Amended in Senate May 20, 2015

Amended in Senate April 20, 2015

Senate Bill No. 518

Introduced by Senator Leno

(Coauthor: Senator Hancock)

February 26, 2015

An act to amend Section 13963.1 of, and to add Sections begin delete 13963.2, 13963.3, and 13963.4 to, end delete begin insert 13963.2 and 13963.3 to, end insert the Government Code, relating to victims of violent crimes.

LEGISLATIVE COUNSEL’S DIGEST

SB 518, as amended, Leno. Victims of violent crimes: trauma recovery centers.

Existing law requires the California Victim Compensation and Government Claims Board to administer a program to assist state residents to obtain compensation for their pecuniary losses suffered as a direct result of criminal acts. Payment is made under these provisions from the Restitution Fund, which is continuously appropriated to the board for these purposes. Existing law requires the California Victim Compensation and Government Claims Board to administer a program to evaluate applications and award grants to trauma recovery centers funded by moneys in the Restitution Fund.

This bill would make legislative findings and would require the board to use the evidence-based Integrated Trauma Recovery Services model developed by the Trauma Recovery Center at San Francisco General Hospital, University of California, San Francisco (UCSF TRC) when it provides grants to trauma recovery centers. This bill would also require the board, upon appropriation of funds begin insert from the Victim Restitution Fund end insert by the Legislature, to enter into an interagency agreement with the Trauma Recovery Center of the Regents of the University of California, San Francisco, to establish the UCSF TRC as the State of California’s Trauma Recovery Center of Excellence (TR-COE). The agreement provided for in this bill would require the TR-COE to support the board by defining the core elements of the evidence-based practice and providing training materials, technical assistance, and ongoing consultation and programming to the board and to each center to enable the grantees to replicate the evidence-based approach.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert begin insert

(a) The Legislature finds and declares all of the
following:

end insert begin insert

(1) Victims of violent crime may benefit from access to
structured programs of practical and emotional support. Research
shows that evidence-based trauma recovery approaches are more
effective, at a lesser cost, than customary fee-for-service programs.
State-of-the-art fee-for-service funding increasingly emphasizes
funding best practices, established through research, that can be
varied but have specific core elements that remain constant from
grantee to grantee. The public benefits when government agencies
and grantees collaborate with institutions with expertise in
establishing and conducting evidence-based services.

end insert begin insert

(2) The Trauma Recovery Center at San Francisco General
Hospital, University of California, San Francisco (UCSF TRC),
is an award-winning, nationally recognized program created in
2001 in partnership with the California Victim Compensation and
Government Claims Board. The UCSF TRC was established by
the Legislature as a four-year demonstration project to develop
and test a comprehensive model of care as an alternative to
fee-for-service care reimbursed by victim restitution funds. It was
designed to increase access for crime victims to these funds.

end insert begin insert

(3) The results of this four-year demonstration project have
established that the UCSF TRC model was both clinically effective
and cost effective when compared to customary fee-for-service
care. Seventy-seven percent of victims receiving trauma recovery
center services engaged in mental health treatment, compared to
34 percent receiving customary care. The UCSF TRC model
increased the rate by which sexual assault victims received mental
health services from 6 percent to 71 percent, successfully linked
53 percent to legal services, 40 percent to vocational services, and
31 percent to safer and more permanent housing. Trauma recovery
center services cost 34 percent less than customary care.

end insert begin insert

(b) The Legislature further finds and declares all of the
following:

end insert begin insert

(1) Systematic training, technical assistance, and ongoing
standardized program evaluations are needed to ensure that all
new state-funded trauma recovery centers are evidence-based,
accountable, and clinically effective and cost effective.

end insert begin insert

(2) By creating a Trauma Recovery Center of Excellence
(TR-COE), it is the intent of the Legislature that these services
will be delivered in a clinically effective and cost-effective manner,
and that victims of crime in California will have increased access
to needed services.

end insert

begin delete SECTION 1. end delete
begin insert SEC. 2. end insert   

Section 13963.1 of the Government Code is amended
to read:

13963.1.  

(a) The Legislature finds and declares all of the
following:

(1) Without treatment, approximately 50 percent of people who
survive a traumatic, violent injury experience lasting or extended
psychological or social difficulties. Untreated psychological trauma
often has severe economic consequences, including overuse of
costly medical services, loss of income, failure to return to gainful
employment, loss of medical insurance, and loss of stable housing.

(2) Victims of crime should receive timely and effective mental
health treatment.

(3) The board shall administer a program to evaluate applications
and award grants to trauma recovery centers.

(b) The board shall award a grant only to a trauma recovery
center that meets all of the following criteria:

(1) The trauma recovery center demonstrates that it serves as a
community resource by providing services, including, but not
limited to, making presentations and providing training to law
enforcement, community-based agencies, and other health care
providers on the identification and effects of violent crime.

