BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 118
---------------------------------------------------------------
|AUTHOR: |Liu |
|---------------+-----------------------------------------------|
|VERSION: |January 14, 2015 |
---------------------------------------------------------------
---------------------------------------------------------------
|HEARING DATE: |March 25, 2015 | | |
---------------------------------------------------------------
---------------------------------------------------------------
|CONSULTANT: |Reyes Diaz |
---------------------------------------------------------------
SUBJECT : School-Based Health and Education Partnership Program
SUMMARY : Renames the Public School Health Center Support Program the
School-Based Health and Education Partnership Program and makes
changes to the requirements and funding levels. Creates a new
type of grant to fund interventions related to obesity, asthma,
alcohol and substance abuse, and mental health.
Existing law:
1.Requires the Department of Public Health (DPH) to establish
the Public School Health Center Support Program (PSHCSP), in
collaboration with the Department of Education (CDE), to
perform specified functions relating to the establishment,
retention, or expansion of school-based health centers (SBHCs)
in California.
2.Establishes a grant program administered by DPH to provide
technical assistance and funding to SBHCs, to the extent funds
are appropriated for implementation of the PSHCSP. Provides
for planning, facilities and startup, and sustainability
grants, as specified.
3.Defines an SBHC, for purposes of the PSHCSP, as a center or
program located at or near a local educational agency that
provides age-appropriate health care services at the program
site or through referrals. Defines a local educational agency
as a school, school district, charter school, or county office
of education, as specified.
This bill:
1.Renames the PSHCSP the School-Based Health and Education
Partnership Program (SBHEPP). Changes sustainability grant
amount from between $25,000 and $125,000 per year for a
SB 118 (Liu) Page 2 of ?
three-year period to between $50,000 and $100,000 on a
one-time basis. Deletes the requirement that the grant be used
for operating SBHCs or enhancing programming at SBHCs to
include oral health or mental health services and instead
requires the grant funds be used to develop new and leveraging
existing funding streams to support a sustainable funding
model for SBHCs. Provides examples of existing funding
streams, such as school district funds available under the
Local Control Funding Formula (LCFF), the federal Affordable
Care Act (ACA), and the Mental Health Services Act.
2.Creates a new population health grant in amounts between
$50,000 and $125,000 for a period of up to three years to fund
interventions to implement population health outcomes and
target specific health or education risk factors, including,
but not limited to: obesity prevention programs; asthma
prevention programs; early intervention for mental health; and
alcohol and substance abuse prevention. Requires applicants
for this grant to meet the same criteria as those for the
facilities and startup grant in existing law.
3.Adds to requirements for SBHEPP grantees to strive to address
the population health of an entire school by focusing on
prevention services, such as group and classroom education,
school wide prevention programs, community outreach
strategies; requires grantees to strive to provide integrated
and individualized support for students and families, and to
act as a partner with students or families to ensure that
health, social, or behavioral challenges are addressed.
4.Makes findings and declarations about the importance of SHBCs
and the role they play in providing an entire school with
prevention and health integration services, as well as a range
of wrap-around services to students and their families; makes
technical, clarifying changes.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1.Author's statement. According to the author, there are
currently 231 SBHCs in California that serve over 242,000
students with a range of services that meet specific needs of
the local student population. These centers have proven to be
an effective anchor for a broader community school strategy. A
SB 118 (Liu) Page 3 of ?
community school is both a place and a set of partnerships
between the school and other community resources that
integrates services and supports into the educational strategy
of the school. This approach improves student academic
achievement, increases attendance, reduces dropout rates,
improves behavior, and promotes parent engagement. These
outcomes benefit families and communities by generating
increased stability and public safety. SBHCs typically piece
together funding through a variety of sources including:
third-party billing reimbursement, such as Medi-Cal, in
kind-donations from schools and community agencies, grants,
and local revenues. The PSHCSP has existed in statute for
eight years yet has never been funded. It is time for this
program to be updated and funded, as it will expand the
availability and scope of medical and mental health services
available to students. This perfectly complements the LCFF
emphasis on addressing the needs of at-risk students and
building community resiliency.
