BILL ANALYSIS Ó SENATE COMMITTEE ON HUMAN SERVICES Senator McGuire, Chair 2015 - 2016 Regular Bill No: SB 524 ----------------------------------------------------------------- |Author: |Lara | ----------------------------------------------------------------- |----------+-----------------------+-----------+-----------------| |Version: |April 14, 2015 |Hearing |April 28, 2015 | | | |Date: | | |----------+-----------------------+-----------+-----------------| |Urgency: |No |Fiscal: |Yes | ---------------------------------------------------------------- ----------------------------------------------------------------- |Consultant|Sara Rogers | |: | | ----------------------------------------------------------------- Subject: Private alternative therapeutic institutions for youth SUMMARY This bill will establish the licensure and regulation category of "private alternative therapeutic institution for youth," defined to mean any residential facility or program operated by a private entity with a focus on serving persons 18 years of age and younger with emotional, behavioral, or mental health issues or disorders, as specified. ABSTRACT Existing law: 1)Establishes the Community Care Facilities Act, which provides for the licensure and regulation by the California Department of Social Services (CDSS) of nonmedical residential and non-residential facilities for mentally ill, developmentally and physically disabled individuals, and children and adults who require care or services. (HSC Section 1500 et seq.) 2)Defines "residential facility" to mean a family home, group care facility, or similar facility providing 24-hour nonmedical care to persons in need of personal services, supervision, or assistance that is essential for sustaining the activities of daily living, or for the protection of the individual. (HSC 1502 (a) (1)) SB 524 (Lara) PageB of? 3)Prohibits the operation of an unlicensed community care facility, defined as a facility providing, or representing that it provides, care or supervision; or a facility which accepts residents demonstrating the need for care and supervision; or which represents itself as a licensed community care facility, that is not exempted from licensure. (HSC 1503.5) 4)Exempts specified facilities from the requirements of the Community Care Facilities Act, including a health facility or clinic, as defined, a juvenile placement facility approved by the Department of Corrections and Rehabilitation, Division of Juvenile Justice or any juvenile hall operated by a county, any child day care facility, foster homes, any facility conducted for the adherents of any well-recognized church or religious denomination who depend upon prayer or spiritual means for healing in the practice of the church or denomination, any school dormitory or similar facility determined by the department, any facility that supplies board and room only, or room only, recovery houses providing group living arrangements, and others. (HSC 1505) This bill: 1)Makes legislative findings and declarations regarding private nontraditional treatment programs serving youth with behavioral issues, noting thousands of allegations of abuse, including death, and that former students have formed national and local organizations to expose the trauma and abuse they experienced at such facilities. 2)Defines "private alternative therapeutic institution for youth" to mean any residential facility or program operated by a private entity with a focus on serving persons 18 years of age and younger with emotional, behavioral, or mental health issues or disorders which provides the following: A program with wilderness or outdoor experience, expedition, or intervention. SB 524 (Lara) PageC of? A boot camp experience or other experience designed to simulate characteristics of basic military training or correctional regimes. A therapeutic boarding school. A behavior modification program. 1)Prohibits a person or specified entity from operating, establishing, managing, conducting, or maintaining a private alternative therapeutic institution for youth, unless the facility is licensed by the department. 2)Requires CDSS to adopt regulations no later than June 1, 2016, establishing oversight and monitoring of private alternative therapeutic institutions for youth that, at a minimum, ensure the physical and mental well-being of youth in those institutions, and create mandated personal rights for those youth. 3)Provides that a school dormitory or similar facility that is a private alternative therapeutic institution for youth, as defined, is not exempt from licensure. FISCAL IMPACT This bill has not been analyzed by a fiscal committee. BACKGROUND AND DISCUSSION Purpose of the bill: According to the author, in recent decades hundreds of alternative treatment institutions have been established for SB 524 (Lara) PageD of? youth with emotional or behavioral problems nationwide and abroad. The author states that such institutions exist across the state and provide services in a range of settings, from residential boarding school facilities to military style academies and boot camps, and offer a range of services such as behavioral programs, emotional counseling, or drug and alcohol treatment. The author further states