Date of Hearing: August 14, 2019

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

SBPCA Bill Id:SB 582

Author:(Beall) – As Amended Ver:August 12, 2019

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

SUMMARY:

This bill modifies the allocation of grant funding made available through the Investment in Mental Health Wellness Act of 2013 (ACT), requiring one half of grant funds be allocated to youth services consistent with the purposes of the Act. It also:

1. Requires the Mental Health Services Oversight and Accountability Commission (MHSOAC) to align the competitive grant process for awarding such funds to a similar mental health partnership competitive grant program created through this year’s budget.
2. Requires the grants supplement and not supplant existing resource allocations.
3. Requires the MHSOAC to prioritize on-campus and off-campus services for youth, including school-based partnerships and off-campus drop-in centers, as specified.

FISCAL EFFECT:

1. As this bill directs half of dollars appropriated to youth services, it may result in cost pressure to maintain funding levels for existing programs displaced by the new funding allocation. This program is funded at $20 million in fiscal year 2019-20 (MHSA administrative set-aside funds).
2. Costs of $200,000 to $350,000 to the MHSOAC to design, administer and evaluate grant programs for youth services pursuant this bill (MHSA administrative set-aside funds).

COMMENTS:

1. Purpose. This bill intends to set aside a portion of triage grant funds for youth mental health services to enhance mental health services for youth and in schools. According to the MHSOAC, in the first round of the Triage grant in 2018, 50 applications for program funds were received. Only six of those proposed programs were specific to youth, and only three of those met or exceeded the minimum threshold for funding. Therefore, youth-centric programs received just over 15% of the total available Triage funds. In order for California’s school-age population to be adequately served, the author believes it is necessary to set aside grant funds for these purposes.
2. History of Triage Grant Funding pursuant to the Investment in Mental Health Wellness Act of 2013. According to the Department of Finance, $200 million has been appropriated since the Act was passed, as shown below.

1. Related Legislation. SB 75 (Committee on Budget and Fiscal Review), Chapter 51, Statutes of 2019, establishes the Mental Health Student Services Act, which requires the MHSOAC to establish a competitive grant program to establish mental health partnerships between counties and local educational agencies. AB 74 (Ting), Chapter 23, Statutes of 2019, allocates up to $50 million for expenditure until June 30, 2024, to support the Act described. This bill requires alignment of the youth services grants with the program newly created by the Mental Health Student Services Act.

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

Date of Hearing: July 10, 2019

ASSEMBLY COMMITTEE ON EDUCATION

Patrick O'Donnell, Chair

SBPCA Bill Id:SB 582

Author:(Beall) – As Amended Ver:May 17, 2019

[Note: This bill was double referred to the Assembly Health Committee and was heard by that Committee as it relates to issues under its jurisdiction.]

SENATE VOTE: 38-0

SUBJECT: Youth mental health and substance use disorder services

SUMMARY: Requires the Mental Health Services Oversight and Accountability Commission (MHSOAC) to allocate at least one-half of the Investment in Mental Health Wellness Act (IMHWA) of 2013 triage grant program funds to local educational agency (LEA) and mental health partnerships, to support prevention, early intervention, and direct services to children and youth. Specifically, this bill:

1. Requires the MHSOAC, after July 1, 2021, when making triage grants under IMHWA, to allocate at least one-half of the funds to LEA and mental health partnerships, as specified, through a competitive process.
2. Provides that after July 1, 2026, the MHSOAC may, if it determines that funds are not being allocated due to a lack of qualified applicants, redirect any funds left unallocated for purposes that are consistent with the priorities of the MHSOAC, as specified.
3. Requires the MHSOAC, in consultation with the Superintendent of Public Instruction (SPI), to establish criteria for the allocation of funds. Requires, in order to be eligible to receive funding, a partnership to include one or more LEAs and one or more mental health partners. Requires a mental health partner to be either a county, including a county mental health plan or a qualified mental health provider operating as part of the county mental health plan network.
4. Requires funding allocated to be available to support prevention, early intervention, and direct services, including but not limited to, support for personnel, training, and other strategies that respond to the mental health needs of children and youth, as determined by the MHSOAC.
5. Provides that the strategies in 5) above may include, but are not limited to, the following:
   1. Communication, coordination, and referral;
   2. Monitoring service delivery to ensure the individual accesses and receives services;
   3. Monitoring the individual’s progress; and,
   4. Providing placement service assistance and service plan development.
6. Requires funding allocated to be made available to meet the mental health needs of children and youth, including those with an individual education plan (IEP) under the federal Individuals with Disabilities Education Act (IDEA) or a plan adopted under the federal Rehabilitation Act of 1973, as well as other children and youth in need of mental health services.
7. Requires the MHSOAC, in consultation with the SPI, to give positive consideration to each of the following factors in determining grant recipients:
8. Need for mental health services for children and youth, including campus-based mental health services, as well as potential gaps in local service connections;
9. Description of the funding request, including personnel and use of peer support;
10. Description of how the funds will be used to facilitate linkage and access to services;
11. Ability of the LEA to obtain federal Medicaid or other reimbursement, including Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) funds;
12. Ability of the LEA to collect information on the health insurance carrier for each child or youth in order to seek reimbursement, as specified;
13. Ability to engage a health care service plan or health insurer in the LEA and mental health partnership, as specified;
14. Ability to administer an effective service program and the degree to which mental health providers and LEAs will support and collaborate; and,
15. Geographic areas or regions of the state, including rural, suburban, and urban areas, as specified.
16. Requires the MHSOAC, in consultation with the SPI, to determine maximum funding awards, and to take into consideration the level of need, population to be served, and related criteria in 8) above.
17. Allows the MHSOAC to allocate less than one-half of the funds to LEA and mental health partnerships if there is an inadequate number of qualified applicants to receive the funds. Allows the MHSOAC to redirect any funds left unallocated toward youth services that are consistent with the priorities of the MHSOAC, as specified.
18. Permits funds awarded by the MHSOAC to be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, city mental health departments, qualified mental health agencies, or LEAs that receive funding.
19. Defines an 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.
20. Permits the MHSOAC, without taking any further regulatory action, to implement, interpret, or make specific this bill by means of informational letters, bulletins, or similar instructions.
21. Requires the MHSOAC to provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2022.
22. Requires that implementation of this bill be subject to an appropriation in the annual Budget Act or any other statute for that purpose.

EXISTING LAW:

1. Establishes the Mental Health Services Act (MHSA), enacted by voters in 2004 as Proposition 63, to provide funds to counties to expand services, develop innovative programs, and integrate service plans for mentally ill children, adults, and seniors through a one percent income tax on personal income above $1 million.
2. Establishes the Investment in Mental Health Wellness Act of 2013 (IMHWA), which requires triage funds appropriated by the Legislature to be made available to specified entities to be used, among other things, for a complete continuum of crisis services for children and youth 21 years of age and under. (Welfare and Institutions Code 5848.5)
3. Requires the California Department of Health Care Services (DHCS), pursuant to the MHSA and in coordination with counties, to establish a program designed to prevent mental illnesses from becoming severe and disabling and requires the program to emphasize strategies to reduce the following negative outcomes that may result from untreated mental illness:
   1. Suicide;
   2. Incarcerations;
   3. School failure or dropout;
   4. Unemployment;
   5. Prolonged suffering;
   6. Homelessness; and
   7. Removal of children from their homes.
4. Requires California counties to be responsible for both Medi-Cal specialty mental health services for seriously mental illness and for safety-net (non-Medi-Cal) community mental health services.
5. Expresses the intent of the Legislature that the governing board of each school district and each county superintendent of schools maintain fundamental school health services at a level that is adequate to accomplish all of the following: preserve pupils’ ability to learn, fulfill existing state requirements and policies regarding pupils’ health, and contain health care costs through preventive programs and education (Education Code 49427).

FISCAL EFFECT: According to the Senate Appropriations Committee:

1. Costs of $15 million (General Fund (GF)), ongoing, in local assistance to allocate IMHWA grants.
2. According to the MHSOAC, 2.0 Health Program Specialist II positions ($239,856) and 1.0 Research Program Specialist II ($119,928) to address the broader scope of applicant available uses, additional funding, additional preparation with California Department of Education (CDE) collaboration on level of need, as well as designing and evaluating the program outcomes to determine the effectiveness of the program. The MHSOAC would need research staff to develop metrics to evaluate the outcome of the triage grants on a statewide level.
3. The DHCS notes to the extent this bill facilitates linkages and access to services and leverages Medicaid funding, this may increase utilization of Medi-Cal Specialty Mental Health Services, and could result in additional claiming in the LEA Billing Option Program or the School-Based Medi-Cal Administrative Activities Program. According to the DHCS, this amount is indeterminate.
4. Staff notes potential one-time costs, likely between $50,000 and $100,000, for the DHCS to develop guidelines for county mental health departments to participate in the partnerships by the (GF).
5. According to the CDE, the 1.0 full-time, ongoing Education Program Consultant position to develop guidelines for local agencies to participate in the partnerships authorized in the bill, and to develop guidelines for the competitive grant program. Staff notes up to $140,000 (GF).

COMMENTS:

Need for the bill. According to the author, “Partnerships between schools and community mental/behavioral health professionals offer students and families an extended network of mental health programs and services that are easily accessible. When programs are able to identify and address student mental and behavioral challenges early, students are more likely to gain resiliency skills and be successful in school and life while the threat of later harm is reduced. Although youth mental health outreach has demonstrable benefits to children, only a handful of California schools have partnered with county mental health agencies and existing triage funds are primarily utilized for adult mental health services. A percentage of future triage grant funds should be dedicated to mental health crisis intervention services geared toward youth. SB 582 is of critical importance in providing equity in triage grant funds for youth mental health services. By directing 50% of the funds to school-based mental health strategies, SB 582 will incentivize partnerships and provide more robust mental health services in California schools.”

Incidence of mental health and behavioral health issues for children and youth. A 2014 UCLA Policy Brief notes that nearly half of all Americans will need mental health treatment some time during their lifetimes, with initial symptoms frequently occurring in childhood or adolescence. According to a report by the American Institutes for Research (AIR), Mental Health Needs of Children and Youth, up to 20 percent of children in the United States experience a mental, emotional, or behavioral health disorder every year.

Mental health needs of children and youth. According to a 2018 audit by the California State Auditor, between 97-98% of California children are enrolled in health coverage, with 5.5 million enrolled in Medi-Cal. The audit found that millions of children do not receive the preventive services to which they are entitled to under Medi-Cal. An annual average of 2.4 million children who were enrolled in Medi-Cal over the past five years had not received all of the preventive health services they were entitled to. California ranks 40th for all states in providing preventive health services to children.

