BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 596
AUTHOR: Yee
AMENDED: January 6, 2014
HEARING DATE: January 15, 2014
CONSULTANT: Valderrama
SUBJECT : Pupil health: Multitiered intervention pilot program
SUMMARY : Requires the State Department of Education to
establish a three year pilot program in four schools to provide
school based mental health services that leverage cross-system
resources and offer comprehensive multitiered interventions.
Allocates a total of $600,000 in start-up funding to each school
selected to participate in the program and requires the
Department to submit a report to the Legislature evaluating the
success of the program.
Existing federal law:
1.Requires the provision of a free, appropriate public education
to all disabled students in the least restrictive environment,
which:
a. Is provided at public expense, under public
supervision and direction, and without charge;
b. Meets the standards of the state education agency;
c. Includes an appropriate preschool, elementary
school, or secondary school in the state; and,
d. Is provided in conformity with the Individual
Education Program established for the child.
1.Establishes the Early and Periodic Screening, Diagnosis, and
Treatment (EPSDT) Program to provide physical and mental
health services to Medicaid (Medi-Cal in California)
beneficiaries under the age of 21, including current and
former foster youth.
Existing state law:
1.Establishes Mental Health Services Act (MHSA) which provides
for local mental health services, including prevention and
early intervention, innovative projects, Full Service
Continued---
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Partnerships, peer support services, housing, and other mental
health treatment services. Establishes the Mental Health
Services Fund in the state Treasury, continuously appropriated
to and administered by the Department of Health Care Services
(DHCS), to fund specified county mental health programs.
This bill:
1.Requires the State Department of Education (CDE) to establish
a three year pilot program in four schools, two in Southern
California and two in Northern California, to provide school
based mental health services that leverage cross-system
resources and offer comprehensive multitiered interventions.
2.Requires CDE to select schools that propose a model approach
that reflects the schools culture and needs and provides
preventative, targeted and intensive interventions that target
the behavioral, emotional and academic needs of the students
and that include all of the following:
a. Formalized collaboration with mental health
agencies to provide school-based mental health
services that are integrated within a multitiered
system of support.
b. Utilization of a designated percentage of a
school district's existing special education
expenditures to provide services within a school
setting;
c. An initial school climate assessment that
includes information from multiple stakeholders that
is used to inform the selection of strategies and
interventions that reflect the culture and goals of
the school;
d. A coordination of services team that considers
referrals for services, oversees school-wide efforts
and utilizes data informed processes to identify
struggling students who require early interventions;
e. Whole school strategies that address school
climate and universal student well-being as well as
comprehensive professional development opportunities
that build the capacity of the entire school community
to recognize and respond to the unique
social-emotional, behavioral, and academic needs of
students, as specified;
f. Targeted interventions for students with
identified social-emotional, behavioral, and academic
needs, as specified; and,
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g. Intensive services that can serve as
school-based alternatives to a youth's placement in a
non-public school setting, as specified.
3.Requires CDE to provide start-up and evaluation funding to
each school participating in the pilot program in the
following amounts: $250,000 in year one, $200,000 in year two
and $150,000 in year three.
4.Requires each school participating in the program to annually
report the following information to CDE:
a. Number of youth referred to the coordination
of service team, referred to alternative school
placements, referred for assessment for diagnosis of
disability and diagnosed with disabilities;
b. Number of training hours and topics provided
for teachers;
c. Number and type of parent engagement
activities;
d. Number of youth served with targeted and
intensive intervention;
e. Annual teacher, school staff, parent and
participating student surveys assessing the impact and
satisfaction of services;
f. Annual school climate assessments, including
multiple stakeholder feedback;
g. Number of school discipline referrals for the
student body as well as those with disabilities;
h. Attendance;
i. Pre- and post-intervention assessments for
students served in targeted and intensive services
using standardized tools appropriate to targeted
needs;
j. Progress made through annual Common Core
standardized testing; and,
aa. Progress made among the student body and
specified populations in the Academic Performance
Index, including students with disabilities, foster
youth, low-income students and students of ethnicities
that experience disproportionate challenges to
academic achievement.
