BILL ANALYSIS                                                                                                                                                                                                    Ó




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          |SENATE RULES COMMITTEE            |                       AB 1997|
          |Office of Senate Floor Analyses   |                              |
          |(916) 651-1520    Fax: (916)      |                              |
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                                   THIRD READING 


          Bill No:  AB 1997
          Author:   Mark Stone (D) 
          Amended:  8/19/16 in Senate
          Vote:     21 

           SENATE HUMAN SERVICES COMMITTEE:  5-0, 6/28/16
           AYES:  McGuire, Berryhill, Hancock, Liu, Nguyen

           SENATE APPROPRIATIONS COMMITTEE:  6-0, 8/11/16
           AYES:  Lara, Bates, Beall, Hill, McGuire, Mendoza
           NO VOTE RECORDED:  Nielsen

           ASSEMBLY FLOOR:  80-0, 6/1/16 - See last page for vote

           SUBJECT:   Foster care


          SOURCE:    The California Department of Social Services 


          DIGEST:  This bill cleans up elements of AB 403 (Stone, Chapter  
          773, Statutes of 2015), which implemented the Continuum of Care  
          Reform effort. Included in this cleanup are changes to the  
          requirements for mental health certification of a short term  
          residential therapeutic program (STRTP) and modifications to  
          probation placement oversight. It establishes additional  
          protocols around the Resource Family Approval process, which  
          moves from a pilot program to a statewide mandate in January  
          2017. It requires the basic rate paid to all families be the  
          same regardless of approval process and other changes. This bill  
          deletes the option to extend the provisional license of a foster  
          family agency (FFA) or STRTP if it fails to obtain accreditation  
          within specified time frames. It deletes statutory language that  
          will become obsolete when this bill is enacted, such as  
          licensure categories and requirements for group homes, changes  








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          the name of the short term residential treatment center to the  
          STRTP and makes other technical changes.


          Senate Floor Amendments of 8/19/16 resolve chaptering conflicts  
          with AB 1762 (Campos), AB 741 (Williams), SB 524 (Lara), AB 2231  
          (Calderon), AB 1001 (Maienschein), AB 1688 (Rodriguez), SB 1336  
          (Jackson), AB 1702 (Stone), AB 2005 (Ridley-Thomas), AB 1838  
          (Ting), AB 1067 (Gipson), and AB 1849 (Gipson).


          ANALYSIS:  


          Existing law:


          1)Establishes a system of juvenile dependency for children who  
            are or are at risk of being physically, sexually or  
            emotionally abused, being neglected or being exploited to  
            ensure their safety, protection and physical and emotional  
            well-being. (WIC 300, et seq.)


          2)Establishes the licensing category of STRTC --  effective  
            January 1, 2017 -- and defines it as a residential facility  
            licensed by California Department of Social Services (CDSS)  
            and operated by any public agency or private organization that  
            provides short-term, specialized, and intensive treatment, and  
            24-hour care and supervision to children. Requires care and  
            supervision provided by a center be nonmedical, except as  
            otherwise permitted by law. (HSC 1502 (a)(18))


          3)Provides for licensure of a FFA, defined to mean a public or  
            private agency engaged in the recruiting, certifying, and  
            training of, and providing professional support to, foster  
            parents, or in finding homes or other places for placement for  
            children for temporary or permanent care, as an alternative to  
            group care. (HSC 1502(a)(4))










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          4)Establishes California's Medicaid program, Medi-Cal, though  
            which eligible low-income individuals receive health care and  
            mental health services, including foster youth. Under  
            Medi-Cal, establishes the federal Early and Periodic  
            Screening, Diagnosis and Treatment (EPSDT) program to provide  
            comprehensive and preventive health services including  
            specialty mental health services to Medi-Cal beneficiaries  
            under the age of 21. (WIC 14000 et seq., 42 USC Section 1396  
            et seq and 42 CFR 435.145.)


