California Assembly Bill AB174 Amended / Bill

 BILL NUMBER: AB 174AMENDED BILL TEXT AMENDED IN ASSEMBLY MAY 24, 2013 AMENDED IN ASSEMBLY APRIL 17, 2013 AMENDED IN ASSEMBLY APRIL 4, 2013 AMENDED IN ASSEMBLY MARCH 19, 2013 INTRODUCED BY Assembly Member Bonta JANUARY 24, 2013 An act to add  and repeal  Section 124174.7  to   of  the Health and Safety Code, relating to public health. LEGISLATIVE COUNSEL'S DIGEST AB 174, as amended, Bonta. Public school health centers. Existing law establishes the Public School Health Center Support Program, pursuant to which the State Department of Public Health, in collaboration with the State Department of Education, provides, among other things, technical assistance to school health centers on effective outreach and enrollment strategies to identify children who are eligible for, but not enrolled in, the Medi-Cal program, the Healthy Families Program, or any other applicable program and technical assistance to facilitate and encourage the establishment, retention, or expansion of school health centers. This bill would require the State Department of Public Health to establish  , within the County of Alameda,  a grant  pilot  program within the Public School Health Center Support Program that would be known as Promoting Resilience: Offering Mental Health Interventions to Support Education (PROMISE).  The program would operate from September 1, 2014, to August 31, 2015. The program would provide resources to eligible applicants, including local education agencies, nonprofit organizations, and community health centers, to fund activities and services to directly address the mental health and related needs of students who are impacted by trauma, as specified. The bill would define trauma for these purposes.  The bill would require the department, within 60 days following the completion of the program, to submit specified information on the program to the appropriate policy and fiscal committees of the   Legislature.  The bill would require the department to implement these provisions only to the extent that funding is made available, as  specified. The bill would also include legislative findings and declarations.   specified, and would require any administrative costs to the department to be paid through nonstate funds. The bill would repeal these provisions on January 1, 2017.  Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated 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) Trauma has serious short- and long-term consequences for health, educational achievement, and well-being. Trauma has been defined as experiences or situations that are emotionally painful and distressing, and that overwhelm an individual's ability to cope, and as chronic adversity, including, but not limited to, discrimination, racism, oppression, and poverty. (b) Children and youth who are neglected or abused, or who feel unsafe in their homes, schools, or communities, experience trauma that can have lasting negative impacts. (c) Children and youth in low-income neighborhoods are disproportionately impacted by trauma, including, but not limited to, violence. For example, 20 percent of California children from families with annual incomes below twenty-five thousand dollars ($25,000) feel somewhat unsafe or very unsafe in their neighborhoods, versus just 2 percent of California children from families with annual incomes above one hundred twenty-five thousand dollars ($125,000). (d) Children and youth of color are disproportionately impacted by violence. Compared to Caucasians, African American children and youth are three times more likely, and Latino children and youth are two times more likely, to be exposed to shootings, bombs, and riots. (e) Boys and young men of color are particularly likely to be impacted by trauma. For example, compared to rates among Caucasians, boys and young men of color have more than twice the risk of witnessing domestic violence, being abused and neglected, or having an incarcerated parent. Homicide is the leading cause of death among male African American adolescents, occurring at a rate 15 times greater than among Caucasians. (f) The likelihood of boys and young men suffering from post-traumatic stress disorder is two and one-half times greater among African American boys and young men and four and one-tenth times greater among Latino boys and young men, as compared to among Caucasians. (g) Mental health services can have a positive and significant impact on life outcomes for children and adolescents impacted by trauma. (h) However, of the almost 13 percent of adolescents who report needing help for emotional or mental health problems, over 60 percent do not receive counseling. Among adolescents living below the poverty line, 92 percent of those who report needing help for emotional or mental health problems did not receive counseling in the past year. The percentage of adolescents who report needing help for emotional or mental health problems is widely assumed to be less than the percentage who would benefit from these services. (i) Adolescents are less likely than almost all other age groups to have a usual source of health care. Male adolescents, and particularly male adolescents of color, are even less likely to have a usual place to go when they are sick or need health advice. (j) California's 200 school health centers are predominantly located in low-income communities, where students are disproportionately impacted by trauma. For example, 80 percent of school health center clients seen in the County of Alameda in the 2010-11 school