BILL ANALYSIS Ó
SB 518
Page 1
Date of Hearing: June 30, 2015
Counsel: Gabriel Caswell
ASSEMBLY COMMITTEE ON PUBLIC SAFETY
Bill Quirk, Chair
SB
518 (Leno) - As Amended May 20, 2015
As Proposed to be Amended in Commitee
SUMMARY: Requires the Victims Compensation and Government
Claims Board (Board) to use a specified evidence-based model
when giving a grant to a Trauma Recovery Center (TRC), as
specified. Specifically, this bill:
SB 518
Page 2
1)Requires the Board to use the evidence-based Integrated Trauma
Recovery Services (ITRS) model developed by the State Pilot
Project Trauma Recovery Center (State Pilot TRC) when it
provides grants to trauma recovery centers.
2)Specifies that programs using the ITRS model shall include the
following:
a) Serve and 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 and juveniles, including
juveniles who have been through the dependency or
delinquency systems.
b) Serve victims of a wide range of crimes, including
sexual assault and other forms of violence.
c) 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.
d) 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.
e) 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.
f) Provide aggressive case management, including
accompanying clients to treatment appointments, community
SB 518
Page 3
appointments and court appearances. Case management shall
include assisting clients in filing for victim
compensation, police reports, housing assistance and other
basic support needs.
g) 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.
h) TRC services shall incorporate established,
evidence-based practices, such as cognitive behavioral
therapy, dialectical behavior and cognitive processing.
i) TRC goals shall be to decrease psychological distress
and improve long-term positive outcomes.
j) 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)Requires the Board, upon appropriation of funds from the
Victim Restitution Fund by the Legislature, to enter into an
interagency agreement with the State Pilot TRC to establish
the pilot project as the State of California's Trauma Recovery
Center of Excellence (TR-COE). The agreement 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. Specifies
that the agreement shall require the following:
a) The Board shall consult with the TR-COE in developing
language for grant application and criteria for reviewing
grants.
SB 518
Page 4
b) The TR-COE shall define an evidence-based practice.
c) The TR-COE shall assist the Board in providing training
materials, technical assistance and provide ongoing
consultation with the Board.
d) The TR-COE shall assist in designing a multisite
evaluation for TRCs.
4)Finds and declares the following:
a) 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.
b) 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 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.
c) Specifies that the UCSF TRC is the State Pilot TRC.
d) The results of this four-year demonstration project have
established that the State Pilot TRC model was both
clinically effective and cost effective when compared to
SB 518
Page 5
customary fee-for-service care. Seventy-seven percent of
victims receiving trauma recovery center services engaged
in mental health treatment, compared to 34 % receiving
customary care. The State Pilot Project TRC model increased
the rate by which sexual assault victims received mental
health services from 6 % to 71 %, successfully linked 53 %
to legal services, 40 % to vocational services, and 31 % to
safer and more permanent housing. Trauma recovery center
services cost 34 % less than customary care.
e) 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.
f) By creating a 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.
EXISTING LAW:
1)Creates the Victims of Crime Program, 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 the 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,
SB 518
Page 6
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: (Gov. Code
§ 7599-7599.2.)
a) 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.
b) Requires the Director of Finance, beginning in 2016, to
calculate the savings from the reduced penalties.
c) 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.
d) The Controller then distributes the money in the fund
according to the following formula:
i) 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.
ii) 10% to the Victims of Crime Program to fund for
grants to TRCs.
iii) 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
SB 518
Page 7
emphasis on reducing recidivism.
FISCAL EFFECT: Unknown
COMMENTS:
1)Author's Statement: According to the author, "The physical
and psychological trauma experienced by victims of crime
requires early treatment and comprehensive care in order to
avoid negative outcomes for the individual victim, as well as
their families and communities. In California today, victims
and survivors of crime often face significant hurdles in
accessing the immediate and comprehensive support needed to
recover adequately, and are often unaware that the state
offers assistance for certain health and support services.
"Victims must navigate an often difficult and bureaucratic
process in accessing state services, involving multiple
agencies across different locations. If a victim is
ultimately approved for state support, they may wait 3 months
or more to access victim's compensation funds to help cover
the costs of critical support services.
"Without timely holistic support, victims often suffer long
term mental health challenges and struggle to take care of
their families, maintain employment and retain stable housing.
Free, holistic care that is easy to access would be life
changing for many.
"In order to address this pressing need, a grant program to
replicate a successful Trauma Recovery Center (TRC) in San
Francisco was created in 2013. This program, housed at the
VCGCB, funds $2 million in grants annually.
"The TRC treatment model was developed in 2001 to address the
multiple barriers victims face recovering from crime. The TRC
model utilizes a comprehensive, flexible approach that
integrates three modes of service: assertive outreach,
clinical case management, and evidence-based trauma-focused
SB 518
Page 8
therapies.
"The model is designed to meet the unique needs of crime
victims suffering from trauma by utilizing a multidisciplinary
staff to provide direct mental health services and health
treatment while coordinating services with law enforcement and
other social service agencies. All of these services are
housed under one roof.