(2) Any other related criteria required by the board.

(3) The trauma recovery center uses the core elements
established in Sections begin delete 13963.3 and 13963.4. end delete begin insert 13963.2 and 13963.3. end insert

(c) It is the intent of the Legislature to provide an annual
appropriation of two million dollars ($2,000,000) per year. All
grants awarded by the board shall be funded only from the
Restitution Fund.

(d) The board may award a grant providing funding for up to a
maximum period of three years. Any portion of a grant that a
trauma recovery center does not use within the specified grant
period shall revert to the Restitution Fund. The board may award
consecutive grants to a trauma recovery center to prevent a lapse
in funding. The board shall not award a trauma recovery center
more than one grant for any period of time.

(e) The board, when considering grant applications, shall give
preference to a trauma recovery center that conducts outreach to,
and serves, both of the following:

(1) Crime victims who typically are unable to access traditional
services, including, but not limited to, victims who are homeless,
chronically mentally ill, of diverse ethnicity, members of immigrant
and refugee groups, disabled, who have severe trauma-related
symptoms or complex psychological issues, or juvenile victims,
including minors who have had contact with the juvenile
dependency or justice system.

(2) Victims of a wide range of crimes, including, but not limited
to, victims of sexual assault, domestic violence, physical assault,
shooting, stabbing, and vehicular assault, and family members of
homicide victims.

(f) The trauma recovery center sites shall be selected by the
board through a well-defined selection process that takes into
account the rate of crime and geographic distribution to serve the
greatest number of victims.

(g) A trauma recovery center that is awarded a grant shall do
both of the following:

(1) Report to the board annually on how grant funds were spent,
how many clients were served (counting an individual client who
receives multiple services only once), units of service, staff
productivity, treatment outcomes, and patient flow throughout
both the clinical and evaluation components of service.

(2) In compliance with federal statutes and rules governing
federal matching funds for victims’ services, each center shall
submit any forms and data requested by the board to allow the
board to receive the 60 percent federal matching funds for eligible
victim services and allowable expenses.

(h) For purposes of this section, a trauma recovery center
provides, including, but not limited to, all of the following
resources, treatments, and recovery services to crime victims:

(1) Mental health services.

(2) Assertive community-based outreach and clinical case
management.

(3) Coordination of care among medical and mental health care
providers, law enforcement agencies, and other social services.

(4) Services to family members and loved ones of homicide
victims.

(5) A multidisciplinary staff of clinicians that includes
psychiatrists, psychologists, begin delete and social workers. end delete begin insert social workers,
case managers, and peer counselors. end insert

begin delete

SEC. 2.  

Section 13963.2 is added to the Government Code, to
read:

13963.2.  

(a) The Legislature finds and declares all of the
following:

(1) Victims of violent crime may benefit from access to
structured programs of practical and emotional support. Research
shows that evidence-based trauma recovery approaches are more
effective, at a lesser cost, than customary fee-for-service programs.
State-of-the-art fee-for-service funding increasingly emphasizes
funding best practices, established through research, that can be
varied but have specific core elements that remain constant from
grantee to grantee. The public benefits when government agencies
and grantees collaborate with institutions with expertise in
establishing and conducting evidence-based services.

(2) The Trauma Recovery Center at San Francisco General
Hospital, University of California, San Francisco (UCSF TRC),
is an award-winning, nationally recognized program created in
2001 in partnership with the California Victim Compensation and
Government Claims Board. The UCSF TRC was established by
the Legislature as a four-year demonstration project to develop
and test a comprehensive model of care as an alternative to
fee-for-service care reimbursed by victim restitution funds. It was
designed to increase access for crime victims to these funds.

(3) The results of this four-year demonstration project have
established that the UCSF TRC model was both clinically effective
and cost effective when compared to customary fee-for-service
care. Seventy-seven percent of victims receiving trauma recovery
center services engaged in mental health treatment, compared to
34 percent receiving customary care. The UCSF TRC model
increased the rate by which sexual assault victims received mental
health services from 6 percent to 71 percent, successfully linked
53 percent to legal services, 40 percent to vocational services and
31 percent to safer and more permanent housing. Trauma recovery
center services cost 34 percent less than customary care.

(b) The Legislature further finds and declares all of the
following:

(1) Systematic training, technical assistance, and ongoing
standardized program evaluations are needed to ensure that all
new state-funded trauma recovery centers are evidenced based,
accountable, and clinically effective and cost effective.

(2) By creating a Trauma Recovery Center of Excellence
(TR-COE), it is the intent of the Legislature that these services
will be delivered in a clinically effective and cost-effective manner,
and that victims of crime in California will have increased access
to needed services.

end delete

SEC. 3.  

