BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON EDUCATION
                              Senator Carol Liu, Chair
                                2015 - 2016  Regular 

          Bill No:             AB 1644            
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          |Author:    |Bonta                                                |
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          |Version:   |May 27, 2016                             Hearing     |
          |           |Date:     June 29, 2016                              |
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          |Urgency:   |No                     |Fiscal:    | Yes             |
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          |Consultant:|Lynn Lorber                                          |
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          Subject:  School-based early mental health intervention and  
          prevention services


           SUMMARY
          
          This bill requires the Department of Public Health (DPH) to  
          establish a four-year program to support local decisions to  
          provide funding for early mental health support services,  
          requires DPH to provide technical assistance to local  
          educational agencies, and requires DPH to select and support  
          schoolsites to participate in the program.

            BACKGROUND
          
          Existing law:

          1)   Establishes the School-based Early Mental Health  
               Intervention and Prevention Services for Children Act  
               (EMHI) and authorizes the Director of the Department of  
               Mental Health, 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 school-based early mental health intervention and  
               prevention services to eligible students, subject to the  
               availability of funding each year. (Welfare & Institutions  
               Code  4370, et seq.)

          2)   Defines "eligible pupil" as a student who attends a  
               publicly funded elementary school and who is in  







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               kindergarten or grades 1 to 3.  (WIC  4372)

          3)   Establishes the Primary Intervention Program, using EMHI  
               funds, to provide school-based early detection and  
               prevention of emotional, behavioral, and learning problems  
               in students in kindergarten and grades 1-3, with services  
               provided by child aides under the supervision of a  
               school-based mental health professional.  (WIC  4343, et  
               seq.)

            ANALYSIS
          
          This bill requires the DPH to establish a four-year program to  
          support local decisions to provide funding for early mental  
          health support services, requires DPH to provide technical  
          assistance to local educational agencies, and requires DPH to  
          select and support schoolsites to participate in the program.   
          Specifically, this bill:

          1)   Requires the director of the DPH, also known as the Public  
               Health Officer, to 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 eligible support services.

          2)   Requires the Department of Public Health (DPH) to provide  
               outreach to local educational agencies and county mental  
               health agencies to inform individuals responsible for local  
               funding decisions of the program established by this bill.

          Selection of schoolsites

          3)   Requires DPH, in providing outreach, training, and  
               technical assistance, to select and support schoolsites as  
               follows:

                    a)             Requires DPH, during the first 12  
                    months of the program, to support, strengthen, and  
                    expand the provision of eligible services at  
                    schoolsites that previously received Early Mental  
                    Health Intervention and Prevention Services for  
                    Children Act funding and have continued to provide  
                    eligible support services.  This bill requires DPH, in  








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                    working with these selected schoolsites, to develop  
                    methods and standards for providing services and  
                    practices to new schoolsites.  

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

                    c)             Requires 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.  This bill requires DPH to  
                    work with these schoolsites to deliver eligible  
                    support services.

          4)   Requires DPH, in selecting schoolsites and providing  
               support, to 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 services  
                    for students who have been exposed to childhood  
                    trauma, including but not limited to, foster youth and  
                    homeless children and youth.

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

          Training

          5)   Requires DPH to provide free regional training on all of  
               the following:

                    a)             Eligible support services, as  
                    specified.

                    b)             The potential for the eligible support  
                    services to help fulfill state priorities described by  
                    the local control funding formula and local goals  
                    described by local control and accountability plans.








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

                    d)             External resources available to support  
                    the eligible support services, which may include  
                    workshops, training, conferences, and peer learning  
                    networks.

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

          Eligible support services

          6)   Authorizes eligible support services to 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 students 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 students on a short-term weekly  
                    basis, in a one-on-one setting as in the primary  
                    intervention program.

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








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          Student mental health and resilience, and trauma-informed  
          learning environments

          7)   Authorizes student mental health and resilience, and  
               trauma-informed learning environments to 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 multi-tiered systems of  
                    behavioral and academic supports, Schoolwide Positive  
                    Behavior Interventions and Supports, restorative  
                    justice or restorative practices, trauma-informed  
                    practices, social and emotional learning, bullying  
                    prevention, mental health consultation, and  
                    parent-child group supports.

