BILL ANALYSIS                                                                                                                                                                                                    






           ----------------------------------------------------------------- 
          |SENATE RULES COMMITTEE            |                        SB 524|
          |Office of Senate Floor Analyses   |                              |
          |(916) 651-1520    Fax: (916)      |                              |
          |327-4478                          |                              |
           ----------------------------------------------------------------- 


                                   THIRD READING 


          Bill No:  SB 524
          Author:   Lara (D), et al.
          Amended:  5/5/15  
          Vote:     21  

           SENATE HUMAN SERVICES COMMITTEE:  4-0, 4/28/15
           AYES:  McGuire, Berryhill, Hancock, Liu
           NO VOTE RECORDED:  Nguyen

           SENATE APPROPRIATIONS COMMITTEE:  5-0, 5/28/15
           AYES:  Lara, Beall, Hill, Leyva, Mendoza
           NO VOTE RECORDED:  Bates, Nielsen

           SUBJECT:   Private residential care facilities for youth


          SOURCE:    Los Angeles LGBT Center
          
          DIGEST:   This bill establishes a new community care licensure  
          category of "private residential care facility for youth," to  
          regulate a 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.

          ANALYSIS:   


          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  








                                                                     SB 524 
                                                                    Page  2


             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" as 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  
             Section 1502 (a) (1))

           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 Section 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 CDSS, any facility that supplies board and room  
             only, or room only, recovery houses providing group living  
             arrangements, and others. (HSC Section 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 residential care facility for youth"  
             (PRCFY) to mean any 24-hour residential facility or program  







                                                                     SB 524  
                                                                    Page  3


             operated by a private entity providing nonmedical care,  
             counseling, educational or vocational support to persons age  
             12 to 18 years of age with social, emotional, behavioral, or  
             mental health issues or disorders including a program that  
             provides any of the following:

              a)    A program with wilderness or outdoor experience,  
                expedition, or intervention.

              b)    A boot camp experience or other experience designed to  
                simulate characteristics of basic military training or  
                correctional regimes.

              c)    A therapeutic boarding school.

              d)    A behavior modification program.

           3) Prohibits a person or specified entity from operating,  
             establishing, managing, conducting, or maintaining a PRCFY,  
             unless the facility is licensed by CDSS.

           4) Requires the CDSS to license and inspect a PRCFY as a  
             community care facility.

           5) Prohibits CDSS from licensing a PRCFY unless all therapeutic  
             components of the programs provided at the facility are  
             licensed by the appropriate agency or department.

           6) Requires a person desiring issuance of a license for PRCFY  
             to file an application that includes specified information  
             and evidence.

           7) Requires the above evidence to include a criminal record  
             clearance, as specified, employment history, and character  
             references, among others.

           8) Authorizes CDSS to charge an application fee, adjusted by  
             capacity, for the issuance of a license to operate a PRCFY,  
             in an amount not to exceed the costs reasonably borne by CDSS  
             in licensing these facilities.

           9) Requires a staff member of a PRCFY who supervises residents  
             to receive appropriate training including 10 hours within the  
             first four weeks of employment and eight hours annually  







                                                                     SB 524  
                                                                    Page  4


             thereafter.

           10)Requires a PRCFY to submit its training plan to CDSS, and  
             require the training include the following subject areas:

              a)    Resident's rights, as specified.

              b)    Psychosocial needs of youth.

              c)    Appropriate response to emergencies.

              d)    Physical needs for youth residents.

              e)    Cultural competency and sensitivity in issues relating  
                to underserved, lesbian, gay, bisexual and transgender  
                communities.

              f)    Laws and regulations pertaining to community care  
                facilities and programs of PRCFY.

           11)Enumerates 14 rights of a resident of a PRCFY including:

              a)    To be accorded dignity in his or her personal  
                relationships with staff, residents, and other persons;

              b)    To have frequent contact with parents or guardians,  
                including scheduled and unscheduled telephone  
                conversations, unrestricted written correspondence, and  
                electronic communications;

              c)    To be free of corporal punishment, deprivation of  
                basic necessities, including education, as a punishment,  
                deterrent, or incentive, and physical restraints of any  
                kind; and

              d)    To receive supportive mental and emotional  
                health-related services from trained staff who are  
                licensed or are overseen by licensed mental health  
                professionals.

           12)         Provides that a PRCFY shall not accept for  
             residential placement a child younger than 12 years of age.

           13)         Prohibits a PRCFY from accepting for placement, or  







                                                                     SB 524  
                                                                    Page  5


             provide care or supervision to, a child assessed as seriously  
             emotionally disturbed, unless the Department of Health Care  
             Services (DHCS) has certified the facility as a program meets  
             the standards to provide mental health treatment services for  
             a seriously emotionally disturbed child, as specified.