2.SBHCs. According to the National School-Based Health Alliance
(NSBHA), SBHCs provide a broad array of primary care and
preventive services, including comprehensive health
assessments; prescriptions for medications; treatment for
acute illness; asthma treatment; oral health education; dental
screenings; and mental health assessments, crisis
intervention, brief and long-term therapy, and other services.
SBHC staff offer small group and classroom health promotion
and outreach, which help increase the number of students
exposed to programs and activities that discourage potentially
harmful behaviors including alcohol, tobacco, and drug abuse,
and violence and bullying. These programs also serve to help
promote healthy eating and active living. SBHCs work to ensure
that adolescents, a hard-to-reach population, have access to
the services they need to stay on a path to success. SBHCs are
the primary, and occasionally only, available health care for
many children and adolescents who otherwise would have no
access. The NSBHA states that Congress recognized the
importance of SBHCs as a key link in the nation's health care
safety net by providing $50 million a year for four years in
one-time funding for construction, renovation, and equipment
for SBHCs in the ACA.
According to the California School-Based Health Alliance
(CSBHA), 40 percent of SBHCs are in high schools, 25 percent
are in elementary schools, 10 percent are in middle schools,
SB 118 (Liu) Page 4 of ?
and 25 percent are "school-linked" or mobile medical vans.
CSBHA states that many SBHCs are located on school campuses
that serve some of the state's most vulnerable children, with
about 70 percent of students receiving free or reduced-price
meals. SBHCs 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. They are financed
through various sources, including grants from state, local,
and private sources; reimbursements from public programs, such
as the Child Health and Disability Prevention Program and
Medi-Cal; partnerships with local community clinics and
nonprofits; and fundraising efforts by their school districts.
According to CSBHA, more than half of SBHCs recover less than
50 percent of their operating costs from billing sources, as
many of them provide health education, case management, parent
support, and teacher consultation, much of which is not
reimbursable. CSBHA states that research shows investments in
SBHCs generate savings through reduced high-cost services,
reduced inappropriate emergency room use, and immunization
initiatives that prevent disease.
CSBHA believes that schools are a natural place to identify
health problems and offer solutions, as children spend six to
eight hours per day at school, and school-based interventions
eliminate transportation barriers faced by other obesity
prevention programs. CSBHA cites cases in which SBHCs have
implemented strategies, such as reducing television viewing,
increasing physical activity, and increasing fruit and
vegetable intake. Studies showed that school-based nutrition
and fitness programs were generally effective in improving
health behaviors, and one study found that 50 percent fewer
children in the intervention schools became overweight
compared to the study's control schools. CSBHA found that one
such SBHC's interventions compared favorably with other public
health campaigns, costing less per quality-adjusted life years
than programs such as adult hypertension prevention and adult
diabetes screening.
3.Obesity and other chronic diseases. DPH issued a study, The
Burden of Chronic Disease and Injury, in 2013 that highlights
some of the leading causes of death, such as heart disease,
cancer, stroke, and respiratory disease, all of which have a
strong connection to obesity. Diabetes is another serious
chronic disease stemming from obesity that adversely affects
SB 118 (Liu) Page 5 of ?
quality of life and results in serious medical costs. The last
decade has witnessed a 32 percent rise in diabetes prevalence,
affecting some 3.9 million people and costing upwards of $24
billion per year. According to the Centers for Disease Control
and Prevention, approximately 12.5 million children and
adolescents ages 2 to 19 years are obese. Research indicates a
tripling in the youth obesity rate over the past three
decades. While this increase has stabilized between the years
2005 and 2010, in 2010, 38 percent of public school children
were overweight and obese. Overweight youth face increased
risks for many serious detrimental health conditions that do
not commonly occur during childhood, including high
cholesterol and type-2 diabetes. Additionally, more than 80
percent of obese adolescents remain obese as adults.
