BILL ANALYSIS                                                                                                                                                                                                    Ó






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          |SENATE RULES COMMITTEE            |                        SB 518|
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                                   THIRD READING 


          Bill No:  SB 518
          Author:   Leno (D), et al.
          Amended:  5/20/15  
          Vote:     21  

           SENATE PUBLIC SAFETY COMMITTEE:  7-0, 4/28/15
           AYES:  Hancock, Anderson, Leno, Liu, McGuire, Monning, Stone
            
           SENATE APPROPRIATIONS COMMITTEE:  6-1, 5/28/15
           AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza
           NOES: Nielsen

           SUBJECT:   Victims of violent crimes: trauma recovery centers


          SOURCE:    Californian's for Safety and Justice


          DIGEST:  This bill 1) requires the Victims Compensation and  
          Government Claims Board (Board) to use the evidence-based model  
          developed by the University of California, San Francisco,  
          General Hospital Trauma Recovery Center (UCSF TRC) when giving a  
          grant to a Trauma Recovery Center (TRC); 2)  requires a TRC  
          receiving a grant to meet specified statutory requirements and  
          standards; 3) establishes the UCSF TRC as the California Trauma  
          Recovery Center of Excellence (TRC COE); and 4) requires the  
          Board to complete an interagency agreement with TRC COE in  
          establishing core elements of an evidence-based TRC.


          ANALYSIS:   










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          Existing law:

          1)Creates the Victims of Crime Program (VCP), administered by  
            the Board, to reimburse victims of crime for the pecuniary  
            losses they suffer as a direct result of criminal acts.   
            Indemnification is made from the Restitution Fund, which is  
            continuously appropriated to the board for these purposes.   
            (Gov. Code §§ 13950-13968.)  

          2)Authorizes reimbursement to a victim for "[t]he medical or  
            medical related expenses incurred by the victim?."  (Gov. Code  
            § 13957, subd. (a)(1).)

          3)Provides that Board shall enter into an interagency agreement  
            with the UCSF to establish a recovery center for victims of  
            crime at the San Francisco General Hospital for comprehensive  
            and integrated services to victims of crime, subject to  
            conditions set by the board.  The University Regents must  
            approve the agreement.  The section shall only be implemented  
            to the extent that funding is appropriated for that purpose.   
            (Gov. Code § 13974.5.)

          4)Includes the Safe Neighborhoods and Schools Act of 2014.  As  
            relevant to this bill, the act does the following:

                 Reclassifies controlled substance felony and alternate  
               felony-misdemeanor crimes as misdemeanors, except for  
               defendants convicted of a sex offense, a specified drug  
               crime involving specified weight of volume of the drug, a  
               crime where the defendant used or was armed with a weapon,  
               a homicide, solicitation of murder and any crime for which  
               the sentence is a life term.

                 Requires the Director of Finance, beginning in 2016, to  
               calculate the savings from the reduced penalties.

                 The Controller transfers the amount of savings  
               calculated by the Finance Director and transfers that  
               amount from the General Fund to the "Safe Neighborhoods and  
               Schools Fund.

                 The Controller then distributes the money in the fund  
               according to the following formula:








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                  o         25% to the Department of Education for a grant  
                    program to public agencies to improve outcomes for  
                    kindergarten through high school students at risk of  
                    dropping out of school or are crime victims.

                  o         10% to the VCP to fund grants to TRCs.

                  o         65% to the Board of State and Community  
                    Corrections for a grant program to public agencies for  
                    mental health and drug abuse treatment and diversion  
                    programs, with an emphasis on reducing recidivism.   
                    (Gov. Code § 7599-7599.2.)

          This bill:

          1)Includes the following legislative findings:

                 Systematic training, technical assistance and  
               standardized evaluations are necessary to ensure that all  
               new state-funded TRCs are evidence based, accountable,  
               clinically effective and cost-effective.

                 The creation of the TRC COE is intended to make TRC  
               services meet these standards.

                 Evidence-based trauma recovery services are more  
               effective and less costly than fee-for-service programs and  
               the public benefits from collaboration between government  
               entities and experts in the field.

                 The UCSF TRC is a nationally recognized, award-winning  
               program developed in 2001 in partnership with the VCP.  A  
               four-year demonstration projected established the clinical  
               and fiscal benefits of an evidence-based TRC program.   
               Specifically, the UCSF TRC greatly increased the rate at  
               which victims accessed services and cost 34% less than  
               customary care. 

          2)Provides that the VCP shall use the evidence-based Integrated  
            Trauma Recovery Services (ITRS) model developed by the UCSF in  
            establishing and funding TRCs.  Programs using ITRS, as  
            modified to apply to different populations, shall do or  
            include the following:








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                 Serve and make reach out to victims unable to access  
               traditional services.  These include those who are  
               homeless, mentally ill, of diverse ethnicity, immigrants  
               and refugees, disabled, suffering from severe trauma and  
               psychological symptoms or issues, juveniles, including  
               juveniles who have been through the dependency or  
               delinquency systems.

                 Serve victims of a wide range of crimes, including  
               sexual assault and other forms of violence.

                 Use a structured evidence-based program of mental health  
               and support services for victims of violence and family  
               members of homicide victims. The services shall include  
               crisis intervention, case management, individual and group  
               treatment and shall be provided so as to increase access,  
               including providing services in the community and the homes  
               of clients.