          Technical assistance

          8)   Requires the Department of Public Health (DPH) to provide  
               technical assistance to local educational agencies that  
               provide or seek to provide eligible services, and requires  
               technical assistance to include assistance in any of the  
               following:

                    a)             Designing programs.

                    b)             Training program staff in intervention  
                    skills.

                    c)             Conducting local evaluations.

                    d)             Coordinating with county mental health  
                    agencies and professionals.

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

          Report and evaluation








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          9)   Requires DPH to submit an interim report to the Legislature  
               at the end of the second year of the program that details  
               the DPH's work to support the schoolsites and includes an  
               assessment of the demand and impact of funding for the  
               program established by this bill.  This bill requires DPH  
               to make the report available to the public and post the  
               report on its Web site.

          10)  Requires DPH to develop an evaluation plan to assess the  
               impact of the program.  

          11)  Requires DPH to 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, and make the report available to the public  
               and post the report on its Web site.

          Miscellaneous

          12)  Provides that implementation of this bill is contingent  
               upon an appropriations in the annual budget act.

          13)  Renames the School-based Early Mental Health Intervention  
               and Prevention Services for Children Act (EMHI) as the  
               Healing from Early Adversity to Level the Impact of Trauma  
               in Schools Act, or the Heal Trauma in Schools Act.

          14)  Expands priority for funding for EMHI applicants by adding  
               local educational agencies that will prioritize services  
               for children who have been exposed to childhood trauma,  
               including but not limited to, foster youth and homeless  
               children and youth.

          15)  Expands "other service or activity" relative to eligible  
               supportive services by adding evidence-based interventions  
               and promising practices intended to mitigate the  
               consequences of childhood adversity and cultivate  
               resilience and protective factors. 

          16)  Deletes the prohibition on more than 20% of the grants to  
               be used for new models of services and the requirement that  
               at least 80% of the grants awarded to include the basic  
               components of the primary intervention program.








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          17)  Expands the definition of "eligible pupil" to include a  
               student who attends a preschool program at a contracting  
               agency of the California state preschool program or local  
               educational agency, and to include students who are in  
               transitional kindergarten.

          18)  Modifies the definition of "supportive services" to change  
               social development to social-emotional development. 

          19)  Expands the definition of "local educational agency" to  
               include charter schools.

          20)  Defines "Department" as the State Department of Public  
               Health.

          21)  Modifies the definition of "director," from the State  
               Director of Mental Health to the State Public Health  
               Officer.

          22)  States legislative findings and declarations relative to  
               the need to provide funding to address the mental health  
               needs of children who have been exposed to childhood  
               adversity and to prioritize communities that experience  
               childhood adversity more severely and profoundly.

          23)  Sunsets the provisions of this bill on January 1, 2022.

          STAFF COMMENTS
          
          1)   Need for the bill.  According to the author, "For 20 years,  
               the EMHI Matching Grant Program was a highly successful  
               state program that provided matching grants to local  
               educational 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 curricula.  Despite its success and the demand  
               for services, the program was defunded in 2012.   
               Additionally, with the dissolution of the Department of  








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               Mental Health, its oversight and agency was eliminated,  
               effectively ending the program.  I believe that restoring  
               and expanding the EMHI Program is a significant step  
               towards addressing the harmful and long-lasting effects of  
               Adverse Childhood Experiences, and will give our children a  
               better shot at success."

          2)   Early Mental Health Initiative (EMHI).  From 1992 to 2012,  
               the then-Department of Mental Health awarded matching  
               grants to local educational agencies to fund prevention and  
               early intervention programs, including EMHI.  In the  
               2011-12 fiscal year, the EMHI received $15 million in state  
               funds.  At its peak, there were 15,823 students receiving  
               EMHI-funded services.  The Department of Mental Health has  
               since been dissolved and funding for EMHI was eliminated  
               beginning in the 2012-13 fiscal year; the state  
               infrastructure for EMHI was not re-established in another  
               state agency.  It is now a local decision whether to  
               continue this program without state matching grant support.  
                The Assembly version of the 2016 Budget included $6  
               million to fund the former EMHI grant program, but no  
               funding was included in the final conference committee  
               report.  Therefore, the EMHI program remains unfunded.

          This bill creates a framework to support and assist local  
               educational agencies in implementing early mental health  
               initiatives at a local level, without the support of a  
               state infrastructure or funding.  