Section begin delete 13963.3 end delete begin insert 13963.2 end insert is added to the Government
Code, to read:

begin delete

13963.3.  

end delete

begin insert

begin insert 13963.2. end insert   

end insert

The California Victim Compensation and Government
Claims Board shall use the begin delete evidenced-based end delete begin insert evidence-based end insert
Integrated Trauma Recovery Services (ITRS) model developed
by the UCSF TRC when it selects, establishes, and implements
trauma recovery centers pursuant to Section 13963.1. In replicating
programs funded by the California begin delete Victims end delete begin insert Victim end insert Compensation
and Government Claims Board, the ITRS can be modified to adapt
to different populations, but it shall include the following core
elements:

(a) Provide outreach and services to crime victims who typically
are unable to access traditional services, including, but not limited
to, victims who are homeless, chronically mentally ill, of diverse
ethnicity, members of immigrant and refugee groups, disabled,
who have severe trauma-related symptoms or complex
psychological issues, or juvenile victims, including minors who
have had contact with the juvenile dependency or justice system.

(b) Victims of a wide range of crimes, including, but not limited
to, victims of sexual assault, domestic violence, physical assault,
shooting, stabbing, and vehicular assault, human trafficking, and
family members of homicide victims.

(c) A structured evidence-based program of mental health and
support services provided to victims of violent crimes or family
members of homicide victims that includes crisis intervention,
individual and group treatment, medication management, substance
abuse treatment, case management, and assertive outreach. This
care shall be provided in a manner that increases access to services
and removes barriers to care for victims of violent crime. This
includes providing services in the client’s home, in the community,
or other locations outside the agency.

(d) Staff shall include a multidisciplinary team of integrated
trauma specialists that includes psychiatrists, psychologists, and
social workers. The integrated trauma specialist shall be a licensed
clinician, or a supervised clinician engaged in completion of the
applicable licensure process. Clinical supervision and other
supports are provided to staff on a weekly basis to ensure the
highest quality of care and to help staff deal constructively with
vicarious trauma.

(e) Psychotherapy and case management shall be provided by
a single point of contact for the client, that is an individual trauma
specialist, with support from an integrated trauma treatment team.
In order to ensure the highest quality of care, the treatment team
shall collaboratively develop treatment plans in order to achieve
positive outcomes for clients.

(f) Services shall include assertive case management, including,
but not limited to, a trauma specialist accompanying the client to
court proceedings, medical appointments, or other community
appointments as needed. Case management services shall include,
but not be limited to, assisting clients file victim compensation
applications, file police reports, help with obtaining safe housing
and financial entitlements, linkages with medical care, assistance
in return to work, liaison with other community agencies, law
enforcement, and other support services as needed.

(g) Clients shall not be excluded from services solely on the
basis of emotional or behavioral issues resulting from trauma,
including, but not limited to, substance abuse problems, low initial
motivation, or high levels of anxiety.

(h) Trauma recovery services shall incorporate established
evidence-based practices, including, but not limited to, motivational
interviewing, harm reduction, seeking safety, cognitive behavioral
therapy, dialectical behavior, and cognitive processing therapy.

(i) The goals of a trauma recovery center shall be to decrease
psychosocial distress, minimize long-term disability, improve
overall quality of life, reduce the risk of future victimization, and
promote post-traumatic growth.

(j) In order to ensure that clients are receiving targeted and
accountable services, treatment shall be provided up to 16 sessions.
For those with ongoing problems and a primary focus on trauma,
treatment may be extended after special consideration with the
clinical supervisor. Extension beyond 32 sessions shall require
approval by a clinical steering and utilization group that considers
the client’s progress in treatment and remaining need.

SEC. 4.  

Section begin delete 13963.4 end delete begin insert 13963.3 end insert is added to the Government
Code, to read:

begin delete

13963.4.  

(a)

end delete

begin insert

begin insert 13963.3. end insert   

end insert

begin insert (a) end insert  Upon appropriation of funds begin insert from the Victim
Restitution Fund end insert by the Legislature, the board shall enter into an
interagency agreement with the Trauma Recovery Center of the
Regents of the University of California, San Francisco, to establish
the UCSF TRC as the State of California’s Trauma Recovery
Center of begin delete Excellence. end delete begin insert Excellence (TR-COE). end insert This agreement shall
require:

(1) The board to consult with the TR-COE in developing
begin delete language end delete begin insert materials and criteria end insert for grant applications begin delete and
development of grant review criteria for grants end delete pursuant to Section
13963.1.

(2) The TR-COE to define the core elements of the
evidence-based practice.

(3) The board to consult with the TR-COE in the replication of
the integrated trauma recovery services approach.

(4) The TR-COE to assist by providing training materials,
technical assistance, and ongoing consultation to the board and to
each center to enable the grantees to replicate the evidence-based
approach.

(5) The TR-COE to assist in evaluation by designing begin delete and end delete a
multisite evaluation to measure adherence to the practice and
effectiveness of each center.

(b) This section does not apply to the University of California
unless the Regents of the University of California, by appropriate
resolution, make this section applicable.