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AB-1644 School-based early mental health intervention and prevention services.(2015-2016)

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Date Published:
AB1644:v95#DOCUMENT

Amended  IN  Senate  August 01, 2016
Amended  IN  Assembly  May 27, 2016
Amended  IN  Assembly  April 14, 2016
Amended  IN  Assembly  March 08, 2016

CALIFORNIA LEGISLATURE— 2015–2016 REGULAR SESSION

Assembly Bill No. 1644


Introduced by Assembly Member Bonta
(Principal coauthor: Assembly Member Achadjian)
(Coauthor: Assembly Member McCarty)
(Coauthor: Senator Beall)(Coauthors: Senators Beall and Mitchell)

January 11, 2016


An act to amend Sections 4370, 4371, 4372, and 4380 of, to add Sections 4384 and 4385 to, and to add and repeal Chapter 4 (commencing with Section 4391) of Part 4 of Division 4 of, the Welfare and Institutions Code, relating to mental health.


LEGISLATIVE COUNSEL'S DIGEST


AB 1644, as amended, Bonta. School-based early mental health intervention and prevention services.
Existing law, the School-Based Early Mental Health Intervention and Prevention Services for Children Act of 1991 (1991 act), authorizes the Director of Health Care Services, in consultation with the Superintendent of Public Instruction, to provide matching grants to local educational agencies to pay the state share of the costs of providing school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, subject to the availability of funding each year. Existing law defines “eligible pupil” for this purpose as a pupil who attends a publicly funded elementary school and who is in kindergarten or grades 1 to 3, inclusive. Existing law also defines “local educational agency” as a school district or county office of education or a state special school.
This bill would rename the 1991 act the Healing from Early Adversity to Level the Impact (HEAL) of Trauma in Schools Act or the HEAL Trauma in Schools Act. The bill would expand the definition of an eligible pupil to include a pupil who attends a preschool program at a contracting agency of the California state preschool program or a local educational agency, and a pupil who is in transitional kindergarten, thereby extending the application of the act to those persons. The bill would also include charter schools in the definition of local educational agency, thereby extending the application of the act to those entities. The bill would increase the percentage of each matching grant that may be used for matching grant evaluation from 10% to 20%. This bill would implement this program only to the extent that the department determines that federal financial participation is not jeopardized, as specified. The bill would require the State Public Health Officer, Director of Health Care Services, in consultation with the Superintendent of Public Schools, the Director of Health Care Services, Instruction, the State Public Heath Officer, and the Attorney General to establish a 4-year program, the HEAL Trauma in Schools Support Program, to provide outreach, free regional training, and technical assistance for local educational agencies in providing mental health services at schoolsites. The bill would require the State Department of Public Health Health Care Services to submit specified reports after 2 and 4 years. The bill would make the implementation of the program contingent upon an appropriation in the annual budget act.
This bill would authorize the department to implement, interpret, or make specific the grant and support programs by means of information notices, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action, until regulations are adopted and would exempt contracts for the HEAL Trauma in Schools Support Program and administration, or ancillary services in support of the program, from specified statutory and administrative requirements and from approval by the Department of General Services. The bill would repeal these provisions the HEAL Trauma in Schools Support Program as of January 1, 2022.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature finds and declares all of the following:
(a) California’s communities and systems are currently facing challenges to prevent and address the far-reaching impacts of childhood adversity, such as Adverse Childhood Experiences (ACEs) and childhood trauma, which can result in negative educational, health, social, and economic outcomes for children, youth, families, and communities across the state.
