BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 291|
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THIRD READING
Bill No: SB 291
Author: Lara (D)
Amended: 4/28/15
Vote: 21
SENATE HEALTH COMMITTEE: 7-0, 4/22/15
AYES: Hernandez, Nguyen, Mitchell, Monning, Pan, Roth, Wolk
NO VOTE RECORDED: Hall, Nielsen
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SUBJECT: Mental health: vulnerable communities
SOURCE: Cambodian Advocacy Collaborative
DIGEST: This bill requires the Office of Statewide Health
Planning and Development to include all of the elements in the
Health Manpower Plan, as specified, when addressing workforce
education and training programs and activities and workforce
shortages and deficits to meet the mental health needs of
vulnerable communities; expands the definition of "vulnerable
communities," as specified; and requires the Department of
Health Care Services to include stakeholders in vulnerable
communities, as specified, in its meaningful decision making
process for purposes of providing technical assistance to
specified entities.
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ANALYSIS:
Existing law:
1)Establishes the Office of Statewide Health Planning and
Development (OSHPD) to, among other duties, collect data and
disseminate information about the state's health care
infrastructure. Requires OSHPD to prepare a Health Manpower
Plan for the state to establish standards for and determine
the adequacy of policies relating to health care practitioners
to serve the needs of the state, consisting of at least the
following elements:
a) The establishment of appropriate standards for
determining the adequacy of supply in California of at
least each of the following categories of health personnel:
physicians, midlevel medical practitioners (physician's
assistants and nurse practitioners); nurses; dentists;
midlevel dental practitioners (dental nurses and dental
hygienists); optometrists; optometry assistants;
pharmacists; and pharmacy technicians.
b) A determination of appropriate standards for the
adequacy of supply of the categories in (a) to be made by
taking into account all of the following: current levels of
demand for health services in California; the capacity of
each category of personnel in (a) to provide health
services; the extent to which midlevel practitioners and
assistants can substitute their services for those of other
personnel; the likely impact of the implementation of a
national health insurance program on the demand for health
services in California; professionally developed standards
for the adequacy of the supply of health personnel; and
assumptions concerning the future organization of health
care services in California.
c) A determination of the adequacy of the current and
future supply of health personnel by category in (a),
taking into account the sources of supply for such
personnel in California, the magnitude of immigration of
personnel to California, and the likelihood of the
immigration continuing.
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d) A determination of the adequacy of the supply of
specialties within each category of health personnel in
(a). The determination shall be made, based upon standards
of appropriate supply to specialty developed in accordance
with (b).
e) Recommendations concerning changes in health manpower
policies, licensing statutes, and programs needed to meet
the state's need for health personnel.
2)Establishes the Office of Health Equity (OHE) within the
Department of Public Health (DPH) to align state resources,
decision making, and programs to establish various goals
relating to health. Requires OHE to perform various duties
relating to vulnerable communities.
3)Defines "vulnerable communities" as, but not limited to:
a) Women;
b) racial or ethnic groups;
c) low-income individuals and families;
d) individuals who are and have been incarcerated;
e) individuals with disabilities;
f) individuals with mental health conditions;
g) children, youth and young adults, and seniors,
h) immigrants and refugees;
i) individuals who are limited-English proficient;
j) lesbian, gay, bisexual, transgender, queer, and
questioning (LGBTQQ) communities; or,
aa) combinations of these populations.
4)Requires the Department of Health Care Services (DHCS) to
provide, to the extent resources are available, technical
assistance to county mental health programs and other local
mental health agencies, through DHCS staff or by contract, in
the areas of program operations, research, evaluation,
demonstration, or quality assurance projects. Requires DHCS to
utilize a meaningful decision making process that includes
local mental health directors and representatives of local
mental health boards, as well as other stakeholders as
determined by DHCS.
This bill:
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1)Requires OSHPD to include all of the elements in the Health
Manpower Plan in 1) above, inclusive, as appropriate, when
addressing workforce education and training programs and
activities and workforce shortages and deficits identified in
the Workforce Needs Assessment for the purposes of meeting the
mental health needs of vulnerable communities.
2)Expands the definition of "vulnerable communities" to include
individuals who have experienced trauma related to genocide.
