BILL ANALYSIS                                                                                                                                                                                                    



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

          BILL NO:                    SB 1404             
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          |AUTHOR:        |Leno                                           |
          |---------------+-----------------------------------------------|
          |VERSION:       |March 29, 2016                                 |
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          |HEARING DATE:  |April 6, 2016  |               |               |
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          |CONSULTANT:    |Vince Marchand                                 |
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           SUBJECT  :  Victims of violent crimes:  trauma recovery centers

           SUMMARY  :  Recognizes the Trauma Recovery Center at San Francisco General  
          Hospital as the State Pilot Trauma Recovery Center, and requires  
          the California Victims Compensation and Government Claims Board  
          to use the model developed by this center when it awards grants  
          to establish additional trauma recovery centers pursuant to new  
          funding made available from Proposition 47.
          
          Existing law:
          1)Establishes the California Victim Compensation and Government  
            Claims Board (CVCGC Board) within the Government Operations  
            Agency, comprised of three members: the Secretary of the  
            Government Operations Agency, the State Controller, and a  
            Governor's appointee. 

          2)Requires the CVCGC Board to administer a program to evaluate  
            applications and award grants to trauma recovery centers  
            (TRCs), and states the intent of the Legislature to provide an  
            annual appropriation of $2 million per year for these grants,  
            funded from the Restitution Fund.

          3)Permits the CVCGC Board to award a grant providing for up to a  
            maximum of three years, and is permitted to award consecutive  
            grants to a TRC to prevent a lapse in funding, but is  
            prohibited from awarding a TRC more than one grant for any  
            period of time.

          4)Establishes, through the passage of Proposition 47 in 2014,  
            the Safe Neighborhoods and Schools Act, which is intended to  
            ensure that prison spending is focused on violent and serious  
            offenses, to maximize alternatives for nonserious, nonviolent  
            crime, and to invest the savings generated from this act into  







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            prevention and support programs in K-12 schools, victim  
            services, and mental health and drug treatment. 

          5)Establishes the Safe Neighborhoods and School Funds (SNS Fund)  
            for carrying out the purposes of Proposition 47, and requires  
            that by August 15 of each fiscal year, the Controller disburse  
            moneys deposited into the SNS Fund as follows: 25 percent to  
            the Department of Education to improve outcomes for pupils by  
            reducing truancy and supporting students who are at risk of  
            dropping out or are victims of crime; 10 percent to the CVCGC  
            Board to make grants to trauma recovery centers to provide  
            services to victims of crime; and, 65 percent to the Board of  
            State and Community Corrections, to administer a grant program  
            to public agencies, as specified.

          This bill:
          1)Recognizes the Trauma Recovery Center at San Francisco General  
            Hospital as the State Pilot  Trauma Recovery Center (State  
            Pilot TRC), and requires the CVCGC Board to use the  
            evidence-based Integrated Trauma Recovery Services (ITRS)  
            model developed by the State Pilot TRC when it selects,  
            establishes, and implements trauma recovery centers.

          2)Requires all ITRS programs funded through the SNS Fund to do  
            all of the following:

                  a)        Provide outreach and services to crime victims  
                    who typically are unable to access traditional  
                    services, including, but not limited to, victims who  
                    are homeless, chronically mentally ill, members of  
                    immigrant and refugee groups, disabled, who have  
                    severe trauma-related symptoms or complex  
                    psychological issues, are of diverse ethnicity or  
                    origin, or are juvenile victims, including minors who  
                    have had contact with the juvenile dependency or  
                    justice system;
                  b)        Serve victims of a wide range of crimes,  
                    including, but not limited to, victims of sexual  
                    assault, domestic violence, battery, crimes of  
                    violence, vehicular assault, human trafficking, as  
                    well as family members of homicide victims;
                  c)        Offer a structured evidence-based program of  
                    mental health and support services that provide  
                    victims with services that include intervention,  
                    individual and group treatment, medication management,  








