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 countymental healthbehavioral 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 theschool 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 theschool or school districtlocal 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 localschool 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 --