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From YouTube: 2/9/2021 - Senate Committee on Health and Human Services
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For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
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A
Thank
you,
I'm
going
to
go
ahead
and
call
to
order
the
february
9th
meeting
of
the
senate
committee
on
health
and
human
services
at
3,
30,
4
p.m.
A
If
you
found
us
here,
you
probably
know
that
all
the
committees
are
on
nellis,
which
is
the
nevada
electronic
legislative
information
system
which
is
accessible
from
the
legislative
website.
If
you,
google,
nevada
legislature
and
you
get
onto
the
website,
there's
a
banner
on
every
page
that
has
a
help
link
and
if
you
click
on
that
help
link,
it
will
tell
you
all
the
ways
that
you
can
participate.
I
want
to
remind
everybody
that
there
are
there's
an
opinion
poll
function.
So
if
you
just
want
to,
let
us
know
how
you
feel
about
a
bill.
A
You
can
go
to
that
opinion
poll.
Put
the
bill
number
in
and
tell
us
how
you
feel,
or
you
can
register
in
a
committee
meeting
when
a
bill
is
up
for
a
hearing
to
testify
on
that
bill.
In
that
case,
you'll
want
to
know
if
you're,
testifying
in
support
opposition
or
neutral
and
listen
to
the
prompts
from
the
bps
staff,
who
will
tell
you
when
to
chime
in
you'll,
be
waiting
in
a
phone
cue.
A
I
do
want
to
note
there
that
we
may
not
always
be
able
to
get
to
everybody
who's
waiting
to
testify,
and
so,
if
you're
on
the
phone
line
and
waiting-
and
you
don't
don't
make
it
through,
you
can
also
email
your
testimony
to
the
address
that
is
listed
on
the
agenda
for
the
committee,
and
you
can
always
do
that.
No
need
to
necessarily
speak.
Your
information
will
be
shared
on
the
record.
All
of
the
senators
on
this
committee
are
well
aware
of
where
they
can
go
to
read
the
public.
Testimony
that's
attached
to
the
bill.
A
You'll
get
the
results
of
the
opinion
poll
and,
of
course,
we'll
be
listening
to
you
here
today.
So
just
want
the
public
to
feel
confident
that
in
any
of
the
ways
that
you
choose
to
participate,
every
member
of
this
committee
knows
how
to
get
access
to
that
information
and
is
committed
to
doing
so.
So
we
will
get
your
input.
We've
received
a
significant
amount
of
written
input
on
the
bills
before
us
today,
and
so
they
are
posted
that
input
that
we
received
in
time
for
this
committee
is
posted
on
nellis.
A
So
with
that
just
a
little
bit
of
housekeeping
meeting
exhibits
and
amendments
should
usually
be
submitted
whenever
possible,
24
hours,
sorry
48
hours
in
advance,
so
that
we
can
facilitate
the
public's
participation
and
folks
can
see
the
information
as
far
in
advance
as
possible.
So
with
that,
I'm
going
to
now
open
the
hearing
on
senate
bill
69.
A
We
have
a
number
of
presenters
here
for
this
bill
today,
and
I
did
just
want
to
briefly
introduce
that
this
is
the
bill
that
is
being
brought
forward
by
the
washoe
regional
behavioral
health
policy
board,
and
I
did
want
to
know
for
the
members,
in
all
transparency,
that
I
am
a
member
of
that
board
and
chair
that
board.
But
the
staff
member
who
supports
the
washoe
behavioral
health
board
will
be
leading
the
presentation
today
and
I'm
going
to
go
ahead
and
turn
it
over
to
dorothy
edwards
to
kick
off
the
presentation.
B
Okay,
good
afternoon,
cher,
ratty
and
members
of
the
committee
I'll
ask
your
forgiveness
for
not
having
great
eye
contact.
As
I
look
to
my
right
for
my
notes,
so
I
am
dorothy
edwards
as
I
was
introduced
and
I
serve
as
the
washoe
regional
behavioral
health
coordinator.
B
B
Board
composition
includes
a
diverse
representation
of
regional
experts
in
all
fields
of
behavioral
health,
subsequent
legislation
in
the
80th
legislative
session
added
a
fifth
regional
board
to
nrs
433,
which
also
outlines
membership
criteria
and
board
obligations
through
our
advocacy
for
washoe
county.
We
strive
to
increase
awareness
and
understanding
of
mental
health
and
substance,
misuse
across
all
populations,
promote
emotional
health
and
wellness,
address
prevention
and
treatment
of
substance,
misuse
and
mental
illness
work
to
ensure
adequate
and
equitable
access
to
effective
treatment
and
support
recovery.
B
We're
committed
to
working
with
state
county
and
local
stakeholders
to
address
training
data,
diversity
of
services
and
fiscal
issues
as
they
relate
to
behavioral
health.
One
method
to
affect
change
in
regional
behavioral
health
is
the
unique
opportunity
that
the
policy
boards
are
afforded
to
develop
and
present
a
bill
draft
request
each
legislative
session,
each
biennium.
The
board
works
on
establishing
priorities
and
opportunities
for
support
within
the
behavioral
health
community
through
review
and
analysis
of
behavioral
health
data
collaboration
and
outreach
with
state
county
and
regional
behavior
health
partners
and
a
review
of
existing
behavior
health
legislation.
B
Board
members
considered
subjects
or
areas
that
might
require
or
benefit
from
policy
development,
revision
and
or
enhancement
in
the
field
of
behavioral
health.
The
washout
policy
board
was
pleased
that
their
bill
ab-66
from
the
80th
legislative
session,
was
passed
and
have
continued
to
support
and
explore
ongoing
regional
efforts
in
the
area
of
crisis
stabilization.
B
However,
in
this
past
biennium
we
were
also
presented
opportunities
for
the
board
to
focus
on
substance
misuse
and
its
impact
on
our
community.
A
review
of
national
and
state
surveys.
Reports,
meetings
with
substance
use,
treatment
and
prevention
organizations
revealed
that
nevada
continues
to
experience
significant
issues
with
substance
misuse.
B
According
to
the
national
drug
helpline,
nevada
was
placed
on
red
alert
in
november
2020
for
an
increased
risk
of
death
from
overdose
data
in
the
electronic
death
registry
system
in
nevada
shows,
there
has
been
a
50
percent
increase
in
opioid
and
fentanyl
involved.
Drug
overdose
dose
deaths
from
the
first
to
the
second
quarter
of
2020..
B
B
B
B
A
Please
do,
and
I
also
wanted
to
point
out
for
the
committee
that
there
are
a
number
of
one-page
summaries
that
are
the
exhibits
that
go
along
with
this
bill
that
might
provide
you
some
helpful
summary
information
on
each
of
the
bill.
Components
go
ahead,
sean.
C
C
We
are
nevada,
statewide
recovery,
community
organization
and
charitable
nonprofit
governed
and
led
by
people
in
recovery
from
substance
use
disorders.
I
will
be
introducing
sb69
in
our
support
of
the
bill
with
amendments
for
the
required
certification
of
peer
recovery
support
specialists
and
supervisors
in
nevada.
C
C
Many
of
us
feel
compelled
to
do
this
work
almost
as
an
obligation
to
reach
out
and
help
the
next
person
who
is
struggling
every
day.
I
witness
hope
and
transformation
as
people
seeking
assistance
connect
with
others
in
recovery
who
share
similar
life
experiences,
as
you
would
heard,
from
dorothy
edwards,
there
is
a
substantial
gap
between
those
who
need
services
and
those
who
receive
them.
C
The
peer
recovery
support
specialists
use
their
lived
experience
and
training
to
connect
people
with
resources
act
as
a
mentor
and
model
recovery,
behavior,
build
relationships
and
help
participants
set
goals
and
build
recovery
plans
peer
recovery
support
specialists
are
utilized
in
a
variety
of
settings,
including
human
services,
non-profits
and
agencies,
community
centers,
hospitals
and
clinics,
behavioral,
health
facilities,
schools
and
universities,
specialty
courts,
jails
and
prisons
and
others,
because
they
are
inherently
non-clinical
and
offer
low
barrier
and
accessible
service.
They
are
one
promising
workforce
to
help
close
the
gap
between
needing
and
receiving
treatment.
C
As
part
of
this
initiative,
a
statewide
survey
was
sent
through
a
variety
of
listservs
requesting
responses
from
providers
about
their
use
of
peers
in
their
service
delivery.
The
survey
included
respondents
from
washoe
clark,
nye,
carson
city,
churchill
and
lyon,
counties
from
for-profit,
non-profit
and
government
agencies.
C
C
Through
the
years
we
have
heard
horror
stories
about
organizations,
who've
hired
individuals
who
are
still
currently
undergoing
treatment
themselves,
or
maybe
they
only
have
a
few
weeks
of
recovery
from
chaotic
substance
use.
One
organization
stated
that
their
hiring
practice
was
to
hire
the
person
in
the
program
who
has
the
most
teeth.
C
Additionally,
we
have
heard
from
people
from
the
people
we
serve
about
pure
recovery
support,
specialist
staff,
not
adhering
to
professional
or
ethical
standards,
with
anticipated
growth
of
this
field
to
address
service
gaps.
We
believe
that
peer
recovery
support
specialists
and
supervisors
should
meet
the
standards
for
certification
by
the
nevada
certification
board
to
ensure
competent
public
and
behavioral
workforce
who
will
provide
quality
care
to
this
vulnerable
population,
those
of
whom
we
keep
losing
to
overdose
and
suicide
required
certification
does
not
create
any
substantial
barriers
for
peer
recovery
support
specialists,
but
helps
our
state
standardize.
