20160406 Health 5

By: CADigitalDemocracy

Good afternoon, my name Ming Kwan Bhoi, from San Jose, in support of Senate Bill 969, thank you. My name is Sal Pham, president of the Vietnamese American Community and Coalition of Northern California. I support the bill 969. I am Duc Dinh. I'm from [INAUDIBLE].

I am a the person who oversees Vietnamese Women's Association. I support senate bill 969. Thank you [FOREIGN] Thank you. Good afternoon my name is Liu Quan Sang and I'm here to support SB 969 for the Vietnamese community thank you.

I am Thai Trang I come from San Jose. I support this bill. My name is Han Nguyen. I'm from North Cal Vietnamese-American Communities and Coalition up in northern, California. I strongly support SB 969.

Thank you. Good afternoon, My name is Phuc Li. I come here from Vietnamese community in San Jose.

20160406 Health 5

Today I come here to support Senate Bill 969. Thank you. Hi, my name is David Nguyen, I am the general secretary of the Vietnamese/American Federation of Southern California and a law student at the University of California, Irvine. I am here to support of SB 969. Thank you.

Hi my name is Lynn with the Southeast Asia Resource Action Center and we're in support of this bill. I'm Nguyen Han. I'm here to offer my very strong support for senate bill 969. Thank you. Maybe I'm the last one. I am Tan [INAUDIBLE] the engineer and also the owner of [INAUDIBLE] I come here to support Senate Bill 969. Thank you.

Is there any opposition to the measure? Mister chair [INAUDIBLE] on behalf of the local environmental health directors, we did have an opposed position. Thank you to the author and thank you to your staff who are working with us to take the amendment that we needed. So, we are removing our opposition, thanks very much. Thank you. Anyone else? Any opposition, any questions, comments from the members? Seeing none, motion by Senator Mitchell. Would you like to close? I just respectfully ask for an aye vote.

Thank you. We are at Item number 2, SB969, do pass to Amendment Appropriations. Call the members. Hernandez.

Aye. Hernandez, Aye, Nguyen. Aye. Nguyen, Aye, Hall. Aye. Aye, Mitchell? Mitchell aye. Neilson, Pan, Pan aye. Roth? Aye.

Aye, Wolk. Aye. Wolk aye. Currently there is 5. Enough to get out. We are going to put that bill on call and we are going to move on to number 12 SB 1377. Cognitively impaired adults, caregiver resource centers, Nguyen.

Please proceed. Thank you Mister Chairman and members. Let me start out by also saying that I accept the committee amendments that clarify the CRC services in person. And also authorize the use of remote technology, except for respite care services. I also again want to thank the chair man and the committee staff for working with us on those amendments. SB 1377 will increase support for much needed respite services from family care givers.

This bill will also statutory update the methods for delivering much needed support of services to California's family caregivers. There are 11 community based, nonprofit caregiver resource centers, CRC's, throughout the state that serve unpaid family care givers of adults effected by chronic health conditions. One third of all California households contain at least one care giver who provides 20 plus unpaid hours a week. SB 1377 will restore the 11 CRC budgets by a mere 300,000 each to fund respite services at a functional level. As the state continues to promote home and community base services and manage health care. Unpaid family care givers will be heavily relied upon by providers to help their loved ones navigate and make choices about their health care.

Respite care providers, provide care givers a temporary rest from care giving. While the person being cared for continues to receive assistance in a safe environment. SB 1377 will also allow a CRC to deliver services beyond in-person meetings. Previous budget cuts removed CRC services in rural areas.

The committee amendments addresses this issue. For all these reasons, I ask for your aye vote. I have with me here today, Kathy Kelly from the San Francisco CRC and a national expert on family care giving to testify in front of the bill, in support of the bill. We have support on both sides, so we can just keep the comments brief, it'd be appreciated.

