BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON PUBLIC SAFETY
                             Senator Loni Hancock, Chair
                                2015 - 2016  Regular 

          Bill No:    SB 1404       Hearing Date:    April 19, 2016     
          
           ----------------------------------------------------------------- 
          |Author:    |Leno                                                 |
          |-----------+-----------------------------------------------------|
          |Version:   |March 29, 2016                                       |
           ----------------------------------------------------------------- 
           ----------------------------------------------------------------- 
          |Urgency:   |No                     |Fiscal:    |Yes              |
           ----------------------------------------------------------------- 
           ----------------------------------------------------------------- 
          |Consultant:|JM                                                   |
          |           |                                                     |
           ----------------------------------------------------------------- 


            Subject:  Victims of Violent Crimes:  Trauma Recovery Centers



          HISTORY

          Source:   Californians for Safety and Justice

          Prior Legislation:SB 518 (Leno) 2015, Held in Assembly  
          Appropriations

                         SB 71 (Budget and Fiscal Review) - Ch. 28, Stats  
          2013

                         SB 733 (Leno) (2010) - died on Senate Floor

                         AB 1669 (Leno) - 2007, vetoed

                         AB 50 (Leno) - Ch. 884, Stats. 2006

                         AB 1768 (Committee on Public Safety) - 2005,  
          vetoed  



          Support:  Crime Victims United of California; Fathers & Families  
                    of San Joaquin; Natividad Medical Center; Two  
                    individuals









          SB 1404  (Leno )                                          PageB  
          of?
          
          Opposition:None known

                                                


          PURPOSE

          The purpose of this bill is to 1) require the Victims  
          Compensation and Government Claims Board (board) to use the  
          evidence-based model developed by the University of California,  
          San Francisco, General Hospital Trauma Recovery Center (UCSF  
          TRC) when giving a grant to a Trauma Recovery Center (TRC); 2 )  
          require a TRC  receiving a grant to meet specified statutory  
          requirements and standards; 3) establish the UCSF TRC as the  
          California Trauma Recovery Center of Excellence (TRC COE); 4)  
          require the board to complete an interagency agreement with TRC  
          COE in establishing core elements of an evidence-based TRC; and  
          5) specify procedures and  policies for using funds designated  
          for TRC programs from the Safe Schools and Neighborhoods Fund  
          created through Proposition 47 in 2014.  

          Existing law creates the Victims of Crime Program, administered  
          by the California Victim Compensation and Government Claims  
          Board ("CVCGCB"), to reimburse victims of crime for the  
          pecuniary losses they suffer as a direct result of criminal  
          acts.  Indemnification is made from the Restitution Fund, which  
          is continuously appropriated to the board for these purposes.   
          (Gov. Code  13950-13968.)

          Existing law authorizes reimbursement to a victim for "[t]he  
          medical or medical related expenses incurred by the victim?."   
          (Gov. Code  13957, subd. (a)(1).)

          Existing law provides that CVCGB shall enter into an interagency  
          agreement with the UCSF to establish a recovery center for  
          victims of crime at the San Francisco General Hospital for  
          comprehensive and integrated services to victims of crime,  
          subject to conditions set by the board.  The University Regents  
          must approve the agreement.  The section shall only be  
          implemented to the extent that funding is appropriated for that  
          purpose.  (Gov. Code  13974.5.)

          Existing law includes the Safe Neighborhoods and Schools Act of  
          2014.  As relevant to this bill, the act does the following:









          SB 1404  (Leno )                                          PageC  
          of?
          

                 Reclassifies controlled substance felony and alternate  
               felony-misdemeanor crimes as misdemeanors, except for  
               defendants convicted of a sex offense, a specified drug  
               crime involving specified weight of volume of the drug, a  
               crime where the defendant used or was armed with a weapon,  
               a homicide, solicitation of murder and any crime for which  
               the sentence is a life term.

                 Requires the Director of Finance, beginning in 2016, to  
               calculate the savings from the reduced penalties.

                 The Controller transfers the amount of savings  
               calculated by the Finance Director and transfers that  
               amount from the General Fund to the "Safe Neighborhoods and  
               Schools Fund.

                 The Controller then distributes the money in the fund  
               according to the following formula:

                  o         25% to the Department of Education for a grant  
                    program to public agencies to improve outcomes for  
                    kindergarten through high school students at risk of  
                    dropping out of school or are crime victims.
                  o         10% to the Victims of Crime Program to fund  
                    for grants to TRCs.
                  o         65% to the Board of State and Community  
                    Corrections for a grant program to public agencies for  
                    mental health and drug abuse treatment and diversion  
                    programs, with an emphasis on reducing recidivism.   
                    (Gov. Code  7599-7599.2.)

