Today's Law As Amended

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AB-1117 Pupil support services: Healthy Start: Toxic Stress and Trauma Resiliency for Children Program.(2021-2022)

As Amends the Law Today

 The Legislature finds and declares all of the following:
(a) The COVID-19 global pandemic has had a multitude of long-term consequences for Californians. A combination of unprecedented economic and public health crises will impact communities for generations to come.
(b) Science continues to show that low-income children and families, especially those from communities of color, experience disproportionate impacts from COVID-19. Further, these communities’ conditions are worsened by preexisting barriers to health. These communities experience greater hardships and higher death rates due to many historic inequities, lack of accessible health care, poverty, and comorbidities.
(c) Children’s mental health has been a crisis in the making for years. Mental illness was, and continues to be, the leading cause of hospitalization among California’s children. One million eight hundred thousand children are in need of mental health services in California. The tremendous need for critical staff and supports continues to go unmet and the COVID-19 pandemic has only exacerbated needs.
(d) California will need a strategic, long-term response that will direct children and families to a multitude of services, including trauma-informed mental health services, educational supports, and social services. Children and families need help navigating the ever-changing and complex systems of services that they need now more than ever to meet their basic needs.
(e) For too long, childhood trauma and toxic stress, along with the accompanying long-term negative impacts on academic achievement and health, have frequently been identified by already burdened teachers and administrators as significant barriers to children’s educational success and overall development. Before the COVID-19 pandemic, 1 in 3 children and more than 6 in 10 adults experienced at least one adverse childhood experience (ACE), a number that will inevitably grow as a result of the pandemic. If unaddressed, ACEs and toxic stress will cost California over $1,000,000,000,000 dollars in the next decade due to the costs of direct health care and years of life lost from poor health, disability, or early death.
(f) Untreated intergenerational trauma and toxic stress creates challenges for the entire family and can contribute to a pupil’s inability to learn and thrive academically and later in life. A lack of a unified systems approach to treat identified trauma in communities that have been both impacted disproportionately by the pandemic and have historically been under-resourced creates an urgent need for a long-term response to direct families to trauma-informed mental health care and services.
(g) Unfortunately, although California is investing heavily in significant efforts to screen for ACEs and toxic stress, it lacks investment in a reliable service delivery system to treat identified trauma and toxic stress in pupils, individual families, and communities. The challenges facing families and children at the state and local levels in accessing wraparound services and trauma-informed mental health supports across child-serving sectors, and the consequences of failure, are intergenerational and may irreparably worsen as communities try to prepare for long-term recovery.
(h) If California is to achieve its goal of cutting ACEs and toxic stress in half in one generation, it must invest in a reliable, ongoing, community-based service delivery system. Coordinated services at the local level, when funded and evaluated by the state previously, showed that the physical, mental, and emotional health of pupils and their families improved and pupils’ academic success improved greatly.
(i) The impacts of the COVID-19 pandemic will require a targeted response that will guide families and pupils to school, community, and state resources that will remain in place long after the pandemic ends to promote long-term recovery. It is imperative that the state invest in a data-driven approach to address trauma and toxic stress in communities with high COVID-19 rates and those that have been historically under-resourced. This includes trauma-informed care and innovative ways to leverage federal, state, and local funding to support a whole-child and whole-family approach.

SEC. 2.

 Chapter 4.5 (commencing with Section 8780) is added to Part 6 of Division 1 of Title 1 of the Education Code, to read:

CHAPTER  4.5. Healthy Start: Toxic Stress and Trauma Resiliency for Children Act
Article  1. General Provisions
 This chapter shall be known, and may be cited, as the Healthy Start: Toxic Stress and Trauma Resiliency for Children Act.
 For purposes of this chapter, the following definitions apply:
(a) “Children’s Coordinated Services Response Team” or “team” means the team established pursuant to Section 8785.
(b) “Community center” means a place, structure, or facility under the jurisdiction of the governing body of a federal, state, or local agency used for community services.
(c) “Consortium” means two or more local educational agencies, or one or more local educational agencies and one or more cooperating agencies.
(d) “Cooperating agency” means a federal, state, or local agency or public or private nonprofit entity that agrees to offer support services at a schoolsite, an agreed-upon community center, or virtually through a program implemented under this chapter.
