AB 1644: School-based early mental health intervention and prevention services.
- Session Year: 2015-2016
- House: Assembly
- Latest Version Date: 2016-08-01
Existing law, the School-Based Early Mental Health Intervention and Prevention Services for Children Act of 1991 (1991 act), authorizes the Director of Health Care Services, in consultation with the Superintendent of Public Instruction, to provide matching grants to local educational agencies to pay the state share of the costs of providing school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, subject to the availability of funding each year. Existing law defines eligible pupil for this purpose as a pupil who attends a publicly funded elementary school and who is in kindergarten or grades 1 to 3, inclusive. Existing law also defines local educational agency as a school district or county office of education or a state special school.
This bill would rename the 1991 act the Healing from Early Adversity to Level the Impact (HEAL) of Trauma in Schools Act or the HEAL Trauma in Schools Act. The bill would expand the definition of an eligible pupil to include a pupil who attends a preschool program at a contracting agency of the California state preschool program or a local educational agency, and a pupil who is in transitional kindergarten, thereby extending the application of the act to those persons. The bill would also include charter schools in the definition of local educational agency, thereby extending the application of the act to those entities. The bill would increase the percentage of each matching grant that may be used for matching grant evaluation from 10% to 20%. This bill would implement this program only to the extent that the department determines that federal financial participation is not jeopardized, as specified. The bill would require the State Public Health Officer, Director of Health Care Services, in consultation with the Superintendent of Public Schools, the Director of Health Care Services, Instruction, the State Public Heath Officer, and the Attorney General to establish a 4-year program, the HEAL Trauma in Schools Support Program, to provide outreach, free regional training, and technical assistance for local educational agencies in providing mental health services at schoolsites. The bill would require the State Department of Public Health Health Care Services to submit specified reports after 2 and 4 years. The bill would make the implementation of the program contingent upon an appropriation in the annual budget act.
This bill would authorize the department to implement, interpret, or make specific the grant and support programs by means of information notices, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action, until regulations are adopted and would exempt contracts for the HEAL Trauma in Schools Support Program and administration, or ancillary services in support of the program, from specified statutory and administrative requirements and from approval by the Department of General Services. The bill would repeal these provisions the HEAL Trauma in Schools Support Program as of January 1, 2022.
Existing law, the School-Based Early Mental Health Intervention and Prevention Services for Children Act of 1991 (1991 act), authorizes the Director of Health Care Services, in consultation with the Superintendent of Public Instruction, to provide matching grants to local educational agencies to pay the state share of the costs of providing school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, subject to the availability of funding each year. Existing law defines eligible pupil for this purpose as a pupil who attends a publicly funded elementary school and who is in kindergarten or grades 1 to 3, inclusive. Existing law also defines local educational agency as a school district or county office of education or a state special school.
This bill would rename the 1991 act the Healing from Early Adversity to Level the Impact (HEAL) of Trauma in Schools Act or the HEAL Trauma in Schools Act. The bill would expand the definition of an eligible pupil to include a pupil who attends a preschool program at a contracting agency of the California state preschool program or a local educational agency, and a pupil who is in transitional kindergarten, thereby extending the application of the act to those persons. The bill would also include charter schools in the definition of local educational agency, thereby extending the application of the act to those entities. The bill would require the State Public Health Officer, in consultation with the Superintendent of Public Schools, the Director of Health Care Services, and the Attorney General to establish a 4-year program, the HEAL Trauma in Schools Support Program, to provide outreach, free regional training, and technical assistance for local educational agencies in providing mental health services at schoolsites. The bill would require the State Department of Public Health to submit specified reports after 2 and 4 years. The bill would make the implementation of the program contingent upon an appropriation in the annual budget act. The bill would repeal these provisions as of January 1, 2022.
Existing law, the School-Based Early Mental Health Intervention and Prevention Services for Children Act of 1991 (1991 act), authorizes the Director of Health Care Services, in consultation with the Superintendent of Public Instruction, to provide matching grants to local educational agencies to pay the state share of the costs of providing school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, subject to the availability of funding each year. Existing law defines eligible pupil for this purpose as a pupil who attends a publicly funded elementary school and who is in kindergarten or grades 1 to 3, inclusive. Existing law also defines local educational agency as a school district or county office of education or a state special school.
This bill would rename the 1991 act the Healing from Early Adversity to Level the Impact (HEAL) of Trauma in Schools Act or the HEAL Trauma in Schools Act. The bill would expand the definition of an eligible pupil to include a pupil who attends a preschool program at a publicly funded elementary school contracting agency of the California state preschool program or a local educational agency, and a pupil who is in transitional kindergarten, thereby extending the application of the act to those persons. The bill would also include charter schools in the definition of local educational agency, thereby extending the application of the act to those entities. The bill would require the State Public Health Officer, in consultation with the Superintendent of Public Schools, the Director of Health Care Services, and the Attorney General to establish a 4-year pilot program, the School-Based Early Mental Health Intervention and Prevention Services HEAL Trauma in Schools Support Program, to provide outreach, free regional training, and technical assistance for local educational agencies in providing mental health services at schoolsites. The bill would require the State Department of Public Health to submit specified reports after 2 and 4 years. The bill would make the implementation of the pilot program contingent upon an appropriation in the annual budget act. The bill would repeal these provisions as of January 1, 2022.
Existing law, the School-based School-Based Early Mental Health Intervention and Prevention Services for Children Act of 1991, 1991 (1991 act), authorizes the Director of Health Care Services, in consultation with the Superintendent of Public Instruction, to provide matching grants to local educational agencies to pay the state share of the costs of providing school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, subject to the availability of funding each year. Existing law defines eligible pupil for this purpose as a pupil who attends a publicly funded elementary school and who is in kindergarten or grades 1 to 3, inclusive. Existing law also defines local educational agency as a school district or county office of education or a state special school.
This bill would rename the 1991 act the Healing from Early Adversity to Level the Impact (HEAL) of Trauma in Schools Act or the HEAL Trauma in Schools Act. The bill would expand the definition of an eligible pupil to include a pupil who attends a preschool program at a publicly funded elementary school and a pupil who is in transitional kindergarten, thereby extending the application of the act to those persons. The bill would also include charter schools in the definition of local educational agency, thereby extending the application of the act to those entities. The bill would require the State Public Health Officer, in consultation with the Superintendent of Public Schools and Schools, the Director of Health Care Services, and the Attorney General to establish a 4-year pilot program, the School-Based Early Mental Health Intervention and Prevention Services Support Program, to provide outreach, free regional training, and technical assistance for local educational agencies in providing mental health services at schoolsites. The bill would require the State Department of Public Health to submit specified reports after 2 and 4 years. The bill would make the implementation of the pilot program contingent upon an appropriation in the annual budget act. The bill would repeal these provisions as of January 1, 2022.
Existing law, the School-based Early Mental Health Intervention and Prevention Services for Children Act of 1991, authorizes the Director of Health Care Services, in consultation with the Superintendent of Public Instruction, to provide matching grants to local educational agencies to pay the state share of the costs of providing school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, subject to the availability of funding each year. Existing law defines eligible pupil for this purpose as a pupil who attends a publicly funded elementary school and who is in kindergarten or grades 1 to 3, inclusive. Existing law also defines local educational agency as a school district or county office of education or a state special school.
This bill would expand the definition of an eligible pupil to include a pupil who attends a preschool program at a publicly funded elementary school and a pupil who is in transitional kindergarten, thereby extending the application of the act to those persons. The bill would also include charter schools in the definition of local educational agency, thereby extending the application of the act to those entities. The bill would require the State Public Health Officer, in consultation with the Superintendent of Public Schools and the Director of Health Care Services, to establish a 4-year pilot program, the School-Based Early Mental Health Intervention and Prevention Services Support Program, to provide outreach, free regional training, and technical assistance for local educational agencies in providing mental health services at schoolsites. The bill would require the State Department of Public Health to submit specified reports after 2 and 4 years. The bill would repeal these provisions as of January 1, 2022.
The Legislature finds and declares all of the following:
(a)Californias communities and systems are currently facing challenges to prevent and address the far-reaching impacts of childhood adversity, such as Adverse Childhood Experiences (ACEs) and childhood trauma, which can result in negative educational, health, social, and economic outcomes for children, youth, families, and communities across the state.
(b)In California, 61.7 percent of adults have experienced at least one ACE and 16.7 percent have experienced four or more ACEs. Compared to an individual who has not experienced an ACE, an individual with four or more ACEs is more likely to experience chronic disease and engage in negative health behaviors. For example, based on results of the California Behavioral Risk Factor Surveillance Survey, a person in California with four or more ACEs is 1.6 times as likely to have diabetes, 1.9 times as likely to have cancer, 2.4 times as likely to suffer from chronic obstructive pulmonary disease, 2.9 times as likely to smoke, 4.2 times as likely to be diagnosed with Alzheimers disease or dementia, 5.1 times as likely to suffer from depression, 7.4 times as likely to be an alcoholic, and 12.2 times as likely to attempt suicide. Individuals are similarly impacted by ACEs, regardless of race and ethnicity.
(c)From the 199293 fiscal year to the 201112 fiscal year, inclusive, the State Department of Mental Health awarded funds each year in matching grants to local educational agencies to fund prevention and early intervention programs, including the Primary Intervention Program, for students experiencing mild to moderate school adjustment difficulty through the School-based Early Mental Health Intervention and Prevention Services for Children Program of 1991, known as the Early Mental Health Initiative (EMHI). In the 201112 fiscal year, the EMHI received $15 million in state funds.
(d)School adjustment difficulties that can impede learning, such as anxiety, withdrawal, and aggressive behaviors, are common symptoms of chronic or traumatic stress resulting from exposure to ACEs and childhood trauma.
(e)Authorizing legislation specified that the EMHI would be deemed successful if at least 75 percent of the children who complete the program show an improvement in at least one of the following four areas: learning behaviors, attendance, school adjustment, and school-related competencies.
(f)The EMHI succeeded in meeting these legislative requirements. According to the 201011 Early Mental Health Initiative Statewide Evaluation Report, of the 15,823 students located in 424 elementary schools across 66 school districts participating in EMHI-funded services during the 201011 school year, 79 percent exhibited positive social competence and school adjustment behaviors more frequently after completing services. Furthermore, the magnitude of the improvements was exceptional in comparison to evaluations of other programs, especially given the short-term and cost-effective nature of the intervention, and improvements were evident across all demographic subgroups.
(g)The 201011 Early Mental Health Initiative Statewide Evaluation Report described an unmet demand for EMHI-funded services at participating schoolsites, as only 37 percent of the students that scored in the appropriate school adjustment difficulty range were served with EMHI-funded services due to program capacity and funding constraints. Based on demographic considerations, similar demand would be expected at schools that did not receive EMHI grants.
(h)The Governors realignment for the 201112 fiscal year renamed the State Department of Mental Health as the State Department of State Hospitals and limited that departments mission. The Budget Act of 2012 disbursed Proposition 98 funds, which had been used to fund the EMHI, directly to local educational agencies in order to provide local schools with enhanced flexibility to manage their finances and give greater control of local decisions.
(i)Multitiered systems and supports, which integrate mental health, special education, and school climate interventions, have been developed as a model framework within which to implement these services. Pilot programs in the Counties of San Bernardino and Alameda are demonstrating that implementing these services as part of a multitiered system is cost effective because the cost of the services is more than fully offset by the reduction in the need for high-cost, nonpublic school placements.
(j)The evidence-based, cost-effective services provided by the EMHI support the Triple Aim of better health, better care, and lower costs. By helping children early on, evidence-based, cost-effective services also support the recommendations of the Lets Get Healthy California Task Force, which used the Triple Aim as its foundation and articulated Healthy Beginnings: Laying the Foundation for a Healthy Life, as a goal that includes reducing childhood trauma, improving early learning, and improving mental health and well-being as priorities.
(k)Providing early mental health service for children exposed to childhood adversity, such as ACEs and childhood trauma, additionally furthers the goal of the California Defending Childhood State Policy Initiative, which is to more effectively align, integrate, and mobilize multisectoral resources to equitably prevent, identify, and heal the impacts of violence and trauma on children and youth.
SEC. 2.Section 4370 of the Welfare and Institutions Code is amended to read:4370.This part shall be known and may be cited as the Healing from Early Adversity to Level the Impact (HEAL) of Trauma in Schools Act or the HEAL Trauma in Schools Act.
SEC. 3.Section 4371 of the Welfare and Institutions Code is amended to read:4371.The Legislature finds and declares all of the following:
(a)Each year in California over 65,000 teenagers become adolescent mothers and 230 teenagers commit suicide. Each year more than 20 percent of Californias teenagers drop out of high school.
(b)Thirty percent of Californias elementary school pupils experience school adjustment problems, many of which are evident the first four years of school, that is, kindergarten and grades 1 to 3, inclusive.
(c)Problems that our children experience, whether in school or at home, that remain undetected and untreated grow and manifest themselves in all areas of their later lives.
(d)There is a clear relationship between early adjustment problems and later adolescent problems, including, but not limited to, poor school attendance, low achievement, delinquency, drug abuse, and high school dropout rates. In many cases, signs of these problems can be detected in the early grades.
(e)It is in Californias best interest, both in economic and human terms, to identify and treat the minor difficulties that our children are experiencing before those difficulties become major barriers to later success. It is far more humane and cost-effective to make a small investment in early mental health intervention and prevention services now and avoid larger costs, including, but not limited to, foster care, group home placement, intensive special education services, mental health treatment, or probation supervised care.
(f)Programs like the Primary Intervention Program and the San Diego Unified Counseling Program for Children have proven very effective in helping children adjust to the school environment and learn more effective coping skills that in turn result in better school achievement, increased attendance, and increased self-esteem.
(g)To create the optimum learning environment for our children, schools, teachers, parents, caregivers, public and private service providers, and community-based organizations must enter into locally appropriate cooperative agreements to ensure that all pupils will receive the benefits of school-based early mental health intervention and prevention services that are designed to meet their personal, social, and educational needs.
(h)Adverse Childhood Experiences (ACEs) are traumatic experiences that can have a profound impact on a childs developing brain and body and lasting impacts on a persons health and livelihood across their lifetime. ACEs include physical, emotional, and sexual abuse; physical and emotional neglect; other experiences, such as substance abuse by a household member and witnessing domestic violence. Other traumatic experiences can include placement instability for foster youth, homelessness, and witnessing violence against family and community members.
(i)The State of California has long recognized the mental health needs of Californias children and the value of addressing these needs by supporting the provision of evidence-based mental health services in publicly funded preschools and elementary schools, as evidenced by the creation in 1981 of the Primary Prevention Project, now named the Primary Intervention Program, and the creation in 1991 of the School-Based Early Mental Health Intervention and Prevention Services for Children Program, known as the Early Mental Health Initiative (EMHI).
(j)It is in the interest of Californias children, families, schools, and communities that the State of California support local decisions to provide funding for evidence-based services in publicly funded preschools and elementary schools to address the mental health needs of children who have been exposed to childhood adversity.
(k)In addressing these needs, priority should be given to children, youth, and communities that experience childhood adversity more severely and profoundly, including those that experience socioeconomic disadvantage and historical and contemporary injustices, vulnerable communities, communities of color, and culturally, linguistically, and geographically isolated communities.
SEC. 4.Section 4372 of the Welfare and Institutions Code is amended to read:4372.For the purposes of this part, the following definitions shall apply:
(a)Cooperating entity means a federal, state, or local, public or private nonprofit agency providing school-based early mental health intervention and prevention services that agrees to offer services at a schoolsite through a program assisted under this part.
(b)Eligible pupil means a pupil who attends a preschool program at a contracting agency of the California state preschool program, as established by Article 7 (commencing with Section 8235) of Chapter 2 of Part 6 of Division 1 of Title 1 of the Education Code, or a local educational agency, or who attends a publicly funded elementary school and who is in kindergarten, transitional kindergarten, or grades 1 to 3, inclusive.
(c)Local educational agency means any school district or county office of education, state special school, or charter school.
(d)Department means the State Department of Public Health. Health Care Services.
(e)Director means the State Public Health Officer. Director of Health Care Services.
(f)Supportive service means a service that will enhance the mental health and social-emotional development of children.
SEC. 5.Section 4380 of the Welfare and Institutions Code is amended to read:4380.Subject Beginning with grants for the 201718 school year and subject to the availability of funding each year, the Legislature authorizes the director, in consultation with the Superintendent of Public Instruction, to award matching grants to local educational agencies to pay the state share of the costs of providing programs that provide school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, as follows:
(a)The director shall award matching grants pursuant to this chapter to local educational agencies throughout the state.
(b)Matching grants awarded under this part shall be awarded for a period of not more than three years and no single schoolsite shall be awarded more than one grant, except for a schoolsite that received a grant prior to July 1, 1992. grant.
(c)The director shall pay to each local educational agency having an application approved pursuant to requirements in this part the state share of the cost of the activities described in the application.
(d)Commencing July 1, 1993, the The state share of matching grants shall be a maximum of 50 percent in each of the three years.
(e)Commencing July 1, 1993, the The local share of matching grants shall be at least 50 percent, from a combination of school district and cooperating entity funds.
(f)The local share of the matching grant may be in cash or payment in-kind.
(g)
(f)Priority shall be given to those applicants that demonstrate the following:
(1)The local educational agency will serve the greatest number of eligible pupils from low-income families.
(2)The local educational agency will provide a strong parental involvement parent and caregiver engagement component.
(3)The local educational agency will provide supportive services with one or more cooperating entities.
(4)The local educational agency will provide services at a low cost per child served in the project.
(5)The local educational agency will provide programs and services that are based on adoption or modification, or both, of existing programs that have been shown to be effective.
(6)The local educational agency will provide services to children who are in out-of-home placement or who are at risk of being in out-of-home placement.
(7)The local educational agency will prioritize for receipt of services children who have been exposed to childhood trauma, including, but not limited to, foster youth, as defined in subdivision (b) of Section 42238.01 of the Education Code, and homeless children and youth, as defined in Section 11434a(2) of the federal McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.).
(h)
(g)Eligible supportive services may include the following:
(1)Individual and group early mental health intervention and prevention services.
(2)Parent involvement and caregiver engagement through conferences or training, or both.
(3)Teacher and staff conferences and training related to meeting project goals.
(4)Referral to outside resources when eligible pupils require additional services.
(5)Use of paraprofessional staff, who are trained and supervised by credentialed school psychologists, school counselors, or school social workers, to meet with pupils on a short-term weekly basis, in a one-on-one setting as in the primary intervention program established pursuant to Chapter 4 (commencing with Section 4343) of Part 3.
(6)Any other service or activity that will improve the mental health of eligible pupils, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
Prior to participation by an eligible pupil in either individual or group services, consent of a parent or guardian shall be obtained.
(i)
(h)Each local educational agency seeking a grant under this chapter shall submit an application to the director at the time, in a manner, and accompanied by any information the director may reasonably require.
(j)
(i)Each matching grant application submitted shall include all of the following:
(1)Documentation of need for the school-based early mental health intervention and prevention services.
(2)A description of the school-based early mental health intervention and prevention services expected to be provided at the schoolsite.
(3)A statement of program goals.
(4)A list of cooperating entities that will participate in the provision of services. A letter from each cooperating entity confirming its participation in the provision of services shall be included with the list. At least one letter shall be from a cooperating entity confirming that it will agree to screen referrals of low-income children the program has determined may be in need of mental health treatment services and that, if the cooperating entity determines that the child is in need of those services and if the cooperating entity determines that according to its priority process the child is eligible to be served by it, the cooperating entity will agree to provide those mental health treatment services.
(5)A detailed budget and budget narrative.
(6)A description of the proposed plan for parent involvement and caregiver engagement in the program.
(7)A description of the population anticipated to be served, including number of pupils to be served and socioeconomic indicators of sites to receive funds.
(8)A description of the matching funds from a combination of local education agencies and cooperating entities.
(9)A plan describing how the proposed school-based early mental health intervention and prevention services program will be continued after the matching grant has expired.
(10)Assurance that grants would supplement and not supplant existing local resources provided for early mental health intervention and prevention services.
(11)A description of an evaluation plan that includes quantitative and qualitative measures of school and pupil characteristics, and a comparison of childrens adjustment to school.
(k)
(j)Matching grants awarded pursuant to this article may be used for salaries of staff responsible for implementing the school-based early mental health intervention and prevention services program, equipment and supplies, training, and insurance.
(l )
(k)Salaries of administrative staff and other administrative costs associated with providing services shall be limited to 5 percent of the state share of assistance provided under this section.
(m)
(l)No more than 10 20 percent of each matching grant awarded pursuant to this article may be used for matching grant evaluation.
(n)
(m)No more than 10 percent of the moneys allocated to the director pursuant to this chapter may be utilized for program administration and evaluation.
Program administration shall include both state staff and field staff who are familiar with and have successfully implemented school-based early mental health intervention and prevention services. Field staff may be contracted with by local school districts or community mental health programs. Field staff shall provide support in the timely and effective implementation of school-based early mental health intervention and prevention services. Reviews of each project shall be conducted at least once during the first year of funding.
(o)
(n)Subject to the approval of the director, at the end of the fiscal year, a school district may apply unexpended funds to the HEAL Trauma in Schools Program budget for the subsequent funding year.
(p)
(o)Contracts for the program and administration, or ancillary services in support of the program, shall be exempt from the requirements of the Public Contract Code and the State Administrative Manual, and from approval by the Department of General Services.
SEC. 6.Section 4384 is added to the Welfare and Institutions Code, to read:4384.Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this chapter by means of information notices, plan letters, plan or provider bulletins, or similar instructions, until regulations are adopted.
SEC. 7.Section 4385 is added to the Welfare and Institutions Code, to read:4385.This chapter shall be implemented only to the extent that the department determines that any existing federal financial participation associated with the four eligible support services and early mental health intervention services is not jeopardized. The department may claim federal financial participation for the administrative activities performed by the department pursuant to this chapter to the extent the department determines federal financial participation is available for this purpose and to the extent any necessary federal approvals are obtained. This chapter shall not be construed to alter any existing funding obligation in law associated with the provision of eligible support services and early mental health intervention services by county mental health departments or local educational agencies, including, but not limited to, responsibility for the nonfederal share of permissible Medicaid expenditures, if any.
SEC. 6.SEC. 8.Chapter 4 (commencing with Section 4391) is added to Part 4 of Division 4 of the Welfare and Institutions Code, to read:4.HEAL Trauma in Schools Support Program4391.(a)The director shall establish a four-year program, in consultation with the Superintendent of Public Instruction, the Director of Health Care Services, Instruction, the State Public Health Officer, and the Attorney General General, to encourage and support local decisions to provide funding for the eligible support services as provided in this section.
(b)The department shall provide outreach to local educational agencies and county mental health agencies to inform individuals responsible for local funding decisions of the program established pursuant to this section.
(c)The department shall provide free regional training regional training at no cost to the local educational agencies on all of the following: following subjects:
(1)Eligible support services, which may include any or all of the following:
(A)Individual and group early mental health intervention and prevention services.
(B)Parent and caregiver engagement through conference or training, or both.
(C)Teacher and staff conferences and training related to meeting project goals.
(D)Referral to outside resources when eligible pupils require additional services.
(E)Use of paraprofessional staff, who are trained and supervised by credentialed school psychologists, school counselors, or school social workers, to meet with pupils on a short-term weekly basis, in a one-on-one setting as in the primary intervention program established pursuant to Chapter 4 (commencing with Section 4343) of Part 3.
(F)Any other service or activity that will improve the mental health of eligible pupils, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
(2)The potential for the eligible support services defined in this section to help fulfill state priorities described by the local control funding formula and local goals described by local control and accountability plans.
(3)How educational, mental health, and other funds subject to local control can be used to finance the eligible support services defined in this section.
(4)External resources available to support the eligible support services defined in this section, which may include workshops, training, conferences, and peer learning networks.
(5)State resources available to support student mental health and resilience, and positive, trauma-informed learning environments, which may include any of the following:
(A)Foundational aspects of learning, childhood social-emotional development, mental health and resilience, toxic stress, childhood trauma, and Adverse Childhood Experiences.