"Survivors of crime who received services through the TRC saw
significant increases in health and wellness. Seventy-four
percent of those served showed an improvement in mental
health, and 51% demonstrated an improvement in physical
health.
"TRC services have also improved community engagement and
public safety. People who receive services at the TRC are 56%
more likely to return to employment, 44% more likely to
cooperate with the district attorney, and 69% more likely to
generally cooperate with law enforcement. All of these
benefits are provided at a 33% lower cost than traditional
providers.
"In order to ensure these same outstanding outcomes and
savings, and to ensure fidelity to the TRC model, clear but
flexible guidelines must be added to the statute governing the
grant program."
2)Background: According to the background submitted by the
author, by setting clear guidelines and providing training for
new TRCs, this bill will ensure that victims of crime in
California receive the comprehensive and timely services they
need in order to heal, and to avoid negative economic
consequences for themselves and their communities. The
physical and psychological trauma experienced by victims of
crime requires early treatment and comprehensive care.
However, in California today, victims and survivors of crime
often face significant hurdles in accessing the immediate and
comprehensive support needed to recover adequately, and are
SB 518
Page 9
often unaware that the state offers assistance for certain
health and support services.
In order to address this pressing need, a grant program to
replicate the successful TRC pioneered by UC San Francisco was
created in 2013. This program, housed at the Board, funds $2
million in grants annually. The TRC treatment model was
developed in 2001 to address the multiple barriers victims
face recovering from crime, and utilizes a comprehensive,
flexible approach designed to meet the unique needs of crime
victims suffering from trauma. TRCs utilize a
multidisciplinary staff to provide direct mental health
services and health treatment while coordinating services with
law enforcement and other social service agencies, and all
services are housed under one roof, with one coordinating
point of contact for the victim.
The TRC model has proven to be extremely successful, and since
the grant program began, survivors of crime who received
services through the TRC saw significant increases in health
and wellness. 74% of those served showed an improvement in
mental health, and 51% demonstrated an improvement in physical
health. People who receive services at the TRC are 56% more
likely to return to employment, 44% more likely to cooperate
with the district attorney, and 69% more likely to generally
cooperate with law enforcement. All of these benefits are
provided at a 33% lower cost than traditional providers.
The Legislative Analyst's Office (LAO) estimates future
additional funding for the TRC grant program at anywhere
between $10-20 million annually, stemming from language in
Proposition 47 of 2014 that directed 10% of the savings
realized from the proposition to this program. Proposition 47
was passed by nearly 60% of the California electorate, and the
LAO has recommended that these savings be spent as effectively
as possible. SB 518 will ensure just that, and is consistent
with the recommendations of the LAO in their recent report
"Improving State Programs for Victims of Crime."
SB 518
Page 10
3)Proposition 47 and Trauma Recovery Center Funding: On
November 4, 2014, California voters approved Proposition 47,
also known as the Safe Neighborhoods and Schools Act, which
reduced penalties for certain offenders convicted of
nonserious and nonviolent property and drug crimes.
Proposition 47 also allows inmates serving sentences for
crimes affected by the reduced penalties to apply to be
resentenced. Proposition 47 directed 10% of the savings
realized from the proposition to trauma recovery centers.
According to the California Secretary of State's Web site, 59.6
% of voters approved Proposition 47. (See
< http://elections.cdn.sos.ca.gov/sov/2014-general/pdf/2014-comp
lete-sov.pdf > [as of Mar. 14, 2015].) The purpose of the
measure was "to maximize alternatives for nonserious,
nonviolent crime, and to invest the savings generated from
this act into prevention and support programs in K-12 schools,
victim services, and mental health and drug treatment."
(Ballot Pamp., Gen. Elec. (Nov. 4, 2014), Text of Proposed
Laws, p. 70.) One of the ways the measure created savings was
by requiring misdemeanor penalties instead of felonies for
nonserious, nonviolent crimes like petty theft and drug
possession for personal use, unless the defendant has prior
convictions for specified violent crimes. (Ibid.)
Four months into its implementation, Proposition 47 has resulted
in fewer inmates in state prisons and county jails. According
to the Legislative Analysts' Office (LAO), "As of January 28,
2015, the inmate population in the state's prisons was about
113,500, or 3,600
inmates below the February 2015 cap, and slightly below the
final February 2016 cap. The expected impact of Proposition 47
on the prison population will make it easier for the state to
remain below the population cap." (LAO, The 2015-16 Budget:
Implementation of Proposition 47 (Feb. 2015), p. 10.) The LAO
report also found that Proposition 47 will likely reduce the
costs of criminal justice for counties, by freeing up jail
beds and reducing the time probation departments need to
follow prisoners after they are released. (Id. at p. 17.)
