Assembly Select Committee on Youth Mental Health and Treatment Accessibility

Greetings to everyone in the audience. While I love to start meetings on time, I'm gonna give it about five minutes for my slack committee members to come, and then we'll go ahead and get started.

Good afternoon. Mic on? Is this better?

Good afternoon, everyone. Thank you for joining us today for the hearing of the Select Committee on Youth Mental Health and Treatment Access. This is our third hearing on this issue, and I hope that it gives us some opportunity to assess the progress that's been made and identify what's working, understand where the challenges remain, and also discuss what issues there are in our next steps.

I believe that one of government's most important responsibilities is to improve the quality of life and ensure that the future is better than the present. By that measure, we—by that measure, the mental health and well-being of California's young people deserve our full attention.

Today's youth are growing up in a world that looks very different from the one many of us experienced. They face increasing academic pressures, constant social pressures, and growing concerns about the safety and their future. They participate in active shooter drills. They navigate a digital world that follows them home every single day, and many are grappling with uncertainty about the future at a time when simply growing up has always been challenging enough.

The result is a generation facing rising levels of anxiety, depression, and other mental health challenges.

The COVID-19 Pandemic accelerated and intensified many of these trends, and we continue to see its effects in our schools, our health care systems, and our communities. As policymakers, we often spend significant time discussing prevention. Prevention is essential. And in many ways, it can be easier to conceptualize through policy, but we must also focus on treatment and access to care. Here, we face an important challenge.

Research consistently tells us that strong relationships, community, trusted adults, and meaningful human connection play a critical role in supporting mental well-being, yet government operates through systems, through programs, through funding streams, and agencies. There's no single law that creates community, and there's no budget line item that can fully replicate human connection. Nevertheless, as legislators, it is our responsibility to build systems that make support and care more accessible when young people need it. Increasingly, schools have become the place where we ask those systems to come together, not because schools can solve every single problem, but because schools are the one institution that reaches every single child.

During my time on the school board in Poway Unified and now as chair of the Assembly Education Committee, I've seen how schools often become the point where education, health care, behavioral health, and social services intersect. Students do not experience their challenges in separate categories like at school or at in community, and families do not navigate crises through the state government organizational chart.

Their needs are interconnected, and our systems must be as well.

Schools are often the first public institution to recognize when a student is struggling, and in many cases, the last institution that remains consistently present with them throughout the student's journey. Because we believe in the power of schools, we frequently ask them to carry responsibilities that extend far beyond the traditional academic workday. As we do so, we must also ensure that they have the support and resources ready to succeed.

That is one of the reasons why I'm excited to discuss the Children and Youth Behavioral Health Initiative today.

CYBHI represents an effort to move beyond traditional government silos and build a more coordinated approach across our agencies, our levels of government, providers, schools, families, and in communities. Its ambition reflects the important principle: public systems should be organized around the needs of the people that they serve, not around the boundaries of government departments. This doesn't mean that the world—that the work—is complete. We know that there have been implementation challenges.

In our hearing in the district, we heard from local school districts and our county offices about the challenges that our local communities are facing. We understand that coordination remains difficult. We know that some successful programs face long term funding questions, and we know that access alone is not enough if we cannot demonstrate meaningful outcomes for the young people that we we want to serve. Ultimately, the question before us is straightforward.

How do we ensure that every public dollar invested translates into better access to care, better support for young people, and better outcomes for the children's and families we serve?

During our previous hearing, we heard valuable perspectives from counties, schools, health care providers, hospitals, community-based organizations, and the students themselves. Their testimony highlighted both the promise of this work and the challenges that remain. Today, we'll hear about the current state of the youth mental—of youth mental health—receive updates on the implementation and progress of CYBHI, and discuss policy and budgetary opportunities to strengthen those efforts moving forward. I look forward to hearing from our panelists and continuing this important conversation.

And with that, I would like to invite our first panel forward.

Is it Shalini or Shalini? Mustela and Ella Cruz. Please come forward.

And you may proceed when ready.

Thank you. Do you hear me?

Yes.

Good afternoon. My name is Shalini Mostala, and I'm a researcher at the Public Policy Institute of California, an independent, nonpartisan, nonprofit research institute dedicated to informing and improving public policy in California. Thank you for inviting me to testify about how teens are faring in terms of their mental health and investments in school based mental health services. Adolescence is a critical developmental period because roughly half of all lifetime mental health conditions emerge by age 14. Early identification and intervention are especially important.

Rates of depressive symptoms and suicidality in teens have been rising since 2009, both nationwide and in California, and worsened during the COVID19 pandemic. Between 2022 and 2024, about 3 in 10 children aged 12 to 17 in California reported experiencing symptoms of serious psychological distress. California also saw increases in teen suicide deaths and hospitalizations for self harm. While teen suicide deaths returned to pre pandemic levels in 2024, hospitalizations for self harm remain elevated, indicating that many young people continue to struggle.

PPIC analyzed responses to the California Healthy Kids survey by students in grade 7, 9, and 11 from 2017,'18 to 2023, and '24.

We found that an average of 33% reported chronic sadness or hopelessness, and 14.5% reported suicidal thoughts. Encouragingly, recent data show statistically significant improvement. Between 2021, '22, and 2023, '24, the share of students reporting chronic sadness declined from about 35% to 28%, while the share reporting suicidal thoughts fell from about 15% to 11%. These declines suggest that the pandemic's effects on youth mental health may be easing.

However, these levels indicate an ongoing need for mental health support.

Girls report substantially worse mental health than boys. This gender gap emerges early in middle school and persists throughout high school. Teens of color, especially native Hawaiian Pacific Islander, and multiracial students report higher levels of distress than their white peers. When we looked at school characteristics, we found that teens in rural schools reported worse mental health than their nonrural peers, which is consistent with the broader body of research. According to data from California Health Interview Survey more adolescents are receiving mental health services than in the past.

Since 2019, about 1 in 5 California adolescents have reported receiving counseling or therapy during the previous year. However, many adolescents continue to face barriers to accessing these services, including provider shortages and low insurance reimbursement rates. Because teens spend much of their time at school, schools are an ideal setting for identifying mental health needs and connecting students to services. Our research suggests that teens strongly prefer talking to friends, family members, or other trusted adults over formal counseling.

For those who do receive mental health services, however, schools are a critical point of access.

Among students who reported getting help after experiencing a mental health need about half got counseling or therapy at school. In recent years, investments by California's k to 12 school district in school health have been bolstered by an influx of state and federal pandemic recovery funds. Total district spending on health and mental health services increased by 75% between 2018, '19 and 2023, '24 school years, supporting growth in staffing and the development of school based resources.

We find that specific resources, including school based health centers, wellness centers, and community schools, are associated with lower levels of suicidal thoughts in teens. While health expenditures increased across all school types, spending per student at rural school districts remained lower than suburban and city districts, despite higher student need in rural schools.

Despite the expiration of pandemic funding and ongoing state budget constraints, California is continuing to support school based mental health through initiatives such as community schools, the multi payer fee schedule under the children and youth behavioral health initiative, and the certified wellness coach program. Ongoing evaluation of these investments will play an important role in refining strategies for effectively addressing student mental health needs. In addition more comprehensive data on school mental health staffing could help target resources to schools with the greatest needs. Thank you.

Thank you for your testimony. You may begin.

Hello, everyone. My name is Ella Cruz, and I'm a youth mental health advocate and a representative for NAMI California. I'm currently an incoming senior here in Sacramento at Christian Brothers High School. Thank you, assembly member, for having me today and for creating a space to discuss such an important issue. I'm honored to share my perspective as a young person living through many of these challenges in real time.

NAMI California. So NAMI California is a national alliance on mental illness in California. It's a grassroots organization that's made up of individuals and families working together to provide hope, help, and health care for people who are affected by mental illness. This focus is especially important because nationally, nearly 40% of high school students reported feeling persistent feelings of sadness or hopelessness. And with that, more than 1 in 5 seriously considered suicide.

Young people today are experiencing a mental health crisis at rates we cannot ignore. I have personally experienced some of these challenges. During my freshman year of high school, I had a career ending basketball injury. For me, sports had been an outlet. And when that was taken from me, I was completely lost.

That coupled with a father living with a severe substance use issue created issues I never thought I would have to deal with. I sank into a deep hole to say the least. I was missing a ton of school. My grades plummeted it, and I stopped all my social connections. During these mental health struggles personally, and I did not have access to adequate counseling or support programs at my public school.

When I was on my phone using social media to find answers, Apps were recommended, and yet they continue to isolate me. Ultimately, I transferred to a private school with a stronger mental health resource system in order to better manage both my well-being and academics. I sought personal therapy, received medication to support my mental health, and learned that getting off my phone and into nature and connecting with others is what helped me most.

I often think about students who may not have that option, and I'm incredibly thankful for Nami, who have taught me how to be vulnerable and to build a community through many events like NAMI advocacy day, where we have the opportunity to learn how to effectively share our stories and experiences with legislators and connect with fellow advocates so that we know we're not alone. I see mental health challenges affecting my peers every single day.

One of the biggest barriers is that many young people don't even know when to start when it comes to personally identifying what they are feeling. It can be difficult to recognize anxiety, depression, or other mental health conditions when no one has really taught you what those warning signs look like. Right now, young people are carrying an enormous amount of pressure between academics, extracurricular activities, family expectations, social media world events, and anxiety about the future, many students are overwhelmed.

We are consistently connected, consistently comparing, and consistently expected to perform at such high levels. It's so critical that programs for youth are developed with youth, not just for the youth.

Adults may have good intentions, but only the young people truly understand what it feels like to navigate adolescence in today's world. So youth voices should be included in shaping the outreach campaigns, peer programs, school supports, and policies intended to help us. For example, NAMI has had a peer program for decades connecting students to resources, peers, and trusted adults. That is also where technology and AI can become a little complicated.

While technology can sometimes provide comfort or information, AI is not a replacement for trained behavioral health professionals.

Trusted adults, peer support, or real human connection. Youth people need access to safe evidence based mental health care and supportive relationships in their communities. Peer to peer relationships and personable conversations are what helps. Organizations like NAMI provides this kind of support. Programs like these are what matter because peer connection matters.

Sometimes hearing you're not alone from a young person can make all the difference. Sharing our stories and educating lawmakers is essential for this. This approach is crucial for developing an uplifting resources that youth will actually use. I also wanna emphasize that mental health support does not only come from the traditional mental health programs. Supportive environments matter too.

A teacher who creates a safe classroom environment, a free food pantry on campus, a quiet place to study after school, or simply having a caring adult to talk about. This can all impact a young person's mental health positively. Only young people truly know what it feels like to grow up in today's environment with the pressures we face. That is why youth voices must continue to be included in conversations about youth mental health policy, treatment, education, and funding decisions.

We have made important progress, and yet there is still so much work to do.

My hope is that California continues investing in youth mental health, continues of confiding the stigma, and continues listening to young people directly. We are not just the future of this conversation. We're living in it right now. Thank you so much for this opportunity to speak with you guys today.

Thank you, Ella for your testimony. I'll turn it over to my colleague, assembly member Nguyen. Do you have any questions at this time?

