BILL ANALYSIS                                                                                                                                                                                                    



                                                                     SB 524


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          Date of Hearing:  July 14, 2015


                        ASSEMBLY COMMITTEE ON HUMAN SERVICES


                                  Kansen Chu, Chair


          SB  
          524 (Lara) - As Amended July 8, 2015


          SENATE VOTE:  35-1


          SUBJECT:  Private residential care facilities for youth.


          SUMMARY:  Establishes a new type of community care facility - a  
          private or public residential care facility for youth - and  
          provides for its licensure and regulation.


          Specifically, this bill:  


          1)Makes Legislative findings and declarations related to  
            nontraditional treatment programs for children, including that  
            such facilities:  receive numerous allegations of abuse,  
            including death; currently operate unlicensed in California;  
            advertise services for youth who may feel they have no other  
            options; and have students who may have been previous victims  
            of trauma, experienced parental rejection based on actual or  
            perceived sexual orientation or gender identity, and have  
            mental health and substance use issues.  Further, states the  
            intent of the Legislature that the state license private or  
            public residential care facilities for youth as community care  
            facilities to ensure the safety of children residing in those  








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            facilities.


          2)Defines "private or public residential care facility for  
            youth" as a facility or program licensed by the Department of  
            Social Services (DSS) as a community care facility to provide  
            nonmedical care, counseling, or education or vocational  
            support to persons under the age of 18 with social, emotional,  
            behavioral, or mental health issues or disorders.  Further,  
            specifies that a private or public residential care facility  
            for youth may provide any of the following:  a program with  
            wilderness or outdoor experience, expedition, or intervention;  
            a boot camp or related, experience; a therapeutic boarding  
            school; or a behavior modification program.


          3)Requires DSS to license a private or public residential care  
            facility for youth as a community care facility. 


          4)Prohibits DSS from licensing a private or public residential  
            care facility for youth unless all therapeutic components of  
            the programs provided are appropriately licensed.


          5)Requires staff members of private or public residential care  
            facility for youth who supervise residents to receive  
            training, as specified.  Further, specifies components to be  
            included in a private or public residential care facility for  
            youth's training plan, including components that DSS shall  
            establish by adopting regulations, and requires the facility  
            to submit its training plan to DSS for approval prior to  
            implementing it.


          6)States that a staff member of a private or public residential  
            care facility for youth is a mandated child abuse reporter,  
            pursuant to current law.









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          7)Enumerates rights of residents of private or public  
            residential care facilities for youth, including, but not  
            limited to, the right to:  be free of corporal punishment,  
            deprivation of basic necessities, including education, as a  
            punishment, deterrent, or incentive, and physical restraints  
            of any kind; be free from abusive, humiliating, degrading, or  
            traumatizing actions; be accorded dignity in his or her  
            relationships; and have frequent contact with parents or  
            guardians.  Further, requires a list of these rights to be  
            publically posted and accessible to residents. 


          8)Prohibits a private or public residential care facility for  
            youth from accepting for placement or providing services to a  
            child assessed as seriously emotionally disturbed, with  
            exceptions as specified.


          9)Prohibits a private or public residential care facility for  
            youth from advertising or otherwise promoting services, as  
            specified, related to alcohol or drug use treatment unless the  
            facility has been licensed accordingly.


          10)Prohibits a private or public residential care facility for  
            youth from using secure containment or restraints of any kind,  
            with specified exceptions.


          11)States that a private or public residential care facility for  
            youth is not an eligible placement option for dependents or  
            wards of the court, and is not eligible for a foster care  
            group home rate.


          12)Prohibits a private or public residential care facility for  
            youth from accepting for residential placement any child under  
            the age of 12.








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          13)Requires a licensee of a private or public residential care  
            facility for youth that advertises or otherwise promotes  
            special care, programming, or environments for persons with  
            mental health, emotional, or social challenges to provide  
            prospective residents and their parents or guardians with a  
            written description of its programs and services prior to  
            admission.


          14)Makes conforming technical changes.


          EXISTING LAW:   


          1)Establishes the California Community Care Facilities Act to  
            provide for the licensure and regulation of community care  
            facilities.  (HSC 1500 et seq.)