(B)Inclusive multitiered systems of behavioral and academic supports, Schoolwide Positive Behavior Interventions and Supports, restorative justice or restorative practices, trauma-informed practices, social and emotional learning, bullying prevention, mental health consultation, and parent-child group supports.
(d)The department shall provide technical assistance to local educational agencies that provide or seek to provide eligible services defined in this section. Technical assistance shall include assistance in any of the following:
(1)Designing programs.
(2)Training program staff in intervention skills.
(3)Conducting local evaluations.
(4)Coordinating with county mental health agencies and professionals.
(5)Leveraging educational, mental health, and other funds that are subject to local control and assisting in budget development.
(e)In providing outreach pursuant to subdivision (b), training pursuant to subdivision (c), and technical assistance pursuant to subdivision (d), the department shall select and support schoolsites as follows:
(1)(A)During the first 12 months of the program, the department department, in collaboration with the Superintendent of Public Instruction, shall support, strengthen, and expand the provision of eligible services at schoolsites that previously received funding pursuant to the former School-Based Early Mental Health Intervention and Prevention Services Matching Grant Program and have continued to provide eligible support services. In working with these selected schoolsites, the department shall develop methods and standards for providing services and practices to new schoolsites.
(B)The department shall develop a process to identify schoolsites that demonstrate the willingness and capacity to participate in the program.
(2)During the subsequent 36 months of the program, the department shall select new schoolsites that are not providing eligible support services but that demonstrate the willingness and capacity to participate in the program. The department shall work with these schoolsites to deliver eligible support services.
(3)In selecting schoolsites and providing support, the department shall prioritize the following:
(A)Schoolsites in communities that have experienced in which local educational agencies have demonstrated high levels of childhood adversity, such as Adverse Childhood Experiences and childhood trauma. including, but not limited to, high-poverty local educational agencies and schools eligible under the Community Eligibility Provision of the Healthy Hunger-Free Kids Act of 2010 (Public Law 111-296) and local educational agencies and schools identified in the California Longitudinal Pupil Achievement Data System as having high rates of foster youth and homeless children and youth.
(B)Schoolsites that prioritize for receipt of services children who have been exposed to childhood trauma, including, but not limited to, foster youth, as defined in subdivision (b) of Section 42238.01 of the Education Code, and homeless children and youth, as defined in Section 11434a(2) of the federal McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.)
(C)Geographic diversity, program effectiveness, program efficiency, and long-term program sustainability.
(f)The department shall submit, in compliance with Section 9795 of the Government Code, an interim report to the Legislature at the end of the second year of the program that details the departments work to support the schoolsites selected pursuant to paragraph (1) of subdivision (e) and includes an assessment of the demand and impact of funding for the HEAL Trauma in Schools Act established pursuant to this part. The department shall make the report available to the public and shall post the report on its Internet Web site.
(g)The department shall develop an evaluation plan to assess the impact of the program. The department, in compliance with Section 9795 of the Government Code, shall submit a report to the Legislature at the end of the four-year period evaluating the impact of the program and providing recommendations for further implementation. The department shall make the report available to the public and shall post the report on its Internet Web site.
4391.2.Contracts for the program and administration, or ancillary services in support of the program, shall be exempt from the requirements of the Public Contract Code and the State Administrative Manual, and from approval by the Department of General Services.
4391.5.Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this chapter by means of information notices, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action, until regulation are adopted.
4392.Implementation of this chapter is contingent upon an appropriation in the annual budget act.
4393.This chapter shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
The Legislature finds and declares all of the following:
(a)Californias communities and systems are currently facing challenges to prevent and address the far-reaching impacts of childhood adversity, such as Adverse Childhood Experiences (ACEs) and childhood trauma, which can result in negative educational, health, social, and economic outcomes for children, youth, families, and communities across the state.
(b)In California, 61.7 percent of adults have experienced at least one ACE and 16.7 percent have experienced four or more ACEs. Compared to an individual who has not experienced an ACE, an individual with four or more ACEs is more likely to experience chronic disease and engage in negative health behaviors. For example, based on results of the California Behavioral Risk Factor Surveillance Survey, a person in California with four or more ACEs is 1.6 times as likely to have diabetes, 1.9 times as likely to have cancer, 2.4 times as likely to suffer from chronic obstructive pulmonary disease, 2.9 times as likely to smoke, 4.2 times as likely to be diagnosed with Alzheimers disease or dementia, 5.1 times as likely to suffer from depression, 7.4 times as likely to be an alcoholic, and 12.2 times as likely to attempt suicide. Individuals are similarly impacted by ACEs, regardless of race and ethnicity.
(c)From the 199293 fiscal year to the 201112 fiscal year, inclusive, the State Department of Mental Health awarded funds each year in matching grants to local educational agencies to fund prevention and early intervention programs, including the Primary Intervention Program, for students experiencing mild to moderate school adjustment difficulty through the School-based Early Mental Health Intervention and Prevention Services for Children Program of 1991, known as the Early Mental Health Initiative (EMHI). In the 201112 fiscal year, the EMHI received $15 million in state funds.
(d)School adjustment difficulties that can impede learning, such as anxiety, withdrawal, and aggressive behaviors, are common symptoms of chronic or traumatic stress resulting from exposure to ACEs and childhood trauma.
(e)Authorizing legislation specified that the EMHI would be deemed successful if at least 75 percent of the children who complete the program show an improvement in at least one of the following four areas: learning behaviors, attendance, school adjustment, and school-related competencies.
(f)The EMHI succeeded in meeting these legislative requirements. According to the 201011 Early Mental Health Initiative Statewide Evaluation Report, of the 15,823 students located in 424 elementary schools across 66 school districts participating in EMHI-funded services during the 201011 school year, 79 percent exhibited positive social competence and school adjustment behaviors more frequently after completing services. Furthermore, the magnitude of the improvements was exceptional in comparison to evaluations of other programs, especially given the short-term and cost-effective nature of the intervention, and improvements were evident across all demographic subgroups.
(g)The 201011 Early Mental Health Initiative Statewide Evaluation Report described an unmet demand for EMHI-funded services at participating schoolsites, as only 37 percent of the students that scored in the appropriate school adjustment difficulty range were served with EMHI-funded services due to program capacity and funding constraints. Based on demographic considerations, similar demand would be expected at schools that did not receive EMHI grants.
(h)The Governors realignment for the 201112 fiscal year renamed the State Department of Mental Health as the State Department of State Hospitals and limited that departments mission. The Budget Act of 2012 disbursed Proposition 98 funds, which had been used to fund the EMHI, directly to local educational agencies in order to provide local schools with enhanced flexibility to manage their finances and give greater control of local decisions.
(i)Multitiered systems and supports, which integrate mental health, special education, and school climate interventions, have been developed as a model framework within which to implement these services. Pilot programs in the Counties of San Bernardino and Alameda are demonstrating that implementing these services as part of a multitiered system is cost effective because the cost of the services is more than fully offset by the reduction in the need for high-cost, nonpublic school placements.
(j)The evidence-based, cost-effective services provided by the EMHI support the Triple Aim of better health, better care, and lower costs. By helping children early on, evidence-based, cost-effective services also support the recommendations of the Lets Get Healthy California Task Force, which used the Triple Aim as its foundation and articulated Healthy Beginnings: Laying the Foundation for a Healthy Life, as a goal that includes reducing childhood trauma, improving early learning, and improving mental health and well-being as priorities.
(k)Providing early mental health service for children exposed to childhood adversity, such as ACEs and childhood trauma, additionally furthers the goal of the California Defending Childhood State Policy Initiative, which is to more effectively align, integrate, and mobilize multisectoral resources to equitably prevent, identify, and heal the impacts of violence and trauma on children and youth.
SEC. 2.Section 4370 of the Welfare and Institutions Code is amended to read:4370.This part shall be known and may be cited as the Healing from Early Adversity to Level the Impact (HEAL) of Trauma in Schools Act or the HEAL Trauma in Schools Act.
SEC. 3.Section 4371 of the Welfare and Institutions Code is amended to read:4371.The Legislature finds and declares all of the following:
(a)Each year in California over 65,000 teenagers become adolescent mothers and 230 teenagers commit suicide. Each year more than 20 percent of Californias teenagers drop out of high school.
(b)Thirty percent of Californias elementary school pupils experience school adjustment problems, many of which are evident the first four years of school, that is, kindergarten and grades 1 to 3, inclusive.
(c)Problems that our children experience, whether in school or at home, that remain undetected and untreated grow and manifest themselves in all areas of their later lives.
(d)There is a clear relationship between early adjustment problems and later adolescent problems, including, but not limited to, poor school attendance, low achievement, delinquency, drug abuse, and high school dropout rates. In many cases, signs of these problems can be detected in the early grades.
(e)It is in Californias best interest, both in economic and human terms, to identify and treat the minor difficulties that our children are experiencing before those difficulties become major barriers to later success. It is far more humane and cost-effective to make a small investment in early mental health intervention and prevention services now and avoid larger costs, including, but not limited to, foster care, group home placement, intensive special education services, mental health treatment, or probation supervised care.
(f)Programs like the Primary Intervention Program and the San Diego Unified Counseling Program for Children have proven very effective in helping children adjust to the school environment and learn more effective coping skills that in turn result in better school achievement, increased attendance, and increased self-esteem.
(g)To create the optimum learning environment for our children, schools, teachers, parents, public and private service providers, and community-based organizations must enter into locally appropriate cooperative agreements to ensure that all pupils will receive the benefits of school-based early mental health intervention and prevention services that are designed to meet their personal, social, and educational needs.
(h)ACEs Adverse Childhood Experiences (ACEs) are traumatic experiences that can have a profound impact on a childs developing brain and body and lasting impacts on a persons health and livelihood across their lifetime. ACEs include physical, emotional, and sexual abuse; physical and emotional neglect; other experiences, such as substance abuse by a household member and witnessing domestic violence. Other traumatic experiences can include placement instability for foster youth, homelessness, and witnessing violence against family and community members.
(i)The State of California has long recognized the mental health needs of Californias children and the value of addressing these needs by supporting the provision of evidence-based mental health services in publicly funded preschools and elementary schools, as evidenced by the creation in 1981 of the Primary Prevention Project, now named the Primary Intervention Program, and the creation in 1991 of the School-Based Early Mental Health Intervention and Prevention Services for Children Program, known as the Early Mental Health Initiative (EMHI).
(j)It is in the interest of Californias children, families, schools, and communities that the State of California support local decisions to provide funding for evidence-based services in publicly funded preschools and elementary schools to address the mental health needs of children who have been exposed to childhood adversity.
(k)In addressing these needs, priority should be given to children, youth, and communities that experience childhood adversity more severely and profoundly, including those that experience socioeconomic disadvantage and historical and contemporary injustices, vulnerable communities, communities of color, and culturally, linguistically, and geographically isolated communities.
SEC. 4.Section 4372 of the Welfare and Institutions Code is amended to read:4372.For the purposes of this part, the following definitions shall apply:
(a)Cooperating entity means a federal, state, or local, public or private nonprofit agency providing school-based early mental health intervention and prevention services that agrees to offer services at a schoolsite through a program assisted under this part.
(b)Eligible pupil means a pupil who attends a preschool program at a contracting agency of the California state preschool program, as established by Article 7 (commencing with Section 8235) of Chapter 2 of Part 6 of Division 1 of Title 1 of the Education Code, or a local educational agency, or who attends a publicly funded elementary school and who is in kindergarten, transitional kindergarten, or grades 1 to 3, inclusive.
(c)Local educational agency means any school district or county office of education, state special school, or charter school.
(d)Department means the State Department of Public Health.
(e)Director means the State Public Health Officer.
(f)Supportive service means a service that will enhance the mental health and social-emotional development of children.
SEC. 5.Section 4380 of the Welfare and Institutions Code is amended to read:4380.Subject to the availability of funding each year, the Legislature authorizes the director, in consultation with the Superintendent of Public Instruction, to award matching grants to local educational agencies to pay the state share of the costs of providing programs that provide school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, as follows:
(a)The director shall award matching grants pursuant to this chapter to local educational agencies throughout the state.
(b)Matching grants awarded under this part shall be awarded for a period of not more than three years and no single schoolsite shall be awarded more than one grant, except for a schoolsite that received a grant prior to July 1, 1992.
(c)The director shall pay to each local educational agency having an application approved pursuant to requirements in this part the state share of the cost of the activities described in the application.
(d)Commencing July 1, 1993, the state share of matching grants shall be a maximum of 50 percent in each of the three years.
(e)Commencing July 1, 1993, the local share of matching grants shall be at least 50 percent, from a combination of school district and cooperating entity funds.
(f)The local share of the matching grant may be in cash or payment in-kind.
(g)Priority shall be given to those applicants that demonstrate the following:
(1)The local educational agency will serve the greatest number of eligible pupils from low-income families.
(2)The local educational agency will provide a strong parental involvement component.
(3)The local educational agency will provide supportive services with one or more cooperating entities.
(4)The local educational agency will provide services at a low cost per child served in the project.
(5)The local educational agency will provide programs and services that are based on adoption or modification, or both, of existing programs that have been shown to be effective.
(6)The local educational agency will provide services to children who are in out-of-home placement or who are at risk of being in out-of-home placement.
(7)The local educational agency will prioritize for receipt of services children who have been exposed to childhood trauma, including, but not limited to, foster youth, as defined in subdivision (b) of Section 42238.01 of the Education Code, and homeless children and youth, as defined in Section 11434a(2) of the federal McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.).
(h)Eligible supportive services may include the following:
(1)Individual and group intervention and prevention services.
(2)Parent involvement through conferences or training, or both.
(3)Teacher and staff conferences and training related to meeting project goals.
(4)Referral to outside resources when eligible pupils require additional services.
(5)Use of paraprofessional staff, who are trained and supervised by credentialed school psychologists, school counselors, or school social workers, to meet with pupils on a short-term weekly basis, in a one-on-one setting as in the primary intervention program established pursuant to Chapter 4 (commencing with Section 4343) of Part 3.
(6)Any other service or activity that will improve the mental health of eligible pupils, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
Prior to participation by an eligible pupil in either individual or group services, consent of a parent or guardian shall be obtained.
(i)Each local educational agency seeking a grant under this chapter shall submit an application to the director at the time, in a manner, and accompanied by any information the director may reasonably require.
(j)Each matching grant application submitted shall include all of the following:
(1)Documentation of need for the school-based early mental health intervention and prevention services.
(2)A description of the school-based early mental health intervention and prevention services expected to be provided at the schoolsite.
(3)A statement of program goals.
(4)A list of cooperating entities that will participate in the provision of services. A letter from each cooperating entity confirming its participation in the provision of services shall be included with the list. At least one letter shall be from a cooperating entity confirming that it will agree to screen referrals of low-income children the program has determined may be in need of mental health treatment services and that, if the cooperating entity determines that the child is in need of those services and if the cooperating entity determines that according to its priority process the child is eligible to be served by it, the cooperating entity will agree to provide those mental health treatment services.
(5)A detailed budget and budget narrative.
(6)A description of the proposed plan for parent involvement in the program.
(7)A description of the population anticipated to be served, including number of pupils to be served and socioeconomic indicators of sites to receive funds.
(8)A description of the matching funds from a combination of local education agencies and cooperating entities.
(9)A plan describing how the proposed school-based early mental health intervention and prevention services program will be continued after the matching grant has expired.
(10)Assurance that grants would supplement and not supplant existing local resources provided for early mental health intervention and prevention services.
(11)A description of an evaluation plan that includes quantitative and qualitative measures of school and pupil characteristics, and a comparison of childrens adjustment to school.
(k)Matching grants awarded pursuant to this article may be used for salaries of staff responsible for implementing the school-based early mental health intervention and prevention services program, equipment and supplies, training, and insurance.
(l)Salaries of administrative staff and other administrative costs associated with providing services shall be limited to 5 percent of the state share of assistance provided under this section.
(m)No more than 10 percent of each matching grant awarded pursuant to this article may be used for matching grant evaluation.
(n)No more than 10 percent of the moneys allocated to the director pursuant to this chapter may be utilized for program administration and evaluation.
Program administration shall include both state staff and field staff who are familiar with and have successfully implemented school-based early mental health intervention and prevention services. Field staff may be contracted with by local school districts or community mental health programs. Field staff shall provide support in the timely and effective implementation of school-based early mental health intervention and prevention services. Reviews of each project shall be conducted at least once during the first year of funding.
(o)Subject to the approval of the director, at the end of the fiscal year, a school district may apply unexpended funds to the budget for the subsequent funding year.
(p)Contracts for the program and administration, or ancillary services in support of the program, shall be exempt from the requirements of the Public Contract Code and the State Administrative Manual, and from approval by the Department of General Services.
SEC. 6.Chapter 4 (commencing with Section 4391) is added to Part 4 of Division 4 of the Welfare and Institutions Code, to read:4.HEAL Trauma in Schools Support Program4391.(a)The director shall establish a four-year program, in consultation with the Superintendent of Public Instruction, the Director of Health Care Services, and the Attorney General to encourage and support local decisions to provide funding for the eligible support services as provided in this section.
(b)The department shall provide outreach to local educational agencies and county mental health agencies to inform individuals responsible for local funding decisions of the program established pursuant to this section.
(c)The department shall provide free regional training on all of the following:
(1)Eligible support services, which may include any or all of the following:
(A)Individual and group intervention and prevention services.
(B)Parent engagement through conference or training, or both.
(C)Teacher and staff conferences and training related to meeting project goals.
(D)Referral to outside resources when eligible pupils require additional services.
(E)Use of paraprofessional staff, who are trained and supervised by credentialed school psychologists, school counselors, or school social workers, to meet with pupils on a short-term weekly basis, in a one-on-one setting as in the primary intervention program established pursuant to Chapter 4 (commencing with Section 4343) of Part 3.
(F)Any other service or activity that will improve the mental health of eligible pupils, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
(2)The potential for the eligible support services defined in this section to help fulfill state priorities described by the local control funding formula and local goals described by local control and accountability plans.
(3)How educational, mental health, and other funds subject to local control can be used to finance the eligible support services defined in this section.
(4)External resources available to support the eligible support services defined in this section, which may include workshops, training, conferences, and peer learning networks.
(5)State resources available to support student mental health and resilience, and positive, trauma-informed learning environments, which may include any of the following:
(A)Foundational aspects of learning, childhood social-emotional development, mental health and resilience, toxic stress, childhood trauma, and Adverse Childhood Experiences.
(B)Inclusive multitiered systems of behavioral and academic supports, Schoolwide Positive Behavior Interventions and Supports, restorative justice or restorative practices, trauma-informed practices, social and emotional learning, and bullying prevention. bullying prevention, mental health consultation, and parent-child group supports.
(d)The department shall provide technical assistance to local educational agencies that provide or seek to provide eligible services defined in this section. Technical assistance shall include assistance in any of the following:
(1)Designing programs.
(2)Training program staff in intervention skills.
(3)Conducting local evaluations.
(4)Coordinating with county mental health agencies and professionals.
(5)Leveraging educational, mental health, and other funds that are subject to local control and assisting in budget development.
(e)In providing outreach pursuant to subdivision (b), training pursuant to subdivision (c), and technical assistance pursuant to subdivision (d), the department shall select and support schoolsites as follows:
(1)(A)During the first 12 months of the program, the department shall support, strengthen, and expand the provision of eligible services at schoolsites that previously received funding pursuant to the former School-Based Early Mental Health Intervention and Prevention Services Matching Grant Program and have continued to provide eligible support services. In working with these selected schoolsites, the department shall develop methods and standards for providing services and practices to new schoolsites.
(B)The department shall develop a process to identify schoolsites that demonstrate the willingness and capacity to participate in the program.
(2)During the subsequent 36 months of the program, the department shall select new schoolsites that are not providing eligible support services but that demonstrate the willingness and capacity to participate in the program. The department shall work with these schoolsites to deliver eligible support services.
(3)In selecting schoolsites and providing support, the department shall prioritize the following:
(A)Schoolsites in communities that have experienced high levels of childhood adversity, such as Adverse Childhood Experiences and childhood trauma.
(B)Schoolsites that prioritize for receipt of services children who have been exposed to childhood trauma, including, but not limited to, foster youth, as defined in subdivision (b) of Section 42238.01 of the Education Code, and homeless children and youth, as defined in Section 11434a(2) of the federal McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.)
(C)Geographic diversity, program effectiveness, program efficiency, and long-term program sustainability.
(f)The department shall submit, in compliance with Section 9795 of the Government Code, an interim report to the Legislature at the end of the second year of the program that details the departments work to support the schoolsites selected pursuant to paragraph (1) of subdivision (e) and includes an assessment of the demand and impact of funding for the HEAL Trauma in Schools Act established pursuant to this part. The department shall make the report available to the public and shall post the report on its Internet Web site.
(g)The department shall develop an evaluation plan to assess the impact of the program. The department, in compliance with Section 9795 of the Government Code, shall submit a report to the Legislature at the end of the four-year period evaluating the impact of the program and providing recommendations for further implementation. The department shall make the report available to the public and shall post the report on its Internet Web site.
4392.Implementation of this chapter is contingent upon an appropriation in the annual budget act.
4393.This chapter shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
The Legislature finds and declares all of the following:
(a)Californias communities and systems are currently facing challenges to prevent and address the far-reaching impacts of childhood adversity, such as Adverse Childhood Experiences (ACEs) and childhood trauma, which can result in negative educational, health, social, and economic outcomes for children, youth, families, and communities across the state.
(b)In California, 61.7 percent of adults have experienced at least one ACE and 16.7 percent have experienced four or more ACEs. Compared to an individual who has not experienced an ACE, an individual with four or more ACEs is more likely to experience chronic disease and engage in negative health behaviors. For example, based on results of the California Behavioral Risk Factor Surveillance Survey, a person in California with four or more ACEs is 1.6 times as likely to have diabetes, 1.9 times as likely to have cancer, 2.4 times as likely to suffer from chronic obstructive pulmonary disease, 2.9 times as likely to smoke, 4.2 times as likely to be diagnosed with Alzheimers disease or dementia, 5.1 times as likely to suffer from depression, 7.4 times as likely to be an alcoholic, and 12.2 times as likely to attempt suicide. Individuals are similarly impacted by ACEs, regardless of race and ethnicity.
(c)From the 199293 fiscal year to the 201112 fiscal year, inclusive, the State Department of Mental Health awarded funds each year in matching grants to local educational agencies to fund prevention and early intervention programs, including the Primary Intervention Program, for students experiencing mild to moderate school adjustment difficulty through the School-based Early Mental Health Intervention and Prevention Services for Children Program of 1991, known as the Early Mental Health Initiative (EMHI). In the 201112 fiscal year, the EMHI received $15 million in state funds.
(d)School adjustment difficulties that can impede learning, such as anxiety, withdrawal, and aggressive behaviors, are common symptoms of chronic or traumatic stress resulting from exposure to ACEs and childhood trauma.
(e)Authorizing legislation specified that the EMHI would be deemed successful if at least 75 percent of the children who complete the program show an improvement in at least one of the following four areas: learning behaviors, attendance, school adjustment, and school-related competencies.
(f)The EMHI succeeded in meeting these legislative requirements. According to the 201011 Early Mental Health Initiative Statewide Evaluation Report, of the 15,823 students located in 424 elementary schools across 66 school districts participating in EMHI-funded services during the 201011 school year, 79 percent exhibited positive social competence and school adjustment behaviors more frequently after completing services. Furthermore, the magnitude of the improvements was exceptional in comparison to evaluations of other programs, especially given the short-term and cost-effective nature of the intervention, and improvements were evident across all demographic subgroups.
(g)The 201011 Early Mental Health Initiative Statewide Evaluation Report described an unmet demand for EMHI-funded services at participating schoolsites, as only 37 percent of the students that scored in the appropriate school adjustment difficulty range were served with EMHI-funded services due to program capacity and funding constraints. Based on demographic considerations, similar demand would be expected at schools that did not receive EMHI grants.
