BILL ANALYSIS Ó 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