BILL ANALYSIS Ó
SB 1404
Page 1
Date of Hearing: June 21, 2016
Counsel: Gabriel Caswell
ASSEMBLY COMMITTEE ON PUBLIC SAFETY
Reginald Byron Jones-Sawyer, Sr., Chair
SB
1404 (Leno) - As Amended May 31, 2016
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.
Specifically, this bill:
1)Provides that the Trauma Recovery Center at the San Francisco
General Hospital, University of California, San Francisco is
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recognized as the State Pilot Trauma Recovery Center (State
Pilot TRC). The California Victim Compensation and Government
Claims Board shall 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 pursuant to Section 13963.1. In replicating
programs funded by the California Victim Compensation and
Government Claims Board, the ITRS can be modified to adapt to
different populations, but it shall include the following core
elements:
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, of diverse ethnicity, members of
immigrant and refugee groups, disabled, who have severe
trauma-related symptoms or complex psychological issues, or
juvenile victims, including minors who have had contact
with the juvenile dependency or justice system.
b) Victims of a wide range of crimes, including, but not
limited to, victims of sexual assault, domestic violence,
physical assault, shooting, stabbing, and vehicular
assault, human trafficking, and family members of homicide
victims.
c) A structured evidence-based program of mental health and
support services provided to victims of violent crimes or
family members of homicide victims that includes crisis
intervention, individual and group treatment, medication
management, substance abuse treatment, case management, and
assertive outreach. This care shall be provided in a manner
that increases access to services and removes barriers to
care for victims of violent crime. This includes providing
services in the client's home, in the community, or other
locations outside the agency.
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d) Staff shall include a multidisciplinary team of
integrated trauma specialists that includes psychiatrists,
psychologists, and social workers. The integrated trauma
specialist shall be a licensed clinician, or a supervised
clinician engaged in completion of the applicable licensure
process. Clinical supervision and other supports are
provided to staff on a weekly basis to ensure the highest
quality of care and to help staff deal constructively with
vicarious trauma.
e) Psychotherapy and case management shall be provided by a
single point of contact for the client, that is an
individual trauma specialist, with support from an
integrated trauma treatment team. In order to ensure the
highest quality of care, the treatment team shall
collaboratively develop treatment plans in order to achieve
positive outcomes for clients.
f) Services shall include assertive case management,
including, but not limited to, a trauma specialist
accompanying the client to court proceedings, medical
appointments, or other community appointments as needed.
Case management services shall include, but not be limited
to, assisting clients file victim compensation
applications, file police reports, help with obtaining safe
housing and financial entitlements, linkages with medical
care, assistance in return to work, liaison with other
community agencies, law enforcement, and other support
services as needed.
g) Clients shall not be 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
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anxiety.
h) Trauma recovery services shall incorporate 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) The goals of a trauma recovery center shall be to
decrease psychosocial distress, minimize long-term
disability, improve overall quality of life, reduce the
risk of future victimization, and promote post-traumatic
growth.
j) In order to ensure that clients are receiving targeted
and accountable services, treatment shall be provided up to
16 sessions. For those with ongoing problems and a primary
focus on trauma, treatment may be extended after special
consideration with the clinical supervisor. Extension
beyond 32 sessions shall require approval by a clinical
steering and utilization group that considers the client's
progress in treatment and remaining need.
2)Finds and declares the following:
a) Victims of violent crime may benefit from access to
structured programs of practical and emotional support.
Research shows that evidence-based trauma recovery
approaches are more effective, at a lesser cost, than
customary fee-for-service programs. State-of-the-art
fee-for-service funding increasingly emphasizes funding
best practices, established through research, that can be
varied but have specific core elements that remain constant
from grantee to grantee. The public benefits when
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government agencies and grantees collaborate with
institutions with expertise in establishing and conducting
evidence-based services.
b) The Trauma Recovery Center at San Francisco General
Hospital, University of California, San Francisco (UCSF
TRC), is an award-winning, nationally recognized program
created in 2001 in partnership with the California Victim
Compensation and Government Claims Board. The UCSF TRC is
hereby recognized as the State Pilot Trauma Recovery Center
(State Pilot TRC). The State Pilot TRC was established by
the Legislature as a four-year demonstration project to
develop and test a comprehensive model of care as an
alternative to fee-for-service care reimbursed by victim
restitution funds. It was designed to increase access for
crime victims to these funds.
c) The results of this four-year demonstration project have
established that the State Pilot TRC model was both
clinically effective and cost effective when compared to
customary fee-for-service care. Seventy-seven percent of
victims receiving trauma recovery center services engaged
in mental health treatment, compared to 34 percent
receiving customary care. The State Pilot TRC model
increased the rate by which sexual assault victims received
mental health services from 6 percent to 71 percent,
successfully linked 53 percent to legal services, 40
percent to vocational services, and 31 percent to safer and
more permanent housing. Trauma recovery center services
cost 34 percent less than customary care.
d) The Legislature further finds and declares that
systematic training, technical assistance, and ongoing
standardized program evaluations are needed to ensure that
all new state-funded trauma recovery centers are evidence
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based, accountable, and clinically effective and cost
effective.
