BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: SB 524
-----------------------------------------------------------------
|Author: |Lara |
-----------------------------------------------------------------
|----------+-----------------------+-----------+-----------------|
|Version: |August 19, 2016 |Hearing |August 26, 2016 |
| | |Date: | |
|----------+-----------------------+-----------+-----------------|
|Urgency: |No |Fiscal: |Yes |
----------------------------------------------------------------
-----------------------------------------------------------------
|Consultant|Mareva Brown |
|: | |
-----------------------------------------------------------------
Subject: Private alternative boarding schools and outdoor
programs
Hearing subject to Joint Rule 29.10
SUMMARY
This bill establishes the licensure categories of "private
alternative boarding school" and "private alternative outdoor
program" and would make those facilities subject to regulation
under the Community Care Licensing Act as of January 1, 2018 and
January 1, 2019, respectively. The bill would also establish
rights for youth admitted to a private alternative boarding
school or a private alternative outdoor program and would
require each prospective youth and his or her parent or guardian
be provided with an accurate written description of the
programs. The bill requires training in specified subject areas,
and makes other regulatory changes.
ABSTRACT
Existing law:
1) Establishes the California Community Care Facilities Act
to provide for the licensure and regulation of community
care facilities by California Department of Social Services
(CDSS). (HSC 1500, et seq.)
2) Defines "community care facility" to mean any facility,
SB 524 (Lara) PageB
of?
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) 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))
4) 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)
5) 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)
SB 524 (Lara) PageC
of?
This bill:
1) Makes various legislative findings and declarations,
including:
a) For decades, 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 CDSS.
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.
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
license private alternative boarding schools and private
alternative outdoor programs as community care facilities
to ensure the safety of children admitted to those
schools or programs
1) Adds to statute the licensure category of "private
alternative boarding school" and defines it as a group
home licensed by CDSS to provide youth with 24-hour
residential care and supervision, which, in addition to
providing educational services to youth, provides, or holds
itself out as providing, behavioral-based services to youth
with social, emotional, or behavioral issues.
SB 524 (Lara) PageD
of?
2) Adds to statute the licensure category of "private
alternative outdoor program" and defines it to mean a group
home licensed by CDSS to operate a program to provide youth
with 24-hour residential care and supervision, which
provides, or holds itself out as providing,
behavioral-based services in an outdoor living setting to
youth with social, emotional, or behavioral issues, as
specified.
3) Requires that the care and supervision provided by
private alternative boarding schools and private
alternative outdoor programs be nonmedical, except as
otherwise permitted by law.
4) Requires a private alternative boarding school or
private alternative outdoor program to comply with all
statutory provisions applicable to group homes, unless
otherwise indicated, and requires the facility to do all of
the following:
Be owned and operated on a nonprofit basis by a
private nonprofit corporation or a nonprofit
organization.
Prepare and maintain a current, written plan of
operation, as defined by CDSS.
Offer 24-hour, nonmedical care and supervision to
youth who voluntarily consent to being admitted to the
program and who are voluntarily admitted by his or her
parent or legal guardian.
Not admit a child younger than 12 years of age.
Not admit a youth who has been assessed by a
licensed mental health professional as seriously
emotionally disturbed, unless the youth does not require
care in a licensed health facility and the facility is
certified to provide appropriate mental health treatment,
as specified.
Provide each prospective youth and his or her parent
or legal guardian with an accurate written description of
the programs and services to be provided. If it
advertises or promotes special care, programming, or
environments for persons with behavioral, emotional, or
social challenges, the written description shall include
how its programs and services are intended to achieve the
advertised or promoted claims.
SB 524 (Lara) PageE
of?
Ensure that all individuals providing
behavioral-based services to youth at the facility are
licensed or certified by the appropriate agency,
department, or accrediting body, as specified by the
department in regulation.
Not employ secure containment or manual or
mechanical restraints.
If it offers access to, or holds itself out as
offering access to, mental health services, it shall
ensure that those services are provided by a licensed
mental health provider.
If it advertises or includes in its marketing
materials reference to providing alcohol or substance
abuse treatment, it shall ensure that the treatment is
provided by a licensed or certified alcoholism or drug
abuse recovery or treatment facility.