(e) “Healthy Start: Toxic Stress and Trauma Resiliency for Children Program” or “program” means the program established by this chapter.
(f) “Lead agency” means the department.
(g) “Local educational agency” means a school district or county office of education.
(h) “Private partner” means a private business, nonprofit, or foundation that provides financial assistance or otherwise assists a support services program operating under this chapter.
(i) “Qualifying entity” means an entity that is any of the following:
(1) A local educational agency in which 50 percent or more of the enrolled pupils are unduplicated pupils.
(2) A local educational agency that has higher than average dropout rates.
(3) A local educational agency that has higher than average rates of reported suicides, suicide ideation, self-inflicted harm, or bullying.
(4) A local educational agency that has higher than average rates of suspension and expulsion.
(5) A local educational agency that has higher than average rates of child homelessness, foster youth, or justice-involved youth.
(6) A school that is not within a local educational agency that satisfies the criteria in paragraph (1), (2), (3), (4), or (5) and that demonstrates other factors that warrant the school’s consideration, including, but not limited to, fulfilling an exceptional need or providing service to a particular target population.
(7) A local educational agency or consortium on behalf of one or more schools that are qualifying entities within the local educational agency or consortium.
(8) A community-based organization that satisfies all of the following:
(A) Specializes in providing pediatric primary care or in addressing mental health, trauma, or toxic stress.
(B) Has a demonstrated history of success in serving underserved communities and populations.
(C) Has had longstanding relationships with the county or with a local educational agency.
(D) Will operate the program in partnership with at least one local educational agency that is a qualifying entity.
(9) A county behavioral health agency that will operate the program in partnership with at least one local educational agency that is a qualifying entity.
(10) A federal Head Start or Early Head Start program or similar early childhood program or agency that will operate the program in partnership with at least one local educational agency that is a qualifying entity.
(11) A childcare program or agency within a higher education institution that will operate the program in partnership with at least one local educational agency that is a qualifying entity.
(j) (1) “Support services” means services that will enhance local responses to ensure trauma and toxic stress treatment is preserved during and after the COVID-19 pandemic to improve physical, behavioral, mental, social, emotional, and intellectual development of children and their families.
(2) “Support services” includes case-managed health, mental health, social, and academic support services benefiting children and their families, and may include, but is not limited to, all of the following:
(A) Health care, including all of the following:
(i) Immunizations.
(ii) Vision and hearing testing and services.
(iii) Dental services.
(iv) Physical examinations and diagnostic and referral services.
(v) Prenatal care.
(B) Mental health services, including all of the following:
(i) Primary prevention.
(ii) Crisis intervention.
(iii) Assessments and referrals.
(C) Trauma-informed mental health care, adapted to COVID-19 response delivery, such as via telehealth, including substance abuse prevention, early intervention, and treatment services, including all of the following:
(i) Training for teachers, early educators, and school personnel in the detection of mental health problems, the impact of trauma and toxic stress, trauma-informed care and education, and building resiliency and helping pupils and families heal.
(ii) Outreach, risk assessment, and education for pupils and families.
(iii) Youth-focused substance use disorder prevention and treatment programs that are culturally and gender competent, trauma informed, and evidence based.
(D) Family support and parenting education, including child abuse prevention and parenting programs, such as home visits or, when in-person home visits are not possible, virtually conducted home visits.
(E) Academic support services, including tutoring, mentoring, employment, and community service internships, and inservice training for teachers and administrators.
(F) Counseling, including family counseling, peer-to-peer counseling, and suicide prevention.
(G) Services and counseling for children who experience violence, toxic stress, or adverse childhood experiences in their communities.
(H) Nutrition services to reduce food insecurity.
(I) Youth development services, including tutoring, mentoring, career development, and job placement.
(J) Case management services.
(K) Provision of onsite or virtual Medi-Cal eligibility workers, as allowed via telehealth pursuant to Section 1135 of the federal Social Security Act (42 U.S.C. Sec. 1320b-5).
(k) (1) “Technical assistance” means a structure to deliver training and technical assistance to grantees using regional collaboratives and state, regional, and local technical assistance providers that have expertise in pupil and family engagement, school-community collaboration of service delivery and financing, the coordination and integration of support services, and multi-indicator data collection and evaluation.