          5)Establishes the Resource Family Approval process to replace  
            the existing multiple processes for licensing foster family  
            homes, approving relatives and nonrelative extended family  
            members as foster care providers, and approving adoptive  
            families. The process includes a home study, psychosocial  
            assessment, background check, and other elements. (WIC  
            16519.5)


          6)Establishes in statute the basic rate for a foster child and  
            codifies modifications to that rate. (WIC 11461)


          7)Restricts the placement of children younger than 6 into a  
            group home or STRTP, except in specified circumstances.  
            Similarly restricts the placement duration of a child aged  
            6-12 years old to a treatment facility for no longer than six  
            months with written authorization required to extend the stay.  
            (WIC 361.2)


          This bill:


          1)Makes changes to the STRTP and FFA structure, licensure and  
            certification:


             a)   Renames the STRTP from the former Short Term Residential  
               Treatment Center (STRTC).









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             b)   Requires an FFA or STRTP to include with an application  
               a letter of recommendation from county placing agencies to  
               identify a need for the program prior to licensure. 


             c)   Requires FFA social workers to meet core competencies to  
               participate in the assessment and evaluation of an  
               applicant, as specified, and clarifies that a social worker  
               may obtain a degree more advanced than a master's degree. 


             d)   Defines components of an FFA's plan of operation  
               including a demonstrated ability to support the needs of  
               differing children and their families, a demonstrated  
               ability to provide or obtain treatment services, and  
               others.


             e)   Prohibits an FFA from considering an applicant who has  
               had a denial within the preceding year or a previous  
               rescission, revocation or exemption denial, but permits an  
               FFA to continue to review an application if it determines  
               that the issue has been corrected or no longer exists.


             f)   Deletes the ability of an FFA or STRTP to receive a  
               provisional license in order to obtain accreditation,  
               provides each FFA with a 24-month window to receive the  
               accreditation and permits CDSS to revoke licensure if  
               accreditation is not obtained in that time.  


          2)Clarifies probation department's role in placing youth into an  
            STRTP:


             a)   Requires that if a child is placed in an STRTP through  
               the probation department, and is older than 13 years old,  
               the chief probation officer must review and approve the  
               placement if it exceeds 12 months and no less frequently  
               than every 12 months thereafter.








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             b)   Requires that a court review the placement decision of a  
               probation department for necessity and appropriateness. 


          3)Revises the Resource Family Approval (RFA) Process in the  
            following ways:


             a)   Establishes the RFA as the only method to approving  
               homes within a foster family agency, sunsets provisions  
               that allow for certification of homes under the prior  
               statute and requires an FFA to document various aspects of  
               the RFA process.


             b)   Requires an FFA to make an announced annual inspection  
               visit, and authorizes inspection of resource family homes  
               as often as necessary to ensure the quality of care.


             c)   Requires CDSS to develop a basic rate that ensures that  
               a child placed in a licensed foster family home, a  
               certified family home, or with a resource family approved  
               by a county or foster family agency is eligible for the  
               same basic rate. 


          4)Makes the following changes to Mental Health components:


             a)   Prohibits an STRTP from providing specialty mental  
               health services without a current mental health program  
               approval from the county mental health plan or state  
               Department of Health Care Services (DHCS), and requires  
               that a licensed STRTP that has not obtained a program  
               approval to provide children in its care access to  
               appropriate mental health services. 


             b)   Authorizes DHCS and county mental health plans to  








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               suspend or revoke a mental health program approval, impose  
               monetary penalties, place a mental health program on  
               probation or require a program to prepare and comply with a  
               corrective action plan.


             c)   Authorizes DHCS and county mental health plans to issue  
               a provisional mental health approval for up to one year and  
               requires DHCS and CDSS to issue regulations defining due  
               process for centers that are seeking to appeal any part of  
               the licensure and program approval process.


             d)   Requires out-of-state group homes to have a mental  
               health program approval equivalent to California's to  
               accept placement of California youth. 


             e)   Removes the requirement for FFAs to obtain a mental  
               health certification or program approval and deletes  
               references to treatment in FFAs throughout the bill. 


             f)   Replaces the requirement that an FFA document how it  
               will provide treatment services, with the requirement that  
               an FFA submit a copy of its program statement to all  
               placing agencies. 


             g)   Requires DHCS and CDSS to identify a dispute resolution  
               process to address disputed interagency placement committee  
               assessments or determinations of a child's service need.


