SB 118 Senate Bill - Bill Analysis

BILL ANALYSIS Ó

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

Bill No: SB 118
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|Author: |Liu |
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|Version: |January 14, 2015 |Hearing |March 11, 2015 |
| | |Date: | |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant: |Lynn Lorber |
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Subject: School-Based Health and Education Partnership Program

NOTE: This bill has been referred to the Committees on
Education and Health. A "do pass" motion should include
referral to the Committee on Health.

SUMMARY

This bill modifies and renames an existing school health center
grant program to add a population health grant, alter existing
sustainability grant amounts, add services for which the grants
may be used, and updates terminology.

BACKGROUND

Current law:

School health centers

1. Requires the Department of Public Health to establish
the Public School Health Center Support Program, in
cooperation with the California Department of Education, to
perform specified functions relating to the establishment,
retention, or expansion of school health centers in
California.
(Health & Safety Code § 124174.2)

2. Defines "school health center" as a center or program,
located at or near a school, that provides age-appropriate
health care services at the program site or through
referrals. Current law authorizes a school health center

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to conduct routine physical, mental health, and oral health
assessments, and provide referrals for any services not
offered onsite. (HSC § 124174)

3. Establishes a grant program administered by the
Department of Public Health to provide technical assistance
and funding to school health centers, to the extent funds
are appropriated for this purpose.

A. Planning grants in amounts between
$25,000-$50,000.

B. Facilities and startup grants in amounts
between $20,000-$250,000

C. Sustainability grants in amounts between
$25,000-$125,000.
(HSC § 124174.6)

1. Requires school health centers that receive a grant to
meet or have a plan to meet the following requirements:

A. Strive to provide a comprehensive set of
services including medical, oral health, mental
health, health education, and related services in
response to community needs.

B. Provide primary and other health care
services, provided or supervised by a licensed
professional, which may include physical exams,
diagnosis and treatment of minor injuries and medical
conditions, management of chronic medical conditions,
referrals and follow-up for specialty care,
reproductive health services, mental health services
as specified, and oral health services.

C. Work in partnership with the school nurse, as
specified.

D. Have a written contract or memorandum of
understanding between the school district and the
health care provider or other community provider.

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E. Serve all students regardless of ability to
pay.

F. Be open during all normal school hours, as
specified.

G. Establish protocols for referring students to
outside services when the school health center is
closed.

H. Facilitate transportation, as specified. (HSC
§ 124174.6)

Authority to assess and provide services

Current law:

1. Authorizes credentialed school nurses to perform
specified duties, including assess and evaluate health and
development, refer students and parents to appropriate
community resources, and counsel students and parents.
(Education Code § 49426)

2. Authorizes school districts to permit specified licensed
health practitioners to administer an immunizing agent to a
student whose parent or guardian has consented in writing
to the administration of the immunizing agent. (EC §
49403)

3. Requires a psychologist employed by a school district to
hold specified credentials, and prohibits an employee of a
school district from administering psychological tests or
engage in psychological activities unless specified
criteria is met. (EC § 49422 and § 49424)

Pupil Personnel Services credentials authorize individuals to
provide school services in preschool through grades 12 as
counselors, school psychologists, school social workers, or
school child welfare and attendance regulators, according to the
specific specialization area and service authorization listed on
the credential.

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Seeking medical services

Current law:

1. Requires school districts to annually notify students in
grades 7-12, and parents of all students enrolled in the
school district, that schools may excuse students for the
purpose of obtaining confidential medical services without
the consent of the student's parent. (Education Code §
46010.1)

2. Authorizes minors to seek confidential medical services,
without the consent of a parent, as follows:

A. A minor who is 12 years of age or older to
consent to mental health treatment or counseling on an
outpatient basis, or to residential shelter services,
if certain conditions are met. Current law requires
the mental health treatment or counseling of a minor
to include involvement of the minor's parent or
guardian unless, in the opinion of the professional
person who is treating or counseling the minor, the
involvement would be inappropriate. (Family Code §
6924)

B. A minor who is 12 years of age or older to
consent to medical care and counseling relating to the
diagnosis and treatment of a drug- or alcohol-related
problem. (FC § 6929)

C. A minor to consent to medical care related to
the prevention or treatment of pregnancy, but may not
be sterilized or receive an abortion without the
consent of a parent, other than in a medical emergency
or pursuant to court order. (FC § 6925)

D. A minor who is 12 years of age or older and
who may have come into contact with an infectious,
contagious, or communicable disease, if the disease or
condition is one that is required to be reported to
the local health officer, or is a related sexually
transmitted disease.
(FC § 6926)

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E. A minor who is 12 years of age or older and
who is alleged to have been raped to consent to
medical care related to the diagnosis or treatment of
the condition and the collection of medical evidence
with regard to the alleged rape. (FC § 6927)

F. A minor who is alleged to have been sexually
assaulted to consent to medical care related to the
diagnosis and treatment of the condition, and the
collection of medical evidence with regard to the
alleged sexual assault. Current law requires the
professional person providing medical treatment to
attempt to contact the minor's parent or guardian.
(FC § 6928)

G. A minor to consent to the minor's medical care
or dental care if the minor is 15 years of age or
older, is living separate and apart from the minor's
parents with or without the consent of the parent, and
is managing the minor's own financial affairs,
regardless of the source of income.
(FC § 6922)

ANALYSIS

1. Renames the Public School Health Center Support Program to
the School-Based Health and Education Partnership Program.

2. Adds the following to the elements that school health
center grantees must include or provide:

A. Strive to address the population health
of the entire school campus by focusing on prevention
services such as group and classroom education,
schoolwide prevention programs, and community outreach
strategies.

