Existing law requires the State Department of Public Health, in cooperation with the State Department of Education, to establish a Public School Health Center Support Program to assist health centers in schools and school districts. Existing law establishes a grant program within the Public School Health Center Support Program to provide technical assistance, assistance and funding for the expansion, renovation, and retrofitting of existing school health centers and the development of new school health centers. These provisions also provide funding for sustainability grants in amounts between $25,000 and $125,000. Existing law authorizes school health centers to provide physical, mental, and oral health assessments, screenings, and services.

This bill would rename the program the School-Based Health and Education Partnership Program. The bill would instead provide funding for the expansion and renovation of existing school health centers. The bill would change the amount of the sustainability grants that are available pursuant to the program to between $50,000 and $100,000, but would make those grants available on a one-time basis and would revise the purposes for which they may be used. The bill would also authorize population health grants in amounts between $50,000 and $125,000 for a funding period of up to 3 years, as specified. The bill would authorize school health centers to provide alcohol and substance abuse assessments, screening, and services.

Existing law requires the State Department of Public Health, in cooperation with the State Department of Education, to establish a Public School Health Center Support Program to assist health centers in schools and school districts. Existing law establishes a grant program within the Public School Health Center Support Program to provide technical assistance, and funding for the expansion, renovation, and retrofitting of existing school health centers and the development of new school health centers. These provisions also provide funding for sustainability grants in amounts between $25,000 and $125,000. Existing law authorizes school health centers to provide physical, mental, and oral health assessments, screenings, and services.

This bill would rename the program the School-Based Health and Education Partnership Program. The bill would instead provide funding for the expansion and renovation of existing school health centers. The bill would change the amount of the sustainability grants that are available pursuant to the program to between $50,000 and $100,000, but would make those grants available on a one-time basis and would revise the purposes for which they may be used. The bill would also authorize population health grants in amounts between $50,000 and $125,000 for a funding period of up to 3 years, as specified. The bill would authorize school health centers to provide alcohol and substance abuse assessments, screening, and services.

Existing law requires the State Department of Public Health, in cooperation with the State Department of Education, to establish a Public School Health Center Support Program to assist health centers in schools and school districts. Existing law establishes a grant program within the Public School Health Center Support Program to provide technical assistance, and funding for the expansion, renovation, and retrofitting of existing school health centers and the development of new school health centers. These provisions also provide funding for sustainability grants in amounts between $25,000 and $125,000.

This bill would rename the program the School-Based Health and Education Partnership Program. The bill would instead provide funding for the expansion and renovation of existing school health centers. The bill would change the amount of the sustainability grants that are available pursuant to the program to between $50,000 and $100,000, but would make those grants available on a one-time basis and would revise the purposes for which they may be used. The bill would also authorize population health grants in amounts between $50,000 and $125,000 for a funding period of up to 3 years, as specified.

Date of Hearing: August 19, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

SBPCA Bill Id:SB 118

Author:(Liu) – As Amended Ver:August 17, 2015

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill modifies an existing unfunded grant program administered by the California Department of Public Health (CDPH) to provide grants to schools. Specifically, this bill:

1. Adds substance abuse as an allowable service, updates terms, and modifies grant amounts.

2. Changes the purposes of "sustainability grants" from operating expenses to development of sustainable funding models.

3. Creates a new "population health grant" category to fund obesity prevention, asthma programs, and similar public health topics.

It also contains chaptering amendments for AB 766 (Ridley-Thomas), which amends the same code section.

FISCAL EFFECT:

Unknown cost pressure, exceeding $150,000 GF or other unknown fund source, to fund designated grants. The bill authorizes a new category of grants. The current program has been authorized in statute for eight years, but was never funded.

COMMENTS:

1. Purpose. This bill intends to update existing program parameters and definitions of an authorized grant program, creating a stronger framework upon which schools may expand and seek additional resources to fund their school-based health centers.

2. School-based Health Centers (SBHCs). There are approximately 200 SBHCs in California, many of them operating in schools with a high share of low-income students. SBHCs are administered by a variety of organizations, including school districts, community clinics, counties, hospitals, and private physician groups. They are financed through school funding; grants from state, local, and private sources; as well as reimbursements from public programs and some private insurance. An existing partnership between the California Department of Education and CDPH related to school-based health, of which the unfunded grant program was a component, was also suspended in 2013 due to loss of funding.

3. Related Legislation. AB 766 (Ridley-Thomas) expands the characteristics of schools that receive preference in the awarding of grant funds from the program that is the subject of this bill. That bill is pending in the Senate Appropriations Committee.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: July 15, 2015

ASSEMBLY COMMITTEE ON EDUCATION

Patrick O'Donnell, Chair

SBPCA Bill Id:SB 118

Author:(Liu) – As Amended Ver:April 7, 2015

[This bill was double referred to the Assembly Health Committee and was heard as it relates to that committee's jurisdiction.]

SENATE VOTE: 38-1

SUBJECT: School-Based Health and Education Partnership Program.

SUMMARY: Renames the "Public School Health Center Support Program" as the "School-Based Health and Education Partnership Program;" changes funding amounts for the grants; and, specifies that school health centers can provide alcohol and substance abuse prevention information and services. Specifically, this bill:

1. Specifies that sustainability grants shall be available on a one-time basis in amounts between fifty thousand dollars and one hundred thousand dollars for the purpose of developing new and leveraging existing funding streams to support a sustainable funding model for school health centers.

2. Specifies population health grants shall be available in amounts between fifty thousand dollars and one hundred twenty-five thousand dollars for a funding period of up to three years to fund interventions to implement population health outcomes and target specific health or education risk factors including, but not limited to, obesity prevention programs, asthma prevention programs, early intervention for mental health, and alcohol and substance abuse prevention.

3. Makes the following Legislative findings and declarations:

   1. School health centers can be integral to providing the entire school community with prevention and health integration services by working collaboratively with school staff and administrators to meet the spectrum of health and prevention needs in a school community.

   2. The federal Patient Protection and Affordable Care Act contains provisions that recognize the importance of  school health centers in the delivery of quality, affordable health care and that would call for their expansion. Under the health care reform, California is developing new strategies to increase access to health care and reduce health care costs through investing in prevention services. School health centers are important sites through which to increase child and adolescent access to health care services and early identification of chronic diseases, such as asthma or obesity, and high-risk behaviors, such as mental health disorders, substance abuse, and teen pregnancy, that significantly impact health care costs later in life. 

   3. Through education finance reform, California has increased accountability strategies for local educational agencies that highlight the need for schools to address important health-related indicators, such as chronic absenteeism.

   4. School-based health centers serve as an effective foundation upon which schools and communities can build and implement a community schools strategy providing a range of wrap-around services to students and their families.

EXISTING LAW:

1. Requires the Department of Public Health to establish the Public School Health Center Support Program, in cooperation with the California Department of Education, to perform specified functions relating to the establishment, retention, or expansion of school health centers in California. (Health & Safety Code (HSC) 124174.2)
   
   

2. Defines “school health center” as a center or program, located at or near a school, that provides age-appropriate health care services at the program site or through referrals. Authorizes a school health center to conduct routine physical, mental health, and oral health assessments, and provide referrals for any services not offered onsite. (HSC 124174)
   
   

3. Establishes a grant program administered by the Department of Public Health to provide technical assistance and funding to school health centers, to the extent funds are appropriated for this purpose.

1. Planning grants in amounts between $25,000-$50,000.

2. Facilities and startup grants in amounts between $20,000-$250,000

3. Sustainability grants in amounts between $25,000-$125,000. (HSC 124174.6)
   
   

1. Requires school health centers that receive a grant to meet or have a plan to meet the following requirements:
   
   

   1. Strive to provide a comprehensive set of services including medical, oral health, mental health, health education, and related services in response to community needs.

2. Provide primary and other health care services, provided or supervised by a licensed professional, which may include physical exams, diagnosis and treatment of minor injuries and medical conditions, management of chronic medical conditions, referrals and follow-up for specialty care, reproductive health services, mental health services as specified, and oral health services.

