BILL ANALYSIS Ó
SB 1404
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Date of Hearing: June 28, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
SB
1404 (Leno) - As Amended May 31, 2016
SENATE VOTE: 39-0
SUBJECT: Victims of violent crimes: trauma recovery centers.
SUMMARY: Recognizes the Trauma Recovery Center at San Francisco
General Hospital, University of California, San Francisco (UCSF
TRC) as the State Pilot Trauma Recovery Center (State Pilot
TRC), and requires the California Victims Compensation and
Government Claims Board (CVCGC Board) to use the model developed
by the State Pilot TRC when it establishes additional trauma
recovery centers. Specifically, this bill:
1)Recognizes the UCSF TRC as the State Pilot TRC, and requires
the CVCGC Board to use the 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 Safe
Neighborhoods and Schools Fund (SNS Fund) to do all of the
following:
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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
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
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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,
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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
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;
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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)Specifies that these provisions do not apply to the University
of California unless the Regents pass resolution agreeing to
do so.
7)Requires the CVCGC Board to create an advisory committee to
advise it on matters pertaining to the administration of funds
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designated for use at TRCs.
8)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.
9)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.
10)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.
11)Prohibits anything in this bill from prohibiting, limiting,
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or otherwise preventing the CVCGC Board from consulting with
additional experts in the performance of its duties.
12)Eliminates a provision that restricted the CVCGC Board from
awarding a TRC more than one grant for any period of time.
13)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
California will have increased access to needed services.
EXISTING LAW:
1)Establishes the 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
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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 Fund (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% 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% 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.
FISCAL EFFECT: According to the Senate Appropriations
Committee:
1)Administrative costs: Annual costs of $925,000 (Special
Fund*/General Fund**) to the CVCGC Board to review and
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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.
2)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.
3)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
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** Safe Neighborhoods and Schools Fund (annual transfer from
the General Fund)
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, this bill
creates clear guidelines for the provision of TRC services
administered by the CVCGC Board, and that by setting clear
guidelines and bolstering training for new trauma recovery
centers, 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 author
states that survivors of crime who received services through
the TRC saw significant increases in health and wellness, for
example 74% of those served showed an improvement in mental
health, and 51% demonstrated an improvement in physical
health. The author contends that TRC services have also
improved community engagement and public safety, pointing out
that 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.
2)BACKGROUND.
a) TRCs. TRCs are centers that directly assist victims in
coping with a traumatic event (such as by providing mental
health care and substance use treatment). For example,
victims may receive weekly counseling sessions with a
licensed mental health professional at a TRC for a
specified amount of time. The centers also sometimes help
victims connect with other services provided in their
community and by the state. While some of the TRCs existed
before receiving grants from CVCGC Board, the board first
began funding TRCs in 2001 with a grant to the San
Francisco TRC. Since then, three other TRCs have also
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received state funding-one in Long Beach and two in Los
Angeles. Currently, CVCGC Board provides a total of $2
million annually in grants to four TRCs located in San
Francisco, Long Beach, and two in Los Angeles.
b) 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 appropriately 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.
Beginning in 2016-17, funding for TRCs will increase
significantly as a result of Proposition 47, passed by
voters in November 2014. Proposition 47 reduces the
penalties for certain crimes, which will result in state
savings, mainly by reducing the number of inmates in state
prisons. Under the measure, these savings will be
deposited into a special fund with 10% of the funds
provided to CVCGC Board for TRCs. The LAO estimates that
Proposition 47 funding for TRCs will likely total between
$10 million and $20 million annually beginning in 2016-17.
This would reflect an increase in funding for TRCs of
roughly five to ten times the current level.
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3)SUPPORT. Californians for Safety and Justice (CFSJ) are the
sponsors of this bill and state, the TRC 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. CFSJ notes that 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. CFSJ concludes that
survivors of crime who received services through the TRC saw
huge increases in health and wellness.
The California Catholic Conference, Inc. (CCC) supports this
bill and notes that victims must navigate an often difficult
and bureaucratic process in accessing state services,
involving multiple agencies across different locations. CCC
states that if a victim is ultimately approved for state
support, they may wait three months or more to access funds to
help cover the costs of critical services. CCC notes the TRC
treatment model was developed in 2001 to address multiple
barriers victims face recovering from crime, and in order to
ensure these same outstanding outcomes and savings, and to
ensure fidelity to the TRC model, clear guidelines must be
added to the statute governing the grant program.
4)PREVIOUS LEGISLATION.
a) SB 518 (Leno), of 2015 would have required the CVCGC
Board to use a specified evidence-based model when giving a
grant to a TRC, as specified. SB 518 was held in the
Assembly Appropriations Committee.
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b) SB 71 (Committee on Budget and Fiscal Review), Chapter
28, Statutes of 2013, authorized the CVCGC Board to
administer a program to award, upon appropriation by the
Legislature, up to $2,000,000 in grants, annually, to TRCs,
as defined, funded from the Restitution Fund.
c) SB 733 (Leno), of the 2009-10 legislative session, would
have authorized the CVCGC 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.
REGISTERED SUPPORT / OPPOSITION:
Support
Californians for Safety and Justice (sponsor)
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Kamala D. Harris, Attorney General, State of California
California Catholic Conference, Inc.
Crime Victims United of California
Fathers & Families of San Joaquin
Natividad Medical Center
San Francisco Department of Public Health
Society for Social Work Leadership in Health Care, California
Chapter
University of California
One individual
Opposition
None on file.
Analysis Prepared by:Lara Flynn / HEALTH / (916)
319-2097