BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 1404| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: SB 1404 Author: Leno (D) Amended: 5/31/16 Vote: 21 SENATE HEALTH COMMITTEE: 9-0, 4/6/16 AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen, Pan, Roth, Wolk SENATE PUBLIC SAFETY COMMITTEE: 7-0, 4/19/16 AYES: Hancock, Anderson, Glazer, Leno, Liu, Monning, Stone SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/27/16 AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen SUBJECT: Victims of violent crimes: trauma recovery centers SOURCE: Californians for Safety and Justice DIGEST: This bill 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. ANALYSIS: Existing law: SB 1404 Page 2 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 for these grants. 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 non-serious, non-violent crime, and to invest the savings generated from this Act into 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 TRCs to provide services to victims of crime; and, 65 percent to SB 1404 Page 3 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 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, 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 SB 1404 Page 4 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 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 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 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 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 SB 1404 Page 5 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% of the total funds it receives from the SNS Fund on an annual basis 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. 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 TRCs. SB 1404 Page 6 7) Provides the advisory committee with the authority to make recommendations to the CVCGC Board related to regulations governing funds for TRCs that are administered by the CVCGC Board, and to make recommendations on the criteria for awarding grants to TRCs. 8) Requires the advisory committee to be composed of the following: a) One representative from each TRC 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 TRC. 9) Requires the advisory committee 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 TRC 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 these services will be delivered in a clinically effective and cost-effective manner, and that the victims of crime in SB 1404 Page 7 California will have increased access to needed services. 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 health. SB 1404 Page 8 2)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, non-serious drug and property crimes, and requiring that the resulting savings be spent on (a) mental health and substance abuse treatment services, (b) truancy and dropout prevention, and (c) 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. 3)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. SB 1404 Page 9 FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: No According to the Senate Appropriations Committee: Administrative costs: Annual costs of $925,000 (Special Fund*/General Fund**) to the CVCGC Board to review and evaluate TRC grant applications, facilitate advisory committee activities, secure an evaluation contractor (potentially UC) and submit annual reports to the Legislature. Administrative costs payable from the SNS Fund would be limited to five percent of the SNS Fund funds received annually. TRC grants: Major future grant awards in the millions of dollars (Special Fund*/General Fund**) annually provided to TRCs meeting specified criteria, including the potential for the issuance of multiple awards to a single TRC with overlapping grant periods. In addition to the $2 million annual appropriation from the Restitution Fund, the LAO has projected annual disbursements from the SNS Fund to the CVCGC Board in the range of $10 million to $20 million to fund TRC grants. The Restitution Fund is structurally imbalanced. In light of the dedicated funding source for TRCs provided by Proposition 47 (2014), removal or reduction of the annual appropriation from the Restitution Fund may be considered in the future. University of California (TR-COE) activities: To the extent the UC resolves to enter into the agreement, significant ongoing costs (Private/Local Fund/Federal Fund/Special Fund*) to comply with the requirements of the agreement including but not limited to providing training materials, ongoing consultation to the CVCGC Board and TRCs, and designing a multisite evaluation to measure effectiveness of TRCs. Staff notes the use of SNS Fund funds awarded as TRC grants may not be allowable for the aforementioned activities to the extent the activities do not "provide services to victims of crime," but are considered administrative in nature. *Restitution Fund ** Safe Neighborhoods and Schools Fund (annual transfer from the General Fund) SB 1404 Page 10 SUPPORT: (Verified 5/31/16) Californians for Safety and Justice (source) California Catholic Conference, Inc. California Department of Justice Crime Victims United of California Fathers & Families of San Joaquin University of California University of California Berkeley, School of Social Welfare Society for Social Work Leadership in Health Care California Chapter San Francisco Department of Public Health Three individuals OPPOSITION: (Verified5/31/16) None received ARGUMENTS IN 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 innovative public responses to interpersonal violence, and that given the effectiveness of this model, strongly supports this bill. Prepared by:Vince Marchand / HEALTH / (916) 651-4111 5/31/16 20:58:26 **** END *** SB 1404 Page 11