EXISTING LAW:
1)Creates the Victims of Crime Program, administered by the
Board , to reimburse victims of crime for the pecuniary losses
they suffer as a direct result of criminal acts.
Indemnification is made from the Restitution Fund, which is
continuously appropriated to the board for these purposes.
(Gov. Code, §§ 13950-13968.)
2)Authorizes reimbursement to a victim for "[t]he medical or
medical related expenses incurred by the victim." (Gov. Code,
§ 13957, subd. (a)(1).)
3)Provides that the Board shall enter into an interagency
agreement with the UCSF to establish a recovery center for
victims of crime at the San Francisco General Hospital for
comprehensive and integrated services to victims of crime,
subject to conditions set by the board. The University
Regents must approve the agreement. The section shall only be
implemented to the extent that funding is appropriated for
that purpose. (Gov. Code, § 13974.5.)
4)Includes the Safe Neighborhoods and Schools Act of 2014. As
relevant to this bill, the act does the following: (Gov.
Code, § 7599-7599.2.)
a) Reclassifies controlled substance felony and alternate
felony-misdemeanor crimes as misdemeanors, except for
defendants convicted of a sex offense, a specified drug
crime involving specified weight of volume of the drug, a
crime where the defendant used or was armed with a weapon,
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a homicide, solicitation of murder and any crime for which
the sentence is a life term.
b) Requires the Director of Finance, beginning in 2016, to
calculate the savings from the reduced penalties.
c) The Controller transfers the amount of savings
calculated by the Finance Director and transfers that
amount from the General Fund to the "Safe Neighborhoods and
Schools Fund.
d) The Controller then distributes the money in the fund
according to the following formula:
i) 25% to the Department of Education for a grant
program to public agencies to improve outcomes for
kindergarten through high school students at risk of
dropping out of school or are crime victims.
ii) 10% to the Victims of Crime Program to fund for
grants to TRCs.
iii) 65% to the Board of State and Community Corrections
for a grant program to public agencies for mental health
and drug abuse treatment and diversion programs, with an
emphasis on reducing recidivism.
FISCAL EFFECT: Unknown.
COMMENTS:
1)Author's Statement: According to the author, "SB 1404 creates
clear guidelines for the provision of Trauma Recovery Center
(TRC) services administered by the Victims Compensation &
Government Claims Board (VCGCB) in California. By setting
clear guidelines and bolstering training for new trauma
recovery centers, this bill will ensure that victims of crime
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in California receive the comprehensive and timely services
they need in order to heal, and to avoid negative economic
consequences for themselves and their communities. 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. TRC services
have also improved community engagement and public safety.
People who receive services at the TRC are 56% more likely to
return to employment, 44% more likely to cooperate with the
district attorney, and 69% more likely to generally cooperate
with law enforcement. All of these benefits are provided at a
33% lower cost than traditional providers."
2)Background: According to the background provided by the
author, Senate Bill 1404 creates clear guidelines for the
provision of Trauma Recovery Center (TRC) services
administered by the Victims Compensation & Government Claims
Board (VCGCB) in California, as well as bolster training and
technical assistance to new centers.
By setting clear guidelines and providing training for new
TRCs, this bill will ensure that victims of crime in
California receive the comprehensive and timely services they
need in order to heal, and to avoid negative economic
consequences for themselves and their communities. The
physical and psychological trauma experienced by victims of
crime requires early treatment and comprehensive care.
However, 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.
In order to address this pressing need, a grant program to
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replicate the successful TRC pioneered by UC San Francisco was
created in 2013. This program, housed at the VCGCB, funds $2
million in grants annually. The TRC treatment model was
developed in 2001 to address the multiple barriers victims
face recovering from crime, and utilizes a comprehensive,
flexible approach designed to meet the unique needs of crime
victims suffering from trauma. TRCs utilize a
multidisciplinary staff to provide direct mental health
services and health treatment while coordinating services with
law enforcement and other social service agencies, and all
services are housed under one roof, with one coordinating
point of contact for the victim.
The TRC model has proven to be extremely successful, and since
the grant program began, survivors of crime who received
services through the TRC saw significant increases in health
and wellness. 74% of those served showed an improvement in
mental health, and 51% demonstrated an improvement in physical
health. People who receive services at the TRC are 56% more
likely to return to employment, 44% more likely to cooperate
with the district attorney, and 69% more likely to generally
cooperate with law enforcement. All of these benefits are
provided at a 33% lower cost than traditional providers.
3)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
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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.
4)Expansion of TRC Model to Other Areas of State: SB 7 (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 Groups,
which partners with the Homeless Outreach Program Integrated
Care System to provide mental health services to underserved
crime victims in south Los Angeles.
5)Proposition 47 and Trauma Recovery Center Funding: 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
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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.
