BILL NUMBER: SB 1452 CHAPTERED 09/19/00 CHAPTER 520 FILED WITH SECRETARY OF STATE SEPTEMBER 19, 2000 APPROVED BY GOVERNOR SEPTEMBER 17, 2000 PASSED THE SENATE AUGUST 25, 2000 PASSED THE ASSEMBLY AUGUST 21, 2000 AMENDED IN ASSEMBLY AUGUST 11, 2000 AMENDED IN ASSEMBLY JUNE 20, 2000 AMENDED IN SENATE APRIL 25, 2000 AMENDED IN SENATE APRIL 5, 2000 INTRODUCED BY Senators Wright and Chesbro FEBRUARY 8, 2000 An act to amend Sections 5851, 5852.5, 5855.5, 5857, 5859, 5860, 5863, 5865, 5866, 5869, and 5880 of, and to add Sections 5856.2 , 5865.1, and 5865.3 to, the Welfare and Institutions Code, relating to child care. LEGISLATIVE COUNSEL'S DIGEST SB 1452, C. Wright. Child welfare: mental health. Existing law, the Children's Mental Health Services Act, authorizes the State Department of Mental Health to enter into annual performance contracts with participating counties for the delivery of mental health services to a target population defined as "seriously emotionally disturbed children." Existing law states the Legislature's intent that 100% of newly appropriated funds be dedicated to this target population. Existing law specifies the criteria to be contained in the county program proposal and imposes additional requirements on participating counties after receiving state funds. Under existing law, the program procedures under the act include the award of funds to counties through a request for proposal bids process. This bill would specify that eligible children also include, within the defined target population, those children that are referred by collaborating programs and that are within the definition of "seriously emotionally disturbed children." This bill would state the Legislature's intent that 100% of newly appropriated funds be dedicated to this expanded target population. The bill would state the Legislature's intent that participating counties be required to permit family members of a child receiving services to be involved in the county's program planning and design as well as the development of individual child treatment plans. This bill would also designate the age groups participating counties would be required to serve, given the available resources. This bill would revise the program procedures under the act to implement instead a request for applications for funding process, to require the department to negotiate with counties to establish appropriate evaluation measures, and to require the department to audit and monitor use of children's system of care program funds. This bill would require additional criteria, such as protocol development and program performance outcome distribution, to be contained in the county proposal. It would require participating counties to consult with family advocacy groups, have a plan to ensure that mental health services are planned to complement and coordinate with existing federal and state services, and meet other requirements within 3 years after receiving state funds. It would also revise program performance goals, require additional information to be included in annual performance contracts, and would require a county system of care serving defined age groups of children to make specified services available, to the extent possible, and, if not available, to identify a timeline for the development of these services. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 5851 of the Welfare and Institutions Code is amended to read: 5851. (a) The Legislature finds and declares that there is no comprehensive county interagency system throughout California for the delivery of mental health services to seriously emotionally and behaviorally disturbed children and their families. Specific problems to be addressed include the following: (1) The population of children which should receive highest priority for services has not been defined. (2) Clear and objective client outcome goals for children receiving services have not been specified. (3) Although seriously emotionally and behaviorally disturbed children usually have multiple disabilities, the many different state and county agencies, particularly education, social services, juvenile justice, health, and mental health agencies, with shared responsibility for these individuals, do not always collaborate to develop and deliver integrated and cost-effective programs. (4) A range of community-based treatment, case management, and interagency system components required by children with serious emotional disturbances has not been identified and implemented. (5) Service delivery standards that ensure culturally competent care in the most appropriate, least restrictive environment have not been specified and required. (6) The mental health system lacks accountability and methods to measure progress towards client outcome goals and cost-effectiveness. There are also no requirements for other state and county agencies to collect or share relevant data necessary for the mental health system to conduct this evaluation. (b) The Legislature further finds and declares that the model developed in Ventura County beginning in the 1984-85 fiscal year through the implementation of Chapter 1474 of the Statutes of 1984 and expanded to the Counties of Santa Cruz, San Mateo, and Riverside in the 1989-90 fiscal year pursuant to Chapter 1361 of the Statutes of 1987, provides a comprehensive, interagency system of care for seriously emotionally and behaviorally disturbed children and their families and has successfully met the performance outcomes required by the Legislature. The Legislature