I do. Thank you. Thank you, Madam Chair. You know, I wanna thank you both for coming and and speaking. And as I was listening to you talk and the importance of youth voice, I I completely agree with that.

I think so often you know, as a parent as somebody that's older, we often think we have all the answers. And we wanna give you all the answers. And we wanna tell you what should or shouldn't do. And it actually pushes you away from the things that you're peer pressured to do or whatnot. Because we have to understand the peer pressure that you have at school, online, amongst your friends, or whatnot.

Me being a senior back then and you being a senior in high school now are two totally different, decades with an s. But I I I actually have some young people that are volant or interning in my office today, and we just had the conversation about how I wanted them to be more vocal. And that I may give ideas, but my ideas are a 40 year old woman's idea, and it's not gonna be the same as your ideas.

And I want you to be able to use your voice and speak up more because so often young people feel like when they're talking to an adult that they can't share their concerns, they can't share their ideas, and that they have to just sit and listen.

You know, my question for you is when you were talking and and you were talking about how you figured out when you put the phone down or, you know, stop getting on social media, how do we encourage young people to do a lot of that as well too?

Because I can tell my kiddo that you can't? But I'm not there twenty four hours, seven days a week. And it's not just my kiddo. I'm I think it's all teenagers, right, that are glued to their phone and are always looking for the the likes, the clicks, you know, how many people commented on it or if they post or, you know, if if anybody saw it or whatnot.

And then when you do see a post and you see that folks went to a party and you didn't get invited, it impacts you as well too.

How do you how do you I guess, let me rephrase that. How do you think as a parent and as policy makers and legislators, how do we go about doing that? Because, you know, I've heard folks also say they're not pleased that we're taking their phones away. Right? That's gonna happen here soon, right, in in school.

And at the same time, we're doing it for a reason. Right? And so we get pushback from young people when we put policies in place or we try to go about doing that. How do we get young people to understand why we're, you know, we're doing such things as that? And and how did you, you know, understand that to be?

And are you using the same platform to also encourage young people in your, you know, circle the same way as well too? And then mental health impacts people of different ethnicities different, and their family also see it differently. Right? Like, if you go seek resources or a counselor in some in some communities, it's a taboo. You don't talk about it.

You better not tell me you went to go see a psychiatrist or a therapist or or whatnot. Right? And so it's also having to deal with that as well too. And as a young person and and really appreciate you coming here and sharing all that. How do you how how would how do you advise us about doing that?

And I'm also doing it as a mother to a teenager too. So I'm, like, trying to seek advice from you as well too. But I I think we just, you know, we we just appreciate you coming out here, sharing, and talking about ways that you've done things to help you. We wanna take that and channel that back to other young people as well too. How do we take that and encourage that all across the board?

Yes. Well, thank you so much again for having me. It it's truly an honor to talk about things that I love and I'm so passionate about. All of your questions were extremely valid and extremely prevalent to this conversation. To start a simple line, mental health is different for everyone.

So my techniques of being in nature and finding a creative outlet and putting my phone down and sitting there could work for me and could not work for you or your kid. And so to give to label, excuse me, someone with some sort of idea of you need to go in nature, it would be immature because that's what works for me.

So although I do very, very highly believe that nature and our our world is such a big part of, you know, grounding ourselves, and I would say that's a universal trick, I could not give one single thing. And I'm honestly blessed to have found myself, not only throughout school, but with NAMI and be able to kind of find what grounds me.

But to answer your question about how we would implement that, I think, ironically, although the conversation of phones is so heavy, it's our biggest tool and our biggest hold back at the same time.

And so what I mean by that is getting off the phones is important, but being on the phones connects us, like you said, on the social media. And I think our generation is lucky to have that and cursed to have that at the same time. And with that, again, it's it's our biggest strength. And I just think that since social media is still technically new, we haven't figured out how to use it right.

And so for me, connecting, and like I said in my my speech, peer to peer connection.

I think if I was gonna say anything that's flat line, everyone can involve themselves in, it's that peer to peer relationship. That's the most important making connections, making genuine connections is something that, at least for me, I know warms my heart, brings a smile to a dark day. And then to go off your question of the different cultures, I know that the stigma around mental health is probably one of the biggest challenges other than implementing things because there's so much diversity.

But no matter your culture, no matter your ethnicity, the stigma is real between genders, between races, between ages. And it's very much easier said than done.

But the stigma is what we need to release. The stigma of not being able to speak up, not being able to say something. You're not your mental health conditioner. So I live with SADS. I was diagnosed with SADS this winter.

And for a minute I was like oh like I have SADS. But that makes me stronger. It doesn't make me weaker. And I feel like as being a part of this generation, I'm I'm so grateful to have my support and especially NAMI. Like, I was so lucky to have connected with NAMI so early in my life.

But I'm able to take that darkness and that challenge and bring it into something that empowers me that brings it to me. So I really do think that it comes down to the stigma when it comes to the blockages of learning more and representing more. And so to release that stigma, again, there's no straight answer. It's a very broad topic. But I mean, I think it stems from, again, parents to kids, even like parents to babies.

The teaching of mental health is the same as physical health. It should be as normalized, and I know it's not. And honestly, my biggest goal is that eventually that will be the case. But I honestly think that the stigma around mental health and the fear around mental health and acknowledgment around mental health is what holds us back. And in order to break that, we need to almost accept it within ourselves and realize it's a strength.

And that is actually something that brings the community of California, The United States of the world, of Sacramento together. And so that's why I I'm so so honored to be here, and I'm so honored to work with NAMI because I get those opportunities to work with youth, and I get those opportunities to work with adults and the community. And we honestly, at those rallies, at those committees, at those events come together under one roof of being human.

And I feel like when it comes down to mental health and what's the issue, we all need to accept each other as human. So no apps, no stigma, just acceptance.

And that's the broad answer. I wish I had a more black and white answer, but I feel like for this conversation, that's unlikely anytime sooner at all. And, honestly, I feel like if we put a positive spin on mental health, it will positively impact our community.

Thank you. At this

time, I'd like to welcome assembly member Pappen. Do you have any opening comments you'd like to make or questions you'd like to ask at this time?

Just very very very very very briefly. I'm just delighted to be here. Thank you to both of you. It is a a topic of great interest. And, you know, I think about when I was a kid, people used to always ask my mother, what do you want for your kids?

And and, you know, what career would you like to see them or whatever it was. And my mother used to always have very one simple goal, may they be able to cope. And so I think this is part of what we're trying to achieve here because you don't know what life's gonna swing your way. I I know some of them are when in particular. And so I look at this as a way of of helping us cope because life will not be perfect.

So how do we handle it? So I'm delighted to be a part of the process, and I I apologize there's another committee, and I'm let's get going.

Thank you for that. I have a specific question for you, Shalini, as you brought forward your research. You noted in your report that there has been an increase of, what is it, almost 75% of spending towards mental health services and intervention over the last several years. That includes some funding carried over from pandemic recovery funds through COVID. But, also, there's a realization that a lot of that is expired.

And the state has intervened with these CYBHI, multi tier, multi payer fee schedules, and we're very appreciative of that. But are we seeing data yet to distinguish between whether those whether that's sufficient funding or whether there's still gonna be funding gaps? And in that vein, are we seeing any schools struggling with keeping up the services that they've put in place?

Yeah. So thanks again for inviting me for this testimony on this very important topic. We have like, with the data that we have looked at, like, we use the school district financial data to understand, like, what kind of spending is going towards health and mental health services at school. And we could identify pandemic related grants based on some of the resource codes, and what we couldn't identify is spending that is going through c by by CYBHI work streams.

But I know, like, through the implementation reports that Mathematica has, like, for CYBHI, there's been, like, increasing claims and increasing billing that's happening through multi payer reschedule.

And we have talked to, like, some school districts and some some providers, and there's been, like, ongoing challenges to that system around, like, setting up those building systems and, like, just getting those started and those, like and they have been receiving a lot of technical assistance from the state, and I think that's all helping. And but it's still, like, in the in the initial stages, and there's a lot of potential for this particular multi fair preschedule because it's not one time funds which can run out.

It's, like, more sustainable ongoing funding stream. So that's that's a great it has a great potential and, like, I think the schools need time to get started with that. They can make a progress.

Yeah. You bring up a very good point with the those funds being one time funds. We don't know how much is gonna be needed to carry over the continuity of supports and services. So it's good to keep that in mind.

I know we're facing some really tough budgetary times right now, but if we can anticipate what that funding looks like in rightsizing the funding, making sure that it's addressing students' needs the way that they want them addressed, we may find, actually, looking at some other reports that were available, that perhaps some of the interventions and support students are looking for are actually lower tier services and supports and maybe even lower dollar services and supports.

We and they may be more enduring. Maybe it's a wellness space or maybe it's, more outdoor learning opportunities, but ways to connect with their environment and their communities more organically. Do you have anything to add about that, Ella? No.

I mean, honestly, I think you hit it spot on. My whole view on this is, like you said, very organic, very, lower tier. For me personally, I believe we have all of the resources already at our fingertips. And with some of this funding, although with the right intentions, might not be what California needs.

And that's why I urge the assembly to look deeper into that, and that's why I make my point of the accessibility in the app or the things that students will actually use, which is more peer to peer, person to person, adult to student, friend to friend, mother to daughter.

And honestly, through NAMI, again, through my work with NAMI, I've learned many things. And one of the things is that we have so many things out there, so many things to connect ourselves to, but we aren't reaching. So I feel like our conversation should be less on money and putting money elsewhere, but communicating and connecting to the organizations that are already here.

Thank you for that. I also wanna welcome Assemblymember Davies to the hearing. If you have any opening statements or questions you'd like to ask, I wanted to open it up to you.

Now just I wanna thank the chair for bringing this information up. We've we've done a lot of this together, and it's it's just amazing what still needs to be done. And I really love the insight. Like I said, is we don't need to start way up here. I think there's a lot of one on one communications and, things that aren't that costly.

And who knows better than, you know, experts like yourself that's been dealing with this for some time. So I think we have to take a step back, listen, find out really what the issues are. And I guess my only question is with other groups that you guys work together, is there a good continuity with the other groups of if somebody needs this, you know where to go? Because, unfortunately, there are some places I could say, like, the homeless, nonprofits.

They all do very great things, but there's no connectivity.

So they don't know where to go once they do what they do best. And I wasn't sure if that's something we could, actually work on or if you think it's where it needs to be. Thank you.

No. Yeah. Thank you so much for being here. I completely agree with that statement of the point that there is some disconnect. I think that's probably one of the only places that California doesn't click when it comes to mental health because there's so many branches.

Like I said earlier, there's so many different things. There's substance. There's mental health. There's homelessness. And so when it comes to that, there's so many different answers, but they're not all easily accessible.

And I I think that that's a huge problem everywhere. But I do think that the effort of connecting and coordinating between these different organizations and facilities would better California. And I think that as of right now, there's not a strong way to do that without a million strings being pulled and many years being set aside for it, but I do believe that that is probably our only disconnection, California.

And I I personally, as a youth representative, as a California citizen, would love to see the connection between these steps even of admitting or of helping and treating. So honestly, through schools and therapists, the connection through rehab facilities, hospitals, and therapist connection, I I do believe that that is extremely important.