C
C
This
bill
seeks
to
address
this
problem
by
creating
a
straightforward
process
for
certification
that
will
ultimately
create
several
benefits
for
nevada
and
the
workforce,
some
of
which
include
basic
standards
for
employers,
solid
baselines
for
education
and
continuing
learning
standards.
In
our
code
of
ethics
and
practice,
standards
and
language
and
the
titles
that
we
use,
it
will
elevate
an
entire
workforce
of
people
like
me,
people
in
recovery,
and
it
will
allow
for
better
workforce
analysis
and
labor
statistics
overall
and,
most
importantly,
it
protects
the
individual,
the
peer
and
the
public.
C
What
sp
69
aims
to
do
is
define
peer
recovery,
support,
specialist
and
peer
recovery.
Support
supervisor
using
nationally
recognized
definitions,
require
certification
for
anyone
holding
this
title
or
providing
these
services,
if
they're
being
compensated
to
be
certified
by
the
data
certification
board,
which
ensures
proper
training.
Continuing
education
proficiency
and
reciprocity
with
other
states
requires
the
board
of
health
to
adopt
regulations
providing
for
the
imposition
of
an
administrative,
fine
against
persons
who
engage
in
peer
support
or
hold
the
title
of
peer
recovery,
support,
specialist
or
peer
recovery
support
specialist
supervisor
who
aren't
currently
certified.
C
I
should
note
that
there
have
been
similar
bills
which
sought
to
mandate
the
certification
of
peer
recovery
support
specialists.
The
recovery
community
and
providers
of
peer
support
had
openly
opposed
these
proposals.
For
many
reasons
they
did
not
align
with
the
fidelity
or
efficacy
of
peer
recovery,
support
or
national
standards.
They
criminalized
people
in
recovery
they
restricted
serving
in
a
volunteer
capacity.
They
required
a
formal
medical
diagnosis
prior
to
engaging
in
services
and
ultimately,
they
restricted
access
to
these
inherently
low
barrier
community
support
services.
C
But
the
proposal
before
you
today
was
drafted
differently.
It
was
drafted
with
input
from
peer
support
stakeholders
and
providers
across
nevada,
with
assistance
from
other
peer
recovery,
support
networks
with
similar
state
statutes
and,
most
importantly,
with
input
from
consumers,
the
very
people
who
give
receive
and
utilize
these
services
every
day.
C
D
First
of
all,
I
want
to
thank
you
senator
rowdy
and
committee
for
allowing
me
the
option
to
speak
today.
I'm
here
for
the
record.
This
is
natalie
powell,
I'm
the
director
of
the
nevada
certification
board
and
I'm
here
to
provide
a
brief
history
of
the
nevada,
certification
board
or
ncb
and
answer
any
questions
about
the
board
or
the
certification
process.
D
D
Icnrc's
mission
is
to
promote
public
protection
by
offering
internationally
recognized
credentials
and
examinations
for
prevention,
substance,
use
treatment
and
recovery
professionals.
So
individual
states
may
maintain
up
to
two
icnrc
boards,
if
needed
so
you're
an
affiliate
member
board
from
your
state
or
from
your
country.
Since
it's
an
international
organization
and
these
boards
can
license
or
certify
behavioral
health
service
providers
in
prevention,
treatment
and
recovery.
D
They
gave
us
permission
in
2016
to
apply
to
be
a
secondary
board
to
icnrc
and
we
were
officially
voted
into
icnrc
at
the
fall
2016
meeting
of
all
the
state
and
international
member
boards,
and
our
task
is
to
or
charge
is
to
provide
a
voluntary
certification
process
for
peer
recovery
and
support
specialists
and
prevention
specialists
in
nevada
that
would
either
meet
at
the
minimum
meet
but
also
exceed
icnrc
standards.
D
So
we
were
a
secondary
board
that
had
these
two
certifications,
so
peer
recovery
and
support
specialists,
which
are
the
topic
today
and
then
prevention,
specialists
in
nevada
and
then
two
years
later,
in
2018,
the
nevada
certification
board
was
asked
by
the
nevada
state
division
of
public
and
behavioral
health
to
provide
a
similar
voluntary
certification
process
for
community
health
workers.
So
we're
currently
providing
voluntary
certification
for
three
occupations
in
community
and
behavioral
health
and
in
terms
of
you
know
our
mission
and
vision
and
and
the
importance
of
certification.
D
I
ask
you
to
please
refer
to
the
one
sheet
for
more
information
on
the
board,
contact
information
and
links
to
the
nevada,
certification
board
and
icnrc
websites,
since
we're
here
today
to
discuss
peer
recovery
and
support
specialists.
I
wanted
to
share
a
little
bit
about
our
history
with
that
certification,
specifically
and
again,
I'm
available
to
answer
questions
later
on
and
2017
after
we
were
granted
icnrc
status,
we
held
an
icnrc
endorsed
pilot
or
grandfathering
period
for
our
peer
specialist
certification
process.
D
So
the
purpose
of
the
pilot
was
really
to
allow
certification
to
our
nevada,
peer
specialist
that
had
our
had
already
been
working
in
the
field
and
were
well
established
and
also
to
work
out
any
issues
in
our
certification
process.
If
there
were
any
kinks
or
you
know,
unexpected
barriers
challenges,
you
know
we
would
clean
that
up
for
our
next
round
of
certification.
So,
during
the
pilot
period
we
certified
59
peer
recovery
and
support
specialists,
and
since
that
pilot
we've
certified
an
additional
91
peers.
D
D
Additionally,
we
have
242
peers,
who've
started
their
applications
with
the
nevada
certification
board
and
the
reason
we
have
so
many
is
that
the
application
they
can
take
up
to
a
year
to
complete.
So
they
consist
of
these
certification
applications
for
our
ncb
certification
for
peers.
You
need
proof
of
a
high
school
diploma
or
equivalency.
D
There's
a
minimum
46
hours
of
nevada
state
approved
specialized
training
in
the
icnrc
peer
domains,
and
we
have
two
state
approved
training
organizations.
One
is
foundation
for
recovery
and
another
one
is
cassat
the
center
for
the
application
of
substance
abuse
technologies
at
the
university
of
natarino.
D
So
you
need
to
have
that
specialized
training
in
the
peer
domains.
You
need
to
have
500
hours
of
supervised
experience
in
those
peer
domains
and
pass
the
icnrc
peer
recovery
examination.
D
Additionally,
to
be
a
certified
peer
in
nevada.
You
need
to
have
lived
experience
in
substance,
abuse
or
mental
health
or
process
addiction
and
to
be
have
been
in
recovery
for
a
minimum
of
two
years.
We
want
people
to
be
stable
so
that
they
can
help
help
others
and
the
icnrc
peer
domains
that
I
was
talking
about,
that
you
need
to
demonstrate
proficiency
in
include
advocacy,
ethical
responsibility,
mentoring
and
education
and
recovery
and
wellness
support.
D
So
there's
a
lot
more
to
our
board,
but
I
wanted
to
keep
it
concise
and
I'm
available
today
to
answer
any
questions
about
the
nevada,
certification
board
or
the
certification
process,
and
I'm
going
to
now
turn
the
presentation
over
to
linda
lang,
the
director
of
the
nevada,
statewide
coalition
partnership.
Thank
you
very
much.
E
Thank
you
good
afternoon,
madam
chair
and
members
of
the
committee
for
the
record.
My
name
is
linda
lang
and
I'm
the
director
of
the
nevada
statewide
coalition
partnership.
In
my
role
with
the
partnership
I
support
and
advocate
for
the
field
of
prevention,
and
today
I
am
here
representing
nevada's
substance,
misuse
prevention
coalitions.
E
The
field
of
prevention
is
often
thought
of
as
providing
direct
programming
to
youth,
to
reduce
the
likelihood
of
them
using
substances
or
engaging
in
other
unhealthy
behaviors.
Even
though
this
is
an
important
component.
Focusing
on
youth
alone
will
never
prevent
issues
from
escalating
in
a
community.
E
Prevention
must
occur
at
all
levels
of
the
socio-ecological
spectrum
and
involve
all
sectors
of
a
defined
community.
Nevada's
certified
community
coalitions,
implement
science-based
interventions
and
evidence-based
programming
in
alignment
with
national
best
practice
standards.
Substance.
Misuse
coalitions
are
singularly
situated
to
deal
with
all
drug
trends
because
they
have
the
necessary
infrastructure
in
place
to
effectively
address
drug-related
issues
within
their
communities.
E
As
members
of
the
community
anti-drug
coalitions
of
america,
which
we
refer
to
as
cadka
coalitions
echo
their
belief
that
prevention
of
substance,
use
and
misuse
before
it
starts,
is
the
most
effective
and
cost-efficient
way
to
mitigate
the
drug
crises
facing
our
nation.
So,
basically,
prevention
is
all
things
that
occur
before
a
person
develops
a
substance
use
disorder.
E
E
There
is
now
science
to
support
instruction
of
substance
use
prevention
in
school
settings
from
k-12,
and
this
legislation
supports
teachers
with
the
tools
to
do
this.
Current
curriculum
and
or
programs
being
implemented
will
be
compiled
and
teachers
will
be
provided
resources
specific
to
nationally
recognized
evidence-based
programs.
E
This
will
allow
partnering
community
organizations
to
fund
more
school-based
prevention
programs.
The
next
section
addresses
the
problem
of
low
survey
response
rates
in
school
districts
that
use
active
or
opt-in
consent
specific
to
the
youth
risk.
