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Jennifer L. Hall From:durfeycraig778@gmail.com Sent:Sunday, PM To:mmccaskill@fullertonpd.org; Don Barnes; publiccomment@sdcounty.ca.gov; Public Comment; publicrecords@buenapark.com; Terra.Lawson-Remer@sdcounty.ca.gov; Theresa Bass; assemblymember.quirk-silva@assembly.ca.gov; DIANA.LARA@sen.ca.gov; senator.umberg@senate.ca.gov; Assemblymember.Davies@assembly.ca.gov; Christopher.Aguilera@asm.ca.gov; sbe@cde.ca.gov; 'Public Records Request'; SENATOR.GONZALEZ@senate.ca.gov; 'Teresa Pomeroy'; 'communityrelations'; assemblymember.rendon@assembly.ca.gov; 'Maria Stipe'; 'Pam Haddad'; SEDN.committee@senate.ca.gov; SHEA.Committee@senate.ca.gov; 'Gabriela Mafi'; ocbe@ocde.us Cc:durfeycraig778@gmail.com; cadurfey@gmail.com Subject:\[EXTERNAL\] support to growing need for dog therapy in schools, improve reading and police, fire suicide prevention under CA State HR 28 2015-2016 House Resolution Attachments:# GGPD SRO TWO DOGS PICTURES 318900952_171055862282638_ 6935747063774260176_n.jpg; # 2 GGPD SRO TWO DOGS PICTURES MERIT AWARD METAL 319021536_171055892282635_7903126182271748030_n.jpg; # 1 GGPD SRO TWO DOGS PICTURES 318611114_171055952282629_7825179097435068204_n.jpg; # 1 Review of the Research Are Therapy Dogs in Classrooms Beneficial.pdf; NYTimes Com Why Dogs Can Be So Healing for Kids.docx; SEAL BEACH POLICE DEPT POLICY 351 FACILITY DOG PROGRAM.pdf; SEAL BEACH PD Police Facility Dog Yosa.pdf; New laws and grant programs expected to help improve mental health among first responders.pdf; AB-638 Mental Health Services Act early intervention and prevention programs OCT 06-2021.pdf; AB 638 (Quirk-Silva) - As Amended March 26, 2021202120220AB638_Assembly Health.pdf; 202120220AB638_Senate Health (1).pdf; 202120220AB638_Assembly Appropriations.pdf; AB-2265 Mental Health Services Act use of funds for substance use disorder treatment.pdf; 201920200AB2265_Senate Health.pdf; 201920200AB2265_Assembly Appropriations.pdf Warning: This email originated from outside the City of Anaheim. Do not click links or open attachments unless you recognize the sender and are expecting the message. 12-11-2022 (P.R.D.D.C.) PARENTS FOR THE RIGHTS OF DEVELOPMENTALLY DISABLED CHILDREN CRAIG A. DURFEY FOUNDER OF P.R.D.D.C. GARDEN GROVE, CA 92842 CELL SOCIALEMOTIONALPAWS.COM FACEBOOK: CRAIG DURFEY 1 U.S. HOUSE OF CONGRESS H2404 - HONORING CRAIG DURFEY FOR HIS FIGHT AGAINST AUTISM ... Ms. LORETTA SANCHEZ of California. https://www.govinfo.gov/content/pkg/CREC-2003-03-27/pdf/CREC-2003-03-27.pdf new website socialemotionalpaws.org Governor Gavin Newsom 1021 O Street, Suite 9000 Sacramento, CA 95814 Phone: (916) 445-2841 Fax: (916) 558-3160 Speaker Anthony Rendon State Capitol Room 219 Sacramento, CA 95814 Tel: (916) 319-2063 Fax: (916) 319-2163 Senate President pro Tempore Toni G. Atkins (D-San Diego) 1021 O Street, Suite 8518 Sacramento, CA 95814 Phone: (916) 651-4039 Fax: (916) 651-4939 State Senator Tom Umberg 1021 O Street, Suite 6730 Sacramento, CA 95814 Phone: (916) 651-4034 Fax: (916) 651-4934 Assemblymember Lowenthal District 69 Assemblymember Avelino Valencia District 68 ASSEMBLYMEMBER Tri Ta State Capitol P.O. Box 942849 Sacramento, CA 94249-0070 Phone - 916-319-2070 2 Janet Nguyen (R) 1021 O Street, Suite 7610 , Sacramento, CA 95814-4900; (916) 651-4036 California State Parent Teacher Association 2327 L St, Sacramento, CA 95816 To whom it may concern. Dear Governor Newsom Request your support to address a growing need for dog therapy in schools, improve reading and police, fire suicide prevention under CA State HR 28 2015-2016 House Resolution No. 28—Relative to humane education.P1 1WHEREAS, Sections 233.5 (part of the Hate Violence 2Prevention Act) and 60042 of the Education Code require 3instruction in kindergarten and grades 1 to 12, inclusive, to promote 4and encourage kindness to pets and humane treatment of animals. Funding under AB 638 Mental Health Service Act : early intervention and prevention programs. Why Dogs Can Be So Healing for Kids A new study suggests that spending time with therapy dogs may help lower children’s stress levels even more than relaxation exercises. SERVICE DOGS FOR FIRST RESPONDERS Service Dogs for First Responders (socialemotionalpaws.com) Mental Health Is Going ToThe Dogs: How Pet Therapy Helps Wounded (socialemotionalpaws.com) Students prove dogged when it comes to reading (socialemotionalpaws.com) How Therapy Dogs Can Help Kids With Stress Relief - The New York Times (nytimes.com) 30 years indicates that therapy dogs may offer physiological, emo (socialemotionalpaws.com) Therapy Dogs Helps Dove Students with Reading (socialemotionalpaws.com) Spotlight - Therapy Dog for Reading Video (socialemotionalpaws.com) Want to raise empathetic kids? Get them a dog & help a child read (socialemotionalpaws.com) 3 The Effect of Dog-Assisted Intervention on Student Well-Being, Mo (socialemotionalpaws.com) Garden Grove Police Department This new team extra social-emotion (socialemotionalpaws.com) Open Letter CA State calling more school-based therapy dogs (socialemotionalpaws.com) Police to support students’ mental health in Garden Grove Unified (socialemotionalpaws.com) Littleton elementary students write dozens of letters to school's (socialemotionalpaws.com) CA STATE House Resolution No. 28—Relative to humane education (socialemotionalpaws.com) Open letter to support therapy dogs in schools in CA as well othe (socialemotionalpaws.com) Paws4Students team hosted the first (ever) West Coast Support K9 (socialemotionalpaws.com) 4 5 6 New laws and grant programs expected to help improve mental health among first responders 7 New laws and grant programs expected to help improve mental health among first responders | Cal Cities Requesting letter off support and seeking CA State Assembly with CA State Senator to sponsor legislation. Thank You Craig A Durfey 8 „-, �w;. � �.Xr; �� `�j��r� ;�� �'� � �t � � �� °'�<<'"'�►,+ � �t��k� �. ; � '�� r �� ., ; �� : �- � �� � �{�� � �” A � '° � , � .�. � ,� � r,;.. 1 �" �► , � -�-� � fi� �� � ,�� � �����' � �i'�'i s� � � '. � � � � \� (^I�. � 'i��� . vil � � ��� ,� W � , . �, � �::a -:. "��)i � � I -�o , � . �. �� � � i� Forum on Public Policy Review of the Research: Are Therapy Dogs in Classrooms Beneficial? Jerri J. Kropp, Ph.D, CCLS, Georgia Southern University, Statesboro, Georgia, Associate Professor, School of Human Ecology and Mikaela M. Shupp, BBA, Georgia Southern University, Statesboro, Georgia (alumna), Academic Advisor, College of Business Abstract Research findings on the presence of a therapy dog in the classroom are summarized. The authors reviewed 30 articles, book chapters, and other sources on the topic of the various uses of dogs in classrooms, published between 2001 and 2017. Ages studied ranged from 3 years to adolescence (high school). In our analysis, three categories of therapeutic benefit emerged: a) increased reading and language skills, b) social, emotional, and humane gains, and c) improved gross motor skills. Numerous studies have found that literacy skills can be improved from reading to dogs and that children gain confidence in reading and report an increased love of reading (Fine 2015). Therapy dogs can also provide stability and comfort to children who are living in poverty or abusive homes. Caring for a classroom animal teaches responsibility, builds confidence, and gives children a sense of pride and accomplishment. Common concerns and objections to having a therapy dog in the classroom are discussed, as well as recommended policies and procedures for having a therapy dog program in a school setting. Introduction: Research over the past 30 years indicates that therapy dogs may offer physiological, emotional, social, and physical support for children (Friesen, 2010). The use of therapy dogs with children is successful due to children's natural tendency to open up to animals and the stress moderating effect of the calm and nonjudgmental presence of a therapy dog (Jalongo, Astorino & Bomboy, 2004). There has not only been an increase in the use of therapy dogs in classrooms in recent years, but the number of articles citing empirical research has greatly increased in the last ten years. Terminology used: Various terms are used to describe the use of therapy dogs. The preferred terms are: a) Animal - Assisted Activities (AAA) which provide opportunities for motivational, educational, or recreational benefits to enhance quality of life, and are delivered in a variety of settings by volunteers or trained professionals with animals that meet specific criteria; there are no specified treatment goals and the visit content is spontaneous; b) Animal -Assisted Education (AAE), which is a goal -oriented, planned intervention directed by a general education or special education professional, c) Animal -Assisted Intervention (AAI), which are goal oriented interventions which incorporate animals in health, education, and human services for improved health and wellness and/or therapeutic gains, and d) Animal -Assisted Therapy (AAT), which is a planned, goal directed therapeutic intervention directed by health and human services providers as part of their profession, in which an animal that meets specific criteria is an integral part of the treatment process. According to Pet Partners, AAI, AAA, AAT and AAE are the preferred terms, and the term "pet therapy" should be avoided because it is inaccurate and misleading (https://petpartners.org/leam/terminology). It is important to note that there are four distinct categories of animals used for various reasons and with various populations. A certified therapy dog provides comfort and affection, and their handlers are volunteers who visit hospitals, schools, nursing homes, hospice, libraries, and other facilities. These therapy animals have no special rights and must have the permission of the facility to visit. There are usually requirements such as grooming, providing veterinarian records, and proof of certification. Assistance animals (also called service dogs) are individually trained (not by the owner) to do work or perform tasks for people with specific disabilities, such as guide dogs for the blind, alerting people who are deaf, calming a person who has post-traumatic stress disorder (PTSD), dogs who provide mobility assistance, or communicate medical alerts for individuals with diabetes or epilepsy, for example. These dogs also greatly enhance the quality of the lives of their owners with a new sense of independence and freedom. Assistance dogs are considered working animals, not pets. According to the Americans with Disabilities Act (ADA), these dogs are permitted to accompany a person with a disability almost anywhere, including restaurants, businesses, and airplanes. An emotional support dog, or comfort animal, is a pet that provides therapeutic support to a person with an emotional or mental illness and must be prescribed by a licensed mental health professional for a person with these conditions. The prescription must state that the individual has an impairment that substantially limits life activities and is necessary for the person's mental health. According to the ADA, emotional support animals do not have the same rights to public access as service dogs, but may travel with their owners on an airplane and may live with their owner in locations covered by the Fair Housing Amendments Act (FHAA). Facility dogs are regularly present in a residential or clinical setting. They may live with a handler who is an employee of the facility and come to work each day or may live at the facility full time under the care of a primary handler. Facility dogs receive special training and may be used for AAA, AAE, or AAT. These animals do not have special rights of access in public unless they are accompanying or supporting a person with a disability. Although many different types of animals can be used for therapeutic purposes, in this paper, the authors only included studies that used dogs. Leading organizations that certify dogs: Therapy animal teams are certified, which implies that a third party has assessed the handler's mastery of knowledge and skills, and the dog's suitability and temperament to be a therapy animal. There are three leading organizations that certify therapy dogs. Pet Partners (formerly Delta Society) was formed in 1977. Built on the organization's research foundation, programs were focused on providing direct services in local communities. Pet Partners was the first comprehensive, standardized training in animal - assisted activities and therapy for volunteers and healthcare professionals. Over 15,000 animal/handler teams across the US are registered with Pet Partners, making approximately three million visits per year (Pet Partners 2017). Therapy Dogs International (TDI) is a volunteer group organized to provide qualified handlers and their therapy dogs for visitations to institutions, facilities, and other places where therapy dogs are needed. Founded in 1976 so that dogs could be tested, certified, and insured as volunteer therapy dogs. TDI is the oldest registry for therapy dogs in the US, with dogs working in the US and Canada and some other countries (Therapy Dogs International 2017). Intermountain Therapy Animals is a non-profit organization bringing animal resources to human needs. The mission statement of the organization is enhancing quality of life through the human -animal bond. They specialize in the areas of physical, occupational, speech, and psychotherapies, as well as special education. They also founded the Reading Education Assistance Dog (R.E.A.D.) program in 1999 to improve children's reading and communication skills by reading to registered therapy dogs and their volunteer handlers who go to schools, libraries, and other settings. Method: The authors reviewed 30 articles, book chapters, and other sources on the topic of the various uses of dogs in classrooms, published between 2001 and 2017; 25 out of 30 articles (83%) were published in the last ten years. Ages studied ranged from 3 years to adolescence (high school); however the majority of the articles (26 out of 30; 87%) focused on children in elementary school. Four studies focused specifically on preschoolers. Three major categories of therapeutic benefit emerged: a) increased reading and language skills (R), b) social, emotional, and humane gains (SE), and c) improved gross motor skills (GM). In addition, several articles discussed common concerns and recommendations for implementing the practice of having a dog in the classroom. Refer to Table 1 for first author, year, category, population, and a summary of main findings. Table 1: Summary of results from article reviews First Year Title Categ. Population Important Findings Author The value of a dog Self contained -Qualitative analysis of data indicated that the dog's in a classroom of classroom of 6 placement in the classroom: children with elementary -Contributed to students' overall emotional stability Anderson, K 2006 severe emotional SE aged children -Improved students' attitudes toward schools disorders diagnosed with -Facilitated students learning lessons in responsibility, severe respect, and empathy emotional disorders Who Let the Dog Self contained -Results indicated: In? How to classroom of 6 -Students' attitudes toward school improved. Incorporate a Dog elementary -Students found companionship with the dog. into a Self- aged children -Students used the dog to remain in control of their Contained diagnosed with emotions and behaviors in order to prevent them from Anderson, K 2007 Classroom SE severe entering emotional crisis. emotional -Students used the dog as a de-escalation tool to calm disorders their minds and bodies when they did enter into emotional crisis. -Students' learning was extended by fostering growth in respect, responsibility, and empathy. Bringing therapy School age -Will help school administrators and educators better dogs to your understand the benefits of having a therapy dog in a school school: A practical setting. guide for school SE -Provides an overview of potential benefits, common administrators and objections, goals of therapy dog programs in schools, and educators steps in implementing a dog therapy program. Bacon, C 2014 The Effects of a 3 elementary -Results indicated that all three students experienced Dog Reading aged students increases in on -task