BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Leland Y. Yee, Chair
BILL NO: SB 367
S
AUTHOR: Block
B
VERSION: April 1, 2013
HEARING DATE: April 9, 2013
3
FISCAL: Yes
6
7
CONSULTANT: Mareva Brown
SUBJECT
Developmental services: regional centers: cultural and
linguistic competency
SUMMARY
This bill requires Regional Centers to develop a Regional
Center Study and Planning Process for Equity and Cultural
and Linguistic Competency (RESPECT) to oversee issues
related to cultural and linguistic competency of regional
center and vendor staff, as specified; requires that
findings of RESPECT be updated every two years; permits a
regional center's board of directors to fulfill the duties
of the RESPECT group, as specified.
ABSTRACT
Existing law
1) Establishes the Lanterman Developmental
Disabilities Services Act, which states
that California is responsible for providing an array
of services and supports sufficient to meet the needs
and choices of each person with developmental
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disabilities, regardless of age or degree of
disability, and at each stage of life and to support
their integration into the mainstream life of the
community. (WIC 4500, et seq.)
2) Establishes a system of nonprofit Regional Centers
to provide fixed points of contact in the community
for all persons with developmental disabilities and
their families, to coordinate services and supports
best suited to them throughout their lifetime. (WIC
4620)
3) Establishes that in order to contract with the
state, a regional center must have a governing board
that conforms to specific criteria, which include:
a. It shall be composed of individuals with
demonstrated interest in, or knowledge of,
developmental disabilities.
b. Its membership shall include persons with
legal, management, public relations, and
developmental disability program skills.
c. Membership shall include representatives
of the various categories of disability to be
served by the regional center.
d. The governing board shall reflect the
geographic and ethnic characteristics of the area
to be served by the regional center. (WIC 4622)
4) Creates a process by which service providers may
"vendorize" service providers, thereby providing a
path to contract for services with that provider. (WIC
4648 (a) (3))
5) Requires DDS, in cooperation with the regional
centers, to ensure that all providers of services and
supports are informed about their responsibility to
comply with conditions of any contract between the
department or regional center and the provider. (WIC
4648.1 (c))
6) Requires, as a condition of satisfying their
contracts with DDS, regional centers to adopt,
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maintain and post on their websites, a board-approved
policy regarding transparency and access to public
information. The policy shall provide for timely
public access to contract information, service
provider rates, documentation related to establishment
of negotiated rates, audits, and other information, as
specified. (WIC 4629.5)
This bill
1) Declares legislative intent for the Department of
Developmental Services (DDS) to require regional
centers to address issues of cultural and linguistic
competency.
2) Requires regional centers to develop a Regional
Center Study and Planning Process for Equity and
Cultural and Linguistic Competency (RESPECT), which
shall address issues, outcomes and monitoring relating
to culturally and linguistically competent services
and other factors that promote equity, fairness and
diversity for underserved populations.
3) Requires that the findings and recommendations
contained in RESPECT shall be updated, at least every
two years, and shall include, but not be limited to:
a. Cultural and linguistic competency staff
training.
b. A requirement that a provider include in
its vendor application to the regional center
information about the language capabilities of
its staff and its ability to provide services in
a culturally and linguistically competent manner.
4) Requires regional centers to establish an Advisory
Board for Leadership and Equity (ABLE) to promote
partnerships between regional centers and
community-based organizations, including, but not
limited to, providers or provider organizations.
5) Requires the advisory board to seek to accomplish
the following:
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a. Meet at least biannually.
b. Provide annual findings and
recommendations to the board of directors of the
regional center on regional center policies and
procedures that will promote equity, diversity
and cultural and linguistic competency for
consumers and their families.
c. Review and provide input on RESPECT.
6) Provides that a regional center may use an existing
group or organization, including its own board of
directors, to meet the requirements of RESPECT if the
group appropriately reflects the diversity and
cultural background of the regional center catchment
area.