Please proceed. Thank you. I'm here to just talk very briefly about the issues around technology and my counter parts will talk a little bit more about respite. But I just need to say that throughout the history, and I've been present for the history of the CRC system. Since its inception, they're early adopters of technology alter the aim of being able to serve more caregivers effectively and efficiently, but also to offer choices and options for people who are otherwise isolated by community or by their caregiving task at hand. It's also interesting to note that when we talk about caregivers two-thirds of caregivers are under the age of 65.

It's really the millennial gen-xers and baby boomers who are the primary caregivers most in the workforce. Not able to actually participate in meetings and go to conferences and other kinds of educational forums. We know that these caregivers, say 86% of them have internet access and they are searching for information on a regular basis. There's many different leaders in technology that can be pointed to not the least of which is the VA where they're experienced in managing very difficult chronic conditions in the home or the use of technology and the support of family caregivers.

But I'd also like to just address the issue of scales. One that we don't talk about very much, but at best all of the kinds of programs that the deliver discreet caregiver support services at best reach 2 to 3% of the population of potential caregivers in this state. So, we need to do better than that. We need to be able to look at utilizing innovative technology means to scale some of our efforts in the areas that'd be most effective. And that, I would surmise, would be in being able to provide counseling, services, consultation, and also, training on care and Planning care and self care demands on caregivers.

We've seen a rapid increase at my agency in San Francisco. Over 10% of families now seek us out, saying that they were referred directly by a direct search on the Internet. And videos that we have developed over the years, looking at direct care schools, have been viewed by over 250,000 individuals on our YouTube channel. That speaks to the needs of these kinds of programs being available on a little bit larger scale than what we're dealing with now. If we were to do those in in-person meetings, it would take 3 to 4,000 classes to do that. So I respectfully seek your approval and support on SB 1377, and allow us to really intelligently look at innovative means to serving more caregivers in our present, in our state at this time, thank you.

Thank you. Move bill. Bill has been moved. We can please proceed. Again, support on both sides, brief, thank you. Yeah, make it quick. I would just simply say, thank you and just respite is so important to speak to that. We've brought one of our family caregivers here.

So I will pass the torch to allow her to elaborate on the importance of respite care. Well, my name is Juanita Turner and I've been a caregiver for ten years with my husband. And it's such a terrible thing. And it just makes you feel so, really bad. It makes you feel hurt, your heart just hurts to see them suffering and there's not much you can do about it.

But what I propose to myself that I loved the man, I respected the man, and I was going to give it everything that I had. And I did it for ten years. My grandchildren, my children, even my great-grandchildren had gloves on trying to assist me. And my friends, they all have assisted me. Without them, I never would have made it at all. It's hurtful, it's just everything that you could think about physically, mentally, socially, everything.

It takes your life almost, you're consumed with the things that you have to do for him first. That's the way I was, and I have no regret today that I did it for ten years. I was very happy that I did it, after the fact that he passed away in February. And I would say, let your hearts be sympathetic to the people that have Alzheimer's because it's really bad. The people you respected and saw them, they didn't complain. They go through, but they don't complain. And I thank God for myself being here among you to tell you, please, pass this bill. The people with Alzheimer's and their families, the caregivers, are hurting very badly.

They might not tell you, but I'm telling you they're hurting. And I ask you please pass this bill. Thank you. Good afternoon. Bless Shepherd representing the ALS Association Golden West Chapter. I want to thank the senator for being our champion and just respectfully ask for your aye vote.

Thank you. Any opposition to the measure? In support or opposition? Support. Support.

Please state your name and position. My name is Jack Kline, I'm the Executive Director of the Family Caregiver Resource Center in Orange County and the Traumatic Brain Injury Network, St. Jude Medical Center.

And I support this bill. Thank you very much. Thank you. I'm Nancy Taylor. And I'm a caregiver and a client of the Mountain Caregiver Resource Center and I, please pass this bill, because they have profoundly helped me through the years. I wouldn't have made it of nine years of caregiving without them.

