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A
Wonderful
good
afternoon,
everyone
welcome
to
assembly
committee
on
health
and
human
services.
We
have
a
huge
day
today
and
numbers
before
we
begin.
Please
remember
to
mute
your
microphone
when
you're,
not
speaking
just
to
minimize
any
background
noise
and
also
please,
if
you
have
to
turn
off
your
camera,
please
leave
your
camera
on,
but
so
the
staff
can
make
sure
that
we
have
a
quorum
present
and
if
you
do
need
to
step
out
or
be
excused,
please
reach
out
to
myself
or
vice
chair
peter.
A
A
Here
so
it
appears
that
we
have
a
quorum,
so
we
are
ready
to
go.
I
know
that
some
people
have
been
having
some
technical
issues,
so
if
we
can
just
mark
assemblywoman,
benitez
thompson
and
assemblywoman
black
absent
excused
and
note
their
presence
if
they
do
return,
let's
get
started
I'd
like
to
welcome
our
audience
joining
us,
either
virtually
on
the
website
legislative
website
or
on
youtube.
Today
we
have
presentations
on
mental
health
here
in
nevada
and
two
hearings
on
two
bills,
and
I.
A
That
I
might
have
been
overly
optimistic
when
scheduling
this
agenda,
but
I
know
that
we
are
all
ready
to
start
making
good
policy
for
our
state,
and
so
we
will
be
able
to
power
through
this,
I'm
very
confident
in
this
committee
and
our
ability
to
get
through
and
get
this
hard
work
done.
A
So
before
we
again
begin
I'd
just
like
to
make
several
housekeeping
announcements
agenda
items
may
be
taken
in
a
different
order
than
listed
two
or
more
agenda
items
may
be
combined
for
consideration
or
removed
from
the
agenda,
or
discussion
of
an
item
may
be
delayed
at
any
time.
This
is
a
virtual
meeting
format
via
zoom,
so
it's
important
to
keep
everyone
safe
and
also
have
access
to
the
public.
So
the
public
may
provide
testimony
in
several
different
ways,
all
of
which
are
listed
on
the
agenda
right
now.
A
You
can
register
to
participate
online
through
the
legislative
website
nellis
or
by
sending
your
comments
directly
to
our
staff.
We
any
committee
exhibits
may
be
submitted
electronically.
You
can
see
them
online
for
our
members,
but
as
well
as
the
public,
and
we
will
try
our
best
to
keep
that
as
up-to-date.
I
know
that
we
have
our
committee
manager,
abigail
lee
is
fantastic
about
getting
that
stuff
up
and
running,
so
we
all
have
access
to
it
before
our
meetings.
A
A
So
with
that,
let's
move
on
to
our
first
agenda
item,
I'm
just
so
thankful
that
our
pres
presenters
are
here
and
available
for
us.
I
know
that
they
could
talk
for
hours
and
days
and
weeks
about
mental
health
and
especially
the
status
of
mental
health
in
our
own
state,
and
I
have
asked
them
to
reduce
that
down
to
20
minutes.
A
I
will
try
to
open
it
up
for
some
limited
com
comments
or
questions
from
our
members,
but
I
would
encourage
you
and
I
believe
our
policy
analysts
will
send
out
all
their
contact
information.
So
if
you
are
not
able
to
ask
your
questions
today,
under
these
limited
circumstances,
I
encourage
you
to
reach
out
to
them.
I
know
that
they
have
been
very
forthcoming
with
information
when
I
have
needed
it,
and
I
am
sure
they
will
be
that
way
with
all
of
you.
A
So,
if
you
guys
could
please
introduce
yourself
and
I'll
remind
all
of
our
members
and
our
guests
to
identify
yourself
before
you
speak,
so
we
have
a
clear
record
going
forward
and
I'll
just
turn
it
over
to
you
guys
right
now,.
F
Great
good
afternoon,
madam
chair
and
members
of
the
committee,
my
name
is
stephanie
woodard
and
I
am
the
department
of
health
and
human
services
senior
advisor
on
behavioral
health
and
I'm
joined
this
afternoon
by
dr
megan
freeman.
The
clinical
and
policy
advisor
on
children's
behavioral
health
with
dcfs.
F
We're
good
okay,
we're
here
today
to
provide
a
brief
overview
of
the
state
of
nevada's
behavioral
health
system,
discuss
the
impacts
of
covid
19
on
behavioral
health
in
nevada
and
opportunities
for
behavioral
health
going
forward.
This
presentation
is
intended
to
be
very
high
level
as
an
introduction
to
the
state
system,
and
we
recognize
from
the
outset
that
the
behavioral
health
system
is
vast
and
incredibly
complex.
F
F
F
This
evolution
has
required
a
lot
of
concerted
effort
and
coordination
across
divisions
within
dhhs
and
gpbh
serves
as
the
state
mental
health
authority
and
the
single
state
authority
for
substance,
abuse,
treatment
and
prevention.
Collectively,
the
three
divisions
work
together
to
plan
provide
regulate,
provide
oversight,
training
and
technical
assistance
and
financing
to
this
very
complex
system.
F
In
order
for
us
to
do
the
job
of
planning
and
the
oversight
that
we
provide
to
the
state
behavioral
health
system,
we
have
several
boards
and
commissions
that
help
to
guide
our
work.
These
include
the
state
board
of
health,
the
regional
behavioral
health
policy
boards,
which
you're
going
to
be
hearing
about
in
a
little
bit,
behavioral
health
planning
and
advisory
council
and
the
substance,
abuse
treatment
and
prevention
agent
agency
advisory
board.
All
of
these
collectively
have
in
one
way
or
another,
an
opportunity
to
provide
planning
oversight
and
regulation
and
advocacy
for
behavioral
health
in
nevada.
F
F
F
They
often
assist
with
the
licensure
of
healthcare
facilities,
including
some
of
the
real
foundational
facilities,
part
of
the
behavioral
health
system
in
nevada,
and
then
we
have
the
administrative
services
which
are
absolutely
essential
for
us
to
be
able
to
administer
the
grant
funds
that
we
receive
next
slide.
F
So
for
our
clinical
services.
On
the
civil
side,
we
have
two
inpatient:
psychiatric
hospitals,
northern
nevada,
adult
mental
health
and
southern
adult
mental
health,
both
in
washoe
and
clark
county.
The
access
to
inpatient
services,
more
often
than
not
is
for
an
individual
that
is
admitted
under
an
emergency
through
a
mental
health
crisis.
However,
they
do
also
have
voluntary
admissions.
F
F
Access
to
outpatient
services
is
completely
voluntary
unless
the
individual
has
been
ordered
to
mental
health
court
or
assisted
outpatient
treatment.
It's
important
to
note
that
our
civil
service,
outpatient
programs
really
do
provide
the
safety
net
services
for
individuals
in
nevada
who
are
uninsured
or
underinsured.
F
On
the
forensic
side,
we
have
two
hospitals
in
nevada
lakes
crossing
in
sparks
nevada
and
stein
forensic
facility
in
in
southern
nevada,
and
these
two
hospitals
work
with
individuals
who
are
working
towards
restoration
of
competency.
F
They
have
recently
been
able
to
move
out
of
the
consent
decree,
but
it's
important
to
acknowledge
that
the
forensic
hospitals
still
are
either
at
or
near
full
capacity.
So,
although
the
consent
degree
has
expired
without
penalties
or
further
oversight,
the
state
is
continuously
focused
on
careful
management
in
order
to
meet
demand
and
avoid
any
other
legal
challenges.
F
So
those
are
the
two
areas
where
there
are
direct
clinical
services
that
are
provided
within
the
division
of
public
and
behavioral
health,
on
both
the
civil
and
forensic
side.
But
as
we
have
worked
to
move
away
from
being
the
largest
behavioral
health
provider
in
nevada
and
really
building
capacity
at
the
community
level,
we
have
recognized
the
need
for
additional
support
to
help
build.
That
community
capacity,
the
behavioral
health
policy
unit
works
to
administer
the
majority
of
our
large
federal
funding
streams
that
are
used
to
address
specific
populations,
including
those
who
are
uninsured
and
underinsured.
F
Next
slide,
there's
a
little
delay.
Okay,
some
of
the
behavioral
health
policy
areas
of
focus
include
addressing
minority
health
and
equity
and
disparities
supporting
evidence-based
practices.
We
did
a
lot
after
covid
to
help
support
community
agencies
to
fully
implement
telehealth
and
a
focus
on
suicide
prevention
and
crisis
services.
H
System,
dr
megan
freeman,
with
the
division
of
child
and
family
services
for
the
record.
Thank
you,
dr
woodard
good
afternoon,
chair
nguyen
and
members
of
the
committee,
and
thank
you
for
the
opportunity
to
present
to
you
on
children's
mental
health
next
slide.
Please,
today,
I'd
like
to
give
you
an
overview
of
our
agency
operations
and
explain
how
our
work
shapes
the
children's
mental
health
system
in
nevada
next
slide.
G
See
our
agency
excuse
me,
ms
freeman.
This
is
american
broadcast.
We
are
unable
to
see
your
screen
share,
so
I
am
going
to
stop
it
for
you
and
if
you
could
bring
it
back
up,
that
would
be
great.
H
H
H
In
addition
to
our
agency
vision,
admission,
three
regional
children's
mental
health
consortia
guide,
the
growth
and
development
of
our
children's
mental
health
system,
the
makeup
and
roles
of
the
children's
mental
health
consortia
are
defined
in
nevada
by
statutes
and
the
consortia
chairs,
and
myself
will
speak
to
this
committee
on
february
15th.
In
more
detail
about
this.
H
Through
this
initiative,
hundreds
of
demonstration
grants
cooperative
agreements
and
expansion
grants
have
been
funded
throughout
the
us
to
encourage
the
widespread
adoption
of
what
is
called
the
systems
of
care
approach.
Dcfs
has
received
three
grants
under
the
children's
mental
health
initiative
and
is
committed
to
the
systems
of
care
or
soc
approach.
H
The
core
values
of
an
soc
approach
include
providing
services
and
creating
systems
that
are
family,
driven
and
youth.
Guided
services
are
community
based,
accessible
and
provided
in
the
least
restrictive
environment
and
services
and
systems
are
culturally
and
linguistically
appropriate
in
order
to
facilitate
access.
H
Dcfs
operations
are
divided
into
four
separate
areas
which
you
can
see
here
in
2019
dcfs
underwent
an
internal
reorganization
to
move
away
from
our
traditional
orientation
around
children's
mental
health,
child
welfare
and
juvenile
justice
services.
This
resulted
in
new
coordination
of
our
services
around
community-based
services,
residential
or
24-hour
services,
and
quality
and
oversight.
H
Since
the
reorganization,
we
have
been
working
to
break
down
silos,
incorporate
children's
mental
health
programming
throughout
the
child
and
family
service
system,
and
incorporate
continuous
quality
improvement
into
all
programs
at
all
levels
in
order
to
better
serve
youth,
many
of
whom
touch
multiple
of
our
systems
in
our
community.
Oh
sorry,
joseph
can
you
go
back
thanks
in
our
community
services
area
are
located
all
of
our
outpatient,
mobile
and
other
community-based
services,
including
child
protective
and
welfare
services
for
rural
nevada.
H
H
The
focus
of
our
residential
services
programs
is
24-hour
care.
This
includes
acute
care,
residential
treatment
and
juvenile
justice
youth
facilities.
Our
youth
facilities
are
focused
on
programming
and
not
punishment
per
policy.
Every
youth
receives
an
assessment
for
mental
health
and
substance.
Use,
treatment
needs
and
treatment
is
provided
as
needed.
H
Our
youth
facilities
also
operate
under
a
recently
modernized
suicide
prevention
policy.
Our
quality
and
oversight
area
is
focused
on
policy,
quality
assurance
and
dcfs,
and
its
oversight
or
regulatory
role
as
a
state
agency.
Additionally,
our
systems
advocate
is
located
in
the
quality
and
oversight
area.
This
position
functions
as
our
public
information
officer
and
legislative
liaison.
