BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1644
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|AUTHOR: |Bonta |
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|VERSION: |May 27, 2016 |
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|HEARING DATE: |June 15, 2016 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : School-based early mental health intervention and
prevention services
SUMMARY : Renames the School-based Early Mental Health Intervention and
Prevention Services for Children Act of 1991, known as the Early
Mental Health Initiative, as the Healing from Early Adversity to
Level the Impact of Trauma in Schools Act. Requires the
Department of Public Health (DPH) to create a new four-year
program, as specified, and requires DPH to perform technical
assistance and outreach to local educational agencies about the
new program, which will target pupils with adverse childhood
experiences, as specified.
Existing law:
1)Establishes the School-based Early Mental Health Intervention
and Prevention Services for Children Act of 1991, known as the
Early Mental Health Initiative (EMHI), subject to the
availability of funding each year. Authorizes the Director of
the Department of Mental Health (now the Department of Health
Care Services [DHCS]), in consultation with the Superintendent
of Public Instruction (SPI), to provide matching grants to
"local educational agencies (LEAs)," as defined, to pay the
state share of the costs of providing school-based EMHI
services to "eligible pupils," as defined.
2)Requires priority for the grants to be given to applicants
that demonstrate specified criteria, including, but not
limited to, serving the greatest number of eligible pupils
from low-income families, providing a strong parental
involvement component, providing services at a low cost per
child, provide programs and services based on existing
programs that have been shown to be effective; and provide
services to children who are in out-of-home placement or at
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risk of being placed out of home.
3)Defines "LEA", for the purposes of the EMHI program, as any
school district or county office of education, or state
special school. Defines "eligible pupil" as a pupil who
attends a publicly funded elementary school and who is in
kindergarten or grades one to three, inclusive. Defines
"supportive services" as a service that will enhance the
mental health and social development of children.
4)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.
5)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 for
periodic screenings to determine health care needs.
6)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.
This bill:
1)Renames the EMHI the Healing from Early Adversity to Level
(HEAL) the Impact of Trauma in Schools Act (the HEAL Trauma in
Schools Act). Requires the Director of DPH, contingent upon an
appropriation in the annual budget act, to establish a
four-year program, in consultation with the SPI, the Director
of DHCS, and the Attorney General to encourage and support
local decisions to provide funding for the eligible support
services, as specified.
2)Requires DPH to provide outreach to LEAs and county mental
health agencies to inform individuals responsible for local
funding decisions of the established program. Requires DPH to
provide free regional training on all of the following:
a) Eligible support services, including
individual and group intervention and prevention
services; parent engagement through conference or
training, or both; teacher and staff conferences and
training, as specified; referral to outside resources,
AB 1644 (Bonta) Page 3 of ?
as specified; use of paraprofessional staff to meet
with pupils on a short-term weekly basis, as
specified; and any other services that will improve
the mental health of eligible pupils, particularly
evidence-based interventions and promising practices,
as specified;
b) The potential for the eligible support
services, as defined, to help fulfill state priorities
described in the local control funding formula (LCFF),
as specified;
c) How educational, mental health, and other
funds subject to the LCFF can be used to finance the
eligible support services;
d) External resources available to support
eligible support services; and,
e) State resources available to support student
mental health and resilience, as positive,
trauma-informed learning environments, including
inclusive multitiered system of behavioral and
academic supports, trauma-informed practices, social
and emotional learning, and parent-child group
supports.
3)Requires DPH to provide technical assistance to LEAs that
provide or seek to provide eligible services to include, but
not limited to, designing programs, training program staff,
conducting local evaluations, and coordinating with county
mental health agencies and professionals.
4)Requires DPH, in providing outreach, training, and technical
assistance, to select and support school sites that meet
specified criteria, including, but not limited to, school
sites that previously received EMHI grants and have continued
to provide eligible supports after the end of the grant
period; school site that are not providing eligible support
services but demonstrate a willingness and capacity to
participate in the program; and prioritize school sites in
communities that have experienced high levels of childhood
adversity and that prioritize services to children exposed to
trauma, including foster and homeless youth, as specified.
5)Expands the definition of "eligible pupil" to include pupils
who attend a preschool program, as specified, and transitional
kindergarten. Expands the definition of "LEA" to include
charter schools. Specifies in the definition of "supportive
AB 1644 (Bonta) Page 4 of ?
service" the social-emotional development of children.
6)Makes findings and declarations about the importance of
preventing and addressing adverse childhood experiences
(ACEs), as specified, and childhood trauma, which can result
in negative educational, health, social, and economic outcomes
for children, youth, families, and communities.
7)Sunsets the program on January 1, 2022, unless a later enacted
statute deletes or extends that date.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)General Fund (GF) administrative costs to DPH of approximately
$300,000 to oversee the program and provide outreach, free
regional training, and technical 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 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.
PRIOR
VOTES :
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|Assembly Floor: |80 - 0 |
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|Assembly Appropriations Committee: |20 - 0 |
|Assembly Health Committee: |18 - 0 |
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|Assembly Education Committee: | 7 - 0 |
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COMMENTS :
1)Author's statement. According to the author, for 20 years, the
EMHI was a highly successful state program that provided
matching grants to LEAs to provide school-based mental health
supports to young pupils experiencing mild to moderate school
adjustment difficulties. EMHI served over 15,000 children per
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year by supporting 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. 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. AB 1644 restores the EMHI program and adds a focus on
addressing the impacts of trauma and ACEs for children.
