BILL ANALYSIS �
SENATE COMMITTEE ON EDUCATION
Carol Liu, Chair
2013-2014 Regular Session
BILL NO: SB 1055
AUTHOR: Liu
AMENDED: April 1, 2014
FISCAL COMM: Yes HEARING DATE: April 30, 2014
URGENCY: No CONSULTANT:Lynn Lorber
SUBJECT : School-Based Health and Education Partnership
Program.
SUMMARY
This bill modifies and renames an existing school health
center grant program to add a population health grant, alter
existing sustainability grant amounts, add services for which
the grants may be used, and updates terminology.
BACKGROUND
Current law:
School health centers
1) Requires the Department of Public Health to establish
the Public School Health Center Support Program, in
cooperation with the California Department of Education,
to perform specified functions relating to the
establishment, retention, or expansion of school health
centers in California. (Health & Safety Code � 124174.2)
2) Defines "school health center" as a center or program,
located at or near a school, that provides
age-appropriate health care services at the program site
or through referrals. Current law authorizes a school
health center to conduct routine physical, mental health,
and oral health assessments, and provide referrals for
any services not offered onsite. (HSC � 124174)
3) Establishes a grant program administered by the
Department of Public Health to provide technical
assistance and funding to school health centers, to the
extent funds are appropriated for this purpose.
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a) Planning grants in amounts between
$25,000-$50,000.
b) Facilities and startup grants in amounts
between $20,000-$250,000
c) Sustainability grants in amounts between
$25,000-$125,000.
(HSC � 124174.6)
1) Requires school health centers that receive a grant to
meet or have a plan to meet the following requirements:
a) Strive to provide a comprehensive set of
services including medical, oral health, mental
health, health education, and related services in
response to community needs.
b) Provide primary and other health care
services, provided or supervised by a licensed
professional, which may include physical exams,
diagnosis and treatment of minor injuries and
medical conditions, management of chronic medical
conditions, referrals and follow-up for specialty
care, reproductive health services, mental health
services as specified, and oral health services.
c) Work in partnership with the school nurse,
as specified.
d) Have a written contract or memorandum of
understanding between the school district and the
health care provider or other community provider.
e) Serve all students regardless of ability to
pay.
f) Be open during all normal school hours, as
specified.
g) Establish protocols for referring students
to outside services when the school health center is
closed.
h) Facilitate transportation, as specified.
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(HSC � 124174.6)
Authority to assess and provide services
Current law authorizes credentialed school nurses to perform
specified duties, including assess and evaluate health and
development, refer students and parents to appropriate
community resources, and counsel students and parents. (EC �
49426)
Pupil Personnel Services credentials authorize individuals to
provide school services in grades 12 and below, including
preschool, as counselors, school psychologists, school social
workers, or school child welfare and attendance regulators,
according to the specific specialization area and service
authorization listed on the credential.
Current law requires a psychologist employed by a school
district to hold specified credentials, and prohibits an
employee of a school district from administering psychological
tests or engage in psychological activities unless specified
criteria is met. (EC � 49422 and � 49424)
Seeking medical services
Current law:
1) Requires school districts to annually notify students in
grades 7-12, and parents of all students enrolled in the
school district, that schools may excuse students for the
purpose of obtaining confidential medical services
without the consent of the student's parent. (Education
Code � 46010.1)
2) Authorizes minors to seek confidential medical services,
without the consent of a parent, as follows:
a) A minor who is 12 years of age or older to
consent to mental health treatment or counseling on
an outpatient basis, or to residential shelter
services, if certain conditions are met. Current
law requires the mental health treatment or
counseling of a minor to include involvement of the
minor's parent or guardian unless, in the opinion of
the professional person who is treating or
counseling the minor, the involvement would be
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inappropriate. (Family Code � 6924)
b) A minor who is 12 years of age or older to
consent to medical care and counseling relating to
the diagnosis and treatment of a drug- or
alcohol-related problem. (Family Code � 6929)
c) A minor to consent to medical care related to
the prevention or treatment of pregnancy, but may
not be sterilized or receive an abortion without the
consent of a parent, other than in a medical
emergency or pursuant to court order. (Family Code
� 6925)
d) A minor who is 12 years of age or older and who
may have come into contact with an infectious,
contagious, or communicable disease, if the disease
or condition is one that is required to be reported
to the local health officer, or is a related
sexually transmitted disease. (Family Code � 6926)
e) A minor who is 12 years of age or older and who
is alleged to have been raped to consent to medical
care related to the diagnosis or treatment of the
condition and the collection of medical evidence
with regard to the alleged rape. (Family Code �
6927)
f) A minor who is alleged to have been sexually
assaulted to consent to medical care related to the
diagnosis and treatment of the condition, and the
collection of medical evidence with regard to the
alleged sexual assault. Current law requires the
professional person providing medical treatment to
attempt to contact the minor's parent or guardian.
