BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON HUMAN SERVICES
                               Senator McGuire, Chair
                                 2015 - 2016 Regular

          Bill No:              SB 174
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          |Author:   |Wolk                                                  |
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          |----------+-----------------------+-----------+-----------------|
          |Version:  |February 5, 2015       |Hearing    |March 24, 2015   |
          |          |                       |Date:      |                 |
          |----------+-----------------------+-----------+-----------------|
          |Urgency:  |No                     |Fiscal:    |Yes              |
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          |Consultant|Sara Rogers                                           |
          |:         |                                                      |
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                         Subject:  Crisis nurseries:  study


            DIGEST
          
          This bill establishes a two-year pilot project in Sacramento and  
          Yolo counties for the purpose of evaluating the effectiveness of  
          crisis nurseries, as specified. This bill also requires the  
          California Department of Social Services (CDSS) to conduct a  
          study of the relationship between crisis respite care and  
          incidents of child abuse. Additionally, this bill states  
          Legislative intent to provide state funding for crisis  
          nurseries.

          Existing law: 
          
          1)Enacts the Community Care Facilities Act, which provides for  
            the licensure and oversight of out-of-home placements of  
            abused and neglected children by CDSS. The Act defines "crisis  
            nursery" to mean a facility licensed by CDSS to operate a  
            program to provide short-term care and supervision for  
            children under six years of age who are voluntarily placed for  
            temporary care by a parent or legal guardian due to a family  
            crisis or stressful situation. (HSC 1502 (a) (17)) 


          2)Requires a crisis nursery to be licensed by the department to  
            operate a crisis residential overnight program for no more  
            than 30 days. Provides that the maximum licensed capacity for  
            a crisis residential overnight program shall be 14 children.  








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            (HSC 1516 (a), (h)(2) and (f)(2))


          3)Permits crisis nurseries to offer crisis day services for  
            children under the age of six, as specified, for no more than  
            14 hours in a day and for no more than 30 days. Exempts crisis  
            nurseries from licensure as a child day care facility under  
            the California Child Care and Development Services Act (HSC  
            1516 and 1596.792)


          This bill:


          1)Requires CDSS to implement a two-year pilot project in  
            Sacramento and Yolo counties for the purpose of evaluating the  
            effectiveness of crisis nurseries in lowering the incidence of  
            child abuse in those counties. 


          2)Conditions implementation of the pilot on the voluntary  
            participation of all of the crisis nurseries in those counties  
            and on those counties providing private funding for one-half  
            of the cost of the project. 


          3)Requires that the pilot project shall consist of both of the  
            following:

                 A CDSS-conducted study of the relationship between  
               crisis respite care and incidents of reported child abuse  
               in pilot project counties,
                 A CDSS report of the results of the study to the  
               Legislature on or before December 31, 2016, as specified.


          1)States Legislative intent to provide state funding for crisis  
            nurseries in the Budget Act of 2015 in order to enable crisis  
            nurseries to continue to provide services to the community and  
            to participate in the pilot project established by this  
            section.


          2)Enacts a sunset on the above provisions on January 1, 2018.









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            FISCAL IMPACT
          
          Last year, the Senate Appropriations Committee, in its  
          evaluation of AB 578 (Dickenson) which was substantially similar  
          to this bill, estimated significant costs in the range of $2.7  
          million (General Fund) over two years to implement the pilot  
          project for the three crisis nurseries in the counties of  
          Sacramento and Yolo. Additionally, the analysis estimated  
          one-time costs to CDSS of about $150,000 (General Fund) to  
          prepare and submit the mandated study. 
           
            BACKGROUND
          
          The author cites a two-year study<1> published in 2006 examining  
          the relationships between crisis respite care and incidents of  
          reported child abuse. According to the author, the study  
          provided evidence that Child Protective Services (CPS) reports  
          on families that accessed crisis respite were significantly less  
          likely to be substantiated than CPS reports on comparison  
          families without crisis respite available. It found that  
          families receiving respite or crisis resolution services were  
          half as likely to have a CPS investigation substantiated than  
          were those who utilized crisis respite with previous CPS  
          involvement. Further, when parents were asked what alternative  
          choices they would have pursued had a crisis nursery not been  
          available, 26 percent said they would have either requested  
          foster care placement or been unable to provide for their  
          children. 