          Background


          Approximately 62,000 children and youth in California are in  
          foster care or roughly 1 in 7 foster children nationwide. For  
          more than a decade California has implemented prevention and  
          early intervention efforts to strengthen families and reduce the  
          number of children in out-of-home foster care placements,  








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          resulting in a decline from more than 100,000 youths in foster  
          care in 1999 to the current 62,000.  About 85 percent were  
          removed from their families due to neglect, 8 percent due to  
          physical abuse, and 2 percent due to sexual abuse.  The median  
          length of time California children spent in foster care was  
          about 15 months, as of 2012.


          At the same time the population was declining, there was a  
          growing national consensus in the field of child welfare that  
          institutionalized settings should be used sparingly.  The  
          placement of maltreated children in group care settings has been  
          increasingly viewed as a temporary solution in instances where  
          emergency or crisis treatment is warranted.  Yet, as of January  
          2015, 48 percent of youth placed in group homes in California  
          through the child welfare services system had been there more  
          than two years, and 23 percent had been there more than five  
          years


          Continuum of Care Reform effort. In 2012, CDSS convened a  
          working group to recommend changes to the current rate-setting  
          system, services, and programs serving children and families in  
          the continuum of foster care settings. The three-year effort  
          came in response to statutory requirements in budget trailer  
          bill (SB 1013, Senate Budget Committee, Chapter 25, Statutes of  
          2012), which mandated the workgroup consider, at a minimum,  
          reforms to programs provided by FFAand group homes, and how to  
          ensure the provision of services in family-like settings,  
          including after care services, when appropriate.


          In January 2015, the CDSS published the "California's Child  
          Welfare Continuum of Care Reform" report. It outlined an  
          interdependent approach to improving California's child welfare  
          system by improving assessments of children and families, and  
          centering support services for children in home-based family  
          care settings rather than in group care.


          AB 403 (Stone).  AB 403 enacted major components of the CCR  
          effort. The bill eliminated the licensure category of children's  








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          group homes and declared Legislative intent to improve  
          California's child welfare system by using comprehensive initial  
          child assessments, increasing the use of and the supports to  
          home-based family care and relying less on congregate care. The  
          bill targeted the delivery of appropriate treatment and services  
          to the child regardless of living arrangement, rather than using  
          the placement setting to drive decisions about services which  
          historically has caused a child to "fail upwards" into higher  
          levels of care.  Overall, it emphasized the creation of supports  
          for resource families to decrease group care.


          Short Term Residential Treatment Centers (STRTCs). AB 403 bill  
          created a new licensure category to replace the eliminated group  
          home category, effective January 1, 2017. All STRTCs are  
          required to have national accreditation from an entity  
          identified by CDSS as well as a mental health approval.  
          Placement of a child into a STRTC is authorized only when the  
          case plan specifies the need for, nature of, and anticipated  
          duration of the identified treatment and includes a plan for  
          transitioning the child to a less restrictive environment and  
          the projected timeline.  


          This bill clarifies the process for an STRTC to obtain mental  
          health approval and makes continued licensure by CDSS contingent  
          upon obtaining the mental health approval. It permits emergency  
          placements of youth and children into STRTCs pending further  
          evaluation. For children with behavioral challenges that are not  
          diagnosed as needing specialty mental health services by a  
          county mental health plan, this bill permits an STRTC to remain  
          licensed and to provide children in its care access to  
          appropriate mental health services.


          Foster Family Agencies (FFAs). Private FFAs are used by county  
          placing departments for children who require more intensive care  
          than a typical foster family home, but do not need the intensive  
          services of a group home, or an STRTP. FFAs recruit, certify and  
          train foster parents and provide social workers and other  
          supports to the foster families. AB 403 maintained the licensure  
          category of FFAs, but required all FFAs to become accredited,  








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          mandated new rates be established, permitted probation  
          departments to place youth into a certified home of an FFA and  
          permitted mental health certification for programs that provide  
          intensive services, according to law.


          This bill removes the requirement that an FFA seek and obtain  
          mental health program approval, however an FFA may still secure  
          mental health treatment for children living within the FFA's  
          foster homes.