(h)The Governors realignment for the 201112 fiscal year renamed the State Department of Mental Health as the State Department of State Hospitals and limited that departments mission. The Budget Act of 2012 disbursed Proposition 98 funds, which had been used to fund the EMHI, directly to local educational agencies in order to provide local schools with enhanced flexibility to manage their finances and give greater control of local decisions.
(i)Multitiered systems and supports, which integrate mental health, special education, and school climate interventions, have been developed as a model framework within which to implement these services. Pilot programs in the Counties of San Bernardino and Alameda are demonstrating that implementing these services as part of a multitiered system is cost effective because the cost of the services is more than fully offset by the reduction in the need for high-cost, nonpublic school placements.
(j)The evidence-based, cost-effective services provided by the EMHI support the Triple Aim of better health, better care, and lower costs. By helping children early on, evidence-based, cost-effective services also support the recommendations of the Lets Get Healthy California Task Force, which used the Triple Aim as its foundation and articulated Healthy Beginnings: Laying the Foundation for a Healthy Life, as a goal that includes reducing childhood trauma, improving early learning, and improving mental health and well-being as priorities.
(k)Providing early mental health service for children exposed to childhood adversity, such as ACEs and childhood trauma, additionally furthers the goal of the California Defending Childhood State Policy Initiative, which is to more effectively align, integrate, and mobilize multisectoral resources to equitably prevent, identify, and heal the impacts of violence and trauma on children and youth.
SEC. 2.Section 4370 of the Welfare and Institutions Code is amended to read:4370.This article part shall be known and may be cited as the Healing from Early Adversity to Level the Impact (HEAL) of Trauma in Schools Act or the HEAL Trauma in Schools Act.
SEC. 3.Section 4371 of the Welfare and Institutions Code is amended to read:4371.The Legislature finds and declares all of the following:
(a)Each year in California over 65,000 teenagers become adolescent mothers and 230 teenagers commit suicide. Each year more than 20 percent of Californias teenagers drop out of high school.
(b)Thirty percent of Californias elementary school pupils experience school adjustment problems, many of which are evident the first four years of school, that is, kindergarten and grades 1 to 3, inclusive.
(c)Problems that our children experience, whether in school or at home, that remain undetected and untreated grow and manifest themselves in all areas of their later lives.
(d)There is a clear relationship between early adjustment problems and later adolescent problems, including, but not limited to, poor school attendance, low achievement, delinquency, drug abuse, and high school dropout rates. In many cases, signs of these problems can be detected in the early grades.
(e)It is in Californias best interest, both in economic and human terms, to identify and treat the minor difficulties that our children are experiencing before those difficulties become major barriers to later success. It is far more humane and cost-effective to make a small investment in early mental health intervention and prevention services now and avoid larger costs, including, but not limited to, foster care, group home placement, intensive special education services, mental health treatment, or probation supervised care.
(f)Programs like the Primary Intervention Program and the San Diego Unified Counseling Program for Children have proven very effective in helping children adjust to the school environment and learn more effective coping skills that in turn result in better school achievement, increased attendance, and increased self-esteem.
(g)To create the optimum learning environment for our children, schools, teachers, parents, public and private service providers, and community-based organizations must enter into locally appropriate cooperative agreements to ensure that all pupils will receive the benefits of school-based early mental health intervention and prevention services that are designed to meet their personal, social, and educational needs.
(h)ACEs are traumatic experiences that can have a profound impact on a childs developing brain and body and lasting impacts on a persons health and livelihood across their lifetime. ACEs include physical, emotional, and sexual abuse; physical and emotional neglect; other experiences, such as substance abuse by a household member and witnessing domestic violence. Other traumatic experiences can include placement instability for foster youth, homelessness, and witnessing violence against family and community members.
(i)The State of California has long recognized the mental health needs of Californias children and the value of addressing these needs by supporting the provision of evidence-based mental health services in publicly funded preschools and elementary schools, as evidenced by the creation in 1981 of the Primary Prevention Project, now named the Primary Intervention Program, and the creation in 1991 of the School-Based Early Mental Health Intervention and Prevention Services for Children Program, known as the Early Mental Health Initiative (EMHI).
(j)It is in the interest of Californias children, families, schools, and communities that the State of California support local decisions to provide funding for evidence-based services in publicly funded preschools and elementary schools to address the mental health needs of children who have been exposed to childhood adversity.
(k)In addressing these needs, priority should be given to children, youth, and communities that experience childhood adversity more severely and profoundly, including those that experience socioeconomic disadvantage and historical and contemporary injustices, vulnerable communities, communities of color, and culturally, linguistically, and geographically isolated communities.
SEC. 4.Section 4372 of the Welfare and Institutions Code is amended to read:4372.For the purposes of this part, the following definitions shall apply:
(a)Cooperating entity means a federal, state, or local, public or private nonprofit agency providing school-based early mental health intervention and prevention services that agrees to offer services at a schoolsite through a program assisted under this part.
(b)Eligible pupil means a pupil who attends a preschool program at a publicly funded elementary school, at a contracting agency of the California state preschool program, as established by Article 7 (commencing with Section 8235) of Chapter 2 of Part 6 of Division 1 of Title 1 of the Education Code, or a local educational agency, or who attends a publicly funded elementary school and who is in kindergarten, transitional kindergarten, or grades 1 to 3, inclusive.
(c)Local educational agency means any school district or county office of education, state special school, or charter school.
(d)Department means the State Department of Public Health.
(e)Director means the State Public Health Officer.
(f)Supportive service means a service that will enhance the mental health and social-emotional development of children.
SEC. 5.Section 4380 of the Welfare and Institutions Code is amended to read:4380.Subject to the availability of funding each year, the Legislature authorizes the director, in consultation with the Superintendent of Public Instruction, to award matching grants to local educational agencies to pay the state share of the costs of providing programs that provide school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, as follows:
(a)The director shall award matching grants pursuant to this chapter to local educational agencies throughout the state.
(b)Matching grants awarded under this part shall be awarded for a period of not more than three years and no single schoolsite shall be awarded more than one grant, except for a schoolsite that received a grant prior to July 1, 1992.
(c)The director shall pay to each local educational agency having an application approved pursuant to requirements in this part the state share of the cost of the activities described in the application.
(d)Commencing July 1, 1993, the state share of matching grants shall be a maximum of 50 percent in each of the three years.
(e)Commencing July 1, 1993, the local share of matching grants shall be at least 50 percent, from a combination of school district and cooperating entity funds.
(f)The local share of the matching grant may be in cash or payment in-kind.
(g)Priority shall be given to those applicants that demonstrate the following:
(1)The local educational agency will serve the greatest number of eligible pupils from low-income families.
(2)The local educational agency will provide a strong parental involvement component.
(3)The local educational agency will provide supportive services with one or more cooperating entities.
(4)The local educational agency will provide services at a low cost per child served in the project.
(5)The local educational agency will provide programs and services that are based on adoption or modification, or both, of existing programs that have been shown to be effective.
(6)The local educational agency will provide services to children who are in out-of-home placement or who are at risk of being in out-of-home placement.
(7)The local educational agency shall will prioritize for receipt of services children who have been exposed to childhood trauma, including, but not limited to, foster youth, as defined in subdivision (b) of Section 42238.01 of the Education Code, and homeless children and youth, as defined in Section 11434a(2) of the federal McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.).
(h)Eligible supportive services may include the following:
(1)Individual and group intervention and prevention services.
(2)Parent involvement through conferences or training, or both.
(3)Teacher and staff conferences and training related to meeting project goals.
(4)Referral to outside resources when eligible pupils require additional services.
(5)Use of paraprofessional staff, who are trained and supervised by credentialed school psychologists, school counselors, or school social workers, to meet with pupils on a short-term weekly basis, in a one-on-one setting as in the primary intervention program established pursuant to Chapter 4 (commencing with Section 4343) of Part 3. A minimum of 80 percent of the grants awarded by the director shall include the basic components of the primary intervention program.
(6)Any other service or activity that will improve the mental health of eligible pupils, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
Prior to participation by an eligible pupil in either individual or group services, consent of a parent or guardian shall be obtained.
(i)Each local educational agency seeking a grant under this chapter shall submit an application to the director at the time, in a manner, and accompanied by any information the director may reasonably require.
(j)Each matching grant application submitted shall include all of the following:
(1)Documentation of need for the school-based early mental health intervention and prevention services.
(2)A description of the school-based early mental health intervention and prevention services expected to be provided at the schoolsite.
(3)A statement of program goals.
(4)A list of cooperating entities that will participate in the provision of services. A letter from each cooperating entity confirming its participation in the provision of services shall be included with the list. At least one letter shall be from a cooperating entity confirming that it will agree to screen referrals of low-income children the program has determined may be in need of mental health treatment services and that, if the cooperating entity determines that the child is in need of those services and if the cooperating entity determines that according to its priority process the child is eligible to be served by it, the cooperating entity will agree to provide those mental health treatment services.
(5)A detailed budget and budget narrative.
(6)A description of the proposed plan for parent involvement in the program.
(7)A description of the population anticipated to be served, including number of pupils to be served and socioeconomic indicators of sites to receive funds.
(8)A description of the matching funds from a combination of local education agencies and cooperating entities.
(9)A plan describing how the proposed school-based early mental health intervention and prevention services program will be continued after the matching grant has expired.
(10)Assurance that grants would supplement and not supplant existing local resources provided for early mental health intervention and prevention services.
(11)A description of an evaluation plan that includes quantitative and qualitative measures of school and pupil characteristics, and a comparison of childrens adjustment to school.
(k)Matching grants awarded pursuant to this article may be used for salaries of staff responsible for implementing the school-based early mental health intervention and prevention services program, equipment and supplies, training, and insurance.
(l)Salaries of administrative staff and other administrative costs associated with providing services shall be limited to 5 percent of the state share of assistance provided under this section.
(m)No more than 10 percent of each matching grant awarded pursuant to this article may be used for matching grant evaluation.
(n)No more than 10 percent of the moneys allocated to the director pursuant to this chapter may be utilized for program administration and evaluation.
Program administration shall include both state staff and field staff who are familiar with and have successfully implemented school-based early mental health intervention and prevention services. Field staff may be contracted with by local school districts or community mental health programs. Field staff shall provide support in the timely and effective implementation of school-based early mental health intervention and prevention services. Reviews of each project shall be conducted at least once during the first year of funding.
(o)Subject to the approval of the director, at the end of the fiscal year, a school district may apply unexpended funds to the budget for the subsequent funding year.
(p)Contracts for the program and administration, or ancillary services in support of the program, shall be exempt from the requirements of the Public Contract Code and the State Administrative Manual, and from approval by the Department of General Services.
SEC. 6.Chapter 4 (commencing with Section 4391) is added to Part 4 of Division 4 of the Welfare and Institutions Code, to read:4.School-Based Early Mental Health Intervention and Prevention Services HEAL Trauma in Schools Support Program4391.(a)The director shall establish a four-year pilot program, in consultation with the Superintendent of Public Instruction, the Director of Health Care Services, and the Attorney General to encourage and support local decisions to provide funding for the eligible support services as provided in this section.
(b)The department shall provide outreach to local educational agencies and county mental health agencies to inform individuals responsible for local funding decisions of the program established pursuant to this section.
(c)The department shall provide free regional training on all of the following:
(1)Eligible support services, which may include any or all of the following:
(A)Individual and group intervention and prevention services.
(B)Parent engagement through conference or training, or both.
(C)Teacher and staff conferences and training related to meeting project goals.
(D)Referral to outside resources when eligible pupils require additional services.
(E)Use of paraprofessional staff, who are trained and supervised by credentialed school psychologists, school counselors, or school social workers, to meet with pupils on a short-term weekly basis, in a one-on-one setting as in the primary intervention program established pursuant to Chapter 4 (commencing with Section 4343) of Part 3.
(F)Any other service or activity that will improve the mental health of eligible pupils, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
(2)The potential for the eligible support services defined in this section to help fulfill state priorities described by the local control funding formula and local goals described by local control and accountability plans.
(3)How educational, mental health, and other funds subject to local control can be used to finance the eligible support services defined in this section.
(4)External resources available to support the eligible support services defined in this section, which may include workshops, training, conferences, and peer learning networks.
(5)State resources available to support student mental health and resilience, and positive, trauma-informed learning environments, which may include any of the following:
(A)Foundational aspects of learning, childhood social-emotional development, mental health and resilience, toxic stress, childhood trauma, and Adverse Childhood Experiences.
(B)Inclusive multitiered systems of behavioral and academic supports, Schoolwide Positive Behavior Interventions and Supports, restorative justice or restorative practices, trauma-informed practices, social and emotional learning, and bullying prevention.
(d)The department shall provide technical assistance to local educational agencies that provide or seek to provide eligible services defined in this section. Technical assistance shall include assistance in any of the following:
(1)Designing programs.
(2)Training program staff in intervention skills.
(3)Conducting local evaluations.
(4)Coordination Coordinating with county mental health agencies and professionals.
(5)Leveraging educational, mental health, and other funds that are subject to local control and assisting in budget development.
(e)In providing outreach pursuant to subdivision (b), training pursuant to subdivision (c), and technical assistance pursuant to subdivision (d), the department shall select and support schoolsites as follows:
(1)(A)During the first 12 months of the program, the department shall support, strengthen, and expand the provision of eligible services at schoolsites that previously received funding pursuant to the HEAL Trauma in Schools Act (Chapter 2 (commencing with Section 4380)) former School-Based Early Mental Health Intervention and Prevention Services Matching Grant Program and have continued to provide eligible support services. In working with these selected schoolsites, the department shall develop methods and standards for providing services and practices to new schoolsites.
(B)The department shall develop a process to identify schoolsites that demonstrate the willingness and capacity to participate in the program.
(2)During the subsequent 36 months of the program, the department shall select new schoolsites that are not providing eligible support services but that demonstrate the willingness and capacity to participate in the program. The department shall work with these schoolsites to deliver eligible support services.
(3)In selecting schoolsites and providing support, the department shall prioritize the following:
(A)Schoolsites in communities that have experienced high levels of childhood adversity, such as Adverse Childhood Experiences and childhood trauma.
(B)Schoolsites that prioritize for receipt of services children who have been exposed to childhood trauma, including, but not limited to, foster youth, as defined in subdivision (b) of Section 42238.01 of the Education Code, and homeless children and youth, as defined in Section 11434a(2) of the federal McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.)
(C)Geographic diversity, program effectiveness, program efficiency, and long-term program sustainability.
(f)The department shall submit, in compliance with Section 9795 of the Government Code, an interim report to the Legislature at the end of the second year of the pilot program that details the departments work to support the schoolsites selected pursuant to paragraph (1) of subdivision (e) and includes an assessment of the demand and impact of funding for the HEAL Trauma in Schools Act established pursuant to Chapter 3 (commencing with Section 4380). this part. The department shall make the report available to the public and shall post the report on its Internet Web site.
(g)The department shall develop an evaluation plan to assess the impact of the pilot program. The department, in compliance with Section 9795 of the Government Code, shall submit a report to the Legislature at the end of the four-year period evaluating the impact of the pilot program and providing recommendations for further implementation. The department shall make the report available to the public and shall post the report on its Internet Web site.
4392.Implementation of this chapter is contingent upon an appropriation in the annual budget act.
4393.This chapter shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
The Legislature finds and declares all of the following:
(a)Californias communities and systems are currently facing challenges to prevent and address the far-reaching impacts of childhood adversity, such as Adverse Childhood Experiences (ACEs) and childhood trauma, which can result in negative educational, health, social, and economic outcomes for children, youth, families, and communities across the state.
(b)ACEs are traumatic experiences that can have a profound impact on a childs developing brain and body and lasting impacts on a persons health and livelihood across their lifetime. ACEs include physical, emotional, and sexual abuse; physical and emotional neglect; and household dysfunction, such as substance abuse by a household member; and witnessing domestic violence. Other traumatic experiences can include placement instability for foster youth, homelessness, and witnessing violence against family and community members.
(c)
(b)In California, 61.7 percent of adults have experienced at least one ACE and 16.7 percent have experienced four or more ACEs. Compared to an individual who has not experienced an ACE, an individual with four or more ACEs is more likely to experience chronic disease and engage in negative health behaviors. For example, based on results of the California Behavioral Risk Factor Surveillance Survey, a person in California with four or more ACEs is 1.6 times as likely to have diabetes, 1.9 times as likely to have cancer, 2.4 times as likely to suffer from chronic obstructive pulmonary disease, 2.9 times as likely to smoke, 4.2 times as likely to be diagnosed with Alzheimers disease or dementia, 5.1 times as likely to suffer from depression, 7.4 times as likely to be an alcoholic, and 12.2 times as likely to attempt suicide. Individuals are similarly impacted by ACEs, regardless of race and ethnicity.
(d)The State of California has long recognized the mental health needs of Californias children and the value of addressing these needs by supporting the provision of evidence-based mental health services in publicly funded preschools and elementary schools, as evidenced by the creation in 1981 of the Primary Prevention Project, now named the Primary Intervention Program, and the creation in 1991 of the School-based Early Mental Health Intervention and Prevention Services for Children Program, known as the Early Mental Health Initiative (EMHI).
(e)
(c)From the 199293 fiscal year to the 201112 fiscal year, inclusive, the State Department of Mental Health awarded funds each year in matching grants to local educational agencies to fund prevention and early intervention programs, including the Primary Intervention Program, for students experiencing mild to moderate school adjustment difficulty through the EMHI. School-based Early Mental Health Intervention and Prevention Services for Children Program of 1991, known as the Early Mental Health Initiative (EMHI). In the 201112 fiscal year, the EMHI received $15 million in state funds.
(f)
(d)School adjustment difficulties that can impede learning, such as anxiety, withdrawal, and aggressive behaviors, are common symptoms of chronic or traumatic stress resulting from exposure to ACEs and childhood trauma.
(g)
(e)Authorizing legislation specified that the EMHI would be deemed successful if at least 75 percent of the children who complete the program show an improvement in at least one of the following four areas: learning behaviors, attendance, school adjustment, and school-related competencies.
(h)
(f)The EMHI succeeded in meeting these legislative requirements. According to the 20102011 201011 Early Mental Health Initiative Statewide Evaluation Report, of the 15,823 students located in 424 elementary schools across 66 school districts participating in EMHI-funded services during the 201011 school year, 79 percent exhibited positive social competence and school adjustment behaviors more frequently after completing services. Furthermore, the magnitude of the improvements was exceptional in comparison to evaluations of other programs, especially given the short-term and cost-effective nature of the intervention, and improvements were evident across all demographic subgroups.
(i)
(g)The 20102011 201011 Early Mental Health Initiative Statewide Evaluation Report described an unmet demand for EMHI-funded services at participating schoolsites, as only 37 percent of the students that scored in the appropriate school adjustment difficulty range were served with EMHI-funded services due to program capacity and funding constraints. Based on demographic considerations, similar demand would be expected at schools that did not receive EMHI grants.
(j)
(h)The Governors realignment for the 201112 fiscal year renamed the State Department of Mental Health as the State Department of State Hospitals and limited that departments mission. The Budget Act of 2012 disbursed Proposition 98 funds, which had been used to fund the EMHI, directly to local educational agencies in order to provide local schools with enhanced flexibility to manage their finances and give greater control of local decisions.
(k)It is in the interest of Californias children, families, schools, and communities that the State of California support local decisions to provide funding for evidence-based services to address the mental health needs of children who have been exposed to childhood adversity in publicly funded preschools and elementary schools.
(l)In addressing these needs, priority should be given to children, youth, and communities that experience childhood adversity, more severely and profoundly, including those that experience socioeconomic disadvantage and historical and contemporary injustices, vulnerable communities, communities of color, and culturally, linguistically, and geographically isolated communities.
(m)
(i)Multitiered systems and supports, which integrate mental health, special education, and school climate interventions, have been developed as a model framework within which to implement these services. Pilot programs in the Counties of San Bernardino and Alameda are demonstrating that implementing these services as part of a multitiered system is cost effective because the cost of the services is more than fully offset by the reduction in the need for high-cost, nonpublic school placements.
(n)
(j)The evidence-based, cost-effective services provided by the EMHI support the Triple Aim of better health, better care, and lower costs. By helping children early on, evidence-based, cost-effective services also support the recommendations of the Lets Get Healthy California Task Force, which used the Triple Aim as its foundation and articulated Healthy Beginnings: Laying the Foundation for a Healthy Life, as a goal that includes reducing childhood trauma, improving early learning, and improving mental health and well-being as priorities.
(o)
(k)Providing early mental health service for children exposed to childhood adversity, such as ACEs and childhood trauma, additionally furthers the goal of the California Defending Childhood State Policy Initiative, which is to more effectively align, integrate, and mobilize multisectoral resources to equitably prevent, identify, and heal the impacts of violence and trauma on children and youth.
SEC. 2.Section 4370 of the Welfare and Institutions Code is amended to read:4370.This part article shall be known and may be cited as the School-based Early Mental Health Intervention and Prevention Services for Children Act of 1991. Healing from Early Adversity to Level the Impact (HEAL) of Trauma in Schools Act or the HEAL Trauma in Schools Act.
SEC. 3.Section 4371 of the Welfare and Institutions Code is amended to read:4371.The Legislature finds and declares all of the following:
(a)Each year in California over 65,000 teenagers become adolescent mothers and 230 teenagers commit suicide. Each year more than 20 percent of Californias teenagers drop out of high school.
(b)Thirty percent of Californias elementary school pupils experience school adjustment problems, many of which are evident the first four years of school, that is, kindergarten and grades 1 to 3, inclusive.
(c)Problems that our children experience, whether in school or at home, that remain undetected and untreated grow and manifest themselves in all areas of their later lives.
(d)There is a clear relationship between early adjustment problems and later adolescent problems, including, but not limited to, poor school attendance, low achievement, delinquency, drug abuse, and high school dropout rates. In many cases, signs of these problems can be detected in the early grades.
(e)It is in Californias best interest, both in economic and human terms, to identify and treat the minor difficulties that our children are experiencing before those difficulties become major barriers to later success. It is far more humane and cost-effective to make a small investment in early mental health intervention and prevention services now and avoid larger costs, including, but not limited to, foster care, group home placement, intensive special education services, mental health treatment, or probation supervised care.
(f)Programs like the Primary Intervention Program and the San Diego Unified Counseling Program for Children have proven very effective in helping children adjust to the school environment and learn more effective coping skills that in turn result in better school achievement, increased attendance, and increased self-esteem.
(g)To create the optimum learning environment for our children, schools, teachers, parents, public and private service providers, and community-based organizations must enter into locally appropriate cooperative agreements to ensure that all pupils will receive the benefits of school-based early mental health intervention and prevention services that are designed to meet their personal, social, and educational needs.
(h)ACEs are traumatic experiences that can have a profound impact on a childs developing brain and body and lasting impacts on a persons health and livelihood across their lifetime. ACEs include physical, emotional, and sexual abuse; physical and emotional neglect; other experiences, such as substance abuse by a household member and witnessing domestic violence. Other traumatic experiences can include placement instability for foster youth, homelessness, and witnessing violence against family and community members.
(i)The State of California has long recognized the mental health needs of Californias children and the value of addressing these needs by supporting the provision of evidence-based mental health services in publicly funded preschools and elementary schools, as evidenced by the creation in 1981 of the Primary Prevention Project, now named the Primary Intervention Program, and the creation in 1991 of the School-Based Early Mental Health Intervention and Prevention Services for Children Program, known as the Early Mental Health Initiative (EMHI).
(j)It is in the interest of Californias children, families, schools, and communities that the State of California support local decisions to provide funding for evidence-based services in publicly funded preschools and elementary schools to address the mental health needs of children who have been exposed to childhood adversity.
(k)In addressing these needs, priority should be given to children, youth, and communities that experience childhood adversity more severely and profoundly, including those that experience socioeconomic disadvantage and historical and contemporary injustices, vulnerable communities, communities of color, and culturally, linguistically, and geographically isolated communities.