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                    substance abuse treatment, case management, and  
                    assertive outreach. Requires this care to be provided  
                    in a manner that increases access to services and  
                    removes barriers to care for victims of violent crime,  
                    such as providing services to a victim in his or her  
                    home, in the community, or other locations that may be  
                    outside the agency;
                  d)        Be comprised of a staff that includes a  
                    multidisciplinary team of integrated trauma clinicians  
                    made up of psychiatrists, psychologists, and social  
                    workers. Requires a trauma clinician to be either a  
                    licensed clinician or a supervised clinician engaged  
                    in completion of the applicable licensure process, and  
                    requires clinical supervision and other supports to be  
                    provided to staff regularly to ensure the highest  
                    quality of care and to help staff constructively  
                    manage vicarious trauma they experience as service  
                    providers to victims of violent crime;
                  e)        Offer psychotherapy and case management that  
                    is coordinated through a single point of contact for  
                    the victim, with support from an integrated  
                    multidisciplinary trauma treatment team. Requires all  
                    treatment teams to collaboratively develop treatment  
                    plans in order to achieve positive outcomes for  
                    clients;
                  f)        Deliver services that include assertive case  
                    management. Requires these services to include, but  
                    not be limited to, accompanying a client to court  
                    proceedings, medical appointments, or other community  
                    appointments as needed, case management services such  
                    as assistance in the completion and filing of an  
                    application for assistance to the California Victims'  
                    Compensation Program, the filing of police reports,  
                    assistance with obtaining safe housing and financial  
                    entitlements, providing linkages to medical care,  
                    providing assistance securing employment, working as a  
                    liaison to other community agencies, law enforcement,  
                    or other supportive service providers as needed;
                  g)        Ensure that no person is excluded from  
                    services solely on the basis of emotional or  
                    behavioral issues resulting from trauma, including,  
                    but not limited to, substance abuse problems,  
                    low-initial motivation, or high levels of anxiety;
                  h)        Adhere to established, evidence-based  
                    practices, including, but not limited to, motivational  








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                    interviewing, harm reduction, seeking safety,  
                    cognitive behavioral therapy, dialectical behavior,  
                    and cognitive processing therapy;

                  i)        Maintain as a primary goal a decrease in  
                    psychosocial distress, minimize long-term disability,  
                    improve overall quality of life, reduce the risk of  
                    future victimization, and promote post-traumatic  
                    growth; and,
                  j)        Provide holistic and accountable services that  
                    ensure treatment will be provided for up to 16  
                    sessions. For those with ongoing problems and a  
                    primary focus on trauma, permits treatment to be  
                    extended after special consideration with the clinical  
                    supervisor. Requires extension beyond 32 sessions to  
                    be approved by a clinical steering and utilization  
                    group that considers the client's progress in  
                    treatment and remaining need.

          3)Requires the CVCGC Board to enter into an interagency  
            agreement with the Trauma Recovery Center of UCSF to establish  
            the State Pilot TRC as California's Trauma Recovery Center of  
            Excellence (TR-COE), and requires this agreement to require:

                  a)        The TR-COE to define the core elements of the  
                    evidence-based practice;
                  b)        The CVCGC Board to consult with the TR-COE in  
                    the replication of the integrated trauma recovery  
                    services approach;
                  c)        The TR-COE to assist by providing training  
                    materials, technical assistance, and ongoing  
                    consultation to the CVCGC Board and to each center to  
                    enable the grantees to replicate the evidence-based  
                    approach; and,
                  d)        The TRE-COE to assist in evaluation by  
                    designing a multisite evaluation to measure adherence  
                    to the practice and effectiveness of each center.

          4)Prohibits the CVCGC Board from spending more than 5% annually  
            of the moneys appropriated to it from the SNS Fund for  
            administrative costs.

          5)Requires the CVCGC Board to annually report to the Legislature  
            on the funding received from the SNS Fund with a detailed  
            summary of the programs funded by the moneys allocated to it.