that many young people have experienced abuse, neglect, and even death at these unregulated institutions. According to the author, survivors report being denied medical care, and subjected to corporal punishment, solitary confinement, gender and sexual orientation discrimination, and non-medically sound therapeutic practices. The author notes that children's residential facilities that receive state or federal funding are required to be licensed by the state. However, according to the author, children sent by their parents or guardians to participate in private programs do not experience the same protections. The author further states that, currently in California, residential boarding schools are exempt from state licensing and do not have any oversight beyond filing a one-page affidavit with the California Department of Education. The current lack of oversight and regulations over private institutions has opened up California's vulnerable youth to abuse, according to the author. Private Children's Residential Facilities Private, self-described "therapeutic boarding schools," "wilderness programs," "residential treatment centers," or "reform schools" are 24-hour residential facilities serving children and adolescents who face emotional, mental, academic, physical or social challenges. In some instances, facilities may be licensed as a residential group home or a residential community treatment facility. However, there are facilities and programs in the state that are unlicensed and either relying on the exemption for "school dormitories" provided for in statute (HSC 1505) or because there is no licensing provision pertaining to wilderness camps or boot camps. Additionally, numerous programs advertise a presence in California, maintaining corporate offices in-state, with the facility itself located another state such as Utah or Texas, which have minimal SB 524 (Lara) PageE of? regulatory oversight. According to the National Association of Therapeutic Schools and Programs (NATSAP), its members "provide residential, therapeutic and/or education services to children, adolescents and young adults entrusted to them by parents and guardians. The common mission of NATSAP members is to promote the healthy growth, learning, motivation, and personal well-being of program participants. The objective of member therapeutic and educational programs is to provide excellent treatment for program participants; treatment that is rooted in concern for their well-being and growth; respect for them as human beings; and sensitivity to their individual needs and integrity."<1> One for-profit corporation operating over two dozen facilities nationwide, for example, recently operated an unlicensed year-round 24-hour residential facility in Reedley, marketed as serving teens struggling with their weight. The Reedley campus was a self-described college preparatory school for grades 8-12, that promised families that children enrolled "achieve immediate and dramatic weight loss from thorough Diet and Activity Management," and that they "undergo behavioral change through intensive cognitive-behavioral therapy, retraining the brain to make better decisions with regard to diet and physical activity as well as addressing other behavioral issues that may be causing (or resulting from) the weight."<2> Safety and Abuse Concerns Aspen Education Group, which operates more than two dozen facilities across the nation, including one in California, has been the subject of numerous lawsuits and accusations of abuse and neglect including incidents of "sexualized role play." --------------------------- <1> http://www.natsap.org/natsap-principles/ <2> National Assoc of Therapeutic Schools. 2011 Directory. http://n.b5z.net/i/u/10044700/f/NATSAP_2011.pdf SB 524 (Lara) PageF of? In 2004, a 14-year-old boy died in an Aspen wilderness program after hiking several miles in 90-degree weather. Reportedly, "a combination of excessive heat, a constrictive uniform, and Matthew's obesity caused his body to overheat. He suffered severe heatstroke requiring immediate medical attention however program staffers ignored complaints and the youth died an hour later at the hospital. In 2012, a mother sued Aspen alleging that her 15-year-old daughter was subjected to hours of stress positions, threats of suffocation, exposure to animal abuse and regular public humiliation. On December 11, 2013, the case was dismissed under the two-year statute of limitations that applies for claims involving a health care provider. General Accounting Office report A US General Accounting Office report entitled, "Residential Facilities: Improved Data and Enhanced Oversight Would Help Safeguard the Well-Being of Youth with Behavioral and Emotional Challenges" from May, 2008 evaluated regulatory oversight of residential facilities serving children, including private facilities receiving no government funding. The report identified gaps in regulatory oversight and licensure of private residential facilities serving youth and states: Licensing all facilities, public or private, can help ensure that residential facilities meet the relevant standards for protecting youth well-being... Facility licensing is also important because parents and others considering