(Family Code � 6928)
g) A minor to consent to the minor's medical care
or dental care if the minor is 15 years of age or
older, is living separate and apart from the
minor's parents with or without the consent of the
parent, and is managing the minor's own financial
affairs, regardless of the source of income.
(Family Code � 6922)
ANALYSIS
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This bill modifies and renames an existing school health
center grant program to add a population health grant, alter
existing sustainability grant amounts, add services for which
the grants may be used, and updates terminology.
Specifically, this bill:
1) Renames the Public School Health Center Support Program
to the School-Based Health and Education Partnership
Program.
2) Adds the following to the elements that school health
center grantees must include or provide:
a) Strive to address the population
health of the entire school campus by focusing on
prevention services such as group and classroom
education, schoolwide prevention programs, and
community outreach strategies.
b) Strive to provide integrated and
individualized support for students and families,
and to act as a partner with the student or family
to ensure that health, social, or behavioral
challenges are addressed.
c) Alcohol and substance abuse services.
3) Establishes population health grants in amounts $50,000
to $125,000 for a funding period of up to three years to
fund interventions to target specific health or education
risk factors that affect a larger segment of the
population including, but not limited to:
a) Obesity prevention programs.
b) Asthma prevention programs.
c) Early intervention for mental health.
d) Alcohol and substance abuse prevention.
4) Limits sustainability grants from a three-year period to
a one-time basis, and modifies the grant amounts as
follows:
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a) Increases the minimum grant amount from $25,000
to $50,000.
b) Decreases the maximum grant amount from
$125,000 to $100,000.
5) Modifies the purpose of sustainability grants from
operating a school health center, or enhancing
programming at a fully operational school health center,
including oral health or mental health services, to:
a) Developing new and leveraging
existing funding streams to support a sustainable
funding model for school health centers .
b) Examples of existing funding streams
include school district funds available under the
Local Control Funding Formula, federal Affordable
Care Act, or Mental Health Services Act.
6) Strikes reference to the obsolete Healthy Families
Program and Managed Risk Medical Insurance Board, adds
references to Covered California, and modifies the name
of the grant program.
7) Adds the following to uncodified legislative findings and
declarations:
a) School health centers are important
sites through which to increase child and adolescent
access to health care services and early
identification of chronic diseases, such as asthma
and obesity, and high-risk health behaviors.
b) School-based health centers serve as
an effective foundation upon which schools and
communities can build and implement a community
schools strategy providing a range of wrap-around
services to students and their families.
STAFF COMMENTS
1) Existing school health centers . Schools currently have
the discretion to provide health services to students, or
refer students to county and community organizations.
There are currently 226 school-based health centers (45%
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are in high schools, 30% are in elementary schools, 10%
are in middle schools, and 15% are "school-linked" or
mobile medical vans) in the State serving approximately
228,000 students and providing a range of services
including comprehensive health assessments, treatment for
acute illness, asthma treatment, oral health education,
dental screenings, mental health assessments, crisis
intervention, brief and long-term therapy, and other
services. Services are provided on-site by qualified
professionals and those that require expertise or
specialization beyond the school health center's capacity
may be referred to county agencies and community
organizations.
School health centers 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. School health centers are financed
through various sources, including grants, reimbursements
from public programs such as the Child Health and
Disability Prevention Program and Medi-Cal, partnerships
with local community clinics and nonprofit, and
fundraising efforts by school districts.
This bill modifies an existing grant program to assist school
districts to establish and maintain school health
centers. This bill does not provide funding for the
school health center grant program.
2) Will kids be provided services without parental consent ?
Current law prohibits a student from being tested by a
school for a behavioral, mental, or emotional evaluation
without the informed written consent of the parent,
prohibits a minor from being sterilized or receiving an
abortion without parental consent (other than in a
medical emergency or pursuant to court order), and places
other restrictions on minors receiving medical care
without parental consent (see Background).