behaviors during intervention and Visitation Program w/ emotional maintained improvements over time. on Academic behavioral -"It was not until the dogs were present during intervention Engagement disabilities that they became engaged in the reading and more willing Behavior in Three SE/R to read aloud" (252). Elementary Students with Emotional and Behavioral Disabilities: A Bassette, L 2013 Single Case Design Socio -emotional 25 students in -"The dog -class students reported a stronger improvement correlates of a third grade with regard to positive attitude toward school and positive Beetz, A 2013 schooldog-teacher- SE (Germany) emotions related to learning" (1). team in the classroom Animal -Assisted -Review of 25 papers relating to animal -assisted Interventions in the interventions conducted in educational settings. Classroom -A -Studies involved three different animals: guinea pigs, Systematic Review rabbits, and dogs. -Studies were grouped within eight topics, including, reading ability, emotional stability and learning, and social SE/R functioning and interpersonal skills. -"The majority of the studies reported beneficial effects on cognitive and socio -emotional behavior and physiological responses" (28). -Recognized the need for more robust research with increased sample sizes, adequate control groups, and strict Brelsford, V 2017 testing protocols. Therapeutic Dog 3-5 year old -When the therapy dog is present, "the whole feeling of the Gets High Praise preschool classroom is calmer" (2). For His Role In students -Waco, the therapy dog, participated in all classroom Preschool activities-toothbrushing time, picking up toys, and opening Classroom the door to the playground. Cambria, N 2010 SE Animal -Assisted -"Animals in counseling sessions and the classroom Therapy in facilitate an atmosphere of trust, nurturance, and Counseling and SE relationship building" (2). School Settings -Overview of benefits of animals in classrooms. Chandler, C 2001 Lessons Learned -Grades K-2, 3- -The therapy dog helped deliver eight life lessons, which from Dogs in the 6 included the importance of waiting, being friendly to Classroom -Alternative everyone, and making sure to eat good foods. education -The therapy dogs in the high school were part of a plan to Education 2013 SE program in a help students meet graduation requirements. Morgan, the World high school therapy dog, calmed anxious students and served as a reward to students who stayed on task with no emotional outbursts. Social Effects of a Three 5-9 year -"The study showed that the presence of the dog during Dog's Presence on old children sessions increased positive initiated interactions toward the Children with with teacher and the dog for all three participants" (13). Esteves, S 2008 Disabilities SE developmental -Authors also noted that the rate of occurrence of negative disabilities interactions decreased with the intervention. How a therapy dog Elementary -Provided an overview of Guthrie's research on literacy may inspire student aged children engagement and potential application using therapy dogs. literacy -Provided anecdotal evidence of impact using author's engagement in personal therapy dog, Tango. Friesen, L 2009 elementary R -"Tango united them [children] in a common and authentic language arts purpose for learning, and therefore served as the classroom springboard for numerous other literary -based activities" (109). Exploring Animal- Wide overview - Expressed that therapy dogs may offer physiological, Assisted Programs of programs, emotional, social, and physical support for children. with Children in emphasis on -Interacting with dogs can help to encourage children's Friesen, L 2010 School and SE special needs social interaction with peers and adults in special needs Therapeutic classrooms classrooms. Contexts Potential for the Elementary -Provided goals and best practices of school-based Role of School- aged children mentorship programs that involve therapy dogs. Based Animal- R - Presented ways mentors can incorporate the six language Assisted Literacy arts into animal -assisted literacy sessions. Mentoring Friesen, L 2010 Programs Animal -assisted 45 students, -Examined five animal -assisted literacy programs in literacy: A grades 1-5 Canada. supportive -"Interaction with the animal served as a conduit for playful environment for communication and fostered a sense of agency on the part constrained and R of the child" (104). unconstrained -"Animal-assisted learning sessions provided meaningful learning and novel opportunities for both constrained and unconstrained literacy skill developments" (105). Friesen, L 2012 The Gifted Child Single case -Illustrated how reading and writing with a dog helped As Cheetah: A study on gifted nurture the child's unique brilliance Unique Animal- 7 year old (2nd -In addition to giving five suggestions for working with Assisted Literacy grader) gifted young children, Friesen outlined five benefits animal - Program assisted literacy learning experiences for high -achieving Friesen, L 2013 R children: individualized learning, unconditional acceptance and companionship, relief from perfectionism, motivation for meaningful learning and advocacy, and increased communication and risk-taking. The role of therapy 14 children, -Study determined whether the presence of a therapy dog dogs in speed and ages 4-6 would affect the performance of a set of gross motor skills accuracy to tasks for preschoolers. Gee, N 2007 complete motor GM -Findings indicated that the "presence of a therapy dog skills tasks for served as an effective motivator for the children, who preschool children performed faster, but without compromising accuracy, in all tasks but one" (375). Child's Best Preschool -"Dogs can indirectly support children's cognitive learning" Friend -Is a Dog (12). Visitor a Good Fit SE/R - A dog provides authentic opportunities for children to Glenn- for our Preschool? develop empathy, caretaking skills, and respect for living Applegate, things. K 2017 Therapy dogs 1 st grade -Anecdotal evidence regarding a pilot program in a primary making move from students school. Graf, T 2012 hospital to SE/R -Therapy dogs are successful because "they can't talk back" classroom (2). Children Reading Children under -Examined 48 studies and aimed to "determine the to Dogs: A 16 years scientific evidence base for the pedagogic effects of reading Systematic Review to dog's programmes" (3). of the Literature -"The papers evidenced improvements to the children's R behavioral processes... However, the quality of the evidence on which these conclusions are drawn is low" (13). -Recognizes the need for more "rigorous investigation," including longitudinal studies, increased sample sizes, and the use of standardized measures (17). Hall, S 2016 Canine Visitors: Ages 5-8 -Examines common objections that are raised to therapy The Influence of dogs in schools and hospitals: sanitation concerns, safety Therapy Dogs on considerations, allergies, cultural differences, fear of dogs. Jalongo, M 2004 Young Children's R -Includes recommendations for those who work with canine Learning and Well- visitor programs. Being in Classrooms and Hospitals "What are all these -This article gives guidelines and suggestions on dogs doing in implementing a reading education assistance dog program. school?" Using -AAT does not replace effective instruction on reading, it therapy dogs to provides a more structured and appealing alternative to Jalongo, M 2005 promote children's R "read by yourself' (155). reading practice -Referenced a 2002 study that showed AAT decreased absenteeism, increased the use of the library, and resulted in better grades. Reading to therapy 2nd grade -Recognized the need to assess impacts of AAI in schools, dogs improves students students experience greater stress, challenging social literacy attitudes in situations, and fear of negative feedback in the school second-grade R setting. students -Scores assessing academic reading attitudes increased significantly among the children who read aloud to dogs. Ko, M 2017 Behavioral effects -24 students -"The group became socially more homogenous due to of the presence of a (mean age: 6.7 decreased behavioral extremes, such as aggressiveness and dog in a classroom years) in hyperactivity. Also, formerly withdrawn individuals Austria became socially more interested" (147). -Effects were more pronounced in the boys than the girls. -Children paid more attention to the teacher. Kotrschal, K 2003 SE -Concluded that the presence of a dog in a classroom could positively stimulate social cohesion in children while improving teaching conditions. -Children seemed to assume responsibility for the dog by acting considerate and observing its needs. When Reading Ages varied -Goals of canine -assisted reading programs include Gets Ruff: Canine- increasing reading fluency, increasing motivation to read, Assisted Reading providing encouragement for reluctant readers, and making Lane, H 2013 Programs R reading fun. -3 case examples: primary classroom in Florida, public library in Colorado, dog scout in Maine. The Effect of an 3rd grade -Reading comprehension scores with dog group scored Animal -Assisted students (Avg. higher than other groups Reading Program age- 8 years), -3 groups- dog group, adult group, teddy bear group on the Reading identified as -Looked at reading rate, accuracy, and comprehension Rate, Accuracy and R poor readers Comprehension of Grade 3 Students: A Randomized Le Roux, M 2014 Control Study Effects of Reading 45 children, -Reading aloud to an adult/therapy dog team tended to with Adult grades 2-5 increase children's scores on a test of oral reading fluency Tutor/Therapy Dog much more than reading aloud to peers. Teams on -"Given these early and high expectations for literacy, the Elementary pressure is on for larger numbers of young children to reach Students' Reading R unprecedented level of proficiency in reading" (4). Achievement and -The dog effect seemed to be more prominent and Attitudes consistent at grade 2 than at other grades, suggesting that such programs may be more effective in the early Levinson, E 2017 elementary grades (k-2), rather than later grades (3-6). What If Schools O'Farrell -"Researchers over the last decade have amassed a sobering Hired Dogs as Charter School, body of evidence showing the inability of stressed students Therapists? grades K-12 to learn" (2). -"The research supporting its effectiveness is sparse and largely anecdotal" (7). Malchik, A 2015 SE -Sejera is a facility dog that works in the charter school. -The therapy dog gives traumatized children an initial point of contact for comfort and safety. -Found that Sejera acts as a stress -reducer and a catalyst for helping students deal with stressful situations. Paws for Reading: 15 students in - Discussed the Paws for Reading Program located in An innovative second grade Wilmington, North Carolina. program using who tested -"Most participants improve their reading skills by at least dogs to help kids R below grade two grade levels of the course of an entire schools year" read better level in fluency (43). and reading -Several participants became mentors and introduced others tests to the program. Newlin, R 2003 Sit, Stay, Read: Preschool -Recommendations on how to implements a SitStayRead Improving Literacy children program Pillow- Skills Using Dogs! R -The averages of the students who participates scored Price, K 2014 significantly higher than both the district and state averages. Therapy Dogs' Ages 3-10 -Focused on the "Read to a Dog" program at Oshkosh Presence Steadily Public Library in Wisconsin Grows in Libraries R -"'Five to six consecutive visits (with therapy dogs) will raise them [children] two reading levels" (1). Schwartz, M 2012 Man's Best Friend -Complete overview of R.E.A.D. program, including as a Reading varying perspectives (teachers, parents, students, and Shaw, D 2013 Facilitator R handlers) and implementation techniques. -Referenced study where all ten students in the R.E.A.D. program significantly improved their reading scores. Why every school Primary to -Referenced University of California study that found a should bring dogs college 12% boost in reading proficiency when kids read aloud to into the classroom R dogs for 10-15 minutes per week. -Recognized that 21 % of American adults read at or below a 5th grade level. Weller, C 2015 Summary of animal -assisted literacy programs: Literacy is defined as the ability to identify, understand, interpret, create, compute, and communicate using visual, audible, and digital materials across disciplines and in any context (International Literacy Association n.d.). There is a mismatch between the literacy demands of society and the literacy standards of education. "The fact that millions of children in North America struggle with learning to read is well documented" (Friesen 2012, 103) Literacy is a necessary foundational skill in life, yet 21% of American adults read at or below a fifth -grade level (Weller 2015). To help remedy this widespread issue, literacy standards in primary classrooms have increased. "Given these early and high expectations for literacy, the pressure is on for larger numbers of young children to reach unprecedented level of proficiency" (Levinson et al. 2017, 4). Educators are using alternative teaching methods to tackle new expectations, one method being the use of animal -assisted literacy programs. Intermountain Therapy Animals launched the R.E.A.D. program as the first comprehensive literacy program whose mission is to improve the literacy skills of children through the assistance of registered therapy teams as literacy mentors. Today, thousands of registered R.E.A.D. teams work throughout the US, Canada, United Kingdom, Italy, Finland, France, Sweden, South Africa, Spain, and beyond. The organization has over 3,000 volunteer teams registered, each passing a test regarding R.E.A.D's procedures and values in addition to passing the therapy dog certification exam (Shaw 2013). The implementation of each satellite program is varied, but most R.E.A.D. sessions span approximately 20-30 minutes while the students sit and read to a therapy dog with the handler present. A case study set in a Florida primary classroom recorded that participating students experienced tremendous gains in reading ability due to the inclusion of a therapy dog. The success of the program led to neighboring schools adopting similar practices. (Lane and Zavada 2013). In an effort to aid others in implementing animal -assisted literacy programs, Jalongo (2005) lists twelve best practices for those wanting to begin a R.E.A.D. program. Among the suggestions, Jalongo discusses the importance of gaining administrative support and creating an operating budget. In addition, Jalongo reiterates the significance of using a certified therapy dog along with combining the training of handlers with the expertise of teachers in order to maximize effectiveness. Therapy Dogs International launched a similar program named Tail Waggin' Tutors. The main objective of this program is to provide a relaxed and dog -friendly atmosphere, which allows students to practice the skill of reading (Therapy Dogs International 2017). Tail Waggin' Tutors is hosted in a multitude of schools and libraries around the United States. Comparably, Robin Newlin created the Paws for Reading program in Wilmington, North Carolina. Fifteen second grade students who tested below grade level in fluency and reading tests participated in the program. The results indicated that most participants improved their reading skills by at least two grade levels (Newlin 2003). Child reading to therapy dog at local Reading to Rover Program. (Photo taken by first author) Throughout the past three decades, multiple variations of animal -assisted literacy programs described above have formed across the world. A comprehensive list of these types of programs can be found in Friesen's (20 10) article entitled "Potential for the Role of School -Based Animal -Assisted Literacy Mentoring Programs " along with the corresponding location and contact information. Summary of findings of increased reading and language skills: Hall, Gee, and Mills (2016) completed a systematic review of literature regarding the pedagogic effects of reading to dogs. While the review of 48 studies recognized the need