placing youth in private facilities at their own expense do not always have the information they need to screen facilities and make an informed decision. In our testimony on private facilities last October, we described cases in which program leaders told parents their programs could provide services that they were not qualified to offer, claimed to have credentials in therapy or medicine that they did not have, and led parents to trust them with youth who had serious mental disabilities. One national association for programs serving youth with behavioral and emotional difficulties testified before SB 524 (Lara) PageG of? Congress that state licensing was important because the field does not currently have the capacity to certify facility integrity. Weaknesses in the current federal-state regulatory structure have failed to safeguard the civil rights and well-being of some of the nation's most vulnerable youth. Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (ASTART) a self-described "community of professionals, family members and survivors working to protect children from abuse and neglect in residential programs" states that private therapeutic boarding schools and residential programs for youth often isolate children from parents and advocates. The organization states that contact with parents and the outside world is often limited and that "survivors consistently report that scheduled calls with parents are permitted only rarely, if at all, and are strictly monitored and controlled. Calls are never granted at the request of the child who feels they may be in danger. Mail, if allowed, is censored and/or withheld. The teens almost never see their parents-a few days a year at most-and family members are rarely, if ever, allowed to visit. Additionally, ASTART states that "nearly all youth we've talked to who were confined in these facilities tell us they were required to attend harsh, confrontational group "rap" groups two to three times per week for two to four hours. In these sessions they were forced to accuse and yell at each other. One student becomes the focus of debasing verbal attacks by the group. The attacks go on until the teen is humiliated and sobbing. Survivors tell us that when they did not participate in attacking another teen, they risked being attacked themselves. These abusive "group therapy" sessions take the place of up to 12 hours of class time each week." SB 524 (Lara) PageH of? Related legislation: SB 1089 (Liu, 2010) would have defined "private nontraditional alternative treatment facility for youth," as any residential or nonresidential facility or program operated by an organization that provides aggressive nontraditional punitive, retaliatory, aversive, or military style behavioral treatment or intervention services for youth, and prohibits their use in California without accreditation by specific entities. Failed passage in the Assembly Appropriations Committee 2012. COMMENTS The author proposes the following amendments to provide additional direction to CDSS in establishing regulatory oversight of these facilities. These amendments provide for a new licensing category "private residential care facilities for youth" as defined, and establishing a series of rights for youth residents, as specified, and clarifying that facilities providing certain mental health and drug dependency services be certified by the California Department of Health Care Services in accordance with requirements applicable to other community care facilities. Staff recommends the author continue discussions with CDSS to clarify regulatory provisions pertaining to the licensing of wilderness camps that do not have a brick-and-mortar facility serving residents. POSITIONS Support: American Civil Liberties Union of California Equality California Gender Health Center LGBTQ Center of Long Beach Transgender Law Center WWASP Survivors Opposition: None. SB 524 (Lara) PageI of? Amendments Mock-up for 2015-2016 SB-524 (Lara (S)) *********Amendments are in BOLD********* Mock-up based on Version Number 98 - Amended Senate 4/14/15 The people of the State of California do enact as follows: SECTION 1. The Legislature finds and declares all of the following: (a) Since the 1990s, hundreds of nontraditional treatment programs that are intended to be less restrictive treatment options for children with significant behavioral issues have been established nationwide, with thousands of allegations of abuse, including death. (b) There are currently facilities operating within California that are not licensed by the State Department of Social Services. (c) These facilities are often owned and operated by nonprofit organizations described in Section 501(c)(3) of the Internal Revenue Code. (d) These facilities advertise services for youth with behavioral issues to families who may feel they have no other options. SB 524 (Lara) PageJ of? (e) Former students have formed national and local organizations to expose the trauma and abuse they experienced at these facilities. (f) Students at these facilities are previous victims of trauma, have experienced parental rejection based on actual or perceived sexual orientation or gender identity, and have mental health and substance use issues. (g) It