5.Requires CDE to submit a report to the Legislature, make it
available to the public, post it on the CDE Internet Web site,
and at the end of the three-year period evaluate the success
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of the program and give further recommendations. Makes this
requirement inoperative four years after the report is due.
6.Makes various findings and declarations and states legislative
intent that upon demonstrated success of the pilot program,
the evaluated models be adopted by a large number of schools
in order to promote the success of all students.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, students in
disadvantaged communities face relational and environmental
stressors that, when left unaddressed, hinder their ability to
achieve their full potential. Compounded traumatic stressors
including poverty and exposure to violence have been found to
negatively affect student academic achievement, learning and
emotional development, and result in disproportionately high
referral rates to special education services. Risk factors
that are known to negatively impact the social-emotional
well-being and academic achievement of students are
widespread. Nearly one in four youth are living in poverty,
almost 60,000 youth are currently placed in foster care and it
is estimated that 20 percent of youth are in need of mental
health intervention.
Unfortunately, the needs of students facing such challenges
often go unrecognized or are misunderstood. The school
setting presents an important opportunity to identify and
respond to the comprehensive needs of youth, reducing barriers
to access as well as the stigma that is often associated with
seeking help. Working in partnership with mental health
providers, the school community can be empowered with the
skills and resources to promote the well-being and achievement
of all students. This bill is intended to provide incentive to
schools to implement tiered intervention strategies to address
student needs prior to imposing discipline or making referrals
to special education.
2.Mental health services in schools. According to the CDE,
mental health services in schools include a broad range of
services, settings, and strategies. Psychological and mental
health services in schools apply learning theory for
individuals and groups to improve instruction and coordinate
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and evaluate plans to meet unique individual needs for
learning or behavior problems. School psychologists also use
research to design prevention and intervention programs, and
provide crisis intervention, suicide prevention, and other
mental health strategies as part of a student support services
team. Mental health services that are provided in schools may
include academic counseling, brief interventions to address
behavior problems, and assessments or referrals to other
systems. However, most of the mental health services provided
by schools are within the context of special education and
meeting the requirements specified in a student's
individualized education program.
3.Individualized education programs (IEP). Pursuant to the
Individuals with Disabilities Education Act (IDEA), each
public school student who receives special education and
related services must have an IEP. An IEP is a written
document developed by a multi-disciplinary team that is
designed for one student and must be truly individualized.
Federal and state law require the instruction and related
services detailed in an IEP to be provided to the student
irrespective of the internal capacity of the school to provide
the instruction and services. In order to meet the
requirements set forth in an IEP, schools may employ qualified
staff directly, partner with county mental health agencies or
contract with private providers.
Prior to 2011, state law required a partnership between school
districts and county mental health agencies to deliver mental
health services to students with IEPs. AB 114 (Committee on
Budget), Chapter 43, Statutes of 2011, repealed the state
mandate on special education and county mental health agencies
and eliminated related references to mental health services in
California statute. As a result of this legislation, school
districts are now solely responsible for ensuring that
students with disabilities receive special education and
related services to meet their needs pursuant to IDEA. Special
education funding can only be used for instruction and related
services specifically identified in IEPs and cannot be used
for any other purpose, such as school-wide interventions.
4.Medi-Cal. EPSDT is a Medi-Cal benefit for individuals under
the age of 21 who have full-scope Medi-Cal. This benefit
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allows for periodic screenings to determine health care needs
and includes all services covered by Medi-Cal, as well as
other services that are determined to be medically necessary.