H
H
H
In
2020,
our
psychiatric
residential
treatment
facilities
achieved
accreditation
by
the
committee
for
accreditation
of
residential
facilities
or
carf.
This
was
a
multi-year
highly
intensive
process
that
has
resulted
in
more
in-state
beds
for
youth
with
higher
levels
of
need
in
the
coming
biennium
residential
services
will
be
focused
on
implementing
the
building
bridges
program,
a
set
of
best
practices
for
transforming
systems
to
create
partnerships
and
collaboration
between
families,
youth
advocates,
service
providers
and
oversight
agencies.
H
A
primary
goal
of
the
building
bridges
program
is
to
sustain
positive
outcomes
after
discharge
from
residential
placement.
Next
slides
on
slide.
Eight,
you
will
see
our
two
active
sources
of
competitive
federal
funding,
including
our
pediatric
mental
health
care
access
grant,
which
works
to
integrate,
pediatric
psychiatry
and
behavioral
health
consultation
services
into
rural
primary
care.
H
Our
systems
of
care
expansion
grant
has
multiple
goals,
but
the
overarching
objective
is
system
improvement
which
will
expand
the
service
array
in
rural
nevada
and
provide
infrastructure
to
grow
dcfs's
capacity
to
serve
in
an
oversight.
Role
for
children's
behavioral
health
in
particular,
the
system
of
care
grant
will
expand
access
to
wrap-around
services,
respite
care
and
family
peer
support.
H
However,
the
funding
is
temporary
and
finally,
within
community
services,
tiered
care
coordination
is
available
to
youth
with
multiple
system
needs
in
order
to
build
the
family's
capacity
to
meet
their
youth
needs,
as
well
as
match
them
to
formal
services
and
supports
tiered
care.
Coordination
includes
high
fidelity,
wraparound
and
a
program
called
focus
for
youth
with
intermediate
level
needs.
H
So
you
will
see
that
a
lot
of
what
we
do
is
focused
on
direct
services,
but
in
our
quality
and
oversight
area
is
where
we
focus
more
on
policy
and
regulatory
role
in
our
quality
and
oversight
area.
We're
currently
recruiting
for
a
position
that
will
be
embedded
at
nevada,
medicaid
to
support
policy
development
and
on-the-ground
technical
assistance
for
schools
implementing
medicaid
billing.
H
H
But
given
the
current
budget
constraints,
we're
looking
at
alternate
ways
to
begin
this
work,
our
current
system
of
care
grant
provides
the
theoretical
framework
and
initial
funding
to
build
the
beginning
infrastructure
for
the
children's
mental
health
authority.
However,
we
need
a
sustainable
plan
to
position
dcfs
as
the
entity
in
nevada
that
ensures
children,
youth
and
families
receive
the
best
possible
mental
and
behavioral
health
care
so
that
they
can
achieve
their
goals.
H
F
Thank
you,
dr
freeman,
so
recognizing
that
we
do
have
some
time
constraints
today.
You
have
been
provided
both
the
slides,
but
also
I
want
to
point
your
attention
to
some
final
slides
on
each
of
the
presentations
which
points
you
to
some
links
to
some
additional
resources.
That
may
be
helpful
if
you
wish
to
learn
more
about
any
of
the
topics
that
we've
discussed
here
today,
so
now
we're
going
to
move
to
an
overview
of
the
state
mental
health
system.
F
So
important
to
recognize
that
kovid
19
as
a
pandemic
is
considered
a
disaster
when
we
have
looked
at
looking
at
how
we
can
best
estimate
the
impact
of
covid19
on
behavioral
health
in
nevada
and
actually
statewide
and
internationally,
what
we've
had
to
do
is
look
at
an
existing
body
of
research
that
helps
us
to
better
understand
what
the
impact
of
previous
disasters
have
had
on
behavioral
health.
We
recognize
that
anyone
excuse
me.
G
F
So
as
a
disaster,
covid19
has
impacted
virtually
everyone
in
one
way
or
another.
Certainly
individuals
who
have
been
most
directly
impacted
may
have
the
most
adverse
experiences
when
it
comes
to
responding
to
covid19,
but
what
we
have
done
is
we've
looked
at
that
body
of
literature
related
to
disaster,
behavioral
health
to
help
us
better
conceptualize
what
we
needed
to
address
in
the
response
and
recovery
efforts
next
slide.
F
This
is
the
best
model
that
we
have
had
in
order
to
help
to
better
anticipate
what
the
impacts
on
behavioral
health
could
be
related
to
covid.
However,
we
recognize
that
there
are
some
significant
limitations
to
using
this
model.
One
of
the
primary
limitations
is
that
this
model
assumes
that
there
is
a
very
clear
beginning
middle
and
end
to
a
disaster
and,
as
we
all
know,
with
covid,
it
has
had
a
very
prolonged
existence
in
nevada
and
the
recovery
is,
although
coming
relatively
slow.
F
We
also
recognize
that
the
recovery
from
an
impact
such
as
a
hurricane
or
a
tornado
tends
to
follow
a
normal
trajectory
where
there
is
an
opportunity
for
inventory
and
a
community
cleanup
and
engagement.
However,
in
covid
we
have
experienced
something
that
is
very
different.
F
Next
slide,
one
of
the
best
ways
for
us
to
conceptualize
the
impacts
of
covid
is
to
look
at
the
stress
continuum,
and
we
recognize
that
there
are
different
impacts
depending
on
different
degrees
of
stress.
This
includes
individuals
who
are
experiencing
healthy
amounts
of
stress
all
the
way
to
individuals
who
have
experienced
incredibly
long,
prolonged
exposures
to
high
degrees
of
stress.
F
F
F
In
order
for
us
to
formulate
how
we,
as
a
state,
were
going
to
respond
to
the
behavioral
health
needs
in
nevada,
subsequent
to
covid19,
we
developed,
along
with
fema
and
samhsa
this
population
exposure
model.
What
this
population
exposure
model
does
is
it
allows
us
to
better
understand
what
the
potential
impacts
are
for
different
populations
that
are
impacted
differently,
including
vulnerable
populations,
so
that
we
could
target
our
response
and
resource
based
on
the
level
of
exposure
or
the
potential
for
significant
distress
due
to
covid19.
F
Here
we
have
prioritized
at
the
very
bottom
those
individuals
who
are
bereaved
or
who
have
experienced
a
hospitalization
recognizing
that
both
of
those
events
could
be
incredibly
difficult
for
someone
to
manage.
We
also
prioritize
frontline
health
workers,
especially
knowing
that
we've
been
experiencing
a
considerable
medical
surge.
As
of
late.
F
We
see
that
frontline
health
workers,
as
well
as
emergency
responders,
have
really
been
shouldering
a
lot
of
the
burden
related
to
their
response
to
covid,
but
we
also
recognize
that
it's
not
only
those
individuals,
who've
been
directly
impacted,
but
also
the
secondary
and
tertiary
impacts
that
covid
has
had
on
individuals.
This
could
also
be
loss
of
employment
students
who
have
been
disconnected
from
school
and
other
individuals
in
the
community
that
have
been
responding
to
covid19.
F
We
have
been
able
to
respond
in
a
number
of
different
ways,
so
just
some
highlights
from
our
response
and
recovery
activities
include
training
well
over
700
people
in
psychological
first
aid
we've
worked
with
the
nevada
hospital
association
on
engaging
hospitals
and
crisis
standards
of
care,
around
behavioral
health
crisis
services
and
emergency
room
diversion
we've
worked
to
establish
24,
7
psychiatric
triage
centers
for
children,
adults
and
adolescents
to
help
to
divert
them
from
with
a
mental
or
behavioral
health
crisis,
to
help
to
divert
them
from
emergency
rooms.
F
F
The
the
crisis,
counseling
assistance
and
training
program
that
I
had
mentioned
before
was
allowed
through
nevada
to
develop
the
nevada
resilience
project.
The
nevada
resilience
project
has
allowed
nevada
to
hire
a
number
of
resilience,
ambassadors
statewide,
with
a
focus
on
intervening
and
providing
promotion,
prevention
and
early
intervention
for
individuals
who
are
struggling
with
stressors
as
they
relate
to
covid19.
H
H
H
H
H
Our
biggest
areas
of
difficulty
are
in
access
to
care
and
prevalence
of
substance
use
among
youth.
These
are
very
actionable
concerns
and
that
can
be
addressed
with
investments
in
screening
prevention
and
early
intervention.
However,
it
will
take
resources
and
time
to
move
the
needle
on
these
rankings
next
slide.
H
H
On
slide
11,
you
will
see
the
top
10
diagnoses
most
commonly
associated
with
medicaid
billing
for
behavioral
health
for
youth
ages,
0
to
18..
These
are
2019
numbers
so
prior
to
the
pandemic.
For
the
sake
of
time,
I
will
leave
this
for
reference,
but
you
will
notice
that
mood
and
anxiety
disorders
are
prominent.
H
H
However,
while
youth
are
reporting,
increased
anxiety,
depression
and
stress
right
now,
some
teenagers
are
actually
also
reporting
increased
life.
Satisfaction
which
they
say
is
because
of
more
time
for
sleep
more
time
with
family
and
protection
from
some
of
the
stressors
of
regular
in-person
life
like
bullying
next
slide.
H
H
This
graph
shows
calls
to
our
children's
mobile
crisis
response
hotline.
You
will
notice
the
same
general
pattern
as
the
cps
hotline
calls.
A
large
decrease
at
the
onset
of
the
pandemic,
followed
by
a
gradual
return
to
regular
seasonal
patterns
for
mobile
crisis.
The
return
to
normal
happened
when
children
returned
to
school
in
the
fall,
and
this
actually
caused
a
spike
in
need
that
has
remained
high
since
that
time.
H
H
Initially
mobile
crisis
saw
a
decrease
in
hospital
diversion
indicating
that
more
youth
were
being
hospitalized
and
the
program
reports
that
this
is
due
to
youth,
with
more
serious
levels
of
risk,
presenting
for
care
and
more
difficulty.
Placing
natural
community
supports
around
the
youth
due
to
isolation
and
quarantine.
H
I
also
want
to
make
you
aware
of
a
national
trend
reported
by
the
cdc
in
the
fall,
although
the
overall
number
of
pediatric
visits
to
emergency
departments
decreased
by
about
70
percent
during
lockdown
and
stay
in
home
efforts,
the
proportion
of
visits
that
were
related
to
behavioral
health
was
40
to
60
higher
than
normal.
During
april,
through
october,
most
emergency
departments
lack
the
appropriate
resources
for
providing
behavioral
health
care.
So
we
want
to
increase
the
availability
of
immediate
and
crisis
care
when
and
where
youth
and
families
need
to
access
it.
H
H
H
On
monday,
you
heard
a
little
bit
about
public
health
surveillance
from
public
and
behavioral
health,
deputy
administrator
julia
peake.
She
talked
about
how
typically
public
health
surveillance
does
not
occur
in
real
time
and
youth
suicide
is
the
same,
although
I
know
that
this
topic
has
been
in
the
news
and
in
all
of
our
parts
recently,
our
2020
numbers
have
not
yet
been
finalized
through
the
office
of
vital
statistics,
so
they
could
change
from
what
you
see
here,
it's
too
early
to
draw
conclusions
about
how
the
pandemic
has
changed
the
suicide
rates
in
nevada
or
anywhere.
H
I
am
a
parent
one.
Fatality
is
too
many
and
we
strive
for
zero
suicides,
but
I
would
like
to
encourage
us,
as
a
public
health
system
not
to
focus
on
fatalities
as
the
only
important
indicator
of
the
burden
of
suicide
in
nevada.
That
is
why
we
are
putting
into
place
syndromic
surveillance
at
hospitals
and
urgent
care
centers
to
better
understand
the
full
spectrum
of
help
seeking
for
suicidal
behavior.
This
is
monitoring
of
the
number
of
visits
where
a
person
presents
with
a
suicide
attempt.
