BILL ANALYSIS                                                                                                                                                                                                    






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          |SENATE RULES COMMITTEE            |                       SB 1404|
          |Office of Senate Floor Analyses   |                              |
          |(916) 651-1520    Fax: (916)      |                              |
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                                   THIRD READING 


          Bill No:  SB 1404
          Author:   Leno (D)
          Amended:  5/31/16  
          Vote:     21 

           SENATE HEALTH COMMITTEE:  9-0, 4/6/16
           AYES:  Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,  
            Pan, Roth, Wolk

           SENATE PUBLIC SAFETY COMMITTEE:  7-0, 4/19/16
           AYES:  Hancock, Anderson, Glazer, Leno, Liu, Monning, Stone

           SENATE APPROPRIATIONS COMMITTEE:  7-0, 5/27/16
           AYES:  Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen

           SUBJECT:   Victims of violent crimes: trauma recovery centers


          SOURCE:    Californians for Safety and Justice

          DIGEST:   This bill 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.


          ANALYSIS:  


          Existing law:








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           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 for these grants.


           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 non-serious,  
             non-violent crime, and to invest the savings generated from  
             this Act into 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 TRCs  
             to provide services to victims of crime; and, 65 percent to  







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             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  
             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, 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  







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                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 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 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 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 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  







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                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% of the  
             total funds it receives from the SNS Fund on an annual basis  
             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.


           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 TRCs.








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


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


              a)    One representative from each TRC 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 TRC.


           9) Requires the advisory committee 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 TRC 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  
             these services will be delivered in a clinically effective  
             and cost-effective manner, and that the victims of crime in  







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             California will have increased access to needed services.


          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  
            health.







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          2)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, non-serious drug and property crimes, and  
            requiring that the resulting savings be spent on (a) mental  
            health and substance abuse treatment services, (b) truancy and  
            dropout prevention, and (c) 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.


          3)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.










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          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   No


          According to the Senate Appropriations Committee:

           Administrative costs:  Annual costs of $925,000 (Special  
            Fund*/General Fund**) to the CVCGC Board to review and  
            evaluate TRC grant applications, facilitate advisory committee  
            activities, secure an evaluation contractor (potentially UC)  
            and submit annual reports to the Legislature. Administrative  
            costs payable from the SNS Fund would be limited to five  
            percent of the SNS Fund funds received annually.

           TRC grants:  Major future grant awards in the millions of  
            dollars (Special Fund*/General Fund**) annually provided to  
            TRCs meeting specified criteria, including the potential for  
            the issuance of multiple awards to a single TRC with  
            overlapping grant periods. In addition to the $2 million  
            annual appropriation from the Restitution Fund, the LAO has  
            projected annual disbursements from the SNS Fund to the CVCGC  
            Board in the range of $10 million to $20 million to fund TRC  
            grants. The Restitution Fund is structurally imbalanced. In  
            light of the dedicated funding source for TRCs provided by  
            Proposition 47 (2014), removal or reduction of the annual  
            appropriation from the Restitution Fund may be considered in  
            the future.  

           University of California (TR-COE) activities:  To the extent  
            the UC resolves to enter into the agreement, significant  
            ongoing costs (Private/Local Fund/Federal Fund/Special Fund*)  
            to comply with the requirements of the agreement including but  
            not limited to providing training materials, ongoing  
            consultation to the CVCGC Board and TRCs, and designing a  
            multisite evaluation to measure effectiveness of TRCs. Staff  
            notes the use of SNS Fund funds awarded as TRC grants may not  
            be allowable for the aforementioned activities to the extent  
            the activities do not "provide services to victims of crime,"  
            but are considered administrative in nature. 

          *Restitution Fund
          ** Safe Neighborhoods and Schools Fund (annual transfer from the  
          General Fund)







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          SUPPORT:   (Verified  5/31/16)

          Californians for Safety and Justice (source)
          California Catholic Conference, Inc.
          California Department of Justice
          Crime Victims United of California
          Fathers & Families of San Joaquin
          University of California
          University of California Berkeley, School of Social Welfare
          Society for Social Work Leadership in Health Care California  
                    Chapter
          San Francisco Department of Public Health
          Three individuals


          OPPOSITION:   (Verified5/31/16)


          None received

          ARGUMENTS IN 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 innovative  
          public responses to interpersonal violence, and that given the  
          effectiveness of this model, strongly supports this bill.
          
          Prepared by:Vince Marchand / HEALTH / (916) 651-4111
          5/31/16 20:58:26


                                   ****  END  ***


          







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