3. Work in partnership with the school nurse, as specified.

4. Have a written contract or memorandum of understanding between the school district and the health care provider or other community provider.

5. Serve all students regardless of ability to pay.

6. Be open during all normal school hours, as specified.

7. Establish protocols for referring students to outside services when the school health center is closed.

8. Facilitate transportation, as specified. (HSC 124174.6)

FISCAL EFFECT: According to the Senate Appropriations Committee, unknown costs to provide additional grants (General Fund or other, unknown fund source). The bill authorizes a new category of grants that may be issued to schools with school health centers for interventions such as obesity prevention or mental health prevention. The bill does not identify a source of funds for these new grants. The current program has been authorized in statute for eight years, but has never been funded.

COMMENTS: This bill changes the name of the "Public School Health Center Support Program" to the "School-Based Health and Education Partnership Program;" changes funding amounts for the grants; and, specifies that school health centers can provide alcohol and substance abuse prevention information and services.

According to the author, school based-health centers (SBHCs) provide a range of services that are designed to meet the specific needs of the local student population. The Public School Health Center Support Program has existed in statute for nine years but has yet has to be funded. Further, this program is outdated. Without intervention, California lacks a coherent and comprehensive system of support for schools to build and sustain the partnerships, resources, and programs necessary to address issues that affect students and the school environment. This bill updates and enhances the framework of how SBHCs may be funded and provides schools with guidance on developing optimal and sustainable SBHC funding strategies.

Existing school health centers. Schools currently have the discretion to provide health services to students, or refer students to county and community organizations. Of the existing 231 school-based health centers, 40% are in high schools, 25% are in elementary schools, 10% are in middle schools, and 25% are "school-linked" or mobile medical vans. They serve over 242,000 students and providing a range of services including comprehensive health assessments, treatment for acute illness, asthma treatment, oral health education, dental screenings, mental health assessments, crisis intervention, brief and long-term therapy, and other services. Services are provided on-site by qualified professionals and those that require expertise or specialization beyond the school health center's capacity may be referred to county agencies and community organizations.

School health centers are administered by a variety of organizations, including school districts, Federally Qualified Health Centers, county health departments, hospitals, community-based agencies, and private physician groups. School health centers are financed through various sources, including grants, reimbursements from public programs such as the Child Health and Disability Prevention Program and Medi-Cal, partnerships with local community clinics and nonprofit, and fundraising efforts by school districts.

This bill modifies the existing grant program to assist school districts to establish and maintain school health centers. This bill does not provide funding for the school health center grant program.

Changes to School Health Center Grants. The Public School Health Center Support Program has existed in statute for eight years but has never been funded, and therefore never implemented. This bill makes the following substantive changes to this grant program:

1. Establishes population health grants, in amounts between $50,000-$125,000 for up to a three-year period, to fund interventions to target specific health or education risk factors that affect a larger segment of the population including, but not limited to obesity prevention programs, asthma prevention programs, early intervention for mental health, alcohol and substance abuse prevention.
   
   

2. Limits sustainability grants from a three-year period to a one-time basis, increases the minimum grant amount from $25,000 to $50,000, and decreases the maximum grant amount from $125,000 to $100,000.
   
   

3. Adds the following to the elements that school health center grantees must include or provide:
   
   

   1. Strive to address the population health of the entire school campus by focusing on prevention services such as group and classroom education, schoolwide prevention programs, and community outreach strategies.

   2. Strive to provide integrated and individualized support for students and families, and to act as a partner with the student or family to ensure that health, social, or behavioral challenges are addressed.

   3. Alcohol and substance abuse services.
      
      

4. Adds the referral to evidence-based mental health treatment services or alcohol and substance abuse treatment services to the list of mental health services that may be provided or supervised by an appropriately licensed mental health professional.
   
   

This bill does not modify the existing condition that the grant program be implemented only to the extent that funds are appropriated to the Department of Public Health for that purpose. It is unclear if the program is intended to be funded in the near future.

Related and Previous Legislation. AB 766 (Ridley-Thomas) from 2015, is pending hearing in the Senate, expands the characteristics of schools that are to receive preference in the awarding of Public School Health Center Support grants to include schools with a high percentage of youth who receive free- or low-cost insurance through Medi-Cal or Covered California.

SB 1055 (Liu) from 2014 was identical to this bill. SB 1055 passed the Senate Education, Health and Appropriations committees but was re-referred to and held in the Senate Rules Committee prior to a vote on the Senate Floor.

AB 174 (Bonta) from 2013 would have required the Department of Public Health to establish a pilot program in Alameda County, to the extent that funding is made available, to provide grants to eligible applicants for activities and services that directly address the mental health and related needs of students impacted by trauma. AB 174 was vetoed by the Governor, with the following veto message:

“I support the efforts of the bill but am returning it without my signature, as Alameda County can establish such a program without state intervention and may even be able to use Mental Health Services Act funding to do so.

Waiting for the state to act may cause unnecessary delays in delivering valuable mental health services to students. All counties - not just Alameda- should explore all potential funding options, including Mental Health Services Act funds, to tailor programs that best meet local needs.”

REGISTERED SUPPORT / OPPOSITION:

Support

Advancement Project

Alliance for Boys and Men of Color

Auburndale Intermediate School

California Association of School Business Officials

California Association of School Business Officials

California Black Health Network

California Council of Community Mental Health Agencies

California Pan Ethnic Health Network

California Primary Care Association

California State PTA

Children Now

Children's Defense Fund-California

Common Sense Kids Action

Community Clinic Association of Los Angeles County

James Morehouse Project

Mental Health America of California

National Association of Social Workers, California Chapter

Planned Parenthood

PolicyLink

Steinberg Institute

The Greenlining Institute

An Individual

Opposition

None on file.

Analysis Prepared by: Chelsea Kelley / ED. / (916) 319-2087

Date of Hearing: June 23, 2015

ASSEMBLY COMMITTEE ON HEALTH

Rob Bonta, Chair

SBPCA Bill Id:SB 118

Author:(Liu) – As Amended Ver:April 7, 2015

SENATE VOTE: 38-1

SUBJECT: School-Based Health and Education Partnership Program

SUMMARY: Renames the Public School Health Center Support Program (PSHCSP) the School-Based Health and Education Partnership Program (SBHEPP) and changes funding criteria and amounts for the grants and specifies that school health centers can provide alcohol and substance abuse assessments, screening, and services. Specifically this bill:

1. Provides that sustainability grants be made available on a one-time basis in amounts between $50,000 and $100,000 for the purpose of developing new, and leveraging existing, funding streams to support a sustainable funding model for school-based health centers (SBHCs).

2. Establishes population health grants in amounts between $50,000 and $125,000 for up to three years to fund interventions to implement population health outcomes and target specific health or education risk factors such as obesity prevention programs, asthma prevention programs, early intervention for mental health, and alcohol and substance abuse prevention.

EXISTING LAW:

1. Defines a SBHC as a center or program, located at or near a local educational agency that provides age-appropriate health care services at the program site or through referrals that may conduct routine physical health, mental health, and oral health assessments, and provide referrals for any services not offered onsite.

2. Establishes the PSHCSP for the purpose of providing technical assistance and grant funding to SHCs in amounts of $20,000 to $250,000 for the purposes of identifying children who are eligible for the Medi-Cal program and similar low or no cost health insurance programs and enrolling them into appropriate programs.

3. Requires any grants to SBHCs to have a plan to provide a comprehensive set of primary and other health care services including medical, oral health, mental health, health education, and related services in response to community needs, as specified.

4. Does not provide funding for the PSHCSP.

FISCAL EFFECT: According to the Senate Appropriations Committee, unknown costs to provide additional grants (General Fund or other, unknown fund source).