for more rigorous investigation regarding the practice, the authors found that the "papers evidenced improvements to the children's behavioural processes, which may improve the environment in which reading is practiced, and therefore lead to better performance" (Hall, Gee, and Mills 2016, 13). The authors created the illustration below to demonstrate how reading to a dog may influence reading performance. Figure 1: An Illustration of how Reading to a Dog may Influence Reading Performance Mood Elevation association with reading increase III confidence .path reading'. attitude to readuig'. tnoti%ation to';- and engagement Willi lmproved Rcading Skills ('hied reads to do€ Likes, connects, feels supported Impact on Aroaf-A Increases' cases i = lncmase in Increase in Decrea_ce in confidence %%ith Reading stress and reading', &txitude to reading;, motivation Anxiety reading', enotivation assocated to`, and engagement nzih reacting with reading° Dislikes, fears. is distracted by dog Reading to dogs is unlikely to be effective in improNing read skills Imprv��ccl Reading Skills Source: Hall, Sophie Susannah, Nancy R. Gee, and Daniel Simon Mills. "Children reading to dogs: A systematic review of the literature." PloS one 11, no. 2 (2016): e0149759. Increase in Improved confidence with Reading reading', attitude to Skills reading;, motivation tot, and engagement With reading6 Imprv��ccl Reading Skills Source: Hall, Sophie Susannah, Nancy R. Gee, and Daniel Simon Mills. "Children reading to dogs: A systematic review of the literature." PloS one 11, no. 2 (2016): e0149759. Based on the chart above and the review of research performed for this article, three categories of benefits that stem from reading to dogs will be discussed: reduction of stress/anxiety, improved attitudes/increased motivation, and improved reading rate, accuracy, and comprehension. Reduction of stress/anxiety when reading: Ko (2017) recognized the lack of research regarding reading programs in schools, a setting where children may experience greater stress, challenging social situations, and fear of negative feedback. In 2012, Beetz measured the cortisol levels of children before, during, and after stressful tasks; stress levels were lower when the children interacted with the dog, suggesting the presence of a dog in an educational setting would help reduce anxiety levels caused by social pressures that exist within a classroom. Lane and Zavada (2013) wrote that many of her students in the aforementioned Florida case study were reluctant readers. Fortunately, "dogs cannot talk back" (Graf 2012, 2), reducing the fear of judgement. The dog acts as a supportive companion as students stumble on new words while reading increasingly challenging books. Lane and Zavada (2013) noted that students participating in the animal -assisted literacy program demonstrated increased self-confidence, oral fluency, and overall motivation to read. Friesen (2013) outlined five benefits of the animal -assisted literacy learning experience, including the benefit of unconditional acceptance and companionship. Similar to Ko's notation, Friesen discusses the social pressures students experience in school. These stresses disappear when reading to a dog since the dog automatically becomes a trusting friend who will listen to them. Improved attitudes/ increased motivation when reading: A second benefit of animal -assisted literacy programs (Friesen 2013) is the motivation for meaningful learning and advocacy that dogs provide. Friesen argues that students' interest in dogs can inspire long term intrinsic motivation. In the article entitled, "How a therapy dog may inspire student literacy engagement in elementary language arts classroom," Friesen (2009) described her classroom experiences with her therapy dog, Tango, who "served as the springboard for numerous other literary -based activities" (109). Students enjoyed reading to Tango so much that it led to the creation of other reading and writing projects that revolved around the topics of dogs. Therapy dogs can be used as a tool to spark the interest of students, especially those who may not enjoy school. Students are given a reason to be excited to read, try new words, and participate. Ko (2017) wrote about a pilot reading program in an afterschool program for second graders. Students read to a therapy dog for thirty minutes once a week. Authors used the Elementary Reading Attitude Survey (ERAS) to assess students' attitudes toward reading and found that the "scores assessing academic reading attitudes increased significantly among the children who read aloud to dogs" (2). The results suggested that animal -assisted literacy programs in an academic setting has the potential to provide motivation. Improved reading rate, accuracy, and comprehension: After completing the review of research, it is evident that the majority of the most recent studies have focused on the impact of animal -assisted literacy programs on reading rates, accuracy, and comprehension. We suggest that this shift of focus is attributed to the pressure to produce quantitative evidence proving the positive effects of therapy dogs in classrooms that have been discussed. This field of research has been scrutinized due to the reliance on anecdotal evidence in earlier studies. Demonstrating an impact on reading rates and levels of comprehension is possible with accelerated reading tests and learning inventories. Four studies are used to examine the effects of using therapy dogs to help children read. Pillow -Price, Yonts, and Stinson (2014) analyzed how the SitStayRead program in a preschool classroom helped students gain literacy skills. After being in the classroom for a year with a therapy dog named D.D., students took the Qualls Early Learning Inventory (QELI), a measure to gauge developmental progress of students. The averages of students coming out of the preschool classroom with D.D. that scored "developed" or "proficient" were significantly higher than both the district and state averages (Pillow -Price, Yonts, and Stinson 2014). The two charts below show the differences in scores. Figure 2: QELI Average Scores in Preschool Classrooms Chart A — 2011 QELI Average Scores (Percent that scored developed or proficient) September 2011 General Written Oral QELI Kindergarten General Written Oral Test Score Averages knowledge Language Communication District average 35% 360i6 37% State average 34% 23°/0 33% Laura's 1 77% 1 66% 66% Chart B — 2010 QELI Average Scores (Percent that scored developed or proficient) September 2010 General Written Oral QELI Kindergarten Test Score Averages knowledge Language Communication District average 48% 46% 44% State average 34% 23% 33% Lauras 181% 81% 72% Source: Pillow -Price, Kathy, Nikki Yonts, and Laura Stinson. "Sit, stay, read: Improving literacy skills using dogs." Dimensions of Early Childhood 42, no. 1 (2014): 5-9. Levinson et al. (2017) also assessed the effect of reading aloud to therapy dogs on students' oral communication. Forty-five students in grades two through five read aloud to therapy dog/handler teams thirty minutes per week for five weeks. One group read to therapy dogs while the second group read to peers. Levinson et al. (2017) found that "reading aloud to an adult/therapy dog team tended to increase children's scores on a test of oral reading fluency much more than reading to peers" (38). A particularly interesting observation that resulted from the study was that the dog effect seemed to be more prominent and consistent at grade two than at other grades (Levinson et al. 2017). This suggests that animal -assisted literacy programs may be more effective in earlier grades, such as kindergarten, first, and second, since this is a heightened developmental stage for children. The authors state, "Problems with reading are serious and pervasive worldwide" (Le Roux, Swartz, and Swart 2014, p.656). In an effort to find a solution, they designed a unique study to evaluate the effects of an animal -assisted reading program on the reading rate accuracy, and comprehension of 102 third grade students in South Africa. Students were identified as poor readers and were randomly assigned to one of the four following groups: control group, students who read to therapy dogs, students who read to an adult, and students who read to a teddy bear in the presence of an adult. The sessions lasted twenty minutes for ten weeks. "Students from the dog group read at a significantly higher reading comprehension age than the students in all three other groups" (667). The authors suggested that perhaps the calming effects of the therapy dogs allowed the students to relax and enjoy the reading sessions. The lack of judgement and criticism from the dogs may also explain the higher scores of the dog group. Friesen (2012) posited that animal -assisted literacy programs provide students opportunities to develop both constrained and unconstrained literacy skills. Constrained skills include letter knowledge, phonics, and concept of prints; these skills are less complex, more concrete, and are easier to teach. In contrast, unconstrained skills are more abstract and complex. Examples of unconstrained skills include vocabulary, written composition, comprehension, critical thinking, and problem solving. Friesen (2012) observed forty-five elementary students across five animal -assisted literacy programs in Canada. During sessions, the handler would use the dog as a tool to teach the student unconstrained and constrained literacy skills. For example, the handler would ask the student to pause and pet the dog after reaching a comma in order to practice punctuation use. The children were also asked to translate the dog's actions into feelings, such as the meaning behind a dog wagging its tail. Friesen (2012) concluded that the animal -assisted literacy program "can contribute to a safe, playful, and caring learning environment in which children are able to gain valuable practice in constrained and unconstrained literary skills, and can provide children with authentic, meaningful, and unique literary skills" (107). Social/emotional/humane findings: Several articles have noted a number of positive social and emotional skills and behaviors associated with having a dog in the classroom. For example, increased social interaction was seen; children formed into social groups more often in the presence of a dog. There also seems to be an increase in the control of emotions and behaviors. One article mentioned a boy who stated "when I'm about to have a bad day, I just pet and hold J.D. to calm down" (Anderson 2007, 6). In a qualitative analysis of a dog present in a self-contained classroom of children with emotional disorders, Anderson and Olson (2006) concluded that that the dog's placement in the classroom contributed to the students overall emotional stability, students' attitudes towards school were improved, and that the students learned lessons in responsibility, respect, and empathy. In another case study of three children with disabilities, the presence of a therapy dog resulted in positive interactions and increased communication between the teacher and the children (Esteves and Stokes, 2006). Beetz (2013) also reported that in contrast to the control class, the class that had a "schooldog" visit once a week had significant improvements in their positive attitude towards school as well as their emotions related to learning. Group photo with two therapy dogs visiting classroom. (Photo taken by first author) Cambria (2010) described a Head Start classroom with children ages three to five years who had a resident therapy dog, Waco. Waco had his own cubby, was trained to help with clean-up and to open the door for recess. This particular classroom had children enrolled who were from low-income homes, some had incarcerated parents or lived with domestic violence. Waco was credited with providing stability and comfort. The teacher stated that "the whole feeling of the room is calmer" (1). The use of a therapy dog in classrooms like this one seems particularly beneficial given research suggesting that most children living in poverty suffer from stress that can hinder their success in school. Malchik (2015) discussed the presence of a facility dog, Sejera, in a k-12 charter school. The author noted the inability of stressed students to learn, and that research on this topic is "sparse and mostly anecdotal" (7). She asked students to write letters to Sejera expressing their feelings. One student wrote "She helps in so many ways helping students calm down when they are having a bad day" (3). One important conclusion of this article is that dogs alone cannot fix trauma, but can ease anxiety and be an "initial point of contact for comfort and safety." Kotrschal & Ortbayer (2003) introduced dogs to an elementary school in Vienna. They concluded that "the group became socially more homogenous due to decreased behavioral extremes, such as aggressiveness and hyperactivity" (147). Also, more withdrawn students became more socially interested, children paid more attention to the teacher, and the children were considerate to the dog and observed its needs. Results were more pronounced in boys than girls. In one anecdotal report of a pilot program in a primary school, the teacher reported that some parents ask for their children to be placed in her classroom "because it's the one with the dogs (Graf 2012, 2). Another school uses three therapy dogs in the classroom to "calm fears, relieve anxiety, and teach" life skills (Education World, 2013, 1). There are "lessons" for grades k-2, 3-6, and these dogs are even part of a plan to help students meet high school graduation requirements. Some of the lessons are "complain less, be thankful more, judge less, accept more, and growl less, smile more" (2). Chandler (2001) and other studies mentioned the benefits of integrating a therapy dog or other animal in a classroom setting including helping children to develop humane skills by incorporating kindness and compassion, witnessing praising or disciplining the dog, practicing loyalty and responsibility, and an increased understanding of how to coexist with animals while gaining knowledge about animals and how to care for them (nurturance). Student providing water to therapy dog during visit to classroom. (Photo taken by first author) Gross motor skills: Gee, Harris & Johnson (2007) completed a case study which included 14 children, ages four to six years old, who were in a classroom with two miniature poodles. The children were able to complete ten tasks related to locomotion, stability, and manipulation faster when the dog was present. The dogs modeled the tasks, which included weaving around cones, walking on a balance beam, a high jump, rolling over and crawling, and an underhand toss to the dog. The authors concluded that the presence of a dog increased the children's motivation to complete motor skill tasks. Suggestions for implementing therapy dogs in classrooms: In order to maximize the effectiveness of animal -assisted literacy sessions, Friesen (2012) suggests that literacy mentors include activities outside of reading. For example, students can write a speech and deliver it to the therapy dog or students can place sticky notes on the dog in order to learn body parts. This is similar to students writing letters to a dog, as previously mentioned. Friesen (2013) lists five suggestions for working with young children in animal -assisted literacy programs; among the suggestions are understanding each child on an individual level and letting the child lead. Reading to a therapy dog allows students to have one on one time with a therapy dog and handler. The session can be tailored to the student's reading level and the student's interests. Allowing the student to lead the session and pick which book to read gives the child a sense of freedom and ownership; the flexibility also encourages them to express their creativity and intellect. Anderson (2007) suggested that incorporating a dog into the classroom takes thorough planning. Steps suggested include: a) conduct preliminary meetings, b) select the appropriate dog (preferably a certified therapy dog who is owned by the teacher or another individual who will be present who understands the dog's behavioral patterns), c) establish classroom policies and procedures, d) obtain written consent, e) provide