finds that this accountability for outcome is a defining characteristic of a system of care as developed under this part. It finds that the system established in these four counties can be expanded statewide to provide greater benefit to children with serious emotional and behavioral disturbances at a lower cost to the taxpayers. It finds further that substantial savings to the state and these four counties accrue annually, as documented by the independent evaluator provided under this part. Of the amount continuing to be saved by the state in its share of out-of-home placement costs and special education costs for those counties and others currently funded by this part, a portion is hereby reinvested to expand and maintain statewide the system of care for children with serious emotional and behavioral disturbances. (c) Therefore, using the Ventura County model guidelines, it is the intent of the Legislature to accomplish the following: (1) To phase in the system of care for children with serious emotional and behavioral problems developed under this part to all counties within the state. (2) To require that 100 percent of the new funds appropriated under this part be dedicated to the targeted population as defined in Sections 5856 and 5856.2. To this end, it is the intent of the Legislature that families of eligible children be involved in county program planning and design and, in all cases, be involved in the development of individual child treatment plans. (3) To expand interagency collaboration and shared responsibility for seriously emotionally and behaviorally disturbed children in order to do the following: (A) Enable children to remain at home with their families whenever possible. (B) Enable children placed in foster care for their protection to remain with a foster family in their community as long as separation from their natural family is determined necessary by the juvenile court. (C) Enable special education pupils to attend public school and make academic progress. (D) Enable juvenile offenders to decrease delinquent behavior. (E) Enable children requiring out-of-home placement in licensed residential group homes or psychiatric hospitals to receive that care in as close proximity as possible to the child's usual residence. (F) Separately identify and categorize funding for these services. (4) To increase accountability by expanding the number of counties with a performance contract that requires measures of client outcome and cost avoidance. (d) It is the intent of the Legislature that the outcomes prescribed by this section shall be achieved regardless of the cultural or ethnic origin of the seriously emotionally and behaviorally disturbed children and their families. SEC. 2. Section 5852.5 of the Welfare and Institutions Code is amended to read: 5852.5. The department shall review those counties that have been awarded funds to implement a comprehensive system for the delivery of mental health services to children with serious emotional disturbance and to their families or foster families to determine compliance with either of the following: (a) The total estimated cost avoidance in all of the following categories shall equal or exceed the applications for funding award moneys: (1) Group home costs paid by Aid to Families with Dependent Children-Foster Care (AFDC-FC) program. (2) Children and adolescent state hospital and acute inpatient programs. (3) Nonpublic school residential placement costs. (4) Juvenile justice reincarcerations. (5) Other short- and long-term savings in public funds resulting from the applications for funding award moneys. (b) If the department determines that the total cost avoidance listed in subdivision (a) does not equal or exceed applications for funding award amounts, the department shall determine that the county that has been awarded funding shall achieve substantial compliance with all of the following goals: (1) Total cost avoidance in the categories listed in subdivision (a) to exceed 50 percent of the applications for funding award moneys. (2) A 20-percent reduction in out-of-county ordered placements of juvenile justice wards and social service dependents. (3) A statistically significant reduction in the rate of recidivism by juvenile offenders. (4) A 25-percent reduction in the rate of state hospitalization of minors from placements of special education pupils. (5) A 10-percent reduction in out-of-county nonpublic school residential placements of special education pupils. (6) Allow at least 50 percent of children at risk of imminent placement served by the intensive in-home crisis treatment programs, which are wholly or partially funded by applications for funding award moneys, to remain at home at least six months. (7) Statistically significant improvement in school attendance and academic performance of seriously emotionally disturbed special education pupils treated in day treatment programs which are wholly or partially funded by applications for funding award moneys. (8) Statistically significant increases in services provided in nonclinic settings among agencies. (9) Increase in ethnic minority and gender access to services proportionate to the percentage of these groups in the county's school-age population. SEC. 3. Section 5855.5 of the Welfare and Institutions Code is amended to read: 5855.5. (a) Projects funded pursuant to Part 4 (commencing with Section 5850) of Division 5, as added by Chapter 89 of the Statutes of 1991, shall continue under the terms of this part. (b) The department shall