BILL ANALYSIS                                                                                                                                                                                                    



                                                                    SB 1404


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          Date of Hearing:   June 28, 2016


                            ASSEMBLY COMMITTEE ON HEALTH


                                   Jim Wood, Chair


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


          SENATE VOTE:  39-0


          SUBJECT:  Victims of violent crimes:  trauma recovery centers.


          SUMMARY:  Recognizes the Trauma Recovery Center at San Francisco  
          General Hospital, University of California, San Francisco (UCSF  
          TRC) as the State Pilot Trauma Recovery Center (State Pilot  
          TRC), and requires the California Victims Compensation and  
          Government Claims Board (CVCGC Board) to use the model developed  
          by the State Pilot TRC when it establishes additional trauma  
          recovery centers.   Specifically, this bill:  


          1)Recognizes the UCSF TRC as the State Pilot TRC, and requires  
            the CVCGC Board to use the 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 Safe  
            Neighborhoods and Schools Fund (SNS Fund) to do all of the  
            following:










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             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  
               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  








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               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,  








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               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  
               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;












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             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)Specifies that these provisions do not apply to the University  
            of California unless the Regents pass resolution agreeing to  
            do so.



          7)Requires the CVCGC Board to create an advisory committee to  
            advise it on matters pertaining to the administration of funds  








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            designated for use at TRCs.



          8)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.



          9)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.



          10)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. 

          11)Prohibits anything in this bill from prohibiting, limiting,  








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            or otherwise preventing the CVCGC Board from consulting with  
            additional experts in the performance of its duties.



          12)Eliminates a provision that restricted the CVCGC Board from  
            awarding a TRC more than one grant for any period of time.



          13)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  
            California will have increased access to needed services.






          EXISTING LAW:  


          1)Establishes the 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  








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            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 Fund (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% 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% 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.


          FISCAL EFFECT:  According to the Senate Appropriations  
          Committee:





          1)Administrative costs:  Annual costs of $925,000 (Special  
            Fund*/General Fund**) to the CVCGC Board to review and  








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            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.

          2)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.  





          3)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










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

          COMMENTS:


          1)PURPOSE OF THIS BILL.  According to the author, this bill  
            creates clear guidelines for the provision of TRC services  
            administered by the CVCGC Board, and that 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.  The author  
            states that survivors of crime who received services through  
            the TRC saw significant increases in health and wellness, for  
            example 74% of those served showed an improvement in mental  
            health, and 51% demonstrated an improvement in physical  
            health.  The author contends that TRC services have also  
            improved community engagement and public safety, pointing out  
            that 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.  

          2)BACKGROUND.  


             a)   TRCs.  TRCs are centers that directly assist victims in  
               coping with a traumatic event (such as by providing mental  
               health care and substance use treatment).  For example,  
               victims may receive weekly counseling sessions with a  
               licensed mental health professional at a TRC for a  
               specified amount of time.  The centers also sometimes help  
               victims connect with other services provided in their  
               community and by the state.  While some of the TRCs existed  
               before receiving grants from CVCGC Board, the board first  
               began funding TRCs in 2001 with a grant to the San  
               Francisco TRC.  Since then, three other TRCs have also  








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               received state funding-one in Long Beach and two in Los  
               Angeles.  Currently, CVCGC Board provides a total of $2  
               million annually in grants to four TRCs located in San  
               Francisco, Long Beach, and two in Los Angeles.



             b)   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 appropriately 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.
               Beginning in 2016-17, funding for TRCs will increase  
               significantly as a result of Proposition 47, passed by  
               voters in November 2014.  Proposition 47 reduces the  
               penalties for certain crimes, which will result in state  
               savings, mainly by reducing the number of inmates in state  
               prisons.  Under the measure, these savings will be  
               deposited into a special fund with 10% of the funds  
               provided to CVCGC Board for TRCs.  The LAO estimates that  
               Proposition 47 funding for TRCs will likely total between  
               $10 million and $20 million annually beginning in 2016-17.   
               This would reflect an increase in funding for TRCs of  
               roughly five to ten times the current level. 









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          3)SUPPORT.  Californians for Safety and Justice (CFSJ) are the  
            sponsors of this bill and state, the TRC 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.  CFSJ notes that 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.  CFSJ concludes that  
            survivors of crime who received services through the TRC saw  
            huge increases in health and wellness.  



          The California Catholic Conference, Inc. (CCC) supports this  
            bill and notes that victims must navigate an often difficult  
            and bureaucratic process in accessing state services,  
            involving multiple agencies across different locations.  CCC  
            states that if a victim is ultimately approved for state  
            support, they may wait three months or more to access funds to  
            help cover the costs of critical services.  CCC notes the TRC  
            treatment model was developed in 2001 to address multiple  
            barriers victims face recovering from crime, and in order to  
            ensure these same outstanding outcomes and savings, and to  
            ensure fidelity to the TRC model, clear guidelines must be  
            added to the statute governing the grant program.
          4)PREVIOUS LEGISLATION.  


             a)   SB 518 (Leno), of 2015 would have required the CVCGC  
               Board to use a specified evidence-based model when giving a  
               grant to a TRC, as specified.  SB 518 was held in the  
               Assembly Appropriations Committee.  











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

             c)   SB 733 (Leno), of the 2009-10 legislative session, would  
               have authorized the CVCGC 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.


          REGISTERED SUPPORT / OPPOSITION:




          Support


          Californians for Safety and Justice (sponsor)










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          Kamala D. Harris, Attorney General, State of California
          California Catholic Conference, Inc.
          Crime Victims United of California
          Fathers & Families of San Joaquin
          Natividad Medical Center


          San Francisco Department of Public Health
          Society for Social Work Leadership in Health Care, California  
          Chapter


          University of California
          One individual




          Opposition


          None on file.




          Analysis Prepared by:Lara Flynn / HEALTH / (916)  
          319-2097