3)Requires DHCS to include stakeholders in vulnerable
communities in its meaningful decision making process, for
purpose of providing technical assistance, including:
a) diverse racial, ethnic, cultural, and LGBTQQ
communities;
b) communities that experience trauma related to genocide;
c) women's health advocates;
d) mental health advocates;
e) health and mental health providers;
f) community-based organizations and advocates;
g) academic institutions;
h) local public health departments;
i) local government entities; and,
j) low-income and vulnerable consumers.
Comments
1)Author's statement. According to the author, OSHPD, OHE, DHCS,
and other state and local entities have been charged with
carrying out various mental health initiatives, yet barriers
remain. In particular the Cambodian-American population, which
has the largest population in California, still suffers from
the effects of the Cambodian Genocide that occurred between
1975 and 1979. Their mental health challenges are
multigenerational, extending past the elders who were refugees
to the youth who are born in the U.S. Unfortunately, the
Cambodian community is lumped together, if recognized at all,
under the Asian Pacific-Islander category by departments. The
current system, where groups are collapsed together in a broad
category, disenfranchises people who suffer from trauma
related to genocide. These individuals have unique challenges
that cannot be generalized by any other category and,
therefore, should be separately assessed. In the absence of
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laws that highlight this group as a vulnerable population,
smaller community and non-profit organizations that serve
these individuals are often unable to access funding under the
current system. In the interest of continuing the state's goal
towards advancing mental health care access, SB 291 will
improve institutional access for Californians who have
experienced trauma related to genocide by improving
stakeholder engagement, service delivery, and ultimately
access to mental health services.
2)Health care disparities. According to the Health Services
Research Community of the National Institutes of Health,
health care disparities refer to differences in access to or
availability of facilities and services. Health status
disparities refer to the variation in rates of disease
occurrence and disabilities between socioeconomic and/or
geographically defined population groups. Health disparities
have been measured between those of a different race,
ethnicity, gender, sexual orientation, age, ability, religion,
socioeconomic status, language proficiency, and geographic
location. Many racial and ethnic minorities, people with
disabilities, and LGBTQQ communities face unique health
challenges, have reduced access to health care and insurance,
and often have poorer health throughout their lives. For
example, research suggests LGBTQQ people and families may face
significant challenges associated with health disparities in
insurance coverage and access to health care services.
3)Behavioral health evidence-based/best practice service
provision lacking in the state? The Technical Assistance
Collaborative/Human Services Research Institute's final report
in February 2012, California Mental Health and Substance Use
System Needs Assessment, notes that the percent of individuals
reported to be receiving an evidence-based practice service
was low: only one percent in 2010, down from two percent in
2009. It also notes that there is a variability among counties
in the use and training of staff in state-of-the-art and
evidence-based and recovery-oriented treatment; there is a
need to address better preparation of physical health
providers to engage and treat people with behavioral health
needs; and there is still disproportionate access to
behavioral health services on the part of certain ethnic
populations-compounded by the relative lack of cultural and
linguistic capacity among providers and practitioners in the
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state.
4)Let's Get Healthy Task Force. In May 2012, Governor Jerry
Brown established the Let's Get Healthy California Task Force
(Task Force) to develop a 10-year plan for improving the
health of Californians, controlling health care costs,
promoting personal responsibility for individual health, and
advancing health equity. The Executive Order directed the Task
Force to issue a report with recommendations for how the state
can make progress toward becoming the healthiest state in the
nation over the next decade. In the report, issued in December
2012, the Task Force developed an overarching framework,
identifying six goals, organized under two strategic
directions: Health Across the Lifespan and Pathways to Health.
The report states that the framework makes clear that health
equity should be fully integrated across the entire effort.
5)State's current efforts. According to OSHPD's Web site, the
passage of Proposition 63, the Mental Health Services Act
(MHSA), provided a unique opportunity with funding to increase
staffing and other resources that support public mental health
programs, increase access to much-needed services, and monitor
progress toward statewide goals for serving children,
transition age youth, adults and older adults, and their
families. California's public mental health system has
suffered from a shortage of public mental health workers,
maldistribution of certain public mental health occupational
classifications, a recognized lack of diversity in the
workforce, and underrepresentation of professionals with
consumer and family member experience, and of racial, ethnic,
and cultural communities in the provision of services and
support. To address the public mental health workforce issues,
the MHSA included a component for Mental Health Workforce
Education and Training (WET) programs. In 2008, the former
Department of Mental Health developed the first WET
Development Five-Year Plan, which covered the period April
2008 to April 2013 and provided vision, values, and mission
for state and local implementation of WET programs. In July
2012, the MHSA WET programs were transferred to OSHPD, which
assumed the responsibility of administering the WET programs
and developing the second MHSA WET Five-Year Plan. OSHPD, with
advice from stakeholders and approval by the California Mental
Health Planning Council, developed the second MHSA WET
Five-Year Plan, which covers the period of April 2014 to April
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2019 and provides a framework on strategies that state, local
government, community partners, education and training
institutions, and other stakeholders can enact to further
public mental health workforce, education, and training
efforts.