Thank you. And if there are no further questions at this time, I wanna thank you both for being with us and helping us, set the ground for the conversation we're gonna have ahead as we look further into the systems we have in place and possible, next steps. So thank you for being with us here today.

Thank you so much for having me.

We'll now move on to panel two, which is our, implementation and behavioral health programs. So we'll be welcoming doctor Sudh Trina Frazier. As well as, Rachel Ngo Bonisuke. And feel free to introduce yourselves and proceed when ready.

Alright. Good afternoon. Can you hear me okay? Alright. So my name is Sohail Sood.

I am a pediatrician by training. I am with the California Health and Human Services Agency, and I have the honor of serving as director of California's Children and Youth Behavioral Health Initiative. Let me begin by thanking the chair, members of this committee, and the legislature overall for your ongoing attention to this important topic. I was asked by committee staff to provide updates on the initiative with a focus on two of our flagship programs.

And I wanna begin just by building off some of the data that was shared by miss Mistalla, in her remarks.

We we chatted in preparation for this hearing. And while her report from the Public Policy Institute of California is excellent, it was released in January. And since then, we actually have more data, a new tranche of data, spanning 2025 that's now available from the California Healthy Kids Survey. And I just wanna make sure that that's part of this conversation. So to start with that, I have a few slides on the screen here if I can direct your attention there.

One of the questions we ask in the California Healthy Kids survey, which is a very large survey, very robust, over a million students interviewed sorry, surveyed every year on that. One of the questions we ask students is whether they have concerns about receiving help for mental health if they need it. So to me, that that's a question that gets a little bit at stigma. It even potentially gets at access to care.

Not saying that I need care, but if I did, would I have concerns about receiving it?

And on the screen here, you'll see the trends over the past decade or so. So starting at about, I'm having trouble seeing that from here, but I think 2013 to '20 or 2016 to 2017, on the left side of the screen here, the number of students who said they had concerns about receiving mental health help if needed was close to sixty percent. So close to two out of every three students said, yes. You know, I'd I'd have concerns.

I'd take pause before thinking about getting some help.

And you can see over the course of this past decade, those levels are now thirty four percent, so down to about one out of every three. And you can also notice in around the middle part of that chart, there was a little bit of a rise at the beginning of the pandemic. So fortunate to see that that is now moving in the right direction overall.

So not only does stigma appear to be reducing, but more and more students are also saying that they are indeed getting care from professionals like counselors or therapists. In 2425, which is the most recent year that's on the far right of the screen, this is, data reporting the percentage of students who reported receiving care from a counselor or therapist.

And you can see it's the highest it's been in the past decade. And, again, you can see the concerning backslide that occurred in the middle part of that chart over the course of the pandemic, which appears to be now moving in the right direction. And, finally, likely, the most important question that that I'll share today on on topics is we ask young people how they're feeling. And we ask questions about sadness as has been mentioned before, and we ask questions about suicidality.

So the question here is, in the past twelve months, have you seriously considered attempting suicide?

And around the time of the pandemic, that number was about fifteen percent. So about one out of every seven students said yes. In the past twelve months, I have seriously considered attempting suicide. If you go a little bit further back in time, that number was close to twenty percent, close to one out of every five. And I believe Ella was just mentioning that that's on par with some of the national statistics that are there.

So really, delighted to announce that now in California, in this most recent year of data, that number for ninth and Eleventh graders is now around nine percent. So a drop over the past decade from one out of every five to about one out of every ten students. I share these statistics to highlight that on a population level, when you look at this most recent year of data, there are signs we're moving in the right direction.

It's corroborated by other metrics, other data sources that I don't have time to share today. But it's not to say that our current status is sufficient.

It is it is not. Nor are these impacts really felt the same by every person or by every community. They are not. So there is much more to do. But if young people are indeed doing a little bit better, I would argue that it's not on a backdrop where the stressors in our life are decreasing.

So in some part, it must be because the supports are increasing and making a difference. And so let's talk about those supports. Part of what we've been doing over the past four years, five years now, in the children and youth behavioral health initiative is to create reforms to the health care sector. We need more services available. We need a bigger workforce.

We need broadly more and more efforts in the health care sector. But as has just been mentioned by other panelists too, we need to meet young people where their lives are lived. And that includes in homes, in communities, in educational settings, and in the in the digital environment. And so this investment has really sought to bring about reforms in all of these environments and just as was previously stated with youth at the center of that approach.

So every program, all aspects have really been co designed with young people in many bits of the effort.

In terms of the work that's been happening, this is a snapshot as of early spring, including some of the data points here even need to be reupdated. And I will not have time to highlight all of them.

So just know that I'm happy to respond to any questions about all of these, including awareness campaigns to try to reduce stigma, including some of the culturally based approaches that I heard Assemblymember Wen talk about, including, the digital tools like BrightLife Kids and Saluna, which have seen, you know, good engagement and good impact as well. But, you asked for a deeper dive on wellness coaches, so let's let's jump into that. As a reminder, the idea here is to foster an entry level behavioral health specialist role.

Right? Someone who can contribute meaningfully by identifying risks, by supporting screening, by providing coaching on emotional regulation, by helping to coordinate care, and to do so under supervision. These are important functions that can be done without a master's degree or without a doctorate degree, and they also allow for more advanced professionals to really serve at the top of their scope so that those professionals can work on considering diagnoses or providing therapies.

But there's a lot of good and important work that folks with an associates or bachelor's degree can do, and that's part of the plan for the certified wellness coaches. We worked with the research and analytics for Mathematica to independently evaluate this profession, and they just released a report less than two weeks ago.

And I've shared it with committee staff who has hopefully shared it with all of you, but happy to recirculate it more. So as as a really quick kind of takeaway of their highlights, here's here's what they said. Number one is that the profession is is fairly solidly established now. We have more than 4,000 coaches, actually more than 4,500 certified wellness coaches in the state of California with nearly statewide geographic reach. That's point number one.

Point number two is that the types of people in these roles are the types of people young people are asking to serve in these roles, meaning a more diverse workforce. So Hispanic and black Californians make up a greater proportion of wellness coaches than they do of the state population as a percentage. More than 19 languages are represented among the 638 individuals who received a scholarship from the state to pursue this profession.

And probably most importantly, there are signs that students, the young people themselves, are benefiting from wellness coach services. As one example from the report I'm sorry if this is too small here.

In at an elementary school in Butte County, they saw their suspension rate cut in half after a wellness coach was deployed there. So from twenty percent was their suspension rate two years ago to ten percent last year. And, that, drop was not experienced statewide. It was not experienced countywide, so there was something unique at that school. And that's something was a certified wellness coach.

And then finally, one of the findings of the report was that implementation of this, this idea of bringing a certified wellness coach into the behavioral health ecosystem was stronger in schools that really had the capacity to think about how this role does integrate. How and the report really does a great job of showing our best practices that are emerging in that area so that everyone can benefit from the thoughts of of how to best integrate there. So that's a little bit about wellness coaches.

Part of the rationale for that profession, for that certification, is that it formalizes the role. And with that formalization comes the ability to bill for services provided.

And so therein leads me to, another flagship component of the initiative, which is the CYV HI fee schedule program. So brief refresher. I know members of the committee are likely familiar with it. First in the nation approach to connect schools, colleges, and designated community providers to health insurance plans that the state has the ability to regulate. And this includes both medical and commercial plans.

It mandates that these plans pay for certain outpatient behavioral health services provided to students when administered in a school linked manner. And these services can and are coming from wellness coaches as well as many other professions supporting students, including school nurses, school counselors, social workers, and therapists. So I'm joined here by Autumn Boylan from the Department of Health Care Services.

And this this amazing team has stood up a third party administrator to help and to really serve as the single conduit for the thousand plus local educational agencies to interface with the more than three dozen health plans that we have in the state that are part of this program. And so where are we, in terms of a status update?

By this chart, you can get an you can get a sense that we're in the middle of rapid growth. In fact, growth so fast my graphic designers cannot keep up. This chart is from early spring, and you can maybe see at that point, we were approaching a 100,000 in claims financed by the program. And you can think of claims as roughly equivalent to services, but it's most definitely an undercount of services that are provided through the program.

But even then even since then, that growth has doubled.

So the most recent numbers we have are from June 1, so just ten days ago, and you can see them here. So almost 200 entities, primarily local educational agencies, meaning school districts for the most part, have submitted more than 230,000 claims through the program for services benefit benefiting more than 48,000 students. So to date, these entities have collectively seen more than 11,000,000 in new revenue, which can help sustain the efforts, much to the points that were raised, to support young people on campus.

Now there's a long way to go here, but the current growth clip is a testament to the collaboration between health and education sectors to do right by young people. And certainly appreciative to the legislator for their support on this.

An evaluation from Mathematica is due out on this program very shortly, matter of days to weeks on that. And so be sure to share that out with the group when that's available. And finally, committee staff asked for my thoughts on innovative grant programs that were administered through this initiative. It's like asking me to pick my favorite child, but I'll nonetheless, note two categories and actually quite, they resonate with some of the themes that we heard from the prior panel.

So one is various types of grants that we put out that have really incentivized collaboration between entities that might not otherwise have worked closely together.

So talking about bringing managed care plans closer to schools is one example, Bringing hospitals and public health and community organizations closer together to think about preventing suicide clusters is another example. California Health and Human Services Agency has worked with Trina and others to think about how we've transformed the ecosystem by bringing multiple partners into the same room as well. So this is tough work, but rethinking the structure of relationships between agencies is important.

And, it's really helpful in putting youth at the center and not thinking about our various silos, and it really has the potential to have durable impacts. And then the other category of grants that I think have have been particularly impactful are those that have allowed youth to explore how they can contribute directly to the field, as many as mentioned.

Many folks turn to friends when they're stressed. I do. And so through these grant programs administered by DHCS, administered by HCAI, the Department of Healthcare Access Information, proud that we've explored ways to train young people to be part of that system of support. And that certainly includes, but is not limited to the peer to peer support program Rebecca's gonna talk about. But it certainly includes that.

So I'm I'm happy to share more about that, but I think she's gonna do a great job doing so. So with that, I'll conclude. Thank you for your time.

Thank you for your testimony. You may begin.

Thank you. Good afternoon. Thank you, chair Patel and members of the committee for the opportunity to speak today. My name is Trina Frazier, and I serve as assistant superintendent of student services at the Fresno County superintendent of schools, supporting 31 school districts countywide through our all for youth system of care. Today, I'll briefly share how Fresno County has implemented the children and youth behavioral health initiative, CYBHI, through a multi tiered system of support along with our successes, challenges, and lessons learned.

Our model, how we built and funded it. Our work in Fresno County began with All four Youth, which we launched in 2018 through a strong partnership with Fresno County Department of Behavioral Health. This was a $111,000,000 investment. That partnership allowed us to bring specialty mental health tier three intensive services directly onto school campuses. From there, we utilize new programs and grants like CalAIM and the CYBHI to expand to a multi tiered system of support.