Behavior
survey,
what
we
call
yrbs
the
center
for
disease
control
funds
the
yrbs
and
requires
nevada
to
have
a
minimum
response
rate
of
60
percent.
E
The
yrbs
is
the
only
common
data
source
related
to
youth,
behaviors,
available
to
nevada's
17
counties
and
the
only
youth
specific
survey
conducted
nationwide
for
comparison
data.
The
survey
also
collects
core
measures
that
are
required
to
compete
for
federal
funds.
This
legislation
establishes
a
uniform
passive
opt-out
consent
process
for
the
state.
It
also
provides
parents
the
opportunity
to
review
the
survey
and
to
receive
a
written
notice
of
how
the
survey
is
administered,
how
the
survey
will
be
used
and
the
persons
that
will
have
access
to
the
results.
E
Passive
consent
requires
less
administrative
burdens,
providing
a
cost
saving
and
greater
participation
among
students
ensures
reliable
data
with
less
chance
of
biases
and
under-representation
of
certain
groups.
The
final
section
addresses
the
legitimization
of
substance
misuse
prevention
coalitions
in
nevada.
E
E
The
current
coalition
structure
was
adopted
20
years
ago
and
is
embedded
in
nevada's
local
communities
without
any
formal
movement
to
establish
them
in
state
statute.
Since
probably
most
important
is
the
amount
of
funding
that
is
leveraged
by
community
coalitions
for
fiscal
year.
2021
coalitions
have
secured
11
million
864
hundred
and
twenty
dollars
to
support
local
level
behavioral
health
issues.
E
This
legislation
will
align
nevada
with
national
best
practice
standards
for
prevention,
as
established
by
cadka.
It
will
ensure
urban,
rural
and
frontier
communities
are
equally
represented
within
the
state
prevention
system
and
recognize
the
importance
of
community
level
decision
making,
and
that
completes
the
high-level
overview
of
our
bill.
We
are
prepared
to
walk
through
the
sections
of
the
bill
at
the
chairs
description,
chair,
ready.
A
A
I
want
to
point
to
folks
that
there
is
a
friendly
amendment
that
is
under
my
name,
that
is
on
nellis,
so
again,
because
these
bills
come
from
community
coalitions
and
were
due.
On
september
1st,
there
was
quite
a
bit
of
work
that
happened
after
september
1st
to
get
the
bill
to
the
place
where
everybody
was
comfortable
with
it.
So
I
want
to
make
sure
that
you
are
seeing
the
amendment
titled
conceptual
amendment
to
senate
bills.
Number
69..
A
I
think
I
already
saw
some
shaking
of
heads
that
we
don't
need
to
walk
through
of
the
bill.
Are
we
comfortable
with
that
all
right?
So
then
we
are
just
going
to
jump
into
questions
and
answers,
and
so,
if
you
could
call
out
which
section
of
the
bill
that
you
are
looking
to
know
to
ask
a
question
out,
so
that
would
be
peer.
A
Recovery
support,
certification,
yrbs
survey,
evidence-based
education
standards
or
clarification
of
the
coalition,
and
if
you
can
indicate
if
you
would
like
to
hear
from
sean
o'donnell
who's,
the
executive
director
of
the
foundation
for
recovery,
linda
lang,
who
is
representing
the
prevention
coalitions
or
natalie
powell,
who
is
representing
the
certification
board.
That
does
the
actual
certification.
F
Thank
you,
madam
chair.
I
appreciate
it.
Thank
you
for
everyone
for
your
for
your
presentations.
I
apologize.
I
read
the
bill
yesterday
and
I
didn't
fully
see
the
amendment
so
bear
with
me.
If
not
I
apologize
so
for
mr
o'donnell,
my
question
is
related
to
what
you
indicated
as
a
trigger
for
for
applicability
and
it
was
related
to
compensation.
I
see
nothing
in
the
bill
that
actually
says
that
someone
has
to
be
compensated
in
order
to
be
captured
in
this.
F
So
the
way
I
read
it
initially
made
it
look
like
we
were
capturing
people's
aaa
sponsors
and
clarity
on
that
would
be
helpful.
C
F
Then
are
these:
are
these
services
billable
under
medicaid
or
commercial
insurance.
F
Is
certification
a
qualification
for
being
billed
for
it?
So
if
you're,
if
you're
not
certified,
can
you
can
you
have
your
services
billed?
Is
there
a
difference.
F
Thank
you.
My
second
question
would
be
for
miss
powell,
I
believe
regarding
certification
standards,
and
did
I
hear
you
right
that
you
have
to
have
a
high
school
diploma
or
equivalency
in
order
to
become
certified.
D
F
D
Yes,
that
absolutely
makes
sense
it's
at
a
requirement
of
our
the
international
certification
and
reciprocity
consortium.
So
it's
a
it's
an
international
requirement
that
that
we
subscribe
to.
D
Well,
we
want
to
be.
We
did
want
to
standardize
the
process
and
we're
absolutely
happy
to
help
people
with
the
ged
process.
If
that's,
if
that's
at
all,
a
barrier
to
work
with
agencies.
F
Okay,
I
mean
if
it's
an
international
standard,
maybe
it's
not
for
you
whether
it
makes
sense,
but
it
seems
like
a
perhaps
unnecessary
barrier
to
me
and
finally,
from
miss
lang
is
the
is
the
yrbs
survey
individually
identifiable
or
is
it
aggregated
and
has
no
individual
information.
E
Linda
lang
for
the
record
senator
kikofer,
no,
it
is
not.
That
is
the
reason
for
the
required
response
rate,
the
minimum
required
response
rate,
and
there
were
some
exhibits
that
were
provided
to
you,
one
of
them,
which
shows
the
the
response
rates
across
the
various
counties
and
how
close
we
are
to
not
reaching
that
60
percent.
This
last
year
was
67
percent.
A
I
I
appreciate
that,
and
I
understand
so
we'll
go
to
senator
spearman.
G
Thank
you,
madam
chair,
and
I
think
I
think
that
senator
keator
touched
on
part
of
what
wanted
you
focused
on
high
school
or
equivalency,
but-
and
I
think
this
will
miss
powell,
why
is
lived
experience
important.
D
It
is
you
know,
I
may
refer
that
that
question
to
sean
o'donnell,
if
that's
possible,
I
kind
of
run
the
day-to-day
administrative
pieces
of
the
certification,
but
he
will
be
able
to
better
explain
the
importance
of
lived
experience.
Okay,
if
that's
acceptable,
sure.
C
Yes,
thank
you.
Senator
spearman,
the
the
lift
experience
portion
for
pure
recovery
support
specialist
is
is
really
like.
The
the
crux
of
what
makes
these
services
work
really
you
know
from
so,
for
instance,
I
can
have
the
training
portion.
The
learned
experience
where
I
learn
about
confidentiality.
C
You
know
tools
like
motivational,
interviewing
advocacy
and
mentorship
those
types
of
things
I
can
learn
in
a
class
setting,
but
as
a
peer
recovery
support
specialist.
My
lived
experience,
you
know
like
personal
experience,
with
incarceration
or
experiencing
homelessness
or
just
using
substances
and
what
that
brings
along
with
it.
I'm
able
to
relate
with
an
individual
and
really
that
lived
experience
removes
what
we
call
a
power
differential.
G
So
so
sean
thank
you
that
that
makes
sense
to
me.
I
guess
what
what
I
hear
you
saying
is
something
that
we
talked
a
lot
about
last
session,
and
that
is
cultural
competency.
Talking
to
people
who
understand
where
you
are
and
what
you've
been
through
and
the
power
differential
would
be
no
judgment.
Is
that
correct.
C
Yes,
I
think
more
or
less
a
great
example
of
that
too,
is
you
know
we
have
this
concept
of
pureness.
So
if
someone
is
seeking
pure
recovery
support,
we
would
try
to
match
somebody
based
off
of
that
pureness.
So,
for
instance,
I'm
a
member
of
the
lgbtq
community
myself,
and
so,
if
some
you
know
it
might
be
more
beneficial
for
me
to
work
directly
with
other
members
of
that
community,
because
we're
able
to
relate
more
as
well.
G
Yeah-
and
I
guess
that's
my
point-
I
like
I
like
this
as
an
as
an
overview,
and
I
wish
that
we
would
adopt
something
like
that
when
it
comes
to
especially
mental
health,
because
when
you're
talking
about
people
going
through
recovery
and
people
who
are
in
a
crisis
with
mental
health
or
emotional
health,
sometimes
having
people
who
don't
understand
your
cultural
background
can
be
an
impediment.
So
I
like
the
I,
like,
I
like
the
concept,
and
I
think
that
you
are
absolutely
correct.
G
Someone
who's
had
that
lived
experience
and
who
can
understand
that
and
someone
who
has
credibility
if
you're,
if
you
remember
the
lgbtq
community
and
you
go
into
the
lgbtq
community,
that
lived
experience
and
the
way
that
you
talk
and
the
way
that
you
receive
them
could
give
you
instant
credibility
and
that's
what
I'm
talking
about
when
I
say
making
sure
that
we
have
mental
health
providers
and
physical
health
providers
that
represent
the
communities
that
are
present
here
in
nevada.
So
thanks
a
lot.
I
just
wanted
to
be
clear
on
that.
G
The
other
thing-
and
I
think
this
is-
I
think
this
is
for
miss
lang.
You
you
mentioned,
you
know
some
of
the
particulars
about
about
the
bill
and
terms
of
what
it
does.
We
had
a
bill
last
time
and
I
was
trying
to
find
a
chapter
of
suicide
youth
suicide
prevention.
It
was
senate
bill
204.
