BILL ANALYSIS Ó
SB 291
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Date of Hearing: July 14, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
SB
291 (Lara) - As Amended April 28, 2015
SENATE VOTE: 36-1
SUBJECT: Mental health: vulnerable communities.
SUMMARY: Requires the Office of Statewide Health Planning and
Development (OSHPD) to create a Workforce Needs Assessment to
assess the mental health needs of vulnerable communities; amends
the definition of vulnerable communities to include individuals
who have experienced trauma related to genocide; and, requires
the Department of Health Care Services (DHCS) to include
stakeholders in vulnerable communities, as defined, in its
decision making process, to promote effective and efficient
quality mental health services.
EXISTING LAW:
1)Establishes OSHPD to collect data and disseminate information
about the state's health care infrastructure. Requires OSHPD
to prepare a Health Manpower Plan (HMP) to evaluate the supply
of health care practitioners; including, physicians;
physicians assistants; nurse practitioners; nurses; dentists,
dental nurses and hygienists; optometrists and optometry
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assistants; and, pharmacists and pharmacy technicians.
2)Requires the HMP to include such elements as the current
levels of demand for services in California; the capacity of
the personnel listed in 1) above to provide services; and, the
extent to which assistants can substitute their services for
those of other personnel. Also requires the HMP to determine
the adequacy of the current and future supply of health
personnel.
3)Establishes the Office of Health Equity (OHE) within the
Department of Public Health (DPH) to help improve the health
status of all populations and places, with a priority on
eliminating health and mental health disparities and
inequities.
4)Defines vulnerable communities as including, but not limited
to, women; racial or ethnic groups; low-income individuals and
families; individuals who are and have been incarcerated;
individuals with disabilities; individuals with mental health
conditions; children, youth and young adults, and seniors;
immigrants and refugees; individuals who are limited-English
proficient; lesbian, gay, bisexual, transgender, queer, and
questioning communities; or, combinations of these
populations.
5)Requires DHCS to provide technical assistance to county mental
health programs and other local mental health agencies.
Technical assistance can be for 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.
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6)Requires state agencies, boards, and commissions which
directly or by contract collect demographic data as to the
ancestry or ethnic origin of Californians to use separate
collection categories and tabulations for each major Asian and
Pacific Islander group, including, but not limited to,
Chinese, Japanese, Filipino, Korean, Vietnamese, Asian Indian,
Hawaiian, Guamanian, Samoan, Laotian, and Cambodian.
FISCAL EFFECT: 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 Office's programs
for vulnerable communities. No additional costs are anticipated
for DHCS to consult with additional stakeholders.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, in the last
decade, the Legislature has sought to expand access to mental
health care. OSHPD, OHE, and DHCS, among other state and
local entities, have been charged with carrying out various
mental health initiatives. Yet barriers to mental health care
remain and community and non-profit organizations that serve
individuals suffering from trauma related to genocide struggle
to access programs and services administered by these
departments. The author states, in particular the
Cambodian-American population still suffers from the effects
of the Cambodian Genocide that occurred between 1975-1979 and
their mental health challenges are multigenerational,
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extending beyond the elders who were refugees to the youth who
are U.S. born citizens.
The author notes the Cambodian community, which has its own
unique challenges, is lumped together, if recognized at all,
under the Asian Pacific Islander category by the various state
departments, and this 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 by state
departments. The author concludes, in the interest of
continuing the state's goal towards advancing mental health
care access, this bill will improve institutional access for
Californians who have experienced with trauma related to
genocide by improving stakeholder engagement, service
delivery, and ultimately access to mental health services.
2)BACKGROUND.
a) Health disparities. According to the federal Centers
for Disease Control and Prevention, health disparities are
preventable differences in the burden of disease, injury,
violence, or opportunities to achieve optimal health that
are experienced by socially disadvantaged populations.
Populations can be defined by factors such as race or
ethnicity, gender, education or income, disability,
geographic location (e.g., rural or urban), or sexual
orientation. Health disparities are inequitable and are
directly related to the historical and current unequal
distribution of social, political, economic, and
environmental resources.
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b) Disparities in data collection. According to a 2010
Asian and Pacific Islander American Health Forum Report, in
California, data available for Asian Americans (AA) and
Native Hawaiians/Pacific Islanders (NHPI) lag far behind
data on other racial/ethnic groups. In addition,
aggregated AA and NHPI data fail to capture the diversity
and differences across subgroups.