I'm Nancy Powers-Stone and I'm the Director of Redwood Caregiver Resource Center and on behalf of of the family caregivers in my seven rural California counties, we thank you for your support. I'm Alexis Glidewell, and I'm a family consultant at Redwood Caregiver Resource Center. And I also thank you for your support on behalf of the family caregivers that we serve. Nancy Conchendony, and I'm the supervisor for the Mountain Caregiver Resource Center. And we cover ten counties, and thank you very much for your support. I'm Janice Spillman, Mountain Caregiver Resource Center, thanking you for your support. Good evening, my name is Dolores Burnett, and I am in home support care provider.

And I support the Senate Bill 1377. Thank you. Any opposition? Questions, comments for any of the members? I see no questions, comments.

It’s been moved by Senator Mitchell, please close. I respectfully ask for your aye vote. Thank you. This is item 12 SB 1377 do pass as amended to appropriations, call the members. Hernandez? Aye. Hernandez, aye.

Nguyen? Aye. Nguyen, aye. Hall, Mitchell? Aye. Mitchell, aye. Monning, Nielson, Pan, Roth, Wolk? Aye.

Wolk, aye. Currently has four, we're going to place that bill on call. We're at item number 14. SB1419, Galgiani, uniform anatomical gift act prison inmates. [INAUDIBLE] We have support on both sides? Thank you. Please proceed.

Thank you Mr. Chair and members. SB1419 would authorize a prisoner in custody in the Department of Corrections to provide a form to allow an inmate to make an anatomical gift. And it would authorize the prisoner to make that election at the time of admittance into the state prison system, or a later time at the prisoner's request. The bill would establish a procedure by which a prisoner may revoke that election as well. The United States is currently facing a shortage of anatomical gift donors, with California making up 20% of the National Donor Waiting List. For the reasons I had mentioned, I respectfully ask for your aye vote. Yes? want to ask a question now, or? Okay, go ahead.

I was going to ask, but there might be hundreds outside. So any support? Any opposition? Seeing none, yes, Senator Mitchell? Mr. Chair, Senator Galgiani, do CVCR inmates lose their right to donate if they've already checked it off on their license, or have made it their wishes known prior to going into custody of corrections? I don't know the answer to that question, but we're going to be working with Public Safety Committee to actually take some additional amendments to make it very clear that for someone who donates while they are in prison. That once they leave it will be clear that they may still donate an organ. Okay, so then my question would be if they have the little pink dot on their license, if once they go in, that that's not communicated some way, thank you. Thank you for raising the question.

Okay, seeing no other questions or comments, would you like to close? I respectfully ask for your aye vote. We have a motion? Yeah. We need a motion.

Senator Wolk moves the bill. We're at item number 14, SB 1419. Do pass to Public Safety Committee, call the members, please.

Hernandez? Aye. Hernandez, aye. Nguyen? Nguyen, aye.

Hall. Mitchell? Aye. Mitchell aye. Manning, Neilson, Pan, Roth, Wolk? Aye. Wolk Aye. Thank you. That has four members absent.

We're going to put that bill on call. We're going to go to item number 4, SB1090, Mitchell. Sexually transmitted diseases, outreach and screening service. Senator Mitch I have a question. Where are we? Senator Hernandez it's 4:20 with budget committee having started at 4:00 and you and I are still in 4203. Thank you very much Senator Mitchell.

And we have support on both sides, Senator Mitchell. Please proceed. I ask for your I vote Senator Woldrop. Okay, anyone like to speak in support of the measure.

Please state your name and position. My name is Garry Richwald and I'm the former director during the 1990s of the Los Angeles County STD program where we were fighting quadruple epidemics of gonorrhea, syphilis, syphilis in newborns and HIV. Also the co-founder of two community clinics in the LA area and I teach STD'S at UCLA, and USC the future of public health students. Throughout California, we call ourselves the California STD Control Branch, or in Los Angeles County it's called the prevention and control program. But the plain truth is, in 2016, we're neither preventing nor controlling most STDs in this state. If we were, I wouldn't be reporting today that we've had drastic increases of over 80% in syphilis, 65% in gonorrhea, 10% in chlamydia in women and, God only knows what the increase in men, since we don't do that much screening in men. And, these increases are not just restricted to Los Angeles county, where we've had a 50% increase over the last three or four years.

