BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1404
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|AUTHOR: |Leno |
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|VERSION: |March 29, 2016 |
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|HEARING DATE: |April 6, 2016 | | |
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|CONSULTANT: |Vince Marchand |
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SUBJECT : Victims of violent crimes: trauma recovery centers
SUMMARY : Recognizes the Trauma Recovery Center at San Francisco General
Hospital as the State Pilot Trauma Recovery Center, and requires
the California Victims Compensation and Government Claims Board
to use the model developed by this center when it awards grants
to establish additional trauma recovery centers pursuant to new
funding made available from Proposition 47.
Existing law:
1)Establishes the California Victim Compensation and Government
Claims Board (CVCGC Board) within the Government Operations
Agency, comprised of three members: the Secretary of the
Government Operations Agency, the State Controller, and a
Governor's appointee.
2)Requires the CVCGC Board to administer a program to evaluate
applications and award grants to trauma recovery centers
(TRCs), and states the intent of the Legislature to provide an
annual appropriation of $2 million per year for these grants,
funded from the Restitution Fund.
3)Permits the CVCGC Board to award a grant providing for up to a
maximum of three years, and is permitted to award consecutive
grants to a TRC to prevent a lapse in funding, but is
prohibited from awarding a TRC more than one grant for any
period of time.
4)Establishes, through the passage of Proposition 47 in 2014,
the Safe Neighborhoods and Schools Act, which is intended to
ensure that prison spending is focused on violent and serious
offenses, to maximize alternatives for nonserious, nonviolent
crime, and to invest the savings generated from this act into
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prevention and support programs in K-12 schools, victim
services, and mental health and drug treatment.
5)Establishes the Safe Neighborhoods and School Funds (SNS Fund)
for carrying out the purposes of Proposition 47, and requires
that by August 15 of each fiscal year, the Controller disburse
moneys deposited into the SNS Fund as follows: 25 percent to
the Department of Education to improve outcomes for pupils by
reducing truancy and supporting students who are at risk of
dropping out or are victims of crime; 10 percent to the CVCGC
Board to make grants to trauma recovery centers to provide
services to victims of crime; and, 65 percent to the Board of
State and Community Corrections, to administer a grant program
to public agencies, as specified.
This bill:
1)Recognizes the Trauma Recovery Center at San Francisco General
Hospital as the State Pilot Trauma Recovery Center (State
Pilot TRC), and requires the CVCGC Board to use the
evidence-based Integrated Trauma Recovery Services (ITRS)
model developed by the State Pilot TRC when it selects,
establishes, and implements trauma recovery centers.
2)Requires all ITRS programs funded through the SNS Fund to do
all of the following:
a) Provide outreach and services to crime victims
who typically are unable to access traditional
services, including, but not limited to, victims who
are homeless, chronically mentally ill, members of
immigrant and refugee groups, disabled, who have
severe trauma-related symptoms or complex
psychological issues, are of diverse ethnicity or
origin, or are juvenile victims, including minors who
have had contact with the juvenile dependency or
justice system;
b) Serve victims of a wide range of crimes,
including, but not limited to, victims of sexual
assault, domestic violence, battery, crimes of
violence, vehicular assault, human trafficking, as
well as family members of homicide victims;
c) Offer a structured evidence-based program of
mental health and support services that provide
victims with services that include intervention,
individual and group treatment, medication management,
SB 1404 (Leno) Page 3 of ?