          Out of state placements. California statute requires that any  
          out-of-state group home meet at least the same rigorous  
          standards it would have to meet in California. It requires CDSS  
          or its designee - typically a county child welfare agency - to  
          perform initial and continuing inspections of out-of-state group  
          homes in order to either certify that the out-of-state group  
          home meets all licensure standards required of group homes  
          operated in California or that the CDSS has granted a waiver to  
          a specific licensing standard upon a finding that there exists  
          no adverse impact to health and safety. AB 403 mandated that  
          after January 1, 2017, the licensing standards applicable to  
          out-of-state group homes be the same as those required of  
          STRTCs, unless the out-of-state group home is granted an  
          extension or waiver, as specified. In January 2016, there were  
          62 youths placed out-of-state from the child welfare system, and  
          252 from the delinquency system. This bill extends the  
          requirement for mental health certification to out-of-state  
          placements.


          Rates. With the establishment of new types of treatment and the  
          new STRTC category, AB 403 required CDSS to create a new payment  
          structure for STRTCs and for FFAs, effective January 1, 2017.  
          These rates were expected to be released in March 2016, however  
          CDSS was delayed in releasing them and they were unveiled with  
          the May Revise. In response to stakeholder concerns about the  
          methodology for creating the rates, the Senate and Assembly  
          budget committees adopted special reporting language requiring  
          CDSS to work with stakeholders through the summer of 2016, and  
          to determine if rate adjustments are necessary.








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          Resource Family Approval. Prior to AB 403, the Legislature  
          approved and CDSS enacted a pilot project to combine the review  
          and approval processes of California's various foster care and  
          adoption programs into a single approval process, the Resource  
          Family Approval (RFA) Process. AB 403 made the pilot statewide,  
          effective January 1, 2017. This bill clarifies the process for  
          conducting an RFA for a family member who is sheltering a foster  
          child. The typical RFA process requires a background check,  
          psychosocial assessment and home study prior to the placement of  
          a child in a foster home. However, since many family placements  
          are done on an emergency basis, without the ability to establish  
          approval prior to placement, this bill establishes a process for  
          emergency placement with a relative, pending final approval  
          through the RFA process.


          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   Yes


          According to an analysis by the Senate Appropriations Committee,  
          the 2016 Budget Act includes a total of $170.6 million ($129.3  
          million GF) in local assistance and state operations for  
          implementation of CCR efforts. The changes made in this bill are  
          addressed in the budget. The analysis also notes that the  
          numerous changes to CCR implementation made in this bill would  
          result in unquantifiable costs. To the extent that changes  
          result in costs that are not included in the 2016 Budget Act,  
          this bill would require additional General Fund costs.




          SUPPORT:   (Verified8/12/16)


          California Department of Social Services (source)
          California Council of Community Behavioral Health Agencies
          California Department of Finance
          California State Association of Counties 








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          County Welfare Directors Association of California
          Los Angeles Unified School District
          National Association of Social Workers, California Chapter


          OPPOSITION:   (Verified8/12/16)


          None received


          ARGUMENTS IN SUPPORT:     The California Department of Social  
          Services, the bill's sponsor, writes that the department  
          continues to work in close collaboration with county partners,  
          stakeholders and advocate groups to further the CCR reform  
          effort. "This initiative will enhance the lives of children and  
          youth in foster care, increasing their chances to grow into  
          self-sufficient, successful adults," writes the department's  
          legislative director, Robert Smith.


          The author states that while most youth in foster care are  
          placed with resource families about 3,000 youth live in group  
          placements, where they often stay for years. Foster youth who  
          live in congregate care settings are more likely to suffer a  
          variety of negative short- and long-term outcomes, the author  
          states. These can include lifelong institutionalized behaviors,  
          and increased likelihood of involvement with the criminal  
          justice system and low educational attainment.

          ASSEMBLY FLOOR:  80-0, 6/1/16
          AYES:  Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,  
            Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,  
            Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,  
            Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth  
            Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto,  
            Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper,  
            Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim,  
            Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis,  
            Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte,  
            O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez,  
            Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,  








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            Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon

          Prepared by:Mareva Brown / HUMAN S. / (916) 651-1524
          8/22/16 20:37:46


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