BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    AB 1025             
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          |AUTHOR:        |Thurmond                                       |
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          |VERSION:       |June 2, 2015                                   |
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          |HEARING DATE:  |July 15, 2015  |               |               |
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          |CONSULTANT:    |Tim Valderrama                                 |
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           SUBJECT  :  Pupil health: multitiered and integrated interventions  
          pilot program.

           SUMMARY  :  Requires the Department of Education to establish a three-year  
          pilot program in school districts to encourage inclusive  
          practices that integrate mental health, special education, and  
          school climate interventions following a multi-tiered framework.
          
          Existing federal law:
          1)Requires the provision of a free, appropriate public education  
            to all disabled students in least restrictive environment,  
            which:

                  a)        Is provided at public expense, under public  
                    supervision and direction, and without charge;
                  b)        Meets the standards of the state education  
                    agency;
                  c)        Includes an appropriate preschool, elementary  
                    school, or secondary school in the state; and,
                  d)        Is provided in conformity with the Individual  
                    Education Program established for the child.

          2)Establishes the Early and Periodic Screening, Diagnosis, and  
            Treatment (EPSDT) Program to provide physical and mental  
            health services to Medicaid (Medi-Cal in California)  
            beneficiaries under the age of 21, including current and  
            former foster youth.

          Existing state law:
          1)Establishes Mental Health Services Act (MHSA) which provides  
            for local mental health services, including prevention and  
            early intervention, innovative projects, Full Service  
            Partnerships, peer support services, housing, and other mental  







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            health treatment services.  Establishes the Mental Health  
            Services Fund in the state Treasury, continuously appropriated  
            to and administered by the Department of Health Care Services  
            (DHCS), to fund specified county mental health programs.

          2)Encourages schools, as comprehensive school safety plans are  
            reviewed and updated, to include in school safety plans clear  
            guidelines for the roles and responsibilities of mental health  
            professionals, community intervention professionals, school  
            counselors, school resource officers, and police officers on  
            school campus, if the school district uses these people. The  
            guidelines may include primary strategies to create and  
            maintain a positive school climate, promote school safety, and  
            increase pupil achievement, and prioritize mental health and  
            intervention services, restorative and transformative justice  
            programs, and positive behavior interventions and support.

          3)Requires the individualized education team for each student  
            with exceptional needs consider the use of positive behavioral  
            interventions and supports for students whose behavior impedes  
            his or her learning.
          
          This bill:
          1)Requires the California Department of Education (CDE) to  
            establish a three-year pilot program, as part of the plan to  
            provide technical assistance and disseminate statewide  
            resources that encourage and assist local educational agencies  
            establish and align schoolwide, data-driven systems of  
            learning, to encourage inclusive practices that integrate  
            mental health, special education, and school climate  
            interventions following a multitiered framework.

          2)Requires the CDE to establish the pilot program in three  
            schools in each of five school districts that submit  
            applications that provide funding estimates for startup and  
            evaluation of the program and specifying their intended  
            models.

          3)Prohibits the selection of participating schools from  
            including those that received a federal Substance Abuse and  
            Mental Health Services Administration's "Now is The Time"  
            grant. 


          4)Requires the California CDE to select schools that meet both  








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            of the following criteria: 


                  a)        At least 60% of the student body is eligible  
                    for free and reduced-price meals; and, 
                  b)        The application details a model approach that  
                    targets the behavioral, emotional, and academic needs  
                    of students with multi-tiered and integrated mental  
                    health, special education, and school climate  
                    interventions. 


          5)Requires an applicant's model to include all of the following:  


                  a)        Formalized collaboration with local mental  
                    health agencies to provide school-based mental health  
                    services that are integrated within a multi-tiered  
                    system of support;
                  b)        Leverage of school and community resources to  
                    offer comprehensive multi-tiered interventions on a  
                    sustainable basis; 
                  c)        An initial school climate assessment that  
                    includes information from multiple stakeholders,  
                    including school staff, students, and families, that  
                    is used to inform the selection of strategies and  
                    interventions that reflect the culture and goals of  
                    the school; 
                  d)        A coordination of services team that considers  
                    referrals for services, oversees schoolwide efforts,  
                    and uses data-informed processes to identify  
                    struggling students who require early interventions;
                  e)        Whole school strategies that address school  
                    climate and universal student well-being, such as  
                    positive behavioral interventions and supports or the  
                    Olweus Bullying Prevention Program, as well as  
                    comprehensive professional development opportunities,  
                    that build the capacity of the entire school community  
                    to recognize and respond to the unique  
                    social-emotional, behavioral, and academic needs of  
                    students;
                  f)        Targeted interventions for students with  
                    identified social-emotional, behavioral, and academic  
                    needs, such as a therapeutic group interventions,  
                    functional behavioral analysis and plan development,  








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                    and targeted skills groups;
                  g)        Intensive services, such as wraparound,  
                    behavioral intervention, or one-on-one support, that  
                    can reduce the need for a student's referral to  
                    special education or placement in more restrictive,  
                    isolated settings; and,
                  h)        Specific strategies and practices that ensure  
                    parent engagement with the school and provide parents  
                    with access to resources that support their children's  
                    educational success.