H
F
You
thank
you,
dr
freeman,
a
little
glimpse
into
the
mental
health
america
report,
as
dr
freeman
had
mentioned
this
time
specific
to
adults
and
mental
health.
This
report
comes
out
annually
and
uses
a
number
of
different
metrics
to
look
at
the
progress
or
a
lack
thereof
that
mental
health
services
are
having
in
specific
states.
F
Here,
you'll
see
a
number
of
different
rankings.
Adults
with
any
mental
illness
has
continued
to
increase
where
nevada
is
about
20
percent,
the
united
states
average
is
19
percent
in
adults
with
a
substance.
Use
disorder
in
the
past
year
is
at
nine
percent,
where
the
united
states
was
at
seven
percent.
F
I
do
also
want
to
note
that
there
have
been
some
improvements
in
some
of
the
areas
related
to
adult
mental
health,
including
a
reduction
in
adults,
expressing
serious
thoughts
of
suicide
adults
with
any
mental
illness
who
did
not
receive
treatment.
We
actually
have
increased
individuals
who
may
have
needed
treatment
and
did
receive
treatment,
as
well
as
adults
with
cognitive
disability,
who
did
not
see
a
doctor
due
to
costs.
F
We've
actually
seen
a
good
reduction
in
those
numbers
which
has
enhanced
our
scores
here.
The
reason
that
I
think
it's
important
to
discuss
these
data
is
because
far
too
often
we
do
hear
people
use
the
shortcut
that
nevada
ranks
51st,
but
there
are
a
lot
of
nuanced
data
points
that
go
into
that
overall
ranking,
and
so
it's
important
to
look
in
a
more
detailed
fashion
to
understand
what
could
possibly
be
driving
some
of
our
rankings.
F
As
dr
freeman
pointed
out,
the
rate
of
suicide
in
nevada
in
2020
specific
for
youth
was
not
unusual
compared
to
years
past,
and
we
actually
see
similar
trends
across
all
age
groups,
including
adults
and
individuals,
age
65..
F
F
We
see
also
that
we
had
a
red
alert
back
in
november
through
the
national
drug
helpline,
which
noted
that
nevada
had
a
50
increase
in
overdose
deaths
between
the
first
quarter
and
the
second
quarter
of
2020.
F
Much
of
this
is
also
driven
by
non-covid
related
issues,
including
the
proliferation
of
synthetic
opioids,
including
fentanyl.
We've
been
seeing
this
troubling
trend
growing
nationally,
even
pre-covered,
but
we
do
realize
that
covid
could
have
had
a
significant
impact
in
changing
some
of
these
numbers
in
nevada.
F
We've
also
seen
an
increase
in
er
utilization
rates
for
individuals
with
suspected
opioid-related
emergency
department
encounters.
We
had
a
26
increase
in
2020,
while
the
overall
drug-related
emergency
department
increased
only
three
percent.
So
while
we
saw
a
three
percent
increase
over
all
26
percent,
the
vast
majority
of
that
was
related
to
opioid
overdoses
next
slide.
F
F
There
are
a
number
of
different
reasons
for
this,
not
the
least
of
which
is.
We
did
have
a
substantial
time
period
where
we
had
stay-at-home
orders,
and
we
know
that
individuals
have
been
avoiding
care.
We
also
know
that,
following
disasters,
we
typically
see
an
increase
in
need
for
traditional
behavioral
health
services
between
12
and
18
months.
Following
the
anniversary
of
the
occurrence
of
the
disaster,
so
we
anticipate
that
we
can
see
increased
needs
for
services
moving
forward
following
march
of
2021..
F
Overall,
traditional
behavioral
health
services,
and
currently
we
have
not
seen
a
significant
increase
where
we
have
seen
some
nice
change
is
in
telehealth,
so
telehealth
utilization
for
behavioral
health
services
actually
helped.
I
think,
with
a
lot
of
continuity
of
care
for
individuals
who
had
previously
been
engaged
in
behavioral
health
services,
but
we
also
saw
a
marked
increase
of
individuals
who
initiated
treatment
services,
utilizing
telehealth
pre-covet,
approximately
24
of
individuals
had
had
their
initial
visit
via
telehealth
and
that
moved
to
41
of
initial
visits.
The
six
months
following
march
of
2020.
F
A
You
guys
did
an
amazing
job
of
compacting
them.
I
know
I
asked
you
a
lot
to
try
to.
You
know,
consolidate
everything
that's
going
on,
especially
recently
in
this
mental
health
field,
and
you
know
everything.
So
I
appreciate
you
guys
doing
that.
We
do
have
a
couple
of
questions
and
I
will
start
with
vice
chair
peters,.
G
Thank
you
chair,
and
I
echo
what
the
chair
has
said
about
doing
an
awesome
job
getting
all
of
that
information
to
us
in
such
a
short
shortened
period
of
time.
Now
I
have
a
follow-up
question
related
to
your
data.
Thank
you
so
much
for
presenting
all
of
that.
G
It's
really
important
to
ensure
that
we're
getting
policies
to
where
and
when
families
and
children
need
it,
but
I'm
just
wondering
what
data
gaps
you
guys
can
identify
or
have
identified
for
ensuring
that
we
have
all
the
information
we
need
to
develop
response
policies
to
ensure
that
we're
getting
those
resources
to
to
children
and
families
when
and
where
they
need
it.
H
Dr
freeman,
for
the
record,
thank
you
for
the
question
through
you
chairwind
to
vice
chair
peters.
Oh.
H
Thank
you
chair,
that's
a
fantastic
question
and
we
one
of
the
amazing
things
about
nevada
is
that
we
actually
are
collecting
a
ton
of
data
on
children,
which
is
wonderful.
We
have
data
from
our
children's
mobile
crisi
crisis
team.
We
get
a
lot
of
data
through
the
school
and
there's
a
couple
of
different
initiatives
on
collecting
data
through
the
schools
right
now.
I
think
where
we
need
to
focus
our
efforts
is
on
suicide
prevention,
and
I
mentioned
this
briefly
during
the
presentation.
We
would
like
to
be
getting
more.
G
Just
a
comment
that
that
that's
great
to
hear
I've
been
working
with
dr
woodard
on
on
a
bill
that
I
hope
will
help
allow
us
to
fill
that
data
gap
in
particular.
So
thank
you
again.
C
Thank
you,
madam
chair,
appreciate
the
opportunity
to
ask
a
question,
and-
and
I
appreciate
both
of
you,
dr
woodard
and
dr
freeman,
being
on
on
this
call
today,
and
I
know
that
it
was
a
lot
of
information
short
amount
of
time.
A
couple
questions
on
on
slides,
number,
eight
and
slide
number
18.
C
We
continue.
Nevada
continues
to
be
51st
and
all
of
those
data
points
at
the
you
know
the
worst
of
the
worst.
As
you
pointed
out,
and
I'm
this
is
my
fourth
session.
I've
seen
these
presentations
every
session
because
I've
been
on
health
and
human
services
each
time
we're
not
moving
that
needle
at
all
and
each
time.
C
Each
time
I
have
you
know
when
we
hear
these
presentations,
we
talk
about
collecting
data
and
at
some
point
we
have
to
make
some
changes
because
I'd
love
to
see
before
I'm
termed
out
wherever
some
of
those
needles
moving
that
some
of
that's
improvement
and
I
haven't
heard
really
anything
more
than
you're
collecting
more
data,
not
really
any
solutions,
and
so
what
I
want
to
know
is
have
has
a
number
of
childhood:
behavior
specialists
increased
and
what
are
we
doing
about?
C
Reaching
out
and
educating
folks
so
that
they
can
have
more,
you
know,
so
we
can
have
more
providers,
so
there's
more
access
to
care,
and
I
I
know
we
have
more
to
more
medicaid
recipients
signed
up,
but
that
doesn't
mean
they're.
You
know
that
having
signed
up
to
medicaid
doesn't
mean
you
have
better
access
to
care.
So
I
have
huge
concerns
about
that
and
I'd
like
to
see
at
some
point
after
this
is
over.
C
You
may
not
have
that
today,
we're
limited
over
time,
I'd
like
to
see
the
number
of
providers
that
you
have
available
in
your
system,
what
we're
doing
to
outreach,
whether
we're
using
some
reciprocity
to
get
these
people
licensed,
so
we
can
have
more
access.
That's
my
first
question.
I
want
to
know
what
you're
doing
for
the
specialists
these
people
see.
Second
question
is
that
telehealth
data,
you
said:
we've
increased
the
use
of
telehealth
from
24
to
41,
but
that
doesn't
mean
there's
actually
been
increased
access
to
care.
C
It
means
they,
maybe
weren't
able
to
get
in
the
office,
maybe
that
you
know
they
weren't
otherwise
going
to
see
that
provider
unless
they
had
the
telehealth.
So
I
don't
know
that
that's
actually
a
more
percentage
of
access
and
actually
real
visits,
so
I'd
like
to
see
some
data
on
on
that
and
what
we're
actually
doing
to
have
folks
get
that
access
to
care,
because
that's
at
the
end
of
the
day,
follow-up
access
to
care
getting
in
treatment
programs.
You
know
having
those
specialists
available
for
these
adults
and
children.
C
H
H
I
think
that's
very
significant
for
children
and
we
just
may
not
be
seeing
those
numbers
reflected
yet
in
the
report.
However,
we
will
submit
a
response
to
you
in
writing
on
your
questions
regarding
providers
and
the
other
aspects
of
your
question.
That's
all
right.
Great
thank.
C
A
Thank
you
and
I
know
we
have
several
other
questions,
but
I'm
just
going
to
do
one
more.
That's
in
the
queue.
If
we
can
turn
to
assembly
woman
summers,
armstrong.
I
Thank
you
chair
when
thank
you
so
much
for
your
presentation,
dr
freeman
assemblywoman
titus
picked
up
on
one
of
my
questions,
but
I'd
like
to.
I
just
expand
with
the
follow-up
question
which
would
be.
I
Is
your
department
partnering
with
any
national
organizations
or
non-profits,
to
help
with
addressing
some
of
the
mental
health
issues
throughout
the
state,
meaning,
for
instance,
do
you
have
any
non-profit
organizations
that
are
certified
that
are
able
to
go
into
the
schools
and
give
presentations
to
kids
or
do
community
outreach
so
that
the
message
that
there
is
help
that
there
are
resources
out
there
so
that
people
know
more
about
it?
I
And
I
can
just
tell
you
that
I'm
seeing
here
in
southern
nevada
a
lot
more
discussion,
open,
frank
discussion
about
mental
health,
and
I
think
that
if
we
had
the
more
support
we
can
have
for
those
conversations
from
your
from
your
department,
the
better.
I
think
that
we
can
reach
people
in
our
community.
So
thank
you.
A
Thank
you
and
if
there's
any
other
documentation
that
you
guys
have,
if
you
can
provide
it
to
our
policy,
analyst
patrick,
he
can
distribute
it
to
all
of
the
members
and
I
would
encourage
everyone
to
reach
out
to
them.
I
believe
we
have
their
contact
information
that
we've
provided
to
you
all
to
follow
up
with
any
additional
offline
conversations
about
more
detailed
discussions
about
what
we
can
do
in
our
state,
but
with
that,
thank
you
guys.
A
I
have
asked
probably
the
impossible
of
these
next
individuals.
I've
asked
them
to
kind
of
briefly
introduce
themselves,
give
us
a
five
minute
presentation
each.
I
know
we
still
have
those
two
bills,
but
I
do
think
it's
really
important
for
us
to
hear
from
them,
and
so
we
are
going
to
start
with
these
regional
behavioral
health
policy
boards,
and
I
will
start
with.
Probably
let's
see
I
will
welcome
and
ask
you
to
introduce
yourself:
miss
valerie,
haskins,
the
rural
regional,
behavioral
health
coordinator.
J
Thank
you
so
much.
I
greatly
appreciate
it
good
afternoon
madam
chair
and
members
of
committee
hold
on
just
a
second.
While
I
get
my
presentation
up
here,
we
had
initially
planned
to
go
in
order
of
our
alphabetical
order,
so
here
we
go
so
for
the
record
again.
