BILL ANALYSIS                                                                                                                                                                                                    



                                                                  SB 367
                                                                  Page  1

          Date of Hearing:   August 13, 2013

                        ASSEMBLY COMMITTEE ON HUMAN SERVICES
                                  Mark Stone, Chair
                      SB 367 (Block) - As Amended:  May 28, 2013

           SENATE VOTE  :  38-0
           
          SUBJECT  :  Developmental services:  regional centers: cultural  
          and linguistic competency

           SUMMARY  :  Includes issues related to cultural and linguistic  
          competency in regional center governing board training  
          requirements. 

          Specifically,  this bill  :

          1)Adds issues relating to linguistic and cultural competency to  
            the training and support a regional center is required to  
            provide to its governing board members.

          2)Requires each regional center to post information regarding  
            the training and support provided to governing board members  
            on its Internet Web site.

          3)Requires a governing board's annual performance review of the  
            regional center director to include an evaluation of the  
            director's performance in providing regional center services  
            that are linguistically and culturally appropriate.

           EXISTING LAW 

          1)Establishes an entitlement to services for individuals with  
            developmental disabilities under the Lanterman Developmental  
            Disabilities Services Act (Lanterman Act).  (WIC 4500 et seq.)

          2)Grants all individuals with developmental disabilities, among  
            all other rights and responsibilities established for any  
            individual by the United States Constitution and laws and the  
            California Constitution and laws, the right to treatment and  
            habilitation services and supports in the least restrictive  
            environment.  (WIC 4502)

          3)Establishes a system of 21 nonprofit regional centers  
            throughout the state to identify needs and coordinate services  








                                                                  SB 367
                                                                  Page  2

            for eligible individuals with developmental disabilities, and  
            requires the Department of Developmental Services (DDS) to  
            contract with the regional centers to provide case management  
            services and arrange for or purchase services that meet the  
            needs of individuals with developmental disabilities, as  
            defined.  (WIC 4620 et seq.)

          4)Requires the governing board of each regional center to meet  
            specified criteria, including that board members must be  
            individuals with demonstrated interest in, or knowledge of,  
            developmental disabilities; each board must reflect the  
            geographic and ethnic characteristics of the regional center  
            catchment area; and at least 25% of board membership must be  
            persons with developmental disabilities.  (WIC 4622)

          5)Requires the governing board of each regional center to  
            annually submit detailed documentation to DDS demonstrating  
            that the composition of the board meets the criteria  
            established in WIC 4622.  (WIC 4622.5)

          6)Sets forth specific requirements and annual performance  
            objectives for contracts between DDS and regional centers.   
            (WIC 4629) 

          7)Provides that each contract between DDS and a regional center  
            must include a requirement that the regional center adopt,  
            maintain, and post on its Internet Web site a board-approved  
            policy regarding transparency and access to public  
            information, and requires that policy to provide, at a  
            minimum, information regarding requests for proposals, service  
            provider rates, documentation related to establishment of  
            negotiated rates, audits, and other forms, as specified.  (WIC  
            4629.5)

          8)Creates a process by which regional centers may "vendorize"  
            service providers, thereby providing a path to contract for  
            services with that provider.  (WIC 4648 (a)(3)) 

           FISCAL EFFECT  :  According to the Senate Appropriations  
          Committee, this bill will result in minor costs to the regional  
          centers to provide additional training (General Fund). 

           COMMENTS  :  This bill is part of a package of legislation that  
          was developed as a result of a 2012 hearing of the Senate Select  
          Committee on Autism & Related Disorders focused on disparities  








                                                                  SB 367
                                                                  Page  3

          in services provided to underserved communities.  It seeks to  
          address inconsistencies in consumer access to services and  
          supports, as well as regional center spending on consumers, by  
          ensuring regional center governing boards and regional center  
          directors are sensitive to the linguistic and cultural needs of  
          the consumers served in their respective catchment areas.

           Background  :  The Lanterman Act guides the provision of services  
          and supports for Californians with developmental disabilities.   
          Each individual under the Act, typically referred to as a  
          "consumer," is legally entitled to treatment and habilitation  
          services and supports in the least restrictive environment.   
          Lanterman Act services are designed to enable all consumers to  
          live more independent and productive lives in the community.  

