BILL ANALYSIS                                                                                                                                                                                                    



                                                                    SB 1404


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          Date of Hearing:  June 21, 2016


          Counsel:               Gabriel Caswell








                         ASSEMBLY COMMITTEE ON PUBLIC SAFETY


                       Reginald Byron Jones-Sawyer, Sr., Chair





          SB  
          1404 (Leno) - As Amended May 31, 2016





          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.   
          Specifically, this bill:  


          1)Provides that the Trauma Recovery Center at the San Francisco  
            General Hospital, University of California, San Francisco is  








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            recognized as the State Pilot Trauma Recovery Center (State  
            Pilot TRC). The California Victim Compensation and Government  
            Claims Board shall 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 pursuant to Section 13963.1. In replicating  
            programs funded by the California Victim Compensation and  
            Government Claims Board, the ITRS can be modified to adapt to  
            different populations, but it shall include the following core  
            elements:


             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, of diverse ethnicity, members of  
               immigrant and refugee groups, disabled, who have severe  
               trauma-related symptoms or complex psychological issues, or  
               juvenile victims, including minors who have had contact  
               with the juvenile dependency or justice system.


             b)   Victims of a wide range of crimes, including, but not  
               limited to, victims of sexual assault, domestic violence,  
               physical assault, shooting, stabbing, and vehicular  
               assault, human trafficking, and family members of homicide  
               victims.


             c)   A structured evidence-based program of mental health and  
               support services provided to victims of violent crimes or  
               family members of homicide victims that includes crisis  
               intervention, individual and group treatment, medication  
               management, substance abuse treatment, case management, and  
               assertive outreach. This care shall be provided in a manner  
               that increases access to services and removes barriers to  
               care for victims of violent crime. This includes providing  
               services in the client's home, in the community, or other  
               locations outside the agency.








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             d)   Staff shall include a multidisciplinary team of  
               integrated trauma specialists that includes psychiatrists,  
               psychologists, and social workers. The integrated trauma  
               specialist shall be a licensed clinician, or a supervised  
               clinician engaged in completion of the applicable licensure  
               process. Clinical supervision and other supports are  
               provided to staff on a weekly basis to ensure the highest  
               quality of care and to help staff deal constructively with  
               vicarious trauma.


             e)   Psychotherapy and case management shall be provided by a  
               single point of contact for the client, that is an  
               individual trauma specialist, with support from an  
               integrated trauma treatment team. In order to ensure the  
               highest quality of care, the treatment team shall  
               collaboratively develop treatment plans in order to achieve  
               positive outcomes for clients.


             f)   Services shall include assertive case management,  
               including, but not limited to, a trauma specialist  
               accompanying the client to court proceedings, medical  
               appointments, or other community appointments as needed.  
               Case management services shall include, but not be limited  
               to, assisting clients file victim compensation  
               applications, file police reports, help with obtaining safe  
               housing and financial entitlements, linkages with medical  
               care, assistance in return to work, liaison with other  
               community agencies, law enforcement, and other support  
               services as needed.


             g)   Clients shall not be 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  








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               anxiety.


             h)   Trauma recovery services shall incorporate 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)   The goals of a trauma recovery center shall be to  
               decrease psychosocial distress, minimize long-term  
               disability, improve overall quality of life, reduce the  
               risk of future victimization, and promote post-traumatic  
               growth.


             j)   In order to ensure that clients are receiving targeted  
               and accountable services, treatment shall be provided up to  
               16 sessions. For those with ongoing problems and a primary  
               focus on trauma, treatment may be extended after special  
               consideration with the clinical supervisor. Extension  
               beyond 32 sessions shall require approval by a clinical  
               steering and utilization group that considers the client's  
               progress in treatment and remaining need.