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, SBHCs are locally designed to meet the specific needs of the student population, and are an effective anchor for a broader community school strategy. The community school strategy is a nationally recognized approach for organizing the resources of the community around student success. It is both a place and a set of partnerships among the school and other community resources. Its integrated focus on academics, health, and social services, youth, and community engagement leads to improved student learning, stronger families, and healthier communities. For years, the existing program has not only remained unfunded, but is also outdated. The author states that this bill creates a stronger framework upon which schools may expand and seek additional resources to fund their school-based health centers. The author concludes that with reductions in funding for other critical safety net programs in recent years, school-based health centers are more important than ever.

2. BACKGROUND. SBHCs provide a broad array of primary care and preventive services, including comprehensive health assessments; prescriptions for medications; treatment for acute illness; asthma treatment; oral health education; and dental screenings. SBHCs have mental health providers on staff to offer mental health assessments, crisis intervention, brief and long-term therapy, and other services. SBHCs are the primary, and occasionally only, available health care for many children and adolescents. The National School-Based Health Alliance states that Congress recognized the importance of SBHCs as a key link in the nation’s health care safety net by providing $50 million a year for four years in one-time funding for construction, renovation, and equipment for SBHCs in the ACA and more than 350 applicants from around the nation are seeking funding through the first round of competitive grants created under the law.
   
   There are approximately 200 SBHCs in California. Half of SBHC's are in high schools, a third are in elementary schools and the remainder are in middle schools or in mobile medical vans. Many SBHCs are located in schools serving some of the state's most vulnerable children and on campuses with SBHCs, about 70% of students receive free or reduced price meals. According to the California School-Based Health Alliance (CSBHA), 13,500 children have gained access to health care in their school since 2012, through the expansion of SBHCs. SBHCs are administered by a variety of organizations, including school districts, Federally Qualified Health Centers, county health departments, hospitals, community-based agencies, and private physician groups. They are financed through grants from state, local, and private sources as well as reimbursements from public programs, such as the Child Health and Disability Prevention Program and Medi-Cal. According to CSBHA, more than half of SHCs recover less than 50% of their operating costs from billing sources.

3. SUPPORT. CSBHA, the California Primary Care Association, Children Now, Children’s Defense Fund—California, the Los Angeles Trust for Children’s Health, and the Partnership for Children & Youth state that children attend school daily suffering from mental health issues, poor nutrition, asthma, diabetes, and other conditions that seriously impact their ability to learn and succeed. Even though 93 percent of children have health insurance, almost 20 percent of them did not have a recommended annual preventive medical visit in 2011. The California Black Health Network states that SBHCs can specifically help boys and young men of color, who are more likely than whites to characterize their health as “poor” or “fair,” through a range of services designed to meet their needs. Students who use SBHCs are more likely to use primary care more consistently and are less likely to visit the emergency room or be hospitalized.

4. RELATED LEGISLATION.

1. AB 1025 (Thurmond) requires 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 is pending in the Assembly Education Committee.

2. AB 1133 (Achadjian) makes technical changes to existing law regarding grants to LEAs to pay the state share of costs of providing school-based early mental health intervention and prevention services to eligible students. AB 1133 is pending in the Assembly Health Committee.

3. AB 766 (Ridley-Thomas, 2015) expands the characteristics of schools that are to receive preference in the awarding of PSHCSP grants to include schools with a high percentage of youth who receive free- or low-cost insurance through Medi-Cal. AB 766 is pending referral in the Senate.
   
   

1. PREVIOUS LEGISLATION.

1. SB 1055 (Liu, 2014) was identical to this bill. SB 1055 passed the Sen. Education, Health, and Appropriations committees but was re-referred to and held in the Sen. Rules committee.

2. AB 2555 (Bocanegra, 2014) required the Superintendent of Public Instruction (SPI), in collaboration with the Department of Social Services and a number of entities, to develop a five-year plan for expanding cradle-to-career initiatives, as specified, throughout the State. AB 2555 was held on the Assembly Appropriations committee’s suspense file.

3. AB 1955 (Pan, 2014) required the SPI to establish the Health Kids, Healthy Minds Demonstration which will provide grants to local educational agencies for the purpose of employing one full-time school nurse and one full-time mental health professional, and ensuring that the schools’ libraries are open one hour before and three hours after the regular school day. AB 1955 was held on the Assembly Appropriations committee’s suspense file.

4. SB 596 (Yee, 2014) 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 multi-tiered framework. SB 596 was held at the Assembly Desk.

6. POLICY COMMENT. Existing law does not provide funding for the currently existing PSHCSP. This bill does not include provisions to provide for future funding, so it is unclear what the impact of the SBEHPP will be.

7. DOUBLE REFERRAL. This bill is double referred; upon passage in this Committee, this bill will be referred to the Assembly Education Committee.

REGISTERED SUPPORT / OPPOSITION:

Support

Alliance for Boys and Men of Color

Auburndale Intermediate School

California Association of School Business Officials

California Black Health Network

California Council of Community Mental Health Agencies

California Pan-Ethnic Health Network

California Primary Care Association

California State Parent Teachers Association

Children's Defense Fund – California

Children Now

Common Sense Kids Action

Community Clinic Association of Los Angeles County

Fight Crime: Invest in Kids California

James Morehouse Project

Mental Health America of California

Planned Parenthood Affiliates of California

PolicyLink

The Greenlining Institute

Opposition

None on file.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 118

Author: Liu (D)

Amended: 4/7/15

Vote: 21

SENATE EDUCATION COMMITTEE: 8-0, 3/11/15

AYES: Liu, Huff, Block, Hancock, Leyva, Mendoza, Pan, Vidak

SENATE HEALTH COMMITTEE: 9-0, 3/25/15

AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen, Pan, Roth, Wolk

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15

AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen

SUBJECT: School-Based Health and Education Partnership Program

SOURCE: Author

DIGEST: This bill modifies and renames an existing school health center grant program to add a population health grant, alters existing sustainability grant amounts, adds services for which the grants may be used, and updates terminology.

ANALYSIS:

Existing law:

School health centers

1. Requires the Department of Public Health (DPH) to establish the Public School Health Center Support Program, in cooperation with the California Department of Education, to perform specified functions relating to the establishment, retention, or expansion of school health centers in California. (Health & Safety Code § 124174.2)
   
   

2. Defines “school health center” as a center or program, located at or near a school, that provides age-appropriate health care services at the program site or through referrals. Current law authorizes a school health center to conduct routine physical, mental health, and oral health assessments, and provide referrals for any services not offered onsite. (HSC § 124174)
   
   

3. Establishes a grant program administered by the DPH to provide technical assistance and funding to school health centers, to the extent funds are appropriated for this purpose.

1. Planning grants in amounts between $25,000-$50,000.

2. Facilities and startup grants in amounts between $20,000-$250,000.

3. Sustainability grants in amounts between $25,000-$125,000. (HSC § 124174.6)
   
   

4. Requires school health centers that receive a grant to meet or have a plan to meet the following requirements:
   
   

1. Strive to provide a comprehensive set of services including medical, oral health, mental health, health education, and related services in response to community needs.

2. Provide primary and other health care services, provided or supervised by a licensed professional, which may include physical exams, diagnosis and treatment of minor injuries and medical conditions, management of chronic medical conditions, referrals and follow-up for specialty care, reproductive health services, mental health services as specified, and oral health services.

3. Work in partnership with the school nurse, as specified.

4. Have a written contract or memorandum of understanding between the school district and the health care provider or other community provider.

5. Serve all students regardless of ability to pay.

6. Be open during all normal school hours, as specified.

7. Establish protocols for referring students to outside services when the school health center is closed.

8. Facilitate transportation, as specified. (HSC § 124174.6)

Authority to assess and provide services

1. Authorizes credentialed school nurses to perform specified duties, including assess and evaluate health and development, refer students and parents to appropriate community resources, and counsel students and parents. (Education Code § 49426)
   
   

2. Authorizes school districts to permit specified licensed health practitioners to administer an immunizing agent to a student whose parent or guardian has consented in writing to the administration of the immunizing agent. (EC § 49403)
   
   

3. Requires a psychologist employed by a school district to hold specified credentials, and prohibits an employee of a school district from administering psychological tests or engage in psychological activities unless specified criteria is met. (EC § 49422 and § 49424)

Pupil Personnel Services credentials authorize individuals to provide school services in preschool through grades 12 as counselors, school psychologists, school social workers, or school child welfare and attendance regulators, according to the specific specialization area and service authorization listed on the credential.