information to school staff members. Addressing concerns: As stated by Glenn -Applegate and Hall (2017), bringing a dog into a classroom requires careful consideration. They asked families, school staff, and a veterinarian four questions: a) would a dog benefit the (preschool) program? b) who would be responsible for the dog? c) do any children have allergies or a fear of dogs? d) are all staff in favor of having a dog? They also consulted with the program's insurance agent, the lawyer at the university, and the national accrediting body, the National Association for the Education of Young Children (NAEYC), who replied that they would need to keep the dog's immunization records on file and that children and staff would need to follow handwashing procedures after interacting with the dog. Bacon refers to the 2002 California school survey which showed that only 20% of those surveyed used dogs in their school. However, 93% of the respondents stated that they would be interested in dog programs if their concerns were addressed. The top three concerns identified were legal implications and liability (50.5%), supervision (43.3%), and allergic reactions (40.2%). Jalongo (2005) also addresses concerns in the list of twelve steps to implement a reading education assistance program. In order to prevent sanitation objections, the author notes that registered therapy dogs have regular check-ups and handlers are required to provide proof of vaccination. Jalongo emphasizes the need to train handlers, educators, and students in protecting the therapy dogs' safety and well-being. Finally, the majority of the articles highlighted the importance of using a certified therapy dog when implementing programs. Limitations and future research: Several limitations were noted by the authors of the reviewed articles. Beetz (2013) points out that "different dogs may have different effects" (6). The author also implicates that a higher frequency and longer duration will yield stronger results. Brelsford et al. (2017) conducted a systematic review of literature relating to animal -assisted interventions conducted in educational settings. After reviewing twenty-five papers, the authors recognized the need for further research in order to quantify the factors regarding findings, a common critique to research in this field. The review of literature expressed that future studies need to incorporate a higher quantity of randomized controlled trials with appropriate control groups (Brelsford et al. 2017). This recommendation was also found in Hall, Gee, and Mills' 2016 systematic review of literature regarding children reading to dogs and they identified the need for researchers to perform longitudinal studies that consist of increased sample sizes and the use of standardized measures. Finally, Bassette and Taber -Doughty (2013) expressed the need to expand beyond studying behavioral measures and also focus on researching academic effects of long-term dog reading programs. Conclusion Based on the review of thirty articles on the benefits of therapy dogs in classrooms, there appears to be many benefits, both anecdotal and empirical. More empirical research studies have been published in the last ten years. There is strong support for increased confidence, literacy skills and actual reading scores when children read to dogs. Additionally, much evidence supports the emotional and social benefits of children interacting with a dog in the classroom. One study was found that showed improved motivation and gross motor skills when a dog modeled these skills. Several authors gave helpful suggestions for starting a therapy dog program in a school setting. Although initial concerns were noted, with careful consideration and communication with all involved, these concerns can be addressed. Limitations of current research have been identified, and more empirical studies with larger sample sizes, control versus experimental groups, and more long term studies will strengthen this body of work. After completing the review, it is evident that the benefits of utilizing a therapy dog within a classroom outweigh the reservations. References Anderson, Katherine L., and Myrna R. Olson. "The value of a dog in a classroom of children with severe emotional disorders." Anthrozoos 19, no. 1 (2006): 35-49. Anderson, Katherine L. "Who Let the Dog in? How to Incorporate a Dog into a Self -Contained Classroom." Teaching Exceptional Children Plus 4, no. 1 (2007): nl . Bacon, Charlotte. "Bringing Therapy Dogs to Your School." Charlotte's Litter. 2014. http://charlotteslitter.org/wp-content/uploads/2014/09/Educator Resource.pdf. Bassette, Laura A., and Teresa Taber -Doughty. "The effects of a dog reading visitation program on academic engagement behavior in three elementary students with emotional and behavioral disabilities: A single case design." In Child & Youth Care Forum, vol. 42, no. 3, pp. 239-256. Springer US, 2013. Beetz, Andrea, Henri Julius, Dennis Turner, and Kurt Kotrschal. "Effects of social support by a dog on stress modulation in male children with insecure attachment." Frontiers in psychology 3 (2012). Beetz, Andrea. "Socio -emotional correlates of a schooldog-teacher-team in the classroom." Frontiers in psychology 4 (2013). Brelsford, Victoria L., Kerstin Meints, Nancy R. Gee, and Karen Pfeffer. "Animal -Assisted Interventions in the Classroom A Systematic Review." International Journal of Environmental Research and Public Health 14, no. 7 (2017): 669. Cambria, Nancy. "Therapeutic dog gets high praise for his role in preschool classroom." Stltoday.com. June 27, 2010. http://www.stltoday.com/news/local/education/therapeutic-dog-gets-high-praise- for-his-role-in-preschool/article_09fa1564-efb7-5e70-bba3-131 a76da4bOc.html. Chandler, Cynthia. "Animal -Assisted Therapy in Counseling and School Settings. ERIC/CASS Digest." (2001). Esteves, Stephanie Walters, and Trevor Stokes. "Social effects of a dog's presence on children with disabilities." Anthrozoos 21, no. 1 (2008): 5-15. Fine, Aubrey H., ed. Handbook on animal -assisted therapy: Foundations and guidelines for animal - assisted interventions. Academic Press, 2015. Friesen, Lori. "How a therapy dog may inspire student literacy engagement in the elementary language arts classroom." LEARNing Landscapes 3, no. 1 (2009): 105-122. Friesen, Lori. "Exploring animal -assisted programs with children in school and therapeutic contexts." Early Childhood Education Journal 37, no. 4 (2010): 261-267. Friesen, Lori. "Potential for the role of school-based animal -assisted literacy mentoring programs." Language and Literacy 12, no. 1 (2010): 21. Friesen, Lori, and Esther Delisle. "Animal -assisted literacy: A supportive environment for constrained and unconstrained learning." Childhood Education 88, no. 2 (2012): 102-107. Friesen, Lori. "The gifted child as cheetah: A unique animal -assisted literacy program." The Latham Letter 34, no. 1 (2013): 6-10. Gee, Nancy R., Shelly L. Harris, and Kristina L. Johnson. "The role of therapy dogs in speed and accuracy to complete motor skills tasks for preschool children." Anthrozoos 20, no. 4 (2007): 375-386. Glenn -Applegate, Katherine, and Kellie Hall. "Child's Best Friend -Is a Dog Visitor a Good Fit for our Preschool?" Teaching Young Children 10, no. 2 (January 2017): 11-13. Graf, Tyler. "Therapy dogs making move from hospital to classroom." The Columbian. December 09, 2012. http://www.columbian.com/news/2012/dec/09/therapy-dogs-go-from-hospital-to- classroom/. Hall, Sophie Susannah, Nancy R. Gee, and Daniel Simon Mills. "Children reading to dogs: A systematic review of the literature." PloS one 11, no. 2 (2016): e0149759. Jalongo, Mary Renck, Terri Astorino, and Nancy Bomboy. "Canine visitors: The influence of therapy dogs on young children's learning and well-being in classrooms and hospitals." Early Childhood Education Journal 32, no. 1 (2004): 9-16. Jalongo, Mary Renck. ""What are all these Dogs Doing at School?": Using Therapy Dogs to Promote Children's Reading Practice." Childhood Education81, no. 3 (2005): 152-158. Ko, Melody. "Reading to Therapy Dogs Improves Literacy Attitudes in Second -Grade Students." Tufts Now. May 31, 2017. http://now.tufts.edu/news-releases/reading-therapy-dogs-improves-literacy- attitudes-second-grade-students-0. Kotrschal, Kurt, and Brita Ortbauer. "Behavioral effects of the presence of a dog in a classroom." Anthrozoos 16, no. 2 (2003): 147-159. Lane, Holly B., and Shannon DW Zavada. "When Reading Gets Ruff: Canine -Assisted Reading Programs." The Reading Teacher 67, no. 2 (2013): 87-95. Le Roux, Marieanna C., Leslie Swartz, and Estelle Swart. "The effect of an animal -assisted reading program on the reading rate, accuracy and comprehension of grade 3 students: A randomized control study." In Child & Youth Care Forum, vol. 43, no. 6, pp. 655-673. Springer US, 2014. "Lessons Learned from Dogs in the Classroom." Education World: Teachers Lead Improvement at State Street School. http://www.educationworld.com/a—admin/admin/admin559.shtml. Levinson, Edward M., Melanee Vogt, William F. Barker, Mary Renck Jalongo, and Pat Van Zandt. "Effects of reading with adult tutor/therapy dog teams on elementary students' reading achievement and attitudes." Society & Animals 25, no. 1 (2017): 38-56. Malchik, Antonia. "What If Schools Hired Dogs As Therapists? — Bright." Bright. July 09, 2015. https://brightreads.com/can-a-dog-at-school-help-struggling-kids-7317a8eff20d. Newlin, Robin. "Paws for Reading: An innovative program uses dogs to help kids read better." School Library Journal. June 1, 2003. http://www.slj.com/2003/06/literacy/paws-for-reading-an- innovative-program-uses-dogs-to-help-kids-read-better/. Pet Partners. 2017. https://petpartners.org/about-us/petpartners-story Pillow -Price, Kathy, Nikki Yonts, and Laura Stinson. "Sit, stay, read: Improving literacy skills using dogs." Dimensions of Early Childhood 42, no. 1 (2014): 5-9. Ryan, Holly McLean. "The Use of Dogs in California Public Schools: Current Use, Support for, Potential Concerns, and Educator Familiarity with Potential Benefits". The Graduate College University of Wisconsin -Stout, Wisconsin (2002). Schwartz, M. "Therapy dogs' presence steadily grows in libraries." Library Journal (2012). Shaw, Donita Massengill. "Man's best friend as a reading facilitator." The Reading Teacher 66, no. 5 (2013): 365-371. Therapy Dogs International. 2017. http://tdi-dog.org/About.aspx?Page=Mission+Statement+and+History Weller, Chris. "Why every school should bring dogs into the classroom." Business Insider. August 21, 2015. http://www.businessinsider.com/why-eveiy-school-should-bring-dogs-into-the-classroom- 2015-8. "Why Literacy?" International Literacy Association. 2017. https://www.literacyworldwide.org/why- literacy NYTimes.com: Why Dogs Can Be So Healing for Kids From The New York Times: Why Dogs Can Be So Healing for Kids A new study suggests that spending time with therapy dogs may help lower children’s stress levels even more than relaxation exercises. https://www.nytimes.com/2022/06/15/well/family/therapy-dogs-kids- stress.html?smid=em-share Seal Beach Police Department Seal Beach PD Policy Manual Facility Dog Program 351.1 PURPOSE AND SCOPE The purpose of the Facility Dog Program is to further promote the Mission, Vision, and Values of the Seal Beach Police Department. Dogs have been used extensively to support and improve mental health. They provide emotional and sensory support to adults and children and help people feel comfortable and decrease symptoms of anxiety. Facility dogs have been used at various schools, courts, and public safety agencies. Past and present Facility Dog programs have improved overall climate and well-being of citizens and staff alike. The Facility Dog will be utilized to: • Lower tension and stress of city employees, • Lessen trauma of critical incidents for employees and civilians • Improve overall work climate • Aid in investigations of crimes or other traumatic events such as interviews and court proceedings. • Help process grief and loss • Conduct presentations for public relations and educational purposes • Other official duties as directed. 351.2 POLICY This policy establishes guidelines for the management and use of the facility dogs, handlers, and support personnel assigned to the unit. If, at any time, the Facility Dog exhibits behavior that alerts the trained handler that the dog or person(s) interacting with the dog are uncomfortable, the dog will be removed from the area immediately. 351.3 FACILITY DOG COORDINATOR / HANDLER The Facility Dog handler shall be appointed by and directly responsible to the Operations Bureau or the authorized designee. A Facility Dog will be assigned to an employee within our agency and will be property of the employee selected. The handler shall successfully graduate a two-week Team Training course at an authorized Canine Companions for Independence training center. The responsibilities of the handler include, but are not limited to: (a) The Facility Dog handler will be responsible for maintaining their assigned workload while handling the dog (b) Maintaining liaison with Canine Companions for Independence (CCI) (c) Maintaining liaison with Command Staff and functional supervisors (d) Scheduling all Facility Dog related activities (e) Maintaining accurate records to document Facility Dog activities Copyright Lexipol, LLC 2021/02/17, All Rights Reserved. Facility Dog Program - 303 Published with permission by Seal Beach Police Department Seal Beach Police Department Seal Beach PD Policy Manual Facility Dog Program (f) Maintaining records of medical treatment (g) Recommending and overseeing the procurement of equipment and services for the team (h) Scheduling and documenting training to maximize their capabilities 351.4 HANDLER COMPENSATION The Facility Dog handler shall be compensated for time spent in the care, feeding, grooming, and other needs of the Facility Dog in accordance with the Fair Labor Standards Act (FLSA) and according to the terms of the collective bargaining agreement (29 USC § 207). 351.5 HANDLER SUPPORT PERSONNEL The Facility Dog handler may appoint support personnel to assist with deployments, transportation, monitoring, and general care of the Facility Dog. Support personnel must be certified through CCI and shall adhere to handler policies when in direct care of the Facility Dog. Support personnel do not qualify for any incentive, special assignment pay, or stipends provided to the primary handler. 351.6 FACILITY DOG Facility Dogs will be certified and provided by Canine Companions for Independence (CCI). The dog will be the property of the handler who will be responsible for the health and welfare of the dog and shall ensure that the dog receives proper licensing, training, nutrition, grooming, medical care, affection, and living conditions. Requirements and Responsibilities: (a) The Facility Dog will not be trained or utilized in any other K9 related duties such as; apprehension, detection, agility, etc. (b) The Facility Dog will not be exposed to any foreseeable and unreasonable risk of harm (c) The Facility Dog will be provided proper lodging, including arrangements for the dog during handler leave or unavailability (d) The dog will not be left unattended in any area where the public may have access (e) When the dog is left alone, it will be secured it in such a manner as to prevent unauthorized access to the dog (f) The Facility Dog will be equipped with a vest for official duties. The dog should not be distracted when working. The handler will educate employees and members of the public when they can or cannot interact with the dog (g) The dog will not be fed any food or treats without the direct approval of the handler (h) The Facility Dog can be transported in any City of Seal Beach vehicle or personal vehicles of the handler or support personnel Copyright Lexipol, LLC 2021/02/17, All Rights Reserved. Facility Dog Program - 304 Published with permission by Seal Beach Police Department Seal Beach Police Department Seal Beach PD Policy Manual Facility Dog Program 351.7 TRAINING Facility Dog teams will be certified by CCI prior to any deployments. The handler will be responsible for scheduling and conducting periodic training to familiarize them how to conduct themselves in deployments. 