          This bill includes the following legislative findings:

                 Systematic training, technical assistance and  
               standardized evaluations are necessary to ensure that all  
               new state-funded TRCs are evidence based, accountable,  
               clinically effective and cost-effective.

                 The creation of the Trauma Recovery Center of Excellence  
               (TR-COE) is intended to make TRC services meet these  
               standards

                 California voters approved Proposition 47 - the Safe  









          SB 1404  (Leno )                                          PageD  
          of?
          
               Neighborhoods and Schools Act of 2014 - to ensure that law  
               enforcement resources are focused on violent crime and to  
               invest savings from reduced penalties for drug possession  
               and low-level theft crimes into prevention and support  
               programs through the Safe Neighborhoods and Schools Fund.

                 Proposition 47 requires that 10% of the Safe  
               Neighborhoods and Schools Funds be allocated to the Victims  
               Compensation Program to fund trauma recovery centers  
               modeled on the UCSF TRC.

          This bill provides that the VCP shall use the evidence-based  
          Integrated Trauma Recovery Services (ITRS) model developed by  
          the UCSF in establishing and funding TRCs.  Programs using ITRS,  
          as modified to apply to different populations, shall do or  
          include the following:

                 Serve and make reach out to victims unable to access  
               traditional services.  These include those who are  
               homeless, mentally ill, of diverse ethnicity, immigrants  
               and refugees, disabled, suffering from severe trauma and  
               psychological symptoms or issues, juveniles, including  
               juveniles who have been through the dependency or  
               delinquency systems.
                 Serve victims of a wide range of crimes, including  
               sexual assault and other forms of violence.
                 Use a structured evidence-based program of mental health  
               and support services for victims of violence and family  
               members of homicide victims. The services shall include  
               crisis intervention, case management, individual and group  
               treatment and shall be provided so as to increase access,  
               including providing services in the community and the homes  
               of clients.
                 Employ multidisciplinary, integrated trauma specialists  
               including psychiatrists, psychologists and social workers  
               who are licensed clinicians or engaged in supervised  
               completion of licensure.  Clinical supervision and support  
               shall be given to staff on a weekly basis.
                 Psychotherapy shall be provided by a single point of  
               client contact with a trauma specialist, with support from  
               the team and a collaboratively developed treatment plan.
                 Provide aggressive case management, including  
               accompanying clients to treatment appointments, community  
               appointments and court appearances.  Case management shall  









          SB 1404  (Leno )                                          PageE  
          of?
          
               include assisting clients in filing for victim  
               compensation, police reports, housing assistance and other  
               basic support needs.
                 Clients shall not be excluded from treatment solely on  
               the basis of "emotional or behavioral issues resulting from  
               trauma, such as drug abuse, serious anxiety or low initial  
               motivation.
                 TRC services shall incorporate established,  
               evidence-based practices, such as cognitive behavioral  
               therapy, dialectical behavior and cognitive processing.
                 TRC goals shall be to decrease psychological distress  
               and improve long-term positive outcomes.
                 Treatment shall be given for up to 16 sessions, with an  
               extension for those with a "primary focus on trauma" after  
               special consideration with a supervisor.  Extensions beyond  
               32 sessions shall require the approval of a clinical  
               steering group. 

          This bill provides that, upon legislative appropriation, the  
          Victims Compensation Board (board) shall enter into an  
          interagency agreement with TRC of the Regents of the University  
          of California, San Francisco, to establish the UCSF TRC as the  
          State of California's Trauma Recovery Center of Excellence (TR-  
          COE).  The agreement shall require the following:

                 The board shall consult with the TR-COE in developing  
               language for grant application and criteria for reviewing  
               grants.
                 The TR-COE shall define an evidence-based practice.
                 The TR-COE shall assist the board in providing training  
               materials, technical assistance and provide ongoing  
               consultation with the board.
                 The TR-COE shall assist in designing a multisite  
               evaluation for TRCs.

          This bill provides that the University of California must agree  
          to these provisions through a resolution.

                    RECEIVERSHIP/OVERCROWDING CRISIS AGGRAVATION

          For the past several years this Committee has scrutinized  
          legislation referred to its jurisdiction for any potential  
          impact on prison overcrowding.  Mindful of the United States  
          Supreme Court ruling and federal court orders relating to the  









          SB 1404  (Leno )                                          PageF  
          of?
          
          state's ability to provide a constitutional level of health care  
          to its inmate population and the related issue of prison  
          overcrowding, this Committee has applied its "ROCA" policy as a  
          content-neutral, provisional measure necessary to ensure that  
          the Legislature does not erode progress in reducing prison  
          overcrowding.   