G
and
there
there
are
a
lot
of
elements
in
that
bill.
That
would
suggest,
and
it
was
it
passed
that
would
suggest
there
would
be
a
nexus
between
what
you're
doing
and
what
the
school
system
is
trying
to
do.
I'm
happy
to
talk
with
you
offline
and
find
out
how
we
might
be
able
to
to
look
at
that
and
and
boost
support
and
collaboration
for
your
program.
E
For
the
record,
linda
lang,
senator
spearman
I'd
be
be
tickled
to
go
ahead
and
speak
with
you
offline,
I'm
very
familiar
with
that
bill
from
last
session.
The
report
I
believe
that
is
required
and
if,
if
we
could
accomplish
that
through
that
bill,
I'd
be
more
than
willing
to
talk
to
you
about
I'll
reach
out
to
you.
Thank
you.
Yeah.
G
I
appreciate
that,
and
I
think
one
of
the
things
that
I'm
very
disappointed
in
is
the
fact
that
we've
had
so
many
suicides
in
clark
county
and
just
trying
to
figure
out
how
we
we
have
to
do
better
with
that,
and
so
there
are
some
elements
that,
if
implemented
integrated
with
with
what
you're
suggesting,
I
think
would
be,
would
be
very
helpful.
So
thanks
a
lot,
I
appreciate
it.
A
Thank
you,
senator
spearman
and
I'll
just
make
two
notes
based
on
your
question.
The
bill
would
include
pure
experiences
in
behavioral
health
as
much
as
it
does
substance
use
disorder.
So
I
just
want
to
make
sure
that
that's
clear
for
the
record
and
then
wanted
to
note
that
the
provisions
of
this
bill
around
evidence-based
prevention
were
actually
based
on
sb204.
H
Because
I
I
think
it's
natalie
powell,
when
I
look
at
the
46
hours,
not
sure
what
the
46
hours
was
versus
the
50
hours
or
the
500
hours.
One
of
my
concerns
is
you
know?
What
does
a
person
do
is
their
tuition
for
the
500
hours?
H
What
do
they
do,
while
they're
waiting
to
be
certified
realistically,
a
12-step
program,
for
instance,
uses
real
people.
Who've
had
real
problems
and
it's
a
the
sponsor
is
not
a
quote.
Certified
person
yet
has
those
life
experiences.
H
H
So.
Is
there
a
problem
with
people
doing
something
that
a
peer
recovery
specialist
is
doing?
That
is
not
certified,
and
how
do
they
become
one
putting
through
the
500
hours?
And
you
know
what's
the
process
for
how
much
do
they
have
to
pay
for
the
certificate
over
a
period
of
time
or
for
the
license?
Or
why
would
you
become
a
peer
recovery
specialist
if
you're
just
living
your
life
and
working
as
a
sponsor
those
those
are
just
okay,.
D
This
is
natalie
powell
for
the
record
senator
hardy.
Thank
you
for
those
questions,
they're
all
very
important.
I
want
to
start
with
the
differentiation
in
the
hours,
so
the
46
hours
are
classroom
hours
and
training.
There
are
10
hours
of
the
advocacy
10
hours
of
the
mentoring
and
education,
10
hours
of
recovery
and
wellness
support,
and
then
there
are
16
hours
of
ethical
responsibility,
so
it's
weighted
more
heavily
towards
ethical
responsibility,
so
those
are
classroom
hours
that
you
take.
D
The
500
hours
are
supervised
experience
working
in
these
domains
and
I
can
provide
you
with.
We
have
a
matrix
of
all
the
tasks
that
all
the
tasks
that
pertain
to
these
domains.
I
see
an
rc
they're,
also
a
resource
for
us,
so
they
do
a
job
analysis
of
every
certification
every
and
every
credential,
every
five
to
seven
years,
where
they
consult
nationwide
or
international,
subject
matter
experts
and
find
out
what
people
are
really
doing
in
the
field.
D
They
also
work
on
updating
the
examination
in
keeping
with
you
know
the
best
evidence-based
practices.
So
that's
where
we
get
those
domains
provided
for
us
and
tasks
associated
with
them.
So
traditionally
in
nevada-
and
this
is
something
that
will
probably
change
peers-
have
been
able
to
be
hired
by
agencies
before
before
becoming
certified.
So
we
raised
this,
we
have
in
the
nevada,
certification
board
advisory
committees
for
each
certification
made
up
of
people
in
the
field.
D
Subject
matter
experts
so
a
few
years
ago
the
peers
felt
that
there
was
enough
employment
available
to
have
people
perform
these
supervised
hours
before
becoming
certified.
We're
changing
that
now
and
part
of,
I
believe,
the
amendment
to
the
bill
sean
can
speak
to
this
is
that
we
are
going
to
provide
for
an
intern.
You
know
possibility
of
an
internship,
so
you
could
be
at
an
intern
level
to
get
those
hours
either.
Volunteering
or
many
agencies
will
pay
peers
for
this
experience.
D
So
so
far
we
haven't
had
any
issue
with
peers,
finding
paid
positions
or
volunteer
positions
to
accomplish
those
hours.
So
so
far
it's
been
great
we're
going
to
keep
an
eye
on
that
and
allow
for
an
internship,
and
then
this
is
something
I
am
going
to
defer
to
sean.
As
a
subject
matter
expert.
D
It's
there
is,
there
is
a
differentiation
between
an
aaa
sponsor
and
and
a
peer
recovery
and
support
specialist,
so
we're
not
allowed
to
we're
not
able
to
take
any
experience
as
a
sponsor
or
working
with
alcohol,
anonymous
or
narcotics
with
those
group
meetings,
12-step
programs
as
peer
experience
and,
if
possible,
I
would
like
to
to
have
sean
address
that,
because
I
think
he
will
understand
the
nuances,
be
better
able
to
articulate
the
nuances
of
those
differences.
H
Questions
your
concept
of
an
intern
gives
theoretically
somebody
a
chance
to
pay
tuition
or
to
have
some
remuneration
while
they're
having
their
life
experience.
It's
unusual,
I
think,
for
someone
to
quote,
become
clean
and
then
step
into
something
that,
quite
frankly
enough
in
order
to
be
able
to
support
themselves
while
they
go
through
500
hours
of
you
know,
four
months,
basically
of
you
know
a
program:
how
how
are
they
living?
How
are
they
producing
and
that's
my
concern
is:
are
you
catching
those
people?
H
I
guess
when
you
say
you
have
two
years
of
sobriety,
then
the
sobriety
theoretically
you've
been
in
the
community
working
doing
something
and
then
you
come
out
and
do
something
for
500
hours,
there's
a
step
down
in
your
level
of
living.
H
D
Absolutely
and
in
practice
I
think,
that's
what's
been
happening,
and
this
peer
recovery
and
support
specialist
position
has
for
many
been
seen.
As
you
know,
the
beginning
of
a
career
ladder,
so
many
people
move
on
to
become
to
become
licensed,
counselors
things
like
that
social
workers.
So
for
some
people
it
is
a
track,
but
it
is
very,
very
entry
level,
but
they
will.
I
think
they,
my
understanding
and
sean,
can
speak
to
this
from
being
an
agency
that
employs
many
peers.
D
Is
that
they're
making
as
much
working
as
a
peer
as
they
would
be
in
any
job
they
were
already
in
and
then
in
terms
of
tuition,
we
charge
some
of
the
lowest
tuition,
national
or
certification
fees
nationally?
It's
165
dollars
to
be
initially
certified,
and
80
of
that
goes
to
the
test
that
we're
you
know
invoiced
for
from
icnrc
and
the
rest
is
for
processing
most,
I
would
say
most
of
our
peers.
Their
agency
pays
for
that
certification
and
helps
them
along
with
the
process
they
work
with
their
supervisors.
D
I
I
communicate
a
lot
with
supervisors
in
terms
of
getting
people
through
the
process,
so
for
most
people
the
agency
will
cover
the
165
dollars
and
then
they're
certified
for
two
years
within
those
two
years.
Their
renewal
obligations
are
to
continue
to
to
gain
20
more
hours
of
continuing
education
units.
Six
of
those
hours
have
to
be
in
ethics
to
just
keep
up
with
essex
and
social
media
and
anything
evolving
drug
trends.
D
D
There
is
a
grandfathering
period
and
sean
wrote
these
pieces
so
again
I'll
defer
to
him,
but
I
believe
they
have
until
2023
to
become
certified
and
we're
happy
to
help
anyone
move
along
in
that
process.
You
should
yes,
you
should
not.
You
could
be
a
peer
recovery
intern
or
you
can
be
a
certified
peer
recovery
and
support
specialist.
D
There
are
some
allowances
for
for
people
that
volunteer
and
specifically
for
professionals
that
volunteer
as
peers
and
such
as
you
know,
lawyers
that
help
provide
legal
advice,
and
I
think
the
other
thing
I
wanted
to
say
about
that.
The
bill
part
of
the
amendment
there's
not
a
a
criminal
penalty
at
this
point,
there's
a
civil
penalty.
D
So
if
someone
were
to
practice
as
a
peer
recovery
and
sports
specialist
and
not
be
certified
after
the
timeline,
then
they
would
be
subject
to
fines
if
they
continued
to
get
fines
over
and
over
again,
they
could
be
held
in
contempt
of
court,
but
that
would
be
as
far
as
it
would
go
and
we
wanted
to.
We
wanted
to
start
with
that
and
then
reassess
next
session.
If
there
was
some
need,
for
you
know,
a
criminal
penalty.