          Additionally, the author states that adverse childhood  
          experiences such as child abuse and neglect result in lifelong  
          negative impacts. These include lower family income levels,  
          higher rates of physical and mental health needs, and issues  
          with addiction/substance abuse. The estimated national average  
          lifetime cost per victim of nonfatal child maltreatment is  
          $210,012 in 2010 dollars. 

          ---------------------------
          <1> ARCH (Access to Respite Care and Help) National Respite  
          Network and Resource Center (NRNRC)










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            Crisis Nursery Model


          Crisis nurseries first were developed as a grassroots movement  
          in the 1960's as a temporary or emergency care model for  
          children at risk of abuse or neglect, and were initially funded  
          through private donations.<2> In 1986, Congress passed the  
          Temporary Child Care for Children with Disabilities and Crisis  
          Nurseries Act, which established federal funding to create  
          temporary child care demonstration projects including crisis  
          nursery services. Beginning in 1988, competitive federal grants  
          were awarded to private and public agencies across the United  
          States to assist them in developing crisis nursery services,  
          funding that has subsequently been eliminated. 


          Crisis nurseries were created as a separate licensing category  
          under the Community Care Facilities Act under SB 855 (Machado,  
          Chapter 664, Statutes of 2004), to provide a temporary and  
          emergency housing and shelter facility option for parents.  The  
          intent of the care model is to provide a voluntary 24-hour  
          placement option for young children when their families are  
          facing difficult or extreme financial, health, or other  
          challenges to prevent the engagement of child welfare services.  
          Under the statute, the crisis nurseries were limited to  
          specified counties and were intended to serve children under the  
          age of six who were voluntarily placed by a parent or guardian  
          or, under limited circumstances, were temporarily placed by a  
          county child welfare service agency.


          Prior to the passage of SB 855, crisis nurseries were licensed  
          as group homes under the Community Care Facility Act, although  
          critics argued that those regulations were excessive and  
          inappropriate for crisis nurseries due to differences between  
          the care needs of very young children who were voluntarily  
          placed by a parent and the needs of children that were removed  
          from parental custody by county child protective services  
          workers due to abuse or neglect. The bill at that time included  
          ---------------------------


          <2> Cole, Susan.  Crisis nurseries: Important services in a  
          system of care for families and children.  University of Illinois  
          School of Social Work. September 2004.








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          a sunset of January 1, 2008, which was subsequently extended to  
          January 1, 2014. Due to concerns that crisis nurseries were  
          serving as temporary placements for children removed from their  
          homes by county social workers, SB 1214 (Wolk, Chapter 519,  
          Statutes of 2010) eliminated crisis nurseries as an allowable  
          child welfare placement, effective January 1, 2012. Following  
          this agreement, the state eliminated the sunset, allowing crisis  
          nurseries to exist permanently under SB 1319 (Liu, Chapter 663,  
          Statutes of 2012).  




          Last year, AB 2228 (Cooley, Chapter 735, Statutes of 2014)  
          revised the regulatory structure of crisis nurseries, permitting  
          facilities operating an overnight and day program to be licensed  
          under a single license. Although crisis day services had  
          previously been exempted from licensure as a day care facility,  
          children in day programs counted against the overnight capacity  
          limit of 14 children. As a result, many facilities sought  
          secondary licensure as a child day care program. AB 2228 permits  
          crisis nurseries to operate day programs that meet specified  
          regulatory requirements without affecting the overnight capacity  
          limit. 


          Currently, there are five crisis nurseries licensed in  
          California, one each in Concord, Davis, Nevada City and two in  
          Sacramento. Since 2009, more than 9,000 children have been  
          served by these nurseries. On average, the lengths of stay have  
          ranged from eight hours to just over 24 hours with 44 children  
          staying for the maximum allowable days. No exemptions have been  
          requested for children to stay beyond the 30-day limit. 


          Currently there are no state or federal monies made available to  
          crisis nurseries, with all five nurseries relying upon  
          philanthropic support and local funds to operate (some  
          facilities may receive funding through their Local First Five  
          Commission). In many instances a related group home provider  
          will support and manage a local crisis nursery, usually at a  
          substantial financial loss. As a result, crisis nurseries rely  
          substantially on trained volunteers to meet the staffing  
          requirements. Crisis nursery staff and volunteers are subject to  









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          the same criminal record clearance requirements as child care  
          providers and the education and experience requirements are  
          similar to those of teachers in child care regulations.<3> 








          Budget Committee 2014 hearing 


          In 2014, the Senate Budget Committee heard, as an informational  
          item, a similar proposal to that proposed under this bill. The  
          committee declined to take action on the proposal. As  
          background, the committee provided the following information:


                        Usage data for the Yolo Crisis Nursery


           EMQ Families First Yolo Crisis
          Nursery
                                  CY 2009    CY 2010    CY 2011    CY 2012  
                            CY 2013   Total
          Respite Day Services
          # of 30 day stays per facility          0             0    0      
            0                            0              0
          # of  children the facility has served      381          339   
          368            329             372         1789
          Average length of stay per child, per
          facility (days)          1.25           1.28            1.19      
                  1.32           1.43          1.29


          Overnight Services
          # of 30 day stays per facility         0                1         
                   0                  0                0               1
          # of  children the facility has served      73               88   

          ---------------------------
          <3> CCR Title 22 101216.1










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                      101              38                6             306
          Average length of stay per facility
          (nights)                                               5.45       
               4.74                  3      3.71           3.67           
          2.93


           Budget history of both Sacramento Crisis Nursery and Yolo Crisis  
                                       Nursery
           
          Sacramento Crisis Nurseries
          o FY 2012- 13, total expense of $2,136,724, with a deficit of  
          $566,724.
          o FY 2013-14 (projected), total expense will be $2,015,452, with  
          deficit of $500,697.


          Yolo Crisis Nursery
          o FY 2012-13, total expense was $603,000, with a loss of  
          $438,000.
          o FY 2013-2014 (projected), total expense will be $659,000, with  
          loss of $480,000.


          Crisis Nursery Outcomes 


          A 2004 report<4> studying crisis nursery outcomes cites a  
          literature review from 1980 that identified crisis nurseries  
          "along with access to counseling for parents as extremely  
          inexpensive forms of prevention when compared to the cost of  
          foster care placements."


          The report also cites a study that found that "thirty-six  
          parents reported a decrease in parenting stress for problems  
          related to their children as well as financial and housing  
          problems when they accessed crisis nursery services and that  
          "parents using crisis nursery services also reported significant  
          ---------------------------


          <4> Cole, Susan.  Crisis nurseries: Important services in a  
          system of care for families and children.  University of Illinois  
          School of Social Work. September 2004.








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          improvements in parenting stress based on pre- and post-test  
          scores on the Parenting Stress Index/Short Form." 


          Additionally, the report cites a user survey in which caregivers  
          reported that "if crisis nursery services were not available  
          they might choose to leave their children alone, in the care of  
          an inappropriate caregiver, or have the child accompany them to  
          a place the parent perceived as dangerous for the child."  
          However, the report states there is "limited research addresses  
          the role crisis nurseries play in strengthening families and  
          developing independence beyond time-limited crisis  
          intervention." 


          Prior legislation:


          SB 2228 (Cooley, Chapter 735, Statutes of 2014) revises the  
          licensing requirements for crisis nurseries and onsite day care  
          centers. 


          AB 578 (Dickinson, 2014) sought to establish a two-year pilot  
          project in Sacramento and Yolo counties for the purpose of  
          evaluating the effectiveness of crisis nurseries. This bill was  
          held in the Senate Appropriations Committee.


          SB 1319 (Liu, Chapter 663, Statutes of 2012) eliminated the  
          sunset date for the establishment of crisis nurseries.

          SB 1214 (Wolk, Chapter 519, Statutes of 2010) extended the  
          sunset date to January 1, 2014, but eliminated provisions of the  
          original legislation which permitted crisis nurseries to provide  
          emergency respite care for a limited number of foster children.   
          Effective July 1, 2012, crisis nurseries were only permitted to  
          serve children placed voluntarily by their parents or legal  
          guardians.

          SB 104 (Machado, Chapter 288, Statutes of 2007) extended the  
          sunset date to January 1, 2011.

          SB 855 (Machado, Chapter 664, Statutes of 2004) established  









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          crisis nurseries as a separate licensing category, with a sunset  
          date of January 1, 2009.



            COMMENTS
          
          This bill states it is the intent of the Legislature to provide  
          state funding in the 2015 Budget Act for the purposes specified  
          in this bill. Last year, a similar item was heard in budget  
          committee, though no appropriation was included. Should the  
          Legislature intend to include this item in the Budget Act this  
          year, it would be necessary for it to be considered and  
          appropriated through the budget process.  


          Staff recommends amending the bill to strike Lines 17-20 on Page  
          2 inclusive, referencing intent language referring to the budget  
          appropriation.


          
            POSITIONS
                                          
          Support:  None. 

          Oppose:   None.


                                      -- END --