SEC. 2.SEC. 4.Section 4372 of the Welfare and Institutions Code is amended to read:4372.For the purposes of this part, the following definitions shall apply:
(a)Cooperating entity means a federal, state, or local, public or private nonprofit agency providing school-based early mental health intervention and prevention services that agrees to offer services at a schoolsite through a program assisted under this part.
(b)Eligible pupil means a pupil who attends a preschool program at a publicly funded elementary school, or who attends a publicly funded elementary school and who is in kindergarten, transitional kindergarten, or grades 1 to 3, inclusive.
(c)Local educational agency means any school district or county office of education, state special school, or charter school.
(d)Department means the State Department of Public Health.
(e)Director means the State Public Health Officer.
(f)Supportive service means a service that will enhance the mental health and social-emotional development of children.
SEC. 5.Section 4380 of the Welfare and Institutions Code is amended to read:4380.Subject to the availability of funding each year, the Legislature authorizes the director, in consultation with the Superintendent of Public Instruction, to award matching grants to local educational agencies to pay the state share of the costs of providing programs that provide school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, as follows:
(a)The director shall award matching grants pursuant to this chapter to local educational agencies throughout the state.
(b)Matching grants awarded under this part shall be awarded for a period of not more than three years and no single schoolsite shall be awarded more than one grant, except for a schoolsite that received a grant prior to July 1, 1992.
(c)The director shall pay to each local educational agency having an application approved pursuant to requirements in this part the state share of the cost of the activities described in the application.
(d)Commencing July 1, 1993, the state share of matching grants shall be a maximum of 50 percent in each of the three years.
(e)Commencing July 1, 1993, the local share of matching grants shall be at least 50 percent, from a combination of school district and cooperating entity funds.
(f)The local share of the matching grant may be in cash or payment in-kind.
(g)Priority shall be given to those applicants that demonstrate the following:
(1)The local educational agency will serve the greatest number of eligible pupils from low-income families.
(2)The local educational agency will provide a strong parental involvement component.
(3)The local educational agency will provide supportive services with one or more cooperating entities.
(4)The local educational agency will provide services at a low cost per child served in the project.
(5)The local educational agency will provide programs and services that are based on adoption or modification, or both, of existing programs that have been shown to be effective. No more than 20 percent of the grants awarded by the director may be utilized for new models.
(6)The local educational agency will provide services to children who are in out-of-home placement or who are at risk of being in out-of-home placement.
(7)The local educational agency shall prioritize for receipt of services children who have been exposed to childhood trauma, including, but not limited to, foster youth, as defined in subdivision (b) of Section 42238.01 of the Education Code, and homeless children and youth, as defined in Section 11434a(2) of the federal McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.).
(h)Eligible supportive services may include the following:
(1)Individual and group intervention and prevention services.
(2)Parent involvement through conferences or training, or both.
(3)Teacher and staff conferences and training related to meeting project goals.
(4)Referral to outside resources when eligible pupils require additional services.
(5)Use of paraprofessional staff, who are trained and supervised by credentialed school psychologists, school counselors, or school social workers, to meet with pupils on a short-term weekly basis, in a one-on-one setting as in the primary intervention program established pursuant to Chapter 4 (commencing with Section 4343) of Part 3. A minimum of 80 percent of the grants awarded by the director shall include the basic components of the primary intervention program.
(6)Any other service or activity that will improve the mental health of eligible pupils. pupils, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
Prior to participation by an eligible pupil in either individual or group services, consent of a parent or guardian shall be obtained.
(i)Each local educational agency seeking a grant under this chapter shall submit an application to the director at the time, in a manner, and accompanied by any information the director may reasonably require.
(j)Each matching grant application submitted shall include all of the following:
(1)Documentation of need for the school-based early mental health intervention and prevention services.
(2)A description of the school-based early mental health intervention and prevention services expected to be provided at the schoolsite.
(3)A statement of program goals.
(4)A list of cooperating entities that will participate in the provision of services. A letter from each cooperating entity confirming its participation in the provision of services shall be included with the list. At least one letter shall be from a cooperating entity confirming that it will agree to screen referrals of low-income children the program has determined may be in need of mental health treatment services and that, if the cooperating entity determines that the child is in need of those services and if the cooperating entity determines that according to its priority process the child is eligible to be served by it, the cooperating entity will agree to provide those mental health treatment services.
(5)A detailed budget and budget narrative.
(6)A description of the proposed plan for parent involvement in the program.
(7)A description of the population anticipated to be served, including number of pupils to be served and socioeconomic indicators of sites to receive funds.
(8)A description of the matching funds from a combination of local education agencies and cooperating entities.
(9)A plan describing how the proposed school-based early mental health intervention and prevention services program will be continued after the matching grant has expired.
(10)Assurance that grants would supplement and not supplant existing local resources provided for early mental health intervention and prevention services.
(11)A description of an evaluation plan that includes quantitative and qualitative measures of school and pupil characteristics, and a comparison of childrens adjustment to school.
(k)Matching grants awarded pursuant to this article may be used for salaries of staff responsible for implementing the school-based early mental health intervention and prevention services program, equipment and supplies, training, and insurance.
(l)Salaries of administrative staff and other administrative costs associated with providing services shall be limited to 5 percent of the state share of assistance provided under this section.
(m)No more than 10 percent of each matching grant awarded pursuant to this article may be used for matching grant evaluation.
(n)No more than 10 percent of the moneys allocated to the director pursuant to this chapter may be utilized for program administration and evaluation.
Program administration shall include both state staff and field staff who are familiar with and have successfully implemented school-based early mental health intervention and prevention services. Field staff may be contracted with by local school districts or community mental health programs. Field staff shall provide support in the timely and effective implementation of school-based early mental health intervention and prevention services. Reviews of each project shall be conducted at least once during the first year of funding.
(o)Subject to the approval of the director, at the end of the fiscal year, a school district may apply unexpended funds to the budget for the subsequent funding year.
(p)Contracts for the program and administration, or ancillary services in support of the program, shall be exempt from the requirements of the Public Contract Code and the State Administrative Manual, and from approval by the Department of General Services.
SEC. 3.SEC. 6.Chapter 4 (commencing with Section 4391) is added to Part 4 of Division 4 of the Welfare and Institutions Code, to read:4.School-Based Early Mental Health Intervention and Prevention Services Support Program4391.(a)The State Public Health Officer director shall establish a four-year pilot program, in consultation with the Superintendent of Public Instruction and Instruction, the Director of Health Care Services, Services, and the Attorney General to encourage and support local decisions to provide funding for the eligible support services as provided in this section.
(b)The department shall provide outreach to local educational agencies and county mental health agencies to inform individuals responsible for local funding decisions of the program established pursuant to this section.
(c)The department shall provide free regional training on all of the following:
(1)Eligible support services, which may include any or all of the following:
(A)Individual and group intervention and prevention services.
(B)Parent engagement through conference or training, or both.
(C)Teacher and staff conferences and training related to meeting project goals.
(D)Referral to outside resources when eligible pupils require additional services.
(E)Use of paraprofessional staff, who are trained and supervised by credentialed school psychologists, school counselors, or school social workers, to meet with pupils on a short-term weekly basis, in a one-on-one setting as in the primary intervention program established pursuant to Chapter 4 (commencing with Section 4343) of Part 3.
(F)Any other service or activity that will improve the mental health of eligible pupils, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
(2)The potential for the eligible support services defined in this section to help fulfill state priorities described by the local control funding formula and local goals described by local control and accountability plans.
(3)How educational, mental health, and other funds subject to local control can be used to finance the eligible support services defined in this section.
(4)External resources available to support the eligible support services defined in this section, which may include workshops, training, conferences, and peer learning networks.
(5)State resources available to support student mental health and resilience, and positive, trauma-informed learning environments, which may include any of the following:
(A)Foundational aspects of learning, childhood social-emotional development, mental health and resilience, toxic stress, childhood trauma, and Adverse Childhood Experiences.
(B)Inclusive multitiered systems of behavioral and academic supports, Schoolwide Positive Behavior Interventions and Supports, restorative justice or restorative practices, trauma-informed practices, social and emotional learning, and bullying prevention.
(d)The department shall provide technical assistance to local educational agencies that provide or seek to provide eligible services defined in this section. Technical assistance shall include assistance in any of the following:
(1)Designing programs.
(2)Training program staff in intervention skills.
(3)Conducting local evaluations.
(4)Coordination with county mental health agencies and professionals.
(4)
(5)Leveraging educational, mental health, and other funds that are subject to local control and assisting in budget development.
(e)In providing outreach pursuant to subdivision (b), training pursuant to subdivision (c), and technical assistance pursuant to subdivision (d), the department shall select and support schoolsites as follows:
(1)(A)During the first 18 12 months of the program, the department shall support, strengthen, and expand the provision of eligible services at schoolsites that previously received funding pursuant to the School-Based Early Mental Health Intervention and Prevention Services Matching Grant Program HEAL Trauma in Schools Act (Chapter 2 (commencing with Section 4380)) and have continued to provide eligible support services. In working with these selected schoolsites, the department shall develop methods and standards for providing services and practices to new schoolsites.
(B)The department shall develop a process to identify schoolsites that demonstrate the willingness and capacity to participate in the program.
(2)During the subsequent 18 36 months of the program, the department shall select new schoolsites that are not providing eligible support services but that demonstrate the willingness and capacity to participate in the program. The department shall work with these schoolsites to deliver eligible support services.
(3)In selecting schoolsites and providing support, the department shall prioritize the following:
(A)Schoolsites in communities that have experienced high levels of childhood adversity, such as Adverse Childhood Experiences and childhood trauma.
(B)Schoolsites that prioritize for receipt of services children who have been exposed to childhood trauma, including, but not limited to, foster youth, as defined in subdivision (b) of Section 42238.01 of the Education Code, and homeless children and youth, as defined in Section 11434a(2) of the federal McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.)
(C)Geographic diversity, program effectiveness, program efficiency, and long-term program sustainability.
(f)The department shall submit, in compliance with Section 9795 of the Government Code, an interim report to the Legislature at the end of the second year of the pilot program that details the departments work to support the schoolsites selected pursuant to paragraph (1) of subdivision (e) and includes an assessment of the demand and impact of funding for the School-Based Early Mental Health Intervention and Prevention Services Matching Grant Program HEAL Trauma in Schools Act established pursuant to Chapter 3 (commencing with Section 4390). 4380). The department shall make the report available to the public and shall post the report on the its Internet Web site.
(g)The department shall develop an evaluation plan to assess the impact of the pilot program. The department, in compliance with Section 9795 of the Government Code, shall submit a report to the Legislature at the end of the four-year period evaluating the impact of the pilot program and providing recommendations for further implementation. The department shall make the report available to the public and shall post the report on its Internet Web site.
4392.Implementation of this chapter is contingent upon an appropriation in the annual budget act.
4392.4393.This chapter shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
The Legislature finds and declares all of the following:
(a)Californias communities and systems are currently facing challenges to prevent and address the far-reaching impacts of childhood adversity, such as Adverse Childhood Experiences (ACEs) and childhood trauma, which can result in negative educational, health, social, and economic outcomes for children, youth, families, and communities across the state.
(b)ACEs are traumatic experiences that can have a profound impact on a childs developing brain and body and lasting impacts on a persons health and livelihood across their lifetime. ACEs include physical, emotional, and sexual abuse; physical and emotional neglect; and household dysfunction, such as substance abuse by a household member; and witnessing domestic violence. Other traumatic experiences can include placement instability for foster youth, homelessness, and witnessing violence against family and community members.
(c)In California, 61.7 percent of adults have experienced at least one ACE and 16.7 percent have experienced four or more ACEs. Compared to an individual who has not experienced an ACE, an individual with four or more ACEs is more likely to experience chronic disease and engage in negative health behaviors. For example, based on results of the California Behavioral Risk Factor Surveillance Survey, a person in California with four or more ACEs is 1.6 times as likely to have diabetes, 1.9 times as likely to have cancer, 2.4 times as likely to suffer from chronic obstructive pulmonary disease, 2.9 times as likely to smoke, 4.2 times as likely to be diagnosed with Alzheimers disease or dementia, 5.1 times as likely to suffer from depression, 7.4 times as likely to be an alcoholic, and 12.2 times as likely to attempt suicide. Individuals are similarly impacted by ACEs, regardless of race and ethnicity.
(d)The State of California has long recognized the mental health needs of Californias children and the value of addressing these needs by supporting the provision of evidence-based mental health services in publicly funded preschools and elementary schools, as evidenced by the creation in 1981 of the Primary Prevention Project, now named the Primary Intervention Program, and the creation in 1991 of the School-based Early Mental Health Intervention and Prevention Services for Children Program, known as the Early Mental Health Initiative (EMHI).
(e)From the 199293 fiscal year to the 201112 fiscal year, inclusive, the State Department of Mental Health awarded funds each year in matching grants to local educational agencies to fund prevention and early intervention programs, including the Primary Intervention Program, for students experiencing mild to moderate school adjustment difficulty through the EMHI. In the 201112 fiscal year, the EMHI received $15 million in state funds.
(f)School adjustment difficulties that can impede learning, such as anxiety, withdrawal, and aggressive behaviors, are common symptoms of chronic or traumatic stress resulting from exposure to ACEs and childhood trauma.
(g)Authorizing legislation specified that the EMHI would be deemed successful if at least 75 percent of the children who complete the program show an improvement in at least one of the following four areas: learning behaviors, attendance, school adjustment, and school-related competencies.
(h)The EMHI succeeded in meeting these legislative requirements. According to the 20102011 Early Mental Health Initiative Statewide Evaluation Report, of the 15,823 students located in 424 elementary schools across 66 school districts participating in EMHI-funded services during the 201011 school year, 79 percent exhibited positive social competence and school adjustment behaviors more frequently after completing services. Furthermore, the magnitude of the improvements was exceptional in comparison to evaluations of other programs, especially given the short-term and cost-effective nature of the intervention, and improvements were evident across all demographic subgroups.
(i)The 20102011 Early Mental Health Initiative Statewide Evaluation Report described an unmet demand for EMHI-funded services at participating schoolsites, as only 37 percent of the students that scored in the appropriate school adjustment difficulty range were served with EMHI-funded services due to program capacity and funding constraints. Based on demographic considerations, similar demand would be expected at schools that did not receive EMHI grants.
(j)The Governors realignment for the 201112 fiscal year renamed the State Department of Mental Health as the State Department of State Hospitals and limited that departments mission. The Budget Act of 2012 disbursed Proposition 98 funds, which had been used to fund the EMHI, directly to local educational agencies in order to provide local schools with enhanced flexibility to manage their finances and give greater control of local decisions.
(k)It is in the interest of Californias children, families, schools, and communities that the State of California support local decisions to provide funding for evidence-based services to address the mental health needs of children who have been exposed to childhood adversity in publicly funded preschools and elementary schools.
(l)In addressing these needs, priority should be given to children, youth, and communities that experience childhood adversity, more severely and profoundly, including those that experience socioeconomic disadvantage and historical and contemporary injustices, vulnerable communities, communities of color, and culturally, linguistically, and geographically isolated communities.
(m)Multitiered systems and supports, which integrate mental health, special education, and school climate interventions, have been developed as a model framework within which to implement these services. Pilot programs in the Counties of San Bernardino and Alameda are demonstrating that implementing these services as part of a multitiered system is cost effective because the cost of the services is more than fully offset by the reduction in the need for high-cost, nonpublic school placements.
(n)The evidence-based, cost-effective services provided by the EMHI support the Triple Aim of better health, better care, and lower costs. By helping children early on, evidence-based, cost-effective services also support the recommendations of the Lets Get Healthy California Task Force, which used the Triple Aim as its foundation and articulated Healthy Beginnings: Laying the Foundation for a Healthy Life, as a goal that includes reducing childhood trauma, improving early learning, and improving mental health and well-being as priorities.
(o)Providing early mental health service for children exposed to childhood adversity, such as ACEs and childhood trauma, additionally furthers the goal of the California Defending Childhood State Policy Initiative, which is to more effectively align, integrate, and mobilize multisectoral resources to equitably prevent, identify, and heal the impacts of violence and trauma on children and youth.
SEC. 2.Section 4372 of the Welfare and Institutions Code is amended to read:4372.For the purposes of this part, the following definitions shall apply:
(a)Cooperating entity means any a federal, state, or local, public or private nonprofit agency providing school-based early mental health intervention and prevention services that agrees to offer services at a schoolsite through a program assisted under this part.
(b)Eligible pupil means a pupil who attends a preschool program at a publicly funded elementary school, or who attends a publicly funded elementary school and who is in kindergarten kindergarten, transitional kindergarten, or grades 1 to 3, inclusive.
(c)Local educational agency means any school district or county office of education, or state special school, or charter school.
(d)Department means the State Department of Public Health.
(d)
(e)Director means the State Director of Mental Health. Public Health Officer.
(e)
(f)Supportive service means a service that will enhance the mental health and social social-emotional development of children.
SEC. 3.Chapter 4 (commencing with Section 4391) is added to Part 4 of Division 4 of the Welfare and Institutions Code, to read:4.School-Based Early Mental Health Intervention and Prevention Services Support Program4391.(a)The State Public Health Officer shall establish a four-year pilot program, in consultation with the Superintendent of Public Instruction and the Director of Health Care Services, to encourage and support local decisions to provide funding for the eligible support services as provided in this section.
(b)The department shall provide outreach to local educational agencies and county mental health agencies to inform individuals responsible for local funding decisions of the program established pursuant to this section.
(c)The department shall provide free regional training on all of the following:
(1)Eligible support services, which may include any or all of the following:
(A)Individual and group intervention and prevention services.
(B)Parent engagement through conference or training, or both.
(C)Teacher and staff conferences and training related to meeting project goals.
(D)Referral to outside resources when eligible pupils require additional services.
(E)Use of paraprofessional staff, who are trained and supervised by credentialed school psychologists, school counselors, or school social workers, to meet with pupils on a short-term weekly basis, in a one-on-one setting as in the primary intervention program established pursuant to Chapter 4 (commencing with Section 4343) of Part 3.
(F)Any other service or activity that will improve the mental health of eligible pupils, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
(2)The potential for the eligible support services defined in this section to help fulfill state priorities described by the local control funding formula and local goals described by local control and accountability plans.
(3)How educational, mental health, and other funds subject to local control can be used to finance the eligible support services defined in this section.
(4)External resources available to support the eligible support services defined in this section, which may include workshops, training, conferences, and peer learning networks.
(5)State resources available to support student mental health and resilience, and positive, trauma-informed learning environments, which may include any of the following:
(A)Foundational aspects of learning, childhood social-emotional development, mental health and resilience, toxic stress, childhood trauma, and Adverse Childhood Experiences.
(B)Inclusive multitiered systems of behavioral and academic supports, Schoolwide Positive Behavior Interventions and Supports, restorative justice or restorative practices, trauma-informed practices, social and emotional learning, and bullying prevention.
(d)The department shall provide technical assistance to local educational agencies that provide or seek to provide eligible services defined in this section. Technical assistance shall include assistance in any of the following:
(1)Designing programs.
(2)Training program staff in intervention skills.
(3)Conducting local evaluations.
(4)Leveraging educational, mental health, and other funds that are subject to local control and assisting in budget development.
(e)In providing outreach pursuant to subdivision (b), training pursuant to subdivision (c), and technical assistance pursuant to subdivision (d), the department shall select and support schoolsites as follows:
(1)During the first 18 months of the program, the department shall support, strengthen, and expand the provision of eligible services at schoolsites that previously received funding pursuant to the School-Based Early Mental Health Intervention and Prevention Services Matching Grant Program (Chapter 2 (commencing with Section 4380)) and have continued to provide eligible support services. In working with these selected schoolsites, the department shall develop methods and standards for providing services and practices to new schoolsites.
(2)During the subsequent 18 months of the program, the department shall select new schoolsites that are not providing eligible support services but that demonstrate the willingness and capacity to participate in the program. The department shall work with these schoolsites to deliver eligible support services.
(3)In selecting schoolsites and providing support, the department shall prioritize the following:
(A)Schoolsites in communities that have experienced high levels of childhood adversity, such as Adverse Childhood Experiences and childhood trauma.
(B)Schoolsites that prioritize for receipt of services children who have been exposed to childhood trauma, including, but not limited to, foster youth, as defined in subdivision (b) of Section 42238.01 of the Education Code, and homeless children and youth, as defined in Section 11434a(2) of the federal McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.)
(C)Geographic diversity, program effectiveness, program efficiency, and long-term program sustainability.
(f)The department shall submit, in compliance with Section 9795 of the Government Code, an interim report to the Legislature at the end of the second year of the pilot program that details the departments work to support the schoolsites selected pursuant to paragraph (1) of subdivision (e) and includes an assessment of the demand and impact of funding for the School-Based Early Mental Health Intervention and Prevention Services Matching Grant Program established pursuant to Chapter 3 (commencing with Section 4390). The department shall make the report available to the public and shall post the report on the its Internet Web site.
(g)The department shall develop an evaluation plan to assess the impact of the pilot program. The department, in compliance with Section 9795 of the Government Code, shall submit a report to the Legislature at the end of the four-year period evaluating the impact of the pilot program and providing recommendations for further implementation. The department shall make the report available to the public and shall post the report on its Internet Web site.
