BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1055
AUTHOR: Liu
INTRODUCED: February 18, 2014
HEARING DATE: March 26, 2014
CONSULTANT: Diaz
SUBJECT : Public School Health Center Support Program.
SUMMARY : Renames the Public School Health Center Support
Program the School-Based Health and Education Partnership
Program and makes changes to the requirements and funding
levels. Creates a new type of grant to fund interventions
related to obesity, asthma, alcohol and substance abuse, and
mental health.
Existing law:
1.Requires the Department of Public Health (DPH) to establish
the Public School Health Center Support Program (PSHCSP), in
collaboration with the Department of Education (CDE), to
perform specified functions relating to the establishment,
retention, or expansion of school health centers (SHCs) in
California.
2.Establishes a grant program administered by DPH to provide
technical assistance and funding to SHCs, to the extent funds
are appropriated for implementation of the PSHCSP. Provides
for planning, facilities and startup, and sustainability
grants, as specified.
3.Defines an SHC, for purposes of the PSHCSP, as a center or
program located on a school campus or at a local educational
agency that provides age-appropriate health care services at
the program site or through referrals.
This bill:
1.Renames the PSHCSP the School-Based Health and Education
Partnership Program (SBHEPP). Changes sustainability grant
amount from between $25,000 and $125,000 per year for a
three-year period to between $50,000 and $100,000 on a
one-time basis. Deletes the requirement that the grant be used
for operating SHCs or enhancing programming at SHCs to include
oral health or mental health services and instead requires the
grant funds be used to develop new and leveraging existing
Continued---
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funding streams to support a sustainable funding model for
SHCs. Provides examples of existing funding streams, such as
school district funds available under the Local Control
Funding Formula, the federal Affordable Care Act (ACA), and
the Mental Health Services Act.
2.Creates a new population health grant in amounts between
$50,000 and $125,000 for a period of up to three years to fund
interventions to implement population health outcomes and
target specific health or education risk factors, including,
but not limited to: obesity prevention programs; asthma
prevention programs; early intervention for mental health;
and, alcohol and substance abuse prevention. Requires
applicants for this grant to meet the same criteria as those
for the facilities and startup grant in existing law.
3.Adds to requirements for SBHEPP grantees to strive to address
the population health of an entire school by focusing on
prevention services, such as group and classroom education,
school wide prevention programs, community outreach
strategies; also strives to provide integrated and
individualized support for students and families, and to act
as a partner with students or families to ensure that health,
social, or behavioral challenges are addressed.
4.Makes technical, clarifying changes.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, there are
currently 226 school-based health centers serving
approximately 228,000 students, providing a range of services
and are locally designed to meet specific needs of the student
population. SHCs can be an effective anchor for a broader
community school strategy. The community school strategy is a
nationally recognized approach for organizing the resources of
the community around student success. It is both a place and a
set of partnerships between the school and other community
resources. Community schools bring fragmented services found
in the community to school campuses, integrating them into
educational strategy and the culture of the school. Research
shows that the community school strategy results in improved
student academic achievement, improved attendance, reduced
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dropout rates, improved behavior, greater parent engagement,
and benefits to families and communities such as increased
stability and safety. The PSHCSP has existed in statute for
eight years yet has never been implemented due to a lack of
funding. It is time for this program to be updated and funded,
as it fits perfectly with the implementation of the Local
Control Funding Formula.
2. SHCs. According to the National School-Based Health
Alliance (NSBHA), SHCs provide a broad array of primary
care and preventive services, including comprehensive
health assessments; prescriptions for medications;
treatment for acute illness; asthma treatment; oral health
education; dental screenings; and mental health
assessments, crisis intervention, brief and long-term
therapy, and other services. SHC staff offer small group
and classroom health promotion and outreach, which help
increase the number of students exposed to programs and
activities that discourage potentially harmful behaviors
including alcohol, tobacco, and drug abuse, and violence
and bullying. These programs also serve to help promote
healthy eating and active living. SHCs work to ensure that
adolescents, a hard-to-reach population, have access to the
services they need to stay on a path to success. SHCs are
the primary, and occasionally only, available health care
for many children and adolescents who otherwise would have
no access. The NSBHA states that Congress recognized the
importance of SHCs as a key link in the nation's health
care safety net by providing $50 million a year for four
years in one-time funding for construction, renovation, and
equipment for SHCs in the ACA.