According to a research brief, Investments in Students’ Physical and Mental Health in California’s Public Schools, published in 2018 as a part of the Getting Down to Facts II Study, “Child mental health is an increasingly important concern throughout the state due to rising rates of school shootings, teen hospitalizations for self-inflicted harm, and teen suicides. More than seven percent of children in California suffer from a serious emotional disturbance, and more than one in five female high school students report experiencing suicidal thoughts. Public schools can be a relatively desirable location for efficient and widespread distribution of mental health services to children. However, California provides fewer physical and mental health services in schools than almost any other state.”

School-based and school-linked mental health services for pupils. Across the country, school systems are increasingly joining forces with community health, mental health, and social service agencies to promote student well-being and to prevent and treat mental health disorders. Because children spend more time in school than in community mental health centers, schools are well positioned to link students with mental health services.

Mental health services that are provided in schools may include counseling, brief interventions to address behavior problems, assessments and referrals to other systems. Providing mental health services in a school-based setting helps address barriers to learning and provides supports so that all students can achieve in school and ultimately in life. Schools are also places where prevention and early intervention activities can occur in a non-stigmatizing environment.

Research suggests that comprehensive school mental health programs offer three tiers of support:

• Universal mental health promotion activities for all students;
• Selective prevention services for students identified as at risk for a mental health problem; and
• Indicated services for students who already show signs of a mental health problem.

Schools offering such programs may rely on partnerships with community systems, such as community mental health centers, hospitals, and universities. Schools, working with their community partners, can collect prevalence data to build a foundation to plan, develop, and implement comprehensive mental health programs and services through strong school-community partnerships.

Barriers to seeking treatment for mental and behavioral health disorders. Studies cite a lack of insurance coverage as one of the barriers to children and youth receiving mental health services. However, as mental health and substance abuse services were deemed to be an essential health benefit under the Affordable Care Act, this may be somewhat mitigated. Additional barriers to accessing mental health services include parents with limited English proficiency – 88% of children whose parents had limited English proficiency did not receive any mental health treatment compared to 66% of children with English proficient parents. Other barriers include the complexity of the care system, the inadequate linguistic capacity of existing professional services and resources, as well as the stigmas and cultural barriers to recognizing and seeking treatment for mental health problems.

Public mental health delivery system. A report from the California Health Care Foundation published in March of 2018 entitled “Mental Health in California: For Too Many, Care Not There,” stated that California’s mental health delivery system is a complex one. California counties are responsible for both Medi-Cal specialty mental health services for the seriously mentally ill and for safety-net (non Medi-Cal) community mental health services.

While counties have the same mandate and same funding streams, each county approaches the delivery of care in its own way. Oftentimes a county may be unaware of programs or activities being conducted in other counties – programs that may work well in their own community. Many counties lack resources and may be unable to develop the level of expertise required to develop or implement new ideas or concepts.

Proposition 63: The Mental Health Services Act (MHSA). Proposition 63 was passed by voters in November, 2004. The MHSA imposes a one percent income tax on personal income in excess of $1 million and creates the 16 member MHSOAC, charged with overseeing the implementation of MHSA. The MHSA addresses a broad continuum of prevention, early intervention and service needs as well as providing funding for infrastructure, technology and training needs for the community mental health system.

The MHSA requires each county behavioral health department to prepare and submit a three-year plan to DHCS that must be updated each year and approved by DHCS after review and comment by the Commission. In their three-year plans, counties are required to include a list of all programs for which MHSA funding is being requested and that identifies how the funds will be spent and which populations will be served. Counties must submit their plans for approval to the Commission before the counties may spend certain categories of funding, including the following:

1. Community Services and Supports: Provides direct mental health services to the severely and seriously mentally ill, such as mental health treatment, cost of health care treatment, and housing supports.
2. Prevention and Early Intervention: Provides services to mental health clients in order to help prevent mental illness from becoming severe and to improve timely access for underserved populations. Prevention and early intervention programs emphasize strategies to reduce negative outcomes that may result from untreated mental illness: suicide, incarcerations, school failure or dropout, unemployment, prolonged suffering, homelessness, and removal of children from their homes.
3. Innovation: Provides services and approaches that are creative in an effort to address mental health clients’ persistent issues, such as improving services for underserved or unserved populations within the community.

Arguments in support. The MHSOAC states, “The Commission has found that children are more likely to experience or express a mental health crisis in a school setting and therefore school-based programs are best able to effectively respond and support the shared goals of promoting mental health and achieving desired educational outcomes for youth with mental health needs. When programs are able to identify and address student mental and behavioral challenges early, students are more likely to gain resiliency skills and be successful in school and life while the threat of later harm is reduced.

SB 582 allocates at least half of the triage grant funds for services targeted to youth and encourages partnerships between schools and local mental health services. Although youth mental health outreach has demonstrable benefits to children, only a handful of California schools have collaborated with county mental health agencies and existing Triage funds are mostly utilized for adult mental health services. The Commission strongly supports SB 582 and the work to increase partnerships between schools and community mental/behavioral health professionals so that California can offer students and families an extended network of mental health programs and services that are easily accessible.”

Related legislation. AB 8 (Chu) of this Session would require public schools, including charter schools, to have one mental health professional who is accessible on campus during school hours for every 600 pupils by December 31, 2024, and requires counties to provide Mental Health Services Act funding to school districts, county offices of education, and charter schools for that purpose.

AB 1126 (O’Donnell) of this Session requires the MHSOAC to take specific measures to increase the transparency and accountability of mental health expenditures, and to support and share innovative practices in the delivery of mental health services, with a focus on youth mental health. This bill was held in the Assembly Appropriations Committee.

AB 1443 (Maienschein) of this Session would require the MHSOAC, subject to available funding to establish one or more technical assistance centers to support counties in addressing mental health issues as determined by the Commission, that are of statewide concern.

SB 604 (Bates) of this Session, would have required the MHSOAC, by January 1, 2021, to establish centers of excellence to provide the counties with technical assistance to implement best practices related to elements of the MHSA, would have required the centers of excellence to be funded with state administrative funds provided under MHSA. This bill was held in the Senate Appropriations Committee.

AB 875 (Wicks) of this Session would update the Healthy Start Support Services for Children Grant Program, previously administered by CDE, and identifies potential funding sources to provide health, mental health and other support services to pupils and their families.

SB 1019 (Beall) of the 2017-18 Session, was substantially similar to this bill. SB 1019 was vetoed by the Governor, with the following message:

The bill as written would limit the Commission's authority to exercise its judgment in the distribution of these grants. I believe the better practice would be to leave this matter to the Commission.

SB 191 (Beall) of the 2017-18 Session, was substantially similar to this bill, and was held in the Senate Appropriations Committee.

SB 1113 (Beall) of the 2015-16 Session was substantially similar to this bill, and was vetoed by the Governor, with the following message:

Despite significant funding increases for local educational agencies over the past few years, the Local Control Funding Formula remains only 96 percent funded. Given the precarious balance of the state budget, establishing new programs with the expectation of funding in the future is counterproductive to the Administration's efforts to sustain a balanced budget and to fully fund the Local Control Funding Formula. Additional spending to support new programs must be considered in the annual budget process.

SB 82 (Committee on Budget and Fiscal Review) Chapter 34, Statutes of 2013, establishes the Investment in Mental Health Wellness Act of 2013 and states the objectives of the Act regarding the need for renewed investment in community-based mental health treatment options.

REGISTERED SUPPORT / OPPOSITION:

Support

Alameda Unified School District
Amador County Unified School District
Aviva Family and Children's Services
Big Valley Joint Unified School District
California Behavioral Health Planning Council
California Academy of Child and Adolescent Psychiatry
California Alliance of Child and Family Services
Courage Campaign
David & Margaret Youth and Family Services
Disability Rights California
East Side Union High School District
Hathaway-Sycamores
Hillsides
Lake County Office of Education
Lassen County Office of Education 
Los Angeles Unified School District
Mental Health Services Oversight And Accountability Commission
NAMI California
National Center For Youth Law
Oakland Unified School District
San Diego County Office of Education
San Diego; County of
San Francisco Unified School District
San Francisco Unified School District Community Advisory Committee For Special Education
Santa Clara County Office of Education

Seneca Family Of Agencies
Teachers For Healthy Kids
The California Association of Local Behavioral Health Boards and Commissions

Opposition

None on file

Analysis Prepared by: Debbie Look / ED. / (916) 319-2087

Date of Hearing: June 18, 2019

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

SBPCA Bill Id:SB 582

Author:(Beall) – As Amended Ver:May 17, 2019

SENATE VOTE: 38-0

SUBJECT: Youth mental health and substance use disorder services.

SUMMARY: Requires the Mental Health Services Oversight and Accountability Commission (MHSOAC) to allocate at least one-half of the Investment in Mental Health Wellness Act (IMHWA) of 2013 triage grant program funds to local educational agency (LEA) and mental health partnerships, as specified, to support prevention, early intervention, and direct services to children and youth, as specified. Specifically, this bill:

1. Requires MHSOAC after July 1, 2021, except as specified in 2) below, when making grants under IMHWA to allocate at least one-half of the funds to LEA and mental health partnerships, as specified, through a competitive process.
2. Allows MHSOAC to allocate less than one-half of the funds to LEA and mental health partnerships if there is an inadequate number of qualified applicants to receive the funds. Allows MHSOAC to redirect any funds left unallocated toward youth services that are consistent with the priorities of the MHSOAC, as specified.
3. Provides that after July 1, 2026, the MHSOAC may, if it determines that funds are not being allocated due to a lack of qualified applicants, redirect any funds left unallocated for purposes that are consistent with the priorities of the MHSOAC, as specified.
4. Requires the MHSOAC, in consultation with the Superintendent of Public Instruction (SPI) to establish criteria for the allocation of funds. Requires, in order to be eligible to receive funding, a partnership to include one or more LEA and one or more mental health partnerships. Requires a mental health partnership to be either a county, including a county mental health plan or a qualified mental health provider operating as part of the county mental health plan network.
5. Requires funding allocated to be available to support prevention, early intervention, and direct services, including but not limited to, support for personnel, training, and other strategies that respond to the mental health needs of children and youth, as determined by MHSOAC.
6. Provides that the strategies in 5) above may include, but not be limited to, the following:
   1. Communication, coordination, and referral;
   2. Monitoring service delivery to ensure the individual accesses and receives services;
   3. Monitoring the individual’s progress; and,
   4. Providing placement service assistance and service plan development.
7. Requires funding allocated to be made available to meet the mental health needs of children and youth, including those with an individual education plan (IEP) under the federal Individuals with Disabilities Education Act (IDEA) or a plan adopted under the federal Rehabilitation Act of 1973, as well as other children and youth in need of mental health services.
8. Requires the MHSOAC, in consultation with the SPI, to give positive consideration to each of the following:
9. Description of need for mental health services for children and youth, including campus-based mental health services, as well as potential gaps in local service connections;
10. Description of the funding request, including personnel and use of peer support;
11. Description of how the funds will be used to facilitate linkage and access to services;
12. Ability to obtain federal Medicaid or other reimbursement, as specified;
13. Ability of the LEA to collect information on the health insurance carrier for each child or youth, as specified;
14. Ability to engage a health care service plan or health insurer in the LEA and mental health partnership, as specified;
15. Ability to administer an effective service program and the degree to which mental health providers and LEAs will support and collaborate; and,
16. Geographic areas or regions of the state to be eligible for funding, including rural, suburban, and urban areas, as specified.
17. Requires MHSOAC, in consultation with the SPI, to determine maximum funding awards, and to take into consideration the level of need, population to be served, and related criteria in 8) above.
18. Permits funds awarded by MHSOAC to be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, city mental health departments, qualified mental health agencies or LEAs that receive funding.
19. Defines an LEA to mean 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.
20. Permits the MHSOAC without taking any further regulatory action to implement, interpret, or make specific this bill by means of informational letters, bulletins, or similar instructions.
21. Requires the MHSOAC to provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2022.
22. Requires that implementation of this bill be subject to an appropriation in the annual Budget Act or any other statute for that purpose.