My
name
is
valerie
kwape
haskin,
rural
regional
behavioral
health
coordinator
today
I'll
be
giving
a
brief
introduction
to
the
rural
regional
behavioral
health
policy
board.
J
There
is
a
handout
in
your
packet
that
accompanies
this
presentation,
which
gives
far
more
detail
about
the
board
that
I'm
able
to
present
to
you
today.
The
rural
regional,
behavioral
health
policy
board
represents
a
six-county
region
in
northeastern
nevada,
which
includes
elko
eureka.
Humble
lander,
oh
wait
are
you?
Can
you
see
my
video
okay?
Sorry
about
that
hi,
humboldt,
lander,
pershing
and
white
pine
counties.
The
combined
area
of
this
region
is
slightly
larger
than
the
state
of
mississippi
and
the
population
sits
just
under
100
000.
J
J
One
of
the
major
issues
community
members
in
our
region
face
is
transportation
both
to
and
from
behavioral
health
services.
This
is
the
case
for
both
crisis
and
non-crisis
services,
while
a
person
in
crisis
may
be
able
to
get
emergency
transportation
to
in-person
services
in
reno,
carson
or
las
vegas.
Our
stakeholders
have
alerted
us
to
many
persons
being
released
from
emergency
care
without
direct
transportation
home.
J
J
Thus,
previous
to
the
covet
19
pandemic,
it
was
a
priority
of
the
board
to
seek
and
maintain
or
to
seek
improved
medicaid
reimbursement
for
behavioral
health
services
to
ensure
that
providers
could
maintain
service
levels
to
meet
their
needs
over
the
last
year.
That
conversation
has
changed
due
to
budgetary
cuts
and
concerns
to
preserving
the
medicaid
services
that
are
currently
available,
while
most
of
the
state
can
be
considered
health
care
service
shortage
areas.
The
issue
is
exacerbated
in
our
most
frontier
communities
and
is
often
even
worse.
J
In
regards
to
behavioral
health
services,
the
board
has
prioritized
seeking
ways
to
improve
the
ability
of
local
organizations
to
recruit
behavioral
health
providers,
including
improving
pasta
licensure
for
those
who
are
moving
to
nevada
from
out
of
state.
This
is
addressed
in
the
board's
bill.
This
legislative
session,
sb
44.,
while
state
and
local
partners
have
made
great
strides
in
improving
data,
quality
and
communication.
J
Last
but
not
least,
the
nevada
department
of
veterans
services
has
made
it
known
to
us
that
our
region
has
a
comparatively
high
percentage
of
veterans
within
our
population.
The
board
prioritizes
efforts
that
improve
the
quality
and
access
to
services
for
those
who
have
served
our
nation
and
arms
forces.
J
While
many
communities
in
our
region
may
be
geographically
isolated,
they
were
not
unaffected
by
the
covit
19
pandemic.
The
information
I'm
discussing
here
has
been
shared
in
community
stakeholder
meetings.
It
should
be
cautioned
that
many
local
organizations
involved
are
focusing
their
limited
resources
on
response.
So
data
available
may
not
currently
reflect
these
concerns.
J
J
However,
with
already
thin
behavioral
health
services
available,
it
does
not
take
much
to
overwhelm
local
resources
so
early
on,
our
local
hospital
saw
an
increase
in
the
number
of
persons
presenting
to
the
emergency
departments
in
crisis.
While
some
of
these
community
members
had
presented
the
local
hospitals
in
crisis
before
most
of
them
were
experiencing
a
mental
health
crisis
for
their
first
time.
This
was
followed
by
a
sort
of
second
wave
of
problems
where
hospitals
were
seeing
more
patients
who
were
presenting
for
reasons
related
to
increased
alcohol
and
substance
use,
as
well
as
increased
intentional
overdoses.
J
J
Additionally,
increased
isolation
among
community
members
is
a
major
concern,
but
even
more
so
for
those
who
are
homebound
or
who
are
more
geographically
isolated,
and
that
is
my
very
very
brief
introduction
to
the
rural
regional
behavioral
health
policy
board.
Thank
you
so
much
for
your
time.
If
you
have
any
further
questions
or
comments,
I
can
do
reach
best
via
email.
J
A
You,
ms
haskin,
I
appreciate
your
brevity.
I
know
that
this
is
a
complex,
complex
subject,
and
so
I
appreciate
that
and
I'm
just
going
to
move
on,
I'm
sorry
to
miss
dorothy
edwards.
I
don't
know
if
this
is
the
order
you
were
told,
but
this
is
the
order
I
have
and
she
is
with
the
washoe
county
regional
behavioral
health
coordinator.
K
D
And
I
just
have
the
one
slide,
so
you
can
start
the
timer
now
so
good
afternoon.
Madam
chair
and
members
of
the
committee,
I'm
dorothy
edwards,
the
washer
regional
behavior
health
coordinator,
and
I
also
will
share
just
a
few
of
the
main
priorities
and
action
strategies
and
some
challenges
that
the
washer
behavioral
health
policy
board
has
identified
for
washoe
county
and
as
it
expanded
throughout
washington.
So
I'll
follow
the
items
on
this
slide
in
that
order.
D
In
response
support,
analysis
of
where
washoe
county
is
in
terms
of
readiness
to
stand
up
a
crisis.
Stabilization
center
remains
something
on
which
the
board
is
focused
in
response
to
the
ongoing
issues
of
individuals
experiencing
a
behavioral
health
crisis
and
often
being
taken
to
jail
or
emergency
rooms.
Inappropriately
these
facilities
are
considered
an
emergency
health
care
alternative.
D
Our
strategy
for
moving
forward
includes
the
completion
of
an
assets
and
gaps
analysis,
a
visit
to
one
of
the
originators
of
the
concept
in
arizona
and
increased
collaboration
with
partners,
including
our
state
city
and
county
leadership,
to
discuss
the
next
steps,
while
washoe
remains
well
poised
in
some
required
elements,
challenges
to
success,
including
finding
sustained
funding,
some
infrastructure
and
then
developing
the
policies
and
processes
required
for
collaboration
between
agencies.
It
does
remain
a
strong
priority
in
our
county,
equitable
focus
on
substance
misuse.
D
We
need
to
work
to
ensure
inclusion
and
collaboration
of
all
sectors
of
behavioral
health
strategy
for
success
here
began
as
we
invited
presenters
from
all
sides
of
behavioral
health,
including
substance,
which
used
treatment,
prevention
and
recovery
to
provide
information
educated
through
a
bill
draft.
Several
of
those
were
selected
for
the
board's
current
bill
senate
bill
69..
D
Our
work
in
focus
will
include
supporting
the
development
of
a
diverse,
culturally,
appropriate,
inclusive
and
well-trained
workforce
in
both
areas
of
behavioral
health,
behavioral
health
response
during
before
and
after
crises
as
dr
woodard
talked
about.
If
we
learned
anything
from
this
public
crisis,
it's
that
we
need
a
robust
plan
and
train
staff
who
can
cope
with
these,
sometimes
overwhelming
behavioral
health
consequences
of
an
emergent
event.
D
Another
strategy
was
the
development
this
year
of
the
draft
to
behavioral
health
annex
to
our
regional
emergency
response
plan,
we'll
continue
to
encourage
and
reach
out
to
all
organizations
from
our
board
and
within
the
community
to
take
advantage
of
resources
for
training
such
as
psychological,
first
aid,
with
the
goal
to
create
community
response
teams
to
activate
when
needed.
During
an
event.
We
look
forward
to
conducting
drills
and
exercises
with
local
and
state
partners
when
it's
safe
and
practice
practical
to
do
so.
D
The
chip,
the
community
health
improvement
plan,
the
chip
is
actually
developed
by
washington,
county
health
district.
It's
a
plan
of
action
to
address
local
conditions
that
are
contributing
or
causing
poor
health
in
washoe
county
behavioral
health
was
seen
as
a
top
concern
cited
by
the
community
and
one
that
greatly
suffers
from
lack
of
adequate
resources
and
available
workforce.
D
D
The
washoe
board
committed
its
support
of
the
behavior
hall
focus
areas
within
the
chip
and
that
will
include
some
robust
and
improved
data
collection
and
analysis
support
participation
by
sun
in
the
build
for
zero
homeless
initiative,
which
is
being
implemented
by
washoe
county
challenges.
No
surprise
include
the
lack
of
housing
and
resources
along
with
a
trained
workforce
and
more
workforce.
D
A
data
website
or
dashboard
is
required
for
the
regions
and
washoe
continues
to
work
on
theirs
with
a
target
completion
date
of
this
year,
as
val
said,
I
am
happy
to
provide
additional
information
on
any
of
these
subjects,
I'll
make
sure
that
you
get
the
copies
of
the
reports
I
addressed.
D
So,
please
feel
free
to
reach
out
to
me
separately
and
we
can
get
you
what
you
need
to
know.
Thank
you
so
much.
L
A
Will
we
will
move
next
to
the
clark
regional
behavioral
health
coordinator,
miss
theresa
and
do
you
say,
is
it
etchberry?
K
I
we
are
the
clark
regional
behavioral
health
coordinator.
This
is
the
board
clark.
County
is
one
of
the
largest
counties
in
nevada.
Just
to
give
you
a
brief
overview
per
our
nevada
state,
democrat
demographer
and
the
census
bureau.
K
The
population
in
2019
for
clark
county
for
for
clark
county
was
two
million
two
hundred
and
fifty
five
thousand
and
175
persons
clark
county
holds
76
73.6
of
nevada's
population,
so
we
have
a
very
diverse
next
screen.
Please
valerie!
Thank
you.
We
have
a
very
diverse
board
members.
We
have.
They
are
well-versed
in
behavioral
health
issues
and
they
hold
different
positions
throughout
the
county
and
other
boards,
and
they
also
share
our
demographics
for
our
our
board
and
for
our
county
next
slide.
K
Please,
the
clark
county,
behavioral
health
board
embraces
a
data-driven
approach
to
identify
the
behavioral
health
outcomes
and
system
gaps
of
the
region.
Therefore,
the
success
of
data
of
the
data
depends
on
the
existence
of
data,
the
types
of
data
and
the
quality
of
data
gathered,
particularly
what
we
are
looking
for
in
our
data
to
look
for
the
gaps
and
challenges
in
our
area.
K
We
also
would
like
to
know
where
people
are
placed
and
discharged
and
the
length
of
stay
for
those
hospitalized
and
treated
in
emergency
rooms.
This
will
guide
the
board
to
assess
the
after
and
ongoing
care
and
for
the
different
reports
that
we
have
to
produce
to
our
stakeholders
and
also
to
our
our
state.
K
Workforce
development
is
another
concern
we
would
like
to
have
an
increase
in
the
supply
of
our
our
providers
in
behavioral
health.
The
board
recognizes
that
the
workforce
and
the
availability
of
qualified
behavioral
health
providers
are
a
concern
here
in
clark
county.
While
the
region
has
seen
a
steady
growth,
our
community
still
falls
below
the
average
of
providers
per
capita.
The
board
wants
to
further
investigate
what
measures
the
board
can
take
to
improve
the
behavioral
health
workforce
supply
in
clark
county
the
data
management
and
application.
K
The
thing
that
happened
in
2020
is
the
pandemic
crisis
and
on.
We
have
seen
an
increase
in
the
number
of
people
seeking
services
and
on
a
national
level
and
as
well
as
nevada
and
what
was
stated
in
dr
woodard's
and
dr
freeman's
presentations
is
that
we
have
increasing
number
of
adults,
youth
and
children,
reporting,
symptoms
of
anxiety,
depression
and
an
increase
in
the
number
of
suicides.
K
These
concerns
and
challenges
drives
the
board's
priorities
and
we
would
like
to
see
the
data
for
oh
sorry,
valerie.
Can
you
go
back
to
one
one
slide
over
just
a
priority?
Thank
you.
So,
as
I
spoke
about
the
priorities
for
the
mental
health
and
workforce
development,
we
also
want
to
see
dedicated
funding
for
crisis
services.
