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  

                                                         Continued---




          STAFF ANALYSIS OF SENATE BILL 367 (Block)               
          PageB


          
               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,  





          STAFF ANALYSIS OF SENATE BILL 367 (Block)               
          PageC


          
               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:





          STAFF ANALYSIS OF SENATE BILL 367 (Block)               
          PageD


          

                  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.





          STAFF ANALYSIS OF SENATE BILL 367 (Block)               
          PageE


          
           
           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  





          STAFF ANALYSIS OF SENATE BILL 367 (Block)               
          PageF


          
          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)





          STAFF ANALYSIS OF SENATE BILL 367 (Block)               
          PageG


          

          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








          STAFF ANALYSIS OF SENATE BILL 367 (Block)               
          PageH


          
               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.







          STAFF ANALYSIS OF SENATE BILL 367 (Block)               
          PageI


          
          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  





          STAFF ANALYSIS OF SENATE BILL 367 (Block)               
          PageJ


          
                 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






                                   -- END --