BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          AB 1644 (Bonta) - School-based early mental health intervention  
          and prevention services
          
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          |Version: August 1, 2016         |Policy Vote: HEALTH 9 - 0, ED.  |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: August 1, 2016    |Consultant: Jillian Kissee      |
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          This bill meets the criteria for referral to the Suspense File.



          Bill  
          Summary:  This bill establishes, contingent upon an  
          appropriation, the HEAL Trauma in Schools Support Program.  It  
          requires the California Department of Health Care Services  
          (DHCS) to establish a four-year program to provide outreach,  
          training, and technical assistance to support local decisions to  
          provide funding for early mental health support services.  This  
          bill also makes changes to the former Early Mental Health  
          Initiative (EMHI). 


          Fiscal  
          Impact:   
           Cost pressure to the DHCS between $312,000 and $439,000 for  
            three to four limited-term positions to provide training on  
            providing eligible services and other topics; to provide  
            technical assistance to local educational agencies (LEAs) on  







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            implementing existing or new programs that provide eligible  
            services; to conduct outreach regarding this training and  
            technical assistance; and to produce required reports.   
            (General Fund) 

           Cost pressure to the Department of Public Health potentially  
            in the low hundreds of thousands and the California Department  
            of Education for one partial position and $47,000 to consult  
            with the DHCS.  (General Fund)

           Amendments to statutes governing the former EMHI program  
            create a cost pressure to provide funding for the program.   
            Implementation of the EMHI is contingent upon an appropriation  
            and a determination that any existing federal financial  
            participation is not jeopardized, as specified.  The program  
            was last funded at $15 million.


          Background:  Existing law establishes the School-based Early Mental Health  
          Intervention and Prevention Services for Children Act and  
          authorizes the Director of the Department of Mental Health, in  
          consultation with the Superintendent of Public Instruction, to  
          award 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.  (Welfare & Institutions Code  
           4370, et seq.) 
          From 1992 until 2012, EMHI grants funded prevention and early  
          intervention programs for students experiencing mild-to-moderate  
          school adjustment difficulty.  At its peak, there were 15,823  
          students receiving EMHI-funded services.  The Department of  
          Mental Health has since been dissolved.  Funding specifically  
          for the EMHI was eliminated and beginning in the 2012-13 fiscal  
          year, was redirected and disbursed directly to LEAs.  It is now  
          a local decision whether to continue this program without state  
          matching grant support.  


          EMHI support services include individual and group intervention  
          and prevention services; parent engagement; teacher and staff  
          conferences and training to meet project goals; referral to  
          outside resources when students require additional services; use  
          of paraprofessional staff, as specified; and any other service  
          that will improve the mental health of students.








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          Proposed Law:  
            This bill establishes, contingent upon an appropriation, the  
          HEAL Trauma in Schools Support Program which requires the DHCS  
          to establish a four-year program to provide outreach, training,  
          and technical assistance to support local decisions to provide  
          funding for early mental health support services.  This bill  
          also makes changes to the former EMHI program.   
          Specifically this bill requires the DHCS to:


          HEAL Trauma in Schools Support Program


           Establish a four-year program in consultation with the  
            Superintendent of Public Instruction, the State Public Health  
            Officer, and the Attorney General to encourage and support  
            local decisions to provide funding for the eligible support  
            services, as specified.  This program is scheduled to sunset  
            January 1, 2022.


           Provide outreach to LEAs to inform individuals responsible for  
            local funding decisions of this program.


           Provide free regional training on: eligible support services  
            consistent with the EMHI program; the potential for services  
            to help fulfill state priorities in the local control funding  
            formula and local goals described in the local control and  
            accountability plans; allowable funding sources; and external  
            resources available to support services including conferences;  
            and state resources available to support student mental health  
            and resilience and trauma-informed learning environments.


           Provide technical assistance to LEAs that provide or seek to  
            provide eligible services through designing programs,  
            providing training on intervention skills, conducting local  
            evaluations, coordinating with county mental health agencies,  
            and leveraging funds that are subject to local control and  
            assisting in budget development.