In your packet, you'll see our multi tiered continuum of care in there. Over the last five years, we further strengthened our model through the student behavioral health incentive program, SB HIP, which was part of CYBHI and provided funding to build partnerships between schools and managed care plans. This one time grant helped us better align school based services with medical delivery systems and prepare to implement the LEA fee schedule, which reimburses schools for behavioral health services.

The HCAI wellness coach grant helped us increase capacity to provide tier one and care coordination services, another part of the CYBHI, and also reimbursement for enhanced care management, ECM, will help us better serve our highest needs students, including homeless and foster youth. We also received to the CYBHI the transforming together grant, and that was to fund peer to peer supports and also coordinate care between other agencies and our other partners in education like community schools.

In all, we now offer tier one and tier three services to 318 school sites, tier two services to 76 school sites, and have established 12 wellness centers and five mobile therapy units. What makes this model work is that we are not building something separate with new grant or reimbursement model. We are integrating education, behavioral health, and health care into one coordinated system of care for students while strategically working to build toward fiscal sustainability. The impact and what we're seeing.

This school year, we have served 5,931 students with treatment across 31 districts in Fresno County through the system of care.

We supported three two hundred and thirty staff, including a 125 Clinicians and case managers. So far, we are seeing students accessing behavioral health services that would not have otherwise been able to get or afford it to them. Earlier identification of student needs before they escalate through prevention and early intervention, and stronger collaboration between schools, families, and providers.

While we are still working to identify the full impact of All four Youth, it is clear that our wellness centers have been highly effective in advancing prevention and early intervention by creating accessible school based spaces where students can receive support before challenges escalate into crisis.

In addition to building students' coping and social emotional skills, schools with wellness centers have decreased chronic absentee rates by 23.2 points over the last four years in comparison to the county average decrease of 15.4, decreased suspension rates by 3.1 points compared to the county average decrease of 0.8, Increase the percent of students meeting or exceeding ELA standards by 6.6 points in comparison to the state's increase of 1.7 points.

These outcomes are even more pronounced for certain student groups. For example, chronic absenteeism at schools with wellness centers declined 27 points for students with disabilities and 21 points for English learners over the last four years versus the statewide decrease of thirteen and fourteen points respectively. Most importantly, students are receiving support in a familiar, trusted environment where they are already every day, our schools, community, and homes. Challenges and lessons learned. While this investment has been transformative, implementation is complex.

Some key challenges include legal compliance and building infrastructure, System alignment, coordinating across education, county behavioral health, and managed care plans takes intentional effort, and relationships are what matters most. Administrative and billing structures, particularly as we integrate LEA billing option program, the fee schedule, and programs like enhanced care management, ECM.

We recently reached 50% cost recovery with the fee schedule, So meaning of the staff that we have associated with the fee schedule, we're recouping about 50% of our costs, and we've done that through building blending programs and braided funding. One key lesson we have learned is that success depends on local coordination, partnerships, and flexibility. It is not a one size fits all model.

Some policy considerations. As policymakers consider how to replicate the success of models like the one in Fresno County, I would offer three recommendations or considerations. Number one, funding needs to be ongoing, whether structured as grants or reimbursement for services, time limited grants, unless they are for specific start up expenses, ultimately lead to the loss of providers and services to students. Number two, program requirements should be flexible enough to allow communities to design systems that meet the needs.

And number three, future programs and grants should build upon existing programs and priorities rather than create new ones.

Braiding funding streams and integrating the priorities of education, medical, and behavioral health systems is critical to sustainability. In closing, I want to thank you again for your leadership and your commitment to improving outcomes for children and youth and offer Fresno County as a resource. We stand ready to partner as state policymakers work to scale and replicate this work thoughtfully and sustainably across California. Thank you for your time.

Braiding funding streams and integrating the priorities of education, medical, and behavioral health systems is critical to sustainability. In closing, I want to thank you again for your leadership and your commitment to improving outcomes for children and youth and offer Fresno County as a resource. We stand ready to partner as state policymakers work to scale and replicate this work thoughtfully and sustainably across California. Thank you for your time.

Thank you, miss Frazier. You may begin.

Good afternoon. My name is Rachel Krow-Boniske, and I work at the James Morehouse Project Wellness Center at El Sutter High School. Thank you so much for having me. I'm honored to be here. The James Morehouse project is a comprehensive wellness center that's been at El Sutter High School for the past twenty seven years.

So we have been sort of on the forefront of talking about youth mental health for many years now. The JMP is a space where students can come in to do something as simple as get a cup of water, get a snack, say hi to an adult who knows their name and face. They can also get reproductive health or a physical or medical treatment in addition to mental health services. So this is a center.

Of our 1,400 students, we see about 1,000 unique individuals come in every year.

And I'm here today to talk a little bit about our peer to peer program and the pilot demonstration that we're a part of. Before I dive into the details, I wanna start with a quick story. Earlier this year, we got a call from the registrar that we had a new student on campus. She was a recent immigrant from Brazil who had just arrived at our school for the first day.

And because of our peer to peer program, we were immediately able to send one of our students down to the office who is a Brazilian immigrant herself, speaks fluent Portuguese, of course, and she was able to give the student a tour of campus, bring her to a support group of Latina girls at lunch that day, and these two students have been meeting every week since.

So this young person who in many ways was set up to feel potentially isolated, overwhelmed, unsure sort of where to go now has a support system on campus, and someone who has helped her talk to teachers, talk to her counselors, as well as someone to just talk to about sort of daily life and adjustment to life in The US. So that's a little glimpse into the work that we do. Student voice and youth empowerment has been a huge part of the JMP in our whole existence.

It's something that is really important to us as we strive to create beloved community in our wellness center. And so of top important to us is that we're creating a space in which students feel connected.

They feel like they belong. They feel like they're seen, that they can sort of leave their mask at that door, which we know is unfortunately not too common in schools to have a space like that. And so in creating a peer to peer program and having this opportunity, that was sort of what we wanted to be uplifting among our students. So this is our second year in our peer to peer program. We've now trained 53 peer mentors.

And of our 32 peer mentors this year, we have peer mentors who speak 13 different languages, which is really important to us in recruiting peer mentors and thinking about the students they're serving. We're thinking about a number of really important priority populations at our school. And these are black students, students who are students who are multilingual, and English language learners, and are neurodivergent students or students in special education.

And the reasons we prioritize these populations are that these are students who are often underserved in our schools, don't have enough sort of resources, maybe don't have adults who look like them, who are providing the support, as well as students who sort of aren't getting maybe the academic support that they need. And so we are providing this intermediate level.

When we think about a multi tiered sort of layer of support, we think of it as, like, a 1.5, like, students providing support for other students. We know they're already talking to each other. We know that's where they mostly turn to for support, so we're giving them those skills so they can have that from each other.

So through our program, peer mentors participate in after school training sessions where they build a strong community with one another, get to sort of question, examine their own beliefs and values, talk to people who have beliefs and identity and experiences different from them, and then learn communication skills. How do you show someone they're actively listening?

How do you use open ended questions? How do you support someone without giving them advice or telling them what to do? And then, of course, they're sort of extensively trained in confidentiality and its exceptions or its limits. So they know what is within the scope of a peer mentor and when is it time to bring an adult or when is it time that this person needs support that they cannot offer.

And after they've gone through that training, these students then have the opportunity to provide one on one peer mentorship as well as small group peer mentorship.

This year, we've provided peer mentorship to over 150 students. Oh, sorry. Not one hundred percent, one hundred and fifty sessions. We've also had students who let a small group. This year, I was noticing an uptick in need among our young Muslim girls.

And so two of our peer mentors were able to facilitate a support group from Muslim girls and meet that needs specifically as students within that community. As I said before, providing support in many languages is really important to us.

And so this year, we've had students provide mentorship in Spanish, Portuguese, or do Punjabi, Vietnamese, Mandarin, French whole range of languages, and it's really wonderful to see these young people coming into our space who might not otherwise have someone they could go to and getting that support directly. We've heard from our students, across the board, our peer mentors, that they are feeling more confident. They are feeling more connected.

They are feeling a stronger sense of belonging, and then they're sort of helping bring that to other students. When I knew I was gonna be coming here today, the first thing I did was turn to the students and say, what what do people need to know? Like, what should I be sharing? And a few of the things that really stood out for me, was one of our young black men saying, I didn't have someone who looked like me to talk to. He's a senior now.

He's an incredible young person who has worked really hard to get to where he is. He said, I didn't have someone. I wanna be that for somebody else. And another student piped in saying, yeah. When you're talking with a student, it's like they're walking alongside you.

But when you talk with an adult, it's kinda like they're talking down to you. And so we're trying to create more of that feeling of someone who can walk alongside them and help support them navigate high school, who knows what it's like to be a teenager now, not to be a teenager whenever that was for all of us. And and so to close, I really wanna share a quote another quote from one of our students at our end of year survey.

This is a student who's an English language learner and immigrant from China. This her second year in the program, and she says it sort of better than I ever could.

She said p to p, which is what we call our peer program, has enriched my life. My mood became better every time after the p to p meeting. This led to people greeting me and caring about me in daily life, so I performed better in school and felt belonging. I couldn't ask for more than that. Thank you so much for your time.

Thank you for all of your testimony. And at this time, we also have, is this Autumn Boylan Yes. That's at the table with us to respond to any technical questions. Can you introduce yourself, please?

Yeah. Good afternoon, and thank you for including me today. My name is Autumn Boylan. I'm the deputy director for the office of strategic partnerships at the Department of Health Care Services. And alongside doctor Sud, I lead many of the initiatives that we discussed today.

Wonderful. I'm gonna open up with a couple of questions, and then I'll open it up to my committee members here. Going back to doctor Sud, thank you for your presentation. It was very comprehensive. I do have a few questions for you.

When I was talking to schools and counties and county office of ed and providers in my district about the initiative, Of course, they mentioned in the initial phases that there was a coordination problem as people ramped up and tried to learn billing services and just working with each other. But from what I'm seeing, it seems like those and and, miss Frazier, maybe you can also provide some input here.

But for those that seem to have better success, seem to be those that are able to leverage expertise from their counties or their county office of ed and sort of work together collaboratively. How can the state help better aid these kinds of or incentivize coordination to not only improve Fidelity and better outcomes, but also just best practices and how to avoid potholes and things like that?

Yeah. Appreciate the question and happy to start that. Also, ask if Autumn is interested to jump in as well. So I think maybe I'll start by saying one of the things that that I heard, miss Frazier mentioned was the importance of flexibility in design.

And I think that's really been some of the core concepts on the design of the fee schedule program in particular is that each entity that's participating can choose who their providers are, can choose if they want to do it solo or be part of a consortium.

They can choose, who is doing the billing, what type of record keeping they want to do. And I think, certainly, we saw a lot of that, those considerations be part of the intentional the in with intentional flexibility comes some pausing, so it comes some additional considerations. Right?

And to your point of how we incentivize further movement in a direction that's more impactful and effective, I think what we're seeing from there is those considerations are now people are acting on them and they're moving on them, and they're sharing that information with one another. And we facilitated spaces for that to occur.

So in addition to the fee schedule program itself, there's a paired grant that's gone out to schools called the capacity grant, partnerships and capacity grant, and part of that includes communities of practice. So not only are they in cohorts where they're working on the operations of the fee schedule, but they have communities of practice where they are learning and sharing from one another, and that continues.