(b) In California, 61.7 percent of adults have experienced at least one ACE and 16.7 percent have experienced four or more ACEs. Compared to an individual who has not experienced an ACE, an individual with four or more ACEs is more likely to experience chronic disease and engage in negative health behaviors. For example, based on results of the California Behavioral Risk Factor Surveillance Survey, a person in California with four or more ACEs is 1.6 times as likely to have diabetes, 1.9 times as likely to have cancer, 2.4 times as likely to suffer from chronic obstructive pulmonary disease, 2.9 times as likely to smoke, 4.2 times as likely to be diagnosed with Alzheimer’s disease or dementia, 5.1 times as likely to suffer from depression, 7.4 times as likely to be an alcoholic, and 12.2 times as likely to attempt suicide. Individuals are similarly impacted by ACEs, regardless of race and ethnicity.
(c) From the 1992–93 fiscal year to the 2011–12 fiscal year, inclusive, the State Department of Mental Health awarded funds each year in matching grants to local educational agencies to fund prevention and early intervention programs, including the Primary Intervention Program, for students experiencing mild to moderate school adjustment difficulty through the School-based Early Mental Health Intervention and Prevention Services for Children Program of 1991, known as the Early Mental Health Initiative (EMHI). In the 2011–12 fiscal year, the EMHI received $15 million in state funds.
(d) School adjustment difficulties that can impede learning, such as anxiety, withdrawal, and aggressive behaviors, are common symptoms of chronic or traumatic stress resulting from exposure to ACEs and childhood trauma.
(e) Authorizing legislation specified that the EMHI would be deemed successful if at least 75 percent of the children who complete the program show an improvement in at least one of the following four areas: learning behaviors, attendance, school adjustment, and school-related competencies.
(f) The EMHI succeeded in meeting these legislative requirements. According to the 2010–11 Early Mental Health Initiative Statewide Evaluation Report, of the 15,823 students located in 424 elementary schools across 66 school districts participating in EMHI-funded services during the 2010–11 school year, 79 percent exhibited positive social competence and school adjustment behaviors more frequently after completing services. Furthermore, the magnitude of the improvements was exceptional in comparison to evaluations of other programs, especially given the short-term and cost-effective nature of the intervention, and improvements were evident across all demographic subgroups.
(g) The 2010–11 Early Mental Health Initiative Statewide Evaluation Report described an unmet demand for EMHI-funded services at participating schoolsites, as only 37 percent of the students that scored in the appropriate school adjustment difficulty range were served with EMHI-funded services due to program capacity and funding constraints. Based on demographic considerations, similar demand would be expected at schools that did not receive EMHI grants.
(h) The Governor’s realignment for the 2011–12 fiscal year renamed the State Department of Mental Health as the State Department of State Hospitals and limited that department’s mission. The Budget Act of 2012 disbursed Proposition 98 funds, which had been used to fund the EMHI, directly to local educational agencies in order to provide local schools with enhanced flexibility to manage their finances and give greater control of local decisions.
(i) Multitiered systems and supports, which integrate mental health, special education, and school climate interventions, have been developed as a model framework within which to implement these services. Pilot programs in the Counties of San Bernardino and Alameda are demonstrating that implementing these services as part of a multitiered system is cost effective because the cost of the services is more than fully offset by the reduction in the need for high-cost, nonpublic school placements.
(j) The evidence-based, cost-effective services provided by the EMHI support the “Triple Aim” of better health, better care, and lower costs. By helping children early on, evidence-based, cost-effective services also support the recommendations of the Let’s Get Healthy California Task Force, which used the “Triple Aim” as its foundation and articulated Healthy Beginnings: Laying the Foundation for a Healthy Life, as a goal that includes reducing childhood trauma, improving early learning, and improving mental health and well-being as priorities.
(k) Providing early mental health service for children exposed to childhood adversity, such as ACEs and childhood trauma, additionally furthers the goal of the California Defending Childhood State Policy Initiative, which is to more effectively align, integrate, and mobilize multisectoral resources to equitably prevent, identify, and heal the impacts of violence and trauma on children and youth.

SEC. 2.

 Section 4370 of the Welfare and Institutions Code is amended to read:

4370.
 This part shall be known and may be cited as the Healing from Early Adversity to Level the Impact (HEAL) of Trauma in Schools Act or the HEAL Trauma in Schools Act.

SEC. 3.