EXISTING LAW:

1. Establishes the IMHWA, which requires funds appropriated by the Legislature to be made available to specified entities to be used, among other things, for a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. States the objectives of the IMHWA as expanding access to early intervention and treatment; expanding continuum of services to address such things as crisis stabilization, intervention, and residential treatment; adding at least 600 triage personnel; and, providing local communities with increased financial resources to leverage additional public and private funds to improve networks for those with mental health disorders.
2. Requires the MHSOAC to allocate grant funds from the IMHWA for triage personnel, using specified criteria, to provide intensive case management and linkage to services, as specified, for individuals with mental health disorders at various access points, including schools.
3. Establishes the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program for eligible people under 21 years of age to provide periodic screenings to determine health care needs, and based upon the identified health care need and diagnosis, treatment services are provided. Requires EPSDT services to be administered through local county mental health plans under contract with the Department of Health Care Services (DHCS).
4. Establishes the School-based Early Mental Health Intervention and Prevention Services for Children Act (EMHI) and authorizes the Director of the DHCS (formerly the Director of the Department of Mental Health), in consultation with the SPI, 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.
5. 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 one through three, with services provided by child aides under the supervision of a school-based mental health professional.
6. Defines “local educational agency” as a school district, a county office of education, a nonprofit charter school participating as a member of a special education local plan area (SELPA).
7. Sets forth the process for the development, review, and revision of a pupil’s individualized education program.

FISCAL EFFECT: According to the Senate Appropriations Committee:

1. Costs of $15 million (General Fund (GF)), ongoing, in local assistance to allocate IMHWA grants.
2. According to the MHSOAC, 2.0 Health Program Specialist II positions ($239,856) and 1.0 Research Program Specialist II ($119,928) to address the broader scope of applicant available uses, additional funding, additional preparation with California Department of Education (CDE) collaboration on level of need, as well as designing and evaluating the program outcomes to determine the effectiveness of the program. The MHSOAC would need research staff to develop metrics to evaluate the outcome of the triage grants on a statewide level.
3. The DHCS notes to the extent this bill facilitates linkages and access to services and leverages Medicaid funding, this may increase utilization of Medi-Cal Specialty Mental Health Services, and could result in additional claiming in the LEA Billing Option Program or the School-Based Medi-Cal Administrative Activities Program. According to the DHCS, this amount is indeterminate.
4. Staff notes potential one-time costs, likely between $50,000 and $100,000, for the DHCS to develop guidelines for county mental health departments to participate in the partnerships by the (GF).
5. According to the CDE, the 1.0 full-time, ongoing Education Program Consultant position to develop guidelines for local agencies to participate in the partnerships authorized in the bill, and to develop guidelines for the competitive grant program. Staff notes up to $140,000 (GF).

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill is of critical importance in providing equity in triage grant funds for youth mental health services. The funding parity established by this bill will open up more resources to provide more robust mental health services in California schools. According to the MHSOAC, in the first round of the Triage grant in 2018, 50 applications for program funds were received. Only six of those proposed programs were specific to youth, and only three of those met or exceeded the minimum threshold for funding. Therefore, the grantees with youth-centric programs received just over 15% of the total available Triage funds. In order for California’s school-age population to be adequately served, equity in the Triage grant fund allocation is a necessary first step. This bill also requires these funds to be used to incentivize counties and school districts to integrate mental health service in schools.
2. BACKGROUND. According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA), 50% of adult mental illness begins before the age of 14, and 75% before age 24. More than 40% of youth ages 13 to 17 have experienced a behavioral health problem by the time they reach seventh grade. In addition, suicide is the third leading cause of death among youth ages 15 to 24 after accidents and homicide. Compared with their peers, people within this age group with mental disorders are more likely to experience homelessness, be arrested, drop out of school, and be underemployed. In 2014, about one in 10 youth ages 12 to 17 (11.4%) had a major depressive episode (MDE) in the past year. Among adolescents with MDE, 41.2% received treatment or counseling for depression in the past year. Combined 2010–2012 data from SAMHSA’s National Survey on Drug Use and Health indicates that one in five young adults ages 18 to 25 (18.7%) reported a mental illness in the past year and 3.9% were diagnosed with a serious mental illness. In 2014, 1.4% of adolescents had a co-occurring MDE and a substance use disorder.
   1. IDEA. The federal IDEA provides that students with exceptional needs identified as having emotional disturbance may be eligible to receive mental health services, which are considered related services and include counseling, psychological services, parent counseling and training, and residential placement, among others. Prior to 2012, a student with exceptional needs, who also had mental health needs and services documented in their IEP, was referred by the LEAs to county mental health agencies for treatment, under AB 3632 (Brown), Chapter 26, Statutes of 1984. AB 114 (Committee on Budget), Chapter 43, Statutes of 2011, shifted responsibility for providing and funding IDEA-related mental health services from county mental health agencies to LEAs (the SPI is responsible for monitoring LEAs to ensure compliance). Any and all services identified in a student’s IEP must be provided, whether directly by LEA employees or through contract with outside providers, such as county mental health agencies. LEAs are required to ensure services are provided to students regardless of who provides or pays for those services.
   2. IMHWA triage grants. The purpose of the triage grants is to increase triage personnel in various settings, including schools, to provide crisis intervention, crisis stabilization, mobile crisis support, and intensive case management and linkage to services for individuals with mental health disorders at various points of access, with a focus on children and youth. Triage personnel are authorized to provide services anywhere in the community and provide services that include monitoring service delivery to ensure individuals access and receive services, monitoring an individual’s progress, and providing placement service assistance. The MHSOAC began an information-gathering process in early 2017 to receive input from counties and stakeholders about the rollout of initial triage grants, and to explore options in improving the process of distributing future grants. The 2016 Budget Act allocated $27 million to the IMHWA, which included nearly $3 million for family respite, such as additional triage personnel. The MHSOAC found that there was confusion among counties and stakeholders regarding the intent of these grants. Of 50 initial applications for triage grants that the MHSOAC received, only six proposed programs were specific to youth services, and only three of the six met or exceeded the minimum threshold score for funding, resulting in only 15% of the initial triage grant funds going to youth-centric programs. The MHSOAC recommends a percentage of future triage grant funds be dedicated to mental health crisis intervention services geared toward youth. The MHSOAC states that because schools are a major access point for children to receive mental health services in their county, the triage grant funds may increase collaboration between schools and county behavioral health departments.

According to the MHSOAC, a second round of triage grants totaling $83 million was awarded in 2018, and will be sustained through 2021. Individuals experiencing a mental health crisis will be assisted in various settings, such as schools, shelters, jails, clinics, and in the community. Berkeley, Calaveras, Humboldt, and Tuolumne Counties were awarded grants with nearly $2 million dedicated to services for transition-age youth (TAY) aged 16-24, and adults, and more than $1 million dedicated to services for those aged 0-21. Butte, Merced, Placer, San Luis Obispo, Santa Barbara, Sonoma, Stanislaus, and Yolo Counties were awarded grants with about $4.3 million dedicated to TAY and adults, and about $3 million dedicated to those aged 0-21. Alameda, Los Angeles, Riverside, Sacramento, San Francisco, and Ventura counties received about $28 million dedicated to TAY and adults, and about $17 million for those aged 0-21. Additionally, Humboldt, Placer, and Tulare Counties and the California Association of Health and Education Linked Professions Joint Power Authority received about $21.2 million to support school-county partnerships.

• 1. Student mental health services audit. In January 2016, the California State Auditor released report 2015-112, which reviewed the effect of AB 114 mental health services provided to pupils through IEPs. Among the findings were: the mental health services and providers did not change at the four LEAs reviewed; in some cases LEAs removed mental health services from student IEPs because of AB 114 and for other students the LEAs could not explain why services were removed; the CDE had not performed an analysis of the education outcomes to determine if pupil outcomes had improved; CDE did not require LEAs to track total expenditures for mental health services; none of the four LEAs could determine their total costs to provide mental health services; and, only one of the four LEAs had contracted with its county to access certain funding for mental health services through Medi-Cal. The audit, among other things, recommended the Legislature require counties to enter into agreements with SELPAs to allow SELPAs and their LEAs to access federal funding.

1. SUPPORT. According to the MHSOAC, sponsor of this bill, children are more likely to experience or express a mental health crisis in a school setting and therefore school-based programs are best able to effectively respond and support the shared goals of promoting mental health and achieving desired educational outcomes for youth with mental health needs. When programs are able to identify and address student mental and behavioral challenges early, students are more likely to gain resiliency skills and be successful in school and life while the threat of later harm is reduced. Although youth mental health outreach has demonstrable benefits to children, only a handful of California schools have collaborated with county mental health agencies and existing Triage funds are mostly utilized for adult mental health services. MHSOAC concludes, they strongly support this will and the work to increase partnerships between schools and community mental/behavioral health professionals so that California can offer students and families an extended network of mental health programs and services that are easily accessible.
2. RELATED LEGISLATION.
   1. AB 8 (Chiu and Eduardo Garcia) would require, on or before December 31, 2022, a school of a school district or county office of education and a charter school to have at least one mental health professional, as defined, for every 400 pupils generally accessible to pupils on campus during school hours. AB 8 is pending in the Senate Health Committee.
   2. AB 1126 (O’Donnell) would require CDE to collaborate with DHCS to streamline and simplify the processes whereby LEAs and county behavioral health agencies collaborate to leverage available funding to provide mental health services to pupils. AB 1126 was held in the Assembly Appropriations Committee.
   3. SB 428 (Pan and Portantino) would require an applicant for a clear multiple or single subject teaching credential to complete a course in youth mental health first aid. SB 428 is pending in the Senate Appropriations Committee.
3. PREVIOUS LEGISLATION.
   1. SB 1019 (Beall) of 2018, SB 191 (Beall) of 2017, and SB 1113 (Beall) of 2016 were all substantially similar to this bill. SB 1019 was vetoed by the Governor who stated the bill: “would limit the MHSOAC’s authority to exercise its judgment in the distribution of these grants, and a better practice would be to leave this matter to the MHSOAC.” SB 191 was held in the Senate Appropriations Committee.
      