substance abuse treatment, case management, and
assertive outreach. Requires this care to be provided
in a manner that increases access to services and
removes barriers to care for victims of violent crime,
such as providing services to a victim in his or her
home, in the community, or other locations that may be
outside the agency;
d) Be comprised of a staff that includes a
multidisciplinary team of integrated trauma clinicians
made up of psychiatrists, psychologists, and social
workers. Requires a trauma clinician to be either a
licensed clinician or a supervised clinician engaged
in completion of the applicable licensure process, and
requires clinical supervision and other supports to be
provided to staff regularly to ensure the highest
quality of care and to help staff constructively
manage vicarious trauma they experience as service
providers to victims of violent crime;
e) Offer psychotherapy and case management that
is coordinated through a single point of contact for
the victim, with support from an integrated
multidisciplinary trauma treatment team. Requires all
treatment teams to collaboratively develop treatment
plans in order to achieve positive outcomes for
clients;
f) Deliver services that include assertive case
management. Requires these services to include, but
not be limited to, accompanying a client to court
proceedings, medical appointments, or other community
appointments as needed, case management services such
as assistance in the completion and filing of an
application for assistance to the California Victims'
Compensation Program, the filing of police reports,
assistance with obtaining safe housing and financial
entitlements, providing linkages to medical care,
providing assistance securing employment, working as a
liaison to other community agencies, law enforcement,
or other supportive service providers as needed;
g) Ensure that no person is excluded from
services solely on the basis of emotional or
behavioral issues resulting from trauma, including,
but not limited to, substance abuse problems,
low-initial motivation, or high levels of anxiety;
h) Adhere to established, evidence-based
practices, including, but not limited to, motivational
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interviewing, harm reduction, seeking safety,
cognitive behavioral therapy, dialectical behavior,
and cognitive processing therapy;
i) Maintain as a primary goal a decrease in
psychosocial distress, minimize long-term disability,
improve overall quality of life, reduce the risk of
future victimization, and promote post-traumatic
growth; and,
j) Provide holistic and accountable services that
ensure treatment will be provided for up to 16
sessions. For those with ongoing problems and a
primary focus on trauma, permits treatment to be
extended after special consideration with the clinical
supervisor. Requires extension beyond 32 sessions to
be approved by a clinical steering and utilization
group that considers the client's progress in
treatment and remaining need.
3)Requires the CVCGC Board to enter into an interagency
agreement with the Trauma Recovery Center of UCSF to establish
the State Pilot TRC as California's Trauma Recovery Center of
Excellence (TR-COE), and requires this agreement to require:
a) The TR-COE to define the core elements of the
evidence-based practice;
b) The CVCGC Board to consult with the TR-COE in
the replication of the integrated trauma recovery
services approach;
c) The TR-COE to assist by providing training
materials, technical assistance, and ongoing
consultation to the CVCGC Board and to each center to
enable the grantees to replicate the evidence-based
approach; and,
d) The TRE-COE to assist in evaluation by
designing a multisite evaluation to measure adherence
to the practice and effectiveness of each center.
4)Prohibits the CVCGC Board from spending more than 5% annually
of the moneys appropriated to it from the SNS Fund for
administrative costs.
5)Requires the CVCGC Board to annually report to the Legislature
on the funding received from the SNS Fund with a detailed
summary of the programs funded by the moneys allocated to it.
SB 1404 (Leno) Page 5 of ?
6)Requires the CVCGC Board to create an advisory committee to
advise it on matters pertaining to the administration of funds
designated for use at trauma recovery centers.
7)Provides the advisory committee with the authority to make
recommendations to the CVCGC Board related to regulations
governing funds for trauma recovery centers that are
administered by the CVCGC Board, and to make recommendations
related to the criteria for awarding grants to trauma recovery
centers.
8)Requires the advisory committee to be composed of the
following:
a) One representative from each trauma recovery
center in California;
b) Three services providers who are experts in
the field of trauma recovery services, each
representing a distinct geographic region with the
state, including at least one provider who has
significant experience in providing services to rural
communities; and,
c) Three people who have previously received or
are current recipients of services from a trauma
recovery center.
9)Provides the advisory committee with the authority to convene
public hearings for the purpose of acting on any of the
authority delegated to it by this bill, and requires all
meetings of the advisory committee to be publicly noticed and
a record of those hearings maintained.
10)Prohibits anything in this bill from prohibiting, limiting,
or otherwise preventing the CVCGC Board from consulting with
additional experts in the performance of its duties.
11)Eliminates a provision that restricted the CVCGC Board from
awarding a trauma recovery center more than one grant for any
period of time.
12)Makes various legislative findings and declarations,
including that the TRC at San Francisco General Hospital is an
award-winning, nationally recognized program, and that by
creating the TR-COE, it is the intent of the Legislature that
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these services will be delivered in a clinically effective and
cost-effective manner, and that the victims of crime in
California will have increased access to needed services.
FISCAL
EFFECT : This bill has not been heard by a fiscal committee.