(2) “Technical assistance” includes, but is not limited to, establishing interagency collaboration, providing information dissemination and referrals, including information about appropriate program models, conducting site visits, ensuring grantees are able to learn from each other, and convening workshops to assist in the implementation of a program developed pursuant to this chapter.
(l) “Unduplicated pupil” has the same meaning as defined in Section 42238.02.
Article  2. Healthy Start: Toxic Stress and Trauma Resiliency for Children Program
 In order to encourage the integration of children’s services at the local level and promote community resiliency, it is the intent of the Legislature in enacting this chapter to promote interagency coordination and collaboration among local agencies, local educational agencies, and community partners that are responsible for providing support services to children and their families. Therefore, upon funds being made available for this purpose as provided in Section 8795, the lead agency and the State Department of Health Care Services shall establish the Children’s Coordinated Services Response Team, as follows:
(a) The membership of the team shall include all of the following:
(1) The Superintendent, or the Superintendent’s designee.
(2) The Director of Health Care Services, or the director’s designee.
(3) The Deputy Director of Behavioral Health, or the deputy director’s designee.
(4) The Director of Social Services, or the director’s designee.
(5) The chairperson of the Mental Health Services Oversight and Accountability Commission, or the chairperson’s designee.
(6) The Surgeon General, or the Surgeon General’s designee.
(7) A representative of community-based organizations with expertise in coordinated and integrated services and supports.
(8) A parent or guardian of a pupil from a community that has been disproportionately impacted by COVID-19.
(b) Duties of the team shall include all of the following:
(1) Developing, promoting, and implementing policy supporting the Healthy Start: Toxic Stress and Trauma Resiliency for Children Program.
(2) Assisting the lead agency in reviewing grant applications submitted to the lead agency and providing the lead agency with recommendations for awarding grants pursuant to Section 8786.
(3) Soliciting input regarding program policy and direction from individuals and entities with experience in the integration of children’s services.
(4) Assisting the lead agency in fulfilling its responsibilities under this chapter.
(5) Providing recommendations to the Governor, the Legislature in compliance with Section 9795 of the Government Code, and the lead agency regarding the Healthy Start: Toxic Stress and Trauma Resiliency for Children Program.
(6) At the request of the Superintendent, assisting a qualifying entity in planning and coordinating its program under this chapter, including assisting with local technical assistance and developing local agency collaboration.
 The Superintendent shall award grants to qualifying entities to pay the costs of planning and operating programs that provide support services to pupils and their families at or near the school at which the pupil is enrolled, as follows:
(a) Grants shall be awarded by the Superintendent based upon the recommendations of the team.
(b) The Superintendent shall issue requests for applications for awarding the grants as soon as reasonably possible after receiving funding as described in Section 8795. The requests for applications shall specify maximum dollar amounts for each type of grant that may be awarded. The Superintendent shall award the grants as follows:
(1) Grants may be awarded to qualifying entities that have demonstrated need and readiness to begin operation of a coordinated response program or to expand existing support services programs. Grants shall supplement, not supplant, existing services and funds.
(2) Grants shall be awarded for no more than five hundred thousand dollars ($500,000) each. Priority for these funds shall be given to supports and services that help mitigate the mental health consequences associated with adverse childhood experiences, school closures, and learning loss. Grants may also be used to design a program evaluation or to hire a consultant.
(c) All grants awarded under this chapter shall be matched by the participating qualifying entity or its cooperating agencies with one dollar ($1) for each two dollars ($2) awarded. The match shall be contributed in cash or as services or resources of comparable value. It is the intent of the Legislature that participants seek and use private funds or resources for this purpose. The Superintendent may waive the match requirement.
(d) The Superintendent shall award grants to qualifying entities in northern, central, and southern California, and in urban, suburban, and rural areas. To the extent possible, grants shall be awarded for programs disproportionately impacted by the COVID-19 pandemic and priority for the grants shall be given to local educational agencies and community-based organizations providing childcare, a federal Head Start or Early Head Start program, preschool, or transitional kindergarten, or serving kindergarten and grades 1 to 6, inclusive.
(e) A qualifying entity is eligible for a grant under this chapter if it demonstrates in its program plan that it satisfies all of the following:
(1) Will give priority for services provided under this chapter to pupils and nonpupil siblings under five years of age that are from low-income families and that have an urgent need of services.