negotiate with each participating county to establish appropriate evaluation measures for the county's children's system of care program after the initial three-year implementation funding period as established in Section 5854. The department shall, on an annual basis, negotiate a performance contract with each county electing to continue its children's system of care program. The annual performance contract shall be consistent county to county, and shall include, but not be limited to, a scope of work plan consistent with the provisions of this part and shall contain a budget that has sufficient detail to meet the requirements of the department. SEC. 4. Section 5856.2 is added to the Welfare and Institutions Code, to read: 5856.2. (a) Eligible children shall include seriously disturbed children who meet the requirements of Section 5856 and who are referred by collaborating programs, including wrap-around programs (Chapter 4 (commencing with Section 18250) of Part 6 of Division 9), Family Preservation programs (Part 4.4 (commencing with Section 16600) of Division 9), Juvenile Crime Enforcement and Accountability Challenge Grant programs (Article 18.7 (commencing with Section 749.2) of Chapter 2 of Part 1 of Division 1), programs serving children with dual diagnosis including substance abuse or whose emotional disturbance is related to family substance abuse, and children whose families are enrolled in CalWORKs (Chapter 2 (commencing with Section 11200.5) of Part 3 of Division 9). (b) Counties shall ensure, within available resources, that programs are designed to serve young children from zero to five years of age, inclusive, their families, and adolescents in transition from 15 to 21 years of age, inclusive. SEC. 5. Section 5857 of the Welfare and Institutions Code is amended to read: 5857. (a) The State Department of Mental Health shall issue a request for applications for funding for new children's system of care programs to nonparticipating counties in each year that additional funds are provided for statewide expansion pursuant to this part. (b) Applications shall be submitted to the department by a county mental health department with joint approval of collaborating local agencies including, but not limited to, special education, juvenile court, probation, child protective services agencies, the board of supervisors, and the mental health advisory board. (c) Program staff from the department shall review all applications for funding for compliance with all requirements of law and the application guidelines established by the department. (d) The department may accept letters of intent from a county in lieu of an application if moneys are not available to the county, to affirm commitment by the county to participate in the request for applications for funding process when moneys become available. Upon approval of an application by the director, a county shall be funded for an initial three-year contract period as described in Section 5854 and annually thereafter, consistent with the provisions of this part. If a county is complying with the provisions of this part, the department shall assure that the county receives an annual allocation consistent with departmental guidelines for full funding, as resources are made available. SEC. 6. Section 5859 of the Welfare and Institutions Code is amended to read: 5859. If applications are deficient and not ready for approval, department program staff shall provide specific written descriptions of areas of deficiency to counties and provide, to the extent feasible, any requested training, consultation, and technical assistance to assist the applicant county to achieve necessary compliance and department approval. SEC. 7. Section 5860 of the Welfare and Institutions Code is amended to read: 5860. (a) Final selection of county proposals shall be subject to the amount of funding approved for expansion of services under this part. (b) Counties shall use funds distributed under this part only in support of a mental health system serving seriously emotionally disturbed children in accordance with the principles and program requirements associated with the system of care model described in this part. The State Department of Mental Health shall audit and monitor the use of these funds to ensure that the funds are used solely in support of the children's system of care program and in accordance with the performance contract described in subdivision (c). If county programs receiving children's system of care funding do not comply with program and audit requirements determined by the department, funds shall be redistributed to other counties to implement, expand, or model children's system of care programs. (c) The department shall enter into annual performance contracts with the selected counties and enter into training and consultation contracts as necessary to fulfill its obligations under this part. These annual performance contracts shall be in addition to the county mental health services performance contracts submitted to the department under Section 5650. Any changes in the staffing patterns or protocols, or both, approved in the original program proposal shall be identified and justified in these annual performance contracts. Annual performance contracts filed by counties operating the program as of January 1, 2001, shall, if approved by the department, serve as the baseline contract for purposes of this subdivision. The contracts shall be exempt from the requirements of the Public Contract Code and the State