D
My
understanding
is
that
we
don't
have
a
fiscal
note
at
this
point
or
the
fiscal
notes
have
been
cleared,
but
I
haven't
I'm
not
an
expert
on
that
discussions.
A
A
G
A
Senator
in
the
interest
of
moving
this
on,
I
think
I'll
just
directly
answer
that
it's
the
same.
It
would
be
the
same
process
as
any
of
the
other
certification
and
licensing,
mostly
a
complaint
driven
process.
A
Okay,
so
we're
going
to
go
ahead
and
open
this
up
for
public
testimony,
we're
going
to
give
folks
a
limit
of
three
minutes
so
bps.
If
you
could
open
up
the
line
for
those
who'd
like
to
testify
in
support
of
sb69.
I
I
I
J
J
J
Our
member's
work
is
affected
by
at
least
two
provisions
in
this
bill.
The
section
is
dealing
with
peer
support
specialists
and
the
youth
behave,
youth
risk,
behavior
surveillance
system
or
yrbs
health
centers
in
the
state
have
been
working
diligently
to
expand
substance
use
disorder.
Services
across
the
state.
State
and
federal
investments
have
encouraged
the
certification
of
providers
able
to
administer
medication-assisted
treatment,
to
expand
options
for
our
communities.
J
J
Mdpca
and
our
members
are
very
reliant
on
federal
grants
to
provide
services
to
uninsured
residents
of
the
state.
In
fact,
between
2015
and
2020,
we
brought
more
than
188
million
dollars
in
grant
funding
to
the
state.
Securing
these
grants
requires
current
and
accurate
data,
and
one
of
the
most
important
data
sources
we
use
is
the
yrbf.
J
I
I
I
K
K
My
unit
is
in
full
support
of
sb69
and
truly
value.
The
support
of
our
community
coalition,
which
is
partnership,
carson
city
or
pcc
pcc,
is
an
instrumental
stakeholder
for
the
health
of
our
community
and
a
proven
leader
on
raising
the
quality
of
life
for
individuals
who
suffer
from
mental
illness
and
substance
abuse.
Thank.
I
L
L
L
Stand
tall
is
a
great
way
to
educate
yourself
and
the
community
on
the
dangers
of
tobacco,
cannabis,
e-cigarettes
and
alcohol,
especially
in
youth
programs
like
this
create
an
open
conversation
for
youth
who
struggle
with
addiction.
Everyone
has
different
experiences,
and
that
is
why
diversity
is
so
important
in
these
kinds
of
prevention
groups.
L
L
I
I
I
I
J
L
G-U-T-M-A-N-D-O-D-S-O-N
and
I'm
representing
the
washoe
county
health
district
in
support
of
sb
69
today,
the
implementation
of
peer
recovery
support
specialists
in
washoe
county
is
part
of,
and
continues
to
be,
a
part
of
the
washoe
county
health
district's
community
health
improvement
plan.
The
certification
for
peer
recovery
support
specialists
will
ensure
a
better
standard
of
practice
elevate.
The
workforce
help
help.
L
Finally,
we
are
supportive
of
every
school
particip
participating
in
the
youth
risk,
behavior
surveillance
system
or
the
yrbss,
and
the
opt
out
method,
the
more
students
that
participate
in
the
survey
that
the
better
data
we
have
to
address
the
needs
of
nevada
youth.
Thank.
I
I
I
I
J
Good
afternoon
my
name
is
mala
m-a-l-a
wheatley
w-h-e-a-t-l-e-y,
I
am
the
director
of
pacific
behavioral
health
and
I
am
in
support
of
sd69
pacific
behavioral.
Health
provides
mental
health
services
to
rural
counties
all
through
nevada
through
our
partnership
with
healthy
communities
coalition,
we
have
successfully
collaborated
with
the
lyon
county
school
district
to
provide
much
needed
school-based
mental
health
services
to
students.
J
The
coalition
has
provided
us
with
a
vital
communication
relationships
and
connections
that
have
allowed
us
to
provide
mental
health
services
to
our
youth.
I
strongly
believe
that
the
successful
connections
of
specific
behavioral
health
therapists
with
the
lion
county
students
is
evidence
of
the
collaborative
efforts
of
the
healthy
communities
coalition.
I
I
J
Good
evening,
my
name
is:
suzanne,
strasser
s:
u
z,
a
n
n
e
s,
t
r,
o
s
s
e
r.
Thank
you,
madam
chair
and
committee
members,
for
allowing
me
to
speak
this
evening
for
the
record.
My
name
is
suzanne
strausser
and
I'm
an
educator
at
mission.
High
school
in
las
vegas
mission.
High
school
is
the
first
fully
education
publicly
funded
recovery
high
school
in
the
nation,
providing
a
comprehensive
high
school
education
to
students
in
recovery
from
substance,
use,
abuse
or
dependency
at
mission
high
school.
J
The
specialists
will
also
address
concerns
that
students
indicate
in
their
weekly
recovery
check-ins
the
peer
recovery
support
specialist
acts
as
a
mentor
and
models
recovery
behavior
for
our
students
as
they
recover.
These
relationships
are
extremely
beneficial
and
important
to
our
students,
especially
since
students
can
be
apprehensive
to
obtain
a
sponsor
in
their
recovery.
Rightfully.
So
since
we
tell
our
children
all
of
their
lives
to
avoid
strangers,
the
baseline
standards
are
necessary
in
providing
this
low
barrier
service
with
safe
adults
who
will
provide
effective
support
to
our
students.
Thank
you.
So
much
for
your
time.
I
O
C
O
E
n,
I
am
a
health
teacher
at
a
high
school
in
carson
city
school
district
and,
as
a
teacher,
I
frequently
use
local
and
state
coalitions
when
needing
tools
to
deliver
evidence-based
substance,
abuse
prevention
and
mental
health
curriculum.
In
my
classes,
I,
as
a
teacher,
also
use
the
youth
risk,
behavior
survey
data
to
frame
evidence-based
curriculum
and
lessons
that
are
directly
identified
by
youth
in
my
community
as
red
flags.
O
As
a
teacher,
I
completely
appreciate
the
passive
permission.
It
is
very
timely
when
you
have
to
get
all
these
forms
out
and
returned.
So
I
appreciate
that
and
I
do
recommend
that
going
into
the
future
with
the
yrbs
survey
coalitions
like
partnership,
carson
city,
the
one
in
my
local
neighborhood
are
so
valuable.
O
Together,
we've
developed
youth
opportunities
after
school
in
the
community
summer
workshops
evening
programs,
as
well
as
extended
learning
opportunities
in
relation
to
substance,
prevention,
substance,
abuse,
prevention
and
mental
health,
and
those
are
what
we
call
as
family
engagement
series.
I
wholeheartedly
support
sbe
69
from
the
teacher
in
the
trenches.
I
rely
on
local
and
statewide
coalitions
to
assist
me
with
reaching
students
within
my
community
with
science
based
approaches
to
prevention
programming.
A
Thank
you,
pps
we'll
go
ahead
and
take
one
more
comment
in
support.
If
you
are
on
the
line
waiting
to
testify
in
support
of
sb69,
I'd
like
to
extend
my
apology
to
you
that
we're
not
going
to
be
able
to
get
to
everybody
today
and
invite
you
to
email,
your
testimony
to
the
email
address
on
the
agenda,
we're
going
to
need
to
move
on
after
this
caller
to
opposition,
and
so
we'll
take
one
more
and
then
we're
going
to
move
on
to
opposition.
I
All
right,
thank
you,
chair.
Let's
see,
we
do
have
a
few
more
callers,
so
please
stand
by
just
one
second,.
I
M
Hi,
my
name
is
joe
joey
joanne
j-o-a-n-n-e,
culver
c-u-l-v-e-r.
M
I
am
bi-gender
gender
non-conforming
and
my
pronouns
are
based
upon
my
current
gender
expression,
which
are
currently
she
her
and
hers,
and
I
am
grateful
to
to
the
committee,
the
chairperson
and
the
committee
for
giving
me
this
time
to
be
in
support
of
of
sb69
as
a
and
in
full
disclosure.
I
myself
am
in
recovery,
13
years
without
a
drink
or
placing
a
bet.
M
So
I
I
really
feel
like
it's
important,
that
we
do
have
these
standards.
I
heard
some
senators
having
some
concerns
about
about
about.
You
know
people
not
being
able
to
do
this,
and
I
I
believe
that
you
know
my
own
recovery
is
one
thing,
but
being
a
professional
is
a
completely
different
thing,
and
so
in
supporting
these
standards,
then
I'm
also
supporting
my
own
standards.
M
M
I
have
other
issues
with
that
and
you've
gotten
your
email,
but
I'm
what
I'm
hearing
is
a
support
for
the
standards
for
for
sb69.
M
So
so
I'm
gonna
ask
if
you
know
if
you
do
have
some
concerns
about
about
these.
The
these.
These
people,
who,
who
don't
have
you
know,
say
like
a
master's
degree
like
I
have
you
know
that
they
can
reach
clients
in
ways
that
that
those
of
us
with
the
fancy
letters
behind
our
names
cannot,
and
I
think
that
having
those
standards
just
keeps
elevating.
You
know
the
need
for
treatment
professionals
that
we
have
within
the
state.
M
A
A
I
All
right
callers,
if
you
wish
to
testify
in
opposition
to
bill
sb
69,
please
press
star,
9
now
to
enter
your
place
in
the
queue
once
again
to
testify
in
opposition
to
the
bill.
Please
press
star,
9.
I
I
P
Good
afternoon
and
early
evening
senators,
this
is
john
pirro
j-o-h-n-p-I-r-o
from
the
clark
county
public
defender's
office.