          2)Finds and declares the following:  


             a)   Victims of violent crime may benefit from access to  
               structured programs of practical and emotional support.  
               Research shows that evidence-based trauma recovery  
               approaches are more effective, at a lesser cost, than  
               customary fee-for-service programs. State-of-the-art  
               fee-for-service funding increasingly emphasizes funding  
               best practices, established through research, that can be  
               varied but have specific core elements that remain constant  
               from grantee to grantee. The public benefits when  








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               government agencies and grantees collaborate with  
               institutions with expertise in establishing and conducting  
               evidence-based services.


             b)   The Trauma Recovery Center at San Francisco General  
               Hospital, University of California, San Francisco (UCSF  
               TRC), is an award-winning, nationally recognized program  
               created in 2001 in partnership with the California Victim  
               Compensation and Government Claims Board. The UCSF TRC is  
               hereby recognized as the State Pilot Trauma Recovery Center  
               (State Pilot TRC). The State Pilot TRC was established by  
               the Legislature as a four-year demonstration project to  
               develop and test a comprehensive model of care as an  
               alternative to fee-for-service care reimbursed by victim  
               restitution funds. It was designed to increase access for  
               crime victims to these funds.


             c)   The results of this four-year demonstration project have  
               established that the State Pilot TRC model was both  
               clinically effective and cost effective when compared to  
               customary fee-for-service care. Seventy-seven percent of  
               victims receiving trauma recovery center services engaged  
               in mental health treatment, compared to 34 percent  
               receiving customary care. The State Pilot TRC model  
               increased the rate by which sexual assault victims received  
               mental health services from 6 percent to 71 percent,  
               successfully linked 53 percent to legal services, 40  
               percent to vocational services, and 31 percent to safer and  
               more permanent housing. Trauma recovery center services  
               cost 34 percent less than customary care. 



             d)   The Legislature further finds and declares that  
               systematic training, technical assistance, and ongoing  
               standardized program evaluations are needed to ensure that  
               all new state-funded trauma recovery centers are evidence  








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               based, accountable, and clinically effective and cost  
               effective.





          EXISTING LAW:  


          1)Creates the Victims of Crime Program, administered by the  
            Board , 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.)

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

          3)Provides that the Board 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.)

          4)Includes the Safe Neighborhoods and Schools Act of 2014.  As  
            relevant to this bill, the act does the following:  (Gov.  
            Code,  7599-7599.2.)

             a)   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,  








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               a homicide, solicitation of murder and any crime for which  
               the sentence is a life term.

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

             c)   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.

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

               i)     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. 

               ii)    10% to the Victims of Crime Program to fund for  
                 grants to TRCs.

               iii)   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.  

          FISCAL EFFECT:  Unknown.


          COMMENTS: 


          1)Author's Statement:  According to the author, "SB 1404 creates  
            clear guidelines for the provision of Trauma Recovery Center  
            (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  








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            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.  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.  TRC services  
            have also improved community engagement and public safety.  
            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."


          2)Background:  According to the background provided by the  
            author, Senate Bill 1404 creates 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 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  








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            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.

          3)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  








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            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. 


          4)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.


          5)Proposition 47 and Trauma Recovery Center Funding:  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  








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            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.

            According to the California Secretary of State's Web site,  
            59.6 % of voters approved Proposition 47. (See  
            <  http://elections.cdn.sos.ca.gov/sov/2014-general/pdf/2014-comp 
            lete-sov.pdf  > [as of Mar. 14, 2015].)  The purpose of the  
            measure was "to maximize alternatives for nonserious,  
            nonviolent 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."  
            (Ballot Pamp., Gen. Elec. (Nov. 4, 2014), Text of Proposed  
            Laws, p. 70.)  One of the ways the measure created savings was  
            by requiring misdemeanor penalties instead of felonies for  
            nonserious, nonviolent crimes like petty theft and drug  
            possession for personal use, unless the defendant has prior  
            convictions for specified violent crimes. (Ibid.)  

            Four months into its implementation, Proposition 47 has  
            resulted in fewer inmates in state prisons and county jails.   
            According to the Legislative Analysts' Office (LAO), "As of  
            January 28, 2015, the inmate population in the state's prisons  
            was about 113,500, or 3,600
            inmates below the February 2015 cap, and slightly below the  
            final February 2016 cap. The expected impact of Proposition 47  
            on the prison population will make it easier for the state to  
            remain below the population cap."  (LAO, The 2015-16 Budget:  








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            Implementation of Proposition 47 (Feb. 2015), p. 10.)  The LAO  
            report also found that Proposition 47 will likely reduce the  
            costs of criminal justice for counties, by freeing up jail  
            beds and reducing the time probation departments need to  
            follow prisoners after they are released. (Id. at p. 17.)