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           During the first 12 months, in collaboration with the  
            Superintendent, to support schools that previously received  
            funding under the former EMHI program and have continued to  
            provide eligible support services.


           During the subsequent 36 months, select and work with new  
            schools that are not providing eligible support services but  
            demonstrate a willingness and capacity to participate in the  
            program.


           Prioritize schools in communities in which LEAs have  
            demonstrated high levels of childhood adversity and schools  
            that prioritize children who have been exposed to childhood  
            trauma, including foster youth and homeless, and geographic  
            diversity, program effectiveness, and long-term program  
            sustainability.


           Submit, and post on its website, an interim report to the  
            Legislature at the end of the second year of the program  
            regarding its work in supporting schools which includes an  
            assessment of the demand and impact of funding.


           Develop an evaluation plan to assess the impact of the program  
            and report, to the Legislature, as well as post on its  
            website, at the end of the four-year period evaluating the  
            impact of the program and providing recommendations for  
            further implementation.


          Changes to the EMHI 


           Authorizes beginning with grants for the 2017-18 school year,  
            and subject to the availability of funding each year, the  
            Director of Health Care Services to, in consultation with the  
            Superintendent of Public Instruction, award matching grants to  
            LEAs to pay the state share of the costs of programs that  
            provide early mental health intervention and prevention  
            services, as specified.








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           Adds to the list of criteria for which applicants receive  
            priority that the LEA will prioritize for services children  
            who have been exposed to childhood trauma, including foster  
            youth and homeless children.


           Specifies that eligible services include any other service  
            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.


           Removes the requirement that program administration must  
            include both state and field staff; that field staff provide  
            support in the implementation of early mental health services;  
            and that reviews of each project are to be conducted at least  
            once during the first year of funding.


           Authorizes the DHCS to implement this program by means of  
            information notices, plan letters, plan or provider bulletins,  
            or similar instruction, until regulations are adopted.


           Only allows the EMHI to be implemented to the extent that the  
            DHCS determines that any existing federal financial  
            participation associated with the eligible support services  
            and early mental health intervention services is not  
            jeopardized.  The DHCS is authorized to claim federal  
            financial participation for the administrative activities  
            performed by the DHCS for EMHI to the extent the department  
            determines it is available and that any necessary federal  
            approvals are obtained.  Further, it states that the EMHI  
            provisions shall not be construed to alter any existing  
            funding obligation in law associated with the provision of  
            eligible support services and early mental health intervention  
            services by county mental health departments or LEAs,  
            including responsibility for the nonfederal share of  
            permissible Medicaid expenditures, if any.










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          EMHI and HEAL Trauma in Schools Support Program
           Provides that the DHCS administers both programs.


           Expands students eligible for the EMHI, and applies the  
            eligibility to the HEAL Trauma in Schools Support Program, to  
            include a student who attends a state preschool program and  
            transitional kindergarten, in addition to students in public  
            kindergarten and in grades one through three.




          Related  
          Legislation:  AB 1133 (Achadjian, 2015), similar to this bill,  
          established a four-year pilot 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 104 (Committee on Budget, Chapter 13, Statutes of 2015)  
          included a one-time appropriation of $10 million Proposition 98  
          to a county office of education to provide technical assistance  
          and disseminate statewide resources that encourage and assist  
          LEAs in aligning systems of learning and behavioral supports,  
          including mental health services.  This funding is also for  
          grants to LEAs to implement these strategies and to evaluate and  
          learn from effective approaches.




          Staff  
          Comments:  This bill makes several changes to the former EMHI  
          program.  For example, it authorizes, beginning with grants for  
          the 2017-18 school year and subject to the availability of  
          funding, the DHCS to award matching grants to LEAs to pay the  
          state share of the costs of programs that provide early mental  








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          health intervention and prevention services.  This creates a  
          cost pressure to provide funds for the 2017-18 school year.   
          When it was last funded in the 2011-12 fiscal year, the EMHI  
          received $15 million in state funds.  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 budget  
          act.  Therefore, the EMHI program remains unfunded.  


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