I
am
hesitant
to
testify
in
opposition
because
I
love
so
much
of
everything
that
this
bill
does.
I
appreciate
senator
ratty
and
the
sponsors
removing
section
8
subsection
2,
which
created
a
new
misdemeanor
through
their
amendment,
but
there
is,
however,
one
more
section
that
we
are
concerned
with,
and
that
is
section
16
subsection,
10d
facially.
P
It
does
not
seem
to
raise
a
criminal
penalty,
but
it
does
add
the
peer
recovery
support
specialist
into
the
growing
list
of
people
whom
an
assault
or
battery
would
constitute
a
gross
misdemeanor
instead
of
a
misdemeanor.
This
list
has
grown
quite
a
bit,
even
in
my
short
time,
appearing
before
this
legislative
body.
So
much
to
the
point
where
the
exceptions
are
starting
to
swallow,
the
rule.
P
Of
course
I
want
peer
support
specialists
to
be
protected
from
aggressive
and
dangerous
conduct,
but
I
do
not
believe
there
is
a
correlation
between
increasing
penalties
and
reduction
in
criminal
behavior.
The
doj
has
even
studied
deterrence
in
this
manner,
and
the
best
indicator
of
deterrence
is
immediacy
of
punishment,
not
an
increase
in
penalty,
which
most
people
won't
even
know
about
anyway.
P
Moreover,
upping
the
penalty
to
a
gross
misdemeanor
triggers
a
jury
trial
as
opposed
to
a
misdemeanor
bench
trial
which,
as
all
of
you
know,
will
increase
the
cost
of
prosecuting
and
defending
these
cases.
Moreover,
most
of
the
people
that
are
affected
by
these
gross
misdemeanor
crimes
are
both
the
mentally
ill
and
the
drug
addicted.
Those
are
the
people
that
we
see
getting
charged
with
these
types
of
crimes
that
fall
into
the
gross
misdemeanor
category.
P
I
I
I
K
Madam
chair
members
of
the
senate,
health
and
human
services
committee,
I
support
the
objectives
and
intents
of
the
bill.
However,
I
think
it
needs
amending
and
technically
I
am
opposed
regarding
senate
bill
69.
As
an
observer
of
the
hearing
this
afternoon,
I
was
seeking
resolutions
to
the
lingering
questions
to
the
purpose
of
the
legislation
regarding
sections
2
through
15,
inclusive,
peer
recovery
support.
K
Current
law
provides
for
the
department
of
health
and
human
services,
department
of
public
and
behavioral
health
and
the
state
board
of
health
to
establish
regulations
for
peer
recovery
support
since
2015.
They
have
chosen
not
to
do
so
why
this
question
is
relevant
because
it
is
if
the
executive,
vis-a-vis,
the
department
of
health
and
human
services
and
its
leadership
are
not
willing
to
properly
engage
and
regulate
peers
with
adequate
legislation
and
regulatory
authority.
How
is
this
bill
going
to
improve
their
ability
or,
more
importantly,
motivate
them
to
do
so?
K
Regarding
section,
26
prevention
coalitions
continuing
the
question
of
leadership.
What
is
the
purpose
of
codifying
coalitions
in
the
statute
when
they
allegedly
have
an
established
relationship
as
community-based
providers
of
prevention
services?
Already
the
governor
proposes
more
than
a
hundred
million
dollars
to
be
dedicated
to
reducing,
quote
risky
and
addictive
behavior.
K
The
bulk
of
substance,
use
prevention
and
treatment
agency
funding
comes
from
formula
federal
block
grants.
Federal
law
requires
that
the
single
state
agency
distribute
this
funding
to
the
community
in
response
to
the
community's
advice
and
council
16
to
20
percent
of
the
allocated.
Federal
funds
is
designated
for
prevention
if
the
if
the
prevention
coalitions
had
an
established
and
well
working
relationship
with
the
state
regarding
strategies,
efficacy
and
delivering
this
funding
directly
to
the
community,
then
the
spill
would
not
seem
necessary,
and
yet
here
it
is.
K
The
question
again
is:
why
does
the
state
require
legislation
in
order
to
ensure
that
it
is
distributing
funding
to
the
community
directly?
Will
the
legislation
compel
the
state
to
address
equity,
fairness
and
transparency
in
the
distributed
distribution
of
federal
funds?
Even
if
a
coalition
complies
with
the
extensive
list
of
requirements
in
section
26?
K
K
Sb69
in
total
is
important
and
needs
to
pass,
but
greater
than
the
substance
of
the
bill
is
confidence
in
the
leadership
and
culture
of
the
agency
charged
with
enforcing
it.
Madam
chair,
I
have
no
confidence
in
dhhs's
leadership
to
enact
this
legislation,
since
they
already
have
the
power
to
do
all
the
things
detailed
in
this
bill,
and
it's
not
happening
and
sb
69's
very
existence
suggests
a
wider
issue
of
equity
and
transparency.
K
I
I
N
B-E-R-T-S-C-H-Y
and
I'm
with
the
washoe
county
public
defender's
office.
I
echo
the
testimony
from
mr
pirro
that
we
also
think
that
this
is
a
very
good
bill
that
has,
and
we
support
the
peer
support
community
and
hope
that
they
are
able
to
help
our
citizens
and
help
our
communities
overcome
their
addictions
with
this
bill.
For
the
reasons
that
he
stated,
we
are
in
opposition,
and
I
would
just
note
that
when
the
enhancement
was
first
established
and
then
there
was
bills
about
it
way
back
in
2005.,
there
was
testimony
about
the
concern
of
that.
N
N
N
I
A
I
A
L
G
A
Good
afternoon
committee
and
chair,
thank
you
for
this
bill
and,
yes,
the
amendment
removes
a
fiscal
note.
A
Thank
you.
Pps
will
go
on
to
neutral
testimonial
from
the
calling.
I
I
L
Madam
chair
and
members
of
the
committee,
my
name
is
allison
stevens
a-l-l-I-s-o-n
s-t-e-p-h-e-n-s
and
I
am
the
statewide
family
network
director
from
nevada
pep
nevada.
Pep
is
a
statewide
nonprofit
that
connects
parents
of
children
with
disabilities,
including
mental
health,
needs,
offering
training
and
support.
L
These
services
are
recognized
nationally
as
family
peer
support,
and
there
is
a
national
certification
process
in
place.
We
also
sponsor
the
organization,
youth,
move,
nevada,
the
youth
move,
nevada,
facilitators
and
mentor
are
focused
on
improving
child
and
youth
serving
systems,
in
addition
to
educating
each
other
motivating
each
other
and
participating
in
social
activities.
L
We
do
not
believe
our
services
were
considered
or
contemplated
as
peer
recovery
support
service
during
the
drafting
of
this
bill,
and
we
ask
that
they
be
exempt
we're
happy
to
provide
any
additional
information
and,
in
the
meantime,
I
have
also
submitted
this
testimony
in
writing,
along
with
a
reference
document
on
family
peer
support.
Thank
you
for
your
time
and.
I
Q
We
are
testifying
in
neutral
today
and
in
conversation
with
senator
ratty
and
with
with
miss
edwards
and
some
of
the
proponents.
We
decided
to
go
and
do
this
in
neutral
today,
because
we
overall
support
the
intent
and
all
of
the
hard
work
that
has
gone
into
this
bill.
We
reviewed
this
bill
and
I'm
really
testifying
today
on
behalf
of
our
department
of
family
services
and
child
welfare.
Q
This
is
very
similar
to
other
background
checks
in
statute.
I
did
file
this
amendment
and
listed
the
other
statutes
and
I've
been
in
consultation
with
senator
raddy
and
hope
to
work
with
her
and
the
proponents
on
this
bill.
Again.
We
are
in
support
of
the
overall
goal
and
want
to
thank
you
for
your
time
and.
I
L
D-E-B-R-A-K-A-M-K-A,
director
of
operations
for
quest
counseling
and
consulting
in
reno
nevada,
my
position
is
neutral
on
this
bill.
My
organization
has
had
a
relationship
with
our
community
coalition
jtnn
for
the
past
16
years.
Jtnn
is
is
a
truly
collaborative
organization,
along
with
our
law
enforcement
they've
created
the
first
prescription
drug
roundup
in
the
state
to
address
the
prescription,
drug
abuse,
facilitate
monthly
committees
on
a
variety
of
drug
related
topics,
and
they
work
with
all
interested
parties
to
provide
solutions
to
community
substance,
use
problems.
L
My
agency
values,
the
y
r
b
s
trend
reports
published
by
jtnn
in
their
biennial
prevention
plan,
and
my
staff
knows
to
call
jtn
when
looking
for
resources
like
informational
rack
cards
or
prescription
drug
lock
boxes
for
our
clients,
the
coalitions
provide
great
value
and
local
knowledge
in
their
communities
and
can
address
community
problems
at
the
local
level
quickly
and
in
a
cost
efficient
manner.
Thank
you
for
allowing
me
to
speak
this.
I
I
Chair,
I
do
believe
that
we
had
one
more
caller,
but
it
looks
like
they
have
either
left
the
queue
or
hung
up.
Oh
I'm,
sorry,
there
is
one
more
person
in
the
queue
right.
I
J
J
our
agency
has
worked
with
jtn
since
1998..
I
am
so
thankful.
My
community
has
a
substance
abuse
prevention
coalition
that
can
respond
to
community
needs,
such
as
underage
drinking,
marijuana,
use
and
prescription
drug
use
through
jtnn.