(2) Has established the local agency collaboration process described in Section 8790, including a mechanism for sharing governance with cooperating agencies and entities, and for integrating or redirecting existing resources and other school support services.
(3) Has submitted or is submitting an application to the State Department of Health Care Service for designation as a Medi-Cal provider pursuant to Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code.
(4) Has used or is seeking to use a waiver or flexibility related to COVID-19 under Section 1135 of the federal Social Security Act (42 U.S.C. Sec. 1320b-5) to receive maximum reimbursements for COVID-19-related health expenditures. This paragraph is contingent on the continuance of the waiver or flexibility by the federal government.
(5) Involves parents or guardians and teachers in the process of identifying the service needs of pupils and nonpupil siblings under five years of age and in the planning for and provision of support services.
(6) Involves representatives from the local public health department and the Medi-Cal managed care plan in the county.
(f) A qualifying entity shall contract with other entities, including county agencies, family resource centers, and private nonprofit community-based organizations or private partners, to provide comprehensive, local-level trauma-informed mental health services, and local-level promising approaches to trauma treatment services to pupils and their families.
(g) A qualifying entity seeking a grant under this chapter shall submit an application to the Superintendent at a time and in a manner, and with any appropriate information, as the Superintendent may reasonably require. Each grant application submitted shall include all of the following:
(1) A description and documentation of how the participating community has been impacted by the COVID-19 crisis and is in need of the Healthy Start: Toxic Stress and Trauma Resiliency for Children Program.
(2) A description of the proposed programs, including two trauma-informed mental health interventions or more support services expected to be provided at the schoolsite at a site near, or adjacent to, the school, virtually or through a community-based organization or county office of behavioral health. Interventions or supports may also be based at or near a federal Head Start program, prekindergarten, or other childcare site.
(3) A description of the existing resources to be used or redirected, the priorities for development of the program, and the agencies responsible for the implementation of the program. The program plan shall include both of the following:
(A) Provisions for data collection and recordkeeping, including records of the population served, the components of the service, the results of the service, and costs, including all of the following:
(i) Direct costs.
(ii) Indirect costs.
(iii) Costs to other agencies.
(iv) Cost savings.
(B) A system for providing case management services, peer-to-peer counseling, or community health workers, including procedures for implementation, identification of the target population, anticipated outcomes, and a list of existing services, resources, and programs that will be used as components of the program.
(4) A plan describing how the proposed program will be implemented after the grant funding expires, including with at least one source of funding through reimbursable Medi-Cal services. This funding may include, but is not limited to, all of the following:
(A) The LEA Medi-Cal Billing Option Program authorized under Section 14132.06 of the Welfare and Institutions Code.
(B) Mental health Medi-Cal administrative activities reimbursement under subsection (a) of Section 1903 of the federal Social Security Act (42 U.S.C. Sec. 1396b(a)) and Section 433.15 of Title 42 of the Code of Federal Regulations.
(C) Reimbursable mental health specialty care services provided by the Early and Periodic Screening, Diagnosis and Treatment Program, as described in Section 51184 of Title 22 of the California Code of Regulations.
(5) In the case of a consortium, a list of its members.
(6) The grant application shall also document any procedures that have been, or will be, taken to designate the qualifying entity as a Medi-Cal provider pursuant to Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code.
(7) A description of the proposed plan for family involvement in the program.
(8) A description of the population anticipated to be served.
(9) A plan describing how service coordination and delivery will comply with social distancing guidelines and, to the extent possible, will emphasize virtual settings for that compliance.
(h) Grants awarded pursuant to this chapter may be used for salaries of staff responsible for developing or implementing the program plan and administrative support staff, equipment and supplies, training, and insurance. To the extent possible, hired staff shall have lived community experience.
(i) (1) No more than 10 percent of the funding made available for purposes of this chapter as described in Section 8795 may be used by the Superintendent for state-level administration of this chapter, including evaluation and technical assistance.
(2) Of the amount made available for purposes of this chapter as described in Section 8795 for state-level administration, up to 75 percent may be used for the purpose of outreach and technical assistance to local educational agencies. The remainder shall be used for state-level program administration.