Seeking medical services

1. Requires school districts to annually notify students in grades 7-12, and parents of all students enrolled in the school district, that schools may excuse students for the purpose of obtaining confidential medical services without the consent of the student's parent. (Education Code § 46010.1)
   
   

2. Authorizes minors to seek confidential medical services, without the consent of a parent, as follows:
   
   

1. A minor who is 12 years of age or older to consent to mental health treatment or counseling on an outpatient basis, or to residential shelter services, if certain conditions are met. Current law requires the mental health treatment or counseling of a minor to include involvement of the minor’s parent or guardian unless, in the opinion of the professional person who is treating or counseling the minor, the involvement would be inappropriate. (Family Code § 6924)

2. A minor who is 12 years of age or older to consent to medical care and counseling relating to the diagnosis and treatment of a drug- or alcohol-related problem. (FC § 6929)

3. A minor to consent to medical care related to the prevention or treatment of pregnancy, but may not be sterilized or receive an abortion without the consent of a parent, other than in a medical emergency or pursuant to court order. (FC § 6925)

4. A minor who is 12 years of age or older and who may have come into contact with an infectious, contagious, or communicable disease, if the disease or condition is one that is required to be reported to the local health officer, or is a related sexually transmitted disease. (FC § 6926)

5. A minor who is 12 years of age or older and who is alleged to have been raped to consent to medical care related to the diagnosis or treatment of the condition and the collection of medical evidence with regard to the alleged rape. (FC § 6927)

6. A minor who is alleged to have been sexually assaulted to consent to medical care related to the diagnosis and treatment of the condition, and the collection of medical evidence with regard to the alleged sexual assault. Current law requires the professional person providing medical treatment to attempt to contact the minor’s parent or guardian. (FC § 6928)
   
   

7. A minor to consent to the minor’s medical care or dental care if the minor is 15 years of age or older, is living separate and apart from the minor’s parents with or without the consent of the parent, and is managing the minor’s own financial affairs, regardless of the source of income. (FC § 6922)

This bill:

1. Renames the Public School Health Center Support Program to the School-Based Health and Education Partnership Program.
   
   

2. Adds the following to the elements that school health center grantees must include or provide:

   1. Strive to address the population health of the entire school campus by focusing on prevention services such as group and classroom education, schoolwide prevention programs, and community outreach strategies.

2. Strive to provide integrated and individualized support for students and families, and to act as a partner with the student or family to ensure that health, social, or behavioral challenges are addressed.

3. Alcohol and substance abuse services.
   
   

1. Adds the referral to evidence-based mental health or alcohol and substance abuse treatment services to the list of mental health services that may be provided or supervised by an appropriately licensed mental health professional.
   
   

2. Establishes population health grants in amounts $50,000 to $125,000 for a funding period of up to three years to fund interventions to target specific health or education risk factors that affect a larger segment of the population including, but not limited to:
   
   

   1. Obesity prevention programs.
      
      

   2. Asthma prevention programs.
      
      

   3. Early intervention for mental health.
      
      

   4. Alcohol and substance abuse prevention.
      
      

3. Limits sustainability grants from a three-year period to a one-time basis, and modifies the grant amounts as follows:
   
   

   1. Increases the minimum grant amount from $25,000 to $50,000.
      
      

   2. Decreases the maximum grant amount from $125,000 to $100,000.
      
      

4. Modifies the purpose of sustainability grants from operating a school health center, or enhancing programming at a fully operational school health center, including oral health or mental health services, to:

1. Developing new and leveraging existing funding streams to support a sustainable funding model for school health centers.
   
   

2. Examples of existing funding streams include school district funds available under the Local Control Funding Formula, federal Affordable Care Act, or Mental Health Services Act.
   
   

1. Strikes reference to the obsolete Healthy Families Program and Managed Risk Medical Insurance Board, adds references to Covered California, and modifies the name of the grant program.
   
   

2. Adds the following to uncodified legislative findings and declarations:

1. School health centers are important sites through which to increase child and adolescent access to health care services and early identification of chronic diseases, such as asthma and obesity, and high-risk health behaviors.

2. School-based health centers serve as an effective foundation upon which schools and communities can build and implement a community schools strategy providing a range of wrap-around services to students and their families.

Background

Schools currently have the discretion to provide health services to students, or refer students to county and community organizations. There are currently 231 school-based health centers (40% are in high schools, 25% are in elementary schools, 10% are in middle schools, and 25% are "school-linked" or mobile medical vans) in the State serving over 242,000 students and providing a range of services including comprehensive health assessments, treatment for acute illness, asthma treatment, oral health education, dental screenings, mental health assessments, crisis intervention, brief and long-term therapy, and other services. Services are provided on-site by qualified professionals and those that require expertise or specialization beyond the school health center's capacity may be referred to county agencies and community organizations.

School health centers are administered by a variety of organizations, including school districts, Federally Qualified Health Centers, county health departments, hospitals, community-based agencies, and private physician groups. School health centers are financed through various sources, including grants, reimbursements from public programs such as the Child Health and Disability Prevention Program and Medi-Cal, partnerships with local community clinics and nonprofit, and fundraising efforts by school districts.

Comments

Will kids be provided services without parental consent? Current law authorizes school districts to permit specified licensed health practitioners to administer an immunizing agent to a student whose parent or guardian has consented in writing to the administration of the immunizing agent.

Current law prohibits a student from being tested by a school for a behavioral, mental, or emotional evaluation without the informed written consent of the parent, prohibits a minor from being sterilized or receiving an abortion without parental consent (other than in a medical emergency or pursuant to court order), and places other restrictions on minors receiving medical care without parental consent (see Background).

Generally speaking, parental consent is required for a minor’s medical treatment. (American Academy of Pediatrics v. Lungren (1997)) There are, however, exceptions such as when the public interest in preserving the health of a minor takes precedence over the parent’s interest in custody and control of the minor. (Wisconsin v. Yoder (1972)) In addition, a number of “medical emancipation” statutes allow minors to consent to medical treatment without parental knowledge, approval or consent (see existing law).

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, this bill imposes unknown costs to provide additional grants (General Fund or other, unknown fund source). The bill does not identify a source of funds for these new grants. The current program has been authorized in statute for eight years, but has never been funded.

SUPPORT: (Verified 5/29/15)

Alliance for Boys and Men of Color

Auburndale Intermediate School

California Black Health Network

California Pan-Ethnic Health Network

California Primary Care Association

Children Now

Common Sense Kids Action

Community Clinic Association of Los Angeles County

James Morehouse Project

Mental Health America of California

Partnership for Children & Youth

Planned Parenthood Affiliates of California

PolicyLink

The Greenlining Institute

OPPOSITION: (Verified 5/29/15)

None received

ARGUMENTS IN SUPPORT: According to the California Pan-Ethnic Health Network, research shows that users of school-based health centers are more likely to have yearly dental and medical check-ups and are less likely to go to the Emergency Room or be hospitalized. Students enrolled in a school with a school-based health center are absent three times less often than students not utilizing a school-based health center.

Prepared by: Lynn Lorber / ED. / (916) 651-4105

5/30/15 18:34:05

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

SB 118 (Liu) - School-Based Health and Education Partnership Program

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

SB 118 would authorize a new category of grants within an existing grant program. The bill would also rename the program and change some of the program’s goals and procedures.

Fiscal Impact:

Unknown costs to provide additional grants (General Fund or other, unknown fund source). The bill authorizes a new category of grants that may be issued to schools with school health centers for interventions such as obesity prevention or mental health prevention. The bill does not identify a source of funds for these new grants. The current program has been authorized in statute for eight years, but has never been funded.