K
K
The
board
also
wants
to
increase
community
access
to
crisis
intervention,
and
we
also
want
to
increase
the
stabilization
of
crisis
services
when
for
aftercare
and
ongoing
services.
A
G
K
A
Thank
you.
You
did
a
great
job
presenting
for
your
first
time.
I
would
have
never
known,
and
finally,
can
we
go
to
miss
jessica
flood
with
the
northern
regional
behavior?
She
is
the
northern
regional
behavioral
health
coordinator.
These
are
long
titles.
M
B
I
M
M
These
are
the
members
on
the
board.
If
you're
interested
of
note,
the
chair
is
taylor,
allison,
executive,
director
of
partnership
douglas
county
and
the
vice
chairs,
dr
ali
bannister,
carson
city
juvenile
protection
office
next
slide,
so
our
board
priorities
have
remained
pretty
stable
over
the
last
five
years.
By
far,
the
top
priority
is
obtaining
sustainable
funding
for
current
crisis
stabilization
and
jail
diversion
programs.
M
M
So
I
know
that
we're
talking
about
priorities
and
gaps
but
to
assemblywoman
titus's
point.
We
have
seen
some
progress
in
our
region
and
it's
pretty
exciting.
I
spoke
about
mallory
crisis
center.
That's
been
really
pivotal:
pivotal
to
have
that
24
7
access
for
people
in
crisis,
we're
also
really
lucky
to
have
ccbhc's
certified
community
behavioral
health
centers
and
both
carson
tahoe
and
the
ccbhcs
have
assertive
community
treatment
teams
which
really
provide
this
wraparound
to
people
that
are
in
serious
mental
illness.
M
Those
programs,
along
with
our
mobile
outreach
safety
teams,
we're
seeing
this
incredible
ability
to
identify
individuals
in
crisis,
really
get
them
into
treatment
and
stabilized
in
a
way
that
we
haven't
seen
before.
So
I
was
just
talking
to
the
most
officer
in
carson
city
yesterday
and
he
was
saying
that
you
know
there's
individuals
that
have
been
in
crisis
for
10
years,
who
are
now
stable,
and
then
you
know
dr
woodard
was
talking
about
their
emphasis
in
making
jail,
re-entry
and
criminal
justice
diversion
evidence
based.
M
M
What
we
think
is
working
in
our
region
is
that
we
have
these
local
behavioral
health
task
forces
that
really
provide
community
input
into
the
northern
board,
and
we
also
have
a
lot
of
a
culture
of
collaboration
in
the
northern
region
with
a
lot
of
organizations
partnering
on
grants
and
again
I
just
have
to
give
a
lot
of
credit
to
the
state.
M
We've
been
able
to
really
identify
community
partners
that
are
willing
to
expand
their
treatment
services
and
the
state's
been
able
to
bring
down
some
funding
for
those
programs
and,
along
with
that,
the
state
provides
quite
a
bit
of
technical
assistance
that
have
allowed
our
programs
to
hopefully
achieve
sustainability
in
the
future
next
slide.
M
M
M
M
So
next
steps,
as
dorothy
was
saying,
and
dr
woodard
we're
working
on
regional
behavioral
health
emergency
operations,
planning
like
dorothy,
was
saying
we're
trying
to
develop
that
website.
M
That's
in
nrs
for
the
boards
to
have
that
shows
that
data
dashboard
and
then
I
think
our
region
is
trying
to
educate
ourselves
about
what
regional
behavioral
health
authorities
would
look
like
really
taking
that
next
step
to
regionalize
mental
health
through
these
boards,
and
that's
because,
with
these
multi-county
arrangements,
we
find
that
we
don't
have
any
central
way
of
applying
for
grants
or
bringing
funding
down
into
the
region.
So
I
think
there's
a
lot
of
benefits
in
looking
in
that
formalization
next
slide.
A
You
so
much,
and
at
this
time
I'm
actually
not
going
to
take
any
questions,
but
I
would
encourage
all
of
my
members.
I
know
that,
prior
to
my
participation
last
session
on
hhs,
I
wasn't
aware
of
all
these
policy
boards
that
exist
in
our
state
and
they
really
are
a
resource
of
things
that
are
happening
regionally
in
your
like
districts.
So
I
would
really
highly
encourage
you
to
reach
out
to
them.
A
You
can
find
the
ones
that
are
appropriate
for
your
area
of
the
state
and
reach
out
to
them
to
see
what
they
are
doing,
because
they
are
really
boots
on
the
ground.
They
have
a
better
idea
of
what's
going
on
locally
and
can
kind
of
give
you
that
information,
especially
if
you're
looking
at
crafting
legislation
in
the
future
in
these
areas.
So
with
that,
I
would
thank
everyone
for
presenting
and
keeping
that
very
brief,
and
I'm
glad
that
we're
able
to
introduce
you
all
to
our
members,
so
thank
you.
A
I'm
gonna
jump
right
into
the
hearings
right
now.
You
know
committee
members
and
members
of
the
public.
This
is
obviously
my
first
time
being
a
chair
of
any
committee
and
I'm
not
a
technology
person,
and
since
my
10
year,
old
son
is
not
here
to
guide
me
through
the
process.
I
really
do
appreciate
everyone's
patience
with
me,
as
I
am
the
first
admit.
I
do
not
know
everything
I
am
not
perfect
and
I'm
always
learning,
and
so
I'm
always
open
to
suggestions
as
we
go
through
this.
A
The
things
that
are
very
important
to
me
are
fairness:
transparency,
equity.
I
think
those
are
key
to
this
process
working
fairly
and
especially
in
this
new
virtual
meeting
format,
and
I
will
do
everything
that
I
can
to
uphold
these
traditional
and
constitutional
values.
So
that's
kind
of
my
commitment
going
into
these
first
hearings.
A
I'm
excited
we
have
two
legislative
measures
being
presented
this
afternoon
and
I
have
allocated
equal
time
and
testimony
in
support
opposition
and
neutral
for
each
bill
after
its
introduction
and
to
be
specific,
each
person
providing
testimony
and
support
or
opposition
will
be
a
maximum
of
two
minutes
and
I'll
have
staff
timing
them
as
well,
just
to
make
sure
that
everyone
is
given
a
fair
opportunity
to
speak
and
we
will
limit
the
overall
presentation
of
testimony
and
support
opposition
and
neutral
to
20
minutes
a
piece.
A
I
don't
actually
anticipate
that
we
will
need
that
kind
of
time,
but
I
do
want
to
set
those
out,
so
we
have
that
all
the
testimony
and
support
and
neutral
will
be
over
the
audio
line
to
ensure
fairness
for
all
the
testifiers
at
this
time,
and
we
anyone
joining
the
meeting
on
camera
is
either
a
committee
member
staff
bill
sponsor
or
presenter
and
certain
staff
from
agencies
to
help
respond
to
any
questions
that
we
may
have
from
committee
members
throughout
this
hearing.
A
But
at
this
time
no
one
is
going
to
be
joining
the
meeting
on
camera
right
now.
I
am
open
to
changing
this
policy
to
make
sure
that
we
are
as
open
and
as
transparent
as
we
possibly
can
to
engage
as
many
of
the
public
members
that
want
to
appear
in
that
new
format
and
I'm
working
with
broadcast
services
as
well
as
all
of
you
to
make
sure
that
we
are
able
to
do
that
fairly.
A
This
bill
relates
to
provisions
related
to
the
nevada,
able
savings
program,
and
hopefully
you
all
have
an
opportunity
to
review
some
of
the
legislation
from
the
2019
session
in
the
links
that
we
provided
to
you
on
monday,
and
with
that
we
have
state
treasurer,
zach,
conan
and
senior
policy
director
eric
kimenez
here
to
introduce
yourselves
and
introduce
their
bill,
and
so
you
guys
can
begin
when
you
are
ready.
N
Thank
you
chairwin
and
members
of
the
committee
for
the
record,
I'm
zach
conan
and
I
have
the
pleasure
of
serving
as
your
nevada
state
treasurer.
I'm
very
excited
to
be
here
today
to
present
assembly
bill
62,
which
helps
to
innovate
and
strengthen
nevada's
able
savings
programs
to
ensure
that
nevadans
with
disabilities
have
the
opportunity
to
save
for
a
better
future.
Broadly
speaking,
able
accounts
are
tax.
Advantaged
savings
accounts
that
allow
people
with
disabilities
to
earn
and
save
money
without
losing
access
to
vital
programs
like
medicaid
and
social
security.
N
By
making
these
tax-free
savings
accounts
available
to
individuals
to
cover
qualified
disability
related
expenses
for
things
like
education,
housing
and
transportation.
The
program
aims
to
ease
the
financial
burden
phased
by
faced
by
citizens
with
disabilities,
who
are
the
most
underemployed
demographic
group
in
the
state.
N
In
the
2019
legislative
session,
our
office
worked
with
assemblywoman
cohen
and
the
division
of
aging
and
disability
services
to
pass
a
b
130
which
moved
the
entire
able
savings
program
into
the
treasurer's
office.
Since
that
time,
our
office
has
worked
with
hundreds
of
nevadans
with
disabilities
and
their
families
to
make
sure
they
can
gain
access
to
these
accounts
without
any
impact
or
cost
to
the
state's
general
fund.
N
The
provisions
of
ab62
would
make
nevada
the
first
state
in
the
country
to
find
innovative
ways
to
incentivize
people
with
disabilities
to
open
these
accounts
and
build
up
account
balances
to
build
their
own
great
big,
beautiful
tomorrow.
I'll
now
pass
it
over
to
eric
jimenez
in
our
office
to
walk
through
the
committee
through
the
specifics
of
the
bill,
and
I'm
happy
to
answer
any
questions
that
the
committee
may
have
before.
I
do
that.
N
O
Eric
thank
you,
mr
treasurer
and
madam
chair
members
of
the
committee,
eric
jimenez
with
the
treasurer's
office
for
the
record.
I
think
it's
important
when
we
talk
about
able
accounts
to
understand
that
the
passage
of
the
able
act
was
the
single
greatest
kind
of
move
towards
disability
independence.
O
Since
the
americans
with
disabilities
act
and
when
we
took
over
the
program
from
aging
and
disability
services
in
2019,
we
had
a
little
over
200
accounts
with
about
a
million
dollars
in
assets.
We've
grown
that
to
over
a
thousand
accounts
with
six
million
dollars
in
assets
all
using
zero
dollars
from
our
state
general
fund.
So
we
do
this.
We
do
this
for
free.
We
do
this
out
of
the
goodness
of
our
hearts,
and
it's
not
in
the
state's
interest
to
make
money
on
these
accounts.
O
We
do
it
so
people
with
disabilities
can
save
and
really
just
get
out
of
bad
situations
and
build
a
brighter
future.
So,
broadly
speaking,
we
have
a
very,
very
simple
bill
in
front
of
you
today
and
I'd
be
remiss
if
I
didn't
thank
carly
o'rent
from
lcb
for
working
with
us
to
kind
of
get
this
really
tight,
and
I
think
it
will
help
a
lot
folks.
O
But
what
this
bill
does?
Is
it
kind
of
modernizes
our
able
accounts
to
after
our
college
kickstart
program,
which
is
something
that
we
do
in
the
treasurer's
office,
which
gives
50
to
every
kindergartener
in
nevada?
So
we
can
kind
of
kick
start
those
savings,
one
of
the
biggest
barriers.
When
I
talk
to
families
about
the
benefits
of
able
accounts,
they
say.
Well,
it's
great.
I
would
love
to
start
saving.
O
You
know
I'd
love
to
start
earning
an
income
without
losing
my
medicaid
and
my
social
security
benefits,
but
I
don't
have
the
startup
capital
to
to
open
a
bank
account.
So
what
we're
thinking
here
is
how
can
we
find
some
innovative
ways
to
pay
for
a
seating
accounts
to
grow
these
accounts
in
a
way
that
makes
it
more
sustainable
for
the
state
going
forward.