Administrative Manual and shall be exempt from approval by the Department of General Services. SEC. 8. Section 5863 of the Welfare and Institutions Code is amended to read: 5863. In addition to the requirements of Section 5862, each county program proposal shall contain all of the following: (a) Methods and protocols for the county mental health department to identify and screen the eligible target population children. These protocols shall be developed with collaborative partners and shall ensure that eligible children can be referred from all collaborating agencies. (b) Measurable system performance goals for client outcome and cost avoidance. Outcomes shall be made available to collaborating partners and used for program improvement. (c) Methods to achieve interagency collaboration by all publicly funded agencies serving children experiencing emotional disturbances. (d) Appropriate written interagency protocols and agreements with all other programs in the county that serve similar populations of children. Agreements shall exist with wrap-around programs (Chapter 4 (commencing with Section 18250) of Part 6 of Division 9), Family Preservation programs (Part 4.4 (commencing with Section 16600) of Division 9), Juvenile Crime Enforcement and Accountability Challenge Grant programs (Article 18.7 (commencing with Section 749.2) of Chapter 2 of Part 1 of Division 1), programs serving children with a dual diagnosis including substance abuse or whose emotional disturbance is related to family substance abuse, and programs serving families enrolled in CalWORKs (Chapter 2 (commencing with Section 11200.5) of Part 3 of Division 9). (e) A description of case management services for the target population. Each county program proposal shall include protocols developed in the county for case management designed to provide assessment, linkage, case planning, monitoring, and client advocacy to facilitate the provision of appropriate services for the child and family in the least restrictive environment as close to home as possible. (f) Mental health services that enable a child to remain in his or her usual family setting and that offer an appropriate alternative to out-of-home placement. (g) Methods to conduct joint interagency placement screening of target population children prior to out-of-home placement. (h) Identification of the number and level of county evaluation staff and the resources necessary to meet requirements established by the State Department of Mental Health to measure client and cost outcome and other system performance measures. (i) A budget specifying all new and currently funded mental health expenditures provided as part of the proposed system of care. The department shall establish reporting requirements for direct and indirect administrative overhead, to be included in the request for proposals. Weight shall be given to counties with lower administrative overhead costs. In no case shall administrative costs exceed those of existing county mental health programs and services. Expenditures for evaluation staff and resources shall not be considered administrative costs for this purpose. (j) Any requirements for interagency collaboration, agreements, or protocols contained in this section shall not diminish requirements for the confidentiality of medical information or information maintained by a county agency or department. SEC. 9. Section 5865 of the Welfare and Institutions Code is amended to read: 5865. Each county shall have in place, with qualified mental health personnel, all of the following within three years of funding by the state: (a) A comprehensive, interagency system of care that serves the target population as defined in Section 5856. (b) A method to screen and identify children in the target population. County mental health staff shall consult with the representatives from special education, social services, and juvenile justice agencies, the mental health advisory board, family advocacy groups, and others as necessary to help identify all of the persons in the target populations, including persons from ethnic minority cultures which may require outreach for identification. (c) A defined mental health case management system designed to facilitate the outcome goals for children in the target population. (d) A defined range of mental health services and program standards that involve interagency collaboration and ensure appropriate service delivery in the least restrictive environment with community-based alternatives to out-of-home placement. (e) A defined mechanism to ensure that services are culturally competent. (f) A defined mechanism to ensure that services are child-centered and family-focused, with parent participation in planning and delivery of services. (g) A method to show measurable improvement in individual and family functional status for children enrolled in the system of care. (h) A method to measure and report cost avoidance and client outcomes for the target population which includes, but is not limited to, state hospital utilization, group home utilization, nonpublic school residential placement, school attendance and performance, and recidivism in the juvenile justice system. (i) A plan to ensure that system of care services are planned to complement and coordinate with services provided under the federal Early and Periodic Screening, Diagnosis and Treatment services (Section 1396d(a)(4)(B) of Title 42 of the United States Code), including foster children served under Section 5867.5, where those services are medically