Summary

HIGHLIGHTS

Our review of the effect of Assembly Bill 114 (AB 114), which transferred to local educational agencies (LEAs) the responsibility for providing mental health services to students through individualized education programs (IEPs), highlighted the following:

Mental health services and the providers of those services generally did not change at the four special education local plan areas we reviewed.

In some cases LEAs removed mental health services from student IEPs because of AB 114 and for other students, the LEAs could not explain why services were removed.

The California Department of Education (Education) has not performed an analysis of the educational outcomes such as graduation and dropout rates for the subset of students who receive mental health services to determine whether student outcomes have improved as a result of AB 114.

Education does not require LEAs to track their total expenditures for mental health services, and none of the LEAs we visited had developed its own methodology for doing so.

None of the four LEAs we reviewed could determine their total costs to provide mental health services to students.

Two of the four LEAs have not spent all the funding they received to provide students with mental health services.

Only one of the four LEAs has contracted with its county to access certain funding for mental health services through the California Medical Assistance Program.

Results in Brief

The federal government provides grant funding to states to ensure that children with disabilities have access to a free and appropriate public education and has established, through the Individuals with Disabilities Education Act (IDEA), the requirements for the state programs that it funds. These programs include two main components: special education and related services. Special education is specially designed instruction to meet the needs of a student with a disability. Related services, including mental health services, are services that students with disabilities require to benefit from special education.

Federal law requires local educational agencies (LEAs), which in California consist of school districts and some county offices of education and charter schools, to evaluate children in all areas of suspected disability to determine their eligibility for special education and related services and the nature of the student’s educational needs. For eligible students, LEAs must develop an individualized education program (IEP). The IEP is a core element of IDEA and, as such, it is integral to the purpose of IDEA. It must describe, among other things, the effects of the student’s disability on educational performance, the educational goals for the student, and the special education and related services the student will receive to assist in his or her educational progress.¹

As the state’s educational agency, the State Board of Education, through the California Department of Education (Education), oversees the special education program and is responsible for ensuring that LEAs comply with the requirements of IDEA and for collecting and reporting data to the public about the special education program. As part of its responsibilities, Education distributes federal and state funds to special education local plan areas (SELPAs), which are made up of individual LEAs or consortia of LEAs and are created by state law to provide special education and related services.

In June 2011 the governor signed into law Assembly Bill 114 (AB 114), which transferred the responsibility for providing mental health services included in student IEPs from county mental health departments to LEAs. As a result, LEAs are now responsible for conducting student mental health assessments, recommending the mental health services required to help the student benefit from special education, and providing those services to the student. At the time he proposed this shift in responsibility, the governor stated that the change would lead to greater cost containment and create a stronger connection between services and student educational outcomes.

To evaluate the effects of the transfer of responsibilities to LEAs and whether AB 114 has achieved the governor’s expectations, we reviewed the special education programs at four SELPAs: Mt. Diablo Unified School District (Mt. Diablo), Long Beach Unified School District (Long Beach), Riverside County Special Education Local Plan Area (Riverside), and South East Consortium for Special Education (South East), located in Santa Clara County.² Because Riverside and South East are SELPAs made up of multiple LEAs, we selected Murrieta Valley Unified School District and East Side Union High School District as the LEA at each respective SELPA for further review. For each SELPA, we reviewed aggregate data, collected both before and after the transfer, for the types of mental health services provided to students, the providers of those services, and the total number of students who had mental health services listed in their IEPs. Although our analysis of the aggregate data did not identify changes in the types of services, the providers of those services, or the number of students served after the transfer of responsibility to LEAs, it also did not enable us to state with certainty that no students were negatively affected by the transfer.

For a further look at how the transfer may have affected individual students, we selected 60 students across the four SELPAs and found that LEAs had removed at least one mental health service from the IEPs of 44 of those students in the two years following the transfer of responsibility to LEAs. We determined that six of these students had a mental health service removed from their IEP because of AB 114. It was the practice at all four SELPAs we visited that IEP teams memorialized each student’s IEP on a written form (IEP document) explaining what services, among other items, each student’s IEP included. Therefore, we reached our conclusions by reviewing the students’ IEP documents and, when possible, identifying documented reasons for the service changes. When reasons were not documented in a student’s IEP documents, we interviewed staff at LEAs and corroborated their statements by obtaining additional documents from the student’s file. For seven of these 44 students, LEAs could not explain why a mental health service was removed from the student’s IEP. In these cases, we concluded that it is possible that the service was removed because of AB 114.

Almost all of the 60 students we reviewed experienced some change to either his or her mental health services or the amount of time that the student participated in the regular classroom. IDEA requires LEAs to notify parents in writing about the reasons for changes to services or educational placement. However, for 22 of the 60 students we reviewed, the student’s IEP document did not explicitly state why a mental health service or the student’s placement changed. In these instances we relied on interviews with special education staff at the LEA where the student attended school to direct us to portions of the IEP document or other information from the student’s file that they claimed were the reasons for changes to the IEP. In all but the seven cases mentioned in the previous paragraph, the additional details that LEA staff presented to us represented plausible reasons why there were changes to services or student placement. Nevertheless, we believe that it is important for a student’s IEP document to contain the explicit reasons for changes to the student’s IEP instead of relying on staff knowledge to connect service reductions to other parts of the IEP document or the student file. When LEAs do not clearly document why a service is added to or removed from a student’s IEP, or why a student’s educational placement is altered, they could limit a parent’s ability to participate in an informed manner in decisions related to the student. Additionally, without clear documentation, other educators who subsequently become involved in assessing a student’s progress may have difficulty understanding why a student is or is not receiving services that were once listed on the IEP document. We saw similar documentation problems with a separate group of students who had received residential treatment through their IEPs. Specifically, we found that, for the students we reviewed, LEAs did not always clearly document the reasons for placing students into residential treatment.

LEAs collect and report to Education outcome data for their students in special education so that Education can comply with federal reporting requirements. However, neither Education nor the LEAs we reviewed perform a thorough analysis of the educational outcomes on key performance indicators—such as graduation and dropout rates—for the subset of students who receive mental health services through IEPs. Without such an analysis, LEAs cannot know whether significant changes to student services, such as changes in providers, negatively affect their students. Also, unless Education analyzes outcome data for the students who receive mental health services relative to key performance indicators, it cannot provide information to policymakers about whether student outcomes have improved as a result of AB 114. Given the governor’s statement that the transition to AB 114 would create a stronger connection between services and student educational outcomes, we believe it is important that Education and LEAs improve their tracking of outcomes for students who receive mental health services through IEPs.

The other expected result of the transfer of responsibility for mental health services to LEAs was that the State would spend less on providing mental health services to students with IEPs than it had previously. However, we found that none of the four LEAs we reviewed could easily determine their total costs to provide mental health services to these students. Each LEA we reviewed uses multiple funding sources to pay for the mental health services they provide to students, including their unrestricted general fund and general special education funding. Education does not require LEAs to track their total expenditures for mental health services, and none of the LEAs we visited had developed its own methodology for doing so. Unless LEAs are required to track these expenditures, the State cannot determine the fiscal impact of the transfer of responsibilities to LEAs or whether it has realized cost savings since AB 114 became effective.

Another source of funding for the mental health services on some students’ IEPs is funding from the California Medical Assistance Program (Medi‑Cal). One of the four LEAs we reviewed, Mt. Diablo, contracts with the county mental health department to receive Medi-Cal funds as a provider of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services to Medi-Cal-eligible students. EPSDT is a program designed to ensure that children under 21 who are eligible for full-scope Medi-Cal receive early detection and care services, including mental health services, so that health problems are averted or diagnosed and treated as early as possible.³ Under state law, counties are responsible for providing certain mental health services and have access to federal EPSDT reimbursements by submitting claims through the California Department of Health Care Services. The federal government provides reimbursement for half of the allowable cost of mental health services, and the State is required to match this amount. Since legislation in 2011 authorized the realignment of various programs, counties became responsible for funding the entire state match for EPSDT mental health services and may use a variety of funding sources to do so. Counties can choose whether to provide EPSDT services directly or contract with outside service providers, which could include LEAs.

Although LEAs cannot access funding for EPSDT services unless they contract with their respective counties, such collaborations could financially benefit both counties and LEAs and increase the provision of services to children. Counties could benefit if the LEAs contributed a portion of the local match required for EPSDT reimbursements. In an October 2011 presentation hosted by Education related to the transition to AB 114, the director of the Children’s Center at Desert Mountain SELPA (Desert Mountain) highlighted her SELPA’s collaboration with San Bernardino County (San Bernardino) as financially beneficial for both the SELPA and the county. Specifically, the director stated that the SELPA contributes a portion of San Bernardino’s match of federal reimbursements, saving the county funds that it would otherwise have to contribute as the local entity. Under the terms of its agreement with San Bernardino, Desert Mountain was able to access approximately $4 million in federal EPSDT funds to provide mental health services in fiscal year 2014–15. This arrangement enables Desert Mountain to provide mental health services to Medi‑Cal‑eligible students with and without IEPs. Such a relationship between counties and LEAs across the State could deliver additional federal funding to the State and increase the number of students to whom LEAs provide needed mental health services. However, Mt. Diablo was the only LEA we reviewed that contracted with its county to access these funds.

Recommendations

Legislature

The Legislature should amend state law to require Education to report annually regarding the outcomes for students receiving mental health services relative to key performance indicators, such as graduation and dropout rates.

The Legislature should amend state law to require counties to enter into agreements with SELPAs to allow SELPAs and their LEAs to access EPSDT funding through the county mental health programs by providing EPSDT mental health services.

Entities We Reviewed

Each SELPA we visited should develop a process to ensure that IEP teams document, in student IEP documents, the reasons for any changes to services, including changes to mental health services. Further, Education should require LEAs to include directly on the IEP document reasons for any changes to student placement or services.

Education should require all LEAs to use the IEP document to communicate the rationale for placing a student in residential treatment.

The LEAs we reviewed should annually use Education’s performance indicators to better understand the effectiveness of their mental health services.

To ensure that the State knows the amount LEAs spend to provide mental health services for student IEPs, Education should develop, and require LEAs to follow, an accounting methodology to track and report expenditures related to special education mental health services.

Agency Comments

The SELPAs and LEAs we reviewed all indicated that they would implement the recommendations that we directed toward them. However, Education agreed with only two of the recommendations that we directed to it. Education disagreed with recommendations related to a lack of documentation in student IEPs, recommendations related to analysis of statewide data, and a recommendation regarding changes to its fiscal oversight.

Footnotes

¹Throughout this report, we refer to services in a student’s IEP as services that the student received. Although it is possible that a student did not actually receive services that were in an IEP (for example, if a student did not attend counseling sessions), federal regulations require LEAs to ensure that all special education and related services listed in a child’s IEP are provided.Go back to text

² Throughout this report, we refer to the SELPA known as Riverside County Special Education Local Plan Area as Riverside. However, it is a separate entity from the county of Riverside and also from the Riverside Unified School District.Go back to text

³ Individuals who are eligible for full-scope Medi-Cal services are eligible for the full range of Medi-Cal benefits, allowing for the most comprehensive Medi-Cal coverage.Go back to text