BILL ANALYSIS                                                                                                                                                                                                    



                                                                    AB 1644


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          Date of Hearing:  April 6, 2016


                           ASSEMBLY COMMITTEE ON EDUCATION


                              Patrick O'Donnell, Chair


          AB 1644  
          (Bonta) - As Amended March 8, 2016


          [Note: This bill is doubled referred to the Assembly Health  
          Committee and will be heard by that Committee as it relates to  
          issues under its jurisdiction.]
          


          SUBJECT:  School-based early mental health intervention and  
          prevention services


          SUMMARY:  Recasts and renames the Early Mental Health Initiative  
          (EMHI) as the HEAL Trauma in Schools Act, expands the program to  
          serve preschool and transitional Kindergarten students, and  
          establishes an initiative to encourage and support local  
          decisions to provide funding for services offered in that  
          program.





          Specifically, this bill:  












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          1)Makes findings and declarations regarding the importance  
            preventing and addressing Adverse Childhood Experiences (ACEs)  
            and childhood trauma.


          2)Renames the EMHI as the Healing from Early Adversity to Level  
            the impact of Trauma in Schools Act or the HEAL Trauma in  
            Schools Act.


          3)Expands the definition of eligible pupils to include preschool  
            and transitional Kindergarten students, and extends the  
            program to charter schools.


          4)Names the Department of Public Health (DPH), and the Director  
            of the DPH as the administrators of the program.


          5)Requires that, in determining which students receive services  
            under the program, local educational agencies prioritize  
            children who have been exposed to childhood trauma, including  
            students in foster care and students who are homeless.  


          6)Includes, as services which may be funded under the program,  
            evidence-based interventions and promising practices intended  
            to mitigate the consequences of childhood adversity and  
            cultivate resilience and protective factors.


          7)Establishes the School-Based Early Mental Health Intervention  
            and Prevention Services Support Program, administered by the  
            DPH, in consultation with the Superintendent of Public  
            Instruction (SPI), the Director of Health Care Services, and  
            the Attorney General to encourage and support local decisions  
            to provide funding for the eligible support services. 









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          8)Requires the DPH to provide outreach to local education  
            agencies (LEAs) and county mental health agencies to inform  
            them of the program. 



          9)Requires the DPH to provide free regional training on eligible  
            support services, including individual and group intervention  
            and prevention services, parent engagement, teacher and staff  
            conferences and training, referral to outside resources, use  
            of trained and supervised paraprofessional staff, and  other  
            services to improve student mental health, particularly  
            evidence-based interventions and promising practices intended  
            to mitigate the consequences of childhood adversity and  
            cultivate resilience and protective factors.





          10) Requires the DPH to also provide free regional training on: 



             a)   the potential for the support services to help fulfill  
               state priorities described by the local control funding  
               formula (LCFF) and local control and accountability plans  
               (LCAPs) 



             b)   how educational, mental health, and other funds subject  
               to local control can be used to finance the eligible  
               support services









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             c)   external resources available to support the eligible  
               support services, including workshops, training,  
               conferences, and peer learning networks 



             d)   state resources available to support student mental  
               health and positive, trauma-informed learning environments




          11) Requires DPH to provide technical assistance to LEAs,  
            including assistance in designing programs, training staff;  
            and conducting evaluations; coordination with county mental  
            health agencies and professionals; and leveraging local funds.



          12) Requires the DPH to select and support schoolsites as  
            follows: 



             a)   requires, during the first 12 months of the program, the  
               DPH to support, strengthen, and expand the provision of  
               eligible services at schoolsites that previously received  
               funding for EMHI and have continued to provide eligible  
               support services



             b)   requires the DPH to develop a process to identify  
               schoolsites that demonstrate the willingness and capacity  
               to participate in the program










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             c)   requires the DPH, during the subsequent 36 months of the  
               program, to select new schoolsites that are not providing  
               eligible support services but that demonstrate the  
               willingness and capacity to participate in the program.   
               Requires the DPH to work with these schoolsites to deliver  
               eligible support services 




          13) Requires the DPH to prioritize school sites in communities  
            that have experienced high levels of childhood adversity, such  
            as adverse childhood experiences and childhood trauma, and  
            schoolsites that prioritize children who have been exposed to  
            childhood trauma, such as students in foster care and those  
            who are homeless.  Also requires that DPH prioritize  
            geographic diversity, program effectiveness, program  
            efficiency, and long-term program sustainability.



          14) Requires the DPH to submit an interim report to the  
            Legislature at the end of the second year of the program, and  
            to submit an evaluation at the end of the four year pilot and  
            submit it to the Legislature. 