Studies such as the Centers for Disease Control and
Prevention's (CDC) ACEs 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. 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.
2)Background. Between 1991 and 2011, the state Department of
Mental Health (DMH) operated the EMHI, providing schools with
approximately $15 million annually. With the transfer of
responsibilities from 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 prevention and early intervention programs. Schools
are the main providers of mental health services for children
in California. The federal Individuals with Disabilities
Education (IDEA) Act 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 LEAs. 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
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to the general student population.
3)EPSDT. The EPSDT benefit provides comprehensive screening,
diagnostic, treatment, and preventive health care services for
children under age 21 who are enrolled in Medi-Cal, and is key
to ensuring that children who are eligible for EPSDT services
receive appropriate preventive, dental, mental health,
developmental, and specialty services. Federal Medicaid law
defines the EPSDT benefit to include a comprehensive array of
preventive, diagnostic, and treatment services for low-income
children under age 21. States are required to provide coverage
of any services listed in a section of the federal Medicaid
Act to children who are eligible for EPSDT services when the
services are determined to be medically necessary to correct
or ameliorate any physical or behavioral conditions. The EPSDT
benefit is more robust than the Medi-Cal benefit package
provided to adults and is designed to ensure that eligible
children receive early detection and preventive care in
addition to medically necessary treatment services, so that
health problems are averted or diagnosed and treated as early
as possible.
4)A shift in responsibilities and its effects. 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),
transferred the responsibility for providing mental health
services for students 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:
a) Although the most common types of mental health
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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;
b) 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;
c) 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,
d) 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.
5)The ACEs Study. The ACEs study is an investigation into
associations between childhood maltreatment and later-life
health and well-being. The ACEs study is a collaboration
between the CDC and Kaiser Permanente's Health Appraisal
Clinic in San Diego. The ACEs 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
ACEs score, the greater one's risk of a broad range of health,
mental health, and at-risk behaviors. The 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 ACEs
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.
According to the federal Substance Abuse and Mental Health
Services Agency, trauma-informed practices in schools can
include those that involve: a realization of the widespread
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prevalence and impact of trauma; recognition of signs of
traumatic exposure; responses grounded in evidence-based
practices; and resisting the re-traumatization of students.
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
instructional modifications that address the specific learning
needs of students exposed to trauma.
6)Double referral. If this bill passes out of this committee, it
will be referred to the Senate Education Committee.
7)Prior legislation. 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.
AB 1025 (Thurmond of 2015), would have required 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.
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 offices of education to
provide technical assistance and develop statewide resources
to assist LEAs in establishing and aligning systems of
learning and behavioral supports.
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 and
transferred that responsibility to school districts.
8)Support. Supporters of this bill argue that childhood trauma
and exposure to violence can have a lasting impact on the
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ability of a child to grow and thrive, resulting in negative
impacts on educational, health, social, and economic outcomes
for children and their families. Supporter state that this
bill is modeled on the success of the EMHI, in which 79% of
participating students exhibited improvements, and that this
bill will not only improve the lives of young people but the
public safety and well-being of the state for years to come.
NAMI California states that almost half of all cases of mental
illness begin by age 14 but only 20% of children with
diagnosable mental illness are identified and receive
treatment and services each year, with Asian and Latino
children being the least likely to have had a mental health
visit.
9)Opposition. California Right to Life Committee, Inc. (CRLC)
opposes with concerns about intervention services for
pre-school and transitional kindergarten-aged children. CRLC
questions who determines at what level ACEs warrant
governmental intervention, what local decision-makers will be
included, and who determines what ACEs are, among other
things.
SUPPORT AND OPPOSITION :
Support: Attorney General Kamala D. Harris (cosponsor)
Children Now (cosponsor)
Time for Kids, Inc. (cosponsor)
Abriendo Puertas/Opening Doors
Alameda Unified School District/Woodstock Child
Developmental 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 Behavioral Health
Agencies
California Pan-Ethnic Health Network
California School-based Health Alliance
California School Nurses Organization
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California State PTA
Californians for Safety and Justice
Center Joint Unified School District
Center for Leadership, Equity, and Research
Center for Youth Wellness
Chico Unified School District
Children's Defense Fund California
Children's Specialty Care Coalition
City of Oakland
Common Sense Kids Action
County Behavioral Health Directors Association of
California
Early Edge California
East Bay Agency for Children
East Bay Asian Youth Center
Family Voices of California
Fight Crime: Invest in Kids
First Place for Youth
Full Court Press Communications
Girls Leadership Institute
Human Impacts Partners
Inland Congregation United for Change
LEMONADE Creative Consulting
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 Association of California
Mental Health & Autism Insurance Project
Montclair Physical Therapy
NAMI California
National Association of Social Workers, California
Chapter
[Nonprofit] Communications
Nurse-Family Partnership
Oakland Natives Give Back
Playworks
Public Counsel
Rape Counseling Services of Fresno
Regional Asthma Management and Prevention
Resource Development Associates
Sacrament ACT (Area Congregations Together)
Santa Clara County Board of Supervisors
Street Level Health Project
The Children's Partnership
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The MADE
thriveSF Fitness
United Ways of California
Violence Prevention Coalition of Greater Los Angeles
Wellness Together
Western Center on Law and Poverty
Young People's Policy Solutions
Youth UpRising
Numerous individuals
Oppose: California Right to Life Committee, Inc.
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