is the role of the Legislature to ensure proper licensing and regulation of residential facilities for the protection and care of all citizens. (h) It is the intent of the legislature that the State of California license private residential care for youth as a community care facility to ensure the safety of children residing in such facilities. SEC. 2. Section 1502.2 is added to the Health and Safety Code, to read: 1502.2. (a) For purposes of this section, the following definitions apply: (1) "Administrator" means the individual designated by the licensee to act on behalf of the licensee in the overall management of the facility. The licensee, if an individual, and the administrator may be one and the same person. (2) "Department" means the State Department of Social Services. (3) "Director" means the Director of Social Services. (4) "License" means a basic permit to operate a private residential care facility for youth. (5) "Private
alternative therapeutic institutionresidential care facility for youth" means any 24-hour residential facility or program operated by a private entity providing nonmedical care, counseling, educational or vocational support to with a focus on servingpersons 18 years of age and younger with SB 524 (Lara) PageK of? social, emotional, behavioral, or mental health issues or disorders, and thatincluding a program that provides any of the following: (1) A program with wilderness or outdoor experience, expedition, or intervention. (2) A boot camp experience or other experience designed to simulate characteristics of basic military training or correctional regimes. (3) A therapeutic boarding school. (4) A behavior modification program. (b) (1) A person, firm, partnership, association, organization, or corporation shall not operate, establish, manage, conduct, or maintain a private alternative therapeutic institutionresidential care facility for youth, unless the facility is licensed by the department. (c) The department shall adopt regulations no later than June 1, 2016, establishing oversight and monitoring of private alternative therapeutic institutions for youth that, at a minimum, ensure the physical and mental well-being of youth in those institutions, and create mandated personal rights for those youth.(2) The department shall inspect and license private residential care facilities for youth as a community care facility. A license is not transferable. (d)(c) The department shall not license a private alternative therapeutic institutionresidential care facility for youth unless all therapeutic components of the programs provided at the institution are licensed by the appropriate agency or department. (d) Any person or entity desiring issuance of a license for a private residential care facility for youth under this chapter shall file an application on forms furnished by the department. The application shall include, but not be limited to, all of the following: SB 524 (Lara) PageL of? (1) Evidence satisfactory to the department of the ability of the applicant to comply with this section and any rules and regulations adopted by the department under this section. (2) (A) Evidence satisfactory to the department that the applicant is of reputable and responsible character. (B) The evidence shall include, but not be limited to, all of the following: (i)(I) A criminal record clearance pursuant to Section 1522. The law enforcement agency from which a criminal record is requested may charge a reasonable fee sufficient to cover its cost in providing the criminal record in accordance with this paragraph. (II) The department shall review the criminal record to determine whether the applicant has ever been convicted of a crime other than a minor traffic violation or arrested for any crime specified in subdivision (c) of Section 290 of the Penal Code, or for violating Section 245, 273ab, or 273.5, subdivision (b) of Section 273a, or, prior to January 1, 1994, paragraph (2) of Section 273a, of the Penal Code, or for any crime for which the department is prohibited from granting a criminal record exemption. If the applicant has been convicted of one of these crimes, the department shall not license the applicant. (ii) Employment history. (iii) Character references. (C) If the applicant is a firm, association, organization, partnership, business trust, corporation, or company, the evidence required by this paragraph shall be submitted for members or shareholders of the entity and the person who will act as administrator. (3) Evidence satisfactory to the department that the applicant has sufficient financial resources to maintain the standards of service required by this section and regulations adopted pursuant to this section. (4) Disclosure of any revocation or other disciplinary action taken, or in the process of being taken, against a license held or previously held by applicant. (5) Evidence satisfactory to the department of the applicant's ability to meet regulatory requirements for the level of care the applicant intends to provide. SB 524 (Lara) PageM of? (6) Evidence satisfactory to the department of adequate knowledge of supportive services and other community supports which may be necessary to meet the needs of youth residents. (7) Designation