          3)   Existing statewide student mental health initiatives.  The  
               state is currently engaged in a number of initiatives aimed  
               at improving support for student mental health needs (none  
               are specifically targeted to the youngest students).  Among  
               them are:

          Student Mental Health Policy Workgroup.  In 2012, the  
               Superintendent of Public Instruction and the California  
               Mental Health Services Act (CalMHSA) convened a Student  
               Mental Health Policy Workgroup (workgroup) to develop  
               policy recommendations that promote early identification,  
               referral, coordination, and access to quality mental health  
               services for students.  The workgroup is comprised of  
               teachers, school counselors, school social workers, school  
               psychologists, school nurses, and school administrators, as  








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               well as state and county mental health professionals.  

          The workgroup has noted the connection between mental wellness  
               and academic achievement, attendance, and behavior.  It has  
               also noted that California's educators acknowledge their  
               lack of preparedness in addressing pupil mental health  
               challenges as a major barrier to instruction.  The  
               workgroup found that "most educators and staff lack  
               training to identify pupils who may be in need of support,  
               make referrals, and, as appropriate, to help pupils  
               overcome or manage mental health barriers and succeed in  
               school."  They also noted that mental health challenges  
               disproportionately impact students who face stressors such  
               as violence, trauma, and poverty.  

          Regional K-12 Student Mental Health training.  Since 2011,  
               CalMHSA has funded a Student Mental Health Initiative  
               through the California County Superintendents Educational  
               Services Association.  This project is designed to build  
               capacity and cross-system collaboration to develop and  
               sustain school-based mental health programs addressing  
               prevention and early identification strategies.

          One of the goals of this project is the training of school  
               staff.  Since 2011 this project has used a  
               train-the-trainer model to provide educators with tools for  
               the early identification and prevention of mental health  
               problems.  Two thousand trainings have been conducted, with  
               over 140,000 participants.  The estimated total reach of  
               this project is two million students, or one third of the  
               state's enrollment.  Since 2014, this project has declined  
               significantly in size as a result of decreased funding.
          
          California Department of Education's training project.   
               California Mental Health Services Act (CalMHSA) has also  
               funded mental health training through the California  
               Department of Education (CDE), Training Educators through  
               Recognition and Identification Strategies (TETRIS),  
               Eliminating Barriers to Learning (EBL) project.  This  
               statewide K-12 Mental Health Program promotes school and  
               student wellness and academic achievement by increasing  
               capacity for all school and administrative staff to  
               identify students who are experiencing mental health issues  
               early on.  To accomplish this goal, the CDE subcontracted  








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               with the Placer County Office of Education to deliver 11  
               TETRIS EBL workshops annually through 2019.  The curriculum  
               used for the TETRIS EBL workshops was developed by the  
               United States Department of Health and Human Services'  
               Substance Abuse and Mental Health Services Administration  
               (SAMHSA).  Kognito Interactive Online Simulation Program is  
               also used as an outside source to help support school staff  
               in initiating conversations with students around the  
               subject of mental health and suicidal ideation.

          SAMHSA "Now is the Time" pilot projects.  Following the school  
               shooting at Sandy Hook Elementary in Connecticut in  
               December 2012, President Obama established a grant program  
               to increase students' access to mental health services.   
               California received $9.7 million from the "Now is the Time  
               Project Advancing Wellness and Resilience in Education"  
               (NITT AWARE) grant in 2014.  According to the CDE, the  
               grant has two components.  Three local educational agencies  
               (LEAs), Garden Grove Unified School District, Santa Rosa  
               City Schools, and the San Diego County Office of Education,  
               were selected to participate in the first component of the  
               grant.  The LEAs will establish a process for referring and  
               connecting children to mental health services.  If  
               successful, the models developed by these LEAs can be  
               shared statewide.  The second component utilizes a training  
               program called Youth Mental Health First Aid.  The training  
               teaches school staff how to help youth experiencing mental  
               health or addictions challenges, or are in crisis. 

          4)   Heard by the Senate Health Committee.  This bill was heard  
               by the Senate Health Committee on June 15, where it passed  
               on a 9-0 vote.

          5)   Fiscal impact.  This bill provides that its implementation  
               is contingent upon an appropriation in the annual budget  
               act.  Funding for the purposes of this bill was not  
               provided in the 2016 Budget Act.