 (a) The Legislature finds and declares that additional local planning and coordinating efforts are necessary among local educational agencies, county governments, community-based organizations, and nonprofit organizations for all of the following reasons:
(1) To avoid the duplication of efforts among agencies that administer the grants pursuant to this chapter.
(2) To develop linkages between several local educational agencies, individual county agencies, statewide organizations, or nonprofit organizations.
(3) To disseminate training and technical assistance materials developed by the lead agency and other involved organizations.
(4) To plan for, and ensure, the continued ability of qualifying entities to provide support services with a grant pursuant to this chapter, including planning and supporting the funding of those services beyond the grant period through means such as Medi-Cal, the Mental Health Services Act, an initiative measure enacted by voter approval of Proposition 63 at the November 2, 2004, statewide general election, and the Control, Regulate and Tax Adult Use of Marijuana Act, an initiative measure enacted by voter approval of Proposition 64 at the November 8, 2016, statewide general election, to the extent allowable.
(5) To plan for, and ensure, the expansion of support services provided with a grant through creative refinancing options and the provision of comprehensive, integrated school-linked services to sites that do not receive a grant.
(b) In awarding grants under this chapter, the lead agency shall give priority to qualifying entities that possess one or more of the following:
(1) An established capacity for leadership in the community and an ability to engage in local problem solving and to creatively approach the restructuring of service delivery methods.
(2) A demonstrated ability to work with and among service delivery agencies and systems, including county mental health, health, probation, and social service systems, including nontraditional partners involved in COVID-19 pandemic response such as community-based organizations, fire stations, and regional and city parks and recreation departments.
(3) The capacity to support county and regional planning and coordination efforts to be more responsive to the needs of children and their families in providing support services.
(4) Knowledge of the most effective strategies for refinancing grants and for integrating services between and among agencies.
(c) A qualifying entity shall collaborate with local service delivery agencies and existing collaborative councils in implementing a grant received pursuant to this chapter.
Article  3. Local Agency Collaboration
 (a) A qualifying entity applying for a grant under this chapter shall establish procedures to ensure ongoing consultation and collaboration with local agencies for the purposes set forth in subdivision (c). The consultation and collaboration process shall involve, at a minimum, parents or guardians and teachers of pupils at schools that are qualifying entities and representatives of each member agency or private partner that will provide, or is anticipated to provide, services pursuant to this chapter.
(b) If the qualifying entity is located within a county that has established an interagency children’s services coordinating council pursuant to Chapter 12.8 (commencing with Section 18986) of Part 6 of Division 9 of the Welfare and Institutions Code, all of the following shall apply:
(1) A Healthy Start: Toxic Stress and Trauma Recovery for Children Program proposal submitted under this chapter shall first be approved by the council.
(2) The implementation of a program developed pursuant to this chapter shall be subject to the regular review of the council.
(3) The qualifying entity may engage in the activities authorized pursuant to Article 3 (commencing with Section 18986.20) of Chapter 12.8 of Part 6 of Division 9 of the Welfare and Institutions Code if the council first approves those activities.
(4) The council or its members may be designated to fulfill the responsibilities of the consultation and collaboration process required by this section.
(c) Responsibilities of individuals designated for consultation and collaboration by the qualifying entity shall include, but are not limited to, all of the following:
(1) Participating in the development of the program during the planning stages.
(2) Participating with the qualifying entity in the design and operation of the program with any accompanying evaluation.
(3) Facilitating communication between the qualifying entity and state, local, and community-based organizations providing support services to children.
(4) Making recommendations to appropriate organizations regarding ways to improve delivery of support services to children in the most cost-effective manner.
Article  4. Fiscal Provisions
 (a) This chapter shall be implemented only to the extent that funds are appropriated for this purpose in the annual Budget Act or another statute, or are made available for this purpose from federal sources. It is the intent of the Legislature that the Superintendent seek and use any federal funds that may be made available for purposes of this chapter.
(b) All moneys appropriated by the Legislature to the Superintendent for purposes of this chapter shall be allocated by the Superintendent to qualifying entities that have been selected to participate in the grant program.
(c) To the extent permitted by federal law, funding made available to a qualifying entity shall be subject to all of the following conditions:
(1) The program is open to children without regard to a child’s religious beliefs or any other factor related to religion.
(2) Religious instruction is not included in the program.
(3) The space in which the program is operated is not used in any manner to foster religion during the time used for operation of the program.