Or San Diego with a 70% increase, but in the rest of California as well. Bute County has had a 400% increase, Fresno just reported a 1600% increase in sexually transmitted diseases over the past three years. Santa Barbara 200% Santa Clara, 150%. These problems disproportionately affect communities of color and they also are important fuel for new HIV cases. If you're infected with one of these STDs your risk of acquiring HIV goes up dramatically.

Why is this happening now? I think there are two reasons. One has to do with effort and the other is where the spending on services go. The effort problem the predicament we're in is California STD control program has a meager budget of $3.2 million, half from the state, half from the Feds to cover 38 million people. That's less than $1 a year per screening. It's not surprising that people can't do a very good job. With that type of budget. The second problem has to do with where we spend our money. Now the authorization I worked under in Los Angeles county was written almost 100 years prior to me being director of that program.

That's how old STD control is. The fact of that matter is we need to work with new models of outreach and innovative, exciting and new technologies that allow for self and home collection. Public Health has begun to experiment with these around the state in a very successful way. And these are the types of programs that this bill authorize.

So what SB 1090 does quite simply is provide additional, substantive direction to the California Department of Public Health to strengthen outreach through the use of innovative technology on the local level to stem the tide of these rising rates of STDs. Investments in STD control and prevention especially using smart technologies and strategies will save money and heart break for Californians. And of course reduce the cost to state and local government. So I urge you to support this bill. Thank you. Please proceed. Hi my name is Whitney Engeran-Cordova, I'm the senior director of public health for AIDS Healthcare Foundation.

I will be very brief. We actually don't spend less that a dollar. It's actually 4.2 cents per citizen, for STD screening.

That really is quite frightening 4. 2 cents per citizen. In finding new and innovative ways to help people know their status and get into treatment for STDs, for instance there's things that aren't expensive that can be done very quickly up to and including looking at your status on an iPhone. And being able to indicate that you're coming into the clinic to get treatment. That alone can save people a lot of time and a lot of money. We estimate we are using electronic systems where people can get results on their iPhones and it reduces the time to treatment by two to three days. Which is significant.

It reduces the time to people knowing their status by checking their results by two to three days, and finally, if we use innovative approaches, for instance, the way it goes right now is people, if they get an STD, they get a call. If they don't, they don't get a call. So that's good news, no news is good news. And so we really want to find a way to help people know, get treatment and this bill helps us down that road, thank you. Thank you. Anyone else in support? Opposition? Questions, comments? Seeing no questions, comments. Do we have motion by Senator Hall? Would you like to close? I would just hope that the committee would see favorably upon my selfless act of not giving you my full long, compelling argument. I appreciate that.

Allowing Dr. Richua with his years of history and experience to outline both the need and what this bill will do and I hope that you will vote aye. It's because you told me where we were this afternoon when I asked where are we that I'm going to support. I aim to support my chair. I ask for your aye vote.

May I ask the question, where are we? Yes. The critical issue and I hope that you will vote aye, thank you. I will vote aye. Anyway item number four, SB 1090, due passed as amended to Appropriations. Call the members.

Hernandez? Aye. Hernandez aye. Nguyen? Aye. Nguyen aye. Hall? Aye. Hall aye. Mitchell? Aye. Mitchell, aye, Monning? Nielsen? Pan? Roth? Wolk? Aye.

Wolk, aye. Yes. Five, zero, enough to get out, we're going to place that bill on call we have some absent members. Item number 15, SB 1466, Mitchell. We have support on both sides Senator Mitchell. Yes. Early [UNKNOWN] screening. Diagnostic treatment of.

