BILL ANALYSIS                                                                                                                                                                                                    Ó






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          |SENATE RULES COMMITTEE            |                        SB 118|
          |Office of Senate Floor Analyses   |                              |
          |(916) 651-1520    Fax: (916)      |                              |
          |327-4478                          |                              |
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                                   THIRD READING 


          Bill No:  SB 118
          Author:   Liu (D)
          Amended:  4/7/15  
          Vote:     21  

           SENATE EDUCATION COMMITTEE:  8-0, 3/11/15
           AYES:  Liu, Huff, Block, Hancock, Leyva, Mendoza, Pan, Vidak

           SENATE HEALTH COMMITTEE:  9-0, 3/25/15
           AYES:  Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,  
            Pan, Roth, Wolk

           SENATE APPROPRIATIONS COMMITTEE:  7-0, 5/28/15
           AYES:  Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen

           SUBJECT:   School-Based Health and Education Partnership  
                     Program


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

          ANALYSIS:   


          Existing law:

          School health centers









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          1)Requires the Department of Public Health (DPH) 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 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 DPH 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.







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

             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

          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.

          Seeking medical services

       1)Requires school districts to annually notify students in grades  
            7-12, and parents of all students enrolled in the school  







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            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)

             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  







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               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)

          This bill:

          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. 

             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 or alcohol  
            and substance abuse 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.








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             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:

             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  







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               implement a community schools strategy providing a range of  
               wrap-around services to students and their families.

          Background
          
          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 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.

           Comments
           
          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  







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

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   No


          According to the Senate Appropriations Committee, this bill  
          imposes 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.  The current program has  
          been authorized in statute for eight years, but has never been  
          funded.




          SUPPORT:   (Verified5/29/15)


          Alliance for Boys and Men of Color
          Auburndale Intermediate School
          California Black Health Network
          California Pan-Ethnic Health Network
          California Primary Care Association
          Children Now
          Common Sense Kids Action
          Community Clinic Association of Los Angeles County
          James Morehouse Project
          Mental Health America of California
          Partnership for Children & Youth
          Planned Parenthood Affiliates of California
          PolicyLink
          The Greenlining Institute








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          OPPOSITION:   (Verified5/29/15)


          None received


          ARGUMENTS IN SUPPORT:     According to the California Pan-Ethnic  
          Health Network, research shows that users of school-based health  
          centers are more likely to have yearly dental and medical  
          check-ups and are less likely to go to the Emergency Room or be  
          hospitalized.  Students enrolled in a school with a school-based  
          health center are absent three times less often than students  
          not utilizing a school-based health center.



          Prepared by:Lynn Lorber / ED. / (916) 651-4105
          5/30/15 18:34:05


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