Generally speaking, parental consent is required for a minor's
medical treatment. (American Academy of Pediatrics v.
Lungren (1997)) There are, however, exceptions such as
when the public interest in preserving the health of a
minor takes precedence over the parent's interest in
custody and control of the minor. (Wisconsin v. Yoder
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(1972)) In addition, a number of "medical emancipation"
statutes allow minors to consent to medical treatment
without parental knowledge, approval or consent (see
Background).
3) School health center grants . The Public School Health
Center Support Program has existed in statute for eight
years but has never been funded, and therefore never
implemented. This bill makes the following substantial
changes to this grant program:
a) Establishes population health grants, in
amounts between $50,000-$125,000 for up to a
three-year period, to fund interventions to target
specific health or education risk factors that
affect a larger segment of the population including,
but not limited to obesity prevention programs,
asthma prevention programs, early intervention for
mental health, alcohol and substance abuse
prevention.
b) Limits sustainability grants from a three-year
period to a one-time basis, increases the minimum
grant amount from $25,000 to $50,000, and decreases
the maximum grant amount from $125,000 to $100,000.
c) Adds the following to the elements that school
health center grantees must include or provide:
i) Strive to address the population
health of the entire school campus by focusing
on prevention services such as group and
classroom education, schoolwide prevention
programs, and community outreach strategies.
ii) Strive to provide integrated and
individualized support for students and
families, and to act as a partner with the
student or family to ensure that health,
social, or behavioral challenges are addressed.
iii) Alcohol and substance abuse services.
This bill does not modify the existing condition
that the grant program be implemented only to the
extent that funds are appropriated to the Department
of Public Health for that purpose.
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4) Author's amendments . The author wishes to amend this
bill as follows:
a) Change references from school districts to
local educational agencies to ensure the inclusion
of charter schools and to be consistent throughout
the bill. (Page 4, lines 21, 29, 32, and 34; page
5, lines 7 and 16; page 6, lines 9, 10, 11, and 39;
page 9, line 25)
b) Add the referral to evidence-based mental
health treatment services to the list of mental
health services that may be provided or supervised.
(Page 4, lines 1-6)
5) Fiscal impact . This bill creates a new population health
grant; the grant program remains contingent upon an
appropriation.
6) Related legislation . AB 2555 (Bocanegra) requires the
Superintendent of Public Instruction (SPI), in
collaboration with the Department of Social Services and
a number of entities, to develop a five-year plan for
expanding cradle-to-career initiatives, as specified,
throughout the State. AB 2555 is scheduled to be heard by
the Assembly Education Committee on April 30.
AB 1955 (Pan) requires the SPI to establish the Healthy Kids,
Healthy Minds Demonstration which will provide grants to
local educational agencies for the purpose of employing
one full-time school nurse and one full-time mental
health professional, and ensuring that the schools'
libraries are open one hour before and three hours after
the regular school day. AB 1955 is scheduled to be heard
by the Assembly Health Committee on April 29.
SB 596 (Yee) requires the California Department of Education
to establish a three-year pilot program to encourage
inclusive practices that integrate mental health, special
education, and school climate interventions following a
multi-tiered framework. SB 596 is pending referral in
the Assembly.
7) Prior legislation. AB 174 (Bonta, 2013) would have
required the Department of Public Health to establish a
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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 1178 (Bocanegra, 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.
AB 1178 was held in the Assembly Appropriations
Committee.
AB 1367 (Mansoor, 2013) would have among other things,
expanded existing outreach about 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 never heard.
AB 2105 (Scott, 2000) would have required the California
Department of Education to establish a two-year pilot
project in three school districts to improve the delivery
of education services to children who need mental health
services. AB 2105 was held in the Assembly
Appropriations Committee.
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SUPPORT
American Association of University Women-California
American Nurses Association
California Partnership to End Domestic Violence
California Primary Care Association
Children Now
Children's Defense Fund-California
James Morehouse Project
Northeast Community Clinic
Partnership for Children & Youth
Planned Parenthood Affiliates of California
Sacramento City Unified School District, Student Support and
Health Services Department
San Diego Unified School District
St. John's Well Child & Family Center
The Children's Partnership
To Help Everyone health and Wellness Centers
Umma Community Clinic
Valley Community Clinic
Watts Healthcare Corporation
OPPOSITION
California Right to Life Committee