O
So
the
idea
here
is
the
bill
would
authorize
our
office
to
promulgate
regulations
that
would
incentivize
the
opening
of
new
accounts
similar
to
how
we
already
do
it
with
college
kickstart
and
then
to
incentivize
regular
deposits
from
existing
account
holders.
So
if
I
have
an
able
account-
and
I
want
to
start
contributing
100
a
month,
how
can
the
state
kind
of
meet
them
halfway
and
start
to
figure
out
how
they
can
match
some
of
those
contributions?
O
All
of
this
we
are
proposing
to
be
funded,
not
out
of
the
general
fund,
no
tax
dollars
for
this
program
and
would
be
done
purely
through
private
philanthropy
and
federal
grant
funding,
and
I
want
to
say
thank
you
to
some
of
the
groups
that
have
already
expressed
interest
in
doing
that,
particularly
the
nevada
bankers.
Association.
They've,
been
a
great
partner
in
making
sure
that
we
get
awareness
about
these
accounts
out
to
the
public
other
than
that.
That's
pretty
much
the
bill
in
a
nutshell
and
I'm
happy
to
take
any
questions
from
the.
A
B
Thank
you
very
much
chair.
I
just
had
a
quick
question,
one
little
bit
of
qual
elaboration
on
what
is
actually
considered
a
qualifying
disability.
O
Thank
you
assemblywoman.
It's
always
good
to
see
you
eric
minis
for
the
record,
I'm
happy
to
go
over
that.
If
you
give
me
a
second,
so
a
qualified
disability
expense
is
any
expense
that
is
occurred
as
a
result
of
living
with
a
disability
and
is
intended
to
improve
someone's
quality
of
life,
and
I
think
it's
important
here
when
the
bill
was
passed
and
signed
by
president
obama.
O
The
idea
was:
how
can
we
make
these
categories
as
flexible
as
possible,
so
we
can
encourage
people
to
save
but
really
allow
them
to
use
these
expenses
for
pretty
much
anything
that
they
would
encounter.
So
those
vary
from
education,
health
and
wellness,
housing,
transportation,
legal
and
professional
fees,
financial
management,
employment
training
and
support,
assistive
technology
and
personal
support
services,
and
I
think,
just
to
kind
of
pop
it
off
assemblywoman.
O
I
get
asked
the
question
when
I
talk
to
families
a
lot
you
know,
could
I
open
an
able
account
and
use
that
money
to
take
a
trip
to
disneyland,
and
I
think
it's
important
that
we're
trying
to
make
a
an
argument
that
says
you
know
if
that
increases
your
quality
of
life-
and
you
know,
gives
you
better
mental
health
or
something
like
that,
then
I
could
make
an
argument
that
that
would
be
an
eligible
expense.
So
the
goal
here
is
to
make
it
as
broad
as
possible.
O
Irritability
for
the
record,
so
there's
a
very
thick
social
security
guidance.
It's
called
the
social
security
blue
blue
book,
but
people
with
significant
different
disabilities
that
occur
prior
to
the
age
of
26
are
eligible
for
an
able
account
in
terms
of
disability
disabilities
that
would
qualify
any
of
your
idd
or
your
intellectual
developmental
disabilities,
autism
down
syndrome,
those
sorts
of
things
as
well
as
we
we
work
with
the
nevada
justice
association
on
this
too,
on
making
sure
that
people
with
mental
health
disorders
also
can
qualify
for
these
accounts.
O
So
our
the
way
we
talk
to
families
is,
if
you
have
a
question,
just
ask,
but
most
disabilities
are
covered
under
the
able
act.
N
N
So
I
guess
I
I
wanted
to
ask
about
the
in
section
one,
your
four
sub
three,
the
methods
and
incentives
to
encourage
contributions
to
saving
trust
account.
And
could
you
tell
us
more
about
what
we
might
expect
to
see
when
we
we
talk
about
incentives.
O
Yes
and
air
committed
for
the
record
assemblywoman,
we
wanted
to
be
very
deliberate
in
this
in
so
far
as
that,
we
don't
know
how
much
money
we'll
be
able
to
bring
in
either
from
federal
grants
or
private
dollars.
We
didn't
want
to
commit
in
statute
to
a
particular
dollar
figure
if
we
couldn't
meet
that
dollar
figure,
so
the
idea
would
be
over
the
next
few
months.
O
Assuming
this
bill
works
its
way
through
the
process,
we
can
go
secure,
some
funding
and
then
outline
what
that
minimum
threshold
would
be-
and
I
think
at
this
point
we're
looking
in
the
realm
of
maybe
50
to
100,
and
we
would
define
that
clearly
through
regulations
that
would
go
through
the
legislative
commission.
O
But
at
this
point
in
time
we
wanted
to
give
us
give
ourselves
the
flexibility
if
that
dollar
number
kind
of
moves
around
a
little
bit.
N
Yes,
go
ahead
thanks
so
much
so
I
guess
then,
should
I
be
expecting
I
I
hear
you
talk
about
a
minimum
amount,
so
we
would.
I
guess
my
assumption,
then,
is
that
the
incentive
would
be
a
cash
incentive
for
opening
account.
Perhaps
something
akin
to
like
the
kick
start
program.
Is
that
what
I
should
hold
as
kind
of
a
frame
of
reference.
O
I
I
think,
that's
exactly
right,
assemblywoman
eric
commanders
for
the
record.
I
also
think
that
you
know
we're
continually
working
through
this
process
and
I
want
to
make
sure
that
we
clarify
in
the
regulations.
Our
able
account
program
is
open
to
anyone
in
the
country
if
they
wanted
to
open
an
account.
I
think
it
would
be
important
just
to
clarify
this
for
the
record
that
nevada
participants
in
the
this
program
would
be
eligible
for
the
incentives.
O
While
I
appreciate
people
from
virginia
and
south
carolina
participating
in
our
program,
I
think
our
goal
here
is
to
try
to
help
as
many
nevadans
as
we
can.
A
Thank
you
and
do
we
have
any
other
questions
here?
I
didn't
get
any
other
messages.
I
I
just
have
one
comment,
or
maybe
you
can
highlight
it.
I
know
that
you
had
when
we
had
spoke
about
this
bill.
You
had
talked
about
how
this
isn't
been
enacted
anywhere
else,
so
this
would
kind
of
be
a
unique,
innovative
program
that
other
people
around
the
country
would
be
looking
at
nevada
as
like
a
model
in
this
area.
Can
you
speak
on
that
yeah.
O
Thank
you,
madam
chair
comments,
for
the
record.
I
think
this
point
is
why
we
wanted
to
bring
this
bill
forward
to
to
get.
You
know
make
it
abundantly
clear
that
the
legislative
intent
was
kind
of
to
move
forward
with
a
program
like
this.
We
would
be
the
first
program
in
the
country
to
do
something
like
this,
assuming
we're
able
to
secure
funding
and
we're
part
of
an
alliance
of
states
that
administer
able
accounts
about
20
of
them,
there's
about
45
nationally
that
administer
them.
I
talk
to
most
of
them
on
a
monthly
basis.
O
I
would
say
that
the
state
of
california,
the
state
of
oregon,
are
anxiously
watching
this
bill
to
see
if
we're
there's
we're
successful
and
they
would
love
to
replicate
that.
Additionally,
we've
been
in
some
conversations
with
the
senate
committee
on
aging,
the
u.s
senate
committee
on
aging
and
the
the
chairman
there
from
pennsylvania,
and
they
are
also
watching
this
to
see.
If
there's,
if
it's
successful,
they
could
replicate
this
on
a
federal
level
to
do
some
sort
of
block
grant
into
able
accounts
to
to
make
sure
that
we
incentivize
that
growth.
A
Thank
you
so
much
and
I
don't
see
any
other
questions
from
members.
I'm
looking
here,
I'm
looking
here.
Nope,
I
don't
see
anything.
Oh
did
someone
say
something.
N
It's
a
someone
with
adidas
thompson.
I
just
did
have
a
follow-up
kind
of
on
the
endowment
and
distribution
part,
but
I
didn't
want
to
ask
like
three
questions
in
a
row,
so
I
I
thought
I'd
take
a
pause.
It's
okay
assembly
go
ahead
thanks,
so
much
so
because
I
I
do
see
here
that
that
you're
gonna
develop
the
methods
and
incentives
to
encourage
contributions
to
the
saving
trust
fund
trust
accounts,
but
that
there's
also
going
to
be
development
piece.
N
O
Assemblywoman,
that's
a
great
question
and
I
don't
think
we're
all
the
way
there
yet,
but
I
think
conceptually
we
wanted
to
figure
out
a
way
that
we
could
find
a
dollar
figure
that
works
for
either
the
initial
contribution
or
the
matching
contribution.
I
think
it
gets
really
hard,
not
using
general
fund
dollars
to
to
do
an
exact
penny
for
penny
match.
O
The
intention
here
would
be
to
make
that
contribution
go
directly
into
the
able
account
so
there's
not
two
separate
accounts
that
are
more
they're
going
to
create
more
friction
in
the
savings.
So
this
the
the
seed
money
would
be
earning
interest
and
then
would
be
able
to
be
used
and
saved
by
the
individual.
C
A
C
And
thank
you
for
for
bringing
this
bill
out.
It
was
always
it
was
an
exciting
hearing
in
2019
when
this
bill
was
presented,
and
one
of
the
things
that
I
thought
was
possible
here
is
that
the
individual
could
contribute
to
the
savings
account
themselves,
and
we
heard
testimony
if
I
remember
correctly
from
folks
that
may
have
had
a
small
little
business
that
they
had
selling
popcorn,
for
example,
and
if
they
earn
some
money,
then
that
wouldn't
be
account
counted
against
them
when
it
comes
to
support
for
some
of
the
social
services
that
they
needed.
O
That
is
100
percent,
accurate,
assemblywoman,
titus,
erica
venice,
for
the
record.
Individuals
with
these
accounts
can
save
up
to
15
000
a
year
without
losing
access
to
mean
tested
benefits.
So
we're
talking
about
food
assistance,
programs,
medicaid,
ssi
and
ssdi.
O
If
you're
working
so
the
individual
with
a
popcorn
company
whose
name
is
jack,
you
can
go
to
jackspopcorncompany.com
or
stop
by
assemblywoman
cohen's
office.
I
know
she's
always
got
a
stash.
Handy
jack
can
save
an
additional
12
000
into
his
account.
So
the
real
kind
of
benefit
is
to
how
we
can
get
people
with
disabilities
to
start
saving,
but
also
to
start
working.
So
they
can
live
independently
and
27.
000
a
year
is
really
really
beneficial
and
can
get
someone
out
of
poverty.
C
Right,
thank
you.
That's
what
I
really
thought
that
was
the
thing
that
I
was
most
impressed
with
this
program
and
I'm
so
supportive
of
it,
because
it
was
really
enabling
for
them
to
get
a
business
going
and
while
they're
doing
that
not
not
have
any
fear
that
they
would
be
kicked
off
the
welfare
system
or
the
healthcare
things
that
they
needed
so
desperately.
So
thank
you
for
that
clarification
and
thank
you
for
bringing
this
forward
and
that's
you
know
making
it
successful.
Thank
you.
A
I
don't
see
any
more
so
at
this
time
we
will
hear
testimony
in
support
opposition
and
neutral
again
to
provide
testimony.
You
must
register
online
at
the
legislative
website,
and
registrants
will
receive
a
phone
number
meeting
id
and
instructions
to
join
the
meeting.
A
L
L
L
A
B
Oops,
my
apologies,
madam
chair,
can
you
hear
me
I
can
hear
you.
B
Sorry
about
that
chairwind
members
of
the
committee,
my
name
is
connor
kane,
I'm
c-o-n-n-o-r-c-a-I-n,
testifying
on
behalf
of
the
nevada
bankers,
association
in
support
of
ab62
and
still
learning
how
to
testify
remotely
this
session.
I
I'd
like
to
first
say
that
that
the
nevada
bankers
association
knows
the
importance
of
saving.