COMMENTS :
1)Author's statement. According to the author, the physical and
psychological trauma experienced by victims of crime requires
early treatment and comprehensive care in order to avoid
negative outcomes for the individual victim, as well as their
families and communities. In California today, victims and
survivors of crime often face significant hurdles in accessing
the immediate and comprehensive support needed to recover
adequately, and are often unaware that the state offers
assistance for certain health and support services. Victims
must navigate an often difficult and bureaucratic process in
accessing state services, involving multiple agencies across
different locations. If a victim is ultimately approved for
state support, they may wait three months or more to access
victim's compensation funds to help cover the costs of
critical support services. Without timely holistic support,
victims often suffer long term mental health challenges and
struggle to take care of their families, maintain employment
and retain stable housing. Free, holistic care that is easy to
access would be life changing for many. In order to address
this pressing need, a grant program to replicate a successful
TRC in San Francisco was created in 2013. This program,
housed at the CVCGC Board, funds $2 million in grants
annually. The TRC treatment model was developed in 2001 to
address the multiple barriers victims face recovering from
crime. The TRC model utilizes a comprehensive, flexible
approach that integrates three modes of service: assertive
outreach, clinical case management, and evidence-based
trauma-focused therapies. The model is designed to meet the
unique needs of crime victims suffering from trauma by
utilizing a multidisciplinary staff to provide direct mental
health services and health treatment while coordinating
services with law enforcement and other social service
agencies. All of these services are housed under one roof.
Survivors of crime who received services through the TRC saw
significant increases in health and wellness. Seventy-four
percent of those served showed an improvement in mental
health, and 51% demonstrated an improvement in physical
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health.
2)History of the TRC at San Francisco General Hospital. The TRC
at San Francisco General Hospital was originally established
pursuant to legislation passed in 2000. AB 2491 (Jackson,
Chapter 1016, Statutes of 2000), among other provisions,
required the CVCGC Board to enter into an interagency
agreement with the University of California, San Francisco, to
establish a victims of crime recovery center at San Francisco
General Hospital as a four year pilot project to demonstrate
the effectiveness of providing comprehensive and integrated
services to victims of crime, as an alternative to
fee-for-service care reimbursed by the Victim Restitution
funds. The goals of the TRC included improving the process of
care for victims of crime by enhancing medical services for
acute victims of sexual assault, linking victims to other
services to facilitate recovery, and improving access to
victim compensation funds. In May 2004, the CVCGC Board
published its required report to the Legislature on the
effectiveness of the victims of crime recovery center, and
concluded that the TRC model provides a wider, more effective,
range of services at a lower cost for trauma victims that the
traditional fee-for-service mental health treatment programs.
According to the report, the data demonstrated that this model
of care is effective in engaging victims of crime with needed
services, improving cooperation with law enforcement, reducing
homelessness, facilitating return to work, reducing alcohol
and drug abuse, and improving quality of life among victims of
interpersonal violence.
3)Expansion of TRC model to other areas of state. SB 71 (Budget
and Fiscal Review, Chapter 28, Statutes of 2013) created a $2
million grant program within the CVCGC Board to expand the TRC
concept to additional areas of the state. With this funding,
in October of 2014, the CVCGC Board awarded grants to two
TRCs: $670,000 to the Downtown Women's Center in Los Angeles,
and $1.3 million to the California State University at Long
Beach. In May of 2015, three grants were awarded: $426,341 to
the Children's Nurturing Project in Fairfield, which partners
with LIFT3 Support Group to provide a comprehensive system of
care focused on domestic violence survivors; $716,932 to
Fathers and Families of San Joaquin, located in Stockton,
partnering with the San Joaquin Behavioral Health Services to
provide comprehensive mental health and recovery services to
victims of crime; and, $856,727 to the Special Service for
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Groups, which partners with the Homeless Outreach Program
Integrated Care System to provide mental health services to
underserved crime victims in south Los Angeles.
4)Proposition 47. On November 4, 2014, voters approved
Proposition 47, titled the Safe Neighborhoods and Schools Act,
which was placed on the ballot as a citizen's initiative.
Proposition 47 made significant changes to the state's
criminal justice system by reducing penalties for certain
non-violent, nonserious drug and property crimes, and
requiring that the resulting savings be spent on (1) mental
health and substance abuse treatment services, (2) truancy and
dropout prevention, and (3) victim services. To carry out its
purpose, Proposition 47 established the SNS Fund, and required
that by August 15 of each fiscal year, the Controller disburse
moneys deposited into the SNS Fund as follows: 25% to the
Department of Education to improve outcomes for pupils by
reducing truancy and supporting students who are risk of
dropping out or are victims of crime; 10% to the CVCGC Board
to make grants to TRCs to provide services to victims of
crime; and, 65% to the Board of State and Community
Corrections, to administer a grant program to public agencies,
as specified.