   2. SB 1113 was vetoed by the Governor, whose veto message stated that the bill: “created an unfunded new program, and given the precarious balance of the state budget, establishing new programs with the expectation of funding in the future is counterproductive to the Administration's efforts to sustain a balanced budget and to fully fund the Local Control Funding Formula.” The Governor further stated that additional spending to support new programs must be considered in the annual budget process.
   3. AB 114 shifts responsibility for mental health services for students from counties to LEAs.
   4. AB 1315 (Mullin) Chapter 414, Statutes of 2018, establishes an advisory committee to the MHSOAC for purposes of creating an early psychosis and mood disorder detection and intervention competitive selection process to, among other things, improve access to effective services for transition-aged youth and young adults at high risk for, or experiencing, psychotic symptoms, as specified.
   5. AB 1644 (Bonta) of 2016 would have required 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, required DPH to provide technical assistance to LEAs, and required DPH to select and support school sites to participate in the program. AB 1644 was held in the Senate Appropriations Committee.
   6. AB 580 (O’Donnell) of 2015 would have required 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 stated that: “California does not currently have specific model referral protocols for addressing student mental health as outlined by the bill; however, the CDE recently received a grant from the federal Department of Health and Human Services SAMHSA to identify and address critical student and family mental health needs.” The Governor further stated that “it's premature to impose an additional and overly prescriptive requirement until the current efforts are completed and the state can strategically target resources to best address student mental health.”
   7. AB 1018 (Cooper) of 2015 would have required DHCS 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.
   8. AB 1025 (Thurmond) of 2015 would have required 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.
   9. SB 82 (Committee on Budget and Fiscal Review) Chapter 34, Statutes 2013, establishes the Investment in Mental Health Wellness Act of 2013 (Act) and states the objectives of this Act regarding the need for a renewed investment in community-based mental health treatment options.
4. DOUBLE REFERRAL. This bill is double referred and upon passage in this committee, will be referred to the Assembly Committee on Education.

REGISTERED SUPPORT / OPPOSITION:

Support

Mental Health Services Oversight and Accountability Commission (sponsor)

Alameda Unified School District

Amador County Unified School District

Amador County Public Schools

Association of California School Administrators

Aviva Family and Children's Services
Big Valley Joint Unified School District
California Academy of Child and Adolescent Psychiatry
California Alliance of Child and Family Services
California Association of Local Behavioral Health Boards and Commissions

Courage Campaign
David & Margaret Youth and Family Services
Disability Rights California
Hillsides
Lake County Office of Education

La Mesa-Spring Valley Schools
Los Angeles Unified School District

Los Angeles Trust for Children’s Health
Murrieta Valley Unified School District

NAMI California
San Jose Unified School District

Seneca Family of Agencies
Teachers for Healthy Kids

Opposition

None on file.

Analysis Prepared by: Judith Babcock / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 582

Author: Beall (D), et al.

Amended: 5/17/19

Vote: 21

SENATE HEALTH COMMITTEE: 9-0, 3/27/19

AYES: Pan, Stone, Durazo, Grove, Hurtado, Leyva, Mitchell, Monning, Rubio

SENATE EDUCATION COMMITTEE: 7-0, 4/10/19

AYES: Leyva, Wilk, Chang, Durazo, Glazer, McGuire, Pan

SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/16/19

AYES: Portantino, Bates, Bradford, Hill, Jones, Wieckowski

SUBJECT: Youth mental health and substance use disorder services

SOURCE: Author

DIGEST:

This bill requires the Mental Health Services Oversight and Accountability Commission to allocate at least one-half of Investment in Mental Health Wellness Act of 2013 triage grant program funds to local educational agency and mental health partnerships, as specified, to support prevention, early intervention, and direct services to children and youth, as specified.

ANALYSIS:

Existing law:

1. Establishes the Investment in Mental Health Wellness Act of 2013 (IMHWA), which requires funds appropriated by the Legislature to be made available to specified entities to be used, among other things, for a complete continuum of crisis services for children and youth 21 years of age and under. [WIC §5848.5]
2. Requires the Mental Health Services Oversight and Accountability Commission (MHSOAC) to allocate grant funds from the IMHWA for triage personnel, using specified criteria, to provide intensive case management and linkage to services, as specified, for individuals with mental health disorders at various access points, including schools. [WIC §5848.5]
3. Establishes the Medi-Cal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program for eligible people under 21 years of age to provide periodic screenings to determine health care needs, and based upon the identified health care need and diagnosis, treatment services are provided. Requires EPSDT services to be administered through local county mental health plans under contract with the Department of Health Care Services (DHCS). [WIC §14132]
4. Defines “local educational agency (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 (SELPA), or a SELPA. [EDC §56026.3]
5. Sets forth the process for the development, review, and revision of a pupil’s individualized education program (IEP). [EDC §56340, et seq.]

This bill:

1. Requires the MHSOAC, on or after July 1, 2021, when issuing grants pursuant to the IMHWA, to allocate at least one-half of the funds to LEA and mental health partnerships through a competitive process.
2. Permits the MHSOAC to allocate less than one-half of the funds to LEA and mental health partnerships if there is an inadequate number of qualified applicants to receive the funds. Permits the MHSOAC to redirect any funds left unallocated toward youth services, as specified.
3. Permits the MHSOAC, on and after July 1, 2026, if it determines that funds are not being allocated pursuant due to a lack of qualified applicants, to redirect any funds left unallocated for purposes that are consistent with the priorities of the MHSOAC, as specified.
4. Requires the MHSOAC, in consultation with the Superintendent of Public Instruction, to establish criteria for the allocation of funds. Requires, in order to be eligible to receive funding, a partnership to include one or more LEA, and one or more mental health partners. Requires a mental health partner to be either a county, including a county mental health plan, or a qualified mental health provider operating as a part of the county mental health plan network.
5. Requires funding allocated to be available to support prevention, early intervention, and direct services, including, but not limited to, support for personnel, training, and other strategies that respond to the mental health needs of children and youth, as determined by the MHSOAC.
6. Requires funding allocated to be available to support prevention, early intervention, and direct services, including, but not limited to, support for personnel, training, and other strategies that respond to the mental health needs of children and youth, as determined by the MHSOAC.
7. Requires the MHSOAC, in consultation with the Superintendent of Public Instruction, to give positive consideration when determining grant recipients to each of the following:
   1. Description of need for mental health services for children and youth, including campus-based mental health services, as well as potential gaps in local service connections;
   2. Description of the funding request, including personnel and use of peer support;
   3. Description of how the funds will be used to facilitate linkage and access to services;
   4. Ability to obtain federal Medicaid or other reimbursement, as specified;
   5. Ability of the LEA to collect information on the health insurance carrier for each child or youth, as specified;
   6. Ability to engage a health care service plan or health insurer in the LEA and mental health partnership, as specified;
   7. Ability to administer an effective service program and the degree wo which mental health providers and LEAs will support and collaborate; and,
   8. Geographic areas or regions of the state to be eligible for funding, including rural, suburban, and urban areas, as specified.
8. Requires the MHSOAC, in consultation with Superintendent of Public Instruction, to determine maximum funding awards and to take into account the criteria in 5) above.
9. Permits funds awarded by the MHSOAC to be used to supplement, but not supplant, existing financial and resource commitments, as specified.
10. Requires the MHSOAC to provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2022.
11. Requires the provisions in this bill to be implemented subject to an appropriation in the annual Budget Act or any other statute, as specified.
12. Makes findings and declarations that school settings, particularly those with multitiered models that ensure prompt support for students, demonstrate that early investments result in savings and improved academic success, and by allocating funds to establish partnerships between LEAs and mental health plans, the entities involved can help yield greater mental health outcomes for California’s youth.

Comments

1. Author’s statement. According to the author, this bill is of critical importance in providing equity in triage grant funds for youth mental health services and restoring the 40% cut in triage grants in 2018. The funding parity established by this bill will open up more resources to provide more robust mental health services in California schools. According to the MHSOAC, in the first round of the triage grants in 2018, 50 applications for program funds were received. Only six of these proposed programs were specific to youth, and only three of those met or exceeded the minimum threshold for funding. Therefore, the grantees with youth-centric programs received just over 15% of the total available triage funds. In order for California’s school-age population to be adequately served, equity in the triage grant fund allocation is a necessary first step. This bill also requires these funds to be used to incentivize counties and school districts to integrate mental health services in schools.
2. Individuals with Disabilities Education Act (IDEA). The federal IDEA provides that students with exceptional needs identified as having emotional disturbance may be eligible to receive mental health services, which are considered related services and include counseling, psychological services, parent counseling and training, and residential placement, among others. Prior to 2012, a student with exceptional needs, who also had mental health needs and services documented in their IEP, was referred by the LEAs to county mental health agencies for treatment, pursuant to AB 3632 (Brown, Chapter 26, Statutes of 1984). AB 114 (Committee on Budget, Chapter 43, Statutes of 2011) shifted responsibility for providing and funding IDEA-related mental health services from county mental health agencies to LEAs (the Superintendent of Public Instruction is responsible for monitoring LEAs to ensure compliance). Any and all services identified in a student’s IEP must be provided, whether directly by LEA employees or through contract with outside providers, such as county mental health agencies. LEAs are required to ensure services are provided to students regardless of who provides or pays for those services.
3. IMHWA triage grants. The purpose of the triage grants is to increase triage personnel in various settings, including schools, to provide crisis intervention, crisis stabilization, mobile crisis support, and intensive case management and linkage to services for individuals with mental health disorders at various points of access, with a focus on children and youth. Triage personnel are authorized to provide services anywhere in the community and provide services that include monitoring service delivery to ensure individuals access and receive services, monitoring an individual’s progress, and providing placement service assistance. The MHSOAC began an information-gathering process in early 2017 to receive input from counties and stakeholders about the rollout of initial triage grants, and to explore options in improving the process of distributing future grants. The 2016 Budget Act allocated $27 million to the IMHWA, which included nearly $3 million for family respite, such as additional triage personnel. The MHSOAC found that there was confusion among counties and stakeholders. Of 50 initial applications for triage grants that the MHSOAC received, only six proposed programs were specific to youth services, and only three of the six met or exceeded the minimum threshold score for funding, resulting in only 15% of the initial triage grant funds going to youth-centric programs. The MHSOAC recommends a percentage of future triage grant funds be dedicated to mental health crisis intervention services geared toward youth. The MHSOAC states that because schools are a major access point for children to receive mental health services in their county, the triage grant funds may increase collaboration between schools and county behavioral health departments.