4392.This chapter shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
|
Date
|
Status
|
|---|---|
| May 27, 2016 | Read second time and amended. Ordered returned to second reading. |
| Aug 11, 2016 | In committee: Held under submission. |
| Aug 1, 2016 | In committee: Referred to APPR. suspense file. |
| Aug 1, 2016 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on APPR. |
| Jun 29, 2016 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (June 29). Re-referred to Com. on APPR. |
| Jun 15, 2016 | From committee: Do pass and re-refer to Com. on ED. (Ayes 9. Noes 0.) (June 15). Re-referred to Com. on ED. |
| Jun 9, 2016 | Referred to Coms. on HEALTH and ED. |
| Jun 2, 2016 | In Senate. Read first time. To Com. on RLS. for assignment. |
| Jun 1, 2016 | Read third time. Passed. Ordered to the Senate. (Ayes 80. Noes 0.) |
| Jun 1, 2016 | Read third time. Passed. Ordered to the Senate. (Ayes 80. Noes 0. Page 5085.) |
| Jun 1, 2016 | Read third time. Passed. Ordered to the Senate. |
| May 31, 2016 | Read second time. Ordered to third reading. |
| Jan 11, 2016 | Read first time. To print. |
| May 27, 2016 | From committee: Amend, and do pass as amended. (Ayes 20. Noes 0.) (May 27). |
| Apr 20, 2016 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| Apr 18, 2016 | Re-referred to Com. on APPR. |
| Apr 14, 2016 | Read second time and amended. |
| Apr 13, 2016 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 18. Noes 0.) (April 12). |
| Apr 7, 2016 | From committee: Do pass and re-refer to Com. on HEALTH. (Ayes 7. Noes 0.) (April 6). Re-referred to Com. on HEALTH. |
| Mar 16, 2016 | In committee: Set, first hearing. Hearing canceled at the request of author. |
| Mar 9, 2016 | Re-referred to Com. on ED. |
| Mar 8, 2016 | From committee chair, with author's amendments: Amend, and re-refer to Com. on ED. Read second time and amended. |
| Feb 4, 2016 | Referred to Coms. on ED. and HEALTH. |
| Jan 12, 2016 | From printer. May be heard in committee February 11. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 1, 2016 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jun 29, 2016 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Education |
Passed |
|
| Jun 15, 2016 | Do pass, but first be re-referred to the Committee on [Education] | Senate Standing Committee on Health |
Passed |
|
| Jun 1, 2016 | AB 1644 BONTA Assembly Third Reading | Assembly Floor |
Passed |
|
| May 27, 2016 | Do pass as amended. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 12, 2016 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
|
| Apr 6, 2016 | Do pass and be re-referred to the Committee on [Health] | Assembly Standing Committee on Education |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| Abriendo Puertas | ** Support | Apr 12, 2016 |
| Alameda Unified School District, Woodstock Child Development Center | ** Support | Apr 12, 2016 |
| Alliance for Education Solutions | ** Support | Apr 12, 2016 |
| American Academy of Pediatrics | ** Support | Apr 12, 2016 |
| Amethod Public Schools | ** Support | Apr 12, 2016 |
| BANANAS | ** Support | Apr 12, 2016 |
| Bay Area Urban Debate League | ** Support | Apr 12, 2016 |
| Beats Rhymes and Life | ** Support | Apr 12, 2016 |
| Bicycle Coffee | ** Support | Apr 12, 2016 |
| Brighter Beginnings | ** Support | Apr 12, 2016 |
| California Academy of Child Adolescent Psychiatry | * Support | Apr 12, 2016 |
| California Alliance Of Child And Family Services | ** Support | Apr 12, 2016 |
| California Attorney General Kamala D. Harris | ** Support | Apr 12, 2016 |
| California Black Health Network | ** Support | Apr 12, 2016 |
| California Center for Public Health Advocacy | ** Support | Apr 12, 2016 |
| California Children'S Hospital Association | ** Support | Apr 12, 2016 |
| California Council Of Community Mental Health Agencies | ** Support | Apr 12, 2016 |
| California Medical Association, Inc. | ** Support | Apr 12, 2016 |
| California Pan-Ethnic Health Network | ** Support | Apr 12, 2016 |
| California Right to Life Committee, Inc. | ** Against | Apr 6, 2016 |
| California School Nurses Organization | ** Support | Apr 12, 2016 |
| California School-Based Health Alliance | ** Support | Apr 12, 2016 |
| California State PTA | ** Support | Apr 12, 2016 |
| Californians for Safety and Justice | ** Support | Apr 12, 2016 |
| Center for Community Health and Engagement | ** Support | Apr 12, 2016 |
| Center for Leadership, Equity, and Research | ** Support | Apr 12, 2016 |
| Center For Youth Wellness | ** Support | Apr 12, 2016 |
| Center Joint Unified School District | ** Support | Apr 12, 2016 |
| Chico Unified School District | ** Support | Apr 12, 2016 |
| Childhood Injury Prevention Network | ** Support | Apr 12, 2016 |
| Children Now | ** Support | Apr 12, 2016 |
| Children's Defense Fund-California | ** Support | Apr 12, 2016 |
| Children's Hospital & Research Center Oakland | ** Support | Apr 12, 2016 |
| Children'S Specialty Care Coalition | ** Support | Apr 12, 2016 |
| Common Sense Kids Action | ** Support | Apr 12, 2016 |
| Early Edge California | ** Support | Apr 12, 2016 |
| East Bay Agency for Children | ** Support | Apr 12, 2016 |
| East Bay Asian Youth Center | ** Support | Apr 12, 2016 |
| Family Voices of California | ** Support | Apr 12, 2016 |
| Fight Crime and Invest in Kids | * Support | Apr 6, 2016 |
| Fight Crime: Invest in Kids California | ** Support | Apr 12, 2016 |
| First Place for Youth | ** Support | Apr 12, 2016 |
| Folsom Cordova Unified School District | ** Support | Apr 12, 2016 |
| Full Court Press Communications | ** Support | Apr 12, 2016 |
| Futures Without Violence | ** Support | Apr 12, 2016 |
| Girls Leadership Institute | ** Support | Apr 12, 2016 |
| Human Impact Partners | ** Support | Apr 12, 2016 |
| Inland Congregations United for Change | ** Support | Apr 12, 2016 |
| Lemonade Creative Consulting | ** Support | Apr 12, 2016 |
| Liberty School District | ** Support | Apr 12, 2016 |
| Los Angeles County Office Of Education | ** Support | Apr 12, 2016 |
| Los Angeles Trust for Children's Health | ** Support | Apr 12, 2016 |
| Lucile Packard Children's Hospital Stanford | ** Support | Apr 12, 2016 |
| Mental Health America of California | ** Support | Apr 12, 2016 |
| Mental Health and Autism Insurance Project | ** Support | Apr 12, 2016 |
| Mental Health Association of California | ** Support | Apr 12, 2016 |
| Montclair Physical Therapy | ** Support | Apr 12, 2016 |
| National Alliance on Mental Illness California | ** Support | Apr 12, 2016 |
| National Association of Social Workers | * Support | Apr 6, 2016 |
| National Association Of Social Workers, California Chapter | ** Support | Apr 12, 2016 |
| Nonprofit Communications | ** Support | Apr 12, 2016 |
| Nurse Family Partnership | * Support | Apr 12, 2016 |
| Nurse-Family Partnership | * Support | Apr 12, 2016 |
| Oakland City Council | ** Support | Apr 12, 2016 |
| Oakland Natives Give Back | ** Support | Apr 12, 2016 |
| Opening Doors | ** Support | Apr 12, 2016 |
| Playworks | ** Support | Apr 12, 2016 |
| Public Counsel | ** Support | Apr 12, 2016 |
| Rape Counseling Services of Fresno | ** Support | Apr 12, 2016 |
| Regional Asthma Management and Prevention | ** Support | Apr 12, 2016 |
| Resource Development Associates | ** Support | Apr 12, 2016 |
| Sacramento Area Congregations Together | ** Support | Apr 12, 2016 |
| Santa Clara County Board of Supervisors | ** Support | Apr 12, 2016 |
| Santa Cruz City Schools | ** Support | Apr 12, 2016 |
| Street Level Health Project | ** Support | Apr 12, 2016 |
| The Children's Partnership | ** Support | Apr 12, 2016 |
| The MADE | ** Support | Apr 12, 2016 |
| ThriveSF Fitness | ** Support | Apr 12, 2016 |
| Time for Kids | * Support | Apr 6, 2016 |
| United Ways Of California | ** Support | Apr 12, 2016 |
| Violence Prevention Coalition of Greater Los Angeles | ** Support | Apr 12, 2016 |
| Waugh School District | ** Support | Apr 12, 2016 |
| Wellness Together | ** Support | Apr 12, 2016 |
| Western Center On Law And Poverty Inc. | * Support | Apr 12, 2016 |
| Young People's Policy Solutions | ** Support | Apr 12, 2016 |
| Youth UpRising | ** Support | Apr 12, 2016 |
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1644 (Bonta) - School-based early mental health intervention and prevention services
Version: August 1, 2016 | Policy Vote: HEALTH 9 - 0, ED. 9 - 0 |
Urgency: No | Mandate: No |
Hearing Date: August 1, 2016 | Consultant: Jillian Kissee |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
This bill establishes, contingent upon an appropriation, the HEAL Trauma in Schools Support Program. It requires the California Department of Health Care Services (DHCS) to establish a four-year program to provide outreach, training, and technical assistance to support local decisions to provide funding for early mental health support services. This bill also makes changes to the former Early Mental Health Initiative (EMHI).
Fiscal Impact:
- Cost pressure to the DHCS between $312,000 and $439,000 for three to four limited-term positions to provide training on providing eligible services and other topics; to provide technical assistance to local educational agencies (LEAs) on implementing existing or new programs that provide eligible services; to conduct outreach regarding this training and technical assistance; and to produce required reports. (General Fund)
- Cost pressure to the Department of Public Health potentially in the low hundreds of thousands and the California Department of Education for one partial position and $47,000 to consult with the DHCS. (General Fund)
- Amendments to statutes governing the former EMHI program create a cost pressure to provide funding for the program. Implementation of the EMHI is contingent upon an appropriation and a determination that any existing federal financial participation is not jeopardized, as specified. The program was last funded at $15 million.
Background:
Existing law establishes the School-based Early Mental Health Intervention and Prevention Services for Children Act and authorizes the Director of the Department of Mental Health, in consultation with the Superintendent of Public Instruction, to award matching grants to LEAs to pay the state share of the costs of providing school-based early mental health intervention and prevention services to eligible students, subject to the availability of funding each year. (Welfare & Institutions Code § 4370, et seq.)
From 1992 until 2012, EMHI grants funded prevention and early intervention programs for students experiencing mild-to-moderate school adjustment difficulty. At its peak, there were 15,823 students receiving EMHI-funded services. The Department of Mental Health has since been dissolved. Funding specifically for the EMHI was eliminated and beginning in the 2012-13 fiscal year, was redirected and disbursed directly to LEAs. It is now a local decision whether to continue this program without state matching grant support.
EMHI support services include individual and group intervention and prevention services; parent engagement; teacher and staff conferences and training to meet project goals; referral to outside resources when students require additional services; use of paraprofessional staff, as specified; and any other service that will improve the mental health of students.
Proposed Law:
This bill establishes, contingent upon an appropriation, the HEAL Trauma in Schools Support Program which requires the DHCS to establish a four-year program to provide outreach, training, and technical assistance to support local decisions to provide funding for early mental health support services. This bill also makes changes to the former EMHI program.
Specifically this bill requires the DHCS to:
HEAL Trauma in Schools Support Program
- Establish a four-year program in consultation with the Superintendent of Public Instruction, the State Public Health Officer, and the Attorney General to encourage and support local decisions to provide funding for the eligible support services, as specified. This program is scheduled to sunset January 1, 2022.
- Provide outreach to LEAs to inform individuals responsible for local funding decisions of this program.
- Provide free regional training on: eligible support services consistent with the EMHI program; the potential for services to help fulfill state priorities in the local control funding formula and local goals described in the local control and accountability plans; allowable funding sources; and external resources available to support services including conferences; and state resources available to support student mental health and resilience and trauma-informed learning environments.
- Provide technical assistance to LEAs that provide or seek to provide eligible services through designing programs, providing training on intervention skills, conducting local evaluations, coordinating with county mental health agencies, and leveraging funds that are subject to local control and assisting in budget development.
- During the first 12 months, in collaboration with the Superintendent, to support schools that previously received funding under the former EMHI program and have continued to provide eligible support services.
- During the subsequent 36 months, select and work with new schools that are not providing eligible support services but demonstrate a willingness and capacity to participate in the program.
- Prioritize schools in communities in which LEAs have demonstrated high levels of childhood adversity and schools that prioritize children who have been exposed to childhood trauma, including foster youth and homeless, and geographic diversity, program effectiveness, and long-term program sustainability.
- Submit, and post on its website, an interim report to the Legislature at the end of the second year of the program regarding its work in supporting schools which includes an assessment of the demand and impact of funding.
- Develop an evaluation plan to assess the impact of the program and report, to the Legislature, as well as post on its website, at the end of the four-year period evaluating the impact of the program and providing recommendations for further implementation.
Changes to the EMHI
- Authorizes beginning with grants for the 2017-18 school year, and subject to the availability of funding each year, the Director of Health Care Services to, in consultation with the Superintendent of Public Instruction, award matching grants to LEAs to pay the state share of the costs of programs that provide early mental health intervention and prevention services, as specified.
- Adds to the list of criteria for which applicants receive priority that the LEA will prioritize for services children who have been exposed to childhood trauma, including foster youth and homeless children.
- Specifies that eligible services include any other service that will improve the mental health of eligible students, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
- Removes the requirement that program administration must include both state and field staff; that field staff provide support in the implementation of early mental health services; and that reviews of each project are to be conducted at least once during the first year of funding.
- Authorizes the DHCS to implement this program by means of information notices, plan letters, plan or provider bulletins, or similar instruction, until regulations are adopted.
- Only allows the EMHI to be implemented to the extent that the DHCS determines that any existing federal financial participation associated with the eligible support services and early mental health intervention services is not jeopardized. The DHCS is authorized to claim federal financial participation for the administrative activities performed by the DHCS for EMHI to the extent the department determines it is available and that any necessary federal approvals are obtained. Further, it states that the EMHI provisions shall not be construed to alter any existing funding obligation in law associated with the provision of eligible support services and early mental health intervention services by county mental health departments or LEAs, including responsibility for the nonfederal share of permissible Medicaid expenditures, if any.
EMHI and HEAL Trauma in Schools Support Program
- Provides that the DHCS administers both programs.
- Expands students eligible for the EMHI, and applies the eligibility to the HEAL Trauma in Schools Support Program, to include a student who attends a state preschool program and transitional kindergarten, in addition to students in public kindergarten and in grades one through three.
Related Legislation:
AB 1133 (Achadjian, 2015), similar to this bill, established a four-year pilot program to provide outreach, free regional training, and technical assistance for LEAs in providing mental health services at school sites. AB 1133 was held in the Assembly Appropriations Committee.
AB 104 (Committee on Budget, Chapter 13, Statutes of 2015) included a one-time appropriation of $10 million Proposition 98 to a county office of education to provide technical assistance and disseminate statewide resources that encourage and assist LEAs in aligning systems of learning and behavioral supports, including mental health services. This funding is also for grants to LEAs to implement these strategies and to evaluate and learn from effective approaches.
Staff Comments:
This bill makes several changes to the former EMHI program. For example, it authorizes, beginning with grants for the 2017-18 school year and subject to the availability of funding, the DHCS to award matching grants to LEAs to pay the state share of the costs of programs that provide early mental health intervention and prevention services. This creates a cost pressure to provide funds for the 2017-18 school year. When it was last funded in the 2011–12 fiscal year, the EMHI received $15 million in state funds. The Assembly version of the 2016 Budget included $6 million to fund the former EMHI grant program, but no funding was included in the final budget act. Therefore, the EMHI program remains unfunded.
-- END --
SENATE COMMITTEE ON EDUCATION
Senator Carol Liu, Chair
2015 - 2016 Regular
Bill No: AB 1644
Author: | |||
Version: | May 27, 2016 Hearing Date: June 29, 2016 | ||
Urgency: | No | Fiscal: | Yes |
Consultant: | Lynn Lorber | ||
Subject: School-based early mental health intervention and prevention services
SUMMARY
This bill requires the Department of Public Health (DPH) to establish a four-year program to support local decisions to provide funding for early mental health support services, requires DPH to provide technical assistance to local educational agencies, and requires DPH to select and support schoolsites to participate in the program.
BACKGROUND
Existing law:
- Establishes the School-based Early Mental Health Intervention and Prevention Services for Children Act (EMHI) and authorizes the Director of the Department of Mental Health, in consultation with the Superintendent of Public Instruction, to award matching grants to local educational agencies to pay the state share of the costs of providing school-based early mental health intervention and prevention services to eligible students, subject to the availability of funding each year. (Welfare & Institutions Code § 4370, et seq.)
- Defines “eligible pupil” as a student who attends a publicly funded elementary school and who is in kindergarten or grades 1 to 3. (WIC § 4372)
- Establishes the Primary Intervention Program, using EMHI funds, to provide school-based early detection and prevention of emotional, behavioral, and learning problems in students in kindergarten and grades 1-3, with services provided by child aides under the supervision of a school-based mental health professional. (WIC § 4343, et seq.)
ANALYSIS
This bill requires the DPH to establish a four-year program to support local decisions to provide funding for early mental health support services, requires DPH to provide technical assistance to local educational agencies, and requires DPH to select and support schoolsites to participate in the program. Specifically, this bill:
- Requires the director of the DPH, also known as the Public Health Officer, to establish a four-year program, in consultation with the Superintendent of Public
Instruction, the Director of Health Care Services, and the Attorney General, to encourage and support local decisions to provide funding for eligible support services.
- Requires the Department of Public Health (DPH) to provide outreach to local educational agencies and county mental health agencies to inform individuals responsible for local funding decisions of the program established by this bill.
Selection of schoolsites
- Requires DPH, in providing outreach, training, and technical assistance, to select and support schoolsites as follows:
- Requires DPH, during the first 12 months of the program, to support, strengthen, and expand the provision of eligible services at schoolsites that previously received Early Mental Health Intervention and Prevention Services for Children Act funding and have continued to provide eligible support services. This bill requires DPH, in working with these selected schoolsites, to develop methods and standards for providing services and practices to new schoolsites.
- Requires DPH to develop a process to identify schoolsites that demonstrate the willingness and capacity to participate in the program.
- Requires DPH, during the subsequent 36 months of the program, to select new schoolsites that are not providing eligible support services but that demonstrate the willingness and capacity to participate in the program. This bill requires DPH to work with these schoolsites to deliver eligible support services.
- Requires DPH, during the first 12 months of the program, to support, strengthen, and expand the provision of eligible services at schoolsites that previously received Early Mental Health Intervention and Prevention Services for Children Act funding and have continued to provide eligible support services. This bill requires DPH, in working with these selected schoolsites, to develop methods and standards for providing services and practices to new schoolsites.
- Requires DPH, in selecting schoolsites and providing support, to prioritize the following:
- Schoolsites in communities that have experienced high levels of childhood adversity, such as Adverse Childhood Experiences and childhood trauma.
- Schoolsites that prioritize services for students who have been exposed to childhood trauma, including but not limited to, foster youth and homeless children and youth.
- Geographic diversity, program effectiveness, program efficiency, and long-term program sustainability.
- Schoolsites in communities that have experienced high levels of childhood adversity, such as Adverse Childhood Experiences and childhood trauma.
Training
- Requires DPH to provide free regional training on all of the following:
- Eligible support services, as specified.
- The potential for the eligible support services to help fulfill state priorities described by the local control funding formula and local goals described by local control and accountability plans.
- How educational, mental health, and other funds subject to local control can be used to finance the eligible support services.
- External resources available to support the eligible support services, which may include workshops, training, conferences, and peer learning networks.
- State resources available to support student mental health and resilience, and positive, trauma-informed learning environments.
- Eligible support services, as specified.
Eligible support services
- Authorizes eligible support services to include any or all of the following:
- Individual and group intervention and prevention services.
- Parent engagement through conference or training, or both.
- Teacher and staff conferences and training related to meeting project goals.
- Referral to outside resources when eligible students require additional services.
- Use of paraprofessional staff, who are trained and supervised by credentialed school psychologists, school counselors, or school social workers, to meet with students on a short-term weekly basis, in a one-on-one setting as in the primary intervention program.
- Any other service or activity that will improve the mental health of eligible students, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
- Individual and group intervention and prevention services.
Student mental health and resilience, and trauma-informed learning environments
- Authorizes student mental health and resilience, and trauma-informed learning environments to include any of the following:
- Foundational aspects of learning, childhood social-emotional development, mental health and resilience, toxic stress, childhood trauma, and Adverse Childhood Experiences.
- Inclusive multi-tiered systems of behavioral and academic supports, Schoolwide Positive Behavior Interventions and Supports, restorative justice or restorative practices, trauma-informed practices, social and emotional learning, bullying prevention, mental health consultation, and parent-child group supports.
- Foundational aspects of learning, childhood social-emotional development, mental health and resilience, toxic stress, childhood trauma, and Adverse Childhood Experiences.
Technical assistance
- Requires the Department of Public Health (DPH) to provide technical assistance to local educational agencies that provide or seek to provide eligible services, and requires technical assistance to include assistance in any of the following:
- Designing programs.
- Training program staff in intervention skills.
- Conducting local evaluations.
- Coordinating with county mental health agencies and professionals.
- Leveraging educational, mental health, and other funds that are subject to local control and assisting in budget development.
- Designing programs.
Report and evaluation
- Requires DPH to submit an interim report to the Legislature at the end of the second year of the program that details the DPH’s work to support the schoolsites and includes an assessment of the demand and impact of funding for the program established by this bill. This bill requires DPH to make the report available to the public and post the report on its Web site.
- Requires DPH to develop an evaluation plan to assess the impact of the program.
- Requires DPH to submit a report to the Legislature at the end of the four-year period evaluating the impact of the program and providing recommendations for further implementation, and make the report available to the public and post the report on its Web site.
Miscellaneous
- Provides that implementation of this bill is contingent upon an appropriations in the annual budget act.
- Renames the School-based Early Mental Health Intervention and Prevention Services for Children Act (EMHI) as the Healing from Early Adversity to Level the Impact of Trauma in Schools Act, or the Heal Trauma in Schools Act.
- Expands priority for funding for EMHI applicants by adding local educational agencies that will prioritize services for children who have been exposed to childhood trauma, including but not limited to, foster youth and homeless children and youth.
- Expands “other service or activity” relative to eligible supportive services by adding evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
- Deletes the prohibition on more than 20% of the grants to be used for new models of services and the requirement that at least 80% of the grants awarded to include the basic components of the primary intervention program.
- Expands the definition of “eligible pupil” to include a student who attends a preschool program at a contracting agency of the California state preschool program or local educational agency, and to include students who are in transitional kindergarten.
- Modifies the definition of “supportive services” to change social development to social-emotional development.
- Expands the definition of “local educational agency” to include charter schools.
- Defines “Department” as the State Department of Public Health.
- Modifies the definition of “director,” from the State Director of Mental Health to the State Public Health Officer.
- States legislative findings and declarations relative to the need to provide funding to address the mental health needs of children who have been exposed to childhood adversity and to prioritize communities that experience childhood adversity more severely and profoundly.
- Sunsets the provisions of this bill on January 1, 2022.
STAFF COMMENTS
- Need for the bill. According to the author, “For 20 years, the EMHI Matching Grant Program was a highly successful state program that provided matching grants to local educational agencies to provide school-based mental health supports to young pupils experiencing mild to moderate school adjustment difficulties. EMHI supported Primary Intervention Programs consisting of one-on-one services or services delivered in small groups to address social skills, anger management, friendship groups, or topic-specific issues such as bullying or divorce; and indirect services such as parent and teacher services and classroom curricula. Despite its success and the demand for services, the program was defunded in 2012. Additionally, with the dissolution of the Department of Mental Health, its oversight and agency was eliminated, effectively ending the program. I believe that restoring and expanding the EMHI Program is a significant step towards addressing the harmful and long-lasting effects of Adverse Childhood Experiences, and will give our children a better shot at success.”
- Early Mental Health Initiative (EMHI). From 1992 to 2012, the then-Department of Mental Health awarded matching grants to local educational agencies to fund prevention and early intervention programs, including EMHI. In the 2011–12 fiscal year, the EMHI received $15 million in state funds. At its peak, there were 15,823 students receiving EMHI-funded services. The Department of Mental Health has since been dissolved and funding for EMHI was eliminated beginning in the 2012-13 fiscal year; the state infrastructure for EMHI was not re-established in another state agency. It is now a local decision whether to continue this program without state matching grant support. The Assembly version of the 2016 Budget included $6 million to fund the former EMHI grant program, but no funding was included in the final conference committee report. Therefore, the EMHI program remains unfunded.
This bill creates a framework to support and assist local educational agencies in implementing early mental health initiatives at a local level, without the support of a state infrastructure or funding. - Existing statewide student mental health initiatives. The state is currently engaged in a number of initiatives aimed at improving support for student mental health needs (none are specifically targeted to the youngest students). Among them are:
Student Mental Health Policy Workgroup. In 2012, the Superintendent of Public Instruction and the California Mental Health Services Act (CalMHSA) convened a Student Mental Health Policy Workgroup (workgroup) to develop policy recommendations that promote early identification, referral, coordination, and access to quality mental health services for students. The workgroup is comprised of teachers, school counselors, school social workers, school psychologists, school nurses, and school administrators, as well as state and county mental health professionals.
The workgroup has noted the connection between mental wellness and academic achievement, attendance, and behavior. It has also noted that California's educators acknowledge their lack of preparedness in addressing pupil mental health challenges as a major barrier to instruction. The workgroup found that "most educators and staff lack training to identify pupils who may be in need of support, make referrals, and, as appropriate, to help pupils overcome or manage mental health barriers and succeed in school." They also noted that mental health challenges disproportionately impact students who face stressors such as violence, trauma, and poverty.
Regional K-12 Student Mental Health training. Since 2011, CalMHSA has funded a Student Mental Health Initiative through the California County Superintendents Educational Services Association. This project is designed to build capacity and cross-system collaboration to develop and sustain school-based mental health programs addressing prevention and early identification strategies.
One of the goals of this project is the training of school staff. Since 2011 this project has used a train-the-trainer model to provide educators with tools for the early identification and prevention of mental health problems. Two thousand trainings have been conducted, with over 140,000 participants. The estimated total reach of this project is two million students, or one third of the state’s enrollment. Since 2014, this project has declined significantly in size as a result of decreased funding.