Background:

Under current law, schools may operate student health centers to provide health services to students.

Under current law, the Department of Public Health is required to establish a Public School Health Center Support Program to support the establishment of school health centers. The Department is also required to establish a grant program to provide funding to school health centers. This program has been in place for the past eight years. To date, no funding has been made available and no program activities have taken place.

Proposed Law:

SB 118 would authorize a new category of grants within an existing grant program. The bill would also rename the program and change some of the program’s goals and procedures.

Specific provisions of the bill would:

• Rename the existing Public School Health Center Support Program as the School-Based Health and Education Partnership;

• Add program goals that participating school health centers provide alcohol and substance abuse services, focus on prevention services, and provide support for students and families;

• Change the criteria for awarding sustainability grants to schools;

• Create a new category of grants to fund interventions focusing on issues such as obesity, asthma, mental health and substance abuse prevention;

• Make technical corrections to current law.

Related Legislation:

• AB 766 (Ridley-Thomas) would expand the characteristics of schools that receive preference in the awarding of grant funds from the program that is the subject of this bill. That bill is pending in the Assembly Health Committee.

• AB 1025 (Thurmond) requires the Department of Education to establish a pilot program to encourage practices that integrate mental health, special education, and other issues. That bill is pending in the Assembly Education Committee.

• AB 1133 (Achadjian) would make changes to the statute governing grants to local education agencies to pay for the costs of providing early mental health interventions. That bill is pending in the Assembly.

• AB 1055 (Liu, 2014) was substantially similar to this bill. That bill was held in the Senate Rules Committee.

• AB 174 (Bonta, 2013) would have required the Department of Public Health to establish a pilot program in Alameda County to address trauma and mental health issues in schools. That bill was vetoed by Governor Brown.

Staff Comments:

As noted above, the current program has never been funded. Staff is not aware of any new sources of non-General Fund funding that could be used to fund the existing program or the newly authorized activities in this bill.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: SB 118

SUBJECT: School-Based Health and Education Partnership Program

SUMMARY:

Renames the Public School Health Center Support Program the School-Based Health and Education Partnership Program and makes changes to the requirements and funding levels. Creates a new type of grant to fund interventions related to obesity, asthma, alcohol and substance abuse, and mental health.

Existing law:

1. Requires the Department of Public Health (DPH) to establish the Public School Health Center Support Program (PSHCSP), in collaboration with the Department of Education (CDE), to perform specified functions relating to the establishment, retention, or expansion of school-based health centers (SBHCs) in California.

2. Establishes a grant program administered by DPH to provide technical assistance and funding to SBHCs, to the extent funds are appropriated for implementation of the PSHCSP. Provides for planning, facilities and startup, and sustainability grants, as specified.

3. Defines an SBHC, for purposes of the PSHCSP, as a center or program located at or near a local educational agency that provides age-appropriate health care services at the program site or through referrals. Defines a local educational agency as a school, school district, charter school, or county office of education, as specified.

This bill:

1. Renames the PSHCSP the School-Based Health and Education Partnership Program (SBHEPP). Changes sustainability grant amount from between $25,000 and $125,000 per year for a three-year period to between $50,000 and $100,000 on a one-time basis. Deletes the requirement that the grant be used for operating SBHCs or enhancing programming at SBHCs to include oral health or mental health services and instead requires the grant funds be used to develop new and leveraging existing funding streams to support a sustainable funding model for SBHCs. Provides examples of existing funding streams, such as school district funds available under the Local Control Funding Formula (LCFF), the federal Affordable Care Act (ACA), and the Mental Health Services Act.

2. Creates a new population health grant in amounts between $50,000 and $125,000 for a period of up to three years to fund interventions to implement population health outcomes and target specific health or education risk factors, including, but not limited to: obesity prevention programs; asthma prevention programs; early intervention for mental health; and alcohol and substance abuse prevention. Requires applicants for this grant to meet the same criteria as those for the facilities and startup grant in existing law.

3. Adds to requirements for SBHEPP grantees to strive to address the population health of an entire school by focusing on prevention services, such as group and classroom education, school wide prevention programs, community outreach strategies; requires grantees to strive to provide integrated and individualized support for students and families, and to act as a partner with students or families to ensure that health, social, or behavioral challenges are addressed.

4. Makes findings and declarations about the importance of SHBCs and the role they play in providing an entire school with prevention and health integration services, as well as a range of wrap-around services to students and their families; makes technical, clarifying changes.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, there are currently 231 SBHCs in California that serve over 242,000 students with a range of services that meet specific needs of the local student population. These centers have proven to be an effective anchor for a broader community school strategy. A community school is both a place and a set of partnerships between the school and other community resources that integrates services and supports into the educational strategy of the school. This approach improves student academic achievement, increases attendance, reduces dropout rates, improves behavior, and promotes parent engagement. These outcomes benefit families and communities by generating increased stability and public safety. SBHCs typically piece together funding through a variety of sources including: third-party billing reimbursement, such as Medi-Cal, in kind-donations from schools and community agencies, grants, and local revenues. The PSHCSP has existed in statute for eight years yet has never been funded. It is time for this program to be updated and funded, as it will expand the availability and scope of medical and mental health services available to students. This perfectly complements the LCFF emphasis on addressing the needs of at-risk students and building community resiliency.

2. SBHCs. According to the National School-Based Health Alliance (NSBHA), SBHCs provide a broad array of primary care and preventive services, including comprehensive health assessments; prescriptions for medications; treatment for acute illness; asthma treatment; oral health education; dental screenings; and mental health assessments, crisis intervention, brief and long-term therapy, and other services. SBHC staff offer small group and classroom health promotion and outreach, which help increase the number of students exposed to programs and activities that discourage potentially harmful behaviors including alcohol, tobacco, and drug abuse, and violence and bullying. These programs also serve to help promote healthy eating and active living. SBHCs work to ensure that adolescents, a hard-to-reach population, have access to the services they need to stay on a path to success. SBHCs are the primary, and occasionally only, available health care for many children and adolescents who otherwise would have no access. The NSBHA states that Congress recognized the importance of SBHCs as a key link in the nation’s health care safety net by providing $50 million a year for four years in one-time funding for construction, renovation, and equipment for SBHCs in the ACA.
   
   According to the California School-Based Health Alliance (CSBHA), 40 percent of SBHCs are in high schools, 25 percent are in elementary schools, 10 percent are in middle schools, and 25 percent are "school-linked" or mobile medical vans. CSBHA states that many SBHCs are located on school campuses that serve some of the state's most vulnerable children, with about 70 percent of students receiving free or reduced-price meals. SBHCs are administered by a variety of organizations, including school districts, Federally Qualified Health Centers, county health departments, hospitals, community-based agencies, and private physician groups. They are financed through various sources, including grants from state, local, and private sources; reimbursements from public programs, such as the Child Health and Disability Prevention Program and Medi-Cal; partnerships with local community clinics and nonprofits; and fundraising efforts by their school districts. According to CSBHA, more than half of SBHCs recover less than 50 percent of their operating costs from billing sources, as many of them provide health education, case management, parent support, and teacher consultation, much of which is not reimbursable. CSBHA states that research shows investments in SBHCs generate savings through reduced high-cost services, reduced inappropriate emergency room use, and immunization initiatives that prevent disease.

CSBHA believes that schools are a natural place to identify health problems and offer solutions, as children spend six to eight hours per day at school, and school-based interventions eliminate transportation barriers faced by other obesity prevention programs. CSBHA cites cases in which SBHCs have implemented strategies, such as reducing television viewing, increasing physical activity, and increasing fruit and vegetable intake. Studies showed that school-based nutrition and fitness programs were generally effective in improving health behaviors, and one study found that 50 percent fewer children in the intervention schools became overweight compared to the study’s control schools. CSBHA found that one such SBHC’s interventions compared favorably with other public health campaigns, costing less per quality-adjusted life years than programs such as adult hypertension prevention and adult diabetes screening.