           14)         Prohibits a PRCFY from advertising or promoting  
             services designed to promote the treatment of, or maintain  
             recovery from, alcohol or drug use, unless the facility has  
             been licensed as an alcoholism or drug abuse recovery or  
             treatment facility, as specified.

           15)         Prohibits a PRCFY from providing secure containment  
             or from using restraints of any kind unless the program  
             components are subject to program standards developed and  
             enforced by DHCS, as specified.

           16)         Provides that PRCFY for youth is not an eligible  
             placement option for dependent children and youth, or wards  
             and is not eligible for a rate pursuant to Section 11462 of  
             the Welfare and Institutions Code.
          
          Background

          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. Such facilities are intended to provide a  
          less-restrictive alternative to incarceration or  
          hospitalization, or an intervention for troubled youth. In some  
          instances, facilities may be licensed as a residential group  
          home or a residential community treatment facility. However, an  
          unknown number of unlicensed facilities and programs operate in  
          the state, relying on the licensure exemption for "school  
          dormitories" or because there is no licensing provision for to  
          wilderness camps or boot camps. 

          General Accounting Office report. A 2008 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" evaluated  
          regulatory oversight of residential facilities serving children,  







                                                                     SB 524  
                                                                    Page  6


          including private facilities receiving no government funding.  
          The report identified gaps in regulatory oversight and licensure  
          of private residential facilities serving youth and states:

              "?while states often regulate publicly funded  
              programs, a number of states do not license or  
              otherwise regulate private programs. Because programs  
              determine how to describe themselves, especially in  
              their marketing materials, there is no standard  
              definition for 'wilderness therapy program,' 'boot  
              camp,' or other terms used to describe the types of  
              programs and facilities considered to be part of this  
              industry." 

              "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 Congress that state  
              licensing was important because the field does not  
              currently have the capacity to certify facility  
              integrity."

          

          Safety and abuse concerns.  Private residential facilities for  
          youth have been the subject of numerous lawsuits and accusations  
          of abuse and neglect including incidents of "sexualized role  
          play." In 2004, a 14-year-old boy died in wilderness program  
          after hiking several miles in 90-degree weather. The child had  
          suffered severe heatstroke requiring immediate medical attention  
          however program staffers reportedly ignored complaints and the  
          youth died an hour later at the hospital. In 2012, a mother sued  
          a facility alleging that her 15-year-old daughter was subjected  
          to hours of stress positions, threats of suffocation, exposure  







                                                                     SB 524  
                                                                    Page  7


          to animal abuse and regular public humiliation. 
          
          The Alliance for the Safe, Therapeutic and Appropriate use of  
          Residential Treatment states it has received hundreds of  
          personal accounts of abuse in residential programs for teens  
          including "traumatic transportation to the program, harsh and  
          cruel punishment, inadequate education, unqualified staff, short  
          stays that grow into multi-year confinements, and lack of access  
          to parents and advocates to whom they might report abuse."   
          Additionally the organization states that facilities rely on  
          deceptive marketing practices to enroll children.

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   Yes

          According to the Senate Appropriations Committee, this bill will  
          result in expected one-time costs potentially in excess of  
          $250,000 (General Fund) to develop two sets of regulations for  
          the new licensure category, for the establishment of the new  
          regulatory category as well as for the training plan  
          requirements for these programs. Additionally, there are  
          potentially significant ongoing costs in excess of $500,000  
          (General Fund) to the CDSS Community Care Licensing Division to  
          license, monitor, and inspect additional facilities, to be  
          offset by the authority to charge both application and  
          regulatory fees.  Ongoing costs will be dependent on the number  
          of entities impacted statewide, which is unknown. To the extent  
          the number of new licensees is significant, it will require  
          additional field staff for monitoring and oversight.

          The Senate Appropriations Committee additionally estimates  
          potential non-reimbursable local enforcement costs, offset to a  
          degree by fine revenue to the extent licensing and regulatory  
          violations are enforced and prosecuted.

          SUPPORT:  (Verified  5/28/15)

          Los Angeles LGBT Center (source)
          American Civil Liberties Union of California
          Equality California
          Gender Health Center
          LGBTQ Center of Long Beach
          Transgender Law Center
          WWASP Survivors







                                                                     SB 524  
                                                                    Page  8




          OPPOSITION:   (Verified5/28/15)


          None received

          ARGUMENTS IN SUPPORT:  According to the author, in recent  
          decades hundreds of alternative treatment institutions have been  
          established for youth with emotional or behavioral problems  
          nationwide and abroad. The author 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 and that the current lack of oversight of private  
          residential institutions has left California's youth vulnerable  
          to abuse.



          Prepared by:Sara Rogers / HUMAN S. / (916) 651-1524
          5/30/15 16:57:51


                                   ****  END  ****