 Section 4371 of the Welfare and Institutions Code is amended to read:

4371.
 The Legislature finds and declares all of the following:
(a) Each year in California over 65,000 teenagers become adolescent mothers and 230 teenagers commit suicide. Each year more than 20 percent of California’s teenagers drop out of high school.
(b) Thirty percent of California’s elementary school pupils experience school adjustment problems, many of which are evident the first four years of school, that is, kindergarten and grades 1 to 3, inclusive.
(c) Problems that our children experience, whether in school or at home, that remain undetected and untreated grow and manifest themselves in all areas of their later lives.
(d) There is a clear relationship between early adjustment problems and later adolescent problems, including, but not limited to, poor school attendance, low achievement, delinquency, drug abuse, and high school dropout rates. In many cases, signs of these problems can be detected in the early grades.
(e) It is in California’s best interest, both in economic and human terms, to identify and treat the minor difficulties that our children are experiencing before those difficulties become major barriers to later success. It is far more humane and cost-effective to make a small investment in early mental health intervention and prevention services now and avoid larger costs, including, but not limited to, foster care, group home placement, intensive special education services, mental health treatment, or probation supervised care.
(f) Programs like the Primary Intervention Program and the San Diego Unified Counseling Program for Children have proven very effective in helping children adjust to the school environment and learn more effective coping skills that in turn result in better school achievement, increased attendance, and increased self-esteem.
(g) To create the optimum learning environment for our children, schools, teachers, parents, caregivers, public and private service providers, and community-based organizations must enter into locally appropriate cooperative agreements to ensure that all pupils will receive the benefits of school-based early mental health intervention and prevention services that are designed to meet their personal, social, and educational needs.
(h) Adverse Childhood Experiences (ACEs) are traumatic experiences that can have a profound impact on a child’s developing brain and body and lasting impacts on a person’s health and livelihood across their lifetime. ACEs include physical, emotional, and sexual abuse; physical and emotional neglect; other experiences, such as substance abuse by a household member and witnessing domestic violence. Other traumatic experiences can include placement instability for foster youth, homelessness, and witnessing violence against family and community members.
(i) The State of California has long recognized the mental health needs of California’s children and the value of addressing these needs by supporting the provision of evidence-based mental health services in publicly funded preschools and elementary schools, as evidenced by the creation in 1981 of the Primary Prevention Project, now named the Primary Intervention Program, and the creation in 1991 of the School-Based Early Mental Health Intervention and Prevention Services for Children Program, known as the Early Mental Health Initiative (EMHI).
(j) It is in the interest of California’s children, families, schools, and communities that the State of California support local decisions to provide funding for evidence-based services in publicly funded preschools and elementary schools to address the mental health needs of children who have been exposed to childhood adversity.
(k) In addressing these needs, priority should be given to children, youth, and communities that experience childhood adversity more severely and profoundly, including those that experience socioeconomic disadvantage and historical and contemporary injustices, vulnerable communities, communities of color, and culturally, linguistically, and geographically isolated communities.

SEC. 4.

 Section 4372 of the Welfare and Institutions Code is amended to read:

4372.
 For the purposes of this part, the following definitions shall apply:
(a) “Cooperating entity” means a federal, state, or local, public or private nonprofit agency providing school-based early mental health intervention and prevention services that agrees to offer services at a schoolsite through a program assisted under this part.
(b) “Eligible pupil” means a pupil who attends a preschool program at a contracting agency of the California state preschool program, as established by Article 7 (commencing with Section 8235) of Chapter 2 of Part 6 of Division 1 of Title 1 of the Education Code, or a local educational agency, or who attends a publicly funded elementary school and who is in kindergarten, transitional kindergarten, or grades 1 to 3, inclusive.
(c) “Local educational agency” means any school district or county office of education, state special school, or charter school.
(d) “Department” means the State Department of Public Health. Health Care Services.
(e) “Director” means the State Public Health Officer. Director of Health Care Services.
(f) “Supportive service” means a service that will enhance the mental health and social-emotional development of children.

SEC. 5.