According to the California Secretary of State's Web site,
59.6 % of voters approved Proposition 47. (See
< http://elections.cdn.sos.ca.gov/sov/2014-general/pdf/2014-comp
lete-sov.pdf > [as of Mar. 14, 2015].) The purpose of the
measure was "to maximize alternatives for nonserious,
nonviolent 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."
(Ballot Pamp., Gen. Elec. (Nov. 4, 2014), Text of Proposed
Laws, p. 70.) One of the ways the measure created savings was
by requiring misdemeanor penalties instead of felonies for
nonserious, nonviolent crimes like petty theft and drug
possession for personal use, unless the defendant has prior
convictions for specified violent crimes. (Ibid.)
Four months into its implementation, Proposition 47 has
resulted in fewer inmates in state prisons and county jails.
According to the Legislative Analysts' Office (LAO), "As of
January 28, 2015, the inmate population in the state's prisons
was about 113,500, or 3,600
inmates below the February 2015 cap, and slightly below the
final February 2016 cap. The expected impact of Proposition 47
on the prison population will make it easier for the state to
remain below the population cap." (LAO, The 2015-16 Budget:
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Implementation of Proposition 47 (Feb. 2015), p. 10.) The LAO
report also found that Proposition 47 will likely reduce the
costs of criminal justice for counties, by freeing up jail
beds and reducing the time probation departments need to
follow prisoners after they are released. (Id. at p. 17.)
6)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.
7)Argument in Support: According to Californians for Safety and
Justice, "We are pleased to sponsor Senate Bill 1404, which
would create programmatic guidelines for the Trauma Recovery
Center (TRC) Grant Program and create the TRC Center of
Excellence, housed at UC San Francisco, to provide systematic
training, technical assistance and ongoing standardized
program evaluations to ensure program fidelity. This bill
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would help provide quality trauma recovery services to crime
victims across the state.
"Californians for Safety and Justice is a nonprofit
organization of Californians from diverse sectors joining
together to replace prison and justice system waste with smart
justice solutions that increase safety and reduce costs. Our
work includes a statewide network of over 5,000 crime victims,
Crime Survivors for Safety and Justice, a group that aims to
reduce barriers to recovery for crime victims and expand
victims' support.
"The Trauma Recovery Center model, pioneered in San Francisco
in 2001, provides a comprehensive, flexible approach that
integrates three modes of service - assertive outreach,
clinical case management, and evidence-based trauma-focused
therapies. This model is designed to meet the special 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 under
one roof. Survivors of crime who received services through
the TRC saw huge increases in health and wellness - 74% show
an improvement in mental health, and 51% demonstrate an
improvement in physical health. TRC services also improved
community engagement and public safety. People who receive
services at the TRC are 56% more likely to return to
employment, and people who receive services are 44% more
likely to cooperate with the district attorney, and 69% more
likely to cooperate with law enforcement.
"In 2013, a grant program was created to replicate this
successful TRC model in other parts of California. This
program, housed at the Victim Compensation and Government
Claims Board (VCGCB), totals $2 million annually. In order to
ensure other TRCs have the same outstanding outcomes as the
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San Francisco TRC, specific programmatic guidelines must be in
place. SB 518 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."
8)Prior Legislation:
a) SB 518 (Leno), Required the Victims Compensation and
Government Claims Board (Board) to use a specified
evidence-based model when giving a grant to a Trauma
Recovery Center (TRC), as specified. SB 518 was held in
the Assembly Appropriations Committee.
b) SB 71 (Budget and Fiscal Review), Chapter 28, Statutes
of 2013, authorized the Board to administer a program to
award, upon appropriation by the Legislature, up to
$2,000,000 in grants, annually, to trauma recovery centers,
as defined, funded from the Restitution Fund.
c) SB 733 (Leno), of the 2009-2010 legislative session,
authorized the Board to evaluate 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 failed
passage on the Senate Floor.
d) AB 1669 (Leno), of the 2007-08 Legislative Session,
would have appropriated $1.5 million for the TRC at the San
Francisco General Hospital. AB 1669 was vetoed.
e) AB 50 (Leno), Chapter 884, Statutes of 2006,
appropriated $1.3 million for the TRC at the San Francisco
General Hospital.
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REGISTERED SUPPORT / OPPOSITION:
Support
Californians for Safety and Justice (sponsor)
Association of Deputy District Attorneys
Association for Los Angeles Deputy Sheriffs
California Association of Code Enforcement Officers
California Attorney General's Office
California Catholic Conference
California College and University Police Chiefs Association
California Narcotic Officers Association
Children's Defense Fund
Crime Victims United
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Fathers and Families of San Joaquin
Los Angeles County Professional Peace Officers Association
Los Angeles Policy Protective League
Natividad Medical Center
Riverside Sheriffs Association
San Francisco Department of Public Health
Society for Social Work Leadership in Health Care, California
Chapter
University of California
University of California at Berkeley School of Social Welfare
Opposition
None
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Analysis Prepared by:Gabriel Caswell / PUB. S. / (916)
319-3744