According to the California School-Based Health Alliance
(CSBHA), there are currently 226 SHCs across California: 45
percent are in high schools, 30 percent are in elementary
schools, 10 percent are in middle schools, and 15 percent
are "school-linked" or mobile medical vans. CSBHA points
out that many SHCs are located in schools serving some of
the state's most vulnerable children, and on campuses with
SHCs, about 70 percent of students receive free or reduced
price meals. SHCs 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. They are financed through various sources,
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including grants from state, local, and private sources;
reimbursements from public programs, such as the Child
Health and Disability Prevention Program and Medi-Cal;
partnerships with local community clinics and nonprofits;
and fundraising efforts by their school districts.
According to CSBHA, more than half of SHCs recover less
than 50 percent of their operating costs from billing
sources, as many of them provide health education, case
management, parent support, and teacher consultation, much
of which is not reimbursable. CSBHA contends that despite
budget cuts, SHCs continue to open across the state, and
research shows that investments in SHCs generate savings
through reduced high-cost services, reduced inappropriate
emergency room use, and immunization initiatives that
prevent disease.
CSBHA believes that schools are a natural place to identify
health problems and offer solutions, as children spend six to
eight hours per day at school, and school-based interventions
eliminate transportation barriers faced by other obesity
prevention programs. CSBHA cites cases in which SHCs have
implemented strategies, such as reducing television viewing,
increasing physical activity, and increasing fruit and
vegetable intake. Studies showed that school-based nutrition
and fitness programs were generally effective in improving
health behaviors, and one study found that 50 percent fewer
children in the intervention schools became overweight
compared to the study's control schools. CSBHA found that one
such SHC's interventions compared favorably with other public
health campaigns, costing less per quality-adjusted life years
than programs such as adult hypertension prevention and adult
diabetes screening.
3.Obesity and other chronic diseases. DPH issued a study, The
Burden of Chronic Disease and Injury, in 2013 that highlights
some of the leading causes of death, such as heart disease,
cancer, stroke, and respiratory disease, all of which have a
strong connection to obesity. Diabetes is another serious
chronic disease stemming from obesity that adversely affects
quality of life and results in serious medical costs. The last
decade has witnessed a 32 percent rise in diabetes prevalence,
affecting some 3.9 million people and costing upwards of $24
billion per year. According to the Centers for Disease Control
and Prevention, more than one-third of U.S. adults are obese,
and approximately 12.5 million children and adolescents ages 2
to 19 years are obese. Research indicates a tripling in the
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youth obesity rate over the past three decades. While this
increase has stabilized between the years 2005 and 2010, in
2010, 38 percent of public school children were overweight and
obese. Overweight youth face increased risks for many serious
detrimental health conditions that do not commonly occur
during childhood, including high cholesterol and type-2
diabetes. Additionally, more than 80 percent of obese
adolescents remain obese as adults.
4.Integrated Student Supports (ISS). In a white paper issued in
February 2014, Child Trends (a national non-profit research
center) looked at the benefits of ISS, which are a
school-based approach to promoting students' academic success
by developing, securing, and coordinating supports that target
academic and non-academic barriers to achievement. To date,
ISS programs have served more than 1.5 million students in
nearly 3,000 schools across the US, and Child Trends estimates
that Hispanic and black students account for more than 75
percent of the students enrolled in ISS programs. Research
cited by Child Trends indicates that the likelihood of
academic success, especially for disadvantaged students, is
enhanced by a more comprehensive set of supports at the
individual, family, and school levels, which implies that
providing an array of academic and non-academic supports in a
coordinated fashion is a more effective strategy than focusing
on one or a small set of supports. Child Trends found that
generally the return on investment for ISS programs ranged
from $4 to almost $15 for every dollar invested, which
suggests that the ISS approach yields a positive return on
investment.
5.Double referral. This bill is double referred. Should it pass
out of this committee, it will be referred to the Senate
Committee on Education.
6.Related legislation. SB 596 (Yee) would require CDE 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 CDE to submit a report to the Legislature
evaluating the success of the program. This bill is currently
in the Assembly.
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7.Prior legislation. AB 174 (Bonta) of 2013 would have required
DPH to establish a pilot grant program in Alameda County, to
the extent that funding is made available, to provide
resources to eligible applicants for activities and services
that directly address the mental health and related needs of
students impacted by trauma. This bill was vetoed by Governor
Brown, who stated in his veto message that, while he supports
the efforts of the bill, Alameda County can establish such a
program without state intervention and may even be able to use
existing funds to do so. In addition, Governor Brown stated
that all counties, not just Alameda, should explore all
funding options, including Mental Health Services Act funds,
to tailor programs that best meet local needs.