 Section 4380 of the Welfare and Institutions Code is amended to read:

4380.
 Subject Beginning with grants for the 2017–18 school year and subject to the availability of funding each year, the Legislature authorizes the director, in consultation with the Superintendent of Public Instruction, to award matching grants to local educational agencies to pay the state share of the costs of providing programs that provide school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, as follows:
(a) The director shall award matching grants pursuant to this chapter to local educational agencies throughout the state.
(b) Matching grants awarded under this part shall be awarded for a period of not more than three years and no single schoolsite shall be awarded more than one grant, except for a schoolsite that received a grant prior to July 1, 1992. grant.
(c) The director shall pay to each local educational agency having an application approved pursuant to requirements in this part the state share of the cost of the activities described in the application.
(d) Commencing July 1, 1993, the The state share of matching grants shall be a maximum of 50 percent in each of the three years.
(e) Commencing July 1, 1993, the The local share of matching grants shall be at least 50 percent, from a combination of school district and cooperating entity funds.

(f)The local share of the matching grant may be in cash or payment in-kind.

(g)

(f) Priority shall be given to those applicants that demonstrate the following:
(1) The local educational agency will serve the greatest number of eligible pupils from low-income families.
(2) The local educational agency will provide a strong parental involvement parent and caregiver engagement component.
(3) The local educational agency will provide supportive services with one or more cooperating entities.
(4) The local educational agency will provide services at a low cost per child served in the project.
(5) The local educational agency will provide programs and services that are based on adoption or modification, or both, of existing programs that have been shown to be effective.
(6) The local educational agency will provide services to children who are in out-of-home placement or who are at risk of being in out-of-home placement.
(7) The local educational agency will prioritize for receipt of services children who have been exposed to childhood trauma, including, but not limited to, foster youth, as defined in subdivision (b) of Section 42238.01 of the Education Code, and homeless children and youth, as defined in Section 11434a(2) of the federal McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.).

(h)

(g) Eligible supportive services may include the following:
(1) Individual and group early mental health intervention and prevention services.
(2) Parent involvement and caregiver engagement through conferences or training, or both.
(3) Teacher and staff conferences and training related to meeting project goals.
(4) Referral to outside resources when eligible pupils require additional services.
(5) Use of paraprofessional staff, who are trained and supervised by credentialed school psychologists, school counselors, or school social workers, to meet with pupils on a short-term weekly basis, in a one-on-one setting as in the primary intervention program established pursuant to Chapter 4 (commencing with Section 4343) of Part 3.
(6) Any other service or activity that will improve the mental health of eligible pupils, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
Prior to participation by an eligible pupil in either individual or group services, consent of a parent or guardian shall be obtained.

(i)

(h) Each local educational agency seeking a grant under this chapter shall submit an application to the director at the time, in a manner, and accompanied by any information the director may reasonably require.

(j)

(i) Each matching grant application submitted shall include all of the following:
(1) Documentation of need for the school-based early mental health intervention and prevention services.
(2) A description of the school-based early mental health intervention and prevention services expected to be provided at the schoolsite.
(3) A statement of program goals.
(4) A list of cooperating entities that will participate in the provision of services. A letter from each cooperating entity confirming its participation in the provision of services shall be included with the list. At least one letter shall be from a cooperating entity confirming that it will agree to screen referrals of low-income children the program has determined may be in need of mental health treatment services and that, if the cooperating entity determines that the child is in need of those services and if the cooperating entity determines that according to its priority process the child is eligible to be served by it, the cooperating entity will agree to provide those mental health treatment services.
(5) A detailed budget and budget narrative.
(6) A description of the proposed plan for parent involvement and caregiver engagement in the program.
(7) A description of the population anticipated to be served, including number of pupils to be served and socioeconomic indicators of sites to receive funds.
(8) A description of the matching funds from a combination of local education agencies and cooperating entities.
(9) A plan describing how the proposed school-based early mental health intervention and prevention services program will be continued after the matching grant has expired.
(10) Assurance that grants would supplement and not supplant existing local resources provided for early mental health intervention and prevention services.
(11) A description of an evaluation plan that includes quantitative and qualitative measures of school and pupil characteristics, and a comparison of children’s adjustment to school.