          According to the Assembly Appropriations Committee, this bill  
               imposes the following costs:

               a)        General Fund administrative costs to the  
                    Department of Public Health (DPH) of approximately  
                    $300,000 to oversee the program, provide outreach,  








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                    free regional training, and technical assistance to  
                    school sites 
                    over four years.  Department of Public Health (DPH)  
                    would also incur costs related to interim reporting  
                    requirements and final evaluation of the program. 

               b)        Proposition 98 General Fund (GF) cost pressure,  
                    in the millions of dollars, to fund grants pursuant to  
                    the Healing from Early Adversity to Level the Impact  
                    Trauma in Schools Act.  Grants are contingent upon an  
                    appropriation in the annual budget act.  

          6)   Related legislation.  SB 1113 (Beall) authorizes local  
               educational agencies to enter into partnerships, as  
               specified, with county mental health plans for the  
               provisions of Early and Periodic Screening, Diagnosis, and  
                                                           Treatment mental health services, and to expand the  
               allowable uses of specified mental health funds.  SB 1113  
               is pending in the Senate Appropriations Committee.

               AB 2017 (McCarty) requires the Department of Health Care  
               Services to create a grant program for public postsecondary  
               education institutions to access mental health services,  
               and appropriates $40 million for this purpose.  AB 2017 is  
               scheduled to be heard by this Committee on June 29.

          7)   Prior legislation.  AB 1133 (Achadjian, 2015) established a  
               four-year pilot program, the School-Based Early Mental  
               Health Intervention and Prevention Services Support Program  
               (EMHI Support Program), to provide outreach, free regional  
               training, and technical assistance for local educational  
               agencies in providing mental health services at school  
               sites.  AB 1133 was held in the Assembly Appropriations  
               Committee.

          AB 1025 (Thurmond, 2015) required California Department of  
               Education (CDE) to establish a three-year pilot program in  
               school districts to encourage inclusive practices that  
               integrate mental health, special education, and school  
               climate interventions following a multi-tiered framework.   
               AB 1025 was held in the Senate Appropriations Committee.

          AB 1018 (Cooper, 2015) required the Department of Health Care  
               Services and CDE to convene a joint taskforce to examine  








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               the delivery of mental health services to children.  AB  
               1018 was held in the Senate Appropriations Committee.

          AB 580 (O'Donnell, 2015) required the CDE to develop model  
               referral protocols for voluntary use by schools to address  
               the appropriate and timely referral by school staff of  
               students with mental health concerns.  AB 580 was vetoed by  
               the Governor, whose veto message read:

                    California does not currently have specific model  
                    referral protocols for addressing student mental  
                    health as outlined by this bill. However, the  
                    California Department of Education recently received a  
                    grant from the federal Department of Health and Human  
                    Services, Substance Abuse and Mental Health Services  
                    Administration to identify and address critical  
                    student and family mental health needs. 

                    It's premature to impose an additional and overly  
                    prescriptive requirement until the current efforts are  
                    completed and we can strategically target resources to  
                    best address student mental health.
          
            SUPPORT
          
          Alameda County Board of Supervisors
          Attorney General Kamala Harris
          California Academy of Child and Adolescent Psychiatry
          California Association for Licensed Professional Clinical  
          Counselors
          California Black Health Network
          California Children's Hospital Association
          California Council of Community Behavioral Health Agencies
          California Federation of Teachers
          California Medical Association
          California Pan-Ethnic Health Network
          California School-Based Health Alliance
          California School Nurses Organization
          California State PTA
          Center for Youth Wellness
          Children Now
          Children's Defense Fund - California
          Children's Specialty Care Coalition
          Common Sense Kids Action








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          Disability Rights California
          East Bay Agency for Children
          Family Paths
          Fight Crime: Invest in Kids
          First 5 California
          First 5 LA
          Foster Care Alumni of America, California Chapter
          Lemonade
          Los Angeles County Office of Education
          Los Angeles Trust for Children's Health
          Mental Health America of California 
          National Association of Social Workers, California Chapter
          Public Health Advocates
          Santa Clara County Board of Supervisors
          Santa Clara County Office of Education
          The Children's Partnership
          United Ways of California
          Western Center on Law & Poverty

            OPPOSITION
           
           None received.

                                      -- END --