          2)Defines "community care facility" to mean any facility, place,  
            or building that is maintained and operated to provide  
            nonmedical residential care, day treatment, adult day care, or  
            foster family agency services for children, adults, or  
            children and adults, including, but not limited to,  
            individuals with physical disabilities or mental impairments  
            and abused or neglected children.  Includes within this  
            definition, among a number of other facilities:  group homes,  
            foster family homes, small family homes, full-service adoption  
            agencies, noncustodial adoption agencies, and transitional  
            shelters.  (HSC 1502)


          3)Requires community care facilities operating in California, as  
            specified, to have a valid license.  (HSC 1503.5)










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          4)Requires DSS to conduct unannounced visits of each licensed  
            community care facility, except for foster family homes, and  
            requires that no facility or center be visited less frequently  
            than once every five years.  Further requires DSS to conduct  
            annual unannounced visits of licensed facilities under  
            specified circumstances, such as when a licensee is on  
            probation.  Additionally requires annual visits of a random  
            sample of at least 20% of facilities and centers not subject  
            to annual inspections for specified circumstances and states  
            that, should the total citations for this 20% of facilities  
            and centers exceed the previous year's by 10%, the random  
            sample subject to annual inspection shall increase in the next  
            year by 10%.  Because of this trigger, 30% of eligible  
            facilities and centers are now randomly sampled each year for  
            inspection.  (HSC 1534) 


          


          FISCAL EFFECT:  According to the May 18, 2015, analysis by the  
          Senate Appropriations Committee, this bill may result in the  
          following costs:


          1)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.

          2)Potentially significant ongoing costs in excess of $500,000  
            (General Fund) to the DSS Community Care Licensing Division  
            (CCLD) to license, monitor, and inspect additional facilities,  
            to be offset by the authority to charge both application and  
            regulatory fees.  Ongoing costs would be dependent on the  
            number of entities impacted statewide, which is unknown.  To  
            the extent the number of new licensees is significant would  
            require additional field staff for monitoring and oversight.








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          3)Potential non-reimbursable local enforcement costs, offset to  
            a degree by fine revenue to the extent licensing and  
            regulatory violations are enforced and prosecuted.



          COMMENTS:  


          Licensing and oversight of community care facilities:  CCLD  
          licenses and regulates a variety of community care facilities,  
          defined as "any facility, place, or building that is maintained  
          and operated to provide nonmedical residential care, day  
          treatment, adult day care, or foster family agency services for  
          children, adults, or children and adults, including, but not  
          limited to, the physically handicapped, mentally impaired,  
          incompetent persons, and abused or neglected children."  There  
          are a number of different types of community care facilities,  
          including: adult day programs, foster family agencies, foster  
          family homes, social rehabilitation facilities, transitional  
          shelters, group homes, runaway and homeless youth shelters, and  
          others.  CCLD also licenses and regulates child care centers,  
          residential care facilities for the elderly (RCFEs), and other  
          facilities.  Currently, approximately 65,000 care facilities are  
          licensed in the state, with the capacity to serve 1.3 million  
          Californians. 


          CCLD conducts random inspections of 30% of facilities annually,  
          and each facility must be visited at least once every five  
          years.  Some exceptions triggering more frequent inspections  
          exist, and federal funding requires approximately10% of  
          facilities to be inspected annually.  Approximately 500  
          licensing analysts are employed by CCLD to conduct inspections  
          and complaint investigations.   


          Prior to 2004, annual inspections were required for most  








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          facilities; the 2003-04 state budget reduced this to once every  
          five years.  The last two state budgets enhanced supports and  
          made changes related to inspections.  The 2014-15 budget  
          included a 10% increase in annual licensing and application  
          fees, and investments in quality enhancement, including  
          increased staff, training, a quality assurance unit, and  
          centralization of application and complaint processes.  The  
          2015-16 budget adopted further supports and reforms, including  
          enacting upcoming changes to the frequency of inspections:  
          starting in January 2017, DSS will increase inspections to once  
          every three years for all facilities, then to once every two  
          years for all facilities except child care by 2018, then to  
          annually for adult day care facilities and RCFEs by 2019.





          Residential facilities for youth with emotional and behavioral  
          challenges:  In 2008, the United States General Accountability  
          Office (GAO) released a report entitled, "Residential  
          Facilities: Improved Data and Enhanced Oversight Would Help  
          Safeguard the Well-Being of Youth with Behavioral and Emotional  
          Challenges."  This reported described the proliferation since  
          the 1990s of residential facilities serving youth with  
          behavioral and emotional challenges.  These facilities include  
          boarding schools and academies, boot camps, and wilderness  
          camps.  Some such facilities have spawned reports of health and  
          safety risks for the youth who attend them.  According to the  
          GAO report, "annual investigations by the Civil Rights Division  
          within the Department of Justice, have detailed incidents of  
          abuse and neglect, which in some cases have been severe enough  
          to result in hospitalization or death."