According to the DHCS, EPSDT mental health services are Medi-Cal
services that correct or improve mental health problems that a
doctor or other health care provider identifies, even if the
health problem will not go away entirely. EPSDT mental health
services must be approved and provided by county mental health
departments. Some of the EPSDT mental health benefits
available are individual or group therapy, family therapy,
crisis counseling, case management, special day programs
medication and Therapeutic Behavioral Services (TBS). TBS are
an EPSDT specialty mental health service that are designed to
help children and young adults who have severe emotional
problems, live in or are at risk of a mental health placement,
or have been or are at risk of being hospitalized for mental
health problems. Schools are not authorized to directly seek
reimbursement for EPSDT benefits but may be reimbursed with
EPSDT funds if agreed to by the county mental health agency.
5.Student Mental Health Initiative (SMHI). The SMHI is a
California Mental Health Services Authority prevention and
early intervention program that identifies strategies to
address student mental health needs across the K-12 and higher
education systems. The program offers four year grants, funded
by the MHSA, to institutions to develop a comprehensive system
of campus-based mental health services and supports for
students. The author indicates this bill has objectives
similar to the SMHI but would be administered through CDE
directly to schools rather than through the county mental
health agency.
6.Double referral. This bill will be heard in Senate Education
January 15, 2014.
7.Related legislation. AB 1178 (Bocanegra) establishes the
California Promise Neighborhood Initiative to provide funding
to schools that have formalized partnerships with local
agencies and community organizations to provide a network of
services to improve the health, safety, education, and
economic development of a defined area. AB 1178 is awaiting
hearing by the Assembly Appropriations Committee.
AB 1367 (Mansoor) would have expanded existing outreach about
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recognition of early signs of potentially severe and disabling
mental illness to include school districts and county offices
of education and charter schools, including funding to provide
training to identify students with mental health issues that
may result in a threat to themselves or others in order to
provide for timely intervention. AB 1367 was referred to the
Senate Health Committee but was never heard.
SB 561 (Fuller) would have required a student who has been
expelled to undergo a mental health evaluation conducted by a
licensed clinical psychologist prior to enrolling in a county
community school, community day school or juvenile court
school. SB 561 was referred to the Education and Health
Committees but was never heard.
8.Prior legislation. AB 174 (Bonta) would have required the
Department of Public Health to establish a pilot program in
Alameda County, to the extent that funding is made available,
to provide grants to eligible applicants for activities and
services that directly address the mental health and related
needs of students impacted by trauma. AB 174 was vetoed by
the Governor, whose veto message read:
I support the efforts of the bill but am returning it without my
signature, as Alameda County can establish such a program
without state intervention and may even be able to use Mental
Health Services Act funding to do so.
Waiting for the state to act may cause unnecessary delays in
delivering valuable mental health services to students. All
counties - not just Alameda- should explore all potential
funding options, including Mental Health Services Act funds,
to tailor programs that best meet local needs.
AB 2105 (Scott) of 2000 sought to establish a two-year pilot
program in three school districts to improve the delivery of
education services to children who need mental health services
through a comprehensive, collaborative model. This bill was
held in the Assembly Appropriations Committee.
9.Support. Seneca Family of Agencies states the proposed pilot
projects in this bill have tremendous potential to transform
how schools serve at-risk students by implementing and
evaluating innovative approaches that meet the needs of youth
in more cost-effective and inclusive ways. Seneca goes on to
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argue, this legislation is appropriately timed, aligning with
the goals of the Local Control Funding Formula, which has
brought needed resources to communities caring for
concentrated populations of at-risk students, as well as the
Statewide Special Education Task Force, which is developing
recommendations on ways to improve California's special
education system.
10.Authors amendments. The author intends to offer amendments in
committee that make a series of technical and clarifying
changes that were recommended by the Education Committee.
11.Policy Comment. While the author indicates this pilot program
is designed to impact disadvantaged communities, there is
nothing in the bill that requires a school be in a
disadvantaged community to be selected for the pilot. The
author may wish to consider including a requirement that a
school's student body must consist of 60 percent free and
reduced lunch students to be eligible to participate in the
pilot program.
SUPPORT AND OPPOSITION :
Support: California Academy of Child and Adolescent Psychiatry
(Cal-ACAP)
California Primary Care Association
Seneca Family of Agencies
Oppose: None on file
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