are trained and supervised
31by credentialed school psychologists, school counselors, or school
32social workers, to meet with pupils on a short-term weekly basis,
33in a one-on-one setting as in the primary intervention program
34established pursuant to Chapter 4 (commencing with Section 4343)
35of Part 3.

36(F) Any other service or activity that will improve the mental
37health of eligible pupils, particularly evidence-based interventions
38and promising practices intended to mitigate the consequences of
39childhood adversity and cultivate resilience and protective factors.

P12   1(2) The potential for the eligible support services defined in this
2section to help fulfill state priorities described by the local control
3funding formula and local goals described by local control and
4accountability plans.

5(3) How educational, mental health, and other funds subject to
6local control can be used to finance the eligible support services
7defined in this section.

8(4) External resources available to support the eligible support
9services defined in this section, which may include workshops,
10training, conferences, and peer learning networks.

11(5) State resources available to support student mental health
12and resilience, and positive, trauma-informed learning
13environments, which may include any of the following:

14(A) Foundational aspects of learning, childhood social-emotional
15development, mental health and resilience, toxic stress, childhood
16trauma, and Adverse Childhood Experiences.

17(B) Inclusive multitiered systems of behavioral and academic
18supports, Schoolwide Positive Behavior Interventions and Supports,
19restorative justice or restorative practices, trauma-informed
20practices, social and emotional learning, and bullying prevention.

21(d) The department shall provide technical assistance to local
22educational agencies that provide or seek to provide eligible
23services defined in this section. Technical assistance shall include
24assistance in any of the following:

25(1) Designing programs.

26(2) Training program staff in intervention skills.

27(3) Conducting local evaluations.

28(4) begin deleteCoordination end deletebegin insertCoordinating end insertwith county mental health
29agencies and professionals.

30(5) Leveraging educational, mental health, and other funds that
31are subject to local control and assisting in budget development.

32(e) In providing outreach pursuant to subdivision (b), training
33pursuant to subdivision (c), and technical assistance pursuant to
34subdivision (d), the department shall select and support schoolsites
35as follows:

36(1) (A) During the first 12 months of the program, the
37 department shall support, strengthen, and expand the provision of
38eligible services at schoolsites that previously received funding
39pursuant to thebegin delete HEAL Trauma in Schools Act (Chapter 2
40(commencing with Section 4380))end delete
begin insert formerend insertbegin insert School-Based Early
P13   1Mental Health Intervention and Prevention Services Matching
2Grant Programend insert
and have continued to provide eligible support
3services. In working with these selected schoolsites, the department
4shall develop methods and standards for providing services and
5practices to new schoolsites.

6(B) The department shall develop a process to identify
7schoolsites that demonstrate the willingness and capacity to
8participate in the program.

9(2) During the subsequent 36 months of the program, the
10department shall select new schoolsites that are not providing
11eligible support services but that demonstrate the willingness and
12capacity to participate in the program. The department shall work
13with these schoolsites to deliver eligible support services.

14(3) In selecting schoolsites and providing support, the
15department shall prioritize the following:

16(A) Schoolsites in communities that have experienced high
17levels of childhood adversity, such as Adverse Childhood
18Experiences and childhood trauma.

19(B) Schoolsites that prioritize for receipt of services children
20who have been exposed to childhood trauma, including, but not
21limited to, foster youth, as defined in subdivision (b) of Section
2242238.01 of the Education Code, and homeless children and youth,
23as defined in Section 11434a(2) of the federal McKinney-Vento
24Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.)

25(C) Geographic diversity, program effectiveness, program
26efficiency, and long-term program sustainability.

27(f) The department shall submit, in compliance with Section
289795 of the Government Code, an interim report to the Legislature
29at the end of the second year of thebegin delete pilotend delete program that details the
30department’s work to support the schoolsites selected pursuant to
31paragraph (1) of subdivision (e) and includes an assessment of the
32demand and impact of funding for the HEAL Trauma in Schools
33Act established pursuant tobegin delete Chapter 3 (commencing with Section
344380).end delete
begin insert this part.end insert The department shall make the report available
35to the public and shall post the report on its Internet Web site.

36(g) The department shall develop an evaluation plan to assess
37the impact of thebegin delete pilotend delete program. The department, in compliance
38with Section 9795 of the Government Code, shall submit a report
39to the Legislature at the end of the four-year period evaluating the
40impact of thebegin delete pilotend delete program and providing recommendations for
P14   1further implementation. The department shall make the report
2available to the public and shall post the report on its Internet Web
3site.

4

4392.  

Implementation of this chapter is contingent upon an
5appropriation in the annual budget act.

6

4393.  

This chapter shall remain in effect only until January 1,
72022, and as of that date is repealed, unless a later enacted statute,
8that is enacted before January 1, 2022, deletes or extends that date.



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