It
has
supported
a
number
of
banking
and
savings
opportunities
for
nevadans.
B
We're
excited
to
support
nevada's
able
program,
as
it
makes
sure
that
a
person
living
with
a
disability
isn't
penalized
because
they're
saving.
We
think
the
proposed
changes
outlined
in
ab62
provide
even
greater
assistance
for
some
of
these
savings.
Savings
accounts
we're
very
proud
of
of
treasurer
conan
and
the
mr
jimenez
for
being
leaders
in
this
in
this
space,
not
only
in
our
state
but
as
you've
heard
influencing
policy
around
the
country
and
last
but
not
least,
treasurer
conan
touched
on
this.
B
But
we
we'd
like
to
recognize
him
and-
and
mr
jimenez
they've
worked
tirelessly
throughout
throughout
this
pandemic,
to
help
help
countless
nevadans
they've
been
answering
phone
calls
and
emails
late
at
night
and
working
on
the
weekends
and
on
holidays,
and
they
were
still
still
able
to
bring
bring
forward.
Impactful
policy
changes
such
as
the
one
for
you
today.
B
We
very
much
appreciate
them
and
everything
they
do
for
nevada
and
are
grateful
for
this
opportunity
to
testify.
We,
we
encourage
your
support,
baby
62..
Thank.
E
P
A
L
A
L
J
A
Thank
you,
and
just
for
the
record,
we
started
at
3
20
in
I
again
allocated
20
minutes
for
testimony.
Obviously
we
did
not
need
that
it
is
620
or
326,
and
we
concluded
that
I
would
open
it
up
for
any
opposition
testimony
at
this
time.
Broadcast
services.
Is
there
anyone
online
for
opposition
testimony.
A
N
Treasurer
conan
for
the
record.
I
do
hate
to
do
this
professionally,
but
we'll
wave
them
in
interest
of
time.
Thank
you
all
for
what
thank
you.
A
C
Thank
you,
madam
chair,
and
thank
you
for
to
the
members
of
this
committee
for
the
record.
I
am
assemblywoman
robin
titus.
I
represent
assembly
district
38,
which
encompasses
churchill,
county
and
parts
of
lyon
county,
I'm
introducing
assembly
joint
resolution,
one
which
proposes
to
amend
the
nevada
constitution.
C
This
resolution
is
straightforward.
It
changes
four
words
in
the
nevada
constitution.
Some
may
wonder:
why
do
we
need
to
change
the
constitution
to
address
four
words?
Well,
let
me
tell
you
what
these
four
words
are
insane
blind,
deaf
and
dumb.
These
words
are
found
in
section
1,
article
13
of
our
constitution.
C
The
section
requires
the
state
to
care
for
certain
populations
with
disabilities
who
suffer
from
a
mental
illness.
The
whole
section
reads
like
this
section
one-
and
this
is
an
article
13
institutions
for
insane
blind,
deaf
and
dumb
to
be
fostered
and
supported
by
state
institutions
for
the
benefit
of
the
same
blind,
deaf
and
dumb,
and
such
other
benevolent
institutions,
as
a
public
good
may
require,
shall
be
fostered
and
supported
by
the
state
subject
to
such
regulations,
as
may
be
described
by
law.
C
I'm
aware
that
when
the
nevada
constitution
was
written,
different
terminologies
were
used
to
describe
persons
with
disabilities
or
a
mental
illness.
However,
more
than
156
years
after
nevada
was
admitted
to
the
union,
it's
time
to
give
these
words
a
more
critical
look.
We
should
change
them
to
contemporary
language.
This
is
not
deemed
to
be
discriminatory
or
narrow.
C
The
idea
to
change
this
language
for
in
our
constitution
came
from
one
of
my
constituents,
mr
andrew
campbell,
who
hopefully
will
be
joining
me
later
for
this
bill
introduction.
He
works
in
the
churchill
county
middle
school
as
a
special
education
teacher.
Most
of
his
students
have
severe
or
some
profound
disabilities.
Mr
kem
also
teaches
american
sign
language
in
an
after-school
program
and
he's
very
much
aware
of
the
needs
of
persons
who
are
deaf
or
hard
of
hearing.
He
describes
them
as
smart,
dedicated
people
in
our
society
who
work
in
banks,
teachers
or
engineers.
C
C
Let
me
explain
a
little
bit
more
about
the
the
details
of
my
amendments.
First,
I
want
the
new
terms
to
start
with
persons.
We
must
stop
categorizing
people
who
suffer
from
an
illness
or
disability
by
putting
an
emphasis
on
their
illness
or
disability,
for
example
the
blind
or
the
deaf.
Instead,
these
are
individuals
that
happen
to
have
an
illness
or
disability,
but
first
and
foremost
they
are
persons.
C
Second
client
persons
who
have
a
hearing
loss
dumb
in
our
constitution
is
plain
offensive.
This
term
must
go
additionally,
many
people
in
our
society
are
not
completely.
Deaf
may
suffer
from
different
degrees
of
hearing
loss
definition.
The
constitution
is
too
narrow
and
therefore
I
think
it
should
be
persons
who
are
deaf
or
hard
of
hearing
insane
is
another
one
of
those
derogatory
terms
that
I
recommend
replacing.
C
We
know
that
words
matter
and
when
you
stigmatize
individuals
with
such
a
term,
it
may
lead
to
negative
results.
In
the
long
run,
research
has
shown
that
stigmatizing
persons
with
a
significant
mental
illness
may
create
barriers
for
them.
They
may
face
discrimination
and
prejudice
when
renting
homes
applying
for
jobs
or
accessing
mental
health
services.
C
Stigmatized
people
also
are
less
likely
to
seek
help
the
help
they
need
to
treat
their
condition,
which
may
be
which
might
make
the
condition
worse
using
the
term
insane
in
our
constitution.
For
people
who
suffer
from
mental
illness
helps
to
perpetuate
the
stigma.
Therefore,
it
should
be
replaced
with
a
more
dignified
term.
Persons
with
a
significant
mental
illness
blind
is
not
necessarily
discriminating
term,
but
I
think
it's
too
narrow.
If
a
person
is
blind,
he
he
or
she
may
suffer
a
complete
or
nearly
complete
vision
loss.
C
However,
this
term
does
not
include
any
person
who
have
visual
impairment
that
causes
difficulties
with
more
normal
daily
activities,
which
cannot
be
fixed
by
simply
wearing
glasses
or
contact
lenses.
Persons
with
visual
impairments
may
not
be
able
to
walk
or
read
without
adaptive,
training
or
the
use
of
assistive
technology.
Contemporary
training
and
assistive
technology
programs
are
for
all
people
who
have
some
kind
of
visual
impairment.
Therefore,
this
language
should
be
updated
as
well,
and
I
propose
that
terms,
persons
who
are
blind
or
visually
impaired.
C
In
closing,
I
believe
we
need
to
do
a
better
job
in
making
sure
that
we
do
not
discriminate
and
stigmatize
persons
with
disabilities
or
mental
illness
in
our
laws,
and
the
first
step
is
to
ensure
no
discrimination,
stigmatizing
or
derogatory
language
is
in
our
nevada
constitution
and
ajr1
will
provide.
For
that.
Please
keep
in
mind.
This
resolution
is
just
a
first
step.
It
will
not
apply
to
nrs.
For
example,
if
you
do
a
simple
search
in
our
law
on
our
library
on
the
legislative
website,
you
can
find
67
hits
in
the
with
the
term
insane.
C
C
I
might
add,
madam
chair,
that
there
has
been
an
amendment
that
hopefully
a
friendly
amendment
that
hopefully
your
members
have
a
copy
of
the
members
of
this
committee.
If
not
I'm
going
to
go
ahead
and
read
it
and
then
we'll
make
sure
everybody
gets
a
copy
of
this
because
from
dana
schmidt,
who's,
administrator
of
our
department
of
health
and
human
services,
aging
and
disability
division,
she
recommended-
and
I
actually
agree
with
this,
so
the
new
section
one
would
read:
institutions
for
the
benefit
of
persons
with
a
significant
mental
illness.
C
C
I
also
might
add
that
a
number
of
members
of
this
body
on
both
sides
of
both
the
senate
and
the
assembly
have
asked
to
be
joint
sponsors
with
me,
and
if
anybody
wants
to
also
be
on
this
bill,
I
would
welcome
everybody's
name
on
this
bill
as
co-sponsors.
C
This
was
a
pre-filed
bill
for
me,
so
I
put
it
in
on
my
own,
but
I
think
this
is
something
we
all
should
embrace,
and
so
I
appreciate
all
of
your
time
and
I'm
going
to
turn
it
over
to
mr
campbell
for
some
remarks
if
we
have
been
able
to
get
him
on
and
if
not
I'll
I'll
take
it
back.
Thank
you,
madam
chair.
A
I
see
mr
campbell
there
and
just
for
the
members
at
vacation.
A
I
believe
that
gail
has
uploaded
that
friendly
amendment
on
to
nellis,
so
you
would
be
able
to
do
that
and
if
you
are
interested
in
having
since
there
will
be
an
amendment
potentially
if
this
bill
goes
forward
to
a
work
session
reach
out
to
assemblywoman
titus.
If
you
would
like
to
be
added
on
to
that
as
a
sponsor,
and
with
that
I
will
turn
this
over
to
mr
campbell.
Is
that
correct?
I
see
you
there.
I
Thank
you,
assemblywoman
titus,
for
initiating
this
process.
It's
one
close
to
my
heart
for
a
few
of
the
reasons.
I
So,
thank
you,
and
this
matter
is
close
to
my
heart.
I
moved
to
the
state
of
nevada
and
I'm
here
testifying
today.
As
a
citizen
of
the
state
of
nevada
and
resident
of
turkey
county,
I
have
personally
experienced
total
deafness.
In
one
year
I've
had
my
hearing
stored.
I've
had
total
temporary
blindness
also,
I
know
what
it's
like
to
live
with
that
and
it's
a
challenge
so
the
fact
that
you're
all
attentive
to
this
matter,
not
only
for
myself
but
so
many
members
of
our
community
and
their
own
families.
I.
A
Thank
you
so
much.
I
don't
see
any
here
in
the
chat,
but
I'm
just
going
to
go
to
gallery
view
and
if
you
have
a
question,
if
you
could
just
wave
or
if
you
have
a
comment,
we
can
take
those
at
this
time.
N
So
much
I
appreciate
that
so,
of
course,
love
the
bill.
Love
the
language
love
the
intent.
You
know,
I
don't
often
talk
about
it,
but
I
was
diagnosed
with
my
hearing
loss
at
30
and
told
that
I
would
you
know,
be
deaf
within
20
years,
and
I
continue
along
on
that
progress.
So
I
am
one
who
definitely
does
not
like
these
types
of
adjectives
to
be
applied
to
me
unless
I've
really
earned
them
in
certain
instances.
N
So
I
appreciate
this
I'm
wondering
about
the
conforming
language
that
where
you
talked
about
a
change
in
statute,
so
this
is
a
change
to
the
constitution
and
it
will
take
some
time-
and
I
guess
I'm
wondering
once
we
have
if
we
have
a
successful
constitutional
change
at
that
time.
Is
that
the
time
where
we
would
look
at
nrs
for
the
conforming
language
to
make
sure
we're
lining
up
with
our
statutes?
N
C
Great
question:
I
I
think
I'd
like
to
turn
it
over
to
our
legal
council
to
answer
that
question,
because
the
process
for
this-
and
I
think
all
the
members
probably
recognize
the
process
that
the
change
in
this
that's.
Why
I'm
open
to
suggestions
on
getting
the
word
incorrect
because
whatever
the
wording
is,
has
to
be
matched
next
session
and
pass
again
and
then
it
has
to
go
to
a
vote
change
your
constitution.
C
So
it's
so
critical
that
we
try
to
get
as
right
as
we
can
and
then
I
know,
there's
been
sessions
in
the
past.
I
think
2011
and
maybe
mr
campbell
can
look
into
that
because
I
know
there's
been
some
in
the
sessions
in
the
past
where
we
changed.