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B. Strive to provide integrated and
individualized support for students and families, and
to act as a partner with the student or family to
ensure that health, social, or behavioral challenges
are addressed.

C. Alcohol and substance abuse services.

3. Adds the referral to evidence-based mental health treatment
services to the list of mental health services that may be
provided or supervised by an appropriately licensed mental
health professional.

4. Establishes population health grants in amounts $50,000 to
$125,000 for a funding period of up to three years to fund
interventions to target specific health or education risk
factors that affect a larger segment of the population
including, but not limited to:

A. Obesity prevention programs.

B. Asthma prevention programs.

C. Early intervention for mental health.

D. Alcohol and substance abuse prevention.

5. Limits sustainability grants from a three-year period to a
one-time basis, and modifies the grant amounts as follows:

A. Increases the minimum grant amount from $25,000
to $50,000.

B. Decreases the maximum grant amount from $125,000
to $100,000.

6. Modifies the purpose of sustainability grants from
operating a school health center, or enhancing programming
at a fully operational school health center, including oral
health or mental health services, to:

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A. Developing new and leveraging existing
funding streams to support a sustainable funding model
for school health centers .

B. Examples of existing funding streams
include school district funds available under the
Local Control Funding Formula, federal Affordable Care
Act, or Mental Health Services Act.

7. Strikes reference to the obsolete Healthy Families Program
and Managed Risk Medical Insurance Board, adds references
to Covered California, and modifies the name of the grant
program.

8. Adds the following to uncodified legislative findings and
declarations:

A. School health centers are important
sites through which to increase child and adolescent
access to health care services and early
identification of chronic diseases, such as asthma and
obesity, and high-risk health behaviors.

B. School-based health centers serve as an
effective foundation upon which schools and
communities can build and implement a community
schools strategy providing a range of wrap-around
services to students and their families.

STAFF COMMENTS

1. Existing school health centers. Schools currently have the
discretion to provide health services to students, or refer
students to county and community organizations. There are
currently 231 school-based health centers (40% are in high
schools, 25% are in elementary schools, 10% are in middle
schools, and 25% are "school-linked" or mobile medical
vans) in the State serving over 242,000 students and
providing a range of services including comprehensive
health assessments, treatment for acute illness, asthma
treatment, oral health education, dental screenings, mental
health assessments, crisis intervention, brief and
long-term therapy, and other services. Services are

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provided on-site by qualified professionals and those that
require expertise or specialization beyond the school
health center's capacity may be referred to county agencies
and community organizations.

School health centers are administered by a variety of
organizations, including school districts, Federally
Qualified Health Centers, county health departments,
hospitals, community-based agencies, and private physician
groups. School health centers are financed through various
sources, including grants, reimbursements from public
programs such as the Child Health and Disability Prevention
Program and Medi-Cal, partnerships with local community
clinics and nonprofit, and fundraising efforts by school
districts.

This bill modifies an existing grant program to assist school
districts to establish and maintain school health centers.
This bill does not provide funding for the school health
center grant program.

2. Will kids be provided services without parental consent?
Current law authorizes school districts to permit specified
licensed health practitioners to administer an immunizing
agent to a student whose parent or guardian has consented
in writing to the administration of the immunizing agent.

Current law prohibits a student from being tested by a school
for a behavioral, mental, or emotional evaluation without
the informed written consent of the parent, prohibits a
minor from being sterilized or receiving an abortion
without parental consent (other than in a medical emergency
or pursuant to court order), and places other restrictions
on minors receiving medical care without parental consent
(see Background).

Generally speaking, parental consent is required for a minor's
medical treatment. (American Academy of Pediatrics v.
Lungren (1997)) There are, however, exceptions such as when
the public interest in preserving the health of a minor
takes precedence over the parent's interest in custody and
control of the minor. (Wisconsin v. Yoder (1972)) In
addition, a number of "medical emancipation" statutes allow

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minors to consent to medical treatment without parental
knowledge, approval or consent (see Background).

3. School health center grants. The Public School Health
Center Support Program has existed in statute for eight
years but has never been funded, and therefore never
implemented. This bill makes the following substantive
changes to this grant program:

A. Establishes population health grants, in amounts
between $50,000-$125,000 for up to a three-year
period, to fund interventions to target specific
health or education risk factors that affect a larger
segment of the population including, but not limited
to obesity prevention programs, asthma prevention
programs, early intervention for mental health,
alcohol and substance abuse prevention.