(k)

(j) Matching grants awarded pursuant to this article may be used for salaries of staff responsible for implementing the school-based early mental health intervention and prevention services program, equipment and supplies, training, and insurance.

(l )

(k) Salaries of administrative staff and other administrative costs associated with providing services shall be limited to 5 percent of the state share of assistance provided under this section.

(m)

(l) No more than 10 20 percent of each matching grant awarded pursuant to this article may be used for matching grant evaluation.

(n)

(m) No more than 10 percent of the moneys allocated to the director pursuant to this chapter may be utilized for program administration and evaluation.

Program administration shall include both state staff and field staff who are familiar with and have successfully implemented school-based early mental health intervention and prevention services. Field staff may be contracted with by local school districts or community mental health programs. Field staff shall provide support in the timely and effective implementation of school-based early mental health intervention and prevention services. Reviews of each project shall be conducted at least once during the first year of funding.

(o)

(n) Subject to the approval of the director, at the end of the fiscal year, a school district may apply unexpended funds to the HEAL Trauma in Schools Program budget for the subsequent funding year.

(p)

(o) Contracts for the program and administration, or ancillary services in support of the program, shall be exempt from the requirements of the Public Contract Code and the State Administrative Manual, and from approval by the Department of General Services.

SEC. 6.

 Section 4384 is added to the Welfare and Institutions Code, to read:

4384.
 Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this chapter by means of information notices, plan letters, plan or provider bulletins, or similar instructions, until regulations are adopted.

SEC. 7.

 Section 4385 is added to the Welfare and Institutions Code, to read:

4385.
 This chapter shall be implemented only to the extent that the department determines that any existing federal financial participation associated with the four eligible support services and early mental health intervention services is not jeopardized. The department may claim federal financial participation for the administrative activities performed by the department pursuant to this chapter to the extent the department determines federal financial participation is available for this purpose and to the extent any necessary federal approvals are obtained. This chapter shall not be construed to alter any existing funding obligation in law associated with the provision of eligible support services and early mental health intervention services by county mental health departments or local educational agencies, including, but not limited to, responsibility for the nonfederal share of permissible Medicaid expenditures, if any.

SEC. 6.SEC. 8.

 Chapter 4 (commencing with Section 4391) is added to Part 4 of Division 4 of the Welfare and Institutions Code, to read:
CHAPTER  4. HEAL Trauma in Schools Support Program