My
agency
has
been
able
to
obtain
subgranted
general
funds
and
federal
grant
dollars
to
reach
youth
through
evidence-based
programming
in
schools,
after
school
programs,
juvenile
probation
and
even
in
our
church.
J
Not
only
do
we
impact
youth,
but
we
can
provide
jobs
to
the
community
members
through
sub-granted
funds,
whether
it's
facilitating
a
committee
bringing
a
national
speaker
to
reno
or
organizing
a
community
event.
Jtnn
is
able
to
bring
community
members
together
to
address
important
drug
issues
and
washoe
county
would
not
be
the
same
without
them.
Thank
you.
I
A
Thank
you
so
with
that
I'll
just
note
for
the
committee
that
we
had
heard
from
all
the
folks
who
were
requesting
amendments
just
in
advance
of
the
meeting
and
we
have
pledged
to
have
conversations
with
them
moving
forward.
So
as
we
get
towards
work
session,
we'll
be
sure
to
keep
you
informed
with
that,
I'm
going
to
go
ahead
and
close
the
hearing
on
sb
69
and
invite
the
presenters
for
sb
70
to
come
forward.
A
It
looks
like
you
might
be
breaking
in
and
out
a
little
bit
jessica
will
just
monitor
your
internet
and
maybe
have
to
turn
off
your
video.
If
that's
continues,
all
right,
who's
gonna
go
ahead.
S
And
kick
off?
Okay,
I'm
I'm
gonna!
Take
off
it's
okay!
Madam
chair,
please
do
great
thank
you
very
much
good
afternoon,
madam
chair,
and
thank
you
for
the
opportunity
to
present
sb
70
before
you
today.
Excuse
me
for
the
record.
I
am
robin
titus
representing
assembly
district
38,
which
includes
churchill
and
lyon,
counties,
and
I'm
here
today
as
a
legislative
representative
to
the
northern
regional
behavioral
health
policy
board
and
it's
my
pleasure
to
introduce
this
bill,
which
addresses
several
very
complex,
very
important,
behavioral
health
care
issues
for
the
citizens
of
nevada.
S
I
know
that
you
were
given
a
brief
overview
when
assembly
bill
69
was
introduced
just
an
hour
ago
or
so,
but
I
also
want
to
kind
of
circle
back
on
on
how
we
got
here.
So
in
2017,
the
legislature
passed
assembly
bill
366,
which
created
the
poor
behavioral
health
policy
regions,
northern
rural
and
southern
behavioral
policy.
S
The
bill
established
a
behavioral
health
policy
mod
for
each
region,
boards
compromised
13
members
appointed
by
the
governor
speaker
of
the
assembly
majority
leader
and
the
legislative
commission.
The
boards
are
responsible
for
improvement
to
delivery,
behavioral
health
services
throughout
the
state,
and
we
are
required
to
advise
relevant
executive
branch
agencies
on
regional
health
issues,
identify
gaps
and
services
and
coordinate
with
each
other
to
provide
recommendations
to
the
department
of
health
and
human
services.
Each
board
is
authorized
to
address,
to
request
one
bdr
with
the
issues
for
its
region,
specifically
and
throughout
the
state
2019.
S
As
was
mentioned,
assembly
bill
76
was
sponsored
by
the
southern
regional
behavioral
health
policy
board
and
it
revised
the
geographic
locations
creating
a
fifth
board
and
establishing
the
clark
regional
behavior
board,
which
now
consists
of
clark
county
and
a
portion
of
nine
the
2021
legislation.
Legislative
recession
is
a
second
session
to
which
the
behavioral
health
policy
boards
have
submitted
a
bill
draft,
and
I
am
proud
to
work
the
of
the
work
that
our
board,
the
northern
regional
behavioral
health
policy
board,
had
done
over
the
past
four
years.
S
The
board
sponsored
ab-85
in
2019
and
sb
70
aims
to
build
on
the
success
of
ab-85
and
address
additional
gaps
and
challenges
existing
in
the
behavioral
health
care
system
in
the
state
to
better
serve
most
of
the
vulnerable
on
nevadans.
At
this
point,
I
would
like
to
turn
the
bill
presentation
over
taylor,
allison,
chair
of
the
northern
regional
behavior
health
policy
board
and
jessica
flood
our
health
coordinator.
Thank
you
very
much
for
your
time
this
evening
and
taylor
allison.
Would
you
like
to
go
ahead
and
go
forward
if
that's?
Okay
with
you,
madam
chair.
L
Thank
you
assemblywoman
titus,
madam
chair
and
members
of
the
committee
for
the
record.
My
name
is
taylor
allison
and
I'm
the
chair
of
the
northern
regional
health
policy
board
representing
carson
city,
churchill,
douglas
lion
and
story
counties.
I'm
also
director
of
partnership
douglas
county,
one.
G
Excuse
me
just
a
minute:
miss
allison,
you're
you're,
breaking
up
like
every
four
or
five
words
it's
going
down
to.
What's
almost
inaudible,
would
it
help
if
you
turned
your
video
off
and
just
use
audio
sure?
Okay,
let's,
let's
see,
let's
see
if
that
worked,
because
it
sounds
like
what
you're
what
you're
giving
to
us
is
important,
and
I
want
us
to
be
able
to
get
all
of
it.
G
G
G
R
A
L
Thank
you,
madam
chair,
and
the
broadcast
team
for
helping
us
with
the
technical
difficulties
I
apologize,
starting
with
sp
70
the
background.
We're
focused
on
modernizing
standardizing
and
reducing
stigma
in
nevada's
mental
health
crisis
holds
process
found
in
nrs
40-33-8
and
continuing
the
work
initiated
by
our
previous
bill.
8085.
L
That
path
with
bipartisan
support
in
the
2019
legislative
session
for
background
1885
was
brought
forth
by
the
northern
board.
After
the
need
for
policy
change
was
identified
back
in
2018..
We
heard
stories
of
individuals
in
crisis
that
were
sitting
in
hospital
emergency
rooms
up
to
10
days,
while
they
waited
awaited
inpatient
beds
at
psychiatric
facilities.
L
We
heard
various
interpretations
from
courts
and
providers
on
when
the
72-hour
clock
started
ticking
and
nrs-433a
utilize
language
that
we
now
know
to
create
additional
stigma
to
individuals
experiencing
mental
health
crisis
jessica,
flood
regional
behavioral
health
coordinator,
which
you
also
hear
from
today,
established
a
multidisciplinary
statewide
mental
health
crisis,
cold
working
group
to
take
a
deep
dive
into
the
language
and
to
address
those
critical
issues.
L
L
Since
8085
passed,
the
statewide
mental
health
crisis,
cold
war
group
has
continued
to
meet.
The
group
has
worked
collaboratively
with
state
staff
and
the
division
of
public
and
behavioral
health
to
work
on
regulations,
including
mandating
hospital
reporting
of
medical
crisis,
hold
clarifying
medical
clearance,
behavioral
health
transportation
and
the
process
for
involuntary
administration
and
medication.
L
L
The
packet
reviews
the
whole
process,
the
current
law,
patient
rights
and,
if
sc
70
passes,
the
working
group
will
continue
to
update
the
package
to
reflect
modern
practice.
I'll
turn
it
over
to
jessica
flood.
Our
regional
behavioral
health
coordinator
to
review
the
mental
health
crisis
hold
process
and
the
five
principal
changes
to
nrs433a
proposed
in
fc
studies.
R
Thanks
taylor,
my
name
is
jessica,
fled
and
I'm
the
northern
regional
behavioral
health
coordinator.
Can
you
hear
me
okay,.
R
Excellent,
so
we
wanted
to
start
off
by
providing
an
overview
of
what
mental
health
crisis
holds
are,
so
they
are
involuntary
holds
for
people
who
are
considered
to
be
a
danger
to
self
or
others
due
to
mental
illness.
So
that's
for
people
who
are
suicidal
may
be
homicidal
when
they're
psychotic
or
gravely
disabled,
so
they're
unable
to
care
for
themselves
due
to
mental
illness.
R
Nevada's
mental
health
crisis
hold
lasts
for
72
hours,
and
it
includes
the
first
step
of
detaining
the
individual
and
filling
out
the
application
on
the
mental
health
crisis
hold
packet.
The
second
is
medical
evaluation
to
determine
that
there
are
no
immediate
medical
needs
that
need
to
be
addressed,
and
then
the
third
step
is
certifying
that
the
individual
is
indeed
in
a
mental
health
crisis
due
to
mental
illness.
R
I've
also
included
an
overview
of
the
mental
health
crisis
whole
process
for
you,
I'm
not
going
to
go
over
it,
but
it
is
a
complex
process,
and
one
of
the
reasons
that
this
has
really
become
a
priority
for
the
northern
region
is
that
we
do
get
a
lot
of
calls
and
feedback
from
families
who
are
trying
to
understand
this
process
and
really
get
lost.
In
terms
of
you
know
what
the
step
they're
on
and
where
their
loved
ones
are
at.
R
So
sp70
made
a
lot
of
changes
across
the
mental
health
crisis.
Hold
process
you'll
see
at
the
top
the
elements
of
the
mental
health
crisis
system,
which
includes
the
actual
mental
health
crisis.
What
we're
doing
to
respond
to
that
detainment,
evaluation
and
treatment
at
a
hospital
or
crisis
center
emergency
admission
to
an
inpatient,
psychiatric
hospital,
involuntary
court
ordered
admission
and
then
some
of
the
laws
regarding
discharge
from
the
inpatient
hospital
and
we'll
step
through
all
of
these
changes
as
we
go
through
the
presentation.
R
They
were
there
to
develop
ab85
through
the
regulation,
development
through
education
and
they
have
worked
hundreds
of
hours
to
develop
sb70.