California Department of Education's training project. California Mental Health Services Act (CalMHSA) has also funded mental health training through the California Department of Education (CDE), Training Educators through Recognition and Identification Strategies (TETRIS), Eliminating Barriers to Learning (EBL) project. This statewide K-12 Mental Health Program promotes school and student wellness and academic achievement by increasing capacity for all school and administrative staff to identify students who are experiencing mental health issues early on. To accomplish this goal, the CDE subcontracted with the Placer County Office of Education to deliver 11 TETRIS EBL workshops annually through 2019. The curriculum used for the TETRIS EBL workshops was developed by the United States Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA). Kognito Interactive Online Simulation Program is also used as an outside source to help support school staff in initiating conversations with students around the subject of mental health and suicidal ideation.
SAMHSA "Now is the Time" pilot projects. Following the school shooting at Sandy Hook Elementary in Connecticut in December 2012, President Obama established a grant program to increase students' access to mental health services. California received $9.7 million from the "Now is the Time Project Advancing Wellness and Resilience in Education" (NITT AWARE) grant in 2014. According to the CDE, the grant has two components. Three local educational agencies (LEAs), Garden Grove Unified School District, Santa Rosa City Schools, and the San Diego County Office of Education, were selected to participate in the first component of the grant. The LEAs will establish a process for referring and connecting children to mental health services. If successful, the models developed by these LEAs can be shared statewide. The second component utilizes a training program called Youth Mental Health First Aid. The training teaches school staff how to help youth experiencing mental health or addictions challenges, or are in crisis. - Heard by the Senate Health Committee. This bill was heard by the Senate Health Committee on June 15, where it passed on a 9-0 vote.
- Fiscal impact. This bill provides that its implementation is contingent upon an appropriation in the annual budget act. Funding for the purposes of this bill was not provided in the 2016 Budget Act.
According to the Assembly Appropriations Committee, this bill imposes the following costs:- General Fund administrative costs to the Department of Public Health (DPH) of approximately $300,000 to oversee the program, provide outreach, free regional training, and technical assistance to school sites
over four years. Department of Public Health (DPH) would also incur costs related to interim reporting requirements and final evaluation of the program.
- Proposition 98 General Fund (GF) cost pressure, in the millions of dollars, to fund grants pursuant to the Healing from Early Adversity to Level the Impact Trauma in Schools Act. Grants are contingent upon an appropriation in the annual budget act.
- Proposition 98 General Fund (GF) cost pressure, in the millions of dollars, to fund grants pursuant to the Healing from Early Adversity to Level the Impact Trauma in Schools Act. Grants are contingent upon an appropriation in the annual budget act.
- Related legislation. SB 1113 (Beall) authorizes local educational agencies to enter into partnerships, as specified, with county mental health plans for the provisions of Early and Periodic Screening, Diagnosis, and Treatment mental health services, and to expand the allowable uses of specified mental health funds. SB 1113 is pending in the Senate Appropriations Committee.
AB 2017 (McCarty) requires the Department of Health Care Services to create a grant program for public postsecondary education institutions to access mental health services, and appropriates $40 million for this purpose. AB 2017 is scheduled to be heard by this Committee on June 29.
- Prior legislation. AB 1133 (Achadjian, 2015) established a four-year pilot program, the School-Based Early Mental Health Intervention and Prevention Services Support Program (EMHI Support Program), to provide outreach, free regional training, and technical assistance for local educational agencies in providing mental health services at school sites. AB 1133 was held in the Assembly Appropriations Committee.
AB 1025 (Thurmond, 2015) required California Department of Education (CDE) to establish a three-year pilot program in school districts to encourage inclusive practices that integrate mental health, special education, and school climate interventions following a multi-tiered framework. AB 1025 was held in the Senate Appropriations Committee.
AB 1018 (Cooper, 2015) required the Department of Health Care Services and CDE to convene a joint taskforce to examine the delivery of mental health services to children. AB 1018 was held in the Senate Appropriations Committee.
AB 580 (O’Donnell, 2015) required the CDE to develop model referral protocols for voluntary use by schools to address the appropriate and timely referral by school staff of students with mental health concerns. AB 580 was vetoed by the Governor, whose veto message read:
California does not currently have specific model referral protocols for addressing student mental health as outlined by this bill. However, the California Department of Education recently received a grant from the federal Department of Health and Human Services, Substance Abuse and Mental Health Services Administration to identify and address critical student and family mental health needs.
It's premature to impose an additional and overly prescriptive requirement until the current efforts are completed and we can strategically target resources to best address student mental health.
SUPPORT
Alameda County Board of Supervisors
Attorney General Kamala Harris
California Academy of Child and Adolescent Psychiatry
California Association for Licensed Professional Clinical Counselors
California Black Health Network
California Children’s Hospital Association
California Council of Community Behavioral Health Agencies
California Federation of Teachers
California Medical Association
California Pan-Ethnic Health Network
California School-Based Health Alliance
California School Nurses Organization
California State PTA
Center for Youth Wellness
Children Now
Children’s Defense Fund - California
Children’s Specialty Care Coalition
Common Sense Kids Action
Disability Rights California
East Bay Agency for Children
Family Paths
Fight Crime: Invest in Kids
First 5 California
First 5 LA
Foster Care Alumni of America, California Chapter
Lemonade
Los Angeles County Office of Education
Los Angeles Trust for Children’s Health
Mental Health America of California
National Association of Social Workers, California Chapter
Public Health Advocates
Santa Clara County Board of Supervisors
Santa Clara County Office of Education
The Children’s Partnership
United Ways of California
Western Center on Law & Poverty
OPPOSITION
None received.
-- END --
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1644
AUTHOR: | Bonta | ||
VERSION: | May 27, 2016 | ||
HEARING DATE: | June 15, 2016 | ||
CONSULTANT: | Reyes Diaz | ||
SUBJECT: School-based early mental health intervention and prevention services
SUMMARY:
Renames the School-based Early Mental Health Intervention and Prevention Services for Children Act of 1991, known as the Early Mental Health Initiative, as the Healing from Early Adversity to Level the Impact of Trauma in Schools Act. Requires the Department of Public Health (DPH) to create a new four-year program, as specified, and requires DPH to perform technical assistance and outreach to local educational agencies about the new program, which will target pupils with adverse childhood experiences, as specified.
Existing law:
- Establishes the School-based Early Mental Health Intervention and Prevention Services for Children Act of 1991, known as the Early Mental Health Initiative (EMHI), subject to the availability of funding each year. Authorizes the Director of the Department of Mental Health (now the Department of Health Care Services [DHCS]), in consultation with the Superintendent of Public Instruction (SPI), to provide matching grants to “local educational agencies (LEAs),” as defined, to pay the state share of the costs of providing school-based EMHI services to “eligible pupils,” as defined.
- Requires priority for the grants to be given to applicants that demonstrate specified criteria, including, but not limited to, serving the greatest number of eligible pupils from low-income families, providing a strong parental involvement component, providing services at a low cost per child, provide programs and services based on existing programs that have been shown to be effective; and provide services to children who are in out-of-home placement or at risk of being placed out of home.
- Defines “LEA”, for the purposes of the EMHI program, as any school district or county office of education, or state special school. Defines “eligible pupil” as a pupil who attends a publicly funded elementary school and who is in kindergarten or grades one to three, inclusive. Defines “supportive services” as a service that will enhance the mental health and social development of children.
- Provides for the Medi-Cal program, administered by DHCS, under which eligible low-income individuals receive health care services subject to state and federal laws and funding.
- Establishes the Medi-Cal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program for eligible individuals up to age 21 pursuant to state and federal law for periodic screenings to determine health care needs.
- Establishes the Mental Health Services Act, enacted by voters in 2004 as Proposition 63, to provide funds to counties to expand services, develop innovative programs, and integrated service plans for mentally ill children, adults, and seniors through a 1% income tax on personal income above $1 million.
This bill:
- Renames the EMHI the Healing from Early Adversity to Level (HEAL) the Impact of Trauma in Schools Act (the HEAL Trauma in Schools Act). Requires the Director of DPH, contingent upon an appropriation in the annual budget act, to establish a four-year program, in consultation with the SPI, the Director of DHCS, and the Attorney General to encourage and support local decisions to provide funding for the eligible support services, as specified.
- Requires DPH to provide outreach to LEAs and county mental health agencies to inform individuals responsible for local funding decisions of the established program. Requires DPH to provide free regional training on all of the following:
- Eligible support services, including individual and group intervention and prevention services; parent engagement through conference or training, or both; teacher and staff conferences and training, as specified; referral to outside resources, as specified; use of paraprofessional staff to meet with pupils on a short-term weekly basis, as specified; and any other services that will improve the mental health of eligible pupils, particularly evidence-based interventions and promising practices, as specified;
- The potential for the eligible support services, as defined, to help fulfill state priorities described in the local control funding formula (LCFF), as specified;
- How educational, mental health, and other funds subject to the LCFF can be used to finance the eligible support services;
- External resources available to support eligible support services; and,
- State resources available to support student mental health and resilience, as positive, trauma-informed learning environments, including inclusive multitiered system of behavioral and academic supports, trauma-informed practices, social and emotional learning, and parent-child group supports.
- Requires DPH to provide technical assistance to LEAs that provide or seek to provide eligible services to include, but not limited to, designing programs, training program staff, conducting local evaluations, and coordinating with county mental health agencies and professionals.
- Requires DPH, in providing outreach, training, and technical assistance, to select and support school sites that meet specified criteria, including, but not limited to, school sites that previously received EMHI grants and have continued to provide eligible supports after the end of the grant period; school site that are not providing eligible support services but demonstrate a willingness and capacity to participate in the program; and prioritize school sites in communities that have experienced high levels of childhood adversity and that prioritize services to children exposed to trauma, including foster and homeless youth, as specified.
- Expands the definition of “eligible pupil” to include pupils who attend a preschool program, as specified, and transitional kindergarten. Expands the definition of “LEA” to include charter schools. Specifies in the definition of “supportive service” the social-emotional development of children.
- Makes findings and declarations about the importance of preventing and addressing adverse childhood experiences (ACEs), as specified, and childhood trauma, which can result in negative educational, health, social, and economic outcomes for children, youth, families, and communities.
- Sunsets the program on January 1, 2022, unless a later enacted statute deletes or extends that date.
FISCAL EFFECT:
According to the Assembly Appropriations Committee:
- General Fund (GF) administrative costs to DPH of approximately $300,000 to oversee the program and provide outreach, free regional training, and technical assistance to school sites over four years. DPH would also incur costs related to interim reporting requirements and final evaluation of program.
- Proposition 98 GF cost pressure, in the millions of dollars, to fund grants pursuant to the HEAL Trauma in Schools Act. Grants are contingent upon an appropriation in the annual budget act. The Assembly Budget proposes $6 million GF for this program.
PRIOR VOTES:
Assembly Floor: | 80 - 0 |
Assembly Appropriations Committee: Assembly Health Committee: | 20 - 0 18 - 0 |
Assembly Education Committee: | 7 - 0 |
COMMENTS:
- Author’s statement. According to the author, for 20 years, the EMHI was a highly successful state program that provided matching grants to LEAs to provide school-based mental health supports to young pupils experiencing mild to moderate school adjustment difficulties. EMHI served over 15,000 children per year by supporting primary intervention programs consisting of one-on-one services or services delivered in small groups to address social skills, anger management, friendship groups, or topic-specific issues, such as bullying or divorce, and indirect services, such as parent and teacher services and classroom curricula. Despite its success and the demand for services, the program was defunded in 2012. Additionally, with the dissolution of the Department of Mental Health, its oversight and agency was eliminated, effectively ending the program. AB 1644 restores the EMHI program and adds a focus on addressing the impacts of trauma and ACEs for children. Studies such as the Centers for Disease Control and Prevention’s (CDC) ACEs Study indicate that childhood exposure to abuse, neglect, and other traumatic experiences has lifelong health impacts. Left unaddressed, ACEs expose children to toxic stress, keeping them in a constant state of fight-or-flight and taking years off their lives and damaging their health. Restoring and expanding the EMHI program is a significant step towards addressing the harmful and long-lasting effects of ACEs, and will give our children a better shot at success.
- Background. Between 1991 and 2011, the state Department of Mental Health (DMH) operated the EMHI, providing schools with approximately $15 million annually. With the transfer of responsibilities from DMH to DHCS in 2012, this program was shifted to local education departments. Many counties also fund on-campus mental health services for non–special education students through EPSDT and Mental Health Services Act-funded prevention and early intervention programs. Schools are the main providers of mental health services for children in California. The federal Individuals with Disabilities Education (IDEA) Act was adopted in 1975 to guarantee children with disabilities a right to public education in the least restrictive setting. In California, the federal IDEA mandate to provide special education services is administered by local school districts and LEAs. Special education students may be eligible for health care services, including mental health services, in specific IDEA disability categories. Mental health services provided to special education students include counseling and guidance, psychological services, parental counseling and training, and residential placement, among others. While federal law requires mental health services to be provided to students who have been identified for special education services, there are little to no services available to the general student population.
- EPSDT. The EPSDT benefit provides comprehensive screening, diagnostic, treatment, and preventive health care services for children under age 21 who are enrolled in Medi-Cal, and is key to ensuring that children who are eligible for EPSDT services receive appropriate preventive, dental, mental health, developmental, and specialty services. Federal Medicaid law defines the EPSDT benefit to include a comprehensive array of preventive, diagnostic, and treatment services for low-income children under age 21. States are required to provide coverage of any services listed in a section of the federal Medicaid Act to children who are eligible for EPSDT services when the services are determined to be medically necessary to correct or ameliorate any physical or behavioral conditions. The EPSDT benefit is more robust than the Medi-Cal benefit package provided to adults and is designed to ensure that eligible children receive early detection and preventive care in addition to medically necessary treatment services, so that health problems are averted or diagnosed and treated as early as possible.
- A shift in responsibilities and its effects. Prior to 2011, special education students who had a severe emotional disturbance condition documented in their individual education plans (IEPs) were referred by their schools to county mental health agencies for treatment. In 2011, the Legislature repealed the state mandate on county mental health agencies to provide IDEA-related mental health services and shifted this financial responsibility to the California Department of Education (CDE). LEAs and local county MHPs were required to develop new agreements defining agency responsibilities that reflected the changes in state law. MHPs remain responsible for providing EPSDT services for students who are Medi-Cal beneficiaries with IDEA-related individualized education, if they meet medical necessity criteria.
AB 114 (Committee on Budget, Chapter 43, Statutes of 2011), transferred the responsibility for providing mental health services for students IEPs from county mental health departments to LEAs. A 2016 state audit on the effect of AB 114 on mental health services for these students reported, among other findings:
- Although the most common types of mental health services offered and the service providers generally did not change, LEAs removed mental health services from student IEPs in the two years after AB 114 took effect;
- Although most service reductions were not related to AB 114, such as those prompted by a student graduating, IEP teams did not always record in the IEP document their rationale of why a service was removed;
- For 40% of the students who had a change to their mental health services or their educational placement within two years of AB 114’s implementation, the IEP teams did not document the rationale for the changes; and,
- For 13 of the 44 students reviewed who had a mental health service removed from their IEPs, either the LEAs could not satisfactorily explain why the services were removed or the removal was related to AB 114. In three cases, the LEA had no assurance that removing services would not adversely affect access to education.
- The ACEs Study. The ACEs study is an investigation into associations between childhood maltreatment and later-life health and well-being. The ACEs study is a collaboration between the CDC and Kaiser Permanente's Health Appraisal Clinic in San Diego. The ACEs study uses a score to represent the degree to which a person has experienced traumatic events. One point is recorded for each type of trauma exposure in the areas of abuse, neglect, and household dysfunction, and the points add up to a score ranging from 0 to 10. The higher an ACEs score, the greater one’s risk of a broad range of health, mental health, and at-risk behaviors. The study has shown that ACEs are major risk factors for the leading causes of illness and death, as well as poor quality of life. Related research has also demonstrated a strong association between high ACEs scores and poor performance in school, including a higher risk of learning and behavior problems. Other research into the effects of chronic stress (often caused by ACEs) on children has identified a profound effect on the developing brain, which in turn affects school performance and behavior.
Recognition of the impact of these childhood experiences has led to the development and increasing use of trauma-informed approaches in a variety of fields, including education. According to the federal Substance Abuse and Mental Health Services Agency, trauma-informed practices in schools can include those that involve: a realization of the widespread prevalence and impact of trauma; recognition of signs of traumatic exposure; responses grounded in evidence-based practices; and resisting the re-traumatization of students. Examples of such practices in schools include professional development for educators on the role of trauma in learning, classroom management practices and discipline policies focused on conflict resolution and restorative practices, and instructional modifications that address the specific learning needs of students exposed to trauma.
- Double referral. If this bill passes out of this committee, it will be referred to the Senate Education Committee.
- Prior legislation. AB 1133 (Achadjian of 2015), would have established a program substantially similar to the one proposed by this bill. Would have established a four year pilot program, the School-Based Early Mental Health Intervention and Prevention Services Support Program, to provide outreach, free regional training, and technical assistance for LEAs in providing mental health services at school sites. AB 1133 was held in the Assembly Appropriations Committee.
AB 1025 (Thurmond of 2015), would have required CDE to establish a three-year pilot program to encourage inclusive practices that integrate mental health, special education, and school climate interventions following a multitiered framework. AB 1025 was held in the Senate Appropriations Committee.
AB 104 (Committee on Budget, Chapter 13, Statutes of 2015), among other things, appropriates $10 million to the SPI to be apportioned to a designated county offices of education to provide technical assistance and develop statewide resources to assist LEAs in establishing and aligning systems of learning and behavioral supports.
AB 114 (Committee on Budget, Chapter 43, Statutes of 2011), a companion measure to the 2011-12 Budget bill, relieved county mental health departments of the responsibility to provide mental health services to students with disabilities and transferred that responsibility to school districts.
- Support. Supporters of this bill argue that childhood trauma and exposure to violence can have a lasting impact on the ability of a child to grow and thrive, resulting in negative impacts on educational, health, social, and economic outcomes for children and their families. Supporter state that this bill is modeled on the success of the EMHI, in which 79% of participating students exhibited improvements, and that this bill will not only improve the lives of young people but the public safety and well-being of the state for years to come. NAMI California states that almost half of all cases of mental illness begin by age 14 but only 20% of children with diagnosable mental illness are identified and receive treatment and services each year, with Asian and Latino children being the least likely to have had a mental health visit.
- Opposition. California Right to Life Committee, Inc. (CRLC) opposes with concerns about intervention services for pre-school and transitional kindergarten-aged children. CRLC questions who determines at what level ACEs warrant governmental intervention, what local decision-makers will be included, and who determines what ACEs are, among other things.
SUPPORT AND OPPOSITION:
Support: Attorney General Kamala D. Harris (cosponsor)
Children Now (cosponsor)
Time for Kids, Inc. (cosponsor)
Abriendo Puertas/Opening Doors
Alameda Unified School District/Woodstock Child Developmental Center
Alliance for Education Solutions
American Academy of Pediatrics
Amethod Public Schools
BANANAS
Bay Area Urban Debate League
Beats Rhymes and Life
Bicycle Coffee
Brighter Beginnings
California Alliance of Child and Family Services
California Black Health Network
California Center for Public Health Advocacy
California Council of Community Behavioral Health Agencies
California Pan-Ethnic Health Network
California School-based Health Alliance
California School Nurses Organization
California State PTA
Californians for Safety and Justice
Center Joint Unified School District
Center for Leadership, Equity, and Research
Center for Youth Wellness
Chico Unified School District
Children’s Defense Fund California
Children’s Specialty Care Coalition
City of Oakland
Common Sense Kids Action
County Behavioral Health Directors Association of California
Early Edge California
East Bay Agency for Children
East Bay Asian Youth Center
Family Voices of California
Fight Crime: Invest in Kids
First Place for Youth
Full Court Press Communications
Girls Leadership Institute
Human Impacts Partners
Inland Congregation United for Change
LEMONADE Creative Consulting
Los Angeles County Office of Education
Los Angeles Trust for Children’s Health
Lucile Packard Children’s Hospital Stanford
Mental Health America of California
Mental Health Association of California
Mental Health & Autism Insurance Project
Montclair Physical Therapy
NAMI California
National Association of Social Workers, California Chapter
[Nonprofit] Communications
Nurse-Family Partnership
Oakland Natives Give Back
Playworks
Public Counsel
Rape Counseling Services of Fresno
Regional Asthma Management and Prevention
Resource Development Associates
Sacrament ACT (Area Congregations Together)
Santa Clara County Board of Supervisors
Street Level Health Project
The Children’s Partnership
The MADE
thriveSF Fitness
United Ways of California
Violence Prevention Coalition of Greater Los Angeles
Wellness Together
Western Center on Law and Poverty
Young People’s Policy Solutions
Youth UpRising
Numerous individuals
Oppose: California Right to Life Committee, Inc.
-- END --
ASSEMBLY THIRD READING
ATR Bill Id:
Author:(Bonta)
As Amended Ver:May 27, 2016
Majority vote
Committee | Votes | Ayes | Noes |
Education | 7-0 | O'Donnell, Olsen, Kim, McCarty, Santiago, Thurmond, Weber | |
Health | 18-0 | Wood, Maienschein, Bonilla, Burke, Campos, Chiu, Dababneh, Gomez, Roger Hernández, Lackey, Nazarian, Olsen, Patterson, Ridley-Thomas, Santiago, Steinorth, Thurmond, Waldron | |
Appropriations | 20-0 | Gonzalez, Bigelow, Bloom, Bonilla, Bonta, Calderon, Chang, Daly, Eggman, Gallagher, Eduardo Garcia, Roger Hernández, Holden, Jones, Obernolte, Quirk, Santiago, Wagner, Weber, Wood |
SUMMARY: Recasts and renames the Early Mental Health Initiative (EMHI) as the HEAL Trauma in Schools Act, expands the program to serve preschool and transitional Kindergarten students, and establishes an initiative to encourage and support local decisions to provide funding for services offered in that program. Specifically, this bill:
- Renames the EMHI as the Healing from Early Adversity to Level the impact of Trauma in Schools Act or the HEAL Trauma in Schools Act.
- Expands the definition of eligible pupils to include preschool and transitional Kindergarten students, and extends the program to charter schools.
- Names the Department of Public Health (DPH), and the Director of the DPH as the administrators of the program.
- Requires that, in determining which students receive services under the program, local educational agencies prioritize children who have been exposed to childhood trauma, including students in foster care and students who are homeless.
- Includes, as services which may be funded under the program, evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
- Establishes the School-Based Early Mental Health Intervention and Prevention Services Support Program, administered by the DPH, in consultation with the Superintendent of Public Instruction (SPI), the Director of Health Care Services, and the Attorney General to encourage and support local decisions to provide funding for the eligible support services.
- Requires the DPH to provide outreach to local education agencies (LEAs) and county mental health agencies to inform them of the program.
- Requires the DPH to provide free regional training on eligible support services, including individual and group intervention and prevention services, parent engagement, teacher and staff conferences and training, referral to outside resources, use of trained and supervised paraprofessional staff, and other services to improve student mental health, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
- Requires the DPH to also provide free regional training on:
- The potential for the support services to help fulfill state priorities described by the local control funding formula (LCFF) and local control and accountability plans (LCAPs)
- How educational, mental health, and other funds subject to local control can be used to finance the eligible support services
- External resources available to support the eligible support services, including workshops, training, conferences, and peer learning networks
- State resources available to support student mental health and positive, trauma-informed learning environments
- Requires DPH to provide technical assistance to LEAs, including assistance in designing programs, training staff; and conducting evaluations; coordination with county mental health agencies and professionals; and leveraging local funds.
- Requires the DPH to select and support schoolsites as follows:
- Requires, during the first 12 months of the program, the DPH to support, strengthen, and expand the provision of eligible services at schoolsites that previously received funding for EMHI and have continued to provide eligible support services
- Requires the DPH to develop a process to identify schoolsites that demonstrate the willingness and capacity to participate in the program
- Requires the DPH, during the subsequent 36 months of the program, to select new schoolsites that are not providing eligible support services but that demonstrate the willingness and capacity to participate in the program. Requires the DPH to work with these schoolsites to deliver eligible support services
- Requires the DPH to prioritize school sites in communities that have experienced high levels of childhood adversity, such as adverse childhood experiences and childhood trauma, and schoolsites that prioritize children who have been exposed to childhood trauma, such as students in foster care and those who are homeless. Also prioritizes geographic diversity, program effectiveness, program efficiency, and long-term sustainability.