DHCS. DHCS recently indicated that, beginning in Fiscal Year
2015-2016, it will stratify quality measures by demographic
factors. Their goal is to focus quality improvement efforts to
eliminate heath disparities and improve quality overall. DHCS
is in the process of identifying initial measures to conduct
this analysis. Another demographic analysis currently
conducted by DHCS is the use of managed care plan grievances
and appeals data. DHCS is able to determine if an
over-prevalence of grievances and/or appeals exists among a
specific demographic group. DHCS has previously collected race
and/or ethnicity data when conducting the Consumer Assessment
of Healthcare Providers and Systems (CAHPS) survey. This
survey is a measure of Medi-Cal beneficiary satisfaction. DHCS
reports they will continue to conduct this analysis by race
and/or ethnicity and use the CAHPS survey to collect
additional demographic factors.
Covered California. Covered California has stated that one of
its missions is to reduce health disparities, and that it
recognizes the diverse cultural, language, economic,
educational, and health status needs of those they serve.
Their ongoing outreach initiatives include efforts to enroll
underserved beneficiaries. Covered California runs the
Community Outreach Network, which partners with local
organizations across the state to provide information,
resources, and training. Community Outreach Network partners
include organizations devoted to serving at-risk (vulnerable)
populations, including immigrants, African Americans, Asians
and Asian sub-populations, LGBTQQ, Mexican Americans, Native
Americans, and HIV and AIDS patients. Partners distribute
materials, provide outreach and enrollment assistance, and are
compensated by Covered California for each application that
leads to a purchase. Covered California has also awarded $43
million in grants to organizations that have trusted
relationships with culturally and linguistically diverse
uninsured markets.
FISCAL EFFECT: Appropriation: No Fiscal
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Com.:YesLocal: No
According to the Senate Appropriations Committee:
One-time costs of $600,000 - $700,000 to develop a needs
assessment of workforce training and educational needs to meet
the mental health needs of vulnerable communities (California
Health Data and Planning Fund).
No additional costs are anticipated for the OHE to include
individuals who have experienced trauma related to genocide in
the OHE programs for vulnerable communities.
No additional costs are anticipated for the DHCS to consult
with additional stakeholders.
SUPPORT: (Verified5/28/15)
Cambodian Advocacy Collaborative (source)
African Communities Public Health Coalition
Asian Americans Advancing Justice - Los Angeles
Asian American Pacific Islander Health Research Group
Asian Pacific Environmental Network
Building Health Communities: Long Beach
Cambodian Americans for Rural Education Foundation
Cambodian Association of America
Center for the Pacific Asian Family
Children's Defense Fund California
Families in Good Health
Institute for Multicultural Counseling and Education Services
Los Angeles Lesbian, Gay, Bisexual, Transgender Center
Khmer Parent Association
Khmer Girls in Action
Kingdom Causes Long Beach
Mental Health America's Homeless Innovations Project
Santa Clara County Board of Supervisors
Southeast Asia Resource Action Center
U.S. Representative Alan Lowenthal
Vietnamese Youth Development Center
OPPOSITION: (Verified5/28/15)
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None received
ARGUMENTS IN SUPPORT: Supporters of this bill argue that
there continues to be barriers to accessing mental health
services, especially for the Cambodian community, which still
suffers from effects of genocide that occurred between the years
of 1975 and 1979. They further argue that because many Asian
subpopulations get lumped together as Asian Pacific-Islander,
groups that have experienced trauma related to genocide are
disenfranchised, particularly because of unique challenges.
Supporters cite mounting research that shows trauma/stress
affects brain development, as well as physical and mental
health.
Prepared by: Reyes Diaz / HEALTH /
5/31/15 13:21:32
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