Some
of
that
word
regarding
insane
and
we've
changed
definitions,
but
we
haven't
gone
through
the
whole
nrs
and
then
retrospectively
changed
all
that
wording
and
that
would
take
a
different
bill.
That's
certainly
you
know
that.
Then.
A
So
craig,
are
you
on
the
line?
Do
you
have
yes,
I'm
here?
Oh
wonderful,
do
you
think
you
can
answer
assemblywoman
titus's
concerns,
or
would
you
need
some
additional
time
to
look
at
that
up.
F
I
think
I
can
make
concerns
now.
So
typically,
if
we're
making
a
change
like
this
in
a
bill,
we
would
include
something
that
would
authorize
us
to
make
the
additional
changes
in
nrs.
D
A
I
see
in
the
chat
that
we
have
assemblyman
hayden
said
that
he
would
like
to
be
considered
as
a
co-sponsor
as
you're
going
through
the
potential
amendment
process.
I
would
like
to
be
included
in
that
as
well.
If
you
do
end
up
doing
that
and
I've
you
know
like,
I
said
all
the
members
that
are
on
here.
If
you
are
interested,
I
would
encourage
you
to
also
reach
out
to
assemblywoman
titus,
as
if
you
want
to
be
included
in
that
as
well.
So
I
see
assemblywoman
gorlo
on
there
as
well
in
the
chat.
B
A
Other
questions,
though,
for
assemblywoman
titus
or
mr
campbell:
okay,
wonderful,
then,
with
that
I
will,
we
will
go
to
hear
testimony
and
support
opposition
and
neutral
on
ajr
one,
and
we
will
start
with
testimony
in
support.
So
I
know
again,
we
have
a
little
bit
of
a
lag
time
between
on
this,
so
if
we
can
be
a
little
patient
while
broadcast
services
sees
if
we're
ready
to
go
on
support
testimony
first.
P
B
A
Thank
you
and
broadcast
services.
We
go
to
the
next
caller.
P
E
L-I-Z-D-A-V-E-N-P-O-R-T,
the
legal
legislative
extern
with
the
aclu
of
nevada,
as
this
bill
removes
derogatory
and
offensive
language
and
provides
modernization
to
the
nevada
constitution.
We
support
aj
r1
legal
terms
must
be
updated
so
that
they
foster
respect
for
people
much
too
often,
derogatory
terms
have
been
in
to
foster
incorrect,
negative
social
stigmas.
E
The
united
states
congress
recognized
this
over
10
years
ago
and
in
2010
and
2012
removed
similar
derogatory
terms
such
as
lunatic
and
mental
retardation
from
the
u.s
code.
Similarly,
as
this
bill
removes
derogatory
and
offensive
terms
for
the
nevada
constitution,
we
support
ajr1.
Thank
you
for
your.
A
P
B
Good
afternoon
this
is
john
pirro
j-o-h-n-p-I-r-o
on
behalf
of
the
clark
county
public
defender's
office
and
the
washoe
county
public
defender's
office
as
lawyers.
We
understand
that
language
is
important
and
the
language
that
dr
titus
is
seeking
to
change
in
this
bill
is
stigmatizing
and
detrimental
to
people
in
our
state.
We
thank
dr
titus
for
bringing
this
legislation
forward
and
we
echo
the
statements
of
the
aclu.
P
P
B
B
B
L
And
here
is
our
second
testimony
hi.
My
name
is
alexis
jones
alexis,
a
l
e
x.
I
s
jones
j,
o
s.
I
am
13
years
old
and
I
am
from
henderson
nevada.
I
am
representing
myself
in
support
of
ajr1.
I
have
severe
to
profound
hearing
loss
in
both
ears
and
rare
hearing
aids.
The
term
in
them
should
not
be
applied
to
deaf
and
hard
of
hearing
people
because
we
are
like
everyone
else.
I've
been
in
national
junior
honor
society
for
two
years.
L
I
have
gotten
straight
a's
in
all
of
my
honors
classes,
for
all
my
years
of
middle
school.
So
far
in
elementary
school,
I
won
gold
medals
in
the
science
olympiads.
I
was
a
tour
guide
for
the
macaw
student
school
of
mines
and
continually
in
the
honor
roll.
I
testified
for
a
different
bill
two
years
ago,
when
I
was
11
regarding
deaf
and
hard
of
hearing
kids
and
I
signed
with
assembly
women
titus
two
years
ago,
when
my
family
attended
children's
day
at
the
legislation.
L
I
was
in
girl
scouts
for
five
years
and
have
been
in
the
in
the
media.
Pr
team
and
I've
served
my
community
on
top
of
that.
I
have
been
playing
soccer
for
over
10
years.
When
I
am
older,
my
goal
is
to
be
on
the
us
women's
national
deaf
soccer
team.
I
am
an
avid
reader
and
can
read
over
a
thousand
words
per
minute.
L
I
have
also
been
a
part
of
a
theater
group
for
deaf
and
hard
of
hearing
children
for
over
six
years
I
applied
to
a
magnet
high
school
and
will
be
finding
out
if
I
got
accepted
next
month.
I
can
do
many,
if
not
all
things
that
hearing
children
can
do
so.
The
term
deaf
and
dumb
is
not
applicable
in
this
situation
anymore.
Not
that
I
was
right
to
call
deaf
and
hard
of
hearing
people
that
term
in
the
first
place.
L
I
am
proud
to
be
hard
of
hearing
and
in
the
deaf
community
and
to
be
here
testifying
to
update
disability
friendly
language
while
being
hard
of
hearing
hasn't
set
facts.
It
has
lots
of
advantages
too.
If
I
had
a
choice
to
have
normal
hearing,
I
wouldn't
take
it.
Having
hearing
loss
is
what
made
me
the
person
I
am
today
and
I
wouldn't
change
that
for
the
world.
Thank
you
to
assemblywoman
titus
for
sponsoring
this
amendment
and
for
allowing
me
an
opportunity
to
speak
and
have
a
great
afternoon.
A
P
P
E
E
E
The
united
states
supreme
court
upheld
compulsory
sterilization
laws
for
those
with
intellectual
disabilities
and
bucksy
bell.
The
court
held
that
persons
with
disabilities
do
not
have
a
fundamental
right
to
make
private
decisions
regarding
their
family
lives
in
delivering
the
decision.
Justice
holmes
declared
that
three
generations
of
imbeciles
is
enough.
E
P
Chair
we
just
had
some
other
people
jump
on
as
well
to
testify
in
support
of
ajr1.
Please
press
star
nine
now
to
take
your
place
in
the
queue.
P
E
My
name
is
jamie
stetson.
I
work
for
renovation,
mental
health
services.
I
also
work
for
nevada
at
coin
assisted
therapy,
and
I
also
work
with
victorious
care,
which
is
an
src
sla
provider
across
the
board.
I
work
for
several
several
different
kinds
of
people
who
have
different
kinds
of
disabilities,
and
I
also
have
children
who
are
on
the
autism
spectrum
this
bill
and
changing
the
language
throughout
our
revised
statutes
is
so
important
to
legitimizing
and
to
taking
away
the
stigma
for
people
with
disabilities
in
our
community.
E
E
We
have
a
significant
lack
of
ability
to
access
resources
in
our
community
and
having
this
kind
of
language
still
be
in
our
revised
statutes,
and
this
kind
of
language
still
being
used
across
the
board
in
our
state.
It's
shameful
and
it's
something
that
needs
to
be
taken
care
of,
and
I'm
really
really
grateful
to
see
that
something
is
being
done
about
it.
E
E
A
Okay,
can
we
open
up
to
see
if
there's
any
callers
in
opposition.
P
P
A
E
G
A
Almost
the
whole
whole
meeting
without
doing
that
anyway,
I
would
assemblywoman
titus
or
mr
campbell.
Do
you
have
any
closing
remarks
at
this
time?.
C
Well,
I
would
just
like
to
say
thank
you
all,
as
I
put
in
the
chat.
I've
never
cried
during
a
testimony
before
so
I
actually
shed
a
tear
with
that
one.
I
didn't
realize
I
would
get
emotional
about
it.
I
was
a
little
surprised
at
myself,
so
thank
you
for
hearing
hearing
this
bill.
I
appreciate
it
as
you
can
hear
from
the
testimony
how
important
it
is.
C
I
thank
all
members
have
reached
out
and
I
will
put
your
names
on
and
when
you
hear
this
bill
again,
hopefully
in
a
work
session,
we'll
add
those
amendments,
and
so
I
just
want
to
thank
you.
I
want
to
get
it
right,
so
if
there's
other
suggestions,
I'm
open
to
them,
as
you
know,
as
you
can
hear,
we
need
to.
We
need
to
fix
this.
So
thank
you
for
all
your
time.
A
Thank
you
so
much
for
your
presentation
and
I
would
encourage
members
to
reach
out
to
assemblywoman
titus
as
she's
working
through
this
and
preparing
it
for
any
potential
work
session
in
the
future.
You
know,
anytime,
we
have
those
constitutional
changes.
We
want
to
make
sure
we
get
it
right,
otherwise
it
just
blows
up
the
process
of
any
kind
of
change
on
these
issues,
and
with
that
I
will
close
hit
the
hearing
on
ajr
one
and
at
this
time
I'm
I'm
gonna
ask
do
we
have
any
people
on
the
line
for
public
comment.
A
So
at
this
time
I
will
remind
the
callers
on
that
are
in
the
queue
that
this
is
public
comment,
so
try
to
again
state
your
name
and
spell
your
name
clearly
and
limit
your
comments
to
hopefully
things
that
are
not
about
the
bill,
but
about
other
areas
of
public
comment
and
with
that
we'll
go
to
that
caller.
P
L
E
Madam
chair,
this
is
nicole
willis
grimes
with
the
ferraro
group.
N-I-C-O-L-E
last
name
is
willis
grimes
w-I-l-l-I-s
hyphen
g-r-I-m-e-s,
and
I
do
apologize
to
the
chair
and
the
members
of
the
committee.
I
could
not
get
my
fingers
typing
fast
enough
to
dial
in
and
support
for
ab-62,
and
I
recognize
sherwin
that
you
would
prefer
for
a
public
comment
to
focus
on
issues
other
than
the
bill,
but
I
appreciate
your
the
opportunity
to
be
able
to
just
very
quickly
voice.
E
Our
support
on
behalf
of
special
olympics
of
nevada,
special
olympics
of
nevada
is
dedicated
to
enriching
lives
of
children
and
adults
with
intellectual.
A
A
Thank
you.
I
know
that
we're
trying
to
be
flexible
as
possible.
Sometimes
it's
a
little
bit
more
difficult
when
we're
in
this
virtual
and
telephonic
world,
so
yeah,
so
that
that's
fine
do
do.
We
have
any
comments
from
the
members
before
we
adjourn.
P
L
Good
afternoon
this
is
dorado
martinez
again,
I
was
gonna,
do
the
support,
but
I
wasn't
fast
enough.
I
love
these
zoom
meetings.
If
I
can
cook
and
talk
at
the
same
time,
I
really
appreciate
you,
dr
titus,
for
recognizing
I'm
sorry
and
mr
andrew
campbell
for
bringing
that
forward.
I
mean,
after
30
years
of
the
ada,
passing
I'm
glad
that
we
are
on
the
right
path.
L
P
The
line,
let
me
check
just
in
case
if
you
would
like
to
participate
in
public
comment,
please
press
star
nine
now
to
take
your
place
in
the
queue.
A
Well,
I
want
to
thank
you
guys,
all
for
being
so
patient.
I
know
that
I
packed
a
lot
in
on
this
meeting,
but
I
will
say
that
this
does
conclude
our
meeting
for
today
and
our
next
meeting
is
not
scheduled
until
monday
february
15th
at
1
30
pm.
A
So
all
this
hard
work
on
this
wednesday
afternoon
will
pay
off
that.
You
won't
have
to
come
here
on
friday
afternoon.
So
with
that
the
meeting
is
adjourned.