Golden Gate Regional Center

In 1963, House Resolution No. 64 created an interim committee to study mental health services in California. In December 1963, mental retardation was selected for intensive study because:

1. Federal funds had recently been made available to speed the development of state programs for the retarded and the Legislature would have to be prepared to make effective use of these funds.
    
2. In 1962 the Department of Mental Hygiene, at the request of the Legislature, prepared a "Long Range Plan for Mental Health Services in California." That plan suggested a sharp change of direction in state services for the retarded, but the Legislature had not yet taken steps to enact laws to accomplish the recommended changes.
    
3. In 1963 the California Study Commission on Mental Retardation was created to suggest additional legislation to the 1965 General Session. The Legislature should be prepared to evaluate the Commission's proposals.
    
4. From time to time questions have been raised regarding conditions  in our state hospitals. Previous legislative committees had probed  specific incidents, but a comprehensive review of hospital programs  and policies was needed.
    
5. The Legislature has long been frustrated in its efforts to solve the chronic problem of families with children on the "waiting list" of state hospitals. Despite the rapid expansion of the state hospital system and the development of community mental health programs, the "waiting list" remains a constant problem. The subcommittee determined to focus a major portion of their energy in an effort to understand and solve this problem.

At the time of this study, about 5% of California's mentally retarded population was served by the state. These were persons who required care and services that their families were unable to provide. Since 1850, California maintained state hospitals (now called Developmental Centers) for these persons. The subcommittee found that:

1. Procedural weaknesses in existing state programs to aid the mentally retarded have resulted in an inability to provide badly needed services on a timely basis.
    
2. By making admission to state hospitals the sole route to gain state support for the costly care of the mentally retarded, lengthy waiting lists have resulted which have worked undue hardship on the afflicted and their families.
    
3. Many mentally retarded persons not requiring hospital care are unnecessarily forced to seek state hospital placement rather than being placed directly in community facilities or receiving other services more suited to their individual needs.
    
4. Public and private community-based services, including residential facilities, are not used to full advantage. While state hospital facilities for the mentally retarded are filled to capacity and lengthy waiting lists exist, state-licensed private facilities have substantial numbers of vacant beds.
    
5. Private residential facilities and professional home care services may be more suited to individual needs and in most instances can be secured at a cost less than the $300-$400 monthly cost of maintaining a mentally retarded patient in a state hospital.
    
6. Mentally retarded children, who can receive proper care in the community and whose parents prefer such service, should remain in the community whenever possible. Few families can now afford this.
    
7. Expanded state support for community residential care of the mentally retarded, in addition to supplying more appropriate care to the patients involved, would ease the strain on state hospital facilities and would reduce the need for the extremely costly construction of new facilities.
    
8. Privately operated facilities providing care for the mentally retarded are hampered by conflicting policies regarding licensing, inspection and standard setting administered by different state agencies.

Among the recommendations made by the study were:

1. State responsibility for the mentally retarded should be shifted from the time the patient enters a state hospital to the earlier point when expert diagnosis determines that special care is needed that the family is unable to provide.
    
2. The State Department of Public Health should be given the responsibility for contracting with appropriate community-based medical agencies to provide regional services, including the initial diagnosis determining whether special care beyond that available in the home is necessary.
    
3. The regional centers, in addition to diagnostic services, should:

1. provide counseling services to affected families;
2. determine eligibility for state support of patients in community facilities;
3. assist families in selecting appropriate community services;
4. provide continuing supervision and case management services for patients receiving state supported care;
5. periodically inspect community service facilities for compliance with established standards.

The subcommittee asked the question: "What do parents of retarded children want the state to do?" They interviewed over 100 families and had questionnaires completed by more than 1200 families with children on the waiting list for state hospitals. The need for community residential care was most frequently mentioned by the parents. The second most often stated needed was for counseling. As one parent said, "There was just no one to talk to - we took her to the state hospital because we didn't know what to do. . . We needed a place for (knowledgeable) advice."

In 1965, Assembly Bill 691 established the concept of "regional centers" in California. It defined "regional centers" to mean "regional diagnostic, counseling and service centers for mentally retarded persons and their families." It shifted "state responsibility for mentally retarded persons from the time they enter a state hospital to the time when they are diagnosed as needing specialized care." It offered persons "alternatives to state hospital placement."

"The regional centers shall provide and perform or cause to be performed services including but not limited to the following:

1. Diagnosis.
    
2. Counseling on a continuous basis. Counseling shall include advice and guidance to any mentally retarded person and his family, to assist them in locating and using suitable community facilities, including, but not limited to: special medical services; nursery and preschool training; public education; recreation; vocational rehabilitation; and suitable residential facilities.
    
3. Provide state funds to vendors of service to the retarded, when failure to provide such services would result in state hospitalization.
    
4. Maintain a registry and individual case records.
    
5. Systematic follow-up of the mentally retarded and reactivation of cases as indicated.
    
6. Assist, where necessary, in state hospital placement of the mentally retarded.
    
7. Call public attention to unmet needs in community care and services, defining and interpreting standards of community care and services as used by the regional center, and stimulating the community to develop such services as needed.
    
8. Maintain a staff according to standards set by the State Department of Public Health."

In 1966, two "pilot" regional centers were established: Golden Gate Regional Center in northern California (serving primarily Alameda, Contra Costa, Marin, San Francisco and San Mateo Counties) through a contract between the State and San Francisco Aid Retarded Children (now, San Francisco Arc) and Children's Hospital Regional Center in southern California (serving primarily Los Angeles County) through a contract between the State and Children's Hospital of L.A. By June of 1968, the two centers are serving 770 clients.

In 1969, Assemblyman Frank Lanterman introduced AB 225 extending regional centers to all of California. That legislation, known as the "Lanterman Mental Retardation Services Act," was enacted July 1, 1971 and provided, as stated by then Governor Ronald Reagan, "a dynamic framework on which we shall build a comprehensive system to assure that the mentally retarded develop to the fullest extent of which they are capable."

In 1973, Assemblyman Lanterman authored AB 846 which expanded eligibility for services to include cerebral palsy, epilepsy, autism and other neurologically handicapping conditions closely related to mental retardation.

In 1976, the last of the current 21 regional centers was formed (Regional Center of the East Bay in Alameda and Contra Costa Counties), and since that time Golden Gate Regional Center has served Marin, San Francisco and San Mateo Counties. In looking at all 50 states, California's regional centers remain unique as a service mechanism through which the needs of developmentally disabled citizens are addressed.