3. Obesity and other chronic diseases. DPH issued a study, The Burden of Chronic Disease and Injury, in 2013 that highlights some of the leading causes of death, such as heart disease, cancer, stroke, and respiratory disease, all of which have a strong connection to obesity. Diabetes is another serious chronic disease stemming from obesity that adversely affects quality of life and results in serious medical costs. The last decade has witnessed a 32 percent rise in diabetes prevalence, affecting some 3.9 million people and costing upwards of $24 billion per year. According to the Centers for Disease Control and Prevention, approximately 12.5 million children and adolescents ages 2 to 19 years are obese. Research indicates a tripling in the youth obesity rate over the past three decades. While this increase has stabilized between the years 2005 and 2010, in 2010, 38 percent of public school children were overweight and obese. Overweight youth face increased risks for many serious detrimental health conditions that do not commonly occur during childhood, including high cholesterol and type-2 diabetes. Additionally, more than 80 percent of obese adolescents remain obese as adults.

4. Integrated Student Supports (ISS). In a white paper issued in February 2014, Child Trends (a national non-profit research center) looked at the benefits of ISS, which are a school-based approach to promoting students’ academic success by developing, securing, and coordinating supports that target academic and non-academic barriers to achievement. To date, ISS programs have served more than 1.5 million students in nearly 3,000 schools across the US, and Child Trends estimates that Hispanic and black students account for more than 75 percent of the students enrolled in ISS programs. Research cited by Child Trends indicates that the likelihood of academic success, especially for disadvantaged students, is enhanced by a more comprehensive set of supports at the individual, family, and school levels, which implies that providing an array of academic and non-academic supports in a coordinated fashion is a more effective strategy than focusing on one or a small set of supports. Child Trends found that generally the return on investment for ISS programs ranged from $4 to almost $15 for every dollar invested, which suggests that the ISS approach yields a positive return on investment.

5. Double referral. This bill was heard in the Senate Education Committee on March 11, 2015, and passed with an 8-0 vote.

6. Related legislation. AB 766 (Ridley-Thomas) expands the characteristics of schools that are to receive preference in the awarding of PSHCSP grants to include schools with a high percentage of youth who receive free or low-cost insurance through Medi-Cal or Covered California. AB 766 is pending in the Assembly Health Committee.

AB 1025 (Thurmond) requires 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 is pending in the Assembly Education Committee.

AB 1133 (Achadjian) makes technical changes to existing law regarding grants to local educational agencies to pay the state share of costs of providing school-based early mental health intervention and prevention services to eligible students. AB 1133 is pending referral in the Assembly.

7. Prior legislation. SB 1055 (Liu), of 2014, was identical to this bill. SB 1055 died in the Senate Rules Committee.

SB 596 (Yee), of 2014, would have required CDE to establish a three-year pilot program in four schools to provide school-based mental health services that leverage cross-system resources and offer comprehensive multitiered interventions; allocated a total of $600,000 in start-up funding to each school selected to participate in the program; and required CDE to submit a report to the Legislature evaluating the success of the program. SB 596 was held at the Assembly Desk.

AB 1955 (Pan), of 2014, would have required the SPI to establish the Healthy Kids, Healthy Minds Demonstration, which would provide grants to local educational agencies for the purpose of employing one full-time school nurse and one full-time mental health professional, and ensured that the schools' libraries were open one hour before and three hours after the regular school day. AB 1955 was held on the Assembly Appropriations Committee’s suspense file.

AB 174 (Bonta), of 2013, would have required DPH to establish a pilot grant program in Alameda County, to the extent that funding was made available, to provide resources to eligible applicants for activities and services that directly address the mental health and related needs of students impacted by trauma. AB 174 was vetoed by Governor Brown, who stated in his veto message that, while he supports the efforts of the bill, Alameda County can establish such a program without state intervention and may even be able to use existing funds to do so. In addition, Governor Brown stated that all counties, not just Alameda, should explore all funding options, including Mental Health Services Act funds, to tailor programs that best meet local needs.

AB 1178 (Bocanegra), of 2013, would have established the California Promise Neighborhood Initiative to provide funding to schools that have formalized partnerships with local agencies and community organizations to provide a network of services to improve the health, safety, education, and economic development of a defined area. AB 1178 failed in the Assembly Appropriations Committee.

SB 564 (Ridley-Thomas), Chapter 381, Statutes of 2008, specified that an SBHC may conduct routine physical health, mental health, and oral health assessments, and provide for any services not offered onsite or through a referral process. The bill also required DPH, to the extent funds are appropriated for implementation of the PSHCSP, to establish a grant program to provide technical assistance, and funding for the expansion, renovation, and retrofitting of existing SBHCs, and the development of new SBHCs, in accordance with specified procedures.

AB 2560 (Ridley-Thomas), Chapter 334, Statutes of 2006, required the Department of Health Services (DHS), in cooperation with CDE, to establish the PSHCSP to perform specified functions relating to the establishment, retention, or expansion of SBHCs; required DHS to establish standardized data collection procedures and collect specified data from SBHCs on an ongoing basis; required CDE, in collaboration with DHS, to coordinate programs within CDE and programs within other specified departments to support SBHCs and to provide technical assistance to facilitate and encourage the establishment, retention, and expansion of SBHCs; and required the program to provide a biennial update to the appropriate policy and fiscal committees of the Legislature containing specified information regarding SBHCs, beginning on or before January 1, 2009.

AB 2105 (Scott) of 2000 would have required the Director of Mental Health, in consultation with the Secretary of Child Development and Education and the Superintendent of Public Instruction, to establish a program to award planning grants to counties for the provision of school-based mental health services to children, according to specified criteria, and to the extent funding was made available for that purpose. This bill would have also required the director to provide a preliminary report on the program to the Governor, appropriate policy and fiscal committees of the Legislature, and the Legislative Analyst on or before January 1, 2003, and to provide a final report to these entities on or before January 1, 2007. AB 2105 failed in the Assembly Appropriations Committee.

SB 566 (Escutia) of 1999 would have established the SBHC Grant Program, to be administered by DHS, to provide grants to qualifying SBHCs in order to assist the centers in providing health services to students, provided that funds were appropriated in the annual Budget Act. This bill also would have required DHS to convene a study group to explore long-term strategies to support SBHCs and incorporate these centers into a comprehensive and coordinated health care system. SB 566 was moved to the inactive file on the Senate Floor.

8. Support. CSBHA, the California Primary Care Association, Children Now, Children’s Defense Fund—California, the Los Angeles Trust for Children’s Health, and the Partnership for Children & Youth state that children attend school daily suffering from mental health issues, poor nutrition, asthma, diabetes, and other conditions that seriously impact their ability to learn and succeed. Even though 93 percent of children have health insurance, almost 20 percent of them did not have a recommended annual preventive medical visit in 2011. The California Black Health Network states that SBHCs can specifically help boys and young men of color, who are more likely than whites to characterize their health as “poor” or “fair,” through a range of services designed to meet their needs. Students who use SBHCs are more likely to use primary care more consistently and are less likely to visit the emergency room or be hospitalized.

9. Policy comment. According to the author’s office, the PSHCSP has existed in statute for eight years and has never been implemented due to a lack of funding. However, this bill does not include provisions to provide for future funding, so it is unclear what the impact would be. The author may wish to include a funding source so that the SBHEPP does not continue to go unfunded should this bill be chaptered.

10. Technical amendments. The author has agreed to the following amendments in bold, italics, and underline:

SEC. 1 Section 124174 of the Health and Safety Code is amended to read:

124174(b) “School health center” means a center or program, located at or near a local educational agency, that provides age-appropriate health care services at the program site or through referrals. A school health center may conduct routine physical, mental health, alcohol and substance abuse, and oral health assessments, and provide referrals for any services not offered onsite. A school health center may serve two or more nonadjacent schools or local educational agencies.