So
core
stakeholders
on
the
adult
side
would
be
clark.
County
judge,
jaeger,
washoe,
county
judge
lou,
both
of
whom
oversee
assisted,
outpatient
treatment
and
the
mental
health
crisis
holds
the
clark
and
washoe
public
defenders,
division
of
public
and
behavioral
health,
the
nevada
hospital
association,
rural
nevada,
hospital
partners,
washoe
county
district
attorney's
office
at
nevada,
psychiatric
association
and
law
enforcement.
R
On
the
youth
side,
we
only
made
a
few
small
changes
to
the
youth
process,
but
we
had
just
a
very
robust
group
in
participation,
since
this
process
is
new
to
nevada,
so
nevada,
department
of
education,
clark,
county
school
district
clerk
in
washoe,
county
district
attorney's
office,
clark,
washoe
and
rural
child
welfare,
division
of
child
and
family,
well,
services,
dpbh,
again,
clark,
washoe
and
rural
children's
consortia,
children
and
family
advocates
from
nevada
pep.
The
state
statewide
family
network.
R
So
sb70
is
70
pages
long
and
can
definitely
seem
daunting,
but
we
really
feel
like
we
can
tell
the
story
through
five
principal
changes,
so
the
first
big
change
is
that
it
updates
and
modernizes
the
mental
health
crisis
hold
law.
The
second
change
we
focus
on
was
assisted,
outpatient
treatment,
the
third
conditional
release,
the
fourth
was
mental
health
christ,
youth
mental
health
crisis
holds
and
then
the
fifth
significant
change
was
in
a
chemical
restraint.
R
So
there's
several
components
to
updating
and
modernizing
the
mental
health
crisis
whole
process.
So
I'll
just
walk
you
through
those
couple
of
components
and
how
I'm
trying
to
present
this
is
really
identifying
what
the
problem
was
and
then
how
we
tried
to
adjust
that
problem.
R
So
the
first
one
was
updating
the
mental
health
crisis
process
and
defining
terms
most
of
nrs
433
a
was
written
in
1975
and
it
really
talks
to
this
system
that
is
not
in
place
today.
If
you
look
at
nrs433a
it,
it
describes
the
situation
where
a
law
enforcement
officer
would
detain
an
individual
and
apply
for
emergency
admission.
That's
the
name
of
the
legal
hold
or
mental
health
crisis
hold.
R
It's
not
this
determined
situation
where
they're
headed
to
an
inpatient
site
unit
and
that's
hard
to
really
see
in
the
law
right
now
and
making
it
very
confusing
for
providers,
law
enforcement
and
for
family
and
peer
advocates.
R
So
our
proposed
solutions
were
to
specify
the
mental
health
crisis
whole
process.
By
clearly
separating
the
mental
health
crisis
hold
from
emergency
admission.
We
also
updated
the
term
application
for
emergency
admission
to
mental
health
crisis
hold
and
we
provided
definitions
for
many
of
the
things
such
as
the
hold
voluntary
admission.
Emergency
admission
and
involuntary
court
ordered
admission.
R
Currently
we
have
this
in
our
law
right
now.
It
speaks
to
this
concept
that
people
that
are
experiencing
ongoing
psychosis
are
actually
damaging
their
brain
and
it's
impairing
their
ongoing
functioning.
There's
a
lot
of
research
around
this,
and
so
many
other
states
also
have
this
deterioration
clause
as
well.
It's
not
being
used
in
nevada,
and
one
of
the
reasons
is
because
it's
kind
of
obscurely
squished
into
the
criteria.
R
We
attempted
to
clarify
that,
but
we
actually
got
quite
a
bit
of
pushback
from
stakeholders
regarding
constitutional
issues
and
also
patient
rights.
So
we
decided
to
take
out
that
clarifying
language
and
just
pursue
education
across
the
state.
If
there's
anything,
that's
been
discovered
through
this
process
is
the
real
gap
in
education
and
understanding
around
this
hold,
and
so
it's
hoped
that
if
this
bill
passes,
we
can
really
push
forward
in
having
more
common
understanding
across
the
state
on
the
nrs433a.
R
The
next
change
is
clarifying
the
family
petition
for
court-ordered
pickup,
so
this
was
already
in
the
law.
It's
basically
the
last
ditch
effort
for
families,
the
the
mechanism
of
last
resort
when
families
are
trying
to
get
help
for
someone
who's,
a
mental
health
crisis
and
other
measures
haven't
worked.
So
examples
could
be
that
someone
calls
911
asks
for
law
enforcement
or
someone
to
come
out
and
talk
to
this
individual
who's
in
their
house.
R
That
person
could
be
threatening
suicide
or
psychotic,
and
when
law
enforcement
shows
up
that
individual
can
kind
of
deny
that
they
have
they're
in
a
mental
health
crisis
or
that
they've
been
saying
certain
things
that
would
make
people
think
that
they're
suicidal.
R
We
definitely
have
heard
concerns
in
terms
of
creating
or
keeping
a
process
that
really
has
law
enforcement,
interacting
with
individuals
with
mental
illness,
and
I
think
the
northern
regional
behavioral
health
policy
board
and
all
the
stakeholders
are
all
for
decreasing
interaction
of
law
enforcement
with
people
with
mental
illness.
We
hope
to
build
that
behavioral
health,
alternative
crisis
response
system,
but
there's
also
a
place
for
you
know
that
time
when
law
enforcement
may
need
to
go
out
and
intervene.
R
Some
of
the
solutions
that
we're
looking
at
is
making
sure
that
it's
a
crisis,
intervention
trained
law
enforcement,
potentially
writing
in
for
mobile
crisis
teams
to
assist,
if
available.
So
we're
really
open
to
really
trying
to
figure
this
out
so
that
people
feel
comfortable
with
it,
the
so
the
other
piece
we
developed
the
process
so
that
it's
workable.
We
also
remove
the
ability
for
spouse,
parent,
adult
children
or
legal
guardian
to
petition
the
courts
for
direct
admission
to
inpatient
psychiatric
facility.
R
That's
because
it
doesn't
reflect
the
process
that
we
have
now
really
anyone
if
a
court
is
ordering
you
to
go
into.
Inpatient
would
like
to
have
an
independent
evaluation
at
a
hospital
so
that
you
make
sure
that
you're
appropriate
to
go.
The
other
thing
is
going
through
a
hospital
or
crisis
center,
make
sure
that
you're
using
insurance
and
we're
not
over
utilizing
state
beds
that
could
be
used
for
people
who
really
have
nothing
else.
R
So
the
last
big
change
for
that
updating
and
modernizing
the
mental
health
crisis
hold
law
is
clarifying
hospital
and
court
procedure
for
individuals
who
cannot
be
medically
cleared
in
72
hours
again.
This
is
just
a
muddy
process
in
law
and
it
was
really
having
hospitals.
This
happens
quite
often,
and
it
was
making
hospitals
have
to
kind
of
create
their
own
process
of
what
they
should
do
with
the
courts,
leading
to
a
lot
of
frustration
on
both
sides.
R
So
now
we
have
a
central
process
that
hospitals
can
turn
to
so
that
they
really
understand
what
to
do
in
situations
such
as
this.
Okay,
I
was
lying.
That
was
not
the
last
one.
This
is
the
last
one,
so
we
also
updated
timelines
for
notifying
guardians
in
courts
in
terms
of
when
people
are
discharging
and
from
under
court
ordered
involuntary
admission.
R
R
It
is
unworkable,
as
it
is
so
we
created
we're
amending
it
so
that
there's
going
to
be
timelines
where
hospitals
have
to
notify
guardians
three
days
prior
to
discharge.
The
thought
is
is
that
they
should
already
be
working
with
guardians
on
that,
and
then
the
hospitals
need
to
be
notifying
courts
three
days
after
discharge,
because
patients
are
actually
getting
lost
in
the
system
right
now,
courts
will
order
them
into
hospitals
and
they
get
transferred
to
different
places
or
discharged,
and
so
for
from
a
patient
rights
perspective.
R
R
In
moving
on
to
the
second
major
change,
this
is
assisted,
outpatient
treatment,
assisted
outpatient
treatment
is
basically
court,
ordered
outpatient
treatment
for
people
with
mental
illness
with
the
intention
of
really
providing
treatment
they
need
so
that
they
can
be
stable
in
the
community.
R
So
the
problem
that
we
have-
oh
so
a
little
history
assisted
outpatient
treatment,
was
first
placed
in
nevada
law
in
2014,
and
it
was
really
built
in
nevada
at
first
as
specific
programs
in
washoe
and
clark
counties
and
through
federal
funding
through
samhsa
funding.
Both
watro
and
clark
programs
have
shown
great
progress.
For
example,
in
washoe
county
judge
liu
cited
that
the
aot
program
reduced
hospitalizations
for
their
participants
by
61
and
decreased
jail
days
by
73
percent.
R
R
We
also
got
technical
assistance
from
the
treatment
advocacy
center,
which
is
kind
of
the
national
expert
on
assisted
outpatient
treatment,
and
they
helped
us
adjust
this
criteria
so
that
we
can
be
accurate
and
really
know
our
target
population,
and
we
all
they
also
helped
us
understand
that
aot
is
not
a
brand.
It's
a
generic
term.
R
That's
really
any
level
of
treatment,
plus
a
court
order,
and
with
that
in
mind,
we
realized
that
we
could
create
a
more
flexible
program
and
might
be
able
to
find
more
sustainable
ways
of
developing
it
in
other
counties
from
other
than
washoe
and
clark