by the applicant of the individual who will be the administrator of the facility, including, if the applicant is an individual, whether or not the licensee will also be the administrator. (8) A signed statement that the person desiring issuance of a license has read and understood the private residential care facility for youth statutes and regulations. (9) Any other information as may be required by the department for the proper administration and enforcement of this chapter. (10) The facilities plan of operation in accordance with Section 80022 of Title 22 of the California Code of Regulations. (e) A prospective applicant for licensure shall be notified at the time of the initial request for information regarding application for licensure that, prior to obtaining licensure, the facility shall secure and maintain a fire clearance approval from the local fire enforcing agency, as defined in Section 13244, or the State Fire Marshal, whichever has primary fire protection jurisdiction. The prospective applicant shall be notified of the provisions of Section 13235, relating to the fire safety clearance application. The prospective applicant for licensure shall be notified that the fire clearance shall be in accordance with state and local fire safety regulations. (f) Failure of the applicant to cooperate with the department in the completion of the application shall result in the denial of the application. Failure to cooperate means that the information described in this section and in regulations of the department has not been provided, or not provided in the form requested by the department, or both. (g) Any duly authorized officer, employee, or agent of the department may, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, SB 524 (Lara) PageN of? this chapter. (h) (1) The department may charge a reasonable application fee adjusted by facility and capacity for the issuance of a license to operate private residential care facilities for youth. (2) The department may also charge an annual regulatory fee on each anniversary of the effective date of the license. (3) The Legislature finds that all revenues generated by fees for licenses computed under this section and used for the purposes for which they were imposed are not subject to Article XIII B of the California Constitution. (i) (1) The Legislature finds that the quality of services provided to residents of a private residential care facility for youth is dependent upon the training and skills of staff. It is the intent of the Legislature in enacting this section to ensure that a direct-care staff member has the knowledge and proficiency to carry out the tasks of his or her job. (2) A staff members of a private residential care facility for youth who supervises residents shall receive appropriate training. This training shall consist of 10 hours of training within the first four weeks of employment and eight hours annually thereafter. This training shall be administered on the job, or in a classroom setting, or any combination of the two. The department shall establish the subject matter required for this training. (3) The training shall be approved by the department and shall include, but not be limited to, all of the following: (A) Residents' rights as described in subdivision (j). (B) Psychosocial needs of youth. (C) Appropriate response to emergencies. (4) Physical needs for youth residents. (5) Cultural competency and sensitivity in issues relating to the underserved, lesbian, gay, bisexual, and transgender community. SB 524 (Lara) PageO of? (6) Laws and regulations pertaining to community care facilities and private residential care programs for youth. (j) Residents of a private residential care facility for youth shall have all of the following rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. (2) To be granted a reasonable level of personal privacy in accommodations, medical care, personal care and assistance, visits, written and electronic communications, and telephone conversations. (3) To confidential care of their records and personal information and to approve their release, except as authorized by law. (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs and ensure their safety. (5) To be served food of the quality and in the quantity necessary to meet their nutritional needs. (6) To present grievances and recommend changes in policies, procedures, and services to the staff of the facility, the facility's management and governing authority, and to any other person without restraint, coercion, discrimination, reprisal, or other retaliatory actions. The licensee shall take prompt actions to respond to residents' grievances. (7) To have frequent contact with parents or guardians including scheduled and unscheduled phone calls, unrestricted correspondence, and electronic communications. (8) To be fully informed, as evidenced by the resident's written acknowledgement, prior to or at the time of admission, of all rules governing residents' conduct and responsibilities. (9) To receive in the admission agreement information that details the planned treatments and care for the resident. SB 524 (Lara) PageP of? (10) For parents or guardians to remove youth from a facility. (11) To consent to have