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          6)Requires the CVCGC Board to create an advisory committee to  
            advise it on matters pertaining to the administration of funds  
            designated for use at trauma recovery centers.

          7)Provides the advisory committee with the authority to make  
            recommendations to the CVCGC Board related to regulations  
            governing funds for trauma recovery centers that are  
            administered by the CVCGC Board, and to make recommendations  
            related to the criteria for awarding grants to trauma recovery  
            centers.

          8)Requires the advisory committee to be composed of the  
            following:

                  a)        One representative from each trauma recovery  
                    center in California;
                  b)        Three services providers who are experts in  
                    the field of trauma recovery services, each  
                    representing a distinct geographic region with the  
                    state, including at least one provider who has  
                    significant experience in providing services to rural  
                    communities; and,
                  c)        Three people who have previously received or  
                    are current recipients of services from a trauma  
                    recovery center.

          9)Provides the advisory committee with the authority to convene  
            public hearings for the purpose of acting on any of the  
            authority delegated to it by this bill, and requires all  
            meetings of the advisory committee to be publicly noticed and  
            a record of those hearings maintained. 

          10)Prohibits anything in this bill from prohibiting, limiting,  
            or otherwise preventing the CVCGC Board from consulting with  
            additional experts in the performance of its duties.

          11)Eliminates a provision that restricted the CVCGC Board from  
            awarding a trauma recovery center more than one grant for any  
            period of time.

          12)Makes various legislative findings and declarations,  
            including that the TRC at San Francisco General Hospital is an  
            award-winning, nationally recognized program, and that by  
            creating the TR-COE, it is the intent of the Legislature that  








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            these services will be delivered in a clinically effective and  
            cost-effective manner, and that the victims of crime in  
            California will have increased access to needed services.

           FISCAL  
          EFFECT  :  This bill has not been heard by a fiscal committee.
           
          COMMENTS  :
          1)Author's statement.  According to the author, the physical and  
            psychological trauma experienced by victims of crime requires  
            early treatment and comprehensive care in order to avoid  
            negative outcomes for the individual victim, as well as their  
            families and communities.  In California today, victims and  
            survivors of crime often face significant hurdles in accessing  
            the immediate and comprehensive support needed to recover  
            adequately, and are often unaware that the state offers  
            assistance for certain health and support services. Victims  
            must navigate an often difficult and bureaucratic process in  
            accessing state services, involving multiple agencies across  
            different locations. If a victim is ultimately approved for  
            state support, they may wait three months or more to access  
            victim's compensation funds to help cover the costs of  
            critical support services. Without timely holistic support,  
            victims often suffer long term mental health challenges and  
            struggle to take care of their families, maintain employment  
            and retain stable housing. Free, holistic care that is easy to  
            access would be life changing for many. In order to address  
            this pressing need, a grant program to replicate a successful  
            TRC in San Francisco was created in 2013.  This program,  
            housed at the CVCGC Board, funds $2 million in grants  
            annually. The TRC treatment model was developed in 2001 to  
            address the multiple barriers victims face recovering from  
            crime. The TRC model utilizes a comprehensive, flexible  
            approach that integrates three modes of service:  assertive  
            outreach, clinical case management, and evidence-based  
            trauma-focused therapies. The model is designed to meet the  
            unique needs of crime victims suffering from trauma by  
            utilizing a multidisciplinary staff to provide direct mental  
            health services and health treatment while coordinating  
            services with law enforcement and other social service  
            agencies. All of these services are housed under one roof.  
            Survivors of crime who received services through the TRC saw  
            significant increases in health and wellness. Seventy-four  
            percent of those served showed an improvement in mental  
            health, and 51% demonstrated an improvement in physical  








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            health.