SEC. 3. Section 124174.6 of the Health and Safety Code is amended to read:

124174.6(a)(2)(H) Mental health and alcohol and substance abuse services provided or supervised by an appropriately licensed mental health or alcohol and substance abuse professional may include: assessments, crisis intervention, counseling, treatment, and referral to a continuum of services including emergency psychiatric care, evidence-based mental health or alcohol and substance abuse treatment services, community support programs, inpatient care, and outpatient programs. School health centers providing mental health and alcohol and substance abuse services as specified in this section shall consult with the local county mental health behavioral health department for collaboration in planning and service delivery.

124174.6(a)(5) Work in partnership with the school nurse, if one is employed by the school or school district, local educational agency, to provide individual and family health education; school or districtwide health promotion; first aid and administration of medications; facilitation of student enrollment in health insurance programs; screening of students to identify the need for physical, mental health, alcohol and substance abuse, and oral health services; referral and linkage to services not offered onsite; public health and disease surveillance; and emergency response procedures. A school health center may receive grant funding pursuant to this section if the school or school district local educational agency does not employ a school nurse. However, it is not the intent of the Legislature that a school health center serve as a substitute for a school nurse employed by a local school or school district. educational agency.

SUPPORT AND OPPOSITION:

Support: California School-Based Health Alliance (sponsor)

California Black Health Network

California Primary Care Association

Children Now

Children’s Defense Fund—California

Los Angeles Trust for Children’s Health

Partnership for Children & Youth

Oppose: None received.

-- END --

SENATE COMMITTEE ON EDUCATION

Senator Liu, Chair

2015 - 2016 Regular

Bill No: SB 118

Subject: School-Based Health and Education Partnership Program

NOTE: This bill has been referred to the Committees on Education and Health. A "do pass" motion should include referral to the Committee on Health.

SUMMARY

This bill modifies and renames an existing school health center grant program to add a population health grant, alter existing sustainability grant amounts, add services for which the grants may be used, and updates terminology.

BACKGROUND

Current law:

School health centers

1. Requires the Department of Public Health to establish the Public School Health Center Support Program, in cooperation with the California Department of Education, to perform specified functions relating to the establishment, retention, or expansion of school health centers in California.
   (Health & Safety Code § 124174.2)
   
   

2. Defines “school health center” as a center or program, located at or near a school, that provides age-appropriate health care services at the program site or through referrals. Current law authorizes a school health center to conduct routine physical, mental health, and oral health assessments, and provide referrals for any services not offered onsite. (HSC § 124174)
   
   

3. Establishes a grant program administered by the Department of Public Health to provide technical assistance and funding to school health centers, to the extent funds are appropriated for this purpose.

1. Planning grants in amounts between $25,000-$50,000.

2. Facilities and startup grants in amounts between $20,000-$250,000

3. Sustainability grants in amounts between $25,000-$125,000.
   (HSC § 124174.6)
   
   
   

4. Requires school health centers that receive a grant to meet or have a plan to meet the following requirements:
   
   

1. Strive to provide a comprehensive set of services including medical, oral health, mental health, health education, and related services in response to community needs.

2. Provide primary and other health care services, provided or supervised by a licensed professional, which may include physical exams, diagnosis and treatment of minor injuries and medical conditions, management of chronic medical conditions, referrals and follow-up for specialty care, reproductive health services, mental health services as specified, and oral health services.

3. Work in partnership with the school nurse, as specified.

4. Have a written contract or memorandum of understanding between the school district and the health care provider or other community provider.

5. Serve all students regardless of ability to pay.

6. Be open during all normal school hours, as specified.

7. Establish protocols for referring students to outside services when the school health center is closed.

8. Facilitate transportation, as specified. (HSC § 124174.6)

Authority to assess and provide services

Current law:

1. Authorizes credentialed school nurses to perform specified duties, including assess and evaluate health and development, refer students and parents to appropriate community resources, and counsel students and parents.
   (Education Code § 49426)
   
   

2. Authorizes school districts to permit specified licensed health practitioners to administer an immunizing agent to a student whose parent or guardian has consented in writing to the administration of the immunizing agent. (EC § 49403)
   
   

3. Requires a psychologist employed by a school district to hold specified credentials, and prohibits an employee of a school district from administering psychological tests or engage in psychological activities unless specified criteria is met. (EC § 49422 and § 49424)

Pupil Personnel Services credentials authorize individuals to provide school services in preschool through grades 12 as counselors, school psychologists, school social workers, or school child welfare and attendance regulators, according to the specific specialization area and service authorization listed on the credential.

Seeking medical services

Current law:

1. Requires school districts to annually notify students in grades 7-12, and parents of all students enrolled in the school district, that schools may excuse students for the purpose of obtaining confidential medical services without the consent of the student's parent. (Education Code § 46010.1)
   
   

2. Authorizes minors to seek confidential medical services, without the consent of a parent, as follows:
   
   

1. A minor who is 12 years of age or older to consent to mental health treatment or counseling on an outpatient basis, or to residential shelter services, if certain conditions are met. Current law requires the mental health treatment or counseling of a minor to include involvement of the minor’s parent or guardian unless, in the opinion of the professional person who is treating or counseling the minor, the involvement would be inappropriate. (Family Code § 6924)

2. A minor who is 12 years of age or older to consent to medical care and counseling relating to the diagnosis and treatment of a drug- or alcohol-related problem. (FC § 6929)

3. A minor to consent to medical care related to the prevention or treatment of pregnancy, but may not be sterilized or receive an abortion without the consent of a parent, other than in a medical emergency or pursuant to court order. (FC § 6925)

4. A minor who is 12 years of age or older and who may have come into contact with an infectious, contagious, or communicable disease, if the disease or condition is one that is required to be reported to the local health officer, or is a related sexually transmitted disease.
   (FC § 6926)

5. A minor who is 12 years of age or older and who is alleged to have been raped to consent to medical care related to the diagnosis or treatment of the condition and the collection of medical evidence with regard to the alleged rape. (FC § 6927)

6. A minor who is alleged to have been sexually assaulted to consent to medical care related to the diagnosis and treatment of the condition, and the collection of medical evidence with regard to the alleged sexual assault. Current law requires the professional person providing medical treatment to attempt to contact the minor’s parent or guardian.
   (FC § 6928)

7. A minor to consent to the minor’s medical care or dental care if the minor is 15 years of age or older, is living separate and apart from the minor’s parents with or without the consent of the parent, and is managing the minor’s own financial affairs, regardless of the source of income.
   (FC § 6922)

ANALYSIS

This bill modifies and renames an existing school health center grant program to add a population health grant, alter existing sustainability grant amounts, add services for which the grants may be used, and updates terminology. Specifically, this bill:

1. Renames the Public School Health Center Support Program to the School-Based Health and Education Partnership Program.
   
   

2. Adds the following to the elements that school health center grantees must include or provide:
   
   

   1. Strive to address the population health of the entire school campus by focusing on prevention services such as group and classroom education, schoolwide prevention programs, and community outreach strategies.
      
      

   2. Strive to provide integrated and individualized support for students and families, and to act as a partner with the student or family to ensure that health, social, or behavioral challenges are addressed.
      
      

   3. Alcohol and substance abuse services.
      
      

3. Adds the referral to evidence-based mental health treatment services to the list of mental health services that may be provided or supervised by an appropriately licensed mental health professional.
   
   

4. Establishes population health grants in amounts $50,000 to $125,000 for a funding period of up to three years to fund interventions to target specific health or education risk factors that affect a larger segment of the population including, but not limited to:
   
   

   1. Obesity prevention programs.
      
      

   2. Asthma prevention programs.
      
      

   3. Early intervention for mental health.
      
      

   4. Alcohol and substance abuse prevention.
      
      
      
      
      

5. Limits sustainability grants from a three-year period to a one-time basis, and modifies the grant amounts as follows:
   
   

   1. Increases the minimum grant amount from $25,000 to $50,000.
      
      

   2. Decreases the maximum grant amount from $125,000 to $100,000.
      
      

6. Modifies the purpose of sustainability grants from operating a school health center, or enhancing programming at a fully operational school health center, including oral health or mental health services, to:
   
   

   1. Developing new and leveraging existing funding streams to support a sustainable funding model for school health centers .
      