necessary but children do not meet the requirements of Section 5600.3. (j) A plan to ensure that system of care services are planned to complement and coordinate with services provided to CalWORKs (Chapter 2 (commencing with Section 11200.5) of Part 3 of Division 9) recipients whose families receive mental health treatment services. (k) A defined partnership between the children's system of care program and family members of children who have been or are currently being served in the county mental health system. This partnership shall include family member involvement in ongoing discussions and decisions regarding policy development, program administration, service development, and service delivery. SEC. 10. Section 5865.1 is added to the Welfare and Institutions Code, to read: 5865.1. When a county system of care serves children 15 to 21 years of age, the following structures and services shall, to the extent possible, be available, and if not available, the county plan shall identify a timeline for the development of these services: (a) Collaborative agreements with schools, community colleges, independent living programs, child welfare services, job training agencies, CalWORKs providers, regional center services, and transportation and recreation services as needed. (b) Collaborative teams involving the youth and two or more agencies to develop a transition plan that identifies needs and resources required to successfully transition to independent living as an adult. (c) Service plans that identify the needs of the youth in the areas of employment, job training, health care, education, counseling, socialization, housing, and independent living skills, to be provided by any of the collaborative agencies and access points for the youth identified. (d) Assistance with identifying the means for health insurance and educational linkages when the young person is more than 18 years of age. (e) Specific plans for the young adult to identify individuals and community services that can provide support during the transition to 21 years of age. (f) Assurances that goals for young adults are individual, identified by the youth, and developmentally appropriate. (g) Any requirements for interagency collaboration, agreements, or protocols contained in this section shall not diminish requirements for the confidentiality of medical information or information maintained by a county agency or department. SEC. 11. Section 5865.3 is added to the Welfare and Institutions Code, to read: 5865.3. When a county system of care services children, zero to five years of age, the following structures and services shall be available, and when not available, the county plan shall identify a timeline for the development of these services: (a) Collaborative agreements with public health systems, regional center services, child care programs, CalWORKs providers, drug and alcohol treatment programs, child welfare services, and other agencies that may identify children and families at risk of mental health problems that affect young children. (b) Outreach protocols that can assist parents to identify child behaviors that may be addressed early to prevent mental or emotional disorders and assure normal child development. (c) Identification of trained specialists that can assist the parents of very young children at risk for emotional, social, or developmental problems with treatment. (d) Performance measures that ensure that services to families of very young children are individual, identified by the family, and developmentally appropriate. SEC. 12. Section 5866 of the Welfare and Institutions Code is amended to read: 5866. (a) Counties shall develop a method to encourage interagency collaboration with shared responsibility for services and the client and cost outcome goals. (b) The local mental health director shall form or facilitate the formation of a county interagency policy and planning committee. The members of the council shall include, but not be limited to, family members of children who have been or are currently being served in the county mental health system and the leaders of participating local government agencies, to include a member of the board of supervisors, a juvenile court judge, the district attorney, the public defender, the county counsel, the superintendent of county schools, the public social services director, the chief probation officer, and the mental health director. (c) The duties of the committee shall include, but not be limited to, all of the following: (1) Identifying those agencies that have a significant joint responsibility for the target population and ensuring collaboration on countywide planning and policy. (2) Identifying gaps in services to members of the target population, developing policies to ensure service effectiveness and continuity, and setting priorities for interagency services. (3) Implementing public and private collaborative programs whenever possible to better serve the target population. (d) The local mental health director shall form or facilitate the formation of a countywide interagency case management council whose function shall be to coordinate resources to specific target population children who are using the services of more than one agency concurrently. The members of this council shall include, but not be limited to, representatives from the local special education, juvenile probation, children's social services, and mental health services agencies, with necessary authority to commit resources from their agency to an