351.8 FACILITY DOG TEAM REQUESTS City employees are encouraged to request the use of the Facility Dog. All requests for the team will be directed to the handler or designee. All requests will be reviewed and if appropriate, will be approved by the handler prior to making any resource commitment. The handler shall have the authority to decline a request for any specific assignment that he/she deems unsuitable Any outside agency requests will generally be governed under mutual aid. The Facility Dog handler will be contacted to assure the request is within the scope and abilities of the Facility Dog. The final determination of the use of the team will be at the discretion of the handler with the approval of their supervisor. The handler is responsible for obtaining resources and coordinating involvement in the demonstration to include proper safety protocols. The Facility Dog team may be requested for call - outs under special conditions. The handler will be compensated for deployments in accordance with the Fair Labor Standards Act (FLSA), and according to the terms of the collective bargaining agreement (29 USC 207) 351.9 INVESTIGATION ASSISTANCE PROTOCOLS The Facility Dog will promote the mission of the Seal Beach Police Department by providing companionship to citizens, employees, witnesses, and victims on a case by case basis. (a) Do not promise that the Facility Dog will be present during interviews (b) Assess the victim's needs to have the Facility Dog in the interview process prior to requesting the team. This must be done in the initial interview with the victim and approved by the Facility Dog supervisor and handler (c) If approved and available, the Facility Dog and the handler will be present and assist in the investigating officer for the interview 351.10 COURT ASSISTANCE PROTOCOLS The Facility Dog may be used to provide further support to employees and/or victims during criminal case proceedings submitted or supported by the Seal Beach Police Department. (a) All court personnel will be informed of the use and purpose of the team and the potential for encountering the Facility Dog throughout their work day (b) Court personnel will receive the same instructions as the Seal Beach Police Department staff regarding "Work Mode" and "Social Mode." The handler will take time to allow the dog to socialize with anyone it encounters during "Social Mode" but will also limit free time as not to interfere with the handler's work duties Copyright Lexipol, LLC 2021/02/17, All Rights Reserved. Facility Dog Program - 305 Published with permission by Seal Beach Police Department Seal Beach Police Department Seal Beach PD Policy Manual Facility Dog Program (c) Court personnel, including the attorney, Presiding Judge, and the handler will determine proper use of the dog within the court setting (d) The Facility Dog will only be allowed in a courtroom with explicit permission by the Presiding Judge in that courtroom. The handler will adhere to all rules and procedures set forth by the District Attorney and the Presiding Judge 351.11 ALLERGENS Potential allergic reactions to dogs may be a concern for some. The allergen is not the pet hair itself but the dander dust and pollen that is carried on the pet hair. Facility Dog teams will always ask permission to enter newly visited buildings and areas. People with allergies can reasonably avoid direct contact with the Facility Dog team to avoid any potential pet dander. 351.12 REPORTING INJURIES Any injuries caused or alleged by the Facility Dog will be immediately reported to the handler's supervisor. The injured person shall be promptly treated by emergency medical services personnel and, if appropriate, transported to a medical facility for treatment. Injuries will be documented in an employee's report. Copyright Lexipol, LLC 2021/02/17, All Rights Reserved. Facility Dog Program - 306 Published with permission by Seal Beach Police Department 3F SEAL & 9 v `s CgQF0 Vk ice Facility Dog Yosa ation and support comes in many forms, including a cold nose and a warm heart. The Seal Beach Police Department welcomed its newest ber, Canine Companions for Independence Facility Dog Yosa. Police Facility Dog Yosa will assist her handler, Lieutenant Nick Nicholas, during with victims, witnesses, and community members exposed to traumatic events. Yosa on Instagram (@k9yosa) Fr POLICE APARTMENT f AWL— ce 1975, Canine Companions@ has bred, raised, and expertly trained service dogs in over 40 commands designed to assist and motivate clients with �cial needs. Yosa, a two-year-old Labrador / Golden Retriever mix, has been selected to work for the Seal Beach Police Department because of her >btrusive and calm demeanor necessary in a criminal justice setting. • aid in the investigation of crimes, • provide comfort to victims and witnesses during interviews and court proceedings, • help victims process grief and loss, • lower tension and stress of community members and staff after traumatic events, • work with children to build relationships, • conduct senior citizen visits and welfare checks • engage with the public during community events, • and so much more! For nearly 46 years, Canine Companions has been enhancing the lives of people with disabilities by training and placing more than 6,700 service dogs with program graduates, including more than 230 dogs with military veterans and more than 2,000 dogs with children. The estimated cost of a highly trained Canine Companions facility dog like Yosa, and all follow up support, is $50,000, however each facility dog is provided at no cost. Canine Companions depends on the support of tens of thousands of donors and volunteers to match facilities and people in need with a service dog like Yosa entirely free of charge. "We are so grateful to Canine Companions for providing Yosa to the Seal Beach Police Department" said Chief of Police Philip L. Gonshak. "YC incredible addition to our Seal Beach family. Her training and personality are perfect for providing comfort to those exposed to trauma and helping the stress that victims and witnesses feel during criminal investigations." I Privacy -T— F. r erms ABOUT CANINE COMPANIONS FOR INDEPENDENCE Canine Companions for Independence provides highly trained service dogs to children . adults with disabilities. Established in 1975, Canine Companions has six regional training centers across the country. Canine Companions is recognized worldwide for the excellence of its dogs, and the quality and longevity of the matches it makes between dogs and people. For more information, visit www.cei.org or call 1 -800 -572 -BARK. CITY WEBSITES City of Seal Beach Fire Department Marine Safety Public Works f� O i✓� CONTACT US 911 Seal Beach Boulevard Seal Beach CA, 90740 Business Hours Monday - Friday 9:00 am - 5:30 pm. Phone: (562) 799-4100 Fax: (562) 493-0634 Non -Emergency Dispatch: (562) 594-7232 Emergency: 9-1-1 Copyright © 2022 Seal Beach Police Department LEAGUE OF CALIFORNIA CITIES New laws and grant programs expected to helpimprove mental health among first responders Oct 12, 2022 Cities can expect additional resources to help improve mental health among first responders over the next few years. The resources are the result of sustained advocacy from the League of California Cities and its partners, as well as an increased focus among lawmakers on improving behavioral health outcomes (https://www.calcities.org/news/post/2022/09/14/milestone-behavioral-health-care-bill- signed-into-law) . According to the Steinberg Institute, suicides have increased by 35% nationally over the last two decades. That rate is likely higher for first responders. A Centers for Disease Control and Prevention study found that first responders may be at an elevated risk for suicide because of their environments, work culture, and occupational stress. In fact, more personnel die by suicide than in the line of duty. AB 662 (Rodriguez) (https://ctweb.capitoltrack.com/public/search.aspx?id=ad485199- 37cd-42cd-8217-d19b4d257119&session=21&s=AB%20662&t=bill) I, signed into law at the end of session, marks an important step toward addressing the acute and chronic traumas of duty, as well as the stigmas surrounding mental health. The measure will create a peer-to-peer suicide prevention curriculum for firefighters and emergency medical services personnel. This is crucial, as general mental health practitioners often lack the background knowledge needed to provide first responders with culturally competent care. The bill was sponsored by Cal Cities, the California Fire Chiefs Association, and the Fire Districts Association of California. Cal Cities and its partners will continue to work with the Administration to secure the resources needed to facilitate this programming in next year's budget. Gov. Gavin Newsom and the Legislature also committed $50 million toward officer wellness grants in this year's budget (https://www.caIcities.org/news/post/2022/07/06/record-state-budget-agreement- includes-many-new-one-time-funding-opportunities-but-misses-the-chance-to-support- shared-city-state-priorities) , which will be distributed to local law enforcement agencies throughout the state. Much like firefighters, police officers are often exposed to a variety of incidents that lead to mental exhaustion, burnout, and overall poor mental health. Improving mental health for police officers from recruitment to retirement is imperative for both personnel and the communities they serve. Additional information — such as funding allocations, when funds will be released, and reporting requirements — will be posted on the California Board of State and Community Corrections' (https://www.bscc.ca.gov/officer-wellness- and-mental-health-grant-program/) website. Cal Cities will also release information as it becomes available. Both programs will be complemented by broader actions at the state and national levels. Congress worked to address the increase in suicides through the National Suicide Hotline Designation Act of 2020, which designated "988" as a three -digit number for the recently launched 988 Suicide & Crisis Lifeline. To comply with this change and to ensure the system's longevity, Cal Cities advocated for AB 988 (Bauer -Kahan) (https://ctweb.capitoltrack.com/public/search.aspx?id=ad485199-37cd-42cd-8217- d19b4d257119&session=21&s=AB%20988&t=bill) . Signed into law by the Governor, AB 988 directs a group of stakeholders — made up of county behavioral health, law enforcement, and other local agencies — to outline a five-year implementation plan. This includes the creation of a new surcharge for 988 to fund the services. The measure will ensure the state is prepared to answer the calls of all Californians in need by providing a seamless transition from the current suicide prevention system. The combination of these efforts illustrates an overt commitment to take care of all California residents. The return on investment will be invaluable as these programs and services will save lives and improve overall wellness. For more information, please contact Legislative Affairs Lobbyist Elisa Arcidiacono(maiIto: earcidiacono@calcities.org) . 1400 K Street, Suite 400 Sacramento, CA 95814 P: (916) 658-8200 F: (916) 658-8240 a j a MISLAiIVE 111f � k INFORMATION Home Bill Information California Law Publications Other Resources My Subscriptions My Favorites AB -638 Mental Health Services Act: early intervention and prevention programs. (2021-2022) SHARE THIS: In C Assembly Bill No. 638 CHAPTER 584 Date Published: 10/07/2021 02:00 PM An act to amend Section 5840 of the Welfare and Institutions Code, relating to mental health, and making an appropriation therefor. Approved by Governor October 06, 2021. Filed with Secretary of State October 06, 2021. LEGISLATIVE COUNSEL'S DIGEST AB 638, Quirk -Silva. Mental Health Services Act: early intervention and prevention programs. Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs and requires counties to spend those funds on mental health services, as specified. The MHSA requires counties to establish a program designed to prevent mental illnesses from becoming severe and disabling and authorizes counties to use funds designated for prevention and early intervention to broaden the provision of those community-based mental health services by adding prevention and early intervention services or activities. Existing law authorizes the MHSA to be amended by a 2/3 vote of the Legislature if the amendments are consistent with, and further the purposes of, the MHSA. This bill would amend the MHSA by including in the prevention and early intervention services authorized to be provided, prevention and early intervention strategies that address mental health needs, substance misuse or substance use disorders, or needs relating to cooccurring mental health and substance use services. By authorizing a new use for continuously appropriated funds, this bill would make an appropriation. The bill would state the finding and declaration of the Legislature that this change is consistent with, and furthers the intent of, the MHSA. Vote: 2/3 Appropriation: yes Fiscal Committee: yes Local Program: no THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 5840 of the Welfare and Institutions Code is amended to read: 5840. (a) The State Department of Health Care Services, in coordination with counties, shall establish a program designed to prevent mental illnesses from becoming severe and disabling. The program shall emphasize improving timely access to services for underserved populations. (b) The program shall include the following components: (1) Outreach to families, employers, primary care health care providers, and others to recognize the early signs of potentially severe and disabling mental illnesses. (2) Access and linkage to medically necessary care provided by county mental health programs for children with severe mental illness, as defined in Section 5600.3, and for adults and seniors with severe mental illness, as defined in Section 5600.3, as early in the onset of these conditions as practicable. (3) Reduction in stigma associated with either being diagnosed with a mental illness or seeking mental health services. (4) Reduction in discrimination against people with mental illness. (c) The program shall include mental health services similar to those provided under other programs that are effective in preventing mental illnesses from becoming severe, and shall also include components similar to programs that have been successful in reducing the duration of untreated severe mental illnesses and assisting people in quickly regaining productive lives. (d) The program shall emphasize strategies to reduce the following negative outcomes that may result from untreated mental illness: (1) Suicide. (2) Incarcerations. (3) School failure or dropout. (4) Unemployment. (5) Prolonged suffering. (6) Homelessness. (7) Removal of children from their homes. (e) Prevention and early intervention funds may be used to broaden the provision of community-based mental health services by adding prevention and early intervention services or activities to these services, including prevention and early intervention strategies that address mental health needs, substance misuse or substance use disorders, or needs relating to cooccurring mental health and substance use services. (f) In consultation with mental health stakeholders, and consistent with regulations from the Mental Health Services Oversight and Accountability Commission, pursuant to Section 5846, the department shall revise the program elements in Section 5840 applicable to all county mental health programs in future years to reflect what is learned about the most effective prevention and intervention programs for children, adults, and seniors. SEC. 2. The Legislature finds and declares that this act is consistent with, and furthers the intent of, the Mental Health Services Act within the meaning of Section 18 of that act. AB 638 Page 1 Date of Hearing: April 6, 2021 ASSEMBLY COMMITTEE ON HEALTH Jim Wood, Chair AB 638 (Quirk-Silva) – As Amended March 26, 2021 SUBJECT: Mental Health Services Act: early intervention and prevention programs. SUMMARY: Revises the Mental Health Services Act (MHSA) by authorizing the use of Prevention and Early Intervention (PEI) funds for prevention and early intervention strategies that address mental health needs, substance misuse or substance use disorders, or needs relating to co-occurring mental health substance use. Specifically, this bill: 1) Revises MHSA by authorizing the use of PEI funds for prevention and early intervention strategies that address mental health needs, substance misuse or substance use disorders, or needs relating to co-occurring mental health substance use. 2) Finds and declares that this bill is consistent with and furthers the intent of the MHSA. EXISTING LAW: 1) Establishes the MHSA, enacted by voters in 2004 as Proposition 63, to provide funds to counties to expand services, develop innovative programs, and integrated service plans for mentally ill children, adults, and seniors through a 1% income tax on personal income above $1 million. 