According to the MHSOAC, a second round of triage grants totaling $83 million was awarded in 2018, and will be sustained through 2021. Individuals experiencing a mental health crisis will be assisted in various settings, such as schools, shelters, jails, clinics, and in the community. Berkeley, Calaveras, Humboldt, and Tuolumne Counties were awarded grants with nearly $2 million dedicated to services for transition-age youth (TAY) and adults, and more than $1 million dedicated to services for those aged 0-21. Butte, Merced, Placer, San Luis Obispo, Santa Barbara, Sonoma, Stanislaus, and Yolo Counties were awarded grants with about $4.3 million dedicated to TAY and adults, and about $3 million dedicated to those aged 0-21. Alameda, Los Angeles, Riverside, Sacramento, San Francisco, and Ventura counties received about $28 million dedicated to TAY and adults, and about $17 million for those aged 0-21. Additionally, Humboldt, Placer, and Tulare Counties and the California Association of Health and Education Linked Professions JPA received about $21.2 million to support school-county partnerships.

1. Student mental health services audit. In January 2016, the California State Auditor released report 2015-112, which reviewed the effect of AB 114 mental health services provided to pupils through IEPs. Among the findings were: the mental health services and providers did not change at the four LEAs reviewed; in some cases LEAs removed mental health services from student IEPs because of AB 114 and for other students the LEAs could not explain why services were removed; the California Department of Education (CDE) had not performed an analysis of the education outcomes to determine if pupil outcomes had improved; CDE did not require LEAs to track total expenditures for mental health services; none of the four LEAs could determine their total costs to provide mental health services; and, only one of the four LEAs had contracted with its county to access certain funding for mental health services through Medi-Cal. The audit, among other things, recommended the Legislature require counties to enter into agreements with SELPAs to allow SELPAs and their LEAs to access federal funding.

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

According to the Senate Appropriations Committee:

• $15 million (General Fund), ongoing, in local assistance to allocate IMHWA grants.
• According to the MHSOAC, 2.0 Health Program Specialist II positions ($239,856) and 1.0 Research Program Specialist II ($119,928) to address the broader scope of applicant available uses, additional funding, additional preparation with CDE collaboration on level of need, as well as designing and evaluating the program outcomes to determine the effectiveness of the program. MHSOAC would need research staff to developed metrics to evaluate the outcome of the triage grants on a statewide level.
• DHCS notes to the extent SB 582 facilitates linkages and access to services and leverages Medicaid funding, this may increase utilization of Medi-Cal Specialty Mental Health Services, and could result in additional claiming in the LEA Billing Option Program or the School-Based Medi-Cal Administrative Activities Program. According to DHCS, this amount is indeterminate.
• Staff notes potential one-time costs, likely between $50,000 and $100,000, for DHCS to develop guidelines for county mental health departments to participate in the partnerships (General Fund).
• According to CDE, the 1.0 full-time, ongoing Education Program Consultant position to develop guidelines for LEAs to participate in the partnerships authorized in the bill, and to develop guidelines for the competitive grant program. Staff notes up to $140,000 (General Fund).

SUPPORT: (Verified 5/17/19)

Alameda Unified School District

Amador County Unified School District

Association of California School Administrators

California Alliance of Child and Family Services

California Association of Local Behavioral Health Boards and Commissions

Disability Rights California

Hillsides

La Mesa-Spring Valley School District

Los Angeles Trust for Children’s Health

Los Angeles Unified School District

Mental Health Services Oversight and Accountability Commission

Murrieta Valley Unified School District

Seneca Family of Agencies

Teachers for Healthy Kids

OPPOSITION: (Verified 5/17/19)

None received

ARGUMENTS IN SUPPORT: Supporters of this bill, largely youth advocates and school districts, state that the MHSOAC found that children are more likely to experience or express mental health crises in a school setting, and thus school-based programs can effectively respond and support the shared goal of promoting mental health and achieving desired educational outcomes for youth with mental health needs. Supporters further argue that partnerships between schools and community mental/behavioral health professionals offer students and families an extended network of mental health programs and services that are easily accessible. Supporters state that although youth mental health outreach has demonstrable benefits to children, only a handful of California schools have collaborated with county mental health agencies, and existing triage funds are mostly utilized for adult mental health services.

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

5/20/19 14:54:14

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

SB 582 (Beall) - Youth mental health and substance use disorder services

Bill Summary:

Senate Bill 582 would appropriate $15 million General Fund to the Mental Health Services Oversight and Accountability Commission (OAC), and require the OAC, on and after July 1, 2021, when making grant funds available from the Mental Health Wellness Act (MHWA), to allocate at least half of the 2013 funds to local education agency and mental health partnerships through a competitive process. Would require the OAC, in consultation with the Superintendent of Public Instruction, to establish criteria for the allocation of funds. Would require LEAs and partnerships to use the funds for mental health for specified services and activities. Would require the OAC to provide an implementation status report to the Legislature by March 1, 2022.

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on May 16, 2019

Fiscal Impact:

• Cost pressures of:
• $15 million (General Fund), ongoing, in local assistance to allocate MHWA grants.
• According to the OAC, 2.0 Health Program Specialist II positions ($239,856) and 1.0 Research Program Specialist II ($119,928) to address the broader scope of applicant available uses, additional funding, additional preparation with CDE collaboration on level of need, as well as designing and evaluating the program outcomes to determine the effectiveness of the program. The Commission would need research staff to developed metrics to evaluate the outcome of the triage grants on a statewide level.
• The Department of Health Care services notes to the extent SB 582 facilitates linkages and access to services and leverages Medicaid funding, this may increase utilization of Medi-Cal Specialty Mental Health Services, and could result in additional claiming in the LEA Billing Option Program or the School-Based Medi-Cal Administrative Activities Program. According to the DHCS, this amount is indeterminate.
• Staff notes potential one-time costs, likely between $50,000 and $100,000, for the Department of Health Care Services to develop guidelines for county mental health departments to participate in the partnerships by the (General Fund)
• According to the Department of Education, the 1.0 full-time, ongoing Education Program Consultant position to develop guidelines for local agencies to participate in the partnerships authorized in the bill, and to develop guidelines for the competitive grant program. Staff notes up to $140,000 General Fund.

Committee Amendments:

The committee would make the bill’s provisions subject to an appropriation in the annual Budget Act or any other statute for that purpose.

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

SB 582 (Beall) - Youth mental health and substance use disorder services

Bill Summary:

Senate Bill 582 would appropriate $15 million General Fund to the Mental Health Services Oversight and Accountability Commission (OAC), and require the OAC, on and after July 1, 2021, when making grant funds available from the Mental Health Wellness Act (MHWA), to allocate at least half of the 2013 funds to local education agency and mental health partnerships through a competitive process. Would require the OAC, in consultation with the Superintendent of Public Instruction, to establish criteria for the allocation of funds. Would require LEAs and partnerships to use the funds for mental health for specified services and activities. Would require the OAC to provide an implementation status report to the Legislature by March 1, 2022.

Fiscal Impact:

• $15 million (General Fund), ongoing, in local assistance to allocate IMHWA grants.
• According to the OAC, 2.0 Health Program Specialist II positions ($239,856) and 1.0 Research Program Specialist II ($119,928) to address the broader scope of applicant available uses, additional funding, additional preparation with CDE collaboration on level of need, as well as designing and evaluating the program outcomes to determine the effectiveness of the program. The Commission would need research staff to developed metrics to evaluate the outcome of the triage grants on a statewide level.
• The Department of Health Care services notes to the extent SB 582 facilitates linkages and access to services and leverages Medicaid funding, this may increase utilization of Medi-Cal Specialty Mental Health Services, and could result in additional claiming in the LEA Billing Option Program or the School-Based Medi-Cal Administrative Activities Program. According to the DHCS, this amount is indeterminate.
• Staff notes potential one-time costs, likely between $50,000 and $100,000, for the Department of Health Care Services to develop guidelines for county mental health departments to participate in the partnerships by the (General Fund)
• According to the Department of Education, the 1.0 full-time, ongoing Education Program Consultant position to develop guidelines for local agencies to participate in the partnerships authorized in the bill, and to develop guidelines for the competitive grant program. Staff notes up to $140,000 General Fund.

Background:

1. The federal Individuals with Disabilities Education Act (IDEA) provides that students with exceptional needs may be eligible to receive mental health services, including counseling, psychological services, parent counseling and training, and residential placement, among others. Prior to 2012, a student with exceptional needs, who also had mental health needs and services documented in their individualized education program (IEP), was referred by the LEAs to county mental health agencies for treatment (AB 3632, Chapter 26, Statutes of 1984). AB 114 (Committee on Budget Chapter 43, Statutes of 2011) shifted responsibility for providing and funding IDEA-related mental health services from county mental health agencies to LEAs. Any and all services identified in a student’s IEP must be provided, whether directly by LEA employees or through contract with outside providers, such as county mental health agencies. LEAs are required to ensure services are provided to students regardless of who provides or pays for those services.

The Mental Health Wellness Act requires funds appropriated by the Legislature to be made available to specified entities for, among other things, a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. States the objectives of the MHWA as expanding access to early intervention and treatment; expanding continuum of services to address such things as crisis stabilization, intervention, and residential treatment; adding at least 600 triage personnel; and providing local communities with increased financial resources to leverage additional public and private funds to improve networks for those with mental health disorders. (Welfare and Institutions Code § 5848.5)

The OAC must allocate grant funds from the MHWA for triage personnel, using specified criteria, to provide intensive case management and linkage to services, as specified, for individuals with mental health disorders at various access points, including schools.

Oftentimes, there is an overlap between the mental health services identified in a student’s individualized education program and mental health services that the student is entitled to under the Medi-Cal program (for those students who are Medi-Cal eligible). In this case, an LEA could use the Medi-Cal program to draw down federal matching funds for the services provided. In order to receive federal matching funds, an LEA must either participate in the Local Educational Agency Medi-Cal Billing Option Program (the LEA must enroll with the state as a Medi-Cal provider and meet certain administrative requirements) or an LEA may contract with a county mental health plan (under which the county mental health plan can provide the services to students or the LEA can become a contracted provider with the county mental health plan in order).

The 2016 Budget Act allocated $27 million to the MHWA. According to the Commission, a second round of triage grants totaling $83 million was awarded in 2018, and will be sustained through 2021. In 2017, the Commission found that, of 50 initial applications for triage grants that the Commission received, only six proposed programs were specific to youth services. Of these, only three of the six met or exceeded the minimum threshold score for funding. As a result, only 15 percent of the initial triage grant funds supported youth-centric programs.