AB 1178 (Bocanegra) of 2013 would have established 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. This bill failed in
the Assembly Appropriations Committee.
SB 564 (Ridley-Thomas), Chapter 381, Statutes of 2008,
specified that an SHC may conduct routine physical health,
mental health, and oral health assessments, and provide for
any services not offered onsite or through a referral process.
The bill also required DPH, to the extent funds are
appropriated for implementation of the PSHCSP, to establish a
grant program to provide technical assistance, and funding for
the expansion, renovation, and retrofitting of existing SHCs,
and the development of new SHCs, in accordance with specified
procedures.
AB 2560 (Ridley-Thomas), Chapter 334, Statutes of 2006,
required the Department of Health Services (DHS), in
cooperation with CDE, to establish the PSHCSP to perform
specified functions relating to the establishment, retention,
or expansion of SHCs; required DHS to establish standardized
data collection procedures and collect specified data from
SHCs on an ongoing basis; required CDE, in collaboration with
DHS, to coordinate programs within CDE and programs within
other specified departments to support SHCs and to provide
technical assistance to facilitate and encourage the
establishment, retention, and expansion of SHCs; and required
the program to provide a biennial update to the appropriate
policy and fiscal committees of the Legislature containing
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specified information regarding SHCs, beginning on or before
January 1, 2009.
AB 2105 (Scott) of 2000 would have required the Director of
Mental Health, in consultation with the Secretary of Child
Development and Education and the Superintendent of Public
Instruction, to establish a program to award planning grants
to counties for the provision of school-based mental health
services to children, according to specified criteria, and to
the extent funding is made available for that purpose. This
bill would have also required the director to provide a
preliminary report on the program to the Governor, appropriate
policy and fiscal committees of the Legislature, and the
Legislative Analyst on or before January 1, 2003, and to
provide a final report to these entities on or before January
1, 2007. This bill failed in the Assembly Appropriations
Committee.
SB 566 (Escutia) of 1999 would have established the SHC Grant
Program, to be administered by DHS, to provide grants to
qualifying SHCs in order to assist the centers in providing
health services to students, provided that funds were
appropriated in the annual Budget Act. This bill also would
have required DHS to convene a study group to explore
long-term strategies to support SHCs and incorporate these
centers into a comprehensive and coordinated health care
system. This bill was moved to the inactive file on the
Senate Floor.
8.Support. The CSBHA, the sponsor of this bill, writes in
support that children attend school every day while suffering
from mental health issues, poor nutrition, asthma, diabetes,
and other conditions that seriously impact their ability to
succeed. CSBHA states that in 2011 even though about nine out
of 10 California children had health insurance, almost 20
percent of them did not have a recommended annual preventive
medical visit.
The California Primary Care Association (CPCA), which
represents nearly 1,000 not-for-profit community clinics and
health centers, writes in support of this bill and SHCs, which
provide approximately 228,000 students with a range of
services, including primary medical care, mental health, and
nutrition/fitness.
The Partnership for Children & Youth writes in support that in
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their direct work with community-based organizations and
school districts they have seen first-hand the vital role that
access to SHCs has on students and their families and the
communities at large.
9.Opposition. The California Right to Life Committee (CRLC)
writes in opposition that this bill represents advocacy for
minors' treatment in many health areas, including reproductive
health services, as well as advances the governance format of
public-private partnerships, which CRLC argues erode
representative government.
10.Policy comments.
a. Requirements for SHCs receiving grant funds. In
addition to the planning, facilities and startup, and
sustainability grants, this bill adds a population health
grant to be used, among other things, to fund
interventions such as alcohol and substance abuse
prevention. The author may wish to update existing
requirements for receiving grants to include references
to alcohol and substance abuse services as follows:
On page 3, line 28, after "mental health," and before
"health education" insert:
alcohol and substance abuse,
b. Continued lack of funding. According to the author's
office, the PSHCSP has existed in statute for eight years
and has never been implemented due to a lack of funding.
However, this bill does not include provisions to provide
for future funding, so it is unclear what the impact
would be. The author may wish to include a funding source
so that the SBHEPP does not continue to go unfunded
should this bill be chaptered.
11.Amendments. The author has agreed to accept the following
technical amendments:
a. On page 7, line 38, strike out "and"
b. On page 7, line 39, after "(d)" insert:
, and (e)
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SUPPORT AND OPPOSITION :
Support: California School-Based Health Alliance (sponsor)
California Alliance of Child and Family Services
California Primary Care Association
Children Now
Partnership for Children & Youth
San Diego Unified School District
Oppose: California Right to Life Committee
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