relatives and other individuals of the resident's choosing visit or call during reasonable hours, privately and without prior notice. (12) To be free of corporal punishment, depravation of basic necessities, including education, as a punishment or incentive, and physical restraints of any kind. (13) To receive supportive mental and emotional health-related services from trained staff who are licensed or are overseen by licensed mental health professionals. (14) To be free from abusive, humiliating, degrading and traumatizing activities. (k) A community care facility licensed as a private residential care facility for youth pursuant to this chapter shall not accept for placement, and provide care and supervision to, a child assessed as seriously emotionally disturbed unless the facility has been certified by the State Department of Social Services pursuant to Section 4096.5 of the Welfare and Institutions Code as a program that provides mental health treatment services for seriously emotionally disturbed children. (1) "Seriously emotionally disturbed" means the same as paragraph (2) of subdivision (a) of Section 5600.3 of the Welfare and Institutions Code. (l) A community care facility licensed as a private residential care facility for youth shall not advertise or promote services designed to promote treatment and maintain recovery from alcohol or drug problems which includes one or more of the following: detoxification, group sessions, individual sessions, educational sessions, and/or alcoholism or drug abuse recovery or treatment planning unless the facility has been licensed as an alcoholism or drug abuse recovery or treatment facility pursuant to Section 11834.01. (m) A community care facility licensed as a private residential care facility for youth shall not provide secure containment or SB 524 (Lara) PageQ of? use restraints of any kind unless the program components are subject to program standards developed and enforced by the State Department of Mental Health pursuant to Section 4094 of the Welfare and Institutions Code. (n) A community care facility licensed as a private residential care facility for youth is not an eligible placement option pursuant to Sections 319, 361.2, 450, and 727 of the Welfare and Institutions Code. (o) A community care facility licensed as a private residential care facility for youth shall not be eligible for a rate pursuant to Section 11462 of the Welfare and Institutions Code. (p) A community care facility licensed as a private residential care facility for youth shall not accept children under the age of 12 for residential placement. (q) A licensee of a private residential care facility for youth that advertises or promotes special care, programming, or environments for persons with a mental health, emotional, or social related challenge, shall provide to each prospective resident and their parent or guardian an accurate narrative description of these programs and services. The description shall be provided in writing prior to admission. SEC. 3. Section 1505 of the Health and Safety Code is amended to read: 1505. This chapter does not apply to any of the following: (a) Any health facility, as defined by Section 1250. (b) Any clinic, as defined by Section 1202. (c) Any juvenile placement facility approved by the Department of Corrections and Rehabilitation, Division of Juvenile Justice, or any juvenile hall operated by a county. (d) Any place in which a juvenile is judicially placed pursuant to subdivision (a) of Section 727 of the Welfare and Institutions Code. SB 524 (Lara) PageR of? (e) Any child day care facility, as defined in Section 1596.750. (f) Any facility conducted by and for the adherents of any well-recognized church or religious denomination for the purpose of providing facilities for the care or treatment of the sick who depend solely upon prayer or spiritual means for healing in the practice of the religion of the church or denomination. (g) Any school dormitory or similar facility determined by the department, except a private alternative therapeutic institutionresidential care facility for youth as defined in Section 1502.2. (h) Any house, institution, hotel, homeless shelter, or other similar place that supplies board and room only, or room only, or board only, provided that no resident thereof requires any element of care as determined by the director. (i) Recovery houses or other similar facilities providing group living arrangements for personsadults recovering from alcoholism or drug addiction where the facility provides no care or supervision. (j) Any alcoholism or drug abuse recovery or treatment facility serving adults, as defined by Section 11834.11. (k) Any arrangement for the receiving and care of persons by a relative or any arrangement for the receiving and care of persons from only one family by a close friend of the parent, guardian, or conservator, if the arrangement is not for financial profit and occurs only occasionally and irregularly, as defined by regulations of the department. For purposes of this chapter, arrangements for the receiving and care of persons by a relative shall include relatives of the child for the purpose of keeping sibling groups together. (l) (1) Any home of a relative