          The term "developmental disability" means a disability that  
          originates before an individual attains 18 years of age, is  
          expected to continue indefinitely, and constitutes a substantial  
          disability for that individual.  It includes intellectual  
          disabilities, cerebral palsy, epilepsy, and autism spectrum  
          disorders (ASD).  Other developmental disabilities are those  
          disabling conditions similar to an intellectual disability that  
          require treatment (i.e., care and management) similar to that  
          required by individuals with intellectual disabilities.  This  
          does not include conditions that are solely psychiatric or  
          physical in nature, and the conditions must occur before age 18,  
          result in a substantial disability, be likely to continue  
          indefinitely, and involve brain damage or dysfunction.  Examples  
          of conditions might include intracranial neoplasms, degenerative  
          brain disease or brain damage associated with accidents. 

           Regional centers  :  The Department of Developmental Services  
          (DDS) contracts with 21 regional centers throughout the state,  
          which are private nonprofit entities, to carry out many of the  
          state's responsibilities under the Lanterman Act.  The regional  
          center caseload is comprised of 260,000 consumers who receive  
          services such as residential placements, supported living  
          services, respite care, transportation, day treatment programs,  
          work support programs, and various social and therapeutic  
          activities.  While most individuals receive treatment and  
          services in the community, 1,600 consumers reside at one of  
          California's four Developmental Centers-and one state-operated,  
          specialized community facility-which provide 24-hour  
          habilitation and medical and social treatment services.









                                                                  SB 367
                                                                  Page  4

          Services provided to consumers with developmental disabilities  
          are determined through an individualized planning process.   
          Under this process, planning teams-which include, among others,  
          the consumer, his or her legally authorized representative, and  
          one or more regional center representatives-jointly prepare an  
          Individual Program Plan (IPP) based on the consumer's needs and  
          choices.  The Lanterman Act requires that the IPP promote  
          community integration and maximize opportunities for each  
          consumer to develop relationships, be part of community life,  
          increase control over his or her life, and acquire increasingly  
          positive roles in the community.  

           Need for the bill  :  A four-part 2011 Los Angeles Times series  
          focused on autism included a report titled "Warrior Parents Fare  
          Best in Securing Autism Services," which addressed inequalities  
          in access to developmental services among families from  
          different regions and demographic groups.  Among the conclusions  
          drawn based on the reporter's research, as indicated by the  
          title of the report, was that parents who fight harder for their  
          children gain more services.  This creates a number of  
          disparities within the regional center system, as all children  
          who are determined to need regional center services based on  
          their assessments and diagnoses are entitled to such services.   
          Also revealed in the report was that the "fighter" parents tend  
          to be sophisticated, wealthier white parents who have the time  
          and resources needed to navigate the bureaucracy that stands  
          between their children and necessary services.  On the other  
          hand, parents who work multiple jobs, for example, with  
          linguistic and cultural barriers that don't allow them to  
          navigate the system as easily, can find it nearly impossible to  
          get their children the effective services they need in a timely  
          manner. 

          Prompted, in part, by the Los Angeles Times series, the Senate  
          Select Committee on Autism and Related Disorders held an  
          informational hearing in April 2012 to discuss questions  
          surrounding equal access to regional center services for  
          consumers with autism spectrum disorders.  An outcome of the  
          hearing was the creation of a 20-member Taskforce on Equity and  
          Diversity for Regional Center Autism Services, which was charged  
          with developing 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.  The report, "A Preliminary Report by  
          the Taskforce on Equity and Diversity for Regional Center Autism  








                                                                  SB 367
                                                                  Page  5

          Services," was published on March 18, 2013, and identified a  
          number of recommendations for changes to current practice within  
          the developmental services system.  Among them was a specific  
          recommendation for regional centers to implement  
          self-assessments in order to evaluate their own performance in  
          areas of equity, diversity and cultural competency, as well as  
          recommendations for the boards of directors of regional centers  
          to receive ongoing training on issues of cultural and linguistic  
          competency.

          July 2013 consumer characteristic data from the Department of  
          Developmental Services shows that 37% of the individuals served  
          by the regional centers are identified as White, whereas 35% are  
          identified as Hispanic just over 6% identify as Asian, 2.4%  
          identify as Filipino, and nearly 10% identify as Black or  
          African American.  While assumptions about the languages spoken  
          by regional center consumers cannot necessarily be made based on  
          this data, the ethnic and cultural diversity represented in the  
          caseload supports the notion that all aspects of the regional  
          center operations and service delivery systems should be  
          linguistically and culturally competent and equitable.