          15) States that implementation of the support program is  
            contingent upon an appropriation in the annual budget act.





          16) Sunsets the support program on January 1, 2022. 










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          EXISTING LAW:  


          1)Establishes the School-based Early Mental Health Intervention  
            and Prevention Services for Children Act of 1991, and  
            authorizes the Director of the Department of Health Care  
            Services, in consultation with the SPI, to provide matching  
            grants to LEAs to pay the state share of the costs of  
            providing school-based early mental health intervention and  
            prevention services to eligible students, subject to the  
            availability of funding each year. 


          2)Defines "eligible pupil" for this purpose as a student 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,  
            county office of education, or a state special school.


          3)Establishes the Primary Intervention Program (PIP) a  
            school-based program designed for the early detection and  
            prevention of emotional, behavioral, and learning problems in  
            primary grade children with services provided by child aides  
            or unpaid volunteers under the supervision of mental health  
            professionals.


          FISCAL EFFECT:  Unknown


          COMMENTS:  


          Need for the bill.  The author states: "For 20 years, the EMHI  
          Matching Grant Program was a highly successful state program  
          that provided matching grants to local education agencies to  
          provide school-based mental health supports to young pupils  








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          experiencing mild to moderate school adjustment difficulties.  
          EMHI supported Primary Intervention Programs consisting of  
          one-on-one services or services delivered in small groups to  
          address social skills, anger management, friendship groups, or  
          topic-specific issues such as bullying or divorce; and indirect  
          services such as parent and teacher services and classroom  
          curricula. 





          The EMHI Matching Grant Program served over 15,000 children per  
          year and its services were in great demand. Despite its success  
          and the demand for services, the program was defunded in 2012.  
          Additionally, with the dissolution of the Department of Mental  
          Health, its oversight and agency was eliminated, effectively  
          ending the program.





          Studies such as the Centers for Disease Control's Adverse  
          Childhood Experiences (ACE) study indicate that childhood  
          exposure to abuse, neglect, and other traumatic experiences has  
          lifelong health impacts. Left unaddressed, ACEs expose children  
          to toxic stress, keeping them in a constant state of  
          fight-or-flight and taking years off their lives and damaging  
          their health. I believe that restoring and expanding the EMHI  
          Program is a significant step towards addressing the harmful and  
          long-lasting effects of ACEs, and will give our children a  
          better shot at success."





          EMHI program history and outcomes.  In 1981 the Legislature  








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          created the Primary Prevention Project, now named the Primary  
          Intervention Program, and in 1991 created the School-based Early  
          Mental Health Intervention and Prevention Services for Children  
          Program, known as EMHI. 


          From 1992 to 2012, the Department of Mental Health awarded  
          matching grants to LEAs to fund prevention and early  
          intervention programs, including EMHI.  In the 2011-12 fiscal  
          year, the EMHI received $15 million in state funds, and there  
          was significant unmet demand for services.  At its peak, there  
          were 15,823 students receiving EMHI-funded services.  Funding  
          for the program was eliminated in 2012.  It is now a local  
          decision whether to continue this program without state matching  
          grant support.


          According to the author, the legislation authorizing this  
          program set a target of at least 75 percent of the participating  
          children showing an improvement in at least one of the following  
          four areas: learning behaviors, attendance, school adjustment,  
          and school-related competencies. A 2010-11 evaluation showed  
          that 79 percent had met that target. 


          When state funding for this program was eliminated, LEAs could  
          continue the program using local resources, and limited evidence  
          suggests that some have continued to operate programs using a  
          range of funding, from federal Title I funds to county mental  
          health funding, to local general purpose funds.  


          The Adverse Childhood Experiences study and trauma-informed  
          practices.  The Adverse Childhood Experiences (ACE) study is a  
          landmark investigation into associations between childhood  
          maltreatment and later-life health and well-being. The ACE study  
          is a collaboration between the Centers for Disease Control and  
          Prevention and Kaiser Permanente's Health Appraisal Clinic in  
          San Diego. 








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          The ACE study uses a score to represent the degree to which a  
          person has experienced traumatic events.  One point is recorded  
          for each type of trauma exposure in the areas of abuse, neglect,  
          and household dysfunction, and the points add up to a score  
          ranging from 0 to 10.  The higher an ACE score, the greater  
          one's risk of a broad range of health, mental health, and  
          at-risk behaviors. 