          On February 10, 2014, the federal court ordered California to  
          reduce its in-state adult institution population to 137.5% of  
          design capacity by February 28, 2016, as follows:   

                 143% of design bed capacity by June 30, 2014;

                 141.5% of design bed capacity by February 28, 2015; and,

                 137.5% of design bed capacity by February 28, 2016. 

          In December of 2015 the administration reported that as "of  
          December 9, 2015, 112,510 inmates were housed in the State's 34  
          adult institutions, which amounts to 136.0% of design bed  
          capacity, and 5,264 inmates were housed in out-of-state  
          facilities.  The current population is 1,212 inmates below the  
          final court-ordered population benchmark of 137.5% of design bed  
          capacity, and has been under that benchmark since February  
          2015."  (Defendants' December 2015 Status Report in Response to  
          February 10, 2014 Order, 2:90-cv-00520 KJM DAD PC, 3-Judge  
          Court, Coleman v. Brown, Plata v. Brown (fn. omitted).)  One  
          year ago, 115,826 inmates were housed in the State's 34 adult  
          institutions, which amounted to 140.0% of design bed capacity,  
          and 8,864 inmates were housed in out-of-state facilities.   
          (Defendants' December 2014 Status Report in Response to February  
          10, 2014 Order, 2:90-cv-00520 KJM DAD PC, 3-Judge Court, Coleman  
          v. Brown, Plata v. Brown (fn. omitted).)  

          While significant gains have been made in reducing the prison  
          population, the state must stabilize these advances and  
          demonstrate to the federal court that California has in place  
          the "durable solution" to prison overcrowding "consistently  
          demanded" by the court.  (Opinion Re: Order Granting in Part and  
          Denying in Part Defendants' Request For Extension of December  
          31, 2013 Deadline, NO. 2:90-cv-0520 LKK DAD (PC), 3-Judge Court,  
          Coleman v. Brown, Plata v. Brown (2-10-14).  The Committee's  
          consideration of bills that may impact the prison population  
          therefore will be informed by the following questions:









          SB 1404  (Leno )                                          PageG  
          of?
          

              Whether a proposal erodes a measure which has contributed  
               to reducing the prison population;

              Whether a proposal addresses a major area of public safety  
               or criminal activity for which there is no other  
               reasonable, appropriate remedy;

              Whether a proposal addresses a crime which is directly  
               dangerous to the physical safety of others for which there  
               is no other reasonably appropriate sanction; 

              Whether a proposal corrects a constitutional problem or  
               legislative drafting error; and

              Whether a proposal proposes penalties which are  
               proportionate, and cannot be achieved through any other  
               reasonably appropriate remedy.



          COMMENTS

          1. Need for This Bill

          According to the author:

                 Senate Bill 1404 will create clear guidelines for  
                 the provision of Trauma Recovery Center (TRC)  
                 services   administered by the Victims Compensation  
                 & Government Claims Board (VCGCB) in California, as  
                 well as bolster training and technical assistance to  
                 new centers.    By setting clear guidelines and  
                 providing training for new TRCs, this bill will  
                 ensure that victims of    crime in California  
                 receive the comprehensive and timely services they  
                 need in order to heal, and to avoid negative  
                 economic consequences for themselves and their  
                 communities.  The physical and psychological trauma  
                 experienced by victims of crime requires early  
                 treatment and comprehensive care.  However, in  
                 California today, victims and survivors of crime  
                 often face significant hurdles in accessing the  
                 immediate and comprehensive support needed to  









          SB 1404  (Leno )                                          PageH  
          of?
          
                 recover adequately, and are often unaware that the  
                 state offers assistance for certain health and  
                 support services.  In order to address this pressing  
                 need, a grant program to replicate the successful  
                 TRC pioneered by UC San Francisco was created in  
                 2013.  This program, housed at the VCGCB, funds $2  
                 million in grants annually.  The TRC treatment model  
                 was developed in 2001 to address the multiple  
                 barriers victims face recovering from crime, and  
                 utilizes a comprehensive, flexible approach designed  
                 to meet the unique needs of crime victims suffering  
                 from trauma.  TRCs utilize a multidisciplinary staff  
                 to provide direct mental health services and health  
                 treatment while coordinating services with law  
                 enforcement and other social service agencies, and  
                 all services are housed under one roof, with one  
                 coordinating point of contact for the victim. The  
                 TRC model has proven to be extremely successful, and  
                 since the grant program began, survivors of crime  
                 who received services through the TRC saw  
                 significant increases in health and wellness. 74% of  
                 those served showed an improvement in mental health,  
                 and 51% demonstrated an improvement in physical  
                 health.  People who receive services at the TRC are  
                 56% more likely to return to employment, 44% more  
                 likely to cooperate with the district attorney, and  
                 69% more likely to generally cooperate with law  
                 enforcement.  All of these benefits are provided at  
                 a 33% lower cost than traditional providers.
                