1) Requires a staffing ratio in private alternative outdoor
programs be one staff person to every four youths.
2) Requires that a staff member of a licensed private
alternative outdoor program who supervises youth receive an
additional number of hours of initial and annual training,
to be determined by CDSS in regulations developed in
consultation with stakeholders in addition to the training
required of group home staff by CDSS regulations.
3) Requires a private alternative boarding school or
private alternative outdoor program to submit a staff
training plan to CDSS as part of its plan of operation. In
addition to other required training, as specified, requires
training in all of the following subject areas:
a) Youth rights, as specified.
b) Physical and psychosocial needs of youth.
c) Appropriate responses to emergencies, including an
emergency intervention plan.
d) Cultural competency and sensitivity in issues
relating to the lesbian, gay, bisexual, and transgender
communities.
e) Laws pertaining to residential care facilities for
youth.
1) Additionally requires training in the following areas
SB 524 (Lara) PageF
of?
for staff of private alternative outdoor programs:
a) Low-impact camping.
b) Navigation skills.
c) Water, food, and shelter procurement.
d) Recognition of poisonous plants.
e) Wilderness first aid.
f) Health issues related to acclimation and exposure.
g) Report writing and log maintenance.
1) Requires youths admitted to a licensed private
alternative boarding school or private alternative outdoor
program to be accorded the following rights and any other
rights adopted by CDSS, as specified. Requires the list of
rights to be publicly posted and accessible to youth, and
specifies that the youth's rights shall not require a
licensee to take any action that would impair the health or
safety of youth in the facility. Exempts these providers
from adhering to the existing bill of rights for foster
children in group homes, as specified in regulation.
a) To be accorded dignity in his or her personal
relationships with staff, youth, and other persons.
b) To live in a safe, healthy, and comfortable
environment where he or she is treated with respect.
c) To be free from physical, sexual, emotional, or
other abuse, or corporal punishment.
d) To be granted a reasonable level of personal privacy
in accommodations, personal care and assistance, and
visits.
e) To confidential care of his or her records and
personal information, and to approve release of those
records prior to release, except as otherwise authorized
or required by law.
f) To care, supervision, and services that meet his or
her individual needs and that are delivered by staff that
are sufficient in numbers, qualifications, and competency
to meet his or her needs and ensure his or her safety.
g) To be served food and beverages of the quality and
in the quantity necessary to meet his or her nutritional
and physical needs.
h) To present grievances and recommend changes in
policies, procedures, and services to the program's
staff, management, and governing authority, or any other
person without restraint, coercion, discrimination,
SB 524 (Lara) PageG
of?
reprisal, or other retaliatory actions, and too have the
licensee take prompt actions to respond to those
grievances.
i) To be able to contact parents or legal guardians,
including visits and scheduled and unscheduled private
telephone conversations, written correspondence, and
electronic communications, unless prohibited by court
order.
j) To be fully informed, as evidenced by the youth's
written acknowledgment, prior to, or at the time of,
admission in the program, of all the rules governing the
youth's conduct and responsibilities.
aa) To receive in the admission agreement information
that details the planned programs and services for the
youth.
bb) To have his or her parents or legal guardians remove
him or her from the program.
cc) To consent to have visitors or telephone calls
during reasonable hours, privately and without prior
notice, provided the visitors or telephone calls do not
disrupt planned activities and are not prohibited by
court order or by the youth's parent or legal guardian.
dd) To be free of corporal punishment, physical
restraints of any kind, and deprivation of basic
necessities, including education, as a punishment,
deterrent, or incentive.
ee) To have caregivers who have received instruction on
cultural competency and sensitivity relating to, and best
practices for, providing adequate care to lesbian, gay,
bisexual, and transgender youth in out-of-home care.
ff) To be free from acts that seek to change his or her
sexual orientation, including efforts to change his or
her gender expressions, or to eliminate or reduce sexual
or romantic attractions or feelings toward individuals of
the same sex.
gg) To have fair and equal access to all available
services, placement, care, treatment, and benefits and to
not be subjected to discrimination or harassment on the
basis of actual or perceived race, ethnic group
identification, ancestry, national origin, color,
religion, sex, sexual orientation, gender identity,
mental or physical disability, or HIV status.
hh) To be free from abusive, humiliating, degrading, or
traumatizing actions.