Yeah. Thank you. I would just add that the communities of practice are inclusive of our county offices of education. And really part of the goal is like a little bit of a train the trainer kind of model to try to loosely describe the approach, but the funding was intentionally awarded to the county offices who then worked locally to make local decisions with school districts about not only funding, but where the different school district participants in each county needed different types of supports.

And so all of the learning through these communities of practice, there's a repository, held by the Sacramento County Office of Education and the Santa Clara County Office of Education of best practices.

There's a lot of sharing of tools like release of information or consent sharing tools as an example. And, and we've really seen a lot of coordination and collaboration across the state through these communities of practice, which are held on a weekly basis, by peers. Right? So we've been talking about peers this afternoon, but it's the Sacramento County office and Santa Clara County offices of education leading peer communities of practice amongst their colleagues from across the state.

And that includes all 58 county offices of education who then share those learnings at the local level.

And many of our county offices hold then regional consortium meetings or other kind of statewide or other convenings for their communities, for their partners. And DHCS, Carolina Behavioral Health, Sacramento and Santa Clara County offices all try to support all of those activities across the state.

DHCS also holds cohort meetings on a weekly basis where based on when folks went live with the fee schedule program, they are able to get information, collaborate, share best practices, ask questions of the department so that we can all work together to implement and learn from the people who came before as well.

And I would agree. I've been a part of those communities of practice, and I've just learned so much from my colleagues learning from each other.

It's wonderful. Just as a follow-up question, miss Muscala, in her report, in the PBIC report, it was described that there's a high incidence of mental health challenges with our students in rural communities. Fresno, of course, serves a lot of rural Fresno County serves a lot of rural communities, but providers are also difficult to find in those rural communities. How are you able to bridge that and still effectively meet the needs of our students?

You know, thankfully, this is real good. I'm gonna knock on it. We have not had an issue finding staff. We have had so many interviews, and so many of them want they're coming from those communities, and they wanna give back to communities, and they wanna be a part of it. And they feel like they didn't have those services when they were in school, and they didn't have them.

And so we have been we've created a an HR family tree where staff can begin with us, and they promote with us, and they stay with us. And I think that's been really, really helpful in keeping staff. We don't have a lot of turnover, and, thankfully, we haven't had an issue of finding staff. And, and you mentioned, you know, having staff that look like our students and that our students can relate to.

About 80% of our direct service staff are an ethnicity other than white, and they about 68% speak another language.

And so that has been really helpful in our rural communities where we really try to hire people that fit those communities and work with those students.

Thank you. Doctor Sud, you mentioned that the California Healthy Kids Survey. And as a former school board trustee, of course, year over year, we looked at those survey data. And I understand that there are multiple modules that are available for districts to adopt. And some of the modules interrogate into their survey process the mental health of the students in the school system.

But those modules are optional, and it requires districts to do more work and students to answer more questions. Do we see any plans of incorporating some of those optional modules into the CHIC survey that's that's widely adopted for all school districts? Is there any changes in the types of questions that we're asking? Or how do we get school districts to participate, to volunteer, opt in to those additional modules to make sure we are able to track outcomes?

Yeah. I appreciate the question. I'm not aware of any current attempts to, I suppose, incentivize the proposal that you're putting on the table, but I'm happy to to talk with you more offline around that. I meet regularly with the Department of Education who is, you know, has a major role in facilitating the administration of that survey. So happy to take that back and discuss with them as well.

Thank you. I believe in continual improvement and wanna make sure that the tools that we are using, as mentioned before, that we know create whole new suites of tools that we leverage the tools that are already available to us. And and if those aren't working, then let's find a better tool.

Yeah.

Right? Another question I have, when we look at strengthening the education pipeline to support long term work workforce needs, especially for those certified wellness coaches, Are we looking at specific partnerships? How are those partnerships going?

Yes. So many different aspects when you talk about the the pipeline. I'll say the Department of Health Care access and information, not represented on the panel today, but I'm happy to to speak to the extent that I can on it. They've supported through CYBHI about 70,000 individuals, along their behavioral health career trajectory in one form or another. And about half of those are very young people, like high schoolers that are contemplating a career of one sort or another.

So from high school to college, there's wellness coach scholarship programs as one example of trying to grow that pipeline there. Right. And then within colleges, HCAI has developed partnerships with a number of different community colleges and Cal States around the state to create wellness coach designated programs. You don't need to go to a designated program to get certified, but it it basically is a package for everything that you need to then be certified once you get your degree in a relevant, basis of experience.

And so that helps support the training at the higher edge place.

And then in addition to that, as miss Frazier mentioned a little bit, HCAI also doled out a 128, I believe, million dollars in grants that were employer support grants. So facilitated the hiring of these individuals into the educational sector in particular, but also to community organizations to start them in these places as they get more comfortable billing for services and finding a more sustainable path to continuing their employment.

Thank you.

Did that answer your question?

Yeah. It did. And we can certainly schedule an offline conversation to dig into it a lot deeper. I'm hoping that this committee will be, serving the California public for years to come. So we have a lot of work to do.

This we're not gonna solve all the challenges today. For, miss Boylan, I have a question. It has come to my attention that a lot of our institutions of higher education are not adopting these multi tier fee schedules. I see that UC Santa Cruz has billed or received reimbursement, but we don't see this happening at community colleges in any widespread adoption. What are the barriers there, and how do we help our higher education institutions?

Yeah. Actually, we have a team at DHCS dedicated to working with all three, public college and university systems. So we are actually working very closely with the California Community Colleges, chancellor's office, as well as the California State University, and the University of California Office of the President. We actually have 21 colleges and universities that are in some phase of onboarding or billing.

As you mentioned, UC Santa Cruz has been particularly successful so far in billing the fee schedule, for services provided to students on their campus, or through partnerships with community organizations.

And we've been working for some time, with the California Community Colleges Chancellor's Office, on a support model that they will be implementing in the coming school year to help support a larger number of the California community colleges, through, a consortia model. As, as Doctor.

Sud alluded to, we tried to arrange, you know, some flexibility in the policy and programmatic design for the fee schedule program so that one entity doesn't have to figure out how to do all of the billing and have all of the administrative capacity that helps support small and rural school districts as well and colleges and universities. But the idea with a partnership with the chancellor's office is that they will build the billing infrastructure through, some existing contracts that they have, with billing entities.

And then all of the California community colleges will be able to bill through the chancellor's office contract.

And so we've been partnering with them and they're very much on board. We have some, community colleges that are participating independently as is their option to do. And we've been working closely and have recently presented to the California State University, school services, and supports teams, as well as, a convening that we're going to, the summer with the University of California folks to get them kind of onboarded and learn from their peers who've been successful in doing this work.

So, lots of efforts in the college or university space. We think it's very important, to, make sure that that young adults are able to access services and supports at school as well.

Yeah. Certainly, look forward to hearing the outcomes of these, recent outreach efforts and establishing, you know, these programs at the higher education level, perhaps in a future hearing. So thank you for that. At this time, I'd like to welcome Assemblymember Pellerin, a committee member on our committee. If you would like to ask any questions, I you haven't had a chance so far.

I'm glad to hear that UCSC is doing well with their their views. So thank you.

Looking forward to hearing your thoughts as we proceed with the hearing. Also, to miss Krow, and I'm not gonna pronounce your second part of your last name, please. Boniske. Boniske? Miss Krow-Boniske.

You described really successful impactful program. What you have there sounds like a gold standard for what we would like to see at many of our high schools as well as middle schools even, maybe even elementary schools, as I learned that some of the anxieties and stresses that our youth are facing go all the way down to the elementary school level, which is hard to hear about, but in a way offers a lot of potential for us to help them develop resiliency and coping skills.

And I have heard of even elementary schools having these kinds of wellness centers, so it's good to know that communities are seeing the need in stepping up. But you have created this great pilot. What have you if you were able to receive ongoing or even increased funding, what would you do in expansion?

Where would you take this next? What is the room to grow?

Wow. I think I love that question to imagine expansive funding. I think that we would wanna grow the peer program even bigger to serve more students. I think right now, we are able to, bring in as peer mentors students who need leadership opportunities who don't always get them, but still are within a segment of our student population who are more successful academically. Not across the board, but more so.

And I wanna be able to reach so many more students because we know there are students who might be struggling academically, but have a lot of leadership potential, have experienced a lot that they could bring to their peers. And so I would wanna expand more broadly that way in terms of who we're serving as peer mentors and the reach they can get.

I think if we could become more embedded within the school system, we're in a unique position in a wellness center that was sort of a fiscally sponsored nonprofit within a public education system. And so we are lucky to have a really wonderful collaboration with their administration and with our school, but still we're sort of different systems operating together.

And so I think to continue to get to integrate those systems and build the peer program into that, we're talking about trying to do sort of up standard trainings, have our peer mentors be leaders across campus, not just in these one on one roles.

Our mental health services and our wellness center are primarily provided by graduate level trainees with clinical supervision by our staff. And we have an incredible training program, and I think that being able to put more funding towards expanding that we're just actually having a conversation recently about how there are other schools who are approaching us and who are interested in our model.

And if we could expand that so we could provide training and we provide support so other schools could replicate a model like this, we'd be so happy to get that opportunity to do so.

And just a follow-up question to that. I think it's wonderful that there are peer counselors. It seems that our young people, for their the earliest intervention phases is if it's not your friends and your family, your loved ones that you're confiding in, it would be a peer mentor because of those shared lived experiences and maybe relatability, authenticity.

Do we see any secondhand trauma from those that are peer counselors, and how do we help those students to mitigate against that and to know when is the right time to hand off?

Yeah. That's a great question. I think, again, because we have the infrastructure of several licensed Clinicians on staff, we're providing a lot of hands on support to our students. So that doesn't mean that they're not experiencing secondhand trauma, but every time a student has a peer mentor session, I get a checkout form immediately so I know a little bit about what happened. If there's any sort of crisis, any sort of, like, exception to confidentiality, they're talking to me in the moment.

And thinking beyond that, I'm following up with them within the next day or two to see sort of how it felt for them to hold that information, what they're doing to process or to get their own support. And we've had peer mentors come to us and say, like, I'm not in a good place myself right now. I don't think I can provide support right now. So they're still a part of our community.

They're still peer mentors, and maybe we're connecting them with a counselor now and giving them a break for providing that peer mentorship.

And so I think one of the things that's been really beautiful is a way that it's sort of connected our peer mentors and the broader system. So they're getting the support that they might not have felt comfortable getting. We have a lot of students who are like, oh, yeah. I can give support, but I don't get it for myself. Like, my family doesn't want me to do that, but I'm happy to do that for others.

And I think by seeing the impact it can have, they're getting to sort of turn around and do that. And so I think that that is one way in which we're yeah.

So Thank you.

I'm just real curious. And how long have you been doing this work in your

This is our second year with our current Peer Mentor Program. We had a prior program pre pandemic that didn't last the pandemic. That was a leadership program, but in this form, it's our second year.

So I'm just wondering, you know, what changes you've seen in youth mental health over the years that you've been working in this space.