- Requires the DPH to submit an interim report to the Legislature at the end of the second year of the program, and to submit an evaluation at the end of the four year pilot and submit it to the Legislature.
- States that implementation of the support program is contingent upon an appropriation in the annual budget act, and sunsets the support program on January 1, 2022.
FISCAL EFFECT: According to the Assembly Appropriations Committee:
1) General Fund administrative costs to the Department of Public Health (DPH) of approximately $300,000 to oversee the program, provide outreach, free regional training, and technical assistance to school sites over four years. DPH would also incur costs related to interim reporting requirements and final evaluation of program.
2) Proposition 98 General Fund (GF) cost pressure, in the millions of dollars, to fund grants pursuant to the HEAL Trauma in Schools Act. Grants are contingent upon an appropriation in the annual budget act. The Assembly Budget proposes $6 million GF for this program.
COMMENTS:
Need for the bill. The author states: "For 20 years, the EMHI Matching Grant Program was a highly successful state program that provided matching grants to local education agencies to provide school-based mental health supports to young pupils experiencing mild to moderate school adjustment difficulties. EMHI supported Primary Intervention Programs consisting of one-on-one services or services delivered in small groups to address social skills, anger management, friendship groups, or topic-specific issues such as bullying or divorce; and indirect services such as parent and teacher services and classroom curricula.
"The EMHI Matching Grant Program served over 15,000 children per year and its services were in great demand. Despite its success and the demand for services, the program was defunded in 2012. Additionally, with the dissolution of the Department of Mental Health, its oversight and agency was eliminated, effectively ending the program.
"Studies such as the Centers for Disease Control's Adverse Childhood Experiences (ACE) study indicate that childhood exposure to abuse, neglect, and other traumatic experiences has lifelong health impacts. Left unaddressed, ACEs expose children to toxic stress, keeping them in a constant state of fight-or-flight and taking years off their lives and damaging their health. I believe that restoring and expanding the EMHI Program is a significant step towards addressing the harmful and long-lasting effects of ACEs, and will give our children a better shot at success."
EMHI program history and outcomes. In 1981 the Legislature created the Primary Prevention Project, now named the Primary Intervention Program, and in 1991 created the School-based Early Mental Health Intervention and Prevention Services for Children Program (EMHI).
From 1992 to 2012, the Department of Mental Health awarded matching grants to LEAs to fund prevention and early intervention programs, including EMHI. In the 2011–12 fiscal year, the EMHI received $15 million in state funds, and there was significant unmet demand for services. At its peak, there were 15,823 students receiving EMHI-funded services. Funding for the program was eliminated in 2012. It is now a local decision whether to continue this program without state matching grant support.
According to the author, the legislation authorizing this program set a target of at least 75% of the participating children showing an improvement in at least one of the following four areas: learning behaviors, attendance, school adjustment, and school-related competencies. A 2010-11 evaluation showed that 79% had met that target.
When state funding for this program was eliminated, LEAs could continue the program using local resources, and limited evidence suggests that some have continued to operate programs using a range of funding, from federal Title I funds to county mental health funding, to local general purpose funds.
The Adverse Childhood Experiences study and trauma-informed practices. The Adverse Childhood Experiences (ACE) study is a landmark investigation into associations between childhood maltreatment and later-life health and well-being. The ACE study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego.
The ACE study uses a score to represent the degree to which a person has experienced traumatic events. One point is recorded for each type of trauma exposure in the areas of abuse, neglect, and household dysfunction, and the points add up to a score ranging from 0 to 10. The higher an ACE score, the greater one's risk of a broad range of health, mental health, and at-risk behaviors.
The ACE Study has shown that adverse childhood experiences are major risk factors for the leading causes of illness and death, as well as poor quality of life. Related research has also demonstrated a strong association between high ACE scores and poor performance in school, including a higher risk of learning and behavior problems. Other research into the effects of chronic stress (often caused by ACEs) on children, has identified a profound effect on the developing brain, which in turn affects school performance and behavior.
Recognition of the impact of these childhood experiences has led to the development and increasing use of "trauma-informed" approaches in a variety of fields, including education. Broadly speaking, trauma-informed practices in schools are those which involve 1) a realization of the widespread prevalence and impact of trauma, 2) recognition of signs of traumatic exposure, 3) responses grounded in evidence-based practices, and 4) resisting the re-traumatization of students [definition from the federal Substance Abuse and Mental Health Agency (SAMHSA)]. Examples of such practices in schools include professional development for educators on the role of trauma in learning, classroom management practices and discipline policies focused on conflict resolution and restorative practices, and even instructional modifications which address the specific learning needs of students exposed to trauma.
Analysis Prepared by: Tanya Lieberman / ED. / (916) 319-2087 FN: 0003353
ASSEMBLY THIRD READING
ATR Bill Id:
Author:(Bonta)
As Amended Ver:May 27, 2016
Majority vote
Committee | Votes | Ayes | Noes |
Education | 7-0 | O'Donnell, Olsen, Kim, McCarty, Santiago, Thurmond, Weber | |
Health | 18-0 | Wood, Maienschein, Bonilla, Burke, Campos, Chiu, Dababneh, Gomez, Roger Hernández, Lackey, Nazarian, Olsen, Patterson, Ridley-Thomas, Santiago, Steinorth, Thurmond, Waldron | |
Appropriations | 20-0 | Gonzalez, Bigelow, Bloom, Bonilla, Bonta, Calderon, Chang, Daly, Eggman, Gallagher, Eduardo Garcia, Roger Hernández, Holden, Jones, Obernolte, Quirk, Santiago, Wagner, Weber, Wood |
SUMMARY: Recasts and renames the Early Mental Health Initiative (EMHI) as the HEAL Trauma in Schools Act, expands the program to serve preschool and transitional Kindergarten students, and establishes an initiative to encourage and support local decisions to provide funding for services offered in that program. Specifically, this bill:
- Renames the EMHI as the Healing from Early Adversity to Level the impact of Trauma in Schools Act or the HEAL Trauma in Schools Act.
- Expands the definition of eligible pupils to include preschool and transitional Kindergarten students, and extends the program to charter schools.
- Names the Department of Public Health (DPH), and the Director of the DPH as the administrators of the program.
- Requires that, in determining which students receive services under the program, local educational agencies prioritize children who have been exposed to childhood trauma, including students in foster care and students who are homeless.
- Includes, as services which may be funded under the program, evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
- Establishes the School-Based Early Mental Health Intervention and Prevention Services Support Program, administered by the DPH, in consultation with the Superintendent of Public Instruction (SPI), the Director of Health Care Services, and the Attorney General to encourage and support local decisions to provide funding for the eligible support services.
- Requires the DPH to provide outreach to local education agencies (LEAs) and county mental health agencies to inform them of the program.
- Requires the DPH to provide free regional training on eligible support services, including individual and group intervention and prevention services, parent engagement, teacher and staff conferences and training, referral to outside resources, use of trained and supervised paraprofessional staff, and other services to improve student mental health, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
- Requires the DPH to also provide free regional training on:
- The potential for the support services to help fulfill state priorities described by the local control funding formula (LCFF) and local control and accountability plans (LCAPs)
- How educational, mental health, and other funds subject to local control can be used to finance the eligible support services
- External resources available to support the eligible support services, including workshops, training, conferences, and peer learning networks
- State resources available to support student mental health and positive, trauma-informed learning environments
- Requires DPH to provide technical assistance to LEAs, including assistance in designing programs, training staff; and conducting evaluations; coordination with county mental health agencies and professionals; and leveraging local funds.
- Requires the DPH to select and support schoolsites as follows:
- Requires, during the first 12 months of the program, the DPH to support, strengthen, and expand the provision of eligible services at schoolsites that previously received funding for EMHI and have continued to provide eligible support services
- Requires the DPH to develop a process to identify schoolsites that demonstrate the willingness and capacity to participate in the program
- Requires the DPH, during the subsequent 36 months of the program, to select new schoolsites that are not providing eligible support services but that demonstrate the willingness and capacity to participate in the program. Requires the DPH to work with these schoolsites to deliver eligible support services
- Requires the DPH to prioritize school sites in communities that have experienced high levels of childhood adversity, such as adverse childhood experiences and childhood trauma, and schoolsites that prioritize children who have been exposed to childhood trauma, such as students in foster care and those who are homeless. Also prioritizes geographic diversity, program effectiveness, program efficiency, and long-term sustainability.
- Requires the DPH to submit an interim report to the Legislature at the end of the second year of the program, and to submit an evaluation at the end of the four year pilot and submit it to the Legislature.
- States that implementation of the support program is contingent upon an appropriation in the annual budget act, and sunsets the support program on January 1, 2022.
FISCAL EFFECT: According to the Assembly Appropriations Committee:
1) General Fund administrative costs to the Department of Public Health (DPH) of approximately $300,000 to oversee the program, provide outreach, free regional training, and technical assistance to school sites over four years. DPH would also incur costs related to interim reporting requirements and final evaluation of program.
2) Proposition 98 General Fund (GF) cost pressure, in the millions of dollars, to fund grants pursuant to the HEAL Trauma in Schools Act. Grants are contingent upon an appropriation in the annual budget act. The Assembly Budget proposes $6 million GF for this program.
COMMENTS:
Need for the bill. The author states: "For 20 years, the EMHI Matching Grant Program was a highly successful state program that provided matching grants to local education agencies to provide school-based mental health supports to young pupils experiencing mild to moderate school adjustment difficulties. EMHI supported Primary Intervention Programs consisting of one-on-one services or services delivered in small groups to address social skills, anger management, friendship groups, or topic-specific issues such as bullying or divorce; and indirect services such as parent and teacher services and classroom curricula.
"The EMHI Matching Grant Program served over 15,000 children per year and its services were in great demand. Despite its success and the demand for services, the program was defunded in 2012. Additionally, with the dissolution of the Department of Mental Health, its oversight and agency was eliminated, effectively ending the program.
"Studies such as the Centers for Disease Control's Adverse Childhood Experiences (ACE) study indicate that childhood exposure to abuse, neglect, and other traumatic experiences has lifelong health impacts. Left unaddressed, ACEs expose children to toxic stress, keeping them in a constant state of fight-or-flight and taking years off their lives and damaging their health. I believe that restoring and expanding the EMHI Program is a significant step towards addressing the harmful and long-lasting effects of ACEs, and will give our children a better shot at success."
EMHI program history and outcomes. In 1981 the Legislature created the Primary Prevention Project, now named the Primary Intervention Program, and in 1991 created the School-based Early Mental Health Intervention and Prevention Services for Children Program (EMHI).
From 1992 to 2012, the Department of Mental Health awarded matching grants to LEAs to fund prevention and early intervention programs, including EMHI. In the 2011–12 fiscal year, the EMHI received $15 million in state funds, and there was significant unmet demand for services. At its peak, there were 15,823 students receiving EMHI-funded services. Funding for the program was eliminated in 2012. It is now a local decision whether to continue this program without state matching grant support.
According to the author, the legislation authorizing this program set a target of at least 75% of the participating children showing an improvement in at least one of the following four areas: learning behaviors, attendance, school adjustment, and school-related competencies. A 2010-11 evaluation showed that 79% had met that target.
When state funding for this program was eliminated, LEAs could continue the program using local resources, and limited evidence suggests that some have continued to operate programs using a range of funding, from federal Title I funds to county mental health funding, to local general purpose funds.
The Adverse Childhood Experiences study and trauma-informed practices. The Adverse Childhood Experiences (ACE) study is a landmark investigation into associations between childhood maltreatment and later-life health and well-being. The ACE study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego.
The ACE study uses a score to represent the degree to which a person has experienced traumatic events. One point is recorded for each type of trauma exposure in the areas of abuse, neglect, and household dysfunction, and the points add up to a score ranging from 0 to 10. The higher an ACE score, the greater one's risk of a broad range of health, mental health, and at-risk behaviors.
The ACE Study has shown that adverse childhood experiences are major risk factors for the leading causes of illness and death, as well as poor quality of life. Related research has also demonstrated a strong association between high ACE scores and poor performance in school, including a higher risk of learning and behavior problems. Other research into the effects of chronic stress (often caused by ACEs) on children, has identified a profound effect on the developing brain, which in turn affects school performance and behavior.
Recognition of the impact of these childhood experiences has led to the development and increasing use of "trauma-informed" approaches in a variety of fields, including education. Broadly speaking, trauma-informed practices in schools are those which involve 1) a realization of the widespread prevalence and impact of trauma, 2) recognition of signs of traumatic exposure, 3) responses grounded in evidence-based practices, and 4) resisting the re-traumatization of students [definition from the federal Substance Abuse and Mental Health Agency (SAMHSA)]. Examples of such practices in schools include professional development for educators on the role of trauma in learning, classroom management practices and discipline policies focused on conflict resolution and restorative practices, and even instructional modifications which address the specific learning needs of students exposed to trauma.
Analysis Prepared by: Tanya Lieberman / ED. / (916) 319-2087 FN: 0003353
Date of Hearing: April 20, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
ABPCA Bill Id:AB 1644
Author:(Bonta) – As Amended Ver:April 14, 2016
Policy Committee: | Education | Vote: | 7 - 0 |
Health | 18-0 | ||
|
|
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill recasts and renames the Early Mental Health Initiative (EMHI) as the HEAL Trauma in Schools Act, expands the program to serve preschool and transitional Kindergarten students, and establishes the program for four years to provide outreach, free regional training, and technical assistance for local educational agencies (LEAs) providing mental health services at school sites. Specifically, this bill:
- Requires the Department of Public Health (DPH), in consultation with the Superintendent of Public Instruction (SPI), the Director of Health Care Services, and the Attorney General to encourage and support local decisions to provide funding for eligible support services.
- Requires LEAs to prioritize children who have been exposed to childhood trauma, including students in foster care and those who are homeless, when determining which students receive services under the program.
- Requires DPH to inform LEAs and county mental health agencies of the program and provide free regional training to LEAs including: intervention and prevention services, parent involvement, teacher and staff conferences and training, referral to outside resources, and use of paraprofessional staff, counselors, and social workers.
- Requires DPH to provide technical assistance to assist in designing programs, training staff, conducting evaluations, and leveraging funds that are subject to local control.
- Requires DPH to prioritize training and technical assistance as follows:
- During the first 12 months of the program, provide support services at schoolsites that previously received funding pursuant to the HEAL Trauma in Schools Act that demonstrate the willingness and capacity to participate in the program.
- During the subsequent 36 months of the program, select new schoolsites that are not providing eligible support services but that demonstrate the willingness and capacity to participate in the program.
- Requires DPH to submit an interim report to the Legislature at the end of the second year of the program that details support provided to schoolsites and includes an assessment of the demand and impact of funding for the HEAL Trauma in Schools Act.
- Requires DPH to develop an evaluation plan to assess the impact of the program and submit a report to the Legislature at the end of the four-year period to evaluate the impact of the program and provide recommendations for further implementation.
- Makes implementation of the HEAL Trauma in Schools Act contingent upon an appropriation in the annual budget act.
- Sunsets the program on January 1, 2022.
FISCAL EFFECT:
- General Fund administrative costs to the Department of Public Health (DPH) of approximately $300,000 to oversee the program, provide outreach, free regional training, and technical assistance to school sites over four years. DPH will also incur costs related to interim reporting requirements and final evaluation of program.
- Proposition 98 General Fund cost pressure, likely in the millions of dollars, to fund grants pursuant to the HEAL Trauma in Schools Act. This bill specifies the program is contingent upon an appropriation in the annual budget act. Costs to administer program will depend upon the size and scope of the grants. In prior years the state provided $15 million (Proposition 98/GF) to support a substantially similar program, Early Mental Health Initiative (EMHI).
COMMENTS:
- Background. Between 1991 and 2011, the state Department of Mental Health (DMH) operated the Early Mental Health Initiative (EMHI). Beginning with the 1997-98 fiscal year, the state provided $15 million (Proposition 98/GF) in matching grant funds to approximately 150 programs. Funds were primarily used to hire trained paraprofessionals (aides) to meet with children identified as needing support services. Aides generally meet with each child, or group of children, for 30 to 40 minutes, once a week to play games, draw or talk. Small group settings also allow children to develop skills such as making friends and resolving conflicts.
In 2012, DMH was eliminated and programs under the department's jurisdiction were transferred to the Department of Health Care Services. In the same year, Governor Brown redirected Proposition 98 funds to local education agencies. The following year the state created the Local Control Funding Formula (LCFF) and eliminated approximately three quarters of all K-12 categorical programs, representing a significant shift away from state control and toward local decision-making.
The author is proposing to reinstate the components of the EMHI program, renaming it the HEAL Trauma in Schools Act, and expands the program to support students from preschool to third grade.
- Technical amendment. The bill gives priority for outreach and assistance to schools that previously received funding under the HEAL Trauma in Schools Act. This bill establishes the HEAL Trauma in Schools Act. The author intended for priority to go to prior EMHI grantees. Staff recommends a technical amendment to clarify prior EHMI grantees receive first priority for assistance.
- Prior related legislation. AB 1133 (Achadjian) of this Session would have established a program substantially similar to the one proposed by this bill. It would have established a four year pilot program, the School-Based Early Mental Health Intervention and Prevention Services Support Program, to provide outreach, free regional training, and technical assistance for LEAs in providing mental health services at school sites. This bill was held on the Suspense file in this committee.
Analysis Prepared by: Misty Feusahrens / APPR. / (916) 319-2081
Date of Hearing: April 12, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 1644
Author:(Bonta) – As Amended Ver:March 8, 2016
SUBJECT: School-based early mental health intervention and prevention services.
SUMMARY: Reestablishes and renames the Early Mental Health Initiative (EMHI) as the Healing from Early Adversity to Level the Impact of Trauma in Schools Act, expands the program to serve preschool and transitional Kindergarten students, and establishes an initiative to encourage and support local decisions to provide funding for services offered in that program. Specifically, this bill:
- Makes findings and declarations regarding the importance preventing and addressing Adverse Childhood Experiences (ACEs) and childhood trauma.
- Establishes the School-Based Early Mental Health Intervention and Prevention Services Support Program, administered by the Department of Public Health (DPH), in consultation with the Superintendent of Public Instruction (SPI), the Director of Health Care Services, and the Attorney General to encourage and support local decisions to provide funding for eligible support services.
- Expands the definition of eligible pupils to include preschool and transitional Kindergarten students, and extends program eligibility to charter schools and preschool programs not operated on school sites.
- Names DPH and the Director of the DPH as the administrators of the program.
- Requires that, in determining which students receive services under the program, local educational agencies (LEAs) prioritize children who have been exposed to childhood trauma, including students in foster care and those who are homeless.
- Includes, as services which may be funded under the program, evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
- Requires DPH to provide outreach to LEAs and county mental health agencies to inform them of the program.
- Requires DPH to provide free regional training on eligible support services, including individual and group intervention and prevention services, parent engagement, teacher and staff conferences and training, referral to outside resources, use of trained and supervised paraprofessional staff, and other services to improve student mental health, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
- Requires DPH to provide free regional training on:
- The potential for the support services to help fulfill state priorities described by the local control funding formula (LCFF) and local control and accountability plans (LCAPs)
- How educational, mental health, and other funds subject to local control can be used to finance the eligible support services;
- External resources available to support the eligible support services, including workshops, training, conferences, and peer learning networks; and,
- State resources available to support student mental health and positive, trauma-informed learning environments.
- Requires DPH to provide technical assistance to LEAs, including assistance in designing programs, training staff; and conducting evaluations; coordination with county mental health agencies and professionals; and leveraging local funds.
- Requires DPH to select and support schoolsites as follows:
- During the first 12 months of the program, DPH to support, strengthen, and expand the provision of eligible services at schoolsites that previously received funding for EMHI and have continued to provide eligible support services;
- DPH to develop a process to identify schoolsites that demonstrate the willingness and capacity to participate in the program; and,
- DPH, during the subsequent 36 months of the program, to select new schoolsites that are not providing eligible support services but that demonstrate the willingness and capacity to participate in the program. Requires the DPH to work with these schoolsites to deliver eligible support services.
- Requires DPH to prioritize school sites in communities that have experienced high levels of childhood adversity, such as adverse childhood experiences and childhood trauma, and schoolsites that prioritize children who have been exposed to childhood trauma, such as students in foster care and those who are homeless. Requires to DPH prioritize geographic diversity, program effectiveness, program efficiency, and long-term program sustainability.
- States that implementation of the support program is contingent upon an appropriation in the annual budget act.
- Sunsets the program on January 1, 2022.
EXISTING LAW:
- Establishes the School-based EMHI Services for Children Act of 1991, and authorizes DHCS, in consultation with the SPI, to provide matching grants to LEAs to pay the state share of the costs of providing school-based EMHI services to eligible students, subject to the availability of funding each year.
- Provides for the Medi-Cal program, administered by DHCS, under which eligible low-income individuals receive health care services subject to state and federal laws and funding.
- Establishes the Medi-Cal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program for eligible individuals up to age 21 pursuant to state and federal law.
- Defines a LEA as a school district, a county office of education, a nonprofit charter school participating as a member of a special education local plan area, or a special education local plan area and allows LEAs to provide and bill for Medi-Cal services provided to students receiving special education services on Medi-Cal (generally, special education students).
- Establishes the Mental Health Services Act, enacted by voters in 2004 as Proposition 63, to provide funds to counties to expand services, develop innovative programs, and integrated service plans for mentally ill children, adults, and seniors through a 1% income tax on personal income above $1 million.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, for 20 years, the EMHI Matching Grant Program was a highly successful state program that provided matching grants to LEAs agencies to provide school-based mental health support to young pupils experiencing mild to moderate school adjustment difficulties. EMHI supported Primary Intervention Programs consisting of one-on-one services or services delivered in small groups to address social skills, anger management, friendship groups, or topic-specific issues such as bullying or divorce; and, indirect services such as parent and teacher services and classroom curricula.
The author states that EMHI Matching Grant Program served over 15,000 children per year and its services were in great demand. Despite its success and the demand for services, the program was defunded in 2012. Additionally, with the dissolution of the Department of Mental Health, its oversight and agency was eliminated, effectively ending the program.
The Centers for Disease Control’s (CDC) Adverse Childhood Experiences (ACE) study indicates that childhood exposure to abuse, neglect, and other traumatic experiences has lifelong health impacts. Left unaddressed, ACEs expose children to toxic stress, keeping them in a constant state of fight-or-flight and taking years off their lives and damaging their health. The author concludes that restoring and expanding the EMHI Program is a significant step towards addressing the harmful and long-lasting effects of ACEs, and will give children a better shot at success.
- BACKGROUND.
- K-12 Mental Health Services. There are a number of different funding mechanisms currently available for school districts and LEAs to provide health care services to pupils, as discussed in more detail below. Between 1991 and 2011, the state Department of Mental Health (DMH) also operated a previous version of the EMHI, which provided schools with approximately $15 million annually to serve children in kindergarten through third grade with mild and moderate mental health problems. With the transfer of responsibilities from the DMH to DHCS in 2012, this program was shifted to local education departments. Many counties also fund on-campus mental health services for non–special education students through EPSDT and Mental Health Services Act-funded early prevention programs.
Schools are the main providers of mental health services for children in California. The federal Individuals with Disabilities Education Act (IDEA) was adopted in 1975 to guarantee children with disabilities a right to public education in the least restrictive setting. In California, the federal IDEA mandate to provide special education services is administered by local school districts and local education agencies. Special education students may be eligible for health care services, including mental health services, in specific IDEA disability categories. Mental health services provided to special education students include counseling and guidance, psychological services, parental counseling and training, and residential placement, among others. While federal law requires mental health services to be provided to students who have been identified for special education services, there are little to no services available to the general student population.
