Amended in Assembly May 27, 2016

Amended in Assembly April 14, 2016

Amended in Assembly March 8, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 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 a contracting agency of the California state preschool program or a local educational agency, 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-year program, the HEAL Trauma in Schools 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 the 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:

SECTION 1.  

The Legislature finds and declares all of the
following:

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

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

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

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

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

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

(g) The 2010-11 Early Mental Health Initiative Statewide
Evaluation Report described an unmet demand for EMHI-funded
services at participating schoolsites, as only 37 percent of the
students that scored in the appropriate school adjustment difficulty
range were served with EMHI-funded services due to program
capacity and funding constraints. Based on demographic
considerations, similar demand would be expected at schools that
did not receive EMHI grants.

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

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

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

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

SEC. 2.  

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

4370.  

This part shall be known and may be cited as the Healing
from Early Adversity to Level the Impact (HEAL) of Trauma in
Schools Act or the HEAL Trauma in Schools Act.

SEC. 3.  

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

4371.  

The Legislature finds and declares all of the following:

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

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

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

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

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

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

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

(h)  begin delete ACEs end delete begin insert Adverse Childhood Experiences (ACEs) end insert are traumatic
experiences that can have a profound impact on a child’s
developing brain and body and lasting impacts on a person’s health
and livelihood across their lifetime. ACEs include physical,
emotional, and sexual abuse; physical and emotional neglect; other
experiences, such as substance abuse by a household member and
witnessing domestic violence. Other traumatic experiences can
include placement instability for foster youth, homelessness, and
witnessing violence against family and community members.

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

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

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

SEC. 4.  

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

4372.  

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

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

(b) “Eligible pupil” means a pupil who attends a preschool
program at a contracting agency of the California state preschool
program, as established by Article 7 (commencing with Section
8235) of Chapter 2 of Part 6 of Division 1 of Title 1 of the
Education Code, or a local educational agency, or who attends a
publicly funded elementary school and who is in kindergarten,
transitional kindergarten, or grades 1 to 3, inclusive.

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

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

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

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

SEC. 5.  

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

4380.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(7) The local educational agency will prioritize for receipt of
services children who have been exposed to childhood trauma,
including, but not limited to, foster youth, as defined in subdivision
(b) of Section 42238.01 of the Education Code, and homeless
children and youth, as defined in Section 11434a(2) of the federal
McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301
et seq.).

(h) Eligible supportive services may include the following:

(1) Individual and group intervention and prevention services.

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

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

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

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

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

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

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

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

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

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

(3) A statement of program goals.

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

(5) A detailed budget and budget narrative.

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

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

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

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

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

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

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

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

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

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

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

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

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

SEC. 6.  

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

 

Chapter  4. HEAL Trauma in Schools Support Program

 

4391.  

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

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

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

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

(A) Individual and group intervention and prevention services.

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

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

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

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

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

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

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

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

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

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

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

begin insert bullying prevention, mental health consultation, and parent-child
group supports. end insert

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

(1) Designing programs.

(2) Training program staff in intervention skills.

(3) Conducting local evaluations.

(4) Coordinating with county mental health agencies and
professionals.

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

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

(1) (A) During the first 12 months of the program, the
department shall support, strengthen, and expand the provision of
eligible services at schoolsites that previously received funding
pursuant to the former School-Based Early Mental Health
Intervention and Prevention Services Matching Grant Program
and have continued to provide eligible support services. In working
with these selected schoolsites, the department shall develop
methods and standards for providing services and practices to new
schoolsites.

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

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

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

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

(B) Schoolsites that prioritize for receipt of services children
who have been exposed to childhood trauma, including, but not
limited to, foster youth, as defined in subdivision (b) of Section
42238.01 of the Education Code, and homeless children and youth,
as defined in Section 11434a(2) of the federal McKinney-Vento
Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.)

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

(f) The department shall submit, in compliance with Section
9795 of the Government Code, an interim report to the Legislature
at the end of the second year of the program that details the
department’s work to support the schoolsites selected pursuant to
paragraph (1) of subdivision (e) and includes an assessment of the
demand and impact of funding for the HEAL Trauma in Schools
Act established pursuant to this part. The department shall make
the report available to the public and shall post the report on its
Internet Web site.

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

4392.  

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

4393.  

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