                 Employ multidisciplinary, integrated trauma specialists  
               including psychiatrists, psychologists and social workers  
               who are licensed clinicians or engaged in supervised  
               completion of licensure.  Clinical supervision and support  
               shall be given to staff on a weekly basis.

                 Psychotherapy shall be provided by a single point of  
               client contact with a trauma specialist, with support from  
               the team and a collaboratively developed treatment plan.

                 Provide aggressive case management, including  
               accompanying clients to treatment appointments, community  
               appointments and court appearances.  Case management shall  
               include assisting clients in filing for victim  
               compensation, police reports, housing assistance and other  
               basic support needs.

                 Clients shall not be excluded from treatment solely on  
               the basis of "emotional or behavioral issues resulting from  
               trauma, such as drug abuse, serious anxiety or low initial  
               motivation.

                 TRC services shall incorporate established,  
               evidence-based practices, such as cognitive behavioral  
               therapy, dialectical behavior and cognitive processing.







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                 TRC goals shall be to decrease psychological distress  
               and improve long-term positive outcomes.

                 Treatment shall be given for up to 16 sessions, with an  
               extension for those with a "primary focus on trauma" after  
               special consideration with a supervisor.  Extensions beyond  
               32 sessions shall require the approval of a clinical  
               steering group. 

          3)Provides that, upon legislative appropriation of funds from  
            the VCP, the Board shall enter into an interagency agreement  
            with TRC 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 (TRC COE).   
            The agreement shall require the following:

                 The Board shall consult with the TRC COE in developing  
               language for grant application and criteria for reviewing  
               grants.

                 The TRC COE shall define an evidence-based practice.

                 The TRC COE shall assist the board in providing training  
               materials, technical assistance and provide ongoing  
               consultation with the board.

                 The TRC COE shall assist in designing a multisite  
               evaluation for TRCs.

          4)Provides that the University of California must agree to these  
            provisions through a resolution.

          Background

          The TRC model addresses what may be lacking in California's  
          current approach to victims - healing the harm that comes to  
          communities through the commission of crime.  (The Culture of  
          Control, Garland, Univ. of Chicago Press, 2001, pp. 11-12.)   
          Arguably, the TRC program demonstrates that harm to the specific  
          victim of a crime spreads through the community.  This is  
          especially true in relatively poor and marginal communities  
          where residents have limited access to, and perhaps some  
          discomfort with, medical care and counseling.







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          A victim who loses a job because he or she is too traumatized to  
          work may be the sole support for more than one generation of  
          relatives.  Younger relatives of such victims may stop attending  
          school and become delinquent.  Untreated victims may seek  
          retribution, especially those who live in areas where the police  
          are not trusted.  Retribution will lead to more victims.   
          Untreated victims often turn to drugs and alcohol, which further  
          damages the victim and his or her community.

          Recent research shows that crime can be seen as equivalent to a  
          disease process.   
          (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684449/.)  Recent  
          studies have even shown that public health research methods can  
          predict where and when violence will occur.   
          (msutoday.msu.edu/news/2012/homicide-spreads-like-infectious-dise 
          ase/.)  It is clear that crime, especially violent crime, causes  
          trauma and stress, which often leads to depression and loss of  
          employment, which in turn prevents crimes victim from adequately  
          caring for their families, which leads to truancy, delinquency,  
          illness and other social ills  
          (http://www.ncbi.nlm.nih.gov/books/NBK262831/ Violent crime  
          victims in minimally functioning communities typically rely on  
          retaliation, not the justice system.  In broken communities with  
          gang problems, most residents do not trust the justice system.   
          Law enforcement can be seen as an occupying or invading army,  
          not a source of protection.  Retaliation crimes create an  
          increasing cycle of violence.  The disease process spreads and  
          essentially metastasizes.   

          The study on Adverse Childhood Experiences (ACE) jointly  
          conducted by the Kaiser Foundation and the Centers for Disease  
          control interviewed 17,000 Kaiser patients from 1995-1997.  The  
          landmark study showed that childhood abuse, neglect and exposure  
          to trauma is clearly associated with a wide range of physical  
          and mental health problems throughout a person's life. TRC  
          programs can intervene or interrupt cycles of trauma and harm  
          that plague high-crime communities.   
          (http://www.cdc.gov/violenceprevention/acestudy/findings.html.)
          
          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   No

          According to the Senate Appropriations Committee:







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           Administrative costs to the Board of $100,000-$300,000  
            (Special Fund). 

          Upon appropriation of funds, the board will be required to  
          develop language for grant applications, and grant review  
          criteria; and to provide training and technical assistance to  
          applicants in conjunction with the UCSF TRC. Additionally, there  
          will be costs with evaluating and measuring grantees' adherence  
          to the model. 


          SUPPORT:   (Verified5/28/15)


          Californians for Safety and Justice (source)
          California Attorneys for Criminal Justice
          California Catholic Conference
          California Chapter of the American College of Emergency  
                    Physicians
          California Psychological Association
          City and County of San Francisco
          Crime Victims United of California
          Natividad Medical Foundation
          San Francisco Department of Public Health
          Society for Social Work Leadership in Health Care California  
                    Chapter
          University of California



          OPPOSITION:   (Verified 5/28/15)


          None received

          Prepared by:Jerome McGuire / PUB. S. / 
          5/31/15 12:09:33


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