caregiver of children who are placed by a juvenile court, supervised by the county welfare or probation department, and the placement of whom is approved according to subdivision (d) of Section 309 of the Welfare and Institutions Code. (2) Any home of a nonrelative extended family member, as SB 524 (Lara) PageS of? described in Section 362.7 of the Welfare and Institutions Code, providing care to children who are placed by a juvenile court, supervised by the county welfare or probation department, and the placement of whom is approved according to subdivision (d) of Section 309 of the Welfare and Institutions Code. (3) On and after January 1, 2012, any supervised independent living placement for nonminor dependents, as defined in subdivision (w) of Section 11400 of the Welfare and Institutions Code, who are placed by the juvenile court, supervised by the county welfare department, probation department, Indian tribe, consortium of tribes, or tribal organization that entered into an agreement pursuant to Section 10553.1 of the Welfare and Institutions Code, and whose placement is approved pursuant to subdivision (k) of Section 11400 of the Welfare and Institutions Code. (4) A Transitional Housing Program-Plus, as defined in subdivision (s) of Section 11400 of the Welfare and Institutions Code, that serves only eligible former foster youth over 18 years of age who have exited from the foster care system on or after their 18th birthday, and that has obtained certification from the applicable county in accordance with subdivision (c) of Section 16522 of the Welfare and Institutions Code. (m) Any supported living arrangement for individuals with developmental disabilities, as defined in Section 4689 of the Welfare and Institutions Code. (n) (1) Any family home agency, family home, or family teaching home as defined in Section 4689.1 of the Welfare and Institutions Code, that is vendored by the State Department of Developmental Services and that does any of the following: (A) As a family home approved by a family home agency, provides 24-hour care for one or two adults with developmental disabilities in the residence of the family home provider or providers and the family home provider or providers' family, and the provider is not licensed by the State Department of Social Services or the State Department of Public Health or certified by a licensee of the State Department of Social Services or the State Department of Public Health. (B) As a family teaching home approved by a family home agency, SB 524 (Lara) PageT of? provides 24-hour care for a maximum of three adults with developmental disabilities in independent residences, whether contiguous or attached, and the provider is not licensed by the State Department of Social Services or the State Department of Public Health or certified by a licensee of the State Department of Social Services or the State Department of Public Health. (C) As a family home agency, engages in recruiting, approving, and providing support to family homes. (2) No part of this subdivision shall be construed as establishing by implication either a family home agency or family home licensing category. (o) Any facility in which only Indian children who are eligible under the federal Indian Child Welfare Act (Chapter 21 (commencing with Section 1901) of Title 25 of the United States Code) are placed and that is one of the following: (1) An extended family member of the Indian child, as defined in Section 1903 of Title 25 of the United States Code. (2) A foster home that is licensed, approved, or specified by the Indian child's tribe pursuant to Section 1915 of Title 25 of the United States Code. (p) (1) (A) Any housing occupied by elderly or disabled persons, or both, that is initially approved and operated under a regulatory agreement pursuant to Section 202 of Public Law 86-372 (12 U.S.C. Sec. 1701q), or Section 811 of Public Law 101-625 (42 U.S.C. Sec. 8013), or whose mortgage is insured pursuant to Section 236 of Public Law 90-448 (12 U.S.C. Sec. 1715z), or that receives mortgage assistance pursuant to Section 221d (3) of Public Law 87-70 (12 U.S.C. Sec. 1715l), where supportive services are made available to residents at their option, as long as the project owner or operator does not contract for or provide the supportive services. (B) Any housing that qualifies for a low-income housing credit pursuant to Section 252 of Public Law 99-514 (26 U.S.C. Sec. 42) or that is subject to the requirements for rental dwellings for low-income families pursuant to Section 8 of Public Law 93-383 (42 U.S.C. Sec. 1437f), and that is occupied by elderly or disabled persons, or both, where supportive services are made SB 524 (Lara) PageU of? available to residents at their option, as long as the project owner or operator does not contract for or provide the supportive services. (2) The project owner or operator to which paragraph (1) applies may coordinate, or help residents gain access to, the supportive services, either directly, or through a service coordinator. (q) A resource family, as defined in Section 16519.5 of the Welfare and Institutions Code (r) Any similar facility determined by the director. SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.