For example, in the 1980s and 1990s, aggregated AA and NHPI
data showed that the group had the lowest incidence of
breast cancer across races and ethnicities, which helped
lead to a belief that Asian women had significantly lower
rates of breast cancer. However, subsequent studies showed
that Native Hawaiian women had a very high incidence of
breast cancer, second only to white women, whereas Korean
women had a very low incidence. The high risk for Native
Hawaiians was hidden by the aggregation of data. Asian
subpopulations also have varying socioeconomic statuses,
which is an important predictor of health access. The
Asian & Pacific Islander American Health Forum stated in
the report that support for new primary data collection and
longitudinal studies are needed to fully capture the
diverse social and health assets and needs faced by all the
AA and NHPI communities.
c) Trauma. According to the California Mental Health
Planning Council's 2014 Report on Trauma Informed Care,
trauma is a widespread, harmful, and costly public health
problem. It occurs as a result of violence, abuse,
maltreatment, neglect, loss, disaster, war, and other
emotionally harmful experiences. Trauma has no boundaries
with regard to age, gender, socioeconomic status, race,
ethnicity, geography, or sexual orientation. Traumatic
exposures may have only transient effects resulting in no
apparent harm; however, traumatic exposures often result in
psychological harm, increased rates of mental illness,
suicide, risk-taking behaviors, and chronic physical
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disorders. Exposure to trauma may increase the likelihood
of substance abuse and lead to disruptions in daily
functioning in educational and employment settings. Trauma
is an almost universally shared experience of people
receiving treatment for mental illness and substance use
disorders, including those served through public systems.
d) DHCS efforts. In March of this year the Senate and
Assembly Health Committees held a joint hearing regarding
health disparities in California. At that time DHCS
informed the Committees that it will soon 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.
3)SUPPORT. Families in Good Health (FGH) supports this bill
stating, in the last 20 years or so there has been a
tremendous amount of research done on how trauma and stress
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affects brain development and physical and mental health. FGH
notes the Cambodian community with its own unique challenges
is lumped together, if recognized at all, under the Asian and
Pacific Islander (API) category by state departments, and this
aggregation of identity does not reveal the real health
conditions of the Cambodians in California.
The California Immigrant Policy Center supports this bill
because it will improve institutional access for community and
non-profit organizations that service individuals who suffer
from trauma related to genocide.
4)RELATED LEGISLATION.
a) AB 176 (Bonta) places specified requirements regarding
the collection of demographic data, by the state's public
segments of postsecondary education and by state
health-related departments, pertaining to tabulation
categories of Native Hawaiian, Asian, and Pacific Islander
groups. AB 176 is currently pending on the Senate Floor.
b) SB 315 (Monning and Ed Hernandez), creates the
California Health Access Model Program Two Account within
the California Health Facilities Financing Authority Fund
to administer a second competitive grant selection process,
to fund projects designed to demonstrate specified new or
enhanced cost-effective methods of delivering quality
health care services to improve access to quality health
care for vulnerable populations or communities, or both.
SB 315 is pending a hearing in the Assembly Appropriations
Committee.
5)PREVIOUS LEGISLATION.
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a) AB 411 (Pan), of 2013, would have required DHCS, when
entering into a new contract with an External Quality
Review Organization (EQRO) for the purpose of performing
work associated with Medi-Cal managed care programs, to
include in the terms of the contract a requirement that the
EQRO stratify all patient-specific Healthcare Effectiveness
Data and Information Set measures, by certain
characteristics, including geographic area and primary
language. AB 411 was vetoed by the Governor who stated
that nothing in current law prevents DHCS from requiring
EQROs to provide more detailed data by geography, race,
ethnicity, or other demographic attribute. He concluded
that if DHCS saw a need or benefit that justifies the costs
of procuring this additional data, he was confident that
they would procure it.
b) AB 1088 (Eng) Chapter 689, Statutes of 2011, requires
the Department of Industrial Relations and the Department
of Fair Employment and Housing to collect and tabulate data
for each major Asian group.
6)SUGGESTED AMENDMENT. As currently drafted this bill requires
OSHPD to develop a mental health workforce needs assessment
based on criteria used to develop a HMP from 20 years ago.
This bill also amends the definition of vulnerable communities
(under the purview of OHE) to include individuals who have
experienced trauma related to genocide. Since OHE is
statutorily required to create a strategic plan to eliminate
health and mental health disparities, the Committee may wish
to amend the bill to delete the outdated reference to the
OSHPD HMP and instead require OHE to include representatives
from vulnerable communities amongst the stakeholders they seek
input from when developing and updating the strategic plan.
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REGISTERED SUPPORT / OPPOSITION:
Support
Cambodian Advocacy Collaborative (sponsor)
The Honorable Alan Lowenthal, 47th Congressional District
Asian Pacific Environmental Network
Asian American Pacific Islander Health Research Group
Building Healthy Communities, Long Beach
California Council of Community Mental Health Agencies
California Immigrant Policy Center
California Pan-Ethnic Health Network
California Primary Care Association
Center for the Pacific Asian Family
Children's Defense Fund
Community Clinic Association of Los Angeles County
Families in Good Health
Homeless Innovations Project
Khmer Parent Association
Kingdom Causes, Long Beach
Los Angeles LGBT Center
Mental Health America of California
Pacific Clinics
Santa Clara county Board of Supervisors
Southeast Asia Resource Action Center
United Cambodian Community
Vietnamese Youth Development Center
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WISEE Queen Dream Institute
Women in Non-Traditional Employment Roles
Opposition
None on file.
Analysis Prepared by:Lara Flynn / HEALTH / (916)
319-2097