                 SB 1404 creates clear guidelines for the provision  
                 of TRC services administered by the Victims  
                 Compensation & Government Claims Board (VCGCB) in  
                 California.  By setting clear guidelines and  
                 bolstering training for new trauma recovery centers,  
                 this bill will ensure that victims of crime in  
                 California receive the comprehensive and timely  
                 services they need in order to heal, and to avoid  
                 negative economic consequences for themselves and  
                 their communities.  This bill will require the board  
                 to create an advisory committee to advise the board  
                 on matters pertaining to the administration of funds  
                 designated for use at trauma recovery centers.










          SB 1404  (Leno )                                          PageI  
          of?
          
               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 3 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  
               VCGCB, funds $2 million in grants annually.  

          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  









          SB 1404  (Leno )                                          PageJ  
          of?
          
          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 7 (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 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  









          SB 1404  (Leno )                                          PageK  
          of?
          
          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.  Research about Victim Recovery and the Community-Wide Harm  
               Caused by Crime

          The concerns of victims have become increasingly recognized over  
          the past decades.  The TRC model addresses what may be lacking  
          in California's current approach to victims - healing the harm  
          that comes to communities through the commission of crime.  (The  
          Culture of Control, Garland, Univ. of Chicago Press, 2001, pp.  
          11-12.)  Arguably, the TRC program demonstrates that harm to the  
          specific victim of a crime spreads through the community.  This  
          is especially true in relatively poor and marginal communities  
          where residents have limited access to, and perhaps some  
          discomfort with, medical care and counseling.  A victim who  
          loses a job because he or she is too traumatized to work may be  









          SB 1404  (Leno )                                          PageL  
          of?
          
          the sole support for more than one generation of relatives.   
          Younger relatives of such victims may stop attending school and  
          become delinquent.  Untreated victims may seek retribution,  
          especially those who live in areas where the police are not  
          trusted.  Retribution will lead to more victims.  Untreated  
          victims often turn to drugs and alcohol, which further damages  
          the victim and his or her community.

          Recent research shows that crime can be seen as equivalent to a  
          disease process.<1>  Recent studies have even shown that public  
          health research methods can predict where and when violence will  
          occur.<2>  It is clear that crime, especially violent crime,  
          causes trauma and stress, which often leads to depression and  
          loss of employment, which in turn prevents crimes victim from  
          adequately caring for their families, which leads to truancy,  
          delinquency, illness and so on. <3>  Violent crime victims in  
          minimally functioning communities typically rely on retaliation,  
          not the justice system.  In broken communities with gang  
          problems, most residents do not trust the justice system.  Law  
          enforcement can be seen as an occupying or invading army, not a  
          source of protection.  Retaliation crimes create an increasing  
          cycle of violence.  The disease process spreads and essentially  
          metastasizes.   

          The study on Adverse Childhood Experiences (ACE) jointly  
          conducted by the Kaiser Foundation and the Centers for Disease  
          control interviewed 17,000 Kaiser patients from 1995-1997.<4>   
          The landmark study showed that childhood abuse, neglect and  
          exposure to trauma is clearly associated with a wide range of  
          physical and mental health problems throughout a person's life.  
          TRC programs can intervene or interrupt cycles of trauma and  
          harm that plague high-crime communities. 

          7.  Author's Amendments from Health Committee Hearing
          ---------------------------

          <1> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684449/

          <2>  
          http://msutoday.msu.edu/news/2012/homicide-spreads-like-infectiou 
          s-disease/

          <3> http://www.ncbi.nlm.nih.gov/books/NBK262831/

          <4> http://www.cdc.gov/violenceprevention/acestudy/findings.html








          SB 1404  (Leno )                                          PageM  
          of?
          

          At the suggestion of Senate Health Committee, the author  
          proposes that the bill be amended at the hearing in this  
          committee to do the following:

          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 bill should be amended 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.

          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.
          

                                      -- END -