BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 118| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 SB 118 Page 2 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. SB 118 Page 3 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 SB 118 Page 4 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 SB 118 Page 5 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. SB 118 Page 6 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 SB 118 Page 7 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 SB 118 Page 8 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 SB 118 Page 9 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 **** END ****