          2)History of the TRC at San Francisco General Hospital. The TRC  
            at San Francisco General Hospital was originally established  
            pursuant to legislation passed in 2000. AB 2491 (Jackson,  
            Chapter 1016, Statutes of 2000), among other provisions,  
            required the CVCGC Board to enter into an interagency  
            agreement with the University of California, San Francisco, to  
            establish a victims of crime recovery center at San Francisco  
            General Hospital as a four year pilot project to demonstrate  
            the effectiveness of providing comprehensive and integrated  
            services to victims of crime, as an alternative to  
            fee-for-service care reimbursed by the Victim Restitution  
            funds. The goals of the TRC included improving the process of  
            care for victims of crime by enhancing medical services for  
            acute victims of sexual assault, linking victims to other  
            services to facilitate recovery, and improving access to  
            victim compensation funds. In May 2004, the CVCGC Board  
            published its required report to the Legislature on the  
            effectiveness of the victims of crime recovery center, and  
            concluded that the TRC model provides a wider, more effective,  
            range of services at a lower cost for trauma victims that the  
            traditional fee-for-service mental health treatment programs.  
            According to the report, the data demonstrated that this model  
            of care is effective in engaging victims of crime with needed  
            services, improving cooperation with law enforcement, reducing  
            homelessness, facilitating return to work, reducing alcohol  
            and drug abuse, and improving quality of life among victims of  
            interpersonal violence. 

          3)Expansion of TRC model to other areas of state. SB 71 (Budget  
            and Fiscal Review, Chapter 28, Statutes of 2013) created a $2  
            million grant program within the CVCGC Board to expand the TRC  
            concept to additional areas of the state. With this funding,  
            in October of 2014, the CVCGC Board awarded grants to two  
            TRCs: $670,000 to the Downtown Women's Center in Los Angeles,  
            and $1.3 million to the California State University at Long  
            Beach. In May of 2015, three grants were awarded: $426,341 to  
            the Children's Nurturing Project in Fairfield, which partners  
            with LIFT3 Support Group to provide a comprehensive system of  
            care focused on domestic violence survivors; $716,932 to  
            Fathers and Families of San Joaquin, located in Stockton,  
            partnering with the San Joaquin Behavioral Health Services to  
            provide comprehensive mental health and recovery services to  
            victims of crime; and, $856,727 to the Special Service for  








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            Groups, which partners with the Homeless Outreach Program  
            Integrated Care System to provide mental health services to  
            underserved crime victims in south Los Angeles.
          
          4)Proposition 47. On November 4, 2014, voters approved  
            Proposition 47, titled the Safe Neighborhoods and Schools Act,  
            which was placed on the ballot as a citizen's initiative.  
            Proposition 47 made significant changes to the state's  
            criminal justice system by reducing penalties for certain  
            non-violent, nonserious drug and property crimes, and  
            requiring that the resulting savings be spent on (1) mental  
            health and substance abuse treatment services, (2) truancy and  
            dropout prevention, and (3) victim services. To carry out its  
            purpose, Proposition 47 established the SNS Fund, and required  
            that by August 15 of each fiscal year, the Controller disburse  
            moneys deposited into the SNS Fund as follows: 25% to the  
            Department of Education to improve outcomes for pupils by  
            reducing truancy and supporting students who are risk of  
            dropping out or are victims of crime; 10% to the CVCGC Board  
            to make grants to TRCs to provide services to victims of  
            crime; and, 65% to the Board of State and Community  
            Corrections, to administer a grant program to public agencies,  
            as specified.
          
          5)Legislative Analyst's Report. In March of 2015, the  
            Legislative Analyst's Office released a report "Improving  
            State Programs for Crime Victims" (LAO report). According to  
            the LAO report, if appropriated structured, TRCs can provide a  
            wide array of services to victims at a single location and can  
            complement existing victim programs. The LAO recommended that  
            the Legislature structure the TRC grants to ensure the funds  
            are spent in an effective and efficient manner and to require  
            the evaluation of TRC grant recipients and their outcomes. The  
            LAO also recommended that the Legislature adopt statutory  
            changes to allow TRCs to have formally recognized victim  
            advocates, which would allow TRCs to have trained staff that  
            can represent victims in their application for victim  
            compensation funds, which would likely increase the approval  
            rate. The LAO also recommended prioritizing TRC grants to  
            regions that do not have a TRC, noting that there are many  
            victims who do not have access to a TRC because they do not  
            live in Los Angeles or San Francisco.