SB 524 (Lara) PageH
of?
2) Prohibits placement of youth in either of these new
licensing categories from the child welfare or probation
systems and prohibits the payment of a rate for a Short
Term Residential Therapeutic Program to either of these
facility types.
3) Exempts the licensure requirements of a private
alternative boarding school from applying to any facility
operated, licensed, or certified by the Department of
Corrections and Rehabilitation (CDCR) and its Division of
Juvenile Justice, the California Conservation Corps, the
Military Department, or any other governmental entity or to
a boarding school that solely focuses on academics.
4) Exempts the licensure requirements of a private
alternative outdoor program from applying to programs
operated, licensed, or certified by CDCR and its Division
of Juvenile Justice, the California Conservation Corps, or
the Military Department, programs operated by any
governmental entity, any organized camp, as defined,
outdoor activities for youth designed to be primarily
recreational, including, but not limited to, activities
organized by Outward Bound, Boy Scouts, Girl Scouts, Camp
Fire, or other similar organizations, or any camp
exclusively serving children with a medical diagnosis for a
physical condition or illness, including, but not limited
to, cancer, muscular dystrophy, or burn injuries.
5) Permits CDSS to adopt emergency regulations and requires
CDSS to adopt regulations by January 1, 2018 for private
alternative boarding schools, and by January 1, 2019 for
private alternative outdoor programs in consultation with
stakeholders, as specified, and requires that existing
programs in each of these categories be compliant with new
regulations no later than six months after those dates.
6) Requires that private alternative boarding schools and
private alternative outdoor programs be governed by
specified existing group home regulations until new
regulations are adoptive and become effective.
7) Defines "youth" as a person who is 12 to 17 years of
age, inclusive, or a person who is 18 years of age if he or
SB 524 (Lara) PageI
of?
she is completing high school or its equivalent.
8) Requires individuals who are volunteer candidates for
mentoring children in private alternative boarding schools
or in private alternative outdoor programs to be subject to
a criminal background investigation, as specified, prior to
having unsupervised contact with the children.
9) Restricts the existing licensure exemption for spiritual
programs by removing the exemption for a private
alternative boarding school or private alternative outdoor
program that uses prayer or spiritual means as a component
of its programming or services in addition to behavioral
based services, thus making those facilities subject to
licensure.
10) Specifies that the existing licensure exemption for a
school dormitory or similar facility does not include a
private alternative boarding school or private alternative
outdoor program.
11) Exempts such facilities from requirements of the
"reasonable and prudent parent standard" as required for
foster homes and group homes.
12) Permits CDSS to set licensure fees via regulation for
both types of new programs.
13) Exempts private alternative boarding schools and private
alternative outdoor programs from participating in
psychotropic medication monitoring and oversight measures
currently required for child welfare placements, as
specified.
14) Contains chaptering language to resolve conflicts with
AB 1997 and AB 741, as specified
FISCAL IMPACT
A fiscal analysis of the current version of this bill has not
been completed.
BACKGROUND AND DISCUSSION
SB 524 (Lara) PageJ
of?
Purpose of the bill:
According to the author, residential boarding schools currently
are exempt from state licensing and do not have oversight
"beyond filing a one-page affidavit with the Department of
Education." The author states that the lack of oversight and
regulation over private institutions for youth has opened the
door to abuse and that parents and guardians often have no idea
that a facility is not subject to rigorous licensure standards.
"Tragically, many young people have experienced horrendous
abuse, neglect, and even death at unregulated boot camps,
wilderness camps, and residential institutions," the author
states. "Survivors report being denied medical care, corporal
punishment, solitary confinement, and discrimination due to
sexual orientation."
This bill seeks to license and regulate residential facilities
and programs aimed at serving youth with social, emotional,
behavioral, or mental health issues or disorders. "By requiring
CDSS to license private alternative treatment facilities, like
boot camps, wilderness camps and others, this bill will protect
youth from abuse and neglect in institutions."