          The ACE Study has shown that adverse childhood experiences are  
          major risk factors for the leading causes of illness and death,  
          as well as poor quality of life.  Related research has also  
          demonstrated a strong association between high ACE scores and  
          poor performance in school, including a higher risk of learning  
          and behavior problems.  Other research into the effects of  
          chronic stress (often caused by ACEs) on children, has  
          identified a profound effect on the developing brain, which in  
          turn affects school performance and behavior.


          Recognition of the impact of these childhood experiences has led  
          to the development and increasing use of "trauma-informed"  
          approaches in a variety of fields, including education.  Broadly  
          speaking, trauma-informed practices in schools are those which  
          involve 1) a realization of the widespread prevalence and impact  
          of trauma, 2) recognition of signs of traumatic exposure, 3)  
          responses grounded in evidence-based practices, and 4) resisting  
          the re-traumatization of students [definition from the federal  
          Substance Abuse and Mental Health Agency (SAMHSA)].  Examples of  
          such practices in schools include professional development for  
          educators on the role of trauma in learning, classroom  
          management practices and discipline policies focused on conflict  
          resolution and restorative practices, and even instructional  
          modifications which address the specific learning needs of  
          students exposed to trauma.










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          Trauma-informed practices are specifically cited in the new  
          federal education law, the Every Student Succeeds Act (ESSA).   
          Several provisions of the law reference staff development "based  
          on trauma-informed practices that are evidence-based?" and  
          "effective and trauma-informed practices in classroom  
          management." 


          Supporting local decisions to implement a program in the era of  
          local control.  The Local Control Funding Formula (Chapter 47,  
          Statutes of 2013), eliminated approximately three quarters of  
          all K-12 categorical programs, and represented a significant  
          shift away from state control and toward local decision-making.   
          This bill aims to recast the EMHI program, and to encourage and  
          support LEAs in administering the program if they determine,  
          through local decision-making, that the program is a priority  
          for the use of their resources.  The Committee may wish to  
          consider whether state promotion and support of a program is  
          contrary to the principle of local control, or whether such  
          support is necessary to assist LEAs in successfully initiating  
          and maintaining complex programs, such as ones which require  
          inter-agency collaboration.  Significant lessons were learned in  
          the design and operation of some categorical programs, and the  
          Committee may further wish to consider the future role of state  
          leadership in assisting LEAs in effectively administering  
          programs which they have determined to be local priorities.


          State audit on mental health services provided to students in  
          special education.  AB 114 (Chapter 43, Statutes of 2011), which  
          took effect in July 2011, transferred the responsibility for  
          providing mental health services for students with  
          individualized education programs (IEPs) from county mental  
          health departments to LEAs.  A 2016 state audit on the effect of  
          AB 114 on mental health services for these students reported,  
          among other findings:


                 Although the most common types of mental health services  








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               offered and the service providers generally did not change,  
               LEAs removed mental health services from student IEPs in  
               the two years after AB 114 took effect. 

                 Although most service reductions were not related to AB  
               114, such as those prompted by a student graduating, IEP  
               teams did not always record in the IEP document their  
               rationale of why a service was removed.
          . 
                 For 40 percent of the students who had a change to their  
               mental health services or their educational placement  
               within two years of AB 114's implementation, the IEP teams  
               did not document the rationale for the changes.

                 For 13 of the 44 students reviewed who had a mental  
               health service removed from their IEPs, either the LEAs  
               could not satisfactorily explain why the services were  
               removed or the removal was related to AB 114.  In three  
               cases, the LEA had no assurance that removing services  
               would not adversely affect access to education.

          Student mental health initiatives.   The CDE is engaged in a  
          number of initiatives aimed at improving support for student  
          mental health needs. Among them are: 1) a Student Mental Health  
          Policy Workgroup established in 2012 to develop policy  
          recommendations that promote early identification, referral,  
          coordination, and access to quality mental health services for  
          students, 2) the TETRIS-EBL project, a mental health training  
          project funded by the California Mental Health Services  
          Authority and administered through a contract with the Placer  
          County Office of Education, and 3) a federally-funded "Now is  
          the Time" project to provide support to three LEAs, and CDE  
          training of school staff in a program called Youth Mental Health  
          First Aid. In addition, since 2011 an initiative called the  
          Regional K-12 Student Mental Health Initiative, operated through  
          the California County Superintendents Educational Services  
          Association, has provided training designed to build capacity  
          and cross-system collaboration to develop and sustain  
          school-based mental health programs addressing prevention and  








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          early identification strategies.


          The new federal education act, ESSA, also appears to offer  
          support for student mental health through a new grant program  
          called Student Support and Academic Enrichment Grants, which may  
          be used, among many other purposes, to "expand access to or  
          coordinate resources for school-based counseling and mental  
          health programs, such as through school-based mental health  
          services partnership programs."  This and other provisions of  
          ESSA are subject to appropriation.



          Related legislation this Session.  AB 1133 (Achadjian) of this  
          Session would have established a program substantially similar  
          to the one proposed by this bill.  It would have established a  
          four year pilot program, the School-Based Early Mental Health  
          Intervention and Prevention Services Support Program, to provide  
          outreach, free regional training, and technical assistance for  
          LEAs in providing mental health services at school sites.


          AB 1025 (Thurmond) of this Session, would require the CDE to  
          establish a 3-year pilot program to encourage inclusive  
          practices that integrate mental health, special education, and  
          school climate interventions following a multitiered framework.   
          AB 1025 was held in the Senate Appropriations Committee.


          SB 463 (Hancock) of this Session requires the CDE to designate a  
          county office of education to be the fiduciary agent for the  
          Safe and Supportive Schools Train the Trainer Program.  SB 463  
          is pending in the Assembly Education Committee.


          AB 104 (Committee on Budget), Chapter 13, Statutes of 2015,  
          among other things, appropriates $10 million to the SPI to be  
          apportioned to a designated COE to provide technical assistance  








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          and develop statewide resources to assist local educational  
          agencies to establish and align systems of learning and  
          behavioral supports.


          Technical amendments. Staff recommends the following technical  
          and clarifying amendments:


          1.Broaden the reference to students enrolled in preschool  
            programs to include those not operated on school sites.
          2.On page 10, line 3, delete the sentence beginning with "A  
            minimum of 80 percent?"


          3.On page 12, change the Chapter title to "The HEAL Trauma in  
            Schools Support Program."


          4.On page 12, line 15, page 14, line 34, and 15, lines 4 and 7,  
            strike the word "pilot."


          REGISTERED SUPPORT / OPPOSITION:




          Support


          California Attorney General Kamala D. Harris (sponsor)


          Children Now (sponsor)


          Time for Kids, Inc. (sponsor)









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          Abriendo Puertas/Opening Doors
          Alameda Unified School District, Woodstock Child Development  
          Center
          Alliance for Education Solutions


          American Academy of Pediatrics


          Amethod Public Schools
          BANANAS


          Bay Area Urban Debate League
          Beats Rhymes and Life
          Bicycle Coffee


          Brighter Beginnings
          California Alliance of Child and Family Services


          California Black Health Network
          California Center for Public Health Advocacy
          California Council of Community Mental Health Agencies
          California Pan-Ethnic Health Network
          California School Nurses Organization 


          California School-Based Health Alliance


          California State PTA










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          Californians for Safety and Justice


          Center for Leadership, Equity, and Research
          Center for Youth Wellness


          Center Joint Unified School District 


          Chico Unified School District


          Children's Specialty Care Coalition


          Children's Defense Fund-California
          Children's Partnership
          Common Sense Kids Action


          Early Edge California


          East Bay Agency for Children


          East Bay Asian Youth Center
          Family Voices of California


          Fight Crime: Invest in Kids California
          First Place for Youth


          Folsom Cordova Unified School District


          Full Court Press Communications








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          Futures Without Violence


          Girls Leadership Institute


          Human Impact Partners
          Inland Congregations United for Change


          Lemonade Creative Consulting
          Liberty School District
          Los Angeles County Office of Education


          Los Angeles Trust for Children's Health


          Lucile Packard Children's Hospital Stanford
                                           

          Mental Health America of California


          Mental Health and Autism Insurance Project
          Mental Health Association of California
          Montclair Physical Therapy
          National Alliance on Mental Illness California
          National Association of Social Workers, California Chapter
          Nonprofit Communications
          Nurse-Family Partnership
          Oakland City Council


          Oakland Natives Give Back 










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          Playworks


          Public Counsel


          Rape Counseling Services of Fresno


          Regional Asthma Management and Prevention
          Resource Development Associates
          Sacramento Area Congregations Together


          Santa Clara County Board of Supervisors


          Santa Cruz City Schools


          Street Level Health Project


          The Children's Partnership


          The MADE


          ThriveSF Fitness


          Time for Kids, Inc.


          United Ways of California


          Violence Prevention Coalition of Greater Los Angeles








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          Waugh School District


          Wellness Together


          Western Center on Law and Poverty


          Young People's Policy Solutions


          Youth UpRising


          Numerous individuals




          Opposition




          California Right to Life Committee, Inc.


          Analysis Prepared by:Tanya Lieberman / ED. / (916) 319-2087
















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