5)Legislative Analyst's Report. In March of 2015, the
Legislative Analyst's Office released a report "Improving
State Programs for Crime Victims" (LAO report). According to
the LAO report, if appropriated structured, TRCs can provide a
wide array of services to victims at a single location and can
complement existing victim programs. The LAO recommended that
the Legislature structure the TRC grants to ensure the funds
are spent in an effective and efficient manner and to require
the evaluation of TRC grant recipients and their outcomes. The
LAO also recommended that the Legislature adopt statutory
changes to allow TRCs to have formally recognized victim
advocates, which would allow TRCs to have trained staff that
can represent victims in their application for victim
compensation funds, which would likely increase the approval
rate. The LAO also recommended prioritizing TRC grants to
regions that do not have a TRC, noting that there are many
victims who do not have access to a TRC because they do not
live in Los Angeles or San Francisco.
6)Double referral. This bill is double-referred. Should it pass
out of this committee, it will be referred to the Senate
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Public Safety Committee.
7)Prior legislation. SB 518 (Leno, 2015), also recognized the
TRC at San Francisco General Hospital as the State Pilot TRC,
and was substantially similar to this bill. SB 518 was held on
the Assembly Appropriations Suspense File.
SB 71 (Budget and Fiscal Review, Chapter 28, Statutes 2013)
authorized the CVCGC Board to administer a program to award up
to $2 million in grants annually to TRCs, funded from the
Restitution Fund.
SB 733 (Leno, 2010) would have authorized the CVCGC Board to
evaluation applications and award grants totaling up to $3
million, up to $1.7 million per center, to multi-disciplinary
TRCs that provide specified services to and resources for
crime victims. SB 733 was vetoed by the Governor.
AB 1669 (Leno, 2007) would have appropriated $1.5 million for
the TRC at San Francisco General Hospital. AB 1669 was vetoed
by the Governor.
AB 50 (Leno, Chapter 884, Statutes of 2006) appropriated $1.3
million for the TRC at San Francisco General Hospital.
AB 2491 (Jackson, Chapter 1016, Statutes of 2000), among other
provisions, required the CVCGC Board to enter into an
interagency agreement with the University of California, San
Francisco, to establish a victims of crime recovery center at
the San Francisco General Hospital to demonstrate the
effective ness of providing comprehensive and integrated
services to victims of crime.
8)Support. This bill is sponsored by Californians for Safety and
Justice (CSJ), which states that it will help provide quality
trauma recovery services to crime victims across the state.
According to CSJ, in order to ensure that other TRCs have the
same outstanding outcomes as the San Francisco TRC, specific
programmatic guidelines must be put in place. CSJ states that
this bill does exactly that, and additionally creates a Center
of Excellence at the original TRC, to provide training,
technical assistance, and ongoing standardized program
evaluations to ensure program fidelity. Fathers & Families of
San Joaquin also supports this bill, stating that the TRC
model is one of the state's most powerful, practical and
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innovative public responses to interpersonal violence, and
that given the effectiveness of this model, strongly supports
this bill.
9)Suggested amendments.
a) Existing law (reflected on Page 4, lines 24-27)
states the intent of the Legislature to provide an annual
appropriation of $2 million, and requires all grants
awarded by the CVCGC Board to be funded only from the
Restitution Fund. However, now the Proposition 47 will be
directing funds to TRCs from the SNS Fund, the author may
wish to consider amending this provision to clarify that
the $2 million annual appropriation is from the
Restitution Fund, and to delete the limitation that
grants only be awarded from this fund, in order to allow
for grants funded by the SNS Fund.
b) On Page 9, lines 12-13, this bill requires the newly
created advisory committee to the CVCGC Board to "have
the authority to convene public hearings" for the purpose
of acting on any of its delegated authority. This
provision should be clarified to actually require the
advisory committee to convene public hearings, rather
than just having the authority to do so.
SUPPORT AND OPPOSITION :
Support: Californians for Safety and Justice (sponsor)
Crime Victims United of California
Fathers & Families of San Joaquin
Two individuals
Oppose: None received
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