year had witnessed violence or been a victim of violence during their lifetime. (k) Among adolescents in managed care plans, those with access to a school health center are 10 times more likely to access mental health or substance abuse services than those without access to a school health center. (l) School health centers see higher proportions of adolescent males than other care settings, including community clinics or private practices. (m) Research shows that students receiving mental health services at school health centers have significant improvements in their presenting problems and that school-based mental health services can be more efficacious than those provided in community settings. (n) School-based mental health programs focused specifically on trauma have been shown to reduce post-traumatic stress disorder, depression, and psychosocial dysfunction. (o) Schools and school health centers do not currently have access to sufficient funding to reach more than a fraction of the students impacted by trauma and who would benefit from mental health services. The many barriers to securing sufficient funding include, but are not limited to, high proportions of uninsured students and restrictions on the services that are reimbursable through programs such as the California Victim Compensation Program and the Medi-Cal program. (p) The Early and Periodic Screening, Diagnosis and Treatment Program, a Medi-Cal program that is a major source of funding for school-based mental health services, excludes many of the young people who need its services. Barriers include, but are not limited to, Medi-Cal eligibility, low provider participation, restrictive diagnostic and medical necessity criteria, and the requirement that a parent or guardian consent for services.   SEC. 2.   SECTION 1.  Section 124174.7 is added to the Health and Safety Code, to read: 124174.7. (a)  (1)    The State Department of Public Health shall establish a grant  pilot  program within the Public School Health Center Support Program to fund activities and services to directly address the mental health and related needs of students who are impacted by trauma. This grant  pilot  program shall be named Promoting Resilience: Offering Mental Health Interventions to Support Education (PROMISE).  (2) The department shall establish the pilot program in the County of Alameda, and up to 10 facilities that meet the requirements in this section may participate in the program.   (3) The program shall operate for one year, beginning September 1, 2014, and ending on August 31, 2015.   (4) Within 60 days following completion of the program, the department shall review and compile the results of the summary reports prepared by participating facilities pursuant to paragraph (3) of subdivision (d) and submit that information to the appropriate policy and fiscal committees of the Legislature. (b) Grant funds shall be used according to the following requirements: (1) Grant funds shall be used by eligible applicants to directly address the mental health and related needs of students who are impacted by trauma. (2) Grant funds may be used for the following activities and services: (A) Individual, family, and group counseling. (B) Targeted outreach and education. (C) Risk screening, triage, and referral to campus-based services. (D) Schoolwide violence prevention and response efforts. (E) Youth development programming related to trauma and violence. (F) Crisis response coordination and services. (G) Case management services. (H) Coordination with off-campus mental health and support services. (I) Staff training and consultation on supporting students' trauma-related needs. (J) Oversight, coordination, and evaluation of the above activities and services. (3) Individual, family, and group counseling funded by a grant awarded pursuant to this section may be provided by any of the following: (A) A mental health clinician licensed by the Board of Behavioral Sciences, including a licensed marriage and family therapist, a licensed clinical social worker, or a licensed educational psychologist. (B) A clinical psychologist licensed by the Board of Psychology. (C) A psychiatric nurse practitioner licensed by the Board of Registered Nursing. (D) A psychiatrist licensed by the Medical Board of California. (E) A school social worker credentialed by the State of California. (F) An unlicensed mental health professional who is registered by either the Board of Behavioral Sciences or the Board of Psychology, and who is receiving clinical supervision as prescribed by that entity. (4) Other activities and services, including schoolwide violence prevention efforts, shall be provided or overseen by a mental health professional as described in subparagraphs (A) through (F), inclusive, of paragraph (3).  (5) Grant funds may be used to provide referrals to evidence-based mental health treatment services in the community.  (c) Grant funds shall be awarded according to the following requirements. (1) Eligible applicants shall include: (A) Local education agencies. (B) Nonprofit organizations. (C) Community health centers. (D)  County   The   county  mental health  departments.   department.  (2) Grant applications shall comply with all of the following: (A) Applicants shall describe their program to address the mental health and other related needs of students who are impacted by trauma, and to foster a positive school climate. At a minimum, the program described in the application shall include: (i) Individual, family, and group counseling. (ii) Youth development programming related to trauma and violence. (iii) Schoolwide violence prevention and response efforts, including, at a minimum, training for staff on trauma and their roles in preventing and responding to it. (iv) Coordination between school-based and community services. (v) A discussion of any components of the program for which funding does not yet exist or is currently insufficient and for which they are seeking grant funding. (B) Demonstrate the applicant's ability to provide a dedicated space located on the school campus that will serve as the hub of the program, that will be youth friendly, and, for middle and high schools, that will be regularly accessible to students on a drop-in basis. (C) Provide evidence of a strong partnership and commitment to collaboration between the school and any agencies or organizations that will provide mental health, medical, or other related services on the school campus, whether funded by this grant or another funding source. Specific mechanisms by which applicants shall provide this evidence shall be detailed in the request for applications, but may include letters of agreement or support, memoranda of understanding, or draft, signed subcontracts. (3) As detailed in the request for applications, priority for awarding a grant shall be given to eligible applicants that demonstrate the following: (A) High levels of exposure to trauma and violence among the target population. (B) Limited access to mental health services among the target population. (C) An ability to meet the cultural and linguistic needs of the target population. (D) An ability to engage and serve subgroups of students within the target population who are disproportionately impacted by trauma and violence. (E) An ability to hire staff with similar backgrounds and experiences to the target population and who can therefore enhance program impact. (F) An ability to obtain additional sources of funding or third-party reimbursement to create a robust and sustainable school-based mental health program. (G) An ability to integrate mental health and related services with primary medical care. (d) An eligible applicant that receives grant funds shall commit to all of the following: (1) Establish a written memorandum of understanding (MOU) between the school, the school district, and other agencies or organizations providing grant-funded mental health, medical, or other related services, in an effort to develop a strong collaborative partnership between involved entities. (A) The collaborative partnership shall do all of the following: (i) Include local education agency-employed personnel, including school administrators, teachers, and staff, and any school health personnel, including school nurses or social workers. (ii) Include personnel employed by other agencies or organizations, including community health centers, who provide relevant services on campus. (iii) Establish and implement regular communication protocols between the school and agencies or organizations. (iv) Engage all relevant personnel in identifying students who would benefit from mental health or other related services and linking them to those services. (v) Promote the integration of funded services into the overall school environment. (B) The MOU shall do both of the following: (i) Describe how services are coordinated on the campus and how services will be integrated into the overall school environment. (ii) Ensure the confidentiality and privacy of both education and health information, consistent with applicable federal and state laws. (2) Make services available to all students in the school, regardless of ability to pay. (3) Submit  an annual   a summary  report  to the department  ,  including   within 30 days following the completion of the program, that includes  a discussion of all of the following: (A) The activities and services funded through the grant award. (B) The number of students served through specific activities and services. (C) The roles and credentials of personnel funded through the grant award. (D) Any additional funding sources that are available to enhance or sustain activities and services. To the extent possible, grant reporting requirements shall be consistent with those required by other funding mechanisms that support the program.  (E) An analysis of the effects of the program on the surrounding community.  (e)  (1)    The department shall implement this section only to the extent that funding is made available from the following sources:  (1)   (   A)  From funding made available through public sources, upon appropriation by the Legislature, as applicable, and to the extent permitted by law.  (2)   (   B)  From other resources, including federal funding, in-kind assistance, private funding, and foundation support for the operation and distribution of grants for this program.  (2) Administrative costs to the department for the establishment and maintenance of this program shall be paid through federal funding, in-kind assistance, private funding, foundation support, and any other nonstate funds.  (f) For purposes of this section, "trauma" or "trauma exposure" is defined as experiencing or being witness to community violence, terrorism, disaster, sexual abuse, or other violent acts. The effects of trauma or trauma exposure include emotional, cognitive, physical, or interpersonal reactions as a result of the event witnessed or experienced.  (g) This section shall remain in effect only until January 1, 2017, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2017, deletes or extends that date.