          These facilities may also carry out concerning (and in some  








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          cases, illegal) practices such as "conversion therapy."  For  
          example, a sponsor of this bill, the Los Angeles LGBT Center,  
          reports that, "Many LGBT young people have been sent to these  
          institutions to change their sexual orientation or gender  
          identity.  These 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." 


          Regarding the licensure and regulation of these types of  
          facilities, the 2008 GAO report observed that:


            "States are primarily responsible for ensuring the well-being  
            of youth in facilities and other settings, and states vary in  
            how they license and monitor facilities in accordance with  
            individual state standards of care.  In addition, in return  
            for receiving funds under various federal grant programs,  
            state agencies agree to comply with federal program  
            requirements, including those related to youth well-being.   
            These programs generally fall under the purview of three  
            federal agencies:  The Department of Health and Human Services  
            (HHS) provides funds to states for child welfare, mental  
            health, and substance abuse; the Department of Justice (DOJ),  
            for serving delinquent youth; and the Department of Education  
            (Education), for educating youth.  These agencies have  
            authority to hold states accountable for state-operated or  
            private facilities that serve youth under federally funded  
            state programs. However, the federal government does not have  
            oversight authority for other private facilities that serve  
            only youth placed and funded by parents or other private  
            entities."


          Nonetheless, the federal government has taken note of these  
          types of facilities and the potentially associated problems.   
          The existence of a GAO report on the issue is a testament to  
          this, as were bills introduced in Congress.  While it ultimately  
          didn't pass, the "Stop Child Abuse in Residential Programs for  








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          Teens Act" was introduced in 2013 (H.R. 1981) and 2014 (S.  
          2054). This Act would have required certain standards and  
          enforcement provisions for the prevention of child abuse and  
          neglect in residential programs.


          Need for this bill:  Reports of abuse and neglect taking place  
          in certain residential facilities for youth - including accounts  
          of highly troubling practices of discrimination and so-called  
          "conversion" related to sexual orientation and gender identity -  
          raise the question of how such programs are able to continue  
          unlicensed and unregulated.  The current lack of licensure  
          requirements also makes it difficult to even get a sense of how  
          many and what types of these facilities exist across the state,  
          and the impacts (positive or negative) on the youth who attend  
          them.





          The 2008 GAO report found that, "States could take action to  
          improve the well-being of youth in residential facilities  
          through their licensing processes, contract provisions, or  
          accreditation requirements.  Expanding licensing coverage would  
          allow states to establish minimum standards for youth in all  
          facilities, but may require state legislation to provide  
          necessary authority, as well as increased funding for oversight  
          and enforcement."





          According to the author:












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            "Tragically, many young people have experienced horrendous  
            abuse, neglect, and even death at unregulated boot camps,  
            wilderness camps, and residential institutions.  Survivors  
            report being denied medical care, corporal punishment,  
            solitary confinement, discrimination due to sexual  
            orientation.  Often parents and guardians have no idea that  
            the facility they are sending their child to is not held to  
            any standards and does not have any oversight.





            The current lack of oversight and regulations over these  
            private institutions has opened up California's most  
            vulnerable youth to abuse.  While private institutions should  
            retain the right to offer the unique programs they specialize  
            in, all children regardless of where they are should have  
            their essential health and safety needs met."


          


          PRIOR LEGISLATION


          SB 1089 (Liu), 2012, sought to license and regulate "private  
          nontraditional alternative treatment facilities for youth."  It  
          died in the Assembly Appropriations Committee.


          REGISTERED SUPPORT / OPPOSITION:




          Support








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          AIDS Project Los Angeles (APLA)


          American Civil Liberties Union of California


          BIENESTAR Human Services Inc.


          California Alliance of Child and Family Services


          California LGBT Health & Human Services Network


          City Council of the City of West Hollywood


          City of Los Angeles


          Equality California (EQCA)


          Gender Health Center


          Los Angeles LGBT Center, co-sponsor


          Sacramento LGBT Community Center


          SIA Organization


          Stonewall Democratic Club








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          Transgender Law Center


          WWASP Survivors





          Opposition


          


          None on file.








          Analysis Prepared by:Daphne Hunt / HUM. S. / (916)  
          319-2089