interagency service plan for a child and family. The roles, responsibilities, and operation of these councils shall be specified in written interagency agreements or memoranda of understanding, or both. (e) The local mental health director shall develop written interagency agreements or memoranda of understanding with the agencies listed in this subdivision, as necessary. Written interagency agreements or memoranda shall specify jointly provided or integrated services, staff tasks and responsibilities, facility and supply commitments, budget considerations, and linkage and referral services. The agreements shall be reviewed and updated annually. (f) The agreements required by subdivision (e) may be established with any of the following: (1) Special education local planning area consortiums. (2) The court juvenile probation department. (3) The county child protective services agency. (4) The county public health department. (5) The county department of drug and alcohol services. (6) Other local public or private agencies serving children. SEC. 13. Section 5869 of the Welfare and Institutions Code is amended to read: 5869. The department shall provide participating counties with all of the following: (a) Applications for funding guidelines and format, and coordination and oversight of the selection process as described in Article 4 (commencing with Section 5857). (b) Contracts with each state funded county specifying the approved budget, performance outcomes, and a scope of work plan for each year of participation in the children's system of care program. (c) A contract with an independent evaluator for the purpose of measuring performance outcomes and providing technical assistance to the state and counties related to system evaluation. (d) Training, consultation, and technical assistance for county applicants and participants, either directly or through contract. SEC. 14. Section 5880 of the Welfare and Institutions Code is amended to read: 5880. For each selected county the department shall define and establish client and cost outcome and other system performance goals, and negotiate the expected levels of attainment for each year of participation. Expected levels of attainment shall include a breakdown by ethnic origin and shall be identified by a county in its proposal. These goals shall include, but not be limited to, both of the following: (a) Client improvement and cost avoidance outcome measures, as follows: (1) To reduce the number of child months in group homes, residential placements pursuant to Chapter 26.5 (commencing with Section 7570) of Division 7 of Title 1 of the Government Code, and state hospital placements. (2) To reduce the cost of AFDC-FC group home care, residential placements as described in paragraph (1), and state hospital utilization, by an amount which equals at least 50 percent of the third year project cost. Cost avoidance shall be based on data comparisons of statewide average expenditure and population. (3) To increase school attendance for pupils in targeted programs. (4) To increase the grade level equivalent of pupils in targeted programs from admission to discharge. (5) To reduce the rate of recidivism incurred for wards in targeted juvenile justice programs. (6) To show measurable improvement in individual and family functional status for a representative sample of children enrolled in the system of care. (7) To achieve statistically significant increases in services provided in nonclinic settings among agencies. (8) To increase ethnic minority and gender access to services proportionate to the percentage of these groups in the county's school-age population. (b) System development and operation measures, as follows: (1) To provide an integrated system of care that includes multiagency programs and joint case planning, to children who are seriously emotionally and behaviorally disturbed as defined in Section 5856. (2) To identify and assess children who comprise the target population in the county evidenced by a roster which contains all children receiving mental health case management and treatment services. This roster shall include necessary standardized and uniform identifying information and demographics about the children served. (3) To develop and maintain individualized service plans that will facilitate interagency service delivery in the least restrictive environment. (4) To develop or provide access to a range of intensive services that will meet individualized service plan needs. These services shall include, but not be limited to, case management, expanded treatment services at schoolsites, local juvenile corrections facilities, and local foster homes, and flexible services. (5) To ensure the development and operation of the interagency policy council and the interagency case management council. (6) To provide culturally competent programs that recognize and address the unique needs of ethnic populations in relation to equal access, program design and operation, and program evaluation. (7) To develop parent education and support groups, and linkages with parents to ensure their involvement in the planning process and the delivery of services. (8) To provide a system of evaluation that develops outcome criteria and which will measure performance, including client outcome and cost avoidance. (9) To gather, manage, and report data in accordance with the requirements of the state funded outcome evaluation. SEC. 15. This act shall be known, and may be cited, as the Cathie Wright Children's Mental Health Services Act.