          6)Requires CDE, in accordance with an appropriation in the  
            Budget Act or another statute, to provide startup and  
            evaluation funds to each participating school in the following  
            amounts:

                  a)        $250,000 in year one;
                  b)        $200,000 in year two; and, 
                  c)        $150,000 in year three.

          7)Requires DHCS, the Mental Health Services Oversight and  
            Accountability Commission, and the CDE to develop a  
            comprehensive evaluation plan to assess the impact of the  
            pilot program and disseminate best practices. 

          8)Requires outcomes and indicators to be reported by  
            participating schools to include those already being collected  
            by schools, as well as designated measures of student  
            well-being, academic achievement, and school engagement and  
            attendance. 

          9)Requires CDE to submit a report to the Legislature at the end  
            of the three-year period evaluating the success of the program  
            and making further recommendations

          10)Requires the CDE to make the report to the Legislature  
            available to the public and to post it on CDE's website. 

          11)Requires the Mental Health Services Oversight and  
            Accountability Commission to revise its guidelines and  
            regulations for Prevention and Early Intervention Programs of  
            the Mental Health Services Act to require the prevention and  
            early intervention programs in K-12 schools to be designed to  
            support the implementation or expansion of model programs in  
            accordance with the criteria set forth in this bill. 








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          12)Sunsets the provisions of this bill on January 1, 2020. 

          13)Makes various legislative findings and declarations stating  
            that all California's pupils deserve adequate behavioral and  
            academic support to achieve their full potential and declares  
            legislative intent, upon demonstrated success of the pilot  
            program, that evaluated models be adopted by a large number of  
            schools.

           FISCAL  
          EFFECT  :  According to the Assembly Appropriations Committee, in  
          excess of $400,000 in administrative General Fund costs to CDE  
          and $600,000, over three years, for startup and evaluation  
          funding to each school participating in the program. As proposed  
          to be amended, this bill establishes pilot programs in a total  
          of 10 schools.

           PRIOR  
          VOTES  :  
          
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          |Assembly Floor:                     |69 - 9                      |
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          |Assembly Appropriations Committee:  |11 - 4                      |
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          |Assembly Education Committee:       |6 - 0                       |
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          COMMENTS  :
          1)Author's statement.  According to the author, students in  
            disadvantaged communities face relational and environmental  
            stressors that, when left unaddressed, hinder their ability to  
            achieve their full potential. Compounded traumatic stressors  
            including poverty and exposure to violence have been found to  
            negatively affect student academic achievement, learning and  
            emotional development, and result in disproportionately high  
            referral rates to special education services. Risk factors  
            that are known to negatively impact the social-emotional  
            well-being and academic achievement of students are  
            widespread. Nearly one in four youth are living in poverty,  
            almost 60,000 youth are currently placed in foster care and it  
            is estimated that 20% of youth are in need of mental health  








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            intervention.

            Unfortunately, the needs of students facing such challenges  
            often go unrecognized or are misunderstood. Unaddressed  
            student needs frequently result in more profound behavioral  
            and academic challenges that can necessitate costly,  
            restrictive interventions including entering into the juvenile  
            justice system. The fragmentation of our education and mental  
            health systems only makes the situation worse. The school  
            setting presents an important opportunity to identify and  
            respond to the comprehensive needs of youth, reducing barriers  
            to access as well as the stigma that is often associated with  
            seeking help. Working in partnership with mental health  
            providers, the school community can be empowered with the  
            skills and resources to promote the wellbeing and achievement  
            of all students.
            
          2)Mental health services in schools.  According to the CDE,  
            mental health services in schools include a broad range of  
            services, settings, and strategies. Psychological and mental  
            health services in schools apply learning theory for  
            individuals and groups to improve instruction and coordinate  
            and evaluate plans to meet unique individual needs for  
            learning or behavior problems. School psychologists also use  
            research to design prevention and intervention programs, and  
            provide crisis intervention, suicide prevention, and other  
            mental health strategies as part of a student support services  
            team. Mental health services that are provided in schools may  
            include academic counseling, brief interventions to address  
            behavior problems, and assessments or referrals to other  
            systems. However, most of the mental health services provided  
            by schools are within the context of special education and  
            meeting the requirements specified in a student's  
            individualized education program.