Proposed Law:

This bill would authorize a county, or a qualified provider as specified, and an LEA to enter into a partnership to create a program for the provision of mental health and substance use disorder services to students. In addition, the bill:

• Requires, on and after July 1, 2021, the Mental Health Services Oversight and Accountability Commission (OAC), when making grant funds available, as specified, to allocate at least one-half of the funds to LEAs and to MHPs, through a competitive process.
• Authorizes the OAC to allocate less than one-half to ELAs and MHPs, if there is an inadequate number of qualified applicants to receive the funds. Authorizes the OAC to redirect any unallocated funds toward youth services consistent with existing law and the priorities of the commission.
• Authorizes the OAC, on and after July 1, 2026, after determining that funds are not being allocated due to a lack of qualified applicants, to redirect any unallocated funds for purposes that are consistent with existing law and with the priorities of the OAC.
• Requires OAC, in consultation with the Superintendent of Public Instruction (SPI), to establish criteria for the allocation of funds and determine maximum funding award. A partnership must include one or more local educational agencies and one or more mental health partners. A mental health partner must be either a county, including a county mental health plan, or a qualified mental health provider operating as part of the county mental health plan network.
• Requires the funding must be to support prevention, early intervention, and direct services, including, but not limited to, support for personnel, training, and other strategies, as specified, that respond to the mental health needs of children and youth, including those with an individual education plan, or a plan adopted to the federal Rehabilitation Act of 1973
• Specifies criteria for how the OAC, in consultation with the Superintendent of Public Instruction, determines grant recipients.
• Authorizes funds to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, city mental health departments, qualified mental health agencies, or local education agencies that receive funding.
• Authorizes OAC to implement the bill by means of informational letters, bulletins, or similar instructions.
• Requires the OAC to provide an implementation status report to the fiscal and policy committees of the Legislature no later than March 1, 2022.

Related Legislation:

• AB 8 (Chiu, Eduardo Garcia) would require, on or before December 31, 2022, a school of a school district or county office of education and a charter school to have at least one mental health professional, as defined, for every 400 pupils generally accessible to pupils on campus during school hours. AB 8 is pending in the Assembly Appropriations Committee.
• AB 1126 (O’Donnell) would require CDE to collaborate with DHCS to streamline and simplify the processes whereby LEAs and county behavioral health agencies collaborate to leverage available funding to provide mental health services to pupils. AB 1126 is pending in the Assembly Appropriations Committee.
• SB 428 (Pan) would require an applicant for a clear multiple or single subject teaching credential to complete a course in youth mental health first aid. SB 428 will be heard in this committee on April 29, 2019.
• SB 1019 (Beall, 2018), SB 191 (Beall, 2017) which was held in the Senate Appropriations Committee, and SB 1113 (Beall, 2016) were substantially similar to this bill. Governor Brown vetoed SB 1019, citing concerns that the bill would limit OAC’s authority to exercise its judgment in grant distribution. Governor Brown vetoed SB 1113, underlying a priority to balance the state budget and fully fund the Local Control Funding Formula. The veto message also noted that additional spending for new programs must be considered in the annual budget process.

Staff Comments:

1. The purpose of the triage grants is to increase triage personnel in various settings, including schools, to provide crisis intervention, crisis stabilization, mobile crisis support, and intensive case management and linkage to services for individuals with mental health disorders at various points of access, with a focus on children and youth. Triage personnel are authorized to provide services anywhere in the community and provide services that include monitoring service delivery to ensure individuals access and receive services, monitoring an individual’s progress, and providing placement service assistance. The 2016 Budget Act allocated $27 million to the IMHWA, which included nearly $3 million for family respite, such as additional triage personnel. The MHSOAC found confusion among counties and stakeholders. Of 50 initial applications for triage grants that the MHSOAC received, only six proposed programs were specific to youth services, and only three of the six met or exceeded the minimum threshold score for funding, resulting in only 15 percent of the initial triage grant funds going to youth-centric programs. The MHSOAC recommends a percentage of future triage grant funds be dedicated to mental health crisis intervention services geared toward youth. The MHSOAC states that because schools are a major access point for children to receive mental health services in their county, the triage grant funds may increase collaboration between schools and county behavioral health departments.

According to the OAC, a second round of triage grants totaling $83 million was awarded in 2018, and will be sustained through 2021. Individuals experiencing a mental health crisis will be assisted in various settings, such as schools, shelters, jails, clinics, and in the community. Berkeley, Calaveras, Humboldt, and Tuolumne Counties were awarded grants with nearly $2 million dedicated to services for transition-age youth (TAY) and adults, and more than $1 million dedicated to services for those aged 0-21. Butte, Merced, Placer, San Luis Obispo, Santa Barbara, Sonoma, Stanislaus, and Yolo Counties were awarded grants with about $4.3 million dedicated to TAY and adults, and about $3 million dedicated to those aged 0-21. Alameda, Los Angeles, Riverside, Sacramento, San Francisco, and Ventura counties received about $28 million dedicated to TAY and adults, and about $17 million for those aged 0-21. Additionally, Humboldt, Placer, and Tulare Counties and the California Association of Health and Education Linked Professions JPA received about $21.2 million to support school-county partnerships.

According to an audit by the Bureau of State Audits (Report 2015-112) only one of four LEAs they studied had contracted with their county mental health plan to access Medi-Cal funding for mental health services being provided by the agency. The Bureau of State Audits recommended the Legislature require counties and LEAs to enter into contracts to allow LEAs to access Medi-Cal funding.

-- END --

SENATE COMMITTEE ON EDUCATION

Senator Connie Leyva, Chair

2019 - 2020 Regular

Bill No: SB 582 Hearing Date: April 10, 2019

Subject: Youth mental health and substance use disorder services.

SUMMARY

This bill authorizes county mental health services providers and local educational agencies (LEAs), to enter into partnerships that provide mental health and substance use disorder services to youth. This bill provides that these partnerships provide prevention, early intervention, and other related mental wellness services. This bill requires the Mental Health Services Oversight and Accountability Commission (MHSOAC) to allocate at least 50 percent of the monies in the Mental Health Wellness Act (MHWA) competitive grant program to fund these partnerships. In the event that there are an insufficient number of these partnerships between LEAs and county providers among the grant applicants, this bill requires the Commission to meet the mandated 50 percent allocation by competitively awarding remaining funds to youth-oriented programs.

BACKGROUND

Existing law:

1) Establishes the MHWA, which requires funds appropriated by the Legislature to be made available to specified entities to be used, among other things, for a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. States the objectives of the MHWA as expanding access to early intervention and treatment; expanding continuum of services to address such things as crisis stabilization, intervention, and residential treatment; adding at least 600 triage personnel; and providing local communities with increased financial resources to leverage additional public and private funds to improve networks for those with mental health disorders. (Welfare and Institutions Code § 5848.5)

2) Requires the MHSOAC to allocate grant funds from the MHWA for triage personnel, using specified criteria, to provide intensive case management and linkage to services, as specified, for individuals with mental health disorders at various access points, including schools. (WIC § 5848.5)

3) Establishes the Medi-Cal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program for eligible people under 21 years of age to provide periodic screenings to determine health care needs, and based upon the identified health care need and diagnosis, treatment services are provided. Requires EPSDT services to be administered through local county mental health plans under contract with the Department of Health Care Services (DHCS). (WIC § 14132)

4) 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 (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. (WIC § 4370, et seq.)

5) 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.)

6) Creates the Youth Education, Prevention, Early Intervention and Treatment Account, pursuant to the 2016 ballot initiative Proposition 64, the Control, Regulate and Tax Adult Use of Marijuana Act,” to be administered by the Department of Health Care Services for programs for youth that are designed to educate about and to prevent substance use disorders and to prevent harm from substance abuse. (Revenue and Taxation Code § 34019)

7) Defines “local educational agency” as a school district, a county office of education, a nonprofit charter school participating as a member of a special education local plan area (SELPA), or a SELPA. (Education Code § 56026.3)

8) Sets forth the process for the development, review, and revision of a pupil’s individualized education program. (EC § 56340, et seq.)

ANALYSIS

This bill:

Partnership

1. Requires the Mental Health Services Oversight and Accountability Commission (MHSOAC), on or after July 1, 2021, when issuing grants pursuant to the Mental Health Wellness Act (MHWA), to allocate at least 50 percent of the funds to LEA and mental health partnerships through a competitive process.
2. This bill specifies that the commission may allocate less than one-half of the grant to these partnerships if there is an insufficient number of qualified applicants to receive the funds. In this event, the commission:
   
   1. Must meet the 50 percent allocation mandate by redirecting any unallocated funds to grant applicants that propose to provide youth-oriented mental health services. This bill sunsets this provision in 2026.
   2. May redirect any unallocated funds that were earmarked for partnerships to other priorities that are consistent objectives of the Mental Health Wellness Act of 2013, in accordance with the priorities of the commission, effective after the sunset date of 2026 pursuant to item 2).
3. Requires the commission, in consultation with the Superintendent of Public Instruction (SPI), to establish criteria for the allocation of funds. Requires, in order to be eligible to receive funding, a partnership to include one or more local educational agency (LEA), and one or more mental health partners. Requires a mental health partner to be either a county, including a county mental health plan, or a qualified mental health provider operating as a part of the county mental health plan network.

Fund

1. Appropriates annually each fiscal year the sum of $15 million from the General Fund to the commission for the purposes of this bill.
2. Requires funding allocated to be available to support prevention, early intervention, and direct services, including, but not limited to, support for personnel, training, and other strategies that respond to the mental health needs of children and youth, as determined by the commission.
3. Requires the commission, in consultation with the SPI, to give positive consideration when determining grant recipients to each of the following:
   1. Description of need for mental health services for children and youth, including campus-based mental health services, as well as potential gaps in local service connections;
   2. Description of the funding request, including personnel and use of peer support;
   3. Description of how the funds will be used to facilitate linkage and access to services;
   4. Ability to obtain federal Medicaid or other reimbursement, as specified;
   5. Ability of the LEA to collect information on the health insurance carrier for each child or youth, as specified;
   6. Ability to engage a health care service plan or health insurer in the LEA and mental health partnership, as specified;
   7. Ability to administer an effective service program and the degree to which mental health providers and LEAs will support and collaborate; and,
   8. Geographic areas or regions of the state to be eligible for funding, including rural, suburban, and urban areas, as specified.
4. Requires the commission, in consultation with SPI, to determine maximum funding awards and to take into account the criteria in # 5) above.
5. Permits funds awarded by the commission to be used to supplement, but not supplant, existing financial and resource commitments, as specified.

Other

1. Requires the commission to provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2022.
2. Makes findings and declarations that school settings, particularly those with multitiered models that ensure prompt support for students, demonstrate that early investments result in savings and improved academic success, and by allocating funds to establish partnerships between local educational agencies and mental health plans, the entities involved can help yield greater mental health outcomes for California’s youth.

STAFF COMMENTS

1. Need for the bill.

Funding

According to the author, this bill adds much needed grant monies to support youth mental health services through the Mental Health Wellness Act (MHWA), This bill enables more robust mental health programs to be provided as wrap-around services within California schools. According to the Mental Health Services Oversight and Accountability Commission (MHSOAC), youth-centric programs receives around 15 percent of the total available triage funds (out of 50 total program applications). The author’s assert that in order for California’s school-age population to be adequately served, equity in the grant fund allocation is a necessary first step. This bill requires these funds to be used to incentivize counties and school districts to integrate mental health services in schools.