7) Requires that regional centers seek to post
information relating to RESPECT on their Internet web
sites.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill
This bill is one of a package that resulted from an April
2012 Senate hearing on cultural competency within the
Regional Center system, and a subsequent report
recommending changes.
According to the author, SB 367 asks Regional Centers to
develop a RESPECT team to address issues raised in a Los
Angeles Times report from 2011, titled, "Warrior Parents
Fare Best in Securing Autism Services." The article states
that people of color, low income, and socio-economically
disadvantaged communities receive fewer services compared
to their white counterparts, and found that DDS spent an
average of $11,723 per child on whites; $11,063 on Asians;
$7,634 on Latinos, and $6,593 on blacks.
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A key point of the article was that parents who fought
more for their children gained more services. Often, these
parents are wealthier, more sophisticated in navigating
bureaucratic systems, fluent in English, and able to devote
significant time to providing for their children. In
contrast, the author states, parents who work multiple
jobs, single parents, immigrants, those who can't speak
English, and those who have multiple children don't have
the time and/or ability to fight for the services that
their children are legally entitled to receive.
Non-English speaking families also are less likely to seek
regional center services and tend to be more comfortable
going to health clinics or providers who are culturally and
linguistically sensitive to their own race/ethnicity.
Often times, families of individuals who are eligible for
regional center services are engaged with community-based
organizations, which provide services and support to
communities with cultural and linguistic barriers as well
as socio-economic barriers. This measure would also ask the
Regional Centers to promote partnerships with these
community-based organizations to assist in addressing this
issue of access for these communities.
Regional Centers
Regional Centers are part of a system of care overseen by
the Department of Developmental Services (DDS). With a
proposed budget of $4.3 billion for community-based
services in 2013-2014, DDS is responsible for coordinating
care and providing services for more than 250,000 people
with developmental disabilities who receive services and
supports to live in their communities, as well as
approximately 1,560 people who resided in developmental
centers as of March 6, 2013. California's 21 regional
centers are non-profit organizations that provide local
services and supports to individuals through contracts with
DDS.
Historically, the regional centers have been praised for
providing services that are tailored to local needs and
responsive to individuals in communities, and criticized
for their inconsistency across the state. While DDS sets
some common standards, there are variations among regional
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centers in access to services across the regional center
system.
Senate Hearing
The Senate Select Committee on Autism and Related Disorders
held an informational hearing on April 30, 2012, to discuss
questions surrounding equal access to regional center
services for consumers with autism spectrum disorders
(ASD). The hearing was prompted by a series of articles in
the Los Angeles Times in 2011, which explored the different
experiences that families of children with autism had in
accessing services. The articles looked at variations in
services among families with different ethnic backgrounds,
socio-economic status, geography and other factors,
including differences in practices at various regional
centers.
As a result of that hearing, Senate President pro Tempore
Darrell Steinberg created a 20-member Taskforce on Equity
and Diversity for Regional Center Autism Services, which
was charged with finding recommendations to ensure that
consumers of regional center services receive appropriate
and timely supports regardless of race, ethnicity,
educational background and other socio-economic factors. A
119-page report, "A Preliminary Report by the Taskforce on
Equity and Diversity for Regional Center Autism Services,"
was published on March 18, 2013, and identified 19
recommended changes to practice within the Developmental
Services system.
Included in those recommendations was:
That DDS should require regional centers to develop
a Regional Center Strategic Plan for Equity and
Cultural and Linguistic Competency (RESPECT) which
shall address issues, outcomes and monitoring related
to culturally and linguistically competent services
and other factors that promote equity, fairness and
diversity.
That the findings and recommendations in the plan
be updated at a minimum of every two years and include
staff training, vendor requirements and data updates.