4.Integrated Student Supports (ISS). In a white paper issued in
February 2014, Child Trends (a national non-profit research
center) looked at the benefits of ISS, which are a
school-based approach to promoting students' academic success
by developing, securing, and coordinating supports that target
academic and non-academic barriers to achievement. To date,
ISS programs have served more than 1.5 million students in
nearly 3,000 schools across the US, and Child Trends estimates
that Hispanic and black students account for more than 75
percent of the students enrolled in ISS programs. Research
cited by Child Trends indicates that the likelihood of
academic success, especially for disadvantaged students, is
enhanced by a more comprehensive set of supports at the
individual, family, and school levels, which implies that
providing an array of academic and non-academic supports in a
coordinated fashion is a more effective strategy than focusing
on one or a small set of supports. Child Trends found that
generally the return on investment for ISS programs ranged
from $4 to almost $15 for every dollar invested, which
suggests that the ISS approach yields a positive return on
investment.
5.Double referral. This bill was heard in the Senate Education
Committee on March 11, 2015, and passed with an 8-0 vote.
6.Related legislation. AB 766 (Ridley-Thomas) expands the
characteristics of schools that are to receive preference in
the awarding of PSHCSP 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 in
SB 118 (Liu) Page 6 of ?
the Assembly Health Committee.
AB 1025 (Thurmond) requires 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 is
pending in the Assembly Education Committee.
AB 1133 (Achadjian) 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.
7.Prior legislation. SB 1055 (Liu), of 2014, was identical to
this bill. SB 1055 died in the Senate Rules Committee.
SB 596 (Yee), of 2014, would have required CDE to establish a
three-year pilot program in four schools to provide
school-based mental health services that leverage cross-system
resources and offer comprehensive multitiered interventions;
allocated a total of $600,000 in start-up funding to each
school selected to participate in the program; and required
CDE to submit a report to the Legislature evaluating the
success of the program. SB 596 was held at the Assembly Desk.
AB 1955 (Pan), of 2014, would have required the SPI to
establish the Healthy Kids, Healthy Minds Demonstration, which
would provide grants to local educational agencies for the
purpose of employing one full-time school nurse and one
full-time mental health professional, and ensured that the
schools' libraries were open one hour before and three hours
after the regular school day. AB 1955 was held on the Assembly
Appropriations Committee's suspense file.
AB 174 (Bonta), of 2013, would have required DPH to establish
a pilot grant program in Alameda County, to the extent that
funding was made available, to provide resources 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 Governor Brown, who stated in his
veto message that, while he supports the efforts of the bill,
Alameda County can establish such a program without state
intervention and may even be able to use existing funds to do
so. In addition, Governor Brown stated that all counties, not
SB 118 (Liu) Page 7 of ?
just Alameda, should explore all funding options, including
Mental Health Services Act funds, to tailor programs that best
meet local needs.
AB 1178 (Bocanegra), of 2013, would have established the
California Promise Neighborhood Initiative to provide 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 failed in the
Assembly Appropriations Committee.
SB 564 (Ridley-Thomas), Chapter 381, Statutes of 2008,
specified that an SBHC may conduct routine physical health,
mental health, and oral health assessments, and provide for
any services not offered onsite or through a referral process.
The bill also required DPH, to the extent funds are
appropriated for implementation of the PSHCSP, to establish a
grant program to provide technical assistance, and funding for
the expansion, renovation, and retrofitting of existing SBHCs,
and the development of new SBHCs, in accordance with specified
procedures.
AB 2560 (Ridley-Thomas), Chapter 334, Statutes of 2006,
required the Department of Health Services (DHS), in
cooperation with CDE, to establish the PSHCSP to perform
specified functions relating to the establishment, retention,
or expansion of SBHCs; required DHS to establish standardized
data collection procedures and collect specified data from
SBHCs on an ongoing basis; required CDE, in collaboration with
DHS, to coordinate programs within CDE and programs within
other specified departments to support SBHCs and to provide
technical assistance to facilitate and encourage the
establishment, retention, and expansion of SBHCs; and required
the program to provide a biennial update to the appropriate
policy and fiscal committees of the Legislature containing
specified information regarding SBHCs, beginning on or before
January 1, 2009.