2) Establishes the Mental Health Services Oversight and Accountability Commission (MHSOAC) to oversee the implementation of MHSA, made up of 16 members appointed by the Governor, and the Legislature, as specified. 3) Specifies that the MHSA can only be amended by a two -thirds vote of both houses of the Legislature and only as long as the amendment is consistent with and furthers the intent of the MHSA. Permits provisions clarifying the procedures and terms of the MHSA to be amended by majority vote. 4) Authorizes the provision of services through the PEI component of the MHSA, to mental health clients in order to help prevent mental illness from becoming severe and disabling. 5) Authorizes the services for adults, older adults, and children, as well as innovative programs and PEI programs that are provided by counties as part of the MHSA to include substance use disorder (SUD) treatment for children, adults, and older adults with c o-occurring mental health and SUD who are eligible to receive mental health services under these programs. 6) Authorizes the use of MHSA funds to perform an assessment of whether a person has co - occurring mental health and SUDs and to treat a person who is initially assessed to have co- occurring mental health and SUDs, even when the person is later determined not to be eligible for services provided with MHSA funds. AB 638 Page 2 7) Requires that a person being treated for co -occurring mental health and SUDs who is determined to not need the mental health services eligible under this act, be referred to SUD treatment services in a timely manner. FISCAL EFFECT: Unknown. This bill has not been heard by a fiscal committee. COMMENTS: 1) PURPOSE OF THIS BILL. According to the author, some people living with serious mental illness (SMI) simultaneously experience alcohol and drug use disorders, thus complicating diagnosis and treatment. A third of adults who receive county mental health services for SMI, have a co-occurring SUD. The stakes for these individuals is especially high. People with drug or alcohol use disorders are almost six times more likely to attempt suicide than those without a drug or alcohol use disorder. Removing programmatic barriers in serving these individuals with mental health and co-occurring SUDs was an important first step with the adoption of AB 2265 (Quirk-Silva), Chapter 144, Statutes of 2020; however, the COVID-19 pandemic has amplified the need to do more. Unfortunately, this pandemic has affected children and adults in unprecedented ways. Anxiety, depression, isolation, and feelings of despair as well as suicide attempts have increased dramatically among adults, school-aged children and young adults. In concluding, the author states that many who had underlying or diagnosed mental health and SUDs are now dealing with an increased need for services and treatment. 2) BACKGROUND. a) MHSA. Proposition 63, the MHSA was approved by voters in November 2004. The MHSA imposes a 1% income tax on personal income in excess of $1 million. It created the 16 member MHSOAC charged with overseeing the implementation of MHSA. The MHSA addresses a broad continuum of prevention, early intervention and service needs as well as providing funding for infrastructure, technology, and training needs for the community mental health system. During the of strong economic growth in the state, the measure raises about $2 billion annually for services such as preventing mental illness from progressing, reducing stigma, and improving treatment. Altogether, counties have received upwards of $16.5 billion. The funds are distributed to County mental health agencies. Counties receive monthly distributions of MHSA funds from the State Controller’s Office, based on the amount of revenues generated by the tax. These County funds are earmarked by law into three primary funding components. Eighty percent of the funds are attributed to Community Services and Supports (CSS) and 20% to PEI. The counties then are required to use 5% of the CSS and PEI amounts exclusively to fund Innovative Projects (leaving 76 % of the original allocation in CSS and 19% in PEI). Counties may then elect to transfer a portion of CSS funds received in any year to one or more of three further categories: Wor kforce Education and Training; Capital Facilities and Technological Needs; and, a “Prudent Reserve” fund. Target populations under MHSA include children and adolescents with serious emotional disturbance and transition-aged youth who are unserved, underserved, or inappropriately served (e.g., homeless, frequent hospital users, individuals with criminal justice history). AB 638 Page 3 The PEI component is to prevent mental illness from becoming severe and disabling. In 2020, AB 2265 clarified counties can treat patients with mental health and co -occurring SUDs under MHSA. This was an important first step to remove programmatic barriers in serving these individuals with mental health and co -occurring SUDS. The MHSA contains a provision that specifies the MHSA can only be amended by a two- thirds vote of both houses of the Legislature and only as long as the amendment is consistent with and furthers the intent of the MHSA. Provisions that clarify the procedures and terms of the MHSA can be amended by a majority vote of both houses of the Legislature. Any other proposed use of MHSA funds or change in terms of usage would require the MHSA be amended by voter approval. b) MHSOAC Report on Co-Occurring Disorder: In November 2007, the MHSOAC authorized a 19-member Workgroup on Co-occurring Disorders (COD) to develop comprehensive recommendations to address the needs of individuals with co -occurring mental illness and substance abuse. The COD Workgroup, which met from November 2007 through June 2008, heard briefings by state leaders and experts on the status of the treatment of CODs in California. A report entitled, “Transforming the Mental Health System Through Integration” was issued and the key findings and recommendation to improve the capacity of state and county policy makers and program administrators to address the needs of individuals with CODs follows : i) The central finding of the COD workgroup is that CODs are pervasive and disabling, yet individuals with co-occurring mental illness and substance abuse are among California’s most underserved; ii) Individuals with CODs touch every part of our health system. They have more medical problems, poorer treatment outcomes, more negative social consequences , and lower quality of life. They are disproportionately represented among arrestees, foster care placements, veterans, hospitalizations and the homeless. The enormous social consequences of untreated COD prompted the Substance Abuse and Mental Health Services Administration to identify the treatment CODS as our nation’s highest priority; iii) Individuals with co-occurring mental illness and substance abuse are among California’s most underserved . Numerous studies demonstrate that integrated care is necessary for successful treatment of CODs. To meet the needs of individuals with COD, there can be “no wrong door” to access treatment. Availability of comprehensively integrated treatment for mental health and substance abuse problems is currently the exception rather than the rule. The unmet need for integrated mental health, alcohol and drug abuse treatment in underserved racial and ethnic communities is even greater; iv) Approximately one-half of the people who have one of these conditions - a mental illness or a substance abuse disorder - also have the other condition. The proportion of co-occurrence may be even higher in adolescent populations. The onset of a diagnosable mental disorder often precedes the onset of a SUD, with SUDs developing typically 5-10 years later in late adolescence or early adulthood. CODs are the norm, not the exception; v) CODs are disabling. Individuals with COD have more medical problems, poorer treatment outcomes, greater social consequences , and lower quality of life. They have more relapses, re-hospitalization, depression and suicidality, interpersonal violence, AB 638 Page 4 housing instability and homelessness, incarceration, treatment non-compliance, HIV, family burden, and service utilization; and, vi) Insufficient support for integrated COD programs leads to a paucity of treatment facilities and properly trained clinicians. Both are essential to provide the full spectrum of necessary care. The lack of such facilities and expertise restricts access to service not just for outpatient care, but also for inpatient mental health units with C OD capability. c) Trends in California Drug Overdose Deaths. California Health Policy Strategies, a Sacramento-based consulting firm with a deep commitment to policies that will improve California’s health care system, issued a policy brief in January of 2021, entitled “Trends in California Drug Overdose Deaths.” The brief reported that drug-related overdose fatalities have risen 50% since 2017. Overdose fatalities are rising faster in California than in the United States in general where overdose deaths are up 15% over the last three years. Other key findings are: i) Drug-related overdose is now a top 10 leading cause of death. In the 12 months between June 2019 and June 2020 there were at least 7,254 overdose deaths, which equals approximately 17 overdose fatalities per 100,000 state residents. Accidental drug overdoses kill twice as many people as car accidents; ii) The rate of overdose deaths related to synthetic opioids (e.g. Fentanyl) has risen by 541% over the last three years. Fentanyl is now the leading cause of opioid -related overdose deaths and 37% of all drug-related overdose fatalities involve fentanyl; iii) The raw number of drug-related overdose deaths are rising in both California and the United States. Preliminary mortality records indicate that in the 12 -month period June 2019 and June 2020 there were at least 7,254 drug overdose deaths in California and over 81,003 in the United States. The number of overdose fatalities is rising faster in California than it is in the United States. In California, overdose deaths are up 50% and in the United States overdose deaths are up 15% since the 12 -month period June 2016 to June 2017. The age-adjusted rate of drug overdose death has also risen dramatically over the last three years and is at an all-time high; there are approximately 17 overdose deaths per 100,000 state residents; and, iv) Overdose death rates are highly variable across counties in California. In 2019, the average rate of all drug-related overdose deaths across the state was 19.6 deaths per 100,000 state residents and the median was 17.3 deaths per 100,000 state residents. 3) SUPPORT. The Racial and Ethnic Mental Health Disparities Coalition (REMHDCO) in support of this bill states that mental health disorders are among t he most common health conditions faced by Californians. Nearly one in six California adults experience a mental illness of some kind, and one in 24 have a serious mental illness that makes it difficult to carry out major life activities. Additionally, one in 13 children have an emotional disturbance that limits participation in daily activities. Left untreated, these illnesses impact qualify of life and survival. REMHDCO concludes by stating that unfortunately, the COVID-19 pandemic has also affected children and adults in unprecedented ways. Many who had underlying or diagnosed mental health and SUDs are now dealing with an increased need for services and treatment. The COVID-19 pandemic has amplified the need to do more. 4) OPPOSITION. The California Right to Life Committee (CRLC), in opposition, states concerns about the apparent lack if any significant improvement in the quality of life for AB 638 Page 5 those suffering from mental illness and questions how more funding will now ensure the quality of life for those livin g with mental illness. CRLC concludes by asking, specifically what new programs are envisioned? 5) RELATED LEGISLATION. a) AB 686 (Arambula) requires the California Health and Human Services Agency (HHS) to establish the California Community-Based Behavioral Health Outcomes and Accountability Review to facilitate a local accountability system that fosters continuous quality improvement in county behavioral health programs and in the collection and dissemination by the agency of best practices in service delive ry. AB 686 is pending in the Assembly Health Committee. b) AB 573 (Carrillo) establishes the California Youth Mental Health Board within HHS to advise the Governor and Legislature o n the challenges facing youth with mental health needs and determine opportunities for improvement. Requires each community mental health service to have a local youth mental health board to advise the county mental health programs, school districts, and other entities on issues relating to youth mental health. AB 573 is pending in the Assembly Appropriations Committee c) SB 749 (Glazer and Eggman), requires the MHSOAC, in consultation with state and local mental health authorities, to create a comprehensive tracking program for county spending on mental and behavioral health programs and services, as specified, including funding sources, funding utilization, and outcome data at the program, service, and statewide levels. SB 749 is pending in the Senate Appropriations Committee. 