B. Limits sustainability grants from a three-year
period to a one-time basis, increases the minimum
grant amount from $25,000 to $50,000, and decreases
the maximum grant amount from $125,000 to $100,000.

C. Adds the following to the elements that school
health center grantees must include or provide:

(1) Strive to address the population health
of the entire school campus by focusing on
prevention services such as group and classroom
education, schoolwide prevention programs, and
community outreach strategies.
(2) Strive to provide integrated and
individualized support for students and families,
and to act as a partner with the student or
family to ensure that health, social, or
behavioral challenges are addressed.
(3) Alcohol and substance abuse services.

D. Adds the referral to evidence-based mental health
treatment services to the list of mental health
services that may be provided or supervised by an
appropriately licensed mental health professional.

This bill does not modify the existing condition that the

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grant program be implemented only to the extent that funds
are appropriated to the Department of Public Health for
that purpose.

4. Fiscal impact. According to the Senate Appropriations
Committee analysis of prior legislation, this bill would
impose "unknown costs to provide additional grants (General
Fund or other, unknown fund source). The bill does not
identify a source of funds for these new grants."

5. Related and prior legislation.

RELATED LEGISLATION

AB 766 (Ridley-Thomas, 2015) expands the characteristics of
schools that are to receive preference in the awarding of
Public School Health Center Support grants to include
schools with a high percentage of youth who receive free-
or low-cost insurance through Medi-Cal or Covered
California. AB 766 is pending referral in the Assembly.

AB 1025 (Thurmond, 2015) requires the California Department of
Education to establish a three-year pilot program to
encourage inclusive practices that integrate mental health,
special education and school climate interventions
following a multi-tiered framework. AB 1025 is pending
referral in the Assembly.

AB 1133 (Achadjian, 2015) makes technical changes to existing
law regarding grants to local educational agencies to pay
the State share of costs of providing school-based early
mental health intervention and prevention services to
eligible students. AB 1133 is pending referral in the
Assembly.

PRIOR LEGISLATION

SB 1055 (Liu, 2014) was identical to this bill. SB 1055 passed
the Senate Education, Health and Appropriations committees
but was re-referred to and held in the Senate Rules
Committee prior to a vote on the Senate Floor.

AB 2555 (Bocanegra, 2014) required the Superintendent of Public
Instruction (SPI), in collaboration with the Department of

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Social Services and a number of entities, to develop a
five-year plan for expanding cradle-to-career initiatives,
as specified, throughout the State. AB 2555 was held on the
Assembly Appropriations Committee's suspense file.

AB 1955 (Pan, 2014) required the SPI to establish the Healthy
Kids, Healthy Minds Demonstration which will provide grants
to local educational agencies for the purpose of employing
one full-time school nurse and one full-time mental health
professional, and ensuring that the schools' libraries are
open one hour before and three hours after the regular
school day. AB 1955 was held on the Assembly
Appropriations Committee's suspense file.

SB 596 (Yee, 2014) required the California Department of
Education to establish a three-year pilot program to
encourage inclusive practices that integrate mental health,
special education, and school climate interventions
following a multi-tiered framework. SB 596 was held at the
Assembly Desk.

AB 174 (Bonta, 2013) would have required the Department of
Public Health to establish a pilot program in Alameda
County, to the extent that funding is made available, to
provide grants to eligible applicants for activities and
services that directly address the mental health and
related needs of students impacted by trauma. AB 174 was
vetoed by the Governor, whose veto message read:

"I support the efforts of the bill but am returning it
without my signature, as Alameda County can establish
such a program without state intervention and may even
be able to use Mental Health Services Act funding to
do so.

Waiting for the state to act may cause unnecessary
delays in delivering valuable mental health services
to students. All counties - not just Alameda- should
explore all potential funding options, including
Mental Health Services Act funds, to tailor programs
that best meet local needs."

AB 1178 (Bocanegra, 2013) would have established the
California Promise Neighborhood Initiative to provide

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funding to schools that have formalized partnerships with
local agencies and community organizations to provide a
network of services to improve the health, safety,
education, and economic development of a defined area. AB
1178 was held in the Assembly Appropriations Committee.

AB 1367 (Mansoor, 2013) would have among other things,
expanded existing outreach about recognition of early signs
of potentially severe and disabling mental illness to
include school districts and county offices of education
and charter schools, including funding to provide training
to identify students with mental health issues that may
result in a threat to themselves or others in order to
provide for timely intervention. AB 1367 was never heard.

AB 2105 (Scott, 2000) would have required the California
Department of Education to establish a two-year pilot
project in three school districts to improve the delivery
of education services to children who need mental health
services. AB 2105 was held in the Assembly Appropriations
Committee.

SUPPORT

California School-Based Health Alliance
Los Angeles Trust for Children's Health

OPPOSITION

None on file.

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