Background
The Community Care Licensing Division of CDSS licenses and
regulates a variety of community care facilities, defined as a
facility 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. CCL also licenses and regulates child
care centers, residential care facilities for the elderly
(RCFEs), and other facilities. Approximately 65,000 care
facilities are licensed in the state, with the capacity to serve
1.3 million Californians.
Private Children's Residential Facilities
SB 524 (Lara) PageK
of?
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, CDSS reports 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 for wilderness camps or boot camps.
Additionally, numerous programs advertise a presence in
California, maintaining corporate offices in-state, with the
facility itself located in another state such as Utah or Texas,
which have minimal 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>
Safety and Abuse Concerns
Various wilderness programs have been the subject of lawsuits
and accusations of abuse and neglect including incidents of
"sexualized role play." In 2004, a 14-year-old boy died in a
wilderness program after hiking several miles in 90-degree
weather. Reportedly, a combination of excessive heat, a
constrictive uniform, and the boy's obesity caused his body to
overheat. He suffered severe heatstroke requiring immediate
---------------------------
<1> http://www.natsap.org/natsap-principles/
SB 524 (Lara) PageL
of?
medical attention but program staffers ignored complaints and
the youth died an hour later at the hospital. In 2012, a mother
filed a lawsuit 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. 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 U.S. 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:
"All states have processes in place to license and monitor
certain types of residential facilities, but our survey
identified several gaps that exempt certain types of
facilities from oversight and allow some of the common
causes of youth death and maltreatment to go unaddressed.
These gaps include the fact that some types of
government-operated and private facilities are exempt from
licensing requirements, licensing requirements do not
always address the primary causes of youth death and
maltreatment, and state agencies inconsistently monitor
facilities and share their monitoring results." (page19)
"The lack of licensing for all facilities serving youth
has several consequences. Within individual states,
facility operators may bypass state licensing requirements
by self-identifying their business as a type that is exempt
from state licensing. (p 23) ? 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
SB 524 (Lara) PageM
of?
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."
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's website states that contact with
parents and the outside world often are 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 organization also states that
teens almost never see their parents-a few days a year at
most-and family members are rarely, if ever, allowed to visit.
ASTART also describes harsh, confrontational "rap" groups held
several times a week in which residents are "forced to accuse
and yell at each other." One student becomes the focus of verbal
attacks by the group.
Related legislation:
SB 1089 (Liu 2012) sought to license and regulate "private
nontraditional alternative treatment facilities for youth" and
was similar to this bill. It was held in the Assembly
Appropriations Committee.
SB 524 (Lara) PageN
of?
PRIOR VOTES
-----------------------------------------------------------------
|Assembly Floor: |49 - |
| |20 |
|-----------------------------------------------------------+-----|
|Assembly Appropriations Committee: |16 - |
| |0 |
|-----------------------------------------------------------+-----|
|Assembly Human Services Committee: |7 - |
| |0 |
-----------------------------------------------------------------
Senate Floor: 35 -
1
Senate Appropriations Committee: 5 -
0
Senate Human Services Committee: 4 -
0
COMMENTS
Senate Rule 29.10 Hearing
SB 524 is back before this committee pursuant to Senate Rule
29.10(d), following amendments taken in the Assembly on Aug. 4.
An earlier version of SB 524 was heard and passed by this
committee on a 4-0 vote on April 28, 2015. The prior version of
this bill was on the inactive file on the Assembly floor until
August 2, and amended with current language. While the
underlying policy and statutory code section remain essentially
unchanged, amendments substantially rewrite the policy and
licensure requirements within this bill. Additional amendments
on Aug. 19th add chaptering language and limit the exemption for
religious camps to be licensed.
SB 524 (Lara) PageO
of?
This Committee may take only one of two actions on SB 524 -
either pass it to the floor or hold it in committee. It cannot
be amended.
POSITIONS
Support:
AIDS Project LA
Buenstar Human Services Inc.
CA Alliance of Child and Family Services
CA LGBT Health and Human Services Network
City of LA
City of West Hollywood
EQCA
Gender Health Center
LGBTQ Center of Long Beach
Sacramento LGBT Center
SIA Organization
Stonewall Democratic Club
Transgender Law Center
WWASP Survivors
Oppose:
Riverview Christian Academy
F.A.C.E.S.S.
-- END --