6) PREVIOUS LEGISLATION. a) AB 2265 authorizes the services for adults, older adults, and children, as well as innovative programs and prevention and early intervention programs that are provided by counties as part of the MHSA to include substance use disorder treatment for children, adults, and older adults with co -occurring mental health and SUD who are eligible to receive mental health services pursuant to those programs. b) AB 2266 (Quirk-Silva) of 2020, would have required the Department of Health Care Services (DHCS) to establish a pilot program in up to 10 counties and would have authorized funding to be used by participating counties to treat a person with co - occurring mental health and SUDs when the person would be eligible for treatment of the mental health disorder pursuant to the MHSA. AB 2266 was not heard in the Assembly Health Committee due to the shortened Legislative calendar brought on by the COVID - 19 pandemic. c) SB 10 (Beall) of 2019, would have required DHCS to establish, a statewide peer support specialist certification program, as a part of the state’s comprehensive mental health and SUD delivery system and the Medi-Cal program. Would have required the certification program’s components to include, among others, defining responsibilities, practice guidelines, and supervision standards, determining curriculum and core competencies, specifying training and continuing education requirements, establishing a code of ethics, and determining a certification revocation process. SB 10 was vetoed by the Governor with the following message: AB 638 Page 6 “This bill would require DHCS to establish a new state certification program for mental health and SUD peer support specialists. Peer support services can play an important role in meeting individuals' behavioral health care needs by pairing those individuals with trained "peers" who offer assistance with navigating local community behavioral health systems and provide needed support. Currently, counties may opt to use peer support services for the delivery of Medicaid specialty mental health services. As the Administration, in partnership with the Legislature and counties, works to transform the state's behavioral health care delivery system, we have an opportunity to more comprehensively include peer support services in these transformation plans.” d) SB 1004 (Wiener), Chapter 843, Statutes of 2018, requires the MHSOAC, on or before January 1, 2020, to establish priorities for the use of PEI funds and to develop a statewide strategy for monitoring implementation of PEI services, including enhancing public understanding of PEI and cre ating metrics for assessing the effectiveness of how PEI funds are used and the outcomes that are achieved. REGISTERED SUPPORT / OPPOSITION : Support California Behavioral Health Directors Association Racial and Ethnic Mental Health Disparities Coalition Opposition California Right to Life Committee, Inc. Analysis Prepared by: Judith Babcock / HEALTH / (916) 319-2097 SENATE COMMITTEE ON HEALTH Senator Dr. Richard Pan, Chair BILL NO: AB 2265 AUTHOR : Quirk-Silva VERSION : May 20, 2020 HEARING DATE: August 10, 2020 CONSULTANT: Reyes Diaz SUBJECT: Mental Health Services Act: use of funds for substance use disorder treatment . SUMMARY: Clarifies that Mental Health Services Act funds are permitted to be used to fund treatment for individuals with co-occurring mental health and substance use disorders. Requires counties to report information about the individuals treated pursuant to the provisions of this bill, as specified. Existing law: 1) Establishes the Mental Health Services Oversight and Accountability Commission (MHSOAC) to oversee the implementation of the Mental Health Services Act (MHSA), enacted by voters in 2004 as Proposition 63 to provide funds to counties to expand services, develop innovative programs, and integrate service plans for mentally ill children, adults, and seniors through a 1% income tax on personal income above $1 million. [WIC §5845] 2) Requires the Department of Health Care Services (DHCS), in coordination with counties, to establish a program designed to prevent mental illnesses from becoming severe and disabling, including an emphasis on strategies to reduce the following negative outcomes that may result from untreated mental illness: a) Suicide; b) Incarcerations; c) School failure or dropout; d) Unemployment; e) Prolonged suffering; f) Homelessness; and, g) Removal of children from their homes. [WIC §5840] 3) Requires each county mental health program to prepare and submit a three -year program and expenditure plan, with annual updates, adopted by the county board of supervisors, to the MHSOAC and DHCS within 30 days after adoption. [WIC §5847] 4) Requires DHCS, in consultation with the MHSOAC and the County Behavioral Health Directors Association of California, to develop and administer instructions for the Annual MHSA Revenue and Expenditure Report, including identifying the expenditure of funds, quantifying the amount of additional funds generated for the mental health system, identifying unexpended funds and interest earned on funds, and determining reversion amounts from prior fiscal year distributions. [WIC §5899] This bill: 1) Clarifies that MHSA funds are permitted to be used to treat a person with co -occurring mental health and substance use disorders (MHD/SUD) when the person would be eligible for treatment of the MHD pursuant to the MHSA, as specified. AB 2265 (Quirk-Silva) Page 2 of 4 2) Requires treatment of co-occurring MHD/SUD to be identified in a county’s three -year program and expenditure plan or annual update. 3) Requires a county to, as quickly as possible, refer a person to SUD treatment services when that person is being treated for co-occurring conditions and it is later determined that the person does not need the mental health services that are eligible for MHSA funding. 4) Permits MHSA funds to be used to assess whether a person has co -occurring MHD/SUDs and to treat a person who is preliminarily asses sed to have the co-occurring conditions, even when the person is later determined not eligible for MHSA-funded services. 5) Requires a county to report to DHCS both of the following: a) The number of people assessed for co-occurring MHD/SUDs; and, b) The number of people assessed for those co-occurring disorders who were ultimately determined to have only an SUD without a MHD. 6) Requires DHCS, by January, 1, 2022, and each January 1 thereafter, to publish on its website a report summarizing county activities pursuant to the provisions of this bill. Requires data to be reported statewide and by county or groupings of counties, as specified. FISCAL EFFECT: According to the Assembly Appropriations Committee, this bill has minor and absorbable one-time costs to DHCS to specify the manner of reporting, and minor ongoing costs to receive reports from counties and report statewide data (MHSA administrative set -aside funds). PRIOR VOTES: Assembly Floor: 76 - 0 Assembly Appropriations Committee: 18 - 0 Assembly Health Committee: 15 - 0 COMMENTS: 1) Author’s statement. According to the author, some people living with serious mental illness simultaneously experience SUDs, complicating diagnosis and treatment. A third of adults who receive county mental health services for serious mental illnesses have a co -occurring SUD. The stakes for these individuals are especially high. People with SUDs are almost six times more likely to attempt suicide than those without. COVID-19 has only exacerbated the need for mental health services. This bill will provide much needed clarity to existing statute so t hat those who are experiencing co-occurring mental illness and SUDs get the care they need. 2) MHSA. The MHSA requires each county mental health program to prepare and submit a three-year plan to DHCS that must be updated each year and approved by DHCS after review and comment by the MHSOAC. DHCS is required to provide guidelines to counties related to each component of the MHSA. In the three-year plans, counties are required to include a list of all programs for which MHSA funding is being requested and that identifies how the funds will be spent and which populations will be served. The MHSA makes explicit reference to those with co-occurring conditions and permits use of funds to treat those with a co-occurring SUD, as long as an individual has a primary me ntal health condition. Counties AB 2265 (Quirk-Silva) Page 3 of 4 also must submit their plans for approval to the MHSOAC before they can spend innovation program funds. The MHSA provides funding for programs within five components: a) Community Services and Supports (CSS): Provides direct mental health services to the severely and seriously mentally ill, such as mental health treatment, cost of health care treatment, and housing supports. Regulations require counties to direct the majority of its CSS funds to Full-Service Partnerships (FSPs). FSPs are county coordinated plans, in collaboration with the client and the family, to provide the full spectrum of community services. These services consist of mental health services and supports, such as peer support and crisis intervention services; and non-mental health services and supports, such as food, clothing, housing, and the cost of medical treatment; b) Prevention and Early Intervention : Provides services to mental health clients in order to help prevent mental illness from becoming severe and disabling; c) Innovation: Provides services and approaches that are creative in an effort to address mental health clients’ persistent issues, such as improving services for underserved or unserved populations within the community; d) Capital Facilities and Technological Needs: Creates additional county infrastructure such as additional clinics and facilities and/or development of a technological infrastructure for the mental health system, such as electronic health records for mental health services; and, e) Workf orce Education and Training: Provides training for existing county mental health employees, outreach and recruitment to increase employment in the mental health system, and financial incentives to recruit or retain employees within the public mental health system. 3) Related legislation. SB 665 (Umberg) establishes a Jail-Based Community Mental Health Innovation Program (JBCMHIP), authorizing up to eight counties, including Orange County, to introduce innovative approaches to meet the mental health needs of t hose in jail, including those who have been convicted of a felony and sentenced to imprisonment in a county jail. Permits MHSA Innovation funds to be used to establish, upon approval from of the MHSOAC, a JBCMHIP. SB 665 passed out of the Assembly Health C ommittee on August 4, 2020, on a vote of 14-0. 4) Prior legislation. SB 389 (Hertzberg, Chapter 209, Statutes of 2019) permits counties to use MHSA funds to provide services to a person who is participating in a presentencing or post - sentencing diversion program or who is on parole, probation, post-release community supervision, or mandatory supervision. 5) Support. Supporters of this bill state that individuals living with serious mental illness often simultaneously experience SUDs, which complicate diagnosis and treatment. One-third of adults who receive county mental health services for serious mental illnesses have a co - occurring SUD. Removing programmatic barriers to serving these individuals with MHSA funded services is particularly important in California’s effort to end homelessness and combat the crisis of suicide, particularly among young people. Supporters argue that individuals living with SUDs are almost six times more likely to attempt suicide than those without these conditions, and believe this bill preserves the MHSA’s focus on meeting the state’s large unmet mental health needs with a more comprehensive approach. Supporters state that while existing law permits county behavioral health programs to serve individuals with co-occurring SUDs and MHDs using MHSA funds, those funds cannot be used for AB 2265 (Quirk-Silva) Page 4 of 4 individuals with only a primary SUD diagnosis. Supporters state some confusion may exist, which this bill helps to clarify. 6) Technical assistance amendments. The author received technical assistance from DHCS on this bill and requests the Committee approve the following amendments: a) Limit the programs eligible under the provisions of this bill to all MHSA-funded programs except the No Place Like Home Program; b) Require SUD services pursuant to this bill to comply with applicable requirements of the MHSA; c) Change “as quickly as possible” to “in a timely manner” in reference to referring those with only an SUD to appropriate treatment services; d) Permit DHCS to implement, interpret, or make specific the provisions of this bill through letters, notices, bulletins, or other similar instructions, as specified; and, e) Require DHCS to adopt regulations by July 1, 2025, to implement the provisions of this bill. SUPPORT AND OPPOSITION : Support: California Alliance of Child and Family Services California Pan-Ethnic Health Network City of Santa Monica County Behavioral Health Directors Association of California County of Orange Disability Rights California Drug Policy Alliance Humanidad Therapy and Education Services Jewish Public Affairs Committee of California NAMI California National Association of Social Workers, California Chapter Racial and Ethnic Mental Health Disparities Coalition SEIU California Oppose: None received -- END -- AB 638 Page 1 Date of Hearing: April 14, 2021 ASSEMBLY COMMITTEE ON APPROPRIATIONS Lorena Gonzalez, Chair AB 638 (Quirk-Silva) – As Amended March 26, 2021 Policy Committee: Health Vote: 15 - 0 Urgency: No State Mandated Local Program: No Reimbursable: No SUMMARY: This bill revises the Mental Health Services Act (MHSA) by authorizing the use of Pre vention and Early Intervention funds for strategies that address mental health needs, substance misuse or substance use disorders (SUDs), or for needs relating to co-occurring mental health and substance use. It also finds and declares this bill is consistent with and furthers the intent of the MHSA, a voter- approved proposition. FISCAL EFFECT: Any costs to Department of Health Care Services are expected to be minor and absorbable (MHSA state administrative funds). COMMENTS: 1) Purpose. According to the author, some people living with mental illness simultaneously experience alcohol abuse or SUDs, thus complicating diagnosis and treatment. The author indicates we need to do more for those who have an SUD or co-occurring disorders. 2) Background. Proposition 63 (the MHSA) was passed by voters in November 2004. The MHSA imposes a 1% income tax on personal income in excess of $1 million and creates a Mental Health Services Oversight and Accountability Commission charged with overseeing the implementation of MHSA. The MHSA addresses a broad continuum of prevention, early intervention and service needs as well as provided funding for infrastructure, technology and training for the community mental health system. The 2021-22 Governor’s Budget proposes $2.6 billion be available for purposes of the MHSA fiscal year 2021-22, about $450 million of which is allocated for Prevention and Early Intervention pursuant to MHSA. Integration of mental health, SUDs and physical health is an evolving trend in the health care delivery system. The MHSA does not explicitly address whether SUDs or co-occurring mental health and substance use needs are allowable uses of PEI dollars. 3) Prior Legislation. AB 2265 (Quirk-Silva), Chapter 144, Statutes of 2020, clarified MHSA funds may be used to fund treatment for individuals with co -occurring mental health and substance use disorders and requires counties to report information about the individuals treated pursuant to the provisions of the bill to DHCS. Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081 12/11/22, 9:13 AM Bill Text - AB -2265 Mental Health Services Act: use of funds for substance use disorder treatment. Il LEGISLATIVE INFORMATION Home Bill Information California Law Publications Other Resources My Subscriptions My Favorites AB -2265 Mental Health Services Act: use of funds for substance use disorder treatment. (2019-2020) SHARE THIS: In k Assembly Bill No. 2265 CHAPTER 144 Date Published: 09/29/2020 02:00 PM An act to add Section 5891.5 to the Welfare and Institutions Code, relating to mental health, and making an appropriation therefor. Approved by Governor September 25, 2020. Filed with Secretary of State September 25, 2020. LEGISLATIVE COUNSEL'S DIGEST AB 2265, Quirk -Silva. Mental Health Services Act: use of funds for substance use disorder treatment. Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, funds a system of county mental health plans for the provision of mental health services, as specified. The act establishes the Mental Health Services Fund, which is continuously appropriated to, and administered by, the State Department of Health Care Services to fund specified county mental health programs. This bill would authorize the services for adults, older adults, and children, as well as innovative programs and prevention and early intervention programs that are provided by counties as part of the MHSA to include substance use disorder treatment for children, adults, and older adults with cooccurring mental health and substance use disorders who are eligible to receive mental health services pursuant to those programs. The bill would also authorize the use of MHSA funds to assess whether a person has cooccurring mental health and substance use disorders and to treat a person who is preliminarily assessed to have cooccurring mental health and substance use disorders, even when the person is later determined not to be eligible for services provided with MHSA funds. The bill would require a person being treated for cooccurring mental health and substance use disorders who is determined to not need the mental health services that are eligible for funding pursuant to the act, to be referred to substance use disorder treatment services in a timely manner. By authorizing the use of continuously appropriated funds for a new purpose, this bill would make an appropriation. This bill would require a county to report to the State Department of Health Care Services the number of people assessed for cooccurring mental health and substance use disorders and the number of people who were ultimately determined to have only a substance use disorder without another cooccurring mental health condition. The bill would also require the department, by January 1, 2022, and each January 1 thereafter, to publish on its internet website a report summarizing the county data for the prior fiscal year. By imposing a new duty on counties, this bill would impose a state -mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above. Vote: 2/3 Appropriation: yes Fiscal Committee: yes Local Program: yes https://Ieginfo.legislature.ca.gov/faces/biIINavClient.xhtml?bill_id=201920200AB2265 1/2 12/11/22, 9:13 AM Bill Text - AB -2265 Mental Health Services Act: use of funds for substance use disorder treatment. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 5891.5 is added to the Welfare and Institutions Code, to read: 5891.5. (a) (1) The programs in paragraphs (1) to (3), inclusive, and paragraph (5) of subdivision (a) of Section 5890 may include substance use disorder treatment for children, adults, and older adults with cooccurring mental health and substance use disorders who are eligible to receive mental health services pursuant to those programs. The MHSA includes persons with a serious mental disorder and a diagnosis of substance abuse in the definition of persons who are eligible for MHSA services in Sections 5878.2 and 5813.5, which reference paragraph (2) of subdivision (b) of Section 5600.3. (2) Provision of substance use disorder services pursuant to this section shall comply with all applicable requirements of the Mental Health Services Act. (3) Treatment of cooccurring mental health and substance use disorders shall be identified in a county's three-year program and expenditure plan or annual update, as required by Section 5847. (b) (1) When a person being treated for cooccurring mental health and substance use disorders pursuant to subdivision (a) is determined to not need the mental health services that are eligible for funding pursuant to the MHSA, the county shall refer the person receiving treatment to substance use disorder treatment services in a timely manner. (2) Funding established pursuant to the MHSA may be used to assess whether a person has cooccurring mental health and substance use disorders and to treat a person who is preliminarily assessed to have cooccurring mental health and substance use disorders, even when the person is later determined not to be eligible for services provided with funding established pursuant to the MHSA. (c) A county shall report to the department, in a form and manner determined by the department, both of the following: (1) The number of people assessed for cooccurring mental health and substance use disorders. (2) The number of people assessed for cooccurring mental health and substance use disorders who were ultimately determined to have only a substance use disorder without another cooccurring mental health condition. (d) The department shall by January 1, 2022, and each January 1 thereafter, publish on its internet website a report summarizing county activities pursuant to this section for the prior fiscal year. Data shall be reported statewide and by county or groupings of counties, as necessary to protect the private health information of persons assessed. (e) (1) 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 section by means of plan or county letters, information notices, plan or provider bulletins, or other similar instructions, without taking any further regulatory action. (2) On or before July 1, 2025, the department shall adopt regulations necessary to implement this section in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. SEC. 2. If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code. https://Ieginfo.legislature.ca.gov/faces/biIINavClient.xhtml?bill_id=201920200AB2265 2/2 SENATE COMMITTEE ON HEALTH Senator Dr. Richard Pan, Chair BILL NO: AB 638 AUTHOR : Quirk-Silva VERSION : March 26, 2021 HEARING DATE: June 9, 2021 CONSULTANT: Reyes Diaz SUBJECT: Mental Health Services Act: early intervention and prevention programs SUMMARY: Permits Mental Health Services Act Prevention and Early Intervention funds to be used for strategies that address mental health needs, substance misuse or substance use disorders, or needs relating to co-occurring mental health and substance use services. Existing law: 1) Establishes the Mental Health Services Oversight and Accountability Commission (MHSOAC) to oversee the implementation of the Mental Health Services Act (MHSA), enacted by voters in 2004 as Proposition 63, to provide funds to county mental health programs (CMHPs) to expand services, develop innovative programs, and integrate service plans for mentally ill children, adults, and seniors through a one percent income tax on personal income above $1 million. [WIC §5845] 2) Permits specified MHSA funds, including prevention and early intervention (PEI) program funds, to be used to assess and treat children, adults, and older adults with co-occurring mental health and substance use disorders (SUD) who are eligible to receive mental health services, as specified. [WIC §5891.5] 3) Permits PEI funds to be used to broaden the provision of community-based mental health services by adding PEI services or activities to those services. [WIC §5840] This bill: Permits PEI funds to be used for strategies that address mental health needs, substance misuse or SUDs, or needs relating to co -occurring mental health and substance use services. FISCAL EFFECT: According to the Assembly Appropriations Committee, any costs to the Department of Health Care Services (DHC S) are expected to be minor and absorbable (MHSA state administrative funds). PRIOR VOTES: Assembly Floor: 77 - 0 Assembly Appropriations Committee: 16 - 0 Assembly Health Committee: 15 - 0 COMMENTS: 1) Author’s statement. According to the author, some people living with serious mental illness simultaneously experience SUD, complicating diagnosis and treatment. A third of adults who receive county mental health servic es for serious mental illnesses have a co-occurring SUD. The stakes for these individuals is especially high. People with SUDs are almost six times more likely to attempt suicide than those without. Removing programmatic barriers in serving these individuals with mental health and co -occurring SUDs was an important first step, however, the COVID-19 pandemic has amplified the need to do more. Unfortunately, this AB 638 (Quirk-Silva ) Page 2 of 3 pandemic has affected children and adults in unprecedented ways. Anxiety, depression, isolation, and feelings of despair, as well as suicide attempts, have increased dramatically among adults, school-aged children, and young adults. Many who had underlining or diagnosed mental health and SUDs are now dealing with an increased need for services and treatment. 2) MHSA. The MHSA requires each CMHP to prepare and submit a three -year plan to DHCS that must be updated each year and approved by DHCS after review and comment by the MHSOAC. DHCS is required to provide guidelines to counties related to each component of the MHSA. In the three-year plans, CMHPs are required to include a list of all programs for which MHSA funding is being requested and that identifies ho w the funds will be spent and which populations will be served. The MHSA makes explicit reference to those with co - occurring conditions and permits use of funds to treat those with a co -occurring SUDs, as long as an individual has a primary mental health c ondition. Counties also must submit their plans for approval to the MHSOAC before they can spend innovation program funds. The MHSA provides funding for programs generally within these five components: a) Community Services and Supports (CSS): Provides direct mental health services to the severely and seriously mentally ill, such as mental health treatment, cost of health care treatment, and housing supports. Regulations require counties to direct the majority of its CSS funds to Full-Service Partnerships (FSPs). FSPs are county coordinated plans, in collaboration with the client and the family, to provide the full spectrum of community services. These services consist of mental health services and supports, such as peer support and crisis intervention services; and non-mental health services and supports, such as food, clothing, housing, and the cost of medical treatment; b) PEI: Provides services to mental health clients in order to help prevent mental illness from becoming severe and disabling; c) Innovation: Provides services and approaches that are creative in an effort to address mental health clients’ persistent issues, such as improving services for underserved or unserved populations within the community; d) Capital Facilities and Technological Needs: Creates additional county infrastructure, such as additional clinics and facilities and/or development of a technological infrastructure for the mental health system, such as electronic health records for mental health services; and, e) Workforce Education and Training: Provides training for existing county mental health employees, outreach and recruitment to increase employment in the mental health system, and financial incentives to recruit or retain employees within the public mental health system. 3) Related legislation. SB 749 (Glazer and Eggman) requires the MHSOAC, in consultation with state and local mental health authorities, to create a comprehensive tracking program for CMHP spending on mental and behavioral health programs and services, including fundi ng sources, funding utilization, and outcome data at the program, service, and statewide levels. SB 749 is pending in the Assembly. 4) Prior legislation. AB 2265 (Quirk-Silva, Chapter 144, Statutes of 2020) clarifies that MHSA funds, including PEI, are permitted to be used to fund treatment for individuals with co - occurring mental illness and SUDs. Requires CMHPs to report information about the individuals treated, as specified. AB 638 (Quirk-Silva ) Page 3 of 3 5) Support. Supporters, largely behavioral health advocates, argue that mental health disorders are among the most common health conditions faced by Californians. Even before the COVID-19 pandemic, nearly one in 13 children were identified as having an emotional disturbance that limited participation in daily activities. Many who had underlining or diagnosed mental health and SUDs are now dealing with an increased need for services and treatment. Drug-related overdose fatalities have risen 50% since 2017 and is one of the top ten leading causes of death in the state. Overdose related deaths are rising higher in California than in the United States. In the 12 -months between June 2019 and June 2020 , there were at least 7,254 overdose deaths, which equals approximately 17 overdose fatalities per 100,000 state residents. The County Behavioral Health Directors Association (CBHDA) states that the first stated purpose of the MHSA is to define serious mental illness amo ng children, adults, and seniors as a condition deserving priority attention, including PEI services and medical and supportive care. CBHDA argues that the National Institute of Mental Health, the National Institute on Drug Abuse, and the Diagnostic and Statistical Manual of Mental Disorders all recognize SUDs as a mental illness. Supporters argue that last year’s AB 2265 was an important first step to remove programmatic barriers in serving individuals with co-occurring conditions, but the reality of the C OVID-19 pandemic has amplified the need to do more. The MHSOAC argues that this bill will strengthen the work of its PEI Project and provide clarity in existing law. The MHSOAC states that it is difficult to determine if someone in crisis has a mental health or SUD, and treatment should be focused on helping the individ ual’s wellness and not determining what came first—the mental health need or the SUD. 6) Opposition. The California Right to Life Committee, Inc. opposes this bill because of concerns about the apparent lack of any significant improvement in the quality of life for those suffering from mental illness and states that California taxpayers should be angry that those funds they paid from 2004 to the present have not transformed the mental health system as was promised. 7) Oppose unless amended. The Depression and Bipolar Support Alliance (DBSA) states that many, even perhaps a majority of those with mental health and mood disorder challenges have co-occurring SUD issues, but there are many other programs for SUDs alone, and there’s no compelling argument to utilize MHSA funds for this. DBSA cannot support the amendment of the MHSA without restricting it to co-occurring conditions. Without this amendment, DBSA states this bill does not further the intent of the MHSA, but rather dilutes it. SUPPORT AND OPPOSITION : Support: California Alliance of Child and Family Services California Consortium of Addiction Programs and Professionals California Family Resource Association Child Abuse Prevention Center County Behavioral Health Directors Association Mental Health Services Oversight and Accountability Commission National Alliance on Mental Illness - California Racial and Ethnic Mental Health Disparities Coalition Oppose: California Right to Life Committee, Inc. Depression and Bipolar Support Alliance (unless amended) AB 2265 Page 1 Date of Hearing: June 2, 2020 ASSEMBLY COMMITTEE ON APPROPRIATIONS Lorena Gonzalez, Chair AB 2265 (Quirk-Silva ) – As Amended May 4, 2020 Policy Committee: Health Vote: 15-0 Urgency: No State Mandated Local Program: No Reimbursable: No SUMMARY: This bill provides flexibility to counties to use Mental Health Services Act (MHSA) dollars to treat someone with a co-occurring substance use and mental health disorder when such an individual would be eligible for MHSA-funded treatment services, as well as to assess such an individual for eligibility for such services. It also specifies related procedures, requires counties to report the use of funding in the manner above to the Department of Health Care Services (DHCS) and requires DHCS to aggregate and report this data annually. FISCAL EFFECT: Minor and absorbable one-time costs to DCHS to specify the manner of reporting, and minor ongoing costs to receive reports from counties and report statewide data (MHSA administrative set-aside funds). COMMENTS: 1) Purpose . According to the author, some people living with serious mental illness simultaneously experience alcohol and drug use disorders, complicating diagnosis and treatment. This bill would provide counties the flexibility to treat these individuals using MHSA dollars. 2) Background. Proposition 63, the MHSA, was passed by voters in November 2004. The MHSA imposes a 1% income tax on personal income in excess of $1 million to fund counties for a broad continuum of mental health prevention, early intervention and other services. It also charges DHCS with overseeing aspects of MHSA implementation. The majority of MHSA dollars, with the exception of a set-aside for state administration, are provided to counties to fund community-based mental health services, prevention and early intervention, innovation, capital and technology needs, and workforce. Funding is allocated subject to a local community planning process. Better integration of substance use and mental health treatment for the large number of individuals with co-occurring disorders has been an emerging policy priority over the last decade. 3) Related Legislation. AB 2025 (Gipson), also to be heard in this committee, authorizes the County of Los Angeles to establish a pilot project for the provision of co mmunity-based care and treatment that addresses the interrelated and complex needs of individuals suffering from mental illness and substance use disorder, homelessness and other medical comorbidities. AB 2265 Page 2 AB 2576 (Gloria), also being heard today in this committee, redirects unspent MHSA to be reallocated to other counties for the purposes of providing services to individuals with mental illness who are also experiencing homelessness or who are involved in the criminal justice system and providing early intervention services to youth. 4) Prior Legislation. SB 389 (Hertzberg), Chapter 209, Statutes of 2019, authorized counties to use MHSA moneys to provide services to persons who are participating in a presentencing or post-sentencing diversion program or who are on parole, probation, post-release community supervision or mandatory supervision. Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081 � - -�►, �� ' ,m" . �. . � .,. , � r �f � �,� �n f � . . .z��f 3J. �': c� � .� / � ��,,// ��. / � , I� ��� � �.� �r": ps id 7