(p 21-22)
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The task force also noted that DDS and regional centers
should build more effective community-based partnerships
with health and other providers that already serve
consumers in underserved communities. Some examples from
the report include the promotoras community health model in
Latino communities, faith-based groups and other
grass-roots organizations. These providers could serve as
ambassadors for families who might not otherwise seek or
obtain services. (p 22-23)
Access to Health Care Services
The U.S. Department of Health and Human Services Office of
Minority Health has issued 14 standards for health
organizations to ensure Culturally and Linguistically
Appropriate Services (CLAS). In 2001, the Office of
Minority Health released a report<1> which identified
adoption of CLAS standards as a way to correct inequities
that currently exist in the provision of health services,
and to make these services more responsive to the
individual needs of all patients/consumers.
Standards are intended to be inclusive of all cultures and
not limited to any particular population group or sets of
groups. However, they are especially designed to address
the needs of racial, ethnic, and linguistic population
groups that experience unequal access to health services.
"The CLAS standards ? provide a common understanding
and consistent definitions of culturally and
linguistically appropriate services in health care.
They offer a practical framework for the
implementation of services and organizational
structures that can help health care organizations and
providers be responsive to the cultural and linguistic
----------------------
<1>
http://minorityhealth.hhs.gov/assets/pdf/checked/executive.p
df
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issues presented by diverse populations."<2>
Related Legislation
This bill is part of a package of legislation drafted from
recommendations in the Taskforce's report, all focusing on
improving cultural and linguistic competency among regional
center staff and providers. Other bills in this 2013
package include:
SB 158 (Correa) would establish a pilot project coordinated
by a major university to identify underserved communities
in regional center catchment areas and improve Autism
identification and services in those communities.
SB 208 (Lara) would require that a request for proposal
prepared by DDS or a regional center that relates to
consumer services and supports include a section on equity
and diversity.
SB 319 (Price) would require DDS to ensure that the
regional centers collect, analyze, and report data in a way
that allows for comparisons across regional centers, and
requires regional centers to identify plans to reduce
disparities that are identified.
SB 321 (Price) would require DDS to establish performance
contract guidelines and measures relating to issues of
cultural and linguistic competency.
SB 555 (Correa) would require that communication about
assessment, individual program plans and other critical
documents and processes be done in a consumer or family
member's native language and other culturally and
linguistically competent manners.
AB 1232 (V. Manuel Perez) would require the existing DDS
quality assurance instrument to assess the provision of
services in a linguistically and culturally competent
manner and include an outcome-based measure on issues of
-------------------------
<2> US Department of Health and Human Services, Office of
Minority Health, "National Standards for Culturally and
Linguistically Appropriate Services in Health Care," March
2001, page ix.
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equity and diversity.
Comments
This bill attempts to address a number of broadly stated
objectives, some of which are covered in other bills within
this package. For example, SB 208 would require that a
request for proposals (RFP) that is prepared by DDS or a
regional center and that relates to consumer programs or
services and supports shall include a section on issues of
equity and diversity, and provides detail about how that
must occur.
To avoid overlap with other bills, and to more precisely
define the objectives within this bill, staff recommends
narrowing the scope of this bill to require the existing
regional center governing boards to perform the duties
described in the RESPECT and ABLE language of this bill.
These boards already are required by current law to reflect
the ethnic and cultural makeup of their geographic
catchment areas.
Specifically, staff recommends deleting the existing
language of the bill and replacing it with the following
amendments:
As a condition of its contract, each regional center's
governing board shall:
1) Require the regional center's executive director,
or proxy, to provide an annual report on the center's
efforts to address issues of inequity in access to
services, including but not limited to:
a) A description of the utilization of various
regional center services, broken down by ethnic and
other demographic data annually.
b) Identification of barriers to services.
c) A description of specific progress made toward
identifying and providing services to underserved
populations within the prior year, including
identifying innovative practices by a regional
center or its contracted community-based
organizations.
d) Efforts made to build partnerships between
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community-based providers of other services for
regional center consumers who are in underserved
communities.
1) Require regional centers to post information
related to the annual report on its Internet web site,
whenever possible.
POSITIONS
Support: None received
Oppose: None received
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