AB 2105 (Scott) of 2000 would have required the Director of
Mental Health, in consultation with the Secretary of Child
Development and Education and the Superintendent of Public
Instruction, to establish a program to award planning grants
to counties for the provision of school-based mental health
services to children, according to specified criteria, and to
SB 118 (Liu) Page 8 of ?
the extent funding was made available for that purpose. This
bill would have also required the director to provide a
preliminary report on the program to the Governor, appropriate
policy and fiscal committees of the Legislature, and the
Legislative Analyst on or before January 1, 2003, and to
provide a final report to these entities on or before January
1, 2007. AB 2105 failed in the Assembly Appropriations
Committee.
SB 566 (Escutia) of 1999 would have established the SBHC Grant
Program, to be administered by DHS, to provide grants to
qualifying SBHCs in order to assist the centers in providing
health services to students, provided that funds were
appropriated in the annual Budget Act. This bill also would
have required DHS to convene a study group to explore
long-term strategies to support SBHCs and incorporate these
centers into a comprehensive and coordinated health care
system. SB 566 was moved to the inactive file on the Senate
Floor.
8.Support. CSBHA, the California Primary Care Association,
Children Now, Children's Defense Fund-California, the Los
Angeles Trust for Children's Health, and the Partnership for
Children & Youth state that children attend school daily
suffering from mental health issues, poor nutrition, asthma,
diabetes, and other conditions that seriously impact their
ability to learn and succeed. Even though 93 percent of
children have health insurance, almost 20 percent of them did
not have a recommended annual preventive medical visit in
2011. The California Black Health Network states that SBHCs
can specifically help boys and young men of color, who are
more likely than whites to characterize their health as "poor"
or "fair," through a range of services designed to meet their
needs. Students who use SBHCs are more likely to use primary
care more consistently and are less likely to visit the
emergency room or be hospitalized.
9.Policy comment. According to the author's office, the PSHCSP
has existed in statute for eight years and has never been
implemented due to a lack of funding. However, this bill does
not include provisions to provide for future funding, so it is
unclear what the impact would be. The author may wish to
include a funding source so that the SBHEPP does not continue
to go unfunded should this bill be chaptered.
SB 118 (Liu) Page 9 of ?
10.Technical amendments. The author has agreed to the following
amendments in bold, italics, and underline:
SEC. 1 Section 124174 of the Health and Safety Code is amended
to read:
124174(b) "School health center" means a center or program,
located at or near a local educational agency, that provides
age-appropriate health care services at the program site or
through referrals. A school health center may conduct routine
physical, mental health, alcohol and substance abuse, and oral
health assessments, and provide referrals for any services not
offered onsite. A school health center may serve two or more
nonadjacent schools or local educational agencies.
SEC. 3. Section 124174.6 of the Health and Safety Code is
amended to read:
124174.6(a)(2)(H) Mental health and alcohol and substance
abuse services provided or supervised by an appropriately
licensed mental health or alcohol and substance abuse
professional may include: assessments, crisis intervention,
counseling, treatment, and referral to a continuum of services
including emergency psychiatric care, evidence-based mental
health or alcohol and substance abuse treatment services,
community support programs, inpatient care, and outpatient
programs. School health centers providing mental health and
alcohol and substance abuse services as specified in this
section shall consult with the local county mental health
behavioral health department for collaboration in planning and
service delivery.
124174.6(a)(5) Work in partnership with the school nurse, if
one is employed by the school or school district, local
educational agency, to provide individual and family health
education; school or districtwide health promotion; first aid
and administration of medications; facilitation of student
enrollment in health insurance programs; screening of students
to identify the need for physical, mental health, alcohol and
substance abuse, and oral health services; referral and
linkage to services not offered onsite; public health and
disease surveillance; and emergency response procedures. A
school health center may receive grant funding pursuant to
this section if the school or school district local
educational agency does not employ a school nurse. However, it
SB 118 (Liu) Page 10 of ?
is not the intent of the Legislature that a school health
center serve as a substitute for a school nurse employed by a
local school or school district. educational agency.
SUPPORT AND OPPOSITION :
Support: California School-Based Health Alliance (sponsor)
California Black Health Network
California Primary Care Association
Children Now
Children's Defense Fund-California
Los Angeles Trust for Children's Health
Partnership for Children & Youth
Oppose: None received.
-- END --