Yeah. I mean, I was having a conversation with so our founder recently, so she's founded the wellness center twenty seven years ago, so has gotten to see a lot and saying, like, we weren't talking about anxiety twenty seven years ago. This is not, you know, a conversation. And so in a lot of ways, mental health needs have sort of increased, but also their ability to talk about it the the way that's there's so much less stigma than there used to be around it.

I think that's something we've really seen a change around.

Students are happy to walk in those spaces. They're happy to tell their friends that they're going to a counseling appointment, And we have the benefit of, like, they don't have to tell their friends. They can say I'm walking in to get a snack, and then, oops, I just walked into this room and started talking to someone.

And so there's it can happen both ways where the space itself, I think, has really contributed to decreasing stigma, but I think that's one of the main things we've seen that people are much more Yeah. Open to getting support, and they're hearing about it from their friends.

Reducing the stigma is so incredibly important to get kids to show up and to share and to be connected to services. So thank you for that. That's good news.

Thank you.

And before we wrap up this panel, doctor Sud, I have one more question for you. I was mulling over the stats you provided around, Butte County. Was it Butte County, Butte School District?

Oh, yes. Sorry. Butte County Office of Education.

With the reduction in suspensions Yeah. With the increase in wellness center or supports and services, tier one, tier two kind of supports, is that have you looked at the details around that? Is that related to reduced suspensions related to substance abuse, maybe through self medicating? Or what what what were how were those reduced suspensions tied to, the services being provided?

It's a good question. I'd probably have to follow-up, to and work with some of our partners who obtained that data to get you more information. That specific example was at an elementary school, just for context, as well where the suspension rate was twenty percent two years ago, so quite significant. But, what I'll also note is that, that came from one of now, we will eventually have 17 counties profiled, in reports about CYBHI implementation.

And so you can dig deep into any county within your jurisdiction that you're interested in in learning more.

There's one coming out on San Diego, again, probably within the order of days to weeks from now that we'll make sure you have access to that will share anecdotes like that, other information that we're having at the at the really local implementation level there.

I believe Assemblymember Davies had a question.

A comment and a question. I just wanna say thank you. It it's so refreshing to hear, and I think that just listening to how you've gone about this and, again, flexibility, being able to one size doesn't fit all, be flexible, think on the box, share with, you know, other schools how they're doing it. And I think that, obviously, that's something you need.

And if you have, like, workshops in that for workers like yourself in in doing all this, include us so that we can be part of that.

And, again, our job is to solve problems. And so when we can sit in a room like this and hear going, what can we do? And, you know, panels are great because they're we don't know. We're not there. But we can actually move policy or hopefully get funding and and find out what's happening.

So include us in this. And I thought it was what was great too was when we're talking about future grants, the need to actually build on the existing programs. Because sometimes and everybody, it's, you know, oh, we've got a great thing that we're gonna do here and we're gonna add this, but we need to work with the programs and make sure that they're doing what they're doing.

And when we're feeding to these programs, again, that continuity, they're coming together where they're organically growing from this first program to instead of starting something over here and something over here, and then that connectivity isn't there. And it's great for a little bit, but then what do you do?

So just you guys are just doing everything right, and we're just I'm so proud just to sit here and listen. And I just then I had a question is like I said, the peer to peer I'm finding is working so well, and a lot of those that came in for help end up being peers after learning the skills and being part of that. Once they graduate from high school, not everyone goes to college.

And so where can these students go to have that, you know, that security that they've had knowing every day when they were going to school?

They they could go here or they could at least have their you know, they could talk to someone, if they weren't feeling safe. But once they leave, a lot of times, they don't know what they're doing in life. And even if they are, maybe you're connecting with the community colleges where they come in and say, you know, I'm go I'm San Diego Orange County.

And maybe they're going to a community college down there the next year to be able to have those counselors come in and meet those that are going to that school. So already giving them kind of a orientation of, hey.

Come on. Take a tour. We're gonna show you what we have here. So once they leave there, they know they've got a place to go. But if they're not going to school, I'm just curious how can we help them move on?

I think one of the ways that we can do that, if you don't mind if I Yeah. Please. Is I mean, there's a lot of ways that we're trying to reach people in communities, community based organizations. We've funded youth run programming that's for up to the age of 26, right, across the state of California as part of our evidence based practice grants and tried to fortify and strengthen some of those community based settings where youth are leading peer based activities.

I would also say that BrightLife Kids in Saloona are opportunities for kids to young people, adults, young adults to connect with wellness coaches, peer support specialists, and those same types of providers that they're getting access to in schools through these other programs that we're talking about.

So through a lot of the partnerships that BrightLife Kids and Saloona have with school districts across the state, there's able to be some continuity, in the services that are provided if people are not going on to college. And if they are still you know, of course, as we all do, my I've a 25 year old and a 21 year old, Adulting has been a lot.

And, and that extra kind of layer of support for kids who aren't in college, I have one that went and one that didn't, I think is super helpful.

So, say I'm, you know, you're a senior and you're graduating next week, and you're you're you've been using the, you know, all the, you know, all the classes, everything, doing this peer to peer. Do you are you able to sit down or maybe you do and say, hey. I know that, you know, this is just you got a week left here, and we wanna make sure that you've got a place to go if, you know, if you feel this is where you go.

And are they getting the information? Or, hey.

Maybe we do a tour and check it out just to be able to give them that lifeline. Because, again, when they leave, they're almost, like, starting all over these people that that they're not they don't know. They've gotta kinda you know, it takes a lot to come in that first time, and it may be easy where they're gonna just drop off going. I just don't wanna do this again.

Yeah. That care navigation support, I think, is super important, and we're funding that through the fee schedule program. We also have care navigation built into the framework of what BrightLife Kids and Solutions offer through CalMAP, our pediatric consultation, service for primary care providers. They are able to get information about coordination of care services through the University of California at San Francisco and and that program. So lots of different ways in which we're trying to provide that coordination of care.

That's also a part of what CalAIM is doing around whole person care and supports through the medical program and and really focusing on these more

kind of coordinated efforts to meet people where they are and provide whole person support.

It sounds like you are the model for other school districts and other areas to match. So thank you.

And we and we will we will connect them to care. If they still want services and they're not going to college or a community college, we will connect them to another provider so that they have that continuity of care. And then also, the CYBHI does serve until age 25. So if they do go to a community college or a college, our therapist, our case managers will follow them to that entity.

And then for specialty mental health, we serve until 22, and we do the same thing. So

Assemblymember Papan, do you have any questions? Feel free to jump in.

I don't know. Yeah.

I'm from San Mateo County, and we have some pretty terrific model programs, and there have been a lot of providers that are in and about our high schools and junior highs as well. So I don't know that I have a lot to complain about. One thing is we're sitting here thinking, and I love the idea of peer to peer. Don't get me wrong. Can you hear me?

Because acoustics in this room are not fantastic, I will say. But, you know, I think about the silver tsunami that is coming, and I wonder if sometimes that may be a resource as well because there are seniors who do have time to give. And as much as we'd like to think our problems are unique to this generation, and some things are, no doubt. I didn't have social media, so I'd like to think my mental health is probably better than most as a result.

But, nonetheless, I just wonder if that ever gets factored in.

If we're looking at perhaps volunteer counselors or something along those lines. You're nodding, but you're my peer to peer gal, so I don't know. But, by the way, I wanna appreciate what Fresno does, and I appreciate the materials that you put together to show us, you know, the different levels. We cover everybody at certain things. It was fascinating.

I really do appreciate it. But, anyway, you were gonna say something about the silver tsunami that's coming along and whether they might be useful.

And for a good price, I might add. More than likely free.

Yeah. My advice is free, baby. Yeah. Exactly. Same price. And, anyway, please.

The only thing I'll quickly add on that is that we've had a wonderful partnership this year with a number of seniors who bring in therapy dogs every month. And so they come, they sort of love coming into our space. Students love getting to hear them and their stories, get the sort of break from the class, their sort of break from the stress of playing with the dogs, and that partnership has been really beautiful this year.

Oh, yeah.

If I may just add, I really appreciate the comment. The First Partner's office alongside California Volunteers and the California Health and Human Services Agency have launched this campaign called California Love, California Strong with the idea of really trying to build a community and bring people together. And the very first activation launch event was at a senior center, very much to your point about bringing people together and included within that. And part of the promotion strategy here is how do we build intergenerational links.

Right? How do we bring young people to do volunteer activities at senior centers and bring a society together so that we can all learn from each other in different ways? So appreciate the comment.

Yeah. Thank you for that. We've also seen great success with therapy dogs and our seniors that, run the therapy dog programs. And it's just been incredible, especially when there are situations of acute trauma on a campus. Following it up not just with counseling, intervention counseling, but with therapy dogs coming in regularly really helps ease that for young people as they try to cope with the traumas that they're experiencing.

I think these are wonderful things to think about. And, certainly, we know the studies show that the direct personal interactions really make a big difference. So happy to hear that at least in Fresno County and our rural communities, we don't have any troubles with staffing, but wanna just be aware that we might still in other places need to make sure. Absolutely. That we're able to develop the pipeline to support our young people as they age into adulthood successfully. Right?

Yes. So thank you for your testimony today. We will move into the final panel, which is opportunities and solutions. I'd like to now invite to the witness stand Lisa Eisenberg as well as Carly Clemons. And once you're situated, feel free to introduce yourselves and get started.

Thank you, Chair Patel and members, for the opportunity to offer insights into the CYBHI multi payer fee schedule and school based behavioral health services in California. My name is Lisa Eisenberg, and I'm the child and youth health financing project director with WestEd. As you mentioned in your opening remarks, we already know from research and experience that sustaining and providing a continuum of mental and behavioral health services in schools has a positive impact on children and youth.

The CYBHI fee schedule supports this by creating a way for schools and partners to generate revenue for some of those school based supports. Before the influx of one time funds in California, a lot of the previous funding and billing models used in schools were somewhat limited to reimbursements for more intensive interventions, so sort of at the top of that tier pyramid of supports.

The fee schedule does provide an opportunity to shift this slightly by creating the ability for schools to bill for targeted supports, like small group counseling sessions, and some prevention approaches, such as screening and behavioral health education. You asked what schools have been most effective. From my perspective, schools that have been most effective at leveraging the fee schedule are those that are leveraging existing staff and existing relationships with health plans and wrapping CYBHI into existing system initiatives, like you heard from Fresno County already.

An example of some of this is that we've heard from schools that have capitalized on Medi Cal Medi Cal health plan relationships that they've built through the student behavioral health incentive program. And then through those existing relationships, they've executed data sharing agreements where they can get better the school can get better information about student health insurance coverage and information, and that's a critical data point for schools to successfully submit claims through the fee schedule.

We've also know that schools have focused on billing for services provided by existing staff such as school counselors, and staff that have been newly certified as wellness coaches. While the high interest and focus on the fee schedule has been a testament to the outreach efforts across the state, expectations for implementation are too high, and the expectations for school is that it's going is too fast. We haven't redesigned a billing system for schools. We've asked schools to redesign themselves to fit a health care billing system.

This requires a monumental effort on the part of schools to shift and adapt.

Most almost every school I hear from is really anxious because they feel like they're behind or they're missing the boat or that revenue is lower than expected. We've already heard folks mention this work is hard. It takes time to get it right. It takes time to increase billing revenue to see that graph continue to go up.

