BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: SB 1404 --------------------------------------------------------------- |AUTHOR: |Leno | |---------------+-----------------------------------------------| |VERSION: |March 29, 2016 | --------------------------------------------------------------- --------------------------------------------------------------- |HEARING DATE: |April 6, 2016 | | | --------------------------------------------------------------- --------------------------------------------------------------- |CONSULTANT: |Vince Marchand | --------------------------------------------------------------- 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 SB 1404 (Leno) Page 2 of ? 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, SB 1404 (Leno) Page 3 of ? 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 SB 1404 (Leno) Page 4 of ? 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. SB 1404 (Leno) Page 5 of ? 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 SB 1404 (Leno) Page 6 of ? 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 SB 1404 (Leno) Page 7 of ? 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 SB 1404 (Leno) Page 8 of ? 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 SB 1404 (Leno) Page 9 of ? 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 SB 1404 (Leno) Page 10 of ? 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 --