          3)Individualized education programs (IEP). Pursuant to the  
            Individuals with Disabilities Education Act (IDEA), each  
            public school student who receives special education and  
            related services must have an IEP. An IEP is a written  
            document developed by a multi-disciplinary team that is  
            designed for one student and must be truly individualized.  
            Federal and state law require the instruction and related  
            services detailed in an IEP to be provided to the student  
            irrespective of the internal capacity of the school to provide  
            the instruction and services. In order to meet the  








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            requirements set forth in an IEP, schools may employ qualified  
            staff directly, partner with county mental health agencies or  
            contract with private providers.

          Prior to 2011, state law required a partnership between school  
            districts and county mental health agencies to deliver mental  
            health services to students with IEPs. AB 114 (Committee on  
            Budget, Chapter 43, Statutes of 2011), repealed the state  
            mandate on special education and county mental health agencies  
            and eliminated related references to mental health services in  
            California statute. As a result of this legislation, school  
            districts are now solely responsible for ensuring that  
            students with disabilities receive special education and  
            related services to meet their needs pursuant to IDEA. Special  
            education funding can only be used for instruction and related  
            services specifically identified in IEPs and cannot be used  
            for any other purpose, such as school-wide interventions.

          4)Medi-Cal services.  EPSDT is a Medi-Cal benefit for  
            individuals under the age of 21 who have full-scope Medi-Cal.  
            This benefit allows for periodic screenings to determine  
            health care needs and includes all services covered by  
            Medi-Cal, as well as other services that are determined to be  
            medically necessary.  

          According to the DHCS, EPSDT mental health services are Medi-Cal  
            services that correct or improve mental health problems that a  
            doctor or other health care provider identifies, even if the  
            health problem will not go away entirely. EPSDT mental health  
            services must be approved and provided by county mental health  
            departments. Some of the EPSDT mental health benefits  
            available are individual or group therapy, family therapy,  
            crisis counseling, case management, special day programs  
            medication and Therapeutic Behavioral Services (TBS). TBS are  
            an EPSDT specialty mental health service that are designed to  
            help children and young adults who have severe emotional  
            problems, live in or are at risk of a mental health placement,  
            or have been or are at risk of being hospitalized for mental  
            health problems. Schools are not authorized to directly seek  
            reimbursement for EPSDT benefits but may be reimbursed with  
            EPSDT funds if agreed to by the county mental health agency.

          5)Student Mental Health Initiative (SMHI).  The SMHI is a  
            California Mental Health Services Authority prevention and  
            early intervention program that identifies strategies to  








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            address student mental health needs across the K-12 and higher  
            education systems. The program offers four year grants, funded  
            by the MHSA, to institutions to develop a comprehensive system  
            of campus-based mental health services and supports for  
            students. The author indicates this bill has objectives  
            similar to the SMHI but would be administered through CDE  
            directly to schools rather than through the county mental  
            health agency and would focus more on early intervention.
          
          6)Recent budget action.  AB 104 (Committee on Budget, Chapter  
            13, Statutes of 2015), among other things, appropriates $10  
            million in one-time funds to a county office of education (or  
            two applying jointly) to provide technical assistance and to  
            develop and disseminate statewide resources that encourage and  
            assist local educational agencies and charter schools in  
            establishing and aligning school-wide, data-driven systems of  
            learning and behavioral supports for the purpose of meeting  
            the needs of the state's diverse learners in the most  
            inclusive environments possible.

          7)Double referral.  This bill was heard in the Senate Education  
            Committee on July 8, 2015 and passed with an 8-1 vote.

          8)Related legislation. SB 463 (Hancock), would require the CDE,  
            to the extent that funding is available in the Budget Act of  
            2015, to designate a county office of education to be the  
            fiduciary agent for the Safe and Supportive Schools Train the  
            Trainer Program. SB 463 is pending in the Assembly Education  
            Committee. 

            AB 1133 (Achadjian), would have required the State Public  
            Health Officer to establish a four-year pilot program to,  
            among other things, provide free regional training and  
            technical assistance in support services that include  
            intervention and prevention services, use of trained staff to  
            meet with students on a short-term weekly basis in a  
            one-on-one setting, the potential for support services to help  
            fulfill state priorities described by the local control  
            funding formula and local goals described by local control and  
            accountability plans, and state resources available to support  
            student mental health and positive learning environments. AB  
            1133 was held in the Assembly Appropriations Committee. 

            AB 580 (O'Donnell), would require the CDE to develop model  
            referral protocols for voluntary use by schools to address the  








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            appropriate and timely referral by school staff of students  
            with mental health concerns. AB 580 is pending in the Senate  
            Appropriations Committee.

            AB 1018 (Cooper),would  require the CDE and the DHCS to  
            convene a task force to examine the delivery of mental health  
            services through the Early and Periodic Screening, Diagnosis,  
            and Treatment services. AB 1018 is pending in Senate  
            Appropriations Committee. 