I took the hint the first time unlike some of my colleagues. I got you Senator. I do want to clarify that the addendum that was handed out does show a support if amended by the California Labor Federation, and I'm not aware of the amendments so I just wanted to put that out there.

If they're here, they should come a calling because We've never seen a letter, or a late letter. Well, me either. So I'll ignore that. Again, thank you for the opportunity to present on SB 1466, which will expand mental healthcare access for foster children by requiring that existing screenings under EPSDT benefit include a screening for trauma. Very briefly, colleagues, the problem is that our city has a complicated delivery service for mental health products for a population who's especially at risk. Under current law responsibility for providing mental health services is divided among three different systems dependent upon the severity of the diagnosis and whether or not the child is enrolled in managed care. What this bill specifically aims to do.

We also acknowledge the fact that state law and regulations also don't provide a clear definition of services. And therefore it's not always clear which agency needs to provide what services for this population. We've had numerous situations arise where foster kids have experienced treatment delays, while the mental health plan and the MediCal managed care plan decide which system should be responsible. So one point of concern for me is that as we go round and round trying to determine whether or not a child has mild, moderate or severe mental health needs, we're failing to acknowledge that children who have experienced abuse or neglect, and who have been removed from their parents, are by definition suffering from trauma, which requires immediate and adequate treatment. And so, this legislation recognizes child abuse, neglect, and removal from the home by a child welfare agency as evidence in and of itself for trauma.

I appreciate the work that the committee has done with the advocacy community and identifying the amendments that have been passed out to committee members that we are prepared to accept. Generally the amendments define trauma for purposes of this bill and I'd ask my expert witnesses here to provide their perspective. Mr.

Chair, John Bauters, one of the co-sponsors from Californians for Safety and Justice along with our co-sponsors, the Youth Law Center and the California Youth Coalition. I'll be very brief and simply say to echo what Senator Mitchell said. We ask for your support on this bill and I will defer my comments to my colleague. Thank you, I'm Lee Collins and the director of the San Luis Obispo County Department of Social Services, the senior Social Services director in California by a lot, with about 33 years in the position. San Luis Obispo Country has been dedicated to reducing the number of children in group homes, keeping children with relatives whenever possible, and ensuring that they have the resources that they need to be healthy. And I can tell you that in these 33 years of being a social services director the biggest frustration for me has not been financed, it has not been arcane federal rules. It has always been the difficulty in getting mental health care for children in foster care. There is no question about trauma, according to the federal government, citing research, they stated that approximately 90% of children in foster care have been exposed to trauma.

I think that's low. That's what their research suggests. My own observations would go along with what Senator Mitchell said in that a child who has been abused and neglected and subsequently removed from the caretaker, even when that caretaker has been the one who has abused or neglected the child, there is trauma.

By the time they are teenagers, according to other research cited by the federal government, 63% of children in foster care have at least 1 mental health diagnosis, 23% have 3 or more diagnoses. There is a early periodic diagnosis testing treatment services program, but the question that we always have is where is the early in this program? Our belief and our observation is that children are not being screened appropriately, they are not being assessed. When they are assessed for trauma, there is not treatment that flows quickly enough or in an efficacious way. The state measures the extent to which mental health services are being provided to children with what they call the penetration rate. That percentage of child who have been assessed and diagnosed and are receiving services for mental health care. Statewide that figure is 52% and has been in significant decline over the last 3 years. And remember feds say it's 90% who have suffered trauma. I believe it's more, and we're seeing it decline in the percentage of children who actually are receiving care.

The actual numbers of children receiving care over the same three year period has gone up, with the exception of African-American children, where the raw numbers have declined. Services per child over this same period have seen steady decline, therapeutic behavioral services down 16%. Basic assessment therapeutic services for children down 9%.

