BILL ANALYSIS                                                                                                                                                                                                    ”

                                                                    AB 1644

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          1644 (Bonta)

          As Amended  May 27, 2016

          Majority vote

          |Committee       |Votes|Ayes                  |Noes                |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |Education       |7-0  |O'Donnell, Olsen,     |                    |
          |                |     |Kim, McCarty,         |                    |
          |                |     |Santiago, Thurmond,   |                    |
          |                |     |Weber                 |                    |
          |                |     |                      |                    |
          |Health          |18-0 |Wood, Maienschein,    |                    |
          |                |     |Bonilla, Burke,       |                    |
          |                |     |Campos, Chiu,         |                    |
          |                |     |Dababneh, Gomez,      |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |Roger HernŠndez,      |                    |
          |                |     |Lackey, Nazarian,     |                    |
          |                |     |Olsen, Patterson,     |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |Ridley-Thomas,        |                    |
          |                |     |Santiago, Steinorth,  |                    |
          |                |     |Thurmond, Waldron     |                    |


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          |                |     |                      |                    |
          |Appropriations  |20-0 |Gonzalez, Bigelow,    |                    |
          |                |     |Bloom, Bonilla,       |                    |
          |                |     |Bonta, Calderon,      |                    |
          |                |     |Chang, Daly, Eggman,  |                    |
          |                |     |Gallagher, Eduardo    |                    |
          |                |     |Garcia, Roger         |                    |
          |                |     |HernŠndez, Holden,    |                    |
          |                |     |Jones, Obernolte,     |                    |
          |                |     |Quirk, Santiago,      |                    |
          |                |     |Wagner, Weber, Wood   |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |

          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:  

          1)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.

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

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


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          4)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.  

          5)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.

          6)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. 

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

          8)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.

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


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             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  

             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 

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

          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 the DPH to select and support schoolsites as  

             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  


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               to participate in the program

             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 

          12) 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 prioritizes geographic diversity,  
            program effectiveness, program efficiency, and long-term  

          13) 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. 

          14) States that implementation of the support program is  
            contingent upon an appropriation in the annual budget act, and  
            sunsets the support program on January 1, 2022. 

          FISCAL EFFECT:  According to the Assembly Appropriations  

          1) General Fund administrative costs to the Department of Public  
          Health (DPH) of approximately $300,000 to oversee the program,  
          provide outreach, free regional training, and technical  


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          assistance to school sites over four years.  DPH would also  
          incur costs related to interim reporting requirements and final  
          evaluation of program. 

          2) Proposition 98 General Fund (GF) cost pressure, in the  
          millions of dollars, to fund grants pursuant to the HEAL Trauma  
          in Schools Act.  Grants are contingent upon an appropriation in  
          the annual budget act.  The Assembly Budget proposes $6 million  
          GF for this program. 


          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  
          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  

          "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  


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          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  
          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 (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% 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% 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  


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          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. 

          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  


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          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.

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