           Arguments in support  :  According to the author, "Regional  
          centers serve the most diverse state in the country. Every  
          regional center has different challenges in serving these  
          communities. It is critical that they understand the barriers  
          that communities have in getting these services. SB 367 seeks to  
          increase the training the board of directors receives related to  
          these barriers, with the goal of increasing services to the most  
          underserved people in the state.  Furthermore, SB 367 requires  
          directors to be evaluated on their performance in providing  
          services to these communities to increase transparency and  
          accountability, and to better understand the barriers that  
          families face in receiving services from regional centers."

           Arguments in opposition  :  The Association of Regional Center  
          Agencies has raised a number of concerns about the current  
          language in the bill.  These include concerns about prescribing  
          training standards for one particular type of board of directors  
          out of an array of similar boards of entities that contract with  
          the state; a concern that and evaluation of linguistic and  
          cultural competency may be too subjective to attain; and they  
          raise a question about whether the Legislature should be  
          dictating internal performance review practices.
           








                                                                 SB 367
                                                                  Page  6

          RECOMMENDED AMENDMENTS
           The May 28, 2013 amendments to this bill require the annual  
          review of a regional center director's performance by the  
          governing board to include an assessment of the director's  
          performance in providing services that are linguistically and  
          culturally appropriate.  While a regional center director  
          oversees regional center operations and provides guidance to  
          regional center staff on the manner in which they should provide  
          services to consumers and their families, evaluating the  
          director's performance in this aspect of service delivery would  
          be subjective from one regional center to the next and may not  
          shed any light on whether daily interactions with consumers are  
          linguistically and culturally appropriate.  The author may wish  
          to clarify the language in the bill to, instead, require the  
          governing board to review the regional center's overall  
          performance in providing linguistically and culturally  
          appropriate services, and allow the governing board to provide  
          recommendations to the regional center director based on the  
          results of that review.
           
           Staff recommends the following amendments, in mock-up form  
          below, beginning on page 3, line 21 of the bill:
           
           21 (j) (1) The governing board shall annually review the  
          performance 
          22 of the director of the regional center.  This performance  
          review 
          23 shall include an evaluation of the director's performance in 
          24 providing regional center services that are linguistically  
          and 
          25 culturally appropriate.  
          (2) The governing board shall annually review the performance of  
          the regional center in providing services that are  
          linguistically and culturally appropriate and may provide  
          recommendations to the director of the regional center based on  
          the results of that review.
          26 (k) No member of the board who is an employee or member of 
          27 the governing board of a provider from which the regional  
          center 
          28 purchases client services shall do any of the following: 
          29 (1) Serve as an officer of the board. 
          30 (2) Vote on any fiscal matter affecting the purchase of  
          services 
          31 from any regional center provider. 
          32 (3) Vote on any issue other than as described in paragraph  








                                                                  SB 367
                                                                  Page  7

          (2), 
          33 in which the member has a financial interest, as defined in  
          Section 
          34 87103 of the Government Code, and determined by the regional 
          35 center board. The member shall provide a list of his or her  
          financial 
          36 interests, as defined in Section 87103, to the regional  
          center board. 
          37 Nothing in this section shall prevent the appointment to a 
          38 regional center governing board of a person who meets the  
          criteria 
          39 for more than one of the categories listed above.
          40  This section shall become operative on July 1, 1999.  

           CURRENT RELATED LEGISLATION :

          SB 158 (Correa) authorizes the establishment of the Regional  
          Center Excellence in Community Autism Partnerships (RE CAP)  
          pilot program to improve regional center services, supports,  
          interventions, and other resources to assist regional center  
          consumers with ASD living in underserved communities.
           
           SB 208 (Lara) requires 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 555 (Correa) requires 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 are otherwise completed in a culturally and  
          linguistically competent manners. 

          AB 1232 (V. Manuel Perez) requires 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 equity and diversity.

           REGISTERED SUPPORT / OPPOSITION  :

           Support 
           
          Autism Care and Treatment (ACT)
          Autism Research Group
          Center for Autism and Related Disorders (CARD)
          Public Counsel's Children's Rights Project








                                                                  SB 367
                                                                  Page  8

          The Help Group
           
            Opposition 
           
          Association of Regional Center Agencies (ARCA)

           Analysis Prepared by  :    Myesha Jackson / HUM. S. / (916)  
          319-2089