4391.
 (a) The director shall establish a four-year program, in consultation with the Superintendent of Public Instruction, the Director of Health Care Services, Instruction, the State Public Health Officer, and the Attorney General General, to encourage and support local decisions to provide funding for the eligible support services as provided in this section.
(b) The department shall provide outreach to local educational agencies and county mental health agencies to inform individuals responsible for local funding decisions of the program established pursuant to this section.
(c) The department shall provide free regional training regional training at no cost to the local educational agencies on all of the following: following subjects:
(1) Eligible support services, which may include any or all of the following:
(A) Individual and group early mental health intervention and prevention services.
(B) Parent and caregiver engagement through conference or training, or both.
(C) Teacher and staff conferences and training related to meeting project goals.
(D) Referral to outside resources when eligible pupils require additional services.
(E) Use of paraprofessional staff, who are trained and supervised by credentialed school psychologists, school counselors, or school social workers, to meet with pupils on a short-term weekly basis, in a one-on-one setting as in the primary intervention program established pursuant to Chapter 4 (commencing with Section 4343) of Part 3.
(F) Any other service or activity that will improve the mental health of eligible pupils, particularly evidence-based interventions and promising practices intended to mitigate the consequences of childhood adversity and cultivate resilience and protective factors.
(2) The potential for the eligible support services defined in this section to help fulfill state priorities described by the local control funding formula and local goals described by local control and accountability plans.
(3) How educational, mental health, and other funds subject to local control can be used to finance the eligible support services defined in this section.
(4) External resources available to support the eligible support services defined in this section, which may include workshops, training, conferences, and peer learning networks.
(5) State resources available to support student mental health and resilience, and positive, trauma-informed learning environments, which may include any of the following:
(A) Foundational aspects of learning, childhood social-emotional development, mental health and resilience, toxic stress, childhood trauma, and Adverse Childhood Experiences.
(B) Inclusive multitiered systems of behavioral and academic supports, Schoolwide Positive Behavior Interventions and Supports, restorative justice or restorative practices, trauma-informed practices, social and emotional learning, bullying prevention, mental health consultation, and parent-child group supports.
(d) The department shall provide technical assistance to local educational agencies that provide or seek to provide eligible services defined in this section. Technical assistance shall include assistance in any of the following:
(1) Designing programs.
(2) Training program staff in intervention skills.
(3) Conducting local evaluations.
(4) Coordinating with county mental health agencies and professionals.
(5) Leveraging educational, mental health, and other funds that are subject to local control and assisting in budget development.
(e) In providing outreach pursuant to subdivision (b), training pursuant to subdivision (c), and technical assistance pursuant to subdivision (d), the department shall select and support schoolsites as follows:
(1) (A) During the first 12 months of the program, the department department, in collaboration with the Superintendent of Public Instruction, shall support, strengthen, and expand the provision of eligible services at schoolsites that previously received funding pursuant to the former School-Based Early Mental Health Intervention and Prevention Services Matching Grant Program and have continued to provide eligible support services. In working with these selected schoolsites, the department shall develop methods and standards for providing services and practices to new schoolsites.
(B) The department shall develop a process to identify schoolsites that demonstrate the willingness and capacity to participate in the program.
(2) During the subsequent 36 months of the program, the department shall select new schoolsites that are not providing eligible support services but that demonstrate the willingness and capacity to participate in the program. The department shall work with these schoolsites to deliver eligible support services.
(3) In selecting schoolsites and providing support, the department shall prioritize the following:
(A) Schoolsites in communities that have experienced in which local educational agencies have demonstrated high levels of childhood adversity, such as Adverse Childhood Experiences and childhood trauma. including, but not limited to, high-poverty local educational agencies and schools eligible under the Community Eligibility Provision of the Healthy Hunger-Free Kids Act of 2010 (Public Law 111-296) and local educational agencies and schools identified in the California Longitudinal Pupil Achievement Data System as having high rates of foster youth and homeless children and youth.
(B) Schoolsites that prioritize for receipt of services children who have been exposed to childhood trauma, including, but not limited to, foster youth, as defined in subdivision (b) of Section 42238.01 of the Education Code, and homeless children and youth, as defined in Section 11434a(2) of the federal McKinney-Vento Homeless Assistance Act (42 U.S.C. Sec. 11301 et seq.)
(C) Geographic diversity, program effectiveness, program efficiency, and long-term program sustainability.
(f) The department shall submit, in compliance with Section 9795 of the Government Code, an interim report to the Legislature at the end of the second year of the program that details the department’s work to support the schoolsites selected pursuant to paragraph (1) of subdivision (e) and includes an assessment of the demand and impact of funding for the HEAL Trauma in Schools Act established pursuant to this part. The department shall make the report available to the public and shall post the report on its Internet Web site.
(g) The department shall develop an evaluation plan to assess the impact of the program. The department, in compliance with Section 9795 of the Government Code, shall submit a report to the Legislature at the end of the four-year period evaluating the impact of the program and providing recommendations for further implementation. The department shall make the report available to the public and shall post the report on its Internet Web site.

4391.2.
 Contracts for the program and administration, or ancillary services in support of the program, shall be exempt from the requirements of the Public Contract Code and the State Administrative Manual, and from approval by the Department of General Services.

4391.5.
 Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this chapter by means of information notices, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action, until regulation are adopted.

4392.
 Implementation of this chapter is contingent upon an appropriation in the annual budget act.

4393.
  This chapter shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.