          6)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.








          7)Argument in Support:  According to Californians for Safety and  
            Justice, "We are pleased to sponsor Senate Bill 1404, which  
            would create programmatic guidelines for the Trauma Recovery  
            Center (TRC) Grant Program and create the TRC Center of  
            Excellence, housed at UC San Francisco, to provide systematic  
            training, technical assistance and ongoing standardized  
            program evaluations to ensure program fidelity.  This bill  








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            would help provide quality trauma recovery services to crime  
            victims across the state.  


            "Californians for Safety and Justice is a nonprofit  
            organization of Californians from diverse sectors joining  
            together to replace prison and justice system waste with smart  
            justice solutions that increase safety and reduce costs.  Our  
            work includes a statewide network of over 5,000 crime victims,  
            Crime Survivors for Safety and Justice, a group that aims to  
            reduce barriers to recovery for crime victims and expand  
            victims' support.  


            "The Trauma Recovery Center model, pioneered in San Francisco  
            in 2001, provides a comprehensive, flexible approach that  
            integrates three modes of service - assertive outreach,  
            clinical case management, and evidence-based trauma-focused  
            therapies.  This model is designed to meet the special 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 under  
            one roof.  Survivors of crime who received services through  
            the TRC saw huge increases in health and wellness - 74% show  
            an improvement in mental health, and 51% demonstrate an  
            improvement in physical health.  TRC services also improved  
            community engagement and public safety.  People who receive  
            services at the TRC are 56% more likely to return to  
            employment, and people who receive services are 44% more  
            likely to cooperate with the district attorney, and 69% more  
            likely to cooperate with law enforcement.  


            "In 2013, a grant program was created to replicate this  
            successful TRC model in other parts of California.  This  
            program, housed at the Victim Compensation and Government  
            Claims Board (VCGCB), totals $2 million annually.  In order to  
            ensure other TRCs have the same outstanding outcomes as the  








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            San Francisco TRC, specific programmatic guidelines must be in  
            place.  SB 518 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."  


          8)Prior Legislation:


             a)   SB 518 (Leno), Required the Victims Compensation and  
               Government Claims Board (Board) to use a specified  
               evidence-based model when giving a grant to a Trauma  
               Recovery Center (TRC), as specified.  SB 518 was held in  
               the Assembly Appropriations Committee.  


             b)   SB 71 (Budget and Fiscal Review), Chapter 28, Statutes  
               of 2013, authorized the Board to administer a program to  
               award, upon appropriation by the Legislature, up to  
               $2,000,000 in grants, annually, to trauma recovery centers,  
               as defined, funded from the Restitution Fund.


             c)   SB 733 (Leno), of the 2009-2010 legislative session,  
               authorized the Board to evaluate 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 failed  
               passage on the Senate Floor.  


             d)   AB 1669 (Leno), of the 2007-08 Legislative Session,  
               would have appropriated $1.5 million for the TRC at the San  
               Francisco General Hospital.  AB 1669 was vetoed.

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








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          REGISTERED SUPPORT / OPPOSITION:




          Support


          Californians for Safety and Justice (sponsor)


          Association of Deputy District Attorneys 


          Association for Los Angeles Deputy Sheriffs 


          California Association of Code Enforcement Officers 


          California Attorney General's Office 


          California Catholic Conference 


          California College and University Police Chiefs Association


          California Narcotic Officers Association  


          Children's Defense Fund 


          Crime Victims United 








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          Fathers and Families of San Joaquin 


          Los Angeles County Professional Peace Officers Association 


          Los Angeles Policy Protective League 


          Natividad Medical Center 


          Riverside Sheriffs Association 


          San Francisco Department of Public Health 


          Society for Social Work Leadership in Health Care, California  
          Chapter 


          University of California 


          University of California at Berkeley School of Social Welfare 




          Opposition


          None  











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          Analysis Prepared by:Gabriel Caswell / PUB. S. / (916)  
          319-3744