Youth-focused partnerships

According to the author, “Partnerships between schools and community mental/behavioral health professionals offer students and families an extended network of mental health programs and services that are easily accessible. When programs are able to identify and address student mental and behavioral challenges early, students are more likely to gain resiliency skills and be successful in school and life while the threat of later harm is reduced. Although youth mental health outreach has demonstrable benefits to children, only a handful of California schools have partnered with county mental health agencies and existing triage funds are primarily utilized for adult mental health services.”

1. Mental Health Wellness Act funding levels. The 2016 Budget Act allocated $27 million to the MHWA. According to the Commission, a second round of triage grants totaling $83 million was awarded in 2018, and will be sustained through 2021.
2. Underfunded youth-oriented programs. Triage grants awarded through the MHWA fund mental health triage personnel in various settings, including schools, with a focus on children and youth. These personnel provide crisis intervention, crisis stabilization, mobile crisis support, and intensive case management and linkage to services for individuals with mental health disorders at various points of access – including school campuses.

In 2017, the Commission found that, of 50 initial applications for triage grants that the Commission received, only six proposed programs were specific to youth services. Of these, only three of the six met or exceeded the minimum threshold score for funding. As a result, only 15 percent of the initial triage grant funds supported youth-centric programs.

The Commission states that because schools are a major access point for children to receive mental health services in their county, the triage grant funds may increase collaboration between schools and county behavioral health departments. The Commission recommended that a percentage of future triage grant funds be dedicated to mental health crisis intervention services geared toward youth.

In line with this recommendation, this bill requires the Commission to, when possible, allocate up to 50 percent of total Mental Health Wellness Act grant funds to awardees that represent a partnership between local educational agencies (LEAs) and county mental health providers.

1. Mental health services in schools. The federal Individuals with Disabilities Education Act provides that students with exceptional needs identified as having emotional disturbance may be eligible to receive mental health services, including counseling, psychological services, parent counseling and training, and residential placement, among others.

Prior to 2012, a student with exceptional needs, who also had mental health needs and services documented in their individualized education plan (IEP), was referred by the LEAs to county mental health agencies for treatment. After 2012, pursuant to AB 114 (Committee on Budget, Chapter 43, 2011) the responsibility of providing these services shifted to LEAs themselves, with the Superintendent of Public Instruction providing oversight.

Currently, any and all services identified in a student’s IEP must be provided, whether directly by LEA employees or through contract with outside providers, such as county mental health agencies. LEAs are required to ensure services are provided to students regardless of who provides or pays for those services.

1. Student mental health services audit. According to the Senate Health Committee analysis for this bill, “In January 2016, the California State Auditor released report 2015-112, which reviewed the effect of AB 114 mental health services provided to pupils through IEPs. Among the findings were: the mental health services and providers did not change at the four LEAs reviewed; in some cases LEAs removed mental health services from student IEPs because of AB 114 and for other students the LEAs could not explain why services were removed; the California Department of Education (CDE) had not performed an analysis of the education outcomes to determine if pupil outcomes had improved; CDE did not require LEAs to track total expenditures for mental health services; none of the four local educational agencies (LEAs) could determine their total costs to provide mental health services; and, only one of the four LEAs had contracted with its county to access certain funding for mental health services through Medi-Cal.

“The audit, among other things, recommended the Legislature require counties to enter into agreements with special education local plan areas (SELPAs), to allow SELPAs and their LEAs to access federal funding.”

1. Partnerships between LEAs and mental health providers

Desert Mountain LEA and San Bernardino County

The auditor’s report found that the Children’s Center at Desert Mountain SELPA’s collaboration with San Bernardino County is financially beneficial for both the SELPA and the county. The SELPA contributes a portion of San Bernardino’s match of federal reimbursements, saving the county funds that it would otherwise have to contribute as the local entity. Under the terms of its agreement with San Bernardino, Desert Mountain was able to access approximately $4 million in federal Early and Periodic Screening, Diagnosis, and Treatment funds to provide mental health services in the 2014–15 fiscal year. This arrangement enables Desert Mountain to provide mental health services to Medi‑Cal‑eligible students regardless of whether the students have IEPs.

Mt. Diablo LEA and Mt. Diablo county mental health department

The State audit also describes a contractual agreement between Mt. Diablo Unified School District and the county mental health department. This partnership allowed Mt. Diablo to receive Medi‑Cal funds as a provider of Early and Periodic Screening, Diagnosis, and Treatment services to Medi‑Cal‑eligible students.

1. Prioritizing youth-focused, school-based programs. This bill authorizes and establishes a framework for counties and LEAs to enter into youth mental health partnerships. This bill requires the Commission to award at least 50 percent of Mental Health Wellness Act grant funds be allocated to such partnerships.

In the event that an insufficient number of county-LEA partnerships apply for the grant, this bill provides that the Commission may allocate less than 50 percent of available grant funding to these youth-focused, school-based partnerships. In this case, and until the year 2026, this bill requires remaining funds in the 50 percent allocation to be awarded to other youth-focused programs.

After 2026, this provision sunsets. Up to 50 percent of funds must be awarded to LEA and county partnerships. If an insufficient number of partnerships are available to receive the funds, any remaining funds may be reallocated to other categories of applicants, based on priority and need, as determined by the Commission.

1. Related legislation. AB 8 (Chiu and Eduardo Garcia) would require, on or before December 31, 2022, a school of a school district or county office of education and a charter school to have at least one mental health professional, as defined, for every 400 pupils generally accessible to pupils on campus during school hours. AB 8 is pending in the Assembly Health Committee.

AB 1126 (O’Donnell) would require CDE to collaborate with DHCS to streamline and simplify the processes whereby LEAs and county behavioral health agencies collaborate to leverage available funding to provide mental health services to pupils. AB 1126 is set to be heard in the Assembly Education Committee on April 10, 2019.

SB 428 (Pan and Portantino) would require an applicant for a clear multiple or single subject teaching credential to complete a course in youth mental health first aid. SB 428 is set to be heard in the Senate Education Committee on April 10, 2019.

1. Prior legislation. SB 1019 (Beall, 2018), SB 191 (Beall, 2017) which was held in the Senate Appropriations Committee, and SB 1113 (Beall, 2016) were substantially similar to this bill. SB 1019 was vetoed by the Governor whose veto message read:

This bill would require the Mental Health Services Oversight and Accountability Commission to allocate at least half of its triage grant funds to local education and mental health partnerships.

The bill as written would limit the Commission's authority to exercise its judgment in the distribution of these grants. I believe the better practice would be to leave this matter to the Commission.

SB 1113 was vetoed by the Governor, whose veto message read:

Despite significant funding increases for local educational agencies over the past few years, the Local Control Funding Formula remains only 96 percent funded. Given the precarious balance of the state budget, establishing new programs with the expectation of funding in the future is counterproductive to the Administration's efforts to sustain a balanced budget and to fully fund the Local Control Funding Formula.

Additional spending to support new programs must be considered in the annual budget process.

SUPPORT

Alameda Unified School District

Amador County Unified School District

Association of California School Administrators

California Alliance of Child and Family Services

The California Association of Local Behavioral Health Boards and Commissions

Disability Rights California

Hillsides

La Mesa-Spring Valley School District

Los Angeles Trust for Children’s Health

Los Angeles Unified School District

Mental Health Services Oversight and Accountability Commission

Murrieta Valley Unified School District

Seneca Family of Agencies

OPPOSITION

None received

-- END --

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: SB 582

SUBJECT: Youth mental health and substance use disorder services.

SUMMARY:

Requires the Mental Health Services Oversight and Accountability Commission to allocate at least one-half of Investment in Mental Health Wellness Act of 2013 triage grant program funds to local educational agency and mental health partnerships, as specified, to support prevention, early intervention, and direct services to children and youth, as specified.

Existing law:

1. Establishes the Investment in Mental Health Wellness Act of 2013 (IMHWA), which requires funds appropriated by the Legislature to be made available to specified entities to be used, among other things, for a complete continuum of crisis services for children and youth 21 years of age and under. [WIC §5848.5]
2. Requires the Mental Health Services Oversight and Accountability Commission (MHSOAC) to allocate grant funds from the IMHWA for triage personnel, using specified criteria, to provide intensive case management and linkage to services, as specified, for individuals with mental health disorders at various access points, including schools. [WIC §5848.5]
3. Establishes the Medi-Cal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program for eligible people under 21 years of age to provide periodic screenings to determine health care needs, and based upon the identified health care need and diagnosis, treatment services are provided. Requires EPSDT services to be administered through local county mental health plans under contract with the Department of Health Care Services (DHCS). [WIC §14132]
4. Defines “local educational agency (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 (SELPA), or a SELPA. [EDC §56026.3]
5. Sets forth the process for the development, review, and revision of a pupil’s individualized education program (IEP). [EDC §56340, et seq.]

This bill:

1. Requires the MHSOAC, on or after July 1, 2021, when issuing grants pursuant to the IMHWA, to allocate at least one-half of the funds to LEA and mental health partnerships through a competitive process.
2. Requires the MHSOAC, in consultation with the Superintendent of Public Instruction, to establish criteria for the allocation of funds. Requires, in order to be eligible to receive funding, a partnership to include one or more LEA, and one or more mental health partners. Requires a mental health partner to be either a county, including a county mental health plan, or a qualified mental health provider operating as a part of the county mental health plan network.
3. Requires funding allocated to be available to support prevention, early intervention, and direct services, including, but not limited to, support for personnel, training, and other strategies that respond to the mental health needs of children and youth, as determined by the MHSOAC.
4. Requires funding allocated to be available to support prevention, early intervention, and direct services, including, but not limited to, support for personnel, training, and other strategies that respond to the mental health needs of children and youth, as determined by the MHSOAC.
5. Requires the MHSOAC, in consultation with the Superintendent of Public Instruction, to give positive consideration when determining grant recipients to each of the following:
   1. Description of need for mental health services for children and youth, including campus-based mental health services, as well as potential gaps in local service connections;
   2. Description of the funding request, including personnel and use of peer support;
   3. Description of how the funds will be used to facilitate linkage and access to services;
   4. Ability to obtain federal Medicaid or other reimbursement, as specified;
   5. Ability of the LEA to collect information on the health insurance carrier for each child or youth, as specified;
   6. Ability to engage a health care service plan or health insurer in the LEA and mental health partnership, as specified;
   7. Ability to administer an effective service program and the degree wo which mental health providers and LEAs will support and collaborate; and,
   8. Geographic areas or regions of the state to be eligible for funding, including rural, suburban, and urban areas, as specified.
6. Requires the MHSOAC, in consultation with Superintendent of Public Instruction, to determine maximum funding awards and to take into account the criteria in 5) above.
7. Permits funds awarded by the MHSOAC to be used to supplement, but not supplant, existing financial and resource commitments, as specified.
8. Requires the MHSOAC to provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2022.
9. Appropriates annually each fiscal year the sum of $15 million from the General Fund to the MHSOAC for the purposes of this bill.
10. Makes findings and declarations that school settings, particularly those with multitiered models that ensure prompt support for students, demonstrate that early investments result in savings and improved academic success, and by allocating funds to establish partnerships between LEAs and mental health plans, the entities involved can help yield greater mental health outcomes for California’s youth.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, this bill is of critical importance in providing equity in triage grant funds for youth mental health services and restoring the 40% cut in triage grants in 2018. The funding parity established by this bill will open up more resources to provide more robust mental health services in California schools. According to the MHSOAC, in the first round of the triage grants in 2018, 50 applications for program funds were received. Only six of these proposed programs were specific to youth, and only three of those met or exceeded the minimum threshold for funding. Therefore, the grantees with youth-centric programs received just over 15% of the total available triage funds. In order for California’s school-age population to be adequately served, equity in the triage grant fund allocation is a necessary first step. This bill also requires these funds to be used to incentivize counties and school districts to integrate mental health services in schools.
2. Background. The federal Individuals with Disabilities Education Act (IDEA) provides that students with exceptional needs identified as having emotional disturbance may be eligible to receive mental health services, which are considered related services and include counseling, psychological services, parent counseling and training, and residential placement, among others. Prior to 2012, a student with exceptional needs, who also had mental health needs and services documented in their IEP, was referred by the LEAs to county mental health agencies for treatment, pursuant to AB 3632 (Brown, Chapter 26, Statutes of 1984). AB 114 (Committee on Budget Chapter 43, Statutes of 2011) shifted responsibility for providing and funding IDEA-related mental health services from county mental health agencies to LEAs (the Superintendent of Public Instruction is responsible for monitoring LEAs to ensure compliance). Any and all services identified in a student’s IEP must be provided, whether directly by LEA employees or through contract with outside providers, such as county mental health agencies. LEAs are required to ensure services are provided to students regardless of who provides or pays for those services.
3. IMHWA triage grants. The purpose of the triage grants is to increase triage personnel in various settings, including schools, to provide crisis intervention, crisis stabilization, mobile crisis support, and intensive case management and linkage to services for individuals with mental health disorders at various points of access, with a focus on children and youth. Triage personnel are authorized to provide services anywhere in the community and provide services that include monitoring service delivery to ensure individuals access and receive services, monitoring an individual’s progress, and providing placement service assistance. The MHSOAC began an information-gathering process in early 2017 to receive input from counties and stakeholders about the rollout of initial triage grants, and to explore options in improving the process of distributing future grants. The 2016 Budget Act allocated $27 million to the IMHWA, which included nearly $3 million for family respite, such as additional triage personnel. The MHSOAC found that there was confusion among counties and stakeholders. Of 50 initial applications for triage grants that the MHSOAC received, only six proposed programs were specific to youth services, and only three of the six met or exceeded the minimum threshold score for funding, resulting in only 15% of the initial triage grant funds going to youth-centric programs. The MHSOAC recommends a percentage of future triage grant funds be dedicated to mental health crisis intervention services geared toward youth. The MHSOAC states that because schools are a major access point for children to receive mental health services in their county, the triage grant funds may increase collaboration between schools and county behavioral health departments.

According to the MHSOAC, a second round of triage grants totaling $83 million was awarded in 2018, and will be sustained through 2021. Individuals experiencing a mental health crisis will be assisted in various settings, such as schools, shelters, jails, clinics, and in the community. Berkeley, Calaveras, Humboldt, and Tuolumne Counties were awarded grants with nearly $2 million dedicated to services for transition-age youth (TAY) and adults, and more than $1 million dedicated to services for those aged 0-21. Butte, Merced, Placer, San Luis Obispo, Santa Barbara, Sonoma, Stanislaus, and Yolo Counties were awarded grants with about $4.3 million dedicated to TAY and adults, and about $3 million dedicated to those aged 0-21. Alameda, Los Angeles, Riverside, Sacramento, San Francisco, and Ventura counties received about $28 million dedicated to TAY and adults, and about $17 million for those aged 0-21. Additionally, Humboldt, Placer, and Tulare Counties and the California Association of Health and Education Linked Professions JPA received about $21.2 million to support school-county partnerships.

1. Student mental health services audit. In January 2016, the California State Auditor released report 2015-112, which reviewed the effect of AB 114 mental health services provided to pupils through IEPs. Among the findings were: the mental health services and providers did not change at the four LEAs reviewed; in some cases LEAs removed mental health services from student IEPs because of AB 114 and for other students the LEAs could not explain why services were removed; the California Department of Education (CDE) had not performed an analysis of the education outcomes to determine if pupil outcomes had improved; CDE did not require LEAs to track total expenditures for mental health services; none of the four LEAs could determine their total costs to provide mental health services; and, only one of the four LEAs had contracted with its county to access certain funding for mental health services through Medi-Cal. The audit, among other things, recommended the Legislature require counties to enter into agreements with SELPAs to allow SELPAs and their LEAs to access federal funding.
2. Double referral. This bill is double referred. Should it pass out of this committee, it will be referred to the Senate Committee on Education.
3. Related legislation. AB 8 (Chiu and Eduardo Garcia) would require, on or before December 31, 2022, a school of a school district or county office of education and a charter school to have at least one mental health professional, as defined, for every 400 pupils generally accessible to pupils on campus during school hours. AB 8 is pending in the Assembly Health Committee.

AB 1126 (O’Donnell) would require CDE to collaborate with DHCS to streamline and simplify the processes whereby LEAs and county behavioral health agencies collaborate to leverage available funding to provide mental health services to pupils. AB 1126 is set to be heard in the Assembly Education Committee on April 10, 2019.

SB 428 (Pan and Portantino) would require an applicant for a clear multiple or single subject teaching credential to complete a course in youth mental health first aid. SB 428 is set to be heard in the Senate Education Committee on April 10, 2019.

1. Prior legislation. SB 1019 (Beall of 2018), SB 191 (Beall of 2017), and SB 1113 (Beall of 2016) were substantially similar to this bill. SB 1019 was vetoed by the Governor who stated the bill would limit the MHSOAC’s authority to exercise its judgment in the distribution of these grants, and a better practice would be to leave this matter to the MHSOAC. SB 191 was held in the Senate Appropriations Committee. SB 1113 was vetoed by the Governor, whose veto message stated that the bill created an unfunded new program, and given the precarious balance of the state budget, establishing new programs with the expectation of funding in the future is counterproductive to the Administration's efforts to sustain a balanced budget and to fully fund the Local Control Funding Formula. The Governor further stated that additional spending to support new programs must be considered in the annual budget process.

AB 114 (Committee on Budget, Chapter 38, Statues of 2017) shifts responsibility for mental health services for students from counties to LEAs.

AB 1315 (Mullin, Chapter 414, Statutes of 2017) establishes an advisory committee to the MHSOAC for purposes of creating an early psychosis and mood disorder detection and intervention competitive selection process to, among other things, improve access to effective services for transition-aged youth and young adults at high risk for, or experiencing, psychotic symptoms, as specified.

AB 1644 (Bonta of 2016) would have required 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, required DPH to provide technical assistance to LEAs, and required DPH to select and support school sites to participate in the program. AB 1644 was held in the Senate Appropriations Committee.

AB 580 (O’Donnell of 2015) would have required 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 stated that California does not currently have specific model referral protocols for addressing student mental health as outlined by the 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. The Governor further stated that it's premature to impose an additional and overly prescriptive requirement until the current efforts are completed and the state can strategically target resources to best address student mental health.

AB 1018 (Cooper of 2015) would have required DHCS 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 1025 (Thurmond of 2015) would have required 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 multitiered framework. AB 1025 was held in the Senate Appropriations Committee.

AB 1133 (Achadjian of 2015) 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.

SB 276 (Wolk, Chapter 653, Statutes of 2015) requires DHCS to seek federal financial participation for covered services that are provided by a LEA to a child who is an eligible Medi-Cal beneficiary, regardless of whether the child has an IEP or an individualized family service plan, or whether those same services are provided at no charge to the beneficiary or to the community at large, if the LEA takes all reasonable measures to ascertain and pursue claims for payment of covered services against legally liable third parties.

AB 2608 (Bonilla, Chapter 755, Statutes of 2012) makes permanent and expands provisions relating to program improvement activities in the Medi-Cal Local Billing Option program, through which LEAs can draw down federal funding for health care services provided to Medi-Cal-eligible students. AB 2608 also expanded the scope of transportation services for which Medicaid reimbursements can be received.

SB 1009 (Committee on Budget and Fiscal Review, Chapter 34, Statutes of 2012) requires DHCS, in collaboration with California Health and Human Services Agency, and in consultation with the MHSOAC and a stakeholder advisory committee, to develop a plan for a performance outcomes system for EPSDT specialty mental health services provided to eligible Medi-Cal beneficiaries under the age of 21. The purpose of the system is to improve beneficiary outcomes and inform decisions regarding the purchase of services.

AB 3632 (Brown, Chapter 1747, Statutes of 1984) requires the referral of students with exceptional needs who also have mental health needs and services documented in their IEPs by LEAs to county mental health agencies for treatment.

1. Support. Supporters of this bill, largely youth advocates and school districts, state that the MHSOAC found that children are more likely to experience or express mental health crises in a school setting, and thus school-based programs can effectively respond and support the shared goal of promoting mental health and achieving desired educational outcomes for youth with mental health needs. Supporters further argue that partnerships between schools and community mental/behavioral health professionals offer students and families an extended network of mental health programs and services that are easily accessible. Supporters state that although youth mental health outreach has demonstrable benefits to children, only a handful of California schools have collaborated with county mental health agencies, and existing triage funds are mostly utilized for adult mental health services.
2. Policy comments.
3. The IMHWA already provides discretion to the MHSOAC when providing triage grants and specifies that the focus should be on children and youth and schools. Requiring the MHSOAC to dedicate one half of the IMHWA grant funds to one subsection of the population may limit the MHSOAC’s discretion in redirecting funds in future years in the case that circumstances change or priorities shift.
4. According to the author’s office, this bill appropriates $15 million on an annual basis from the General Fund to restore funding that was cut from the IMHWA in 2018. The author may wish to pursue the funding restoration through the budget process.

SUPPORT AND OPPOSITION:

Support: Alameda Unified School District

Amador County Unified School District

California Alliance of Child and Family Services

Disability Rights California

Hillsides

La Mesa-Spring Valley School District

Los Angeles Trust for Children’s Health

Mental Health Services Oversight and Accountability Commission

Murrieta Valley Unified School District

Seneca Family of Agencies

Oppose: None received

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