SB 518
Page 11
4)Argument in Support: According to Californians for Safety and
Justice, "Californians for Safety and Justice is a nonprofit
organization of Californians from diverse sectors joining
together to replace prison and justice system waste with smart
justice solutions that increase safety and reduce costs. Our
work includes a statewide network of over 5,000 crime victims,
Crime Survivors for Safety and Justice, a group that aims to
reduce barriers to recovery for crime victims and expand
victims' supports.
"We are proud to be the sponsor of SB 518 (Leno) which would
create programmatic guidelines for the Trauma Recovery Center
(TRC) Grant Program and create the TRC Center of Excellence,
housed at UC San Francisco, to provide systematic training,
technical assistance, and ongoing standardized program
evaluations to ensure program fidelity. This bill will help
provide quality trauma recovery services to crime victims and
survivors across the state.
"The Trauma Recovery Center model, pioneered in San Francisco
in 2001, provides a comprehensive, flexible approach that
integrates three modes of service - assertive outreach,
clinical case management, and evidence-based trauma-focused
therapies. This model is designed to meet the special needs of
crime victims suffering from trauma by utilizing a
multidisciplinary staff to provide direct mental health
services and health treatment while coordinating services with
law enforcement and other social service agencies - all under
one roof. Survivors of crime who received services through
the TRC saw huge increases in health and wellness- 74% show
and improvement in mental health, and 51% demonstrate an
improvement in physical health. TRC services also improved
community engagement and public safety. People who receive
services at the TRC are 56% more likely to return to
employment, and people who receive services are 44% more
likely to cooperate with the district attorney, and 69% more
likely to cooperate with law enforcement.
SB 518
Page 12
"In 2013, a grant program was created to replicate this
successful TRC model in other parts of California. This
program, housed at the Victim Compensation and Government
Claims Board (VCGCB), totals $2 million annually. In order to
ensure other TRCs have the same outstanding outcomes as the
San Francisco TRC, specific programmatic guidelines must be
put in place. SB 518 does exactly that, and additionally
creates a Center of Excellence at the original TRC, to provide
training, technical assistance, and ongoing standardized
program evaluations to ensure program fidelity.
"This bill will ensure that crime victims and survivors
receive quality trauma recovery services. Please vote yes on
SB 518."
5)Argument in Opposition: According to the California Coalition
Against Sexual Assault, "The California Coalition Against
Sexual Assault (CALCASA) is formally registering our
opposition to SB 518 unless the bill is amended to reflect
creation and inclusion of a California Trauma Recovery Center
Taskforce.
"We believe that the development of criteria for California
Trauma Recovery Centers should be comprised of a diverse
working group that represents the disparate needs of
California communities and the victims of crime served at a
local level.
"CALCASA provides leadership, vision, and resources to rape
crisis centers, individuals and other entities committed to
ending sexual violence. As the association for the 84 rape
crisis centers serving all California, CALCASA is committed to
ending sexual violence through a multifaceted approach of
SB 518
Page 13
prevention, intervention, education, research, advocacy, and
public policy.
"We strongly feel that there cannot be a "one size fit all"
approach to victims services; each TRC must have the freedom
to create and implement a model appropriate for the local
culture and existing systems of support for victims of crime.
We believe a better approach would be to develop a taskforce
to establish the guidelines based on best practices in the
field, with a focus on trauma recovery for survivors of all
forms of violence and crimes, including consideration to the
special needs of survivors of domestic violence and sexual
assault.
"For these reasons, CALCASA is opposed to SB 518 unless the
bill language is amended."
6)Prior Legislation:
a) SB 71 (Budget and Fiscal Review) , Chapter 28, Statutes
of 2013, authorized the Board to administer a program to
award, upon appropriation by the Legislature, up to
$2,000,000 in grants, annually, to trauma recovery centers,
as defined, funded from the Restitution Fund.
b) SB 733 (Leno), of the 2009-2010 legislative session,
authorized the Board to evaluate applications and award
grants totaling up to $3 million, up to $1.7 million per
center, to multi-disciplinary TRCs that provide specified
services to and resources for crime victims. SB 733 failed
passage on the Senate Floor.
c) AB 1669 (Leno), of the 2007-08 Legislative Session,
would have appropriated $1.5 million for the TRC at the San
Francisco General Hospital. AB 1669 was vetoed.
SB 518
Page 14
d) AB 50 (Leno), Chapter 884, Statutes of 2006,
appropriated $1.3 million for the TRC at the San Francisco
General Hospital.
REGISTERED SUPPORT / OPPOSITION:
Support
American College of Emergency Physicians, California Chapter
Californians for Safety and Justice
California Attorneys for Criminal Justice
California Catholic Conference
California Psychological Association
Crime Victims United of California
Natividad Medical Foundation
San Francisco Department of Public Health
San Francisco District Attorney's Office
Society for Social Work Leadership in Health Care, California
Chapter
University of California
Opposition
California Coalition Against Sexual Assault
Peace Over Violence
Analysis Prepared by:Gabriel Caswell / PUB. S. / (916)
319-3744
SB 518
Page 15