      

   2. Examples of existing funding streams include school district funds available under the Local Control Funding Formula, federal Affordable Care Act, or Mental Health Services Act.
      
      

7. Strikes reference to the obsolete Healthy Families Program and Managed Risk Medical Insurance Board, adds references to Covered California, and modifies the name of the grant program.
   
   

8. Adds the following to uncodified legislative findings and declarations:

1. School health centers are important sites through which to increase child and adolescent access to health care services and early identification of chronic diseases, such as asthma and obesity, and high-risk health behaviors.
   
   

2. School-based health centers serve as an effective foundation upon which schools and communities can build and implement a community schools strategy providing a range of wrap-around services to students and their families.
   
   

STAFF COMMENTS

1. Existing school health centers. Schools currently have the discretion to provide health services to students, or refer students to county and community organizations. There are currently 231 school-based health centers (40% are in high schools, 25% are in elementary schools, 10% are in middle schools, and 25% are "school-linked" or mobile medical vans) in the State serving over 242,000 students and providing a range of services including comprehensive health assessments, treatment for acute illness, asthma treatment, oral health education, dental screenings, mental health assessments, crisis intervention, brief and long-term therapy, and other services. Services are provided on-site by qualified professionals and those that require expertise or specialization beyond the school health center's capacity may be referred to county agencies and community organizations.
   
   
   School health centers are administered by a variety of organizations, including school districts, Federally Qualified Health Centers, county health departments, hospitals, community-based agencies, and private physician groups. School health centers are financed through various sources, including grants, reimbursements from public programs such as the Child Health and Disability Prevention Program and Medi-Cal, partnerships with local community clinics and nonprofit, and fundraising efforts by school districts.
   
   This bill modifies an existing grant program to assist school districts to establish and maintain school health centers. This bill does not provide funding for the school health center grant program.
   
   

2. Will kids be provided services without parental consent? Current law authorizes school districts to permit specified licensed health practitioners to administer an immunizing agent to a student whose parent or guardian has consented in writing to the administration of the immunizing agent.
   
   Current law prohibits a student from being tested by a school for a behavioral, mental, or emotional evaluation without the informed written consent of the parent, prohibits a minor from being sterilized or receiving an abortion without parental consent (other than in a medical emergency or pursuant to court order), and places other restrictions on minors receiving medical care without parental consent (see Background).
   
   Generally speaking, parental consent is required for a minor’s medical treatment. (American Academy of Pediatrics v. Lungren (1997)) There are, however, exceptions such as when the public interest in preserving the health of a minor takes precedence over the parent’s interest in custody and control of the minor. (Wisconsin v. Yoder (1972)) In addition, a number of “medical emancipation” statutes allow minors to consent to medical treatment without parental knowledge, approval or consent (see Background).
   
   

3. School health center grants. The Public School Health Center Support Program has existed in statute for eight years but has never been funded, and therefore never implemented. This bill makes the following substantive changes to this grant program:
   
   

   1. Establishes population health grants, in amounts between $50,000-$125,000 for up to a three-year period, to fund interventions to target specific health or education risk factors that affect a larger segment of the population including, but not limited to obesity prevention programs, asthma prevention programs, early intervention for mental health, alcohol and substance abuse prevention.
      
      

   2. Limits sustainability grants from a three-year period to a one-time basis, increases the minimum grant amount from $25,000 to $50,000, and decreases the maximum grant amount from $125,000 to $100,000.
      
      

   3. Adds the following to the elements that school health center grantees must include or provide:
      
      

      1. Strive to address the population health of the entire school campus by focusing on prevention services such as group and classroom education, schoolwide prevention programs, and community outreach strategies.

      2. Strive to provide integrated and individualized support for students and families, and to act as a partner with the student or family to ensure that health, social, or behavioral challenges are addressed.

      3. Alcohol and substance abuse services.
         
         

   4. Adds the referral to evidence-based mental health treatment services to the list of mental health services that may be provided or supervised by an appropriately licensed mental health professional.
      
      

This bill does not modify the existing condition that the grant program be implemented only to the extent that funds are appropriated to the Department of Public Health for that purpose.

4. Fiscal impact. According to the Senate Appropriations Committee analysis of prior legislation, this bill would impose “unknown costs to provide additional grants (General Fund or other, unknown fund source). The bill does not identify a source of funds for these new grants.”
   
   

5. Related and prior legislation.
   
   RELATED LEGISLATION
   
   AB 766 (Ridley-Thomas, 2015) expands the characteristics of schools that are to receive preference in the awarding of Public School Health Center Support grants to include schools with a high percentage of youth who receive free- or low-cost insurance through Medi-Cal or Covered California. AB 766 is pending referral in the Assembly.
   
   AB 1025 (Thurmond, 2015) requires the California Department of Education to establish a three-year pilot program to encourage inclusive practices that integrate mental health, special education and school climate interventions following a multi-tiered framework. AB 1025 is pending referral in the Assembly.
   
   AB 1133 (Achadjian, 2015) makes technical changes to existing law regarding grants to local educational agencies to pay the State share of costs of providing school-based early mental health intervention and prevention services to eligible students. AB 1133 is pending referral in the Assembly.
   
   PRIOR LEGISLATION
   
   SB 1055 (Liu, 2014) was identical to this bill. SB 1055 passed the Senate Education, Health and Appropriations committees but was re-referred to and held in the Senate Rules Committee prior to a vote on the Senate Floor.
   
   AB 2555 (Bocanegra, 2014) required the Superintendent of Public Instruction (SPI), in collaboration with the Department of Social Services and a number of entities, to develop a five-year plan for expanding cradle-to-career initiatives, as specified, throughout the State. AB 2555 was held on the Assembly Appropriations Committee’s suspense file.
   
   AB 1955 (Pan, 2014) required the SPI to establish the Healthy Kids, Healthy Minds Demonstration which will provide grants to local educational agencies for the purpose of employing one full-time school nurse and one full-time mental health professional, and ensuring that the schools' libraries are open one hour before and three hours after the regular school day. AB 1955 was held on the Assembly Appropriations Committee’s suspense file.
   
   SB 596 (Yee, 2014) required the California Department of Education to establish a three-year pilot program to encourage inclusive practices that integrate mental health, special education, and school climate interventions following a multi-tiered framework. SB 596 was held at the Assembly Desk.
   
   AB 174 (Bonta, 2013) would have required the Department of Public Health to establish a pilot program in Alameda County, to the extent that funding is made available, to provide grants to eligible applicants for activities and services that directly address the mental health and related needs of students impacted by trauma. AB 174 was vetoed by the Governor, whose veto message read:
   
   

“I support the efforts of the bill but am returning it without my signature, as Alameda County can establish such a program without state intervention and may even be able to use Mental Health Services Act funding to do so.

Waiting for the state to act may cause unnecessary delays in delivering valuable mental health services to students. All counties - not just Alameda- should explore all potential funding options, including Mental Health Services Act funds, to tailor programs that best meet local needs.”

AB 1178 (Bocanegra, 2013) would have established the California Promise Neighborhood Initiative to provide funding to schools that have formalized partnerships with local agencies and community organizations to provide a network of services to improve the health, safety, education, and economic development of a defined area. AB 1178 was held in the Assembly Appropriations Committee.

AB 1367 (Mansoor, 2013) would have among other things, expanded existing outreach about recognition of early signs of potentially severe and disabling mental illness to include school districts and county offices of education and charter schools, including funding to provide training to identify students with mental health issues that may result in a threat to themselves or others in order to provide for timely intervention. AB 1367 was never heard.

AB 2105 (Scott, 2000) would have required the California Department of Education to establish a two-year pilot project in three school districts to improve the delivery of education services to children who need mental health services. AB 2105 was held in the Assembly Appropriations Committee.

SUPPORT

California School-Based Health Alliance

Los Angeles Trust for Children’s Health

OPPOSITION

None on file.

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