- County Mental Health Plans (MHPs). Prior to 2011, special education students who had a severe emotional disturbance condition documented in their individual education plans (IEPs) were referred by their schools to county mental health agencies for treatment. In 2011, the Legislature repealed the state mandate on county mental health agencies to provide IDEA-related mental health services and shifted this financial responsibility to the California Department of Education (CDE). LEAs and local county MHPs were required to develop new agreements defining agency responsibilities that reflected the changes in state law. MHPs remain responsible for providing EPSDT services for students who are Medi-Cal beneficiaries with IDEA-related individualized education, if they meet medical necessity criteria.
AB 114 (Committee on Budget), Chapter 43, Statutes of 2011, transferred the responsibility for providing mental health services for students with individualized education programs (IEPs) from county mental health departments to LEAs. A 2016 state audit on the effect of AB 114 on mental health services for these students reported, among other findings:
- Although the most common types of mental health services offered and the service providers generally did not change, LEAs removed mental health services from student IEPs in the two years after AB 114 took effect;
- Although most service reductions were not related to AB 114, such as those prompted by a student graduating, IEP teams did not always record in the IEP document their rationale of why a service was removed;
- For 40% of the students who had a change to their mental health services or their educational placement within two years of AB 114’s implementation, the IEP teams did not document the rationale for the changes; and,
- For 13 of the 44 students reviewed who had a mental health service removed from their IEPs, either the LEAs could not satisfactorily explain why the services were removed or the removal was related to AB 114. In three cases, the LEA had no assurance that removing services would not adversely affect access to education.
- EPSDT. EPSDT is a federally mandated Medi-Cal benefit for individuals up to the age of 21 who have full-scope Medi-Cal eligibility. This benefit allows for periodic screenings to determine health care needs and based upon the identified health care need and diagnosis, treatment services are provided. EPSDT services include all services otherwise covered by Medi-Cal and EPSDT beneficiaries can receive additional medically necessary services. EPSDT mental health services are Medi-Cal services that correct or improve mental health problems that have been determined by a physician, psychologist, counselor, social worker, or other health or social services provider. EPSDT provides eligible children access to a range of mental health services that include, but are not limited to mental health assessment, collateral contracts, therapy, rehabilitation, mental health services, medication support services, day rehabilitation, day treatment intensive, crisis intervention and stabilization, targeted case management, and therapeutic behavioral services.
- The Adverse Childhood Experiences Study. The ACE study is a landmark investigation into associations between childhood maltreatment and later-life health and well-being. The ACE study is a collaboration between the CDC and Kaiser Permanente's Health Appraisal Clinic in San Diego.
The ACE study uses a score to represent the degree to which a person has experienced traumatic events. One point is recorded for each type of trauma exposure in the areas of abuse, neglect, and household dysfunction, and the points add up to a score ranging from 0 to 10. The higher an ACE score, the greater one’s risk of a broad range of health, mental health, and at-risk behaviors.
The ACE Study has shown that ACEs are major risk factors for the leading causes of illness and death, as well as poor quality of life. Related research has also demonstrated a strong association between high ACE scores and poor performance in school, including a higher risk of learning and behavior problems. Other research into the effects of chronic stress (often caused by ACEs) on children, has identified a profound effect on the developing brain, which in turn affects school performance and behavior.
Recognition of the impact of these childhood experiences has led to the development and increasing use of “trauma-informed” approaches in a variety of fields, including education. Broadly speaking, trauma-informed practices in schools are those which involve: i) a realization of the widespread prevalence and impact of trauma; ii) recognition of signs of traumatic exposure; iii) responses grounded in evidence-based practices; and, iv) resisting the re-traumatization of students [definition from the federal Substance Abuse and Mental Health Agency]. Examples of such practices in schools include professional development for educators on the role of trauma in learning, classroom management practices and discipline policies focused on conflict resolution and restorative practices, and even instructional modifications which address the specific learning needs of students exposed to trauma.
Trauma-informed practices are specifically cited in the new federal education law, the Every Student Succeeds Act (ESSA). Several provisions of the law reference staff development “based on trauma-informed practices that are evidence-based…” and “effective and trauma-informed practices in classroom management.”
- SUPPORT. Children Now and Time for Kids, sponsors of this bill, state that state that the rationale for creating the EMHI program in 1991 still resonates today: “It is in California’s best interest, both in economic and human terms, to identify and treat minor difficulties that our children are experiencing before those difficulties become major barriers to later success.” For 20 years, the EMHI Matching Grant Program was the solution: a highly successful program that provided matching grants to LEAs to provide school-based mental health supports to young pupils experiencing mild to moderate school adjustment difficulties such as isolation, anxiety, and bullying.
The California Medical Association and others state in support that this bill would build on the success of the EMHI program by authorizing the provision of non-financial supports to help LEAs maximize the use of funds that are under local control for EMHI programs. The proposed program would benefit young children from preschool through third grade with evidence-based and developmentally appropriate services and be both cost effective and consistent with the principles of local control.
The Steinberg Institute and Autism Deserves Equal Coverage, state in support that this measure would create a prevention and early intervention pilot program to help students from preschool to third grade through the delivery of EMHI services, which have a long track record of success in California. - RELATED LEGISLATION. SB 463 (Hancock) of 2015 requires the CDE to designate a county office of education to be the fiduciary agent for the Safe and Supportive Schools Train the Trainer Program. SB 463 is pending in the Assembly Education Committee.
- PREVIOUS LEGISLATION.
- AB 1133 (Achadjian) of 2015 would have established a program substantially similar to the one proposed by this bill. Would have established a four year pilot program, the School-Based Early Mental Health Intervention and Prevention Services Support Program, to provide outreach, free regional training, and technical assistance for LEAs in providing mental health services at school sites. AB 1133 was held in the Assembly Appropriations Committee.
- AB 1025 (Thurmond) of 2015 would have required the CDE to establish a three year pilot program to encourage inclusive practices that integrate mental health, special education, and school climate interventions following a multitiered framework. AB 1025 was held in the Senate Appropriations Committee.
- AB 114 (Committee on Budget), Chapter 43, Statutes of 2011, a companion measure to the 2011-12 Budget bill, relieved county mental health departments of the responsibility to provide mental health services to students with disabilities (AB 3632 program) and transferred that responsibility to school districts.
- AB 104 (Committee on Budget), Chapter 13, Statutes of 2015, among other things, appropriates $10 million to the SPI to be apportioned to a designated county office of education to provide technical assistance and develop statewide resources to assist local educational agencies to establish and align systems of learning and behavioral supports.
- DOUBLE REFERRAL. This bill was double referred to the Assembly Education Committee, where it passed unanimously.
REGISTERED SUPPORT / OPPOSITION:
Support
California Attorney General Kamala D. Harris (sponsor)
Children Now (sponsor)
Time for Kids, Inc. (sponsor)
Abriendo Puertas/Opening Doors
Alameda Unified School District, Woodstock Child Development Center
Alliance for Education Solutions
American Academy of Pediatrics
Amethod Public Schools
BANANAS
Bay Area Urban Debate League
Beats Rhymes and Life
Bicycle Coffee
Brighter Beginnings
California Alliance of Child and Family Services
California Black Health Network
California Center for Public Health Advocacy
California Children's Hospital Association
California Council of Community Mental Health Agencies
California Medical Association
California Pan-Ethnic Health Network
California School Nurses Organization
California School-Based Health Alliance
California State PTA
Californians for Safety and Justice
Center for Community Health and Engagement
Center for Leadership, Equity, and Research
Center for Youth Wellness
Center Joint Unified School District
Chico Unified School District
Childhood Injury Prevention Network
Children’s Hospital & Research Center Oakland
Children’s Specialty Care Coalition
Children's Defense Fund-California
Children's Partnership
Common Sense Kids Action
Early Edge California
East Bay Agency for Children
East Bay Asian Youth Center
Family Voices of California
Fight Crime: Invest in Kids California
First Place for Youth
Folsom Cordova Unified School District
Full Court Press Communications
Futures Without Violence
Girls Leadership Institute
Human Impact Partners
Inland Congregations United for Change
Lemonade Creative Consulting
Liberty School District
Los Angeles County Office of Education
Los Angeles Trust for Children's Health
Lucile Packard Children's Hospital Stanford
Mental Health America of California
Mental Health and Autism Insurance Project
Mental Health Association of California
Montclair Physical Therapy
National Alliance on Mental Illness California
National Association of Social Workers, California Chapter
Nonprofit Communications
Nurse-Family Partnership
Oakland City Council
Oakland Natives Give Back
Playworks
Public Counsel
Rape Counseling Services of Fresno
Regional Asthma Management and Prevention
Resource Development Associates
Sacramento Area Congregations Together
Santa Clara County Board of Supervisors
Santa Cruz City Schools
Street Level Health Project
The Children's Partnership
The MADE
ThriveSF Fitness
Time for Kids, Inc.
United Ways of California
Violence Prevention Coalition of Greater Los Angeles
Waugh School District
Wellness Together
Western Center on Law and Poverty
Young People's Policy Solutions
Youth UpRising
Numerous individuals
Opposition
None on file.
Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097
Date of Hearing: April 6, 2016
ASSEMBLY COMMITTEE ON EDUCATION
Patrick O'Donnell, Chair
ABPCA Bill Id:AB 1644 (
Author:Bonta) – As Amended Ver:March 8, 2016
[Note: This bill is doubled referred to the Assembly Health Committee and will be heard by that Committee as it relates to issues under its jurisdiction.]
SUBJECT: School-based early mental health intervention and prevention services
SUMMARY: Recasts and renames the Early Mental Health Initiative (EMHI) as the HEAL Trauma in Schools Act, expands the program to serve preschool and transitional Kindergarten students, and establishes an initiative to encourage and support local decisions to provide funding for services offered in that program.
Specifically, this bill:
- Makes findings and declarations regarding the importance preventing and addressing Adverse Childhood Experiences (ACEs) and childhood trauma.
- Renames the EMHI as the Healing from Early Adversity to Level the impact of Trauma in Schools Act or the HEAL Trauma in Schools Act.
- Expands the definition of eligible pupils to include preschool and transitional Kindergarten students, and extends the program to charter schools.
- Names the Department of Public Health (DPH), and the Director of the DPH as the administrators of the program.
- Requires that, in determining which students receive services under the program, local educational agencies prioritize children who have been exposed to childhood trauma, including students in foster care and students who are homeless.
- Includes, as services which may be funded under the program, evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
- Establishes the School-Based Early Mental Health Intervention and Prevention Services Support Program, administered by the DPH, in consultation with the Superintendent of Public Instruction (SPI), the Director of Health Care Services, and the Attorney General to encourage and support local decisions to provide funding for the eligible support services.
- Requires the DPH to provide outreach to local education agencies (LEAs) and county mental health agencies to inform them of the program.
- Requires the DPH to provide free regional training on eligible support services, including individual and group intervention and prevention services, parent engagement, teacher and staff conferences and training, referral to outside resources, use of trained and supervised paraprofessional staff, and other services to improve student mental health, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
- Requires the DPH to also provide free regional training on:
- the potential for the support services to help fulfill state priorities described by the local control funding formula (LCFF) and local control and accountability plans (LCAPs)
- how educational, mental health, and other funds subject to local control can be used to finance the eligible support services
- external resources available to support the eligible support services, including workshops, training, conferences, and peer learning networks
- state resources available to support student mental health and positive, trauma-informed learning environments
- Requires DPH to provide technical assistance to LEAs, including assistance in designing programs, training staff; and conducting evaluations; coordination with county mental health agencies and professionals; and leveraging local funds.
- Requires the DPH to select and support schoolsites as follows:
- requires, during the first 12 months of the program, the DPH to support, strengthen, and expand the provision of eligible services at schoolsites that previously received funding for EMHI and have continued to provide eligible support services
- requires the DPH to develop a process to identify schoolsites that demonstrate the willingness and capacity to participate in the program
- requires the DPH, during the subsequent 36 months of the program, to select new schoolsites that are not providing eligible support services but that demonstrate the willingness and capacity to participate in the program. Requires the DPH to work with these schoolsites to deliver eligible support services
- Requires the DPH to prioritize school sites in communities that have experienced high levels of childhood adversity, such as adverse childhood experiences and childhood trauma, and schoolsites that prioritize children who have been exposed to childhood trauma, such as students in foster care and those who are homeless. Also requires that DPH prioritize geographic diversity, program effectiveness, program efficiency, and long-term program sustainability.
- Requires the DPH to submit an interim report to the Legislature at the end of the second year of the program, and to submit an evaluation at the end of the four year pilot and submit it to the Legislature.
- States that implementation of the support program is contingent upon an appropriation in the annual budget act.
- Sunsets the support program on January 1, 2022.
EXISTING LAW:
- Establishes the School-based Early Mental Health Intervention and Prevention Services for Children Act of 1991, and authorizes the Director of the Department of Health Care Services, in consultation with the SPI, to provide matching grants to LEAs to pay the state share of the costs of providing school-based early mental health intervention and prevention services to eligible students, subject to the availability of funding each year.
- Defines “eligible pupil” for this purpose as a student who attends a publicly funded elementary school and who is in kindergarten or grades 1 to 3, inclusive. Existing law also defines “local educational agency” as a school district, county office of education, or a state special school.
- Establishes the Primary Intervention Program (PIP) a school-based program designed for the early detection and prevention of emotional, behavioral, and learning problems in primary grade children with services provided by child aides or unpaid volunteers under the supervision of mental health professionals.
FISCAL EFFECT: Unknown
COMMENTS:
Need for the bill. The author states: “For 20 years, the EMHI Matching Grant Program was a highly successful state program that provided matching grants to local education agencies to provide school-based mental health supports to young pupils experiencing mild to moderate school adjustment difficulties. EMHI supported Primary Intervention Programs consisting of one-on-one services or services delivered in small groups to address social skills, anger management, friendship groups, or topic-specific issues such as bullying or divorce; and indirect services such as parent and teacher services and classroom curricula.
The EMHI Matching Grant Program served over 15,000 children per year and its services were in great demand. Despite its success and the demand for services, the program was defunded in 2012. Additionally, with the dissolution of the Department of Mental Health, its oversight and agency was eliminated, effectively ending the program.
Studies such as the Centers for Disease Control’s Adverse Childhood Experiences (ACE) study indicate that childhood exposure to abuse, neglect, and other traumatic experiences has lifelong health impacts. Left unaddressed, ACEs expose children to toxic stress, keeping them in a constant state of fight-or-flight and taking years off their lives and damaging their health. I believe that restoring and expanding the EMHI Program is a significant step towards addressing the harmful and long-lasting effects of ACEs, and will give our children a better shot at success.”
EMHI program history and outcomes. In 1981 the Legislature created the Primary Prevention Project, now named the Primary Intervention Program, and in 1991 created the School-based Early Mental Health Intervention and Prevention Services for Children Program, known as EMHI.
From 1992 to 2012, the Department of Mental Health awarded matching grants to LEAs to fund prevention and early intervention programs, including EMHI. In the 2011–12 fiscal year, the EMHI received $15 million in state funds, and there was significant unmet demand for services. At its peak, there were 15,823 students receiving EMHI-funded services. Funding for the program was eliminated in 2012. It is now a local decision whether to continue this program without state matching grant support.
According to the author, the legislation authorizing this program set a target of at least 75 percent of the participating children showing an improvement in at least one of the following four areas: learning behaviors, attendance, school adjustment, and school-related competencies. A 2010-11 evaluation showed that 79 percent had met that target.
When state funding for this program was eliminated, LEAs could continue the program using local resources, and limited evidence suggests that some have continued to operate programs using a range of funding, from federal Title I funds to county mental health funding, to local general purpose funds.
The Adverse Childhood Experiences study and trauma-informed practices. The Adverse Childhood Experiences (ACE) study is a landmark investigation into associations between childhood maltreatment and later-life health and well-being. The ACE study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego.
The ACE study uses a score to represent the degree to which a person has experienced traumatic events. One point is recorded for each type of trauma exposure in the areas of abuse, neglect, and household dysfunction, and the points add up to a score ranging from 0 to 10. The higher an ACE score, the greater one’s risk of a broad range of health, mental health, and at-risk behaviors.
The ACE Study has shown that adverse childhood experiences are major risk factors for the leading causes of illness and death, as well as poor quality of life. Related research has also demonstrated a strong association between high ACE scores and poor performance in school, including a higher risk of learning and behavior problems. Other research into the effects of chronic stress (often caused by ACEs) on children, has identified a profound effect on the developing brain, which in turn affects school performance and behavior.
Recognition of the impact of these childhood experiences has led to the development and increasing use of “trauma-informed” approaches in a variety of fields, including education. Broadly speaking, trauma-informed practices in schools are those which involve 1) a realization of the widespread prevalence and impact of trauma, 2) recognition of signs of traumatic exposure, 3) responses grounded in evidence-based practices, and 4) resisting the re-traumatization of students [definition from the federal Substance Abuse and Mental Health Agency (SAMHSA)]. Examples of such practices in schools include professional development for educators on the role of trauma in learning, classroom management practices and discipline policies focused on conflict resolution and restorative practices, and even instructional modifications which address the specific learning needs of students exposed to trauma.
Trauma-informed practices are specifically cited in the new federal education law, the Every Student Succeeds Act (ESSA). Several provisions of the law reference staff development “based on trauma-informed practices that are evidence-based…” and “effective and trauma-informed practices in classroom management.”
Supporting local decisions to implement a program in the era of local control. The Local Control Funding Formula (Chapter 47, Statutes of 2013), eliminated approximately three quarters of all K-12 categorical programs, and represented a significant shift away from state control and toward local decision-making. This bill aims to recast the EMHI program, and to encourage and support LEAs in administering the program if they determine, through local decision-making, that the program is a priority for the use of their resources. The Committee may wish to consider whether state promotion and support of a program is contrary to the principle of local control, or whether such support is necessary to assist LEAs in successfully initiating and maintaining complex programs, such as ones which require inter-agency collaboration. Significant lessons were learned in the design and operation of some categorical programs, and the Committee may further wish to consider the future role of state leadership in assisting LEAs in effectively administering programs which they have determined to be local priorities.
State audit on mental health services provided to students in special education. AB 114 (Chapter 43, Statutes of 2011), which took effect in July 2011, transferred the responsibility for providing mental health services for students with individualized education programs (IEPs) from county mental health departments to LEAs. A 2016 state audit on the effect of AB 114 on mental health services for these students reported, among other findings:
- Although the most common types of mental health services offered and the service providers generally did not change, LEAs removed mental health services from student IEPs in the two years after AB 114 took effect.
- Although most service reductions were not related to AB 114, such as those prompted by a student graduating, IEP teams did not always record in the IEP document their rationale of why a service was removed.
.
- For 40 percent of the students who had a change to their mental health services or their educational placement within two years of AB 114’s implementation, the IEP teams did not document the rationale for the changes.
- For 13 of the 44 students reviewed who had a mental health service removed from their IEPs, either the LEAs could not satisfactorily explain why the services were removed or the removal was related to AB 114. In three cases, the LEA had no assurance that removing services would not adversely affect access to education.
Student mental health initiatives. The CDE is engaged in a number of initiatives aimed at improving support for student mental health needs. Among them are: 1) a Student Mental Health Policy Workgroup established in 2012 to develop policy recommendations that promote early identification, referral, coordination, and access to quality mental health services for students, 2) the TETRIS-EBL project, a mental health training project funded by the California Mental Health Services Authority and administered through a contract with the Placer County Office of Education, and 3) a federally-funded "Now is the Time" project to provide support to three LEAs, and CDE training of school staff in a program called Youth Mental Health First Aid. In addition, since 2011 an initiative called the Regional K-12 Student Mental Health Initiative, operated through the California County Superintendents Educational Services Association, has provided training designed to build capacity and cross-system collaboration to develop and sustain school-based mental health programs addressing prevention and early identification strategies.
The new federal education act, ESSA, also appears to offer support for student mental health through a new grant program called Student Support and Academic Enrichment Grants, which may be used, among many other purposes, to “expand access to or coordinate resources for school-based counseling and mental health programs, such as through school-based mental health services partnership programs.” This and other provisions of ESSA are subject to appropriation.
Related legislation this Session. AB 1133 (Achadjian) of this Session would have established a program substantially similar to the one proposed by this bill. It would have established a four year pilot program, the School-Based Early Mental Health Intervention and Prevention Services Support Program, to provide outreach, free regional training, and technical assistance for LEAs in providing mental health services at school sites.
AB 1025 (Thurmond) of this Session, would require the CDE to establish a 3-year pilot program to encourage inclusive practices that integrate mental health, special education, and school climate interventions following a multitiered framework. AB 1025 was held in the Senate Appropriations Committee.
SB 463 (Hancock) of this Session requires the CDE to designate a county office of education to be the fiduciary agent for the Safe and Supportive Schools Train the Trainer Program. SB 463 is pending in the Assembly Education Committee.
AB 104 (Committee on Budget), Chapter 13, Statutes of 2015, among other things, appropriates $10 million to the SPI to be apportioned to a designated COE to provide technical assistance and develop statewide resources to assist local educational agencies to establish and align systems of learning and behavioral supports.
Technical amendments. Staff recommends the following technical and clarifying amendments:
- Broaden the reference to students enrolled in preschool programs to include those not operated on school sites.
- On page 10, line 3, delete the sentence beginning with “A minimum of 80 percent…”
- On page 12, change the Chapter title to “The HEAL Trauma in Schools Support Program.”
- On page 12, line 15, page 14, line 34, and 15, lines 4 and 7, strike the word “pilot.”
REGISTERED SUPPORT / OPPOSITION:
Support
California Attorney General Kamala D. Harris (sponsor)
Children Now (sponsor)
Time for Kids, Inc. (sponsor)
Abriendo Puertas/Opening Doors
Alameda Unified School District, Woodstock Child Development Center
Alliance for Education Solutions
American Academy of Pediatrics
Amethod Public Schools
BANANAS
Bay Area Urban Debate League
Beats Rhymes and Life
Bicycle Coffee
Brighter Beginnings
California Alliance of Child and Family Services
California Black Health Network
California Center for Public Health Advocacy
California Council of Community Mental Health Agencies
California Pan-Ethnic Health Network
California School Nurses Organization
California School-Based Health Alliance
California State PTA
Californians for Safety and Justice
Center for Leadership, Equity, and Research
Center for Youth Wellness
Center Joint Unified School District
Chico Unified School District
Children’s Specialty Care Coalition
Children's Defense Fund-California
Children's Partnership
Common Sense Kids Action
Early Edge California
East Bay Agency for Children
East Bay Asian Youth Center
Family Voices of California
Fight Crime: Invest in Kids California
First Place for Youth
Folsom Cordova Unified School District
Full Court Press Communications
Futures Without Violence
Girls Leadership Institute
Human Impact Partners
Inland Congregations United for Change
Lemonade Creative Consulting
Liberty School District
Los Angeles County Office of Education
Los Angeles Trust for Children's Health
Lucile Packard Children's Hospital Stanford
Mental Health America of California
Mental Health and Autism Insurance Project
Mental Health Association of California
Montclair Physical Therapy
National Alliance on Mental Illness California
National Association of Social Workers, California Chapter
Nonprofit Communications
Nurse-Family Partnership
Oakland City Council
Oakland Natives Give Back
Playworks
Public Counsel
Rape Counseling Services of Fresno
Regional Asthma Management and Prevention
Resource Development Associates
Sacramento Area Congregations Together
Santa Clara County Board of Supervisors
Santa Cruz City Schools
Street Level Health Project
The Children's Partnership
The MADE
ThriveSF Fitness
Time for Kids, Inc.
United Ways of California
Violence Prevention Coalition of Greater Los Angeles
Waugh School District
Wellness Together
Western Center on Law and Poverty
Young People's Policy Solutions
Youth UpRising
Numerous individuals
Opposition
California Right to Life Committee, Inc.
Analysis Prepared by: Tanya Lieberman / ED. / (916) 319-2087
Discussed in Hearing
1MIN
Assembly Floor
3MIN
Assembly Standing Committee on Health
9MIN
Assembly Standing Committee on Education
Bill Author