And even basic case management services declined over 17%. There is very wide variation among counties. The counties, if you'll pardon the pun, are literally all over the map in terms of that penetration rate. And there's no correlation between demographics or geography, it just really seems to be a matter of practice and process by county. Those penetration rates range from as low as 12% to almost 100% with that statewide average around 52%. And so it's not getting better in my view, it's declining according to the data.

And I don't find it difficult at all to draw a line between the failure of a system to identify and treat trauma early on, to the point where untreated trauma begins to manifest itself in behaviors of youth, to the point where the system concludes that the best means of addressing that trauma is through the use of psychotropic medications. I want to recognized Senator Hernandez for your role in having the hearings that brought that to light. So we need to start earlier so that we're not getting to place where untreated trauma leads to an over prescription of psychotropic medication. And really this is our opportunity, we have a chance with the implementation of Continuum of Care Reform which represents the most comprehensive change in the system of care for foster children in a generation. And I know because I was there for the last one.

The focus on family based care, rather than congregate care, assumes a radical change in our approach with youth. Instead of sending children to where the services are, in group homes, knowing all that we do about them, we propose a change or we anticipate a change that brings the services to the children where they are, whether it's in their own home, whether it's in the home of relatives, whether it's in a foster family home. But the idea is to bring that specialized care, home to the children, and my observation, is that the system is not prepared to do that. So I welcome the oversight and vision by Senate Bill 1291, which you heard earlier today. I welcome the discussion on psychotropic meds, and note that many psychiatrists have said that they do this because it's their belief that there aren't alternative therapeutic services available. And I particularly welcome the changes envisioned by this bill, that recognizes if there is trauma, it must be screened, it must be assessed, and it must be treated before these children end up in much worse health than they are.

I would say in closing that we have, in San Obispo County, according to our model, we have moved 173 former foster children into college. We have a program that's unique to San Obispo County. We are firmly dedicated to ensuring that there are better lives for youth when they leave care. But it has to begin when they enter care. Thank you for your support of Senate Bill 1466, and for your attention today. Thank you, Senator Mitchell.

Thank you. Mr. Chair, Frank Mecca, with the County Welfare Directors Association. On behalf of the 58 county human services agencies, including the one in San Obispo, and we are in support of this bill. Thank you. Anyone else in support, please state your name and position. Tam Ma, with Health Axis, in strong support. Linda Nguy, with Western Center on Law and Poverty, in support Kimberly Chen, with the California Pan-Ethnic Health Network, in support.

Vanessa Hernandez, with the California Youth Connection, CYC is proud to support and cosponsor this. [UNKNOWN] Shepard, representing the American Association for Marriage and Family Therapy, California Division, in support. Lynn Thull, from California Alliance of Child and Family Service, in support. Jessica Haspel, with Children Now, in support. Robin Goldfaden, with Youth Law Center, a cosponsor of the bill and in support, thank you. Thank you, any opposition? Questions, comments? Seeing none, we have a motion by Senator Wolk.

Would you like to close? Just very briefly. I want to thank Mr.Boddard, Mr. Meck, and Mr.Collins for coming today. And what I couldn't find before, I had too many papers in front of me, Mr. Chair, was just the definition for trauma. Again, we worked very hard to make sure that the committee will be comfortable with the goal of this bill.

And I think we've reached that with the mock-up amendments that I hope members were able to find easier than I was able to find my own. And it's a very critical issue. Children who've been removed from their homes have been found to have experienced twice the rate of post-traumatic stress disorder than a war veteran. And early screening and detection, and making sure that they get in the right mental health, early mental health services, is our responsibility as their caregivers, as legislators. So, I ask for your aye vote. Thank you, we have amends. We'll take it in the next committee. This is item number 15, SB 1466, due passed to Human Services Committee.

Thank you. Call the members, please. Hernandez? Aye. Hernandez, Aye. Nguyen? Hall? Aye.

Hall, aye. Mitchell? Aye. Mitchell, aye. Monning? Nielsen? Pan? Roth? Wolk? Aye.

Wolk, aye. Currently, it's four. We'll place that bill on call.

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