            SB 527 (Liu), would establish the Safe Neighborhoods and  
            Schools Fund Grant Program, using Proposition 47 funds to  
            reward school districts that have demonstrated a commitment  
            to, and developed a comprehensive plan for, utilizing  
            research-based strategies to increase attendance rates, to  
            reduce school removals of all types and referrals to police,  
            to address trauma, mental health needs and other social and  
            emotional factors that impact pupil outcomes, to address and  
            to remedy school push-out and dropout rates, coordinate pupil  
            support programs with community and other public agencies at  
            school sites and across the school district, and create a  
            strong and supportive school culture that identifies and  
            addresses the needs of pupils, including victims of crime,  
            abuse, and neglect. SB 527 is scheduled to be heard by Senate  
            Education Committee on July 15.
            
          9)Prior legislation.  SB 1396 (Hancock, 2014), would have  
            required CDE, to the extent one-time funding is available in  
            the 2014-15 Budget Act, to designate funds to a county office  
            of education to establish professional development activities  
            to support the development and expansion of multi-tiered  
            intervention and support programs, including but not limited  
            to, schoolwide positive behavior intervention and support. SB  
            1396 was held on the Assembly Appropriations Committee's  
            suspense file. 
          
            SB 596 (Yee, 2014) would have required the CDE to establish a  
            three-year pilot program to encourage inclusive practices that  
            integrate mental health, special education, and school climate  
            interventions following a multi-tiered framework. SB 596 was  
            held at the Assembly Desk.
            
          10)Support.  The Steinberg Institute argues that for many years,  
            educators have recognized that signs of mental health issues  
            emerge at an early age and that early intervention is key in  








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            preventing children afflicted with a mental illness from  
            worsening symptoms, falling behind and dropping out of school,  
            juvenile delinquency, and a future marked by a lower standard  
            of living than their peers. They express hope that this bill  
            will be a step in the right direction towards making early  
            intervention programs more readily available in our public  
            schools. The Association of California School Administrators  
            state that youth with mental health challenges often fail to  
            receive the services they need and our youngest learners,  
            especially those from low income backgrounds, often will  
            perform substantially below their higher income peers in areas  
            of social and emotional skill, social and emotional  
            development, engagement in school, and physical well-being.  
            They believe this gap in performance is noticeable if mental  
            health challenges are not identified by the third grade and  
            that current funding practices do not invest in preventative  
                                                                        measures that would reduce overall cost of special education.  
            The California State PTA maintain that youth in economically  
            depressed circumstances are particularly vulnerable to social,  
            emotional and academic pressures and may not have access to  
            services that can ease these pressures. Placing the pilot  
            program in multiple schools and school districts that have at  
            least 60% of the student body eligible for free and reduced  
            price meal programs supports the needs of these children.

          11)Opposition.  The Special Education Local Plan Area  
            Administrators of California opposes this bill and argues it  
            would draw funding from a recent budget allocation intended  
            for broader purposes as recommended by the Statewide Task  
            Force on Special Education. They state that this bill would  
            specifically link pilot programs that are narrowly targeted  
            for mental health and only available in a small number of  
            schools to a one-time $10 million dollar budget augmentation  
            that was intended to assist students with learning  
            disabilities, cognitive disabilities or behavioral needs  
            statewide.

          12)Author's amendments. The author wishes to amend this bill as  
            follows:
          
             a)   Require the designated county office of education to  
               establish the pilot program, rather than requiring the  
               California Department of Education (CDE) to establish the  
               pilot program. 
             b)   Reduce the number of pilot programs, from three to two,  








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               schools in each of the five school districts that apply to  
               participate. 
             c)   Require applications to provide evidence of a plan to  
               serve students using a combination of school funds and  
               mental health funds. 
             d)   Modify the required components of an applicant school's  
               model approach to: 
                  i.        Delete reference to formalized collaboration  
                    with local mental health agencies.
                  ii.       Add reference to partnerships with the county  
                    and demonstrations of access to adequate funding to  
                    serve Medi-Cal eligible students who are not receiving  
                    special education or related services. 
             e)   Delete the requirement that the State Department of  
               Health Care Services, the Mental Health Services Oversight  
               and Accountability Commission, and the CDE to develop a  
               comprehensive evaluation plan to assess the impact of the  
               pilot program and disseminate best practices.

           SUPPORT AND OPPOSITION  :
          Support:  Association of California School Administrators
                    Association of Regional Center Agencies
                    California Alliance of Child and Family Services
                    California Chapter of the National Association of  
               Social Workers
                    California Council of Community Mental Health Agencies
                    California Pan-Ethnic Health Network
                    California Psychological Association
                    California State PTA
                    Children Now
                    Mental Health America of California
                    Pacific Clinics
                    Steinberg Institute
                    
          Oppose:   Special Education Local Plan Area Administrators of  
                    California

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