          6)Double referral. This bill is double-referred. Should it pass  
            out of this committee, it will be referred to the Senate  








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            Public Safety Committee.

          7)Prior legislation. SB 518 (Leno, 2015), also recognized the  
            TRC at San Francisco General Hospital as the State Pilot TRC,  
            and was substantially similar to this bill. SB 518 was held on  
            the Assembly Appropriations Suspense File.

            SB 71 (Budget and Fiscal Review, Chapter 28, Statutes 2013)  
            authorized the CVCGC Board to administer a program to award up  
            to $2 million in grants annually to TRCs, funded from the  
            Restitution Fund.

            SB 733 (Leno, 2010) would have authorized the CVCGC Board to  
            evaluation applications and award grants totaling up to $3  
            million, up to $1.7 million per center, to multi-disciplinary  
            TRCs that provide specified services to and resources for  
            crime victims. SB 733 was vetoed by the Governor.

            AB 1669 (Leno, 2007) would have appropriated $1.5 million for  
            the TRC at San Francisco General Hospital. AB 1669 was vetoed  
            by the Governor.

            AB 50 (Leno, Chapter 884, Statutes of 2006) appropriated $1.3  
            million for the TRC at San Francisco General Hospital.

            AB 2491 (Jackson, Chapter 1016, Statutes of 2000), among other  
            provisions, required the CVCGC Board to enter into an  
            interagency agreement with the University of California, San  
            Francisco, to establish a victims of crime recovery center at  
            the San Francisco General Hospital to demonstrate the  
            effective ness of providing comprehensive and integrated  
            services to victims of crime.
            
          8)Support. This bill is sponsored by Californians for Safety and  
            Justice (CSJ), which states that it will help provide quality  
            trauma recovery services to crime victims across the state.  
            According to CSJ, in order to ensure that other TRCs have the  
            same outstanding outcomes as the San Francisco TRC, specific  
            programmatic guidelines must be put in place. CSJ states that  
            this bill does exactly that, and additionally creates a Center  
            of Excellence at the original TRC, to provide training,  
            technical assistance, and ongoing standardized program  
            evaluations to ensure program fidelity. Fathers & Families of  
            San Joaquin also supports this bill, stating that the TRC  
            model is one of the state's most powerful, practical and  








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            innovative public responses to interpersonal violence, and  
            that given the effectiveness of this model, strongly supports  
            this bill.

          9)Suggested amendments.
               a)     Existing law (reflected on Page 4, lines 24-27)  
                 states the intent of the Legislature to provide an annual  
                 appropriation of $2 million, and requires all grants  
                 awarded by the CVCGC Board to be funded only from the  
                 Restitution Fund. However, now the Proposition 47 will be  
                 directing funds to TRCs from the SNS Fund, the author may  
                 wish to consider amending this provision to clarify that  
                 the $2 million annual appropriation is from the  
                 Restitution Fund, and to delete the limitation that  
                 grants only be awarded from this fund, in order to allow  
                 for grants funded by the SNS Fund. 

               b)     On Page 9, lines 12-13, this bill requires the newly  
                 created advisory committee to the CVCGC Board to "have  
                 the authority to convene public hearings" for the purpose  
                 of acting on any of its delegated authority. This  
                 provision should be clarified to actually require the  
                 advisory committee to convene public hearings, rather  
                 than just having the authority to do so.
          
           SUPPORT AND OPPOSITION  :
          Support:  Californians for Safety and Justice (sponsor)
                    Crime Victims United of California
                    Fathers & Families of San Joaquin
                    Two individuals
          
          Oppose:   None received
          
                                      -- END --