And I think we should be balancing enthusiasm and opportunity with realistic expectations around change, especially given that schools and child serving systems are managing many other initiatives at the same time.

Messaging, engagement, and expectations should also reflect that even once maximized, fee schedule revenue will only cover a portion of a school's actual costs for sustaining comprehensive school based behavioral health services. You asked a question earlier about how much funding is needed. I can't give you that answer, but I wanna offer you a data point.

The PPIC policy brief that was provided earlier noted an increase of funding of $706,000,000 from pre pandemic to mid pandemic levels, and the dollar amount of claims submitted through the CYBHI fee schedule is 1.8% of that. So we're gonna see that increase.

We're gonna see that go up, but I wanna offer that as a data point on on just sort of rightsizing expectations about how to build a a sustainable system. We talk all the time, I talk all the time, about blending and braiding funds. We hear it ad nauseam. And in all honesty, right now, I don't have an easy answer for schools when they ask me where other funding is going to come from.

There's local control funding formula, and there are new initiatives that have been mentioned already, like enhanced care management, Family First Prevention Services Act.

There's the Behavioral Health Services Act as well, and all of those require a high degree of negotiation within school districts and across partners for resources that are or at least feel scarce and are or at least feel like they are contracting right now. Creating sustainability models that leverage multiple resources in addition to the CYBHI fee schedule will be critical for schools as they look to maintain that incredible investments that they have made in school based mental and behavioral health services.

And then I just wanna sort of cosign on what my colleague, Trina Frazier, was saying. Policies and practices that continue to support and even incentivize collaboration between schools, county health and behavioral health departments, health plans, community based organizations will be critical for sustaining these investments that we've made and we've built in recent years. Thank you very much for your time, and I'm happy to answer any questions that I can.

Thank you for your testimony. You may begin.

Thank you to the chair for having me. My name is Carly Clemons, and I'm with Children Now. You probably hear from us and know us, but we are a research policy and advocacy organization focused on the whole child. I'm really glad to be here to speak with you today about the state of student behavioral health in California and the policy levers we have to improve upon it.

A study we did last year found that ninety four percent of California youth between the ages of 14 and 25 report mental health concerns in a given month with anxiety and stress being the most common.

This is actually an increase from eighty seven percent in 2023. Another survey found that thirty seven percent of all seventh graders in California have trouble focusing on their schoolwork. Threats of immigration rates and a rise in anti LGBTQ plus rhetoric have disrupted attendance and contributed to a climate of fear, including increased rates of depression, anxiety, and stress, particularly among black, brown, and LGBTQ plus students.

During the last school year, the chronic absence rate in San Diego County for Latino students was almost double the rate for white students with rates of twenty two percent and twelve percent, respectively. In response, the state's taken steps to designate schools as safe from immigration rates and invested in student wellness by funding the new certified wellness coach model and other things we've heard about today.

Chronic absenteeism has begun to improve. During the 2021-2022 school year, closer to the pandemic, the statewide rate was as high as thirty five percent for Latino students and twenty three percent for white students. However, rates do remain elevated compared to pre pandemic levels. As we've talked about today, social media and online safety are a significant factor in students' mental well-being and academic performance.

In the same survey I mentioned, over half of 14-25 year olds report spending four or more hours on social media every day, and seventy one percent report negative impacts on their life from social media dependency.

As we know, poor Internet habits impact sleep habits, which in turn impact academic outcomes and mental health. The current administration has made significant changes to the traditional structure of how kids are able to access mental health services. Prop One has substantively shifted how dollars are used at the county level. New requirements for increased spending on housing interventions mean that counties have less money to spend on other services. Many school districts have voiced concerns that their programs will lose funding as a result of these shifts.

As we've talked about a lot, the administration has also made a $4,000,000,000 investment in the form of the CYBHI, most of which was one time funding. We've heard from young people that some of the most impactful components of the CYBHI for them have been investments in people who provide face to face support.

Certified wellness coaches actually in the same report that doctor said mentioned, have been credited with improving student belonging on campus as well as attendance by creating nonjudgmental spaces for students to talk to a trusted adult. The peer to peer model we just heard about is also a great example of this. In order to meet the needs of youth, the state must make sure that schools are places where kids wanna be.

In a healthy school climate, students feel safe, connected to their peers, and supported by caring adults. Nearly two thirds of youth say they prefer to receive mental health care face to face investment in positive human connection from a culturally competent mental health workforce of psychologists, school social workers, peer support, support specialists and certified wellness coaches is crucial. And on the other hand, unfair punitive discipline policies negatively impact school climate. They dampen student attendance, and they disproportionately affect students of color.

Too many schools still have police on campus, but no nurses, social workers, or counselors.

Given the relationship between mental health and use use addiction, the state needs to make sure that policies are in place so that students struggling with substance use trust that they can get help without being punished. Currently, school officials have discretion in whether to suspend or expel a student for possession or use of substances, and this discretion is not equitably exercised. Although there is little difference in who uses drugs by race, over seventy percent of drug related suspensions are of youth of color.

Policies like this contribute to a negative school climate and should be eliminated. And investments in school climate include the physical environment.

We often don't think about that, but campus screening and access to natural spaces can have significant impacts on youth well-being. Green spaces reduce anxiety. They increase positive emotions. Rainer school environments are associated with improved concentration and reduced stress. Recently, the Cal Fire Green Schoolyard grants have been used to reduce asphalt or sorry, replace asphalt with trees on campuses.

The outdoors for all initiative has invested in local activity hubs and nature trips to expand access to outdoor experiences for you specifically in low income communities. But even with investments like these 2,600,000 students in California go to schools with less than 5% tree canopy. And in a recent survey survey, 70% of youth were concerned about their ability to access green spaces.

And as we heard from Ella and her excellent testimony, nature is an incredible tool for grounding ourselves, and all young people should have access to that. Finally, investments in crisis services literally save lives.

Plan A should always be to provide young people with preventive services as early as possible before behavioral health concerns devolve into crises. However, crisis can't be planned, and many young people still find themselves in mental health crises while at school. Mobile crisis services meet people wherever they are, including at school, and provide safety escalation. Making sure that 988 is implemented effectively and connected to mobile crisis units will provide to will prove to be a strong return on investment for the state.

So I would just leave you with the thought that as the state faces budget constraints, we recommend focusing on human connection, positive school climate, and effective crisis services is the highest return investments.

Thank you for the opportunity, and I'm happy to answer any questions.

Thank you for that incredible testimony. And, certainly, we've heard from folks repeatedly over the years that that face to face connection is the most valuable connection. And being able to look somebody in the eye and feel that compassion pouring through as you're struggling through something is really gonna be most helpful for a young person as they're perhaps facing that intense of a struggle for the first time in their lives. Before I get into my questions, I wanted to turn it over to my colleagues.

Do any of you have a question you wanna ask at this time?

So what investments could we make? I'm I'm a big fan of prevention and, you know, catching people before they end up in a crisis. So what investments in prevention would have the greatest impact before youth, find themselves in a crisis point?

I mean, I think we've been making a lot of them. I think I come to this from the school based health perspective, so my answer would be investing in staff and positions in schools that can catch kids early. Some of the impactful prevention investments I have seen, and they all cost money.

So there's, like, staff that can implement social emotional learning curriculum across the campus, Trainers that can come in and train teachers on how to identify mental health needs early, and also how to create school class in classroom environments that aren't punitive, that are respectful, that talk that integrate mental health literacy throughout the class. Those are some I I'm a huge fan of the James Morehouse project.

I'm a huge fan of their peer to peer work. I think that example of those peer to peer programs are excellent. I would also highlight that the services that peers are offering is not reimbursable under the fee schedule. You can reimburse for some of the collateral supports that the adults in the system provide to those peers.

But the one on one interaction between a high school student and another high school student is not reimbursable in any of the mechanisms that we have currently.

So I think that is a great prevention initiative that doesn't have a clear sustainability mechanism at least from a billing or reimbursement perspective.

And then, you know, in talking about prevention and your comment about somebody graduating and needing continued care, we're getting into summertime. So what happens with these kids during a summer break like we're having? Is there a continued connection with them and what's available?

Yeah. I think that that's the role. I think the way to address summer break time is to include community based organizations and other county agencies in partnerships, in intervention approaches in school campuses. So you do have a referral network and a network of other adults that are either on the campus during the school year or at least there are strong relationships to connect kids to those resources during break time.

So that's where I think that the reducing silos between schools and other agencies and community based organizations is a core part of sustaining these services.

And then just one more question. So so when when you're doing that kind of transition, is there a way to hand off the student and provide the new person who's gonna be filling in with care with the background as far as what's been done, how they're doing, what works, what doesn't work? I mean, is there sort of a debrief on

Yeah. I think it can look like a lot of different ways. I am not a school based practitioner, so I I haven't firsthand experience I don't have firsthand experience of this, but would be happy to come up with some scenarios or reach out and find provide some examples of where this happens.

I think one of the things that I have seen that works in schools is you have school employees and community based organizations collocated on the school during the school year, and so those community based practitioners are actually embedded in the environment of the school during the school year. And so that that hand off, that referral process isn't clunky because those practitioners are actually baked into the network of support on the school campus.

Really. Can you feed off? Great.

And that's a great question. I was just thinking when you have the peer to peer, obviously, you have one where someone is coming in, testing. You know, they they're they're kind of getting a training because I know there's a peer training they can do. With these communities, one school is out for the summer.

This to me would be a perfect opportunity for these peers that have been helping to get to have a summer job and work in these communities and not only maybe good credits, summer credits expect to be able to have where they can, you know, sixteen, fifteen and a half, sixteen, seventeen, where we could work together and perhaps help finance these other, you know, whether it's boys and girls clubs or whatever it may be, but they get credits or perhaps, you know, they get some type of, wage where, you know, it's your summer job instead of going and working at a fast food restaurant or, you know, whatever it may be.

To that way, they're like, hey. I'm over here now. And if that those people were going to them as peer one on one, they're like, great. I'll see you there. And it's almost like it's just continuing.

Yeah. That comment is well taken.

These are certainly things we would need some kind of philanthropic funding for or state, you know, public private partnerships to help support and bridge those programs to the to the summers.

Yeah. And we would wanna make sure that there was a supervisor there to make sure there's no secondhand trauma because situations do get intense at times. I do have a specific question for Ms. Eisenberg. It's been described by several folks in our LEAs that it's been difficult navigating the billing and the complex systems as they work to what is reimbursable, what is not reimbursable.

And for some of our smaller school districts or our rural communities, they don't have the in house expertise to do that kind of billing work or even the time with their fraction of the time they're allowed to dedicate to reimbursement and billing, to dedicate to training.

Is there something we can do something more we could do at the state level or through the legislature specifically to help support some of this training and onboarding and learning for our LEAs that are still catching up to adopting the reimbursement process? Or is it just a matter of is is this just do we have to wait for it to happen organically or through communities of practice that just seems so slow and inefficient?

I don't know if I have a good answer for what the state can provide. I will say I would also add to the comment you were making or the question you were asking, is that the return on investment is skewed for our smaller districts. They have less students. There's gonna be less billable units for that population, and so there's some fixed cost to implementing this program. Okay.

And so the ability for smaller districts with smaller populations to recoup those costs is challenging. I will say that we have seen models, particularly with the fee schedule, billing in California before this fee schedule, where there's a structure called consortiums where you have a lead LEA that is the primary biller, and they are billing on behalf of districts that participate in this consortium. So we have the privilege of working with Imperial County Office of Education.

Imperial County Office of Education is the lead LEA in a consortium Where all of their member LEAs are participating and sharing information about their practitioners. There's sort of a centralized cost for the billing infrastructure.

There's a centralized cost for the training. It's still early days, so the sustainability of that model, we we're we will be working with that team to figure out what that looks like. But I I think that is an example of how to support implementation in rural counties. I think messaging about the program is also sometimes a challenge in rural counties.

I've at least heard that in some of the cohort meetings is rural folks from rural counties saying, we have a hard time getting buy in and getting traction around this.

So that's not a good answer to your question about how to push it forward. I do think that there's infrastructure that the state has already invested in that is supportive. It is investing in county offices of education to support the implementation in their rural communities. I would have to defer to my DHCS colleagues, but I I think we've seen some really great billing models. I wanna say, Shasta, Butte, Mendocino.

So there there's some uptick, and there's some good resources being shared. Yeah.

I think the statistics show that, like, 50%, 500 of our LEAs are rural. And to hear statistics that some of our hardest hit kiddos are in rural communities, that does elevate as a concern. I started off my journey in public service with three children. I now say I have 6,000,000.

I care about all of them and wanna make sure that they have access to the supports and care that they need to thrive and wanna make sure that, there are opportunities for if you are in really rural communities, you can work together, band together to maybe share one staffer or something like that.

I don't know what that would look like. But we have to be more creative and efficient with the resources that we have to make sure we're able to deliver on the promise of, youth mental health care and treatment access. So look forward to finding ways to brainstorm with you on our rural communities that does seem to be an area where we need a little extra support for our our kiddos.

Madam Chair, can I add that too? One thing when I served on City Council, we'd have the local grants and it really got to the point. The smaller nonprofits, they're like, it's too expensive for us to even try to do this because by the time it's costing us this much money, we won't even break even by the time we would get the grant.

And, like, since maybe instead of one size fits all, maybe it's looking at you know, you have a a high school doing something that has 2,000 kids compared to maybe have a a smaller grade school or whatever. But, like, since it's more of a population, because and you can do it more regionally where the the the smaller schools can come together in, like, total so so many numbers.

And then they've got one person that will sit there and do it as a regional thing plus, and you have the coordinating of these. So they're all kind of doing the same thing. But, I mean, that's maybe what and I don't even know if that would be something we would do, if that would be something the superintendents and would end up voting on and doing a process, but maybe we just come up with another program for them and let them work together regionally.

Yeah. I think it's just clarifying whether there's flexibility in the program to do that. And I I I would imagine there would be. I know, like, with Fresno, Fresno is is centralizing their billing. I'm sure there are counties, even the ones that are single school district counties.

Right? It's the one school district and the one county. Maybe counties can partner together to be able to provide the efficiency of those numbers so that they can have one person focused on billing and becoming good at it instead of spending, like, 10% of their time trying to figure this out. To Ms. Clemons, a couple of questions. In the research you presented today, was there any noticeable geographic variation in mental health needs across the state?

We did hear a little bit about rural communities. Do we see differences in urban communities or suburban communities?

I can't speak to that specifically with this survey, but, generally, I know that there are sort of correlations as far as kids in urban environments having higher mental health or lower mental health and kids in rural environments having higher mental health needs. But I can't speak to that in this survey, unfortunately.

Okay. And then, to either panelist, we've been asking our schools to offer comprehensive mental and behavioral health care and provided the fee schedule as a way to fund those services. And that's great. That's really good progress, and I think it's meaningful that the state take on this initiative. It does help destigmatize when the state is actually being very proactive about doing that.

However, not all schools are able to fully take advantage of those fee schedules. And then we did hear earlier testimony that even when they do take advantage of them, it's not fully reimbursable what they're providing. And they're trying to provide at the lowest tier levels. Peer to peer is not reimbursable. If we're asking schools to negotiate for funding for these programs with their districts or their agencies, their local agencies, how will that impact equitable access to behavioral health care?

Because some districts are better at doing those negotiations than others. Some districts are better resourced or just have the the acumen to do a better job. How how do we make sure that kids all kids have access equitably to this level of care? And you if you don't have the answer, we can always have a follow-up question. I don't mean to put you on the spot because it's a bigger philosophical question.

It's a great and important question, and I wanna be sure that the answer I give is responsive to the importance of the question. So I'd love to ponder and get back to you

Absolutely. I'm gonna be here a while.

So I don't have an obvious answer off the top of my head, but if you'd allow us some time to think about it and get back to you. Absolutely. That equity piece is pretty important, and I I I am encouraged by the amount of investment we've seen in one time funding. I think it has shifted a lot of the in the internal dynamics across the state and seeing the importance of school based mental and behavioral services.

I think we are at a different place than we were five or six years ago in terms of the of folks I don't even have to I don't have to make the case for why school based behavior like, I skipped over that part in these in these remarks.

So I think we've seen change, and I don't think it's about a lack of desire or a difference of desire in sustaining it. I think it's I think districts are faced with really challenging decisions when they are looking at their budgets in the next coming year, and and that is that is the decision that they have to make. They have to look at really tough budget decisions.

And let me think about it with the team at WestEd, my colleague at Children Now, and we can get back to you about what we think the role is they could be.

Love a good brainstorming session. I know when I was on our local school board and we faced budget cuts or budget challenges, sometimes it was a conversation between really tough things because all of the services we provide at the school site level seem very essential to us. Is it the home to school transportation? Is it the librarian? Is it the counselor?

These are all it's it's horrible decisions to have to choose between one and the other. And and getting some insight as to what's effective and how we can be more efficient with the limited dollars that we have will certainly be helpful as we try and endeavor to solve these problems in the state state legislature. Assemblymember Pellerin, do you have any closing remarks you wanna offer?

I just wanna appreciate everybody for the work you're doing. I think the time and our resource investment in children is really essential, and, you know, they're really suffering right now, and it's very concerning. So I think that everything you're doing, I'm just very grateful for your time and effort. And thank you to the chair for holding this hearing.

And with that, we will wrap up this hearing. We'll take some public comments. Would anyone like to step up and make a public comment? You have a minute. Please introduce yourself and state the organization you're with as you step up to the microphone.

Hi. Thank you so much for the opportunity to speak today. My name is Natasha Dosco. I'm with Youth Leadership Institute. We're a statewide nonprofit serving young people and advocating for their voices to be heard.

And I support and coordinate a program, a juvenile justice program called Concrete Rose, which is implemented within the San Francisco Juvenile Hall. Data consistently shows the value of behavioral health programs during adolescent brain development and its success in averting the school to prison pipeline. Not only is this funding ethical and, a part of our moral duty to serve young people, it is also financially responsible. It costs half $1,000,000 annually to hold just one young person in San Francisco Juvenile Hall.

Martin Luther King once said budgets are moral documents. Please do not ignore youth voices at this pivotal moment. Thank you.

Good afternoon, Chair and members. George Cruz on behalf of the California Behavioral Health Association. We just wanna express our appreciation in convening this important conversation to evaluate the opportunities to expand access to mental health treatment for youth. CBHA represents behavioral health providers across the state that work with populations across the lifespan and work to provide that equitable and culturally responsive care that we spoke about today across multiple settings.

Although it has not been discussed today, we do wanna emphasize the value of the digital approach that we've been seeing, the improvement to to mental health well-being as a digital format meets youth where they're at across rural rural and urban communities.

We request consideration for continued investments in these valuable programs, including for BrightLife and Soluna. And we look forward to continuing working with members of this committee to advancing this specific issue. Thank you so much.

Good to see you again, members. Amanda Dickey. I am proud to represent Fresno County Office of Education and wanna echo the recommendations that, Trina made today. And in addition, I also represent Monterey County Office of Education and wanted to take the opportunity because of your comments regarding small and rural schools.

I'm hearing that a lot as well and wanted to. I would be remiss if I did not mention AB 2704, which is sponsored by the Monterey County Office of Education as one really excellent way of helping to address the need in small and rural communities with regards to the lack of capacity, the lack of expertise, etcetera.

It is a bill that is authored by Assemblymember Addis, one of your colleagues and your delegation, and we would love to have additional conversations about the need for that and what we're hearing from the community as well as the need for funding to support what we're calling an intensive technical assistance program for small and rural LEAs. Thank you.

Good afternoon. My name is Brian Gaither. I'm a local school psychologist. As you guys know with budget cuts, we are losing counselors, social workers, and all sorts of services for our students. So I just wanted to come in today and advocate for some of these services I've heard about today, like Soluna and BrightLife and all these other programs that are occurring.

They're very important for us to be able to utilize to help support our students. And I've I've used those services numerous times this year, and it's been extremely beneficial, especially for our students who are not able to access those services, because of stigma, or because of cultural differences. And so, again, I just wanted to advocate for those, and and thank you all for the work you're doing. Thanks.

Hello, Chair and members. Michael Henning, California Alliance of Child and Family Services. We represent nonprofit community based organizations that serve children, youth, and families across the state. We are very appreciative of the hearing today and attention to youth mental health. California Alliance members have been very involved in the implementation of the CYBHI, including the new program for school based behavioral health known as the multi payer fee schedule.

We're supportive of the program and want to note that community based providers have been engaging with schools to ensure that students are connected to resources. We would note our concern with funding cuts and, in particular, the proposal to eliminate the Medi Cal certified wellness coaches. These individuals have been instrumental in working within the fee schedule. This challenging budget landscape puts considerable strain on community based organizations, some of whom are seeing their county contracts and or decrease or are expecting cuts down the line.

Due to these cuts, we will see fewer mental health services for youth in the years ahead.

In a time when youth are experiencing greater mental health needs. We encourage the select committee to engage on BHSA implementation both at the local and state level. We thank the select committee for raising the importance of youth mental health services, and we respectfully ask for this committee to convene on the impact that BHSA will have on youth mental health in the state. Thank you.

Good evening, everyone. Oops. I'm short. Okay. My name is Diancea Magesh.

I'm 21 years old, and I live in Davis, Yolo County. I'm a youth ambassador with Soluna, which is a free mental health platform for all youth ages 13 to 25. I'm here to support Soluna and share how it helped me. I used to be really overwhelmed trying to manage classes, homework, and everything that college throws at you. When I joined Soluna, I was able to connect with a coach, a real person who's a mental health professional and not an AI chatbot.

This happened within minutes. The coach helped me find ways to manage stress and have more balance in life. Soluna helped me get support that I needed before I reached crisis, and that kind of access really matters to youth like me. Thank you.

Thank you everyone for your participation in this very important hearing today, the third one in our series on youth mental health and treatment accessibility. Appreciate the participation of my colleagues, my assembly colleagues, and it looks like we have a lot to still work on, but a lot of progress has been made. And so we will see you all in the next session. Thank you very much.