Senate Bill 153: Model Referral Protocols

Model Referral Protocols for Addressing Pupil Behavioral Health Concerns

Legal Notification: This document is a model guidance resource created by the California Department of Education (CDE). It is intended for optional use and does not carry the force of law. Content is provided for informational purposes only, and references to external sources are for convenience without CDE endorsement.

Per California Education Code (EC) Section 49428.1(b), the protocols are designed for voluntary use by school districts, charter schools, county offices of education, and other educational institutions and preparation programs.

Introduction

The Model Referral Protocols for Addressing Pupil Behavioral Health Concerns ("the Protocols") are designed to assist schools in creating or refining timely referral systems that support students' behavioral health needs. Developed in accordance with EC Section 49428.1, the Protocols provide guidance for identifying, referring, and supporting students experiencing behavioral health challenges.

The Protocols promote best practices to enhance collaboration between schools, families, and external service providers. They are grounded in multi-tiered systems of support (MTSS), trauma-informed care, and culturally responsive approaches. The goal is to establish consistent, effective, and accessible referral systems that contribute to positive outcomes for all students.

EC 49428.2(a) defines “youth behavioral health disorders” as “pupil mental health and substance use disorders.”

The Protocols use the term “behavioral health” as an umbrella term for factors that influence an individual’s overall health, including mental health, substance use, stress-related symptoms, and actions or habits that impact physical, mental, and social emotional well-being.

According to students in the Project Aware Youth Advisory group, behavioral health reflects how someone feels mentally and emotionally, and how those feelings show up in words, actions, and relationships. When mentally healthy, students tend to express themselves in positive, respectful ways, engage in safe and supportive behaviors, and build healthy connections.

Framework Overview

The Protocols are structured around five key components:

1. Needs Assessment: Understand behavioral health trends, gaps, and available supports.
2. Building Capacity: Strengthen internal and community-based systems.
3. Planning: Develop coordinated strategies based on assessed needs.
4. Implementation: Execute referral protocols through a collaborative model.
5. Evaluation: Assess system impact and make continuous improvements.

Key Considerations

• Intended Audience: Certificated and classified school employees, administrators, mental health professionals, and preparation programs.
  
  
• Legal Scope: Per EC Section 49428.1(b)(8), the Protocols must not be interpreted to authorize staff to diagnose or treat behavioral health conditions unless they are licensed and employed to do so.
  
  
• Differentiated Referrals: In alignment with EC Section 49428.1(b)(7), the Protocols reflect differentiated processes for students with disabilities and other distinct populations. A single standard referral pathway may not be appropriate for all students. Groups that may require unique approaches include, but are not limited to:
  • Students with Individualized Education Programs (IEPs)
  • Students with Section 504 Plans
  • English learners
  • Foster and homeless youth

Students may experience behavioral health needs shaped by disability status, prior adversity, or other challenges. For students with disabilities, referrals may need to incorporate existing supports outlined in their IEP or 504 Plans. Collaborating with special education teams helps prevent misinterpretation of behaviors or redundant referrals. Observable behaviors like emotional dysregulation or social withdrawal may be directly linked to a disability rather than an additional behavioral health concern. Staff should consult with case managers or special education professionals before initiating new referrals.

Referral systems should also account for language needs, cognitive processing styles, sensory sensitivities, and diverse family dynamics. Principles of universal design, cultural responsiveness, and trauma-informed care should guide referral environments. Staff training should support the ability to discern when behavior stems from disability-related or intersecting challenges such as trauma or poverty. Embedding differentiated pathways reflects a school’s commitment to supporting the unique needs and the holistic well-being of every student.

Additional Considerations

In alignment with EC 49428.1(b), these Protocols are intended to promote the use of positive behavioral intervention supports, and to be considered for use in lieu of disciplinary action when addressing pupil behavioral health concerns. The referral process should actively include parents and guardians, ensuring that families are engaged as collaborative partners in supporting student well-being.

Part 1: Needs Assessment

A meaningful behavioral health system begins with understanding community-specific needs. Schools should gather data across attendance, academic performance, and behavioral indicators, while also engaging diverse stakeholders.

Key Steps

• Identify trends and service gaps
• Gather community and student voice
• Analyze funding sources
• Form cross-disciplinary teams

Tools & Resources

• California Healthy Kids Survey
• Collaborative for Academic, Social, and Emotional Learning (CASEL) Stakeholder Engagement Toolkit
• Substance Abuse and Mental Health Services Administration (SAMHSA) School Mental Health Implementation Guide

Part 2: Building Capacity

Effective referral systems depend on trained staff and coordinated roles.

Strategies

• Offer training on trauma-informed care, MTSS, and evidence-based practices
• Clarify staff roles and reduce stigma around behavioral health
• Form multi-disciplinary teams within and beyond the school site

Considerations

• Align training with community needs
• Foster collaboration between education and health partners

Part 3: Planning

Effective planning connects assessment results to actionable strategies. Planning should include clearly defined goals and integration with MTSS.

Focus Areas

• Set short- and long-term objectives
• Engage families and students
• Develop interagency agreements and memorandums of understanding

Note: Planning should reflect local capacity and available data systems.

Part 4: Implementation

Put strategies into action using evidence-based tools and clear workflows.

Steps

• Prepare by documenting pre-referral efforts
• Develop a case management system for referrals
• Involve families and obtain consent
• Track referrals and follow-ups through secure systems

Data Practices

• Comply with The Family Educational Rights and Privacy Act (FERPA) and The Health Insurance Portability and Accountability Act (HIPAA)
• Establish protocols for safe data sharing
• Train staff in responsible data use

Part 5: Evaluation

Continuous improvement is essential to ensure systems remain relevant and effective.

Key Practices

• Collect and analyze quantitative and qualitative data
• Monitor referral access across student groups
• Schedule regular review cycles (e.g., Plan-Do-Study-Act)

Feedback Tools

• Student and caregiver surveys
• Staff focus groups
• Meeting with external partners

Final Notes

The Protocols are intended to evolve with user feedback. Stakeholders are encouraged to review, adapt, and improve them based on local context and input from the field. For questions, please contact the California Department of Education.

(Appendices, forms, and references have been consolidated and can be provided upon request or accessed via the CDE website.)