BILL ANALYSIS Ó
AB 1644
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Date of Hearing: April 12, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 1644
(Bonta) - As Amended March 8, 2016
SUBJECT: School-based early mental health intervention and
prevention services.
SUMMARY: Reestablishes and renames the Early Mental Health
Initiative (EMHI) as the Healing from Early Adversity to Level
the Impact of 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:
1)Makes findings and declarations regarding the importance
preventing and addressing Adverse Childhood Experiences (ACEs)
and childhood trauma.
2)Establishes the School-Based Early Mental Health Intervention
and Prevention Services Support Program, administered by the
Department of Public Health (DPH), in consultation with the
Superintendent of Public Instruction (SPI), the Director of
Health Care Services, and the Attorney General to encourage
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and support local decisions to provide funding for eligible
support services.
3)Expands the definition of eligible pupils to include preschool
and transitional Kindergarten students, and extends program
eligibility to charter schools and preschool programs not
operated on school sites.
4)Names 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 (LEAs)
prioritize children who have been exposed to childhood trauma,
including students in foster care and those 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)Requires DPH to provide outreach to LEAs and county mental
health agencies to inform them of the program.
8)Requires DPH to provide free regional training on eligible
support services, including individual and group intervention
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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.
9) Requires DPH to 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;
c) External resources available to support the eligible
support services, including workshops, training,
conferences, and peer learning networks; and,
d) State resources available to support student mental
health and positive, trauma-informed learning environments.
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10) 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.
11) Requires DPH to select and support schoolsites as follows:
a) During the first 12 months of the program, 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) DPH to develop a process to identify schoolsites that
demonstrate the willingness and capacity to participate in
the program; and,
c) 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.
12) Requires DPH to prioritize school sites in communities that
have experienced high levels of childhood adversity, such as
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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. Requires to DPH prioritize geographic
diversity, program effectiveness, program efficiency, and
long-term program sustainability.
13) States that implementation of the support program is
contingent upon an appropriation in the annual budget act.
14) Sunsets the program on January 1, 2022.
EXISTING LAW:
1)Establishes the School-based EMHI Services for Children Act of
1991, and authorizes DHCS, in consultation with the SPI, to
provide matching grants to LEAs to pay the state share of the
costs of providing school-based EMHI services to eligible
students, subject to the availability of funding each year.
2)Provides for the Medi-Cal program, administered by DHCS, under
which eligible low-income individuals receive health care
services subject to state and federal laws and funding.
3)Establishes the Medi-Cal Early and Periodic Screening,
Diagnostic and Treatment (EPSDT) program for eligible
individuals up to age 21 pursuant to state and federal law.
4)Defines a LEA as a school district, a county office of
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education, a nonprofit charter school participating as a
member of a special education local plan area, or a special
education local plan area and allows LEAs to provide and bill
for Medi-Cal services provided to students receiving special
education services on Medi-Cal (generally, special education
students).
5)Establishes the Mental Health Services Act, enacted by voters
in 2004 as Proposition 63, to provide funds to counties to
expand services, develop innovative programs, and integrated
service plans for mentally ill children, adults, and seniors
through a 1% income tax on personal income above $1 million.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, for 20 years,
the EMHI Matching Grant Program was a highly successful state
program that provided matching grants to LEAs agencies to
provide school-based mental health support to young pupils
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 author states that 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
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dissolution of the Department of Mental Health, its oversight
and agency was eliminated, effectively ending the program.
The Centers for Disease Control's (CDC) Adverse Childhood
Experiences (ACE) study indicates 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. The author concludes that restoring and
expanding the EMHI Program is a significant step towards
addressing the harmful and long-lasting effects of ACEs, and
will give children a better shot at success.
2)BACKGROUND.
a) K-12 Mental Health Services. There are a number of
different funding mechanisms currently available for school
districts and LEAs to provide health care services to
pupils, as discussed in more detail below. Between 1991
and 2011, the state Department of Mental Health (DMH) also
operated a previous version of the EMHI, which provided
schools with approximately $15 million annually to serve
children in kindergarten through third grade with mild and
moderate mental health problems. With the transfer of
responsibilities from the DMH to DHCS in 2012, this program
was shifted to local education departments. Many counties
also fund on-campus mental health services for non-special
education students through EPSDT and Mental Health Services
Act-funded early prevention programs.
Schools are the main providers of mental health services for
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children in California. The federal Individuals with
Disabilities Education Act (IDEA) was adopted in 1975 to
guarantee children with disabilities a right to public education
in the least restrictive setting. In California, the federal
IDEA mandate to provide special education services is
administered by local school districts and local education
agencies. Special education students may be eligible for health
care services, including mental health services, in specific
IDEA disability categories. Mental health services provided to
special education students include counseling and guidance,
psychological services, parental counseling and training, and
residential placement, among others. While federal law requires
mental health services to be provided to students who have been
identified for special education services, there are little to
no services available to the general student population.
b) County Mental Health Plans (MHPs). Prior to 2011,
special education students who had a severe emotional
disturbance condition documented in their individual
education plans (IEPs) were referred by their schools to
county mental health agencies for treatment. In 2011, the
Legislature repealed the state mandate on county mental
health agencies to provide IDEA-related mental health
services and shifted this financial responsibility to the
California Department of Education (CDE). LEAs and local
county MHPs were required to develop new agreements
defining agency responsibilities that reflected the changes
in state law. MHPs remain responsible for providing EPSDT
services for students who are Medi-Cal beneficiaries with
IDEA-related individualized education, if they meet medical
necessity criteria.
AB 114 (Committee on Budget), Chapter 43, Statutes of 2011,
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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:
i) Although the most common types of mental health
services 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;
ii) 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;
iii) For 40% 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;
and,
iv) 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.
c) EPSDT. EPSDT is a federally mandated Medi-Cal benefit
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for individuals up to the age of 21 who have full-scope
Medi-Cal eligibility. This benefit allows for periodic
screenings to determine health care needs and based upon
the identified health care need and diagnosis, treatment
services are provided. EPSDT services include all services
otherwise covered by Medi-Cal and EPSDT beneficiaries can
receive additional medically necessary services. EPSDT
mental health services are Medi-Cal services that correct
or improve mental health problems that have been determined
by a physician, psychologist, counselor, social worker, or
other health or social services provider. EPSDT provides
eligible children access to a range of mental health
services that include, but are not limited to mental health
assessment, collateral contracts, therapy, rehabilitation,
mental health services, medication support services, day
rehabilitation, day treatment intensive, crisis
intervention and stabilization, targeted case management,
and therapeutic behavioral services.
d) The Adverse Childhood Experiences Study. The 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
CDC and Kaiser Permanente's Health Appraisal Clinic in San
Diego.
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.
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The ACE Study has shown that ACEs 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: i) a realization of the widespread prevalence and
impact of trauma; ii) recognition of signs of traumatic
exposure; iii) responses grounded in evidence-based practices;
and, iv) resisting the re-traumatization of students [definition
from the federal Substance Abuse and Mental Health Agency].
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.
Trauma-informed practices are specifically cited in the new
federal education law, the Every Student Succeeds Act (ESSA).
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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."
3)SUPPORT. Children Now and Time for Kids, sponsors of this
bill, state that state that the rationale for creating the
EMHI program in 1991 still resonates today: "It is in
California's best interest, both in economic and human terms,
to identify and treat minor difficulties that our children are
experiencing before those difficulties become major barriers
to later success." For 20 years, the EMHI Matching Grant
Program was the solution: a highly successful program that
provided matching grants to LEAs to provide school-based
mental health supports to young pupils experiencing mild to
moderate school adjustment difficulties such as isolation,
anxiety, and bullying.
The California Medical Association and others state in support
that this bill would build on the success of the EMHI program
by authorizing the provision of non-financial supports to help
LEAs maximize the use of funds that are under local control
for EMHI programs. The proposed program would benefit young
children from preschool through third grade with
evidence-based and developmentally appropriate services and be
both cost effective and consistent with the principles of
local control.
The Steinberg Institute and Autism Deserves Equal Coverage,
state in support that this measure would create a prevention
and early intervention pilot program to help students from
preschool to third grade through the delivery of EMHI
services, which have a long track record of success in
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California.
4)RELATED LEGISLATION. SB 463 (Hancock) of 2015 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.
5)PREVIOUS LEGISLATION.
a) AB 1133 (Achadjian) of 2015 would have established a
program substantially similar to the one proposed by this
bill. 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
1133 was held in the Assembly Appropriations Committee.
b) AB 1025 (Thurmond) of 2015 would have required the CDE
to establish a three year pilot program to encourage
inclusive practices that integrate mental health, special
education, and school climate interventions following a
multitiered framework. AB 1025 was held in the Senate
Appropriations Committee.
c) AB 114 (Committee on Budget), Chapter 43, Statutes of
2011, a companion measure to the 2011-12 Budget bill,
relieved county mental health departments of the
responsibility to provide mental health services to
students with disabilities (AB 3632 program) and
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transferred that responsibility to school districts.
d) 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 county office of
education to provide technical assistance and develop
statewide resources to assist local educational agencies to
establish and align systems of learning and behavioral
supports.
6)DOUBLE REFERRAL. This bill was double referred to the
Assembly Education Committee, where it passed unanimously.
REGISTERED SUPPORT / OPPOSITION:
Support
California Attorney General Kamala D. Harris (sponsor)
Children Now (sponsor)
Time for Kids, Inc. (sponsor)
Abriendo Puertas/Opening Doors
Alameda Unified School District, Woodstock Child Development
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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 Children's Hospital Association
California Council of Community Mental Health Agencies
California Medical Association
California Pan-Ethnic Health Network
California School Nurses Organization
California School-Based Health Alliance
California State PTA
Californians for Safety and Justice
Center for Community Health and Engagement
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Center for Leadership, Equity, and Research
Center for Youth Wellness
Center Joint Unified School District
Chico Unified School District
Childhood Injury Prevention Network
Children's Hospital & Research Center Oakland
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
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Folsom Cordova Unified School District
Full Court Press Communications
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
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Oakland Natives Give Back
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.
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United Ways of California
Violence Prevention Coalition of Greater Los Angeles
Waugh School District
Wellness Together
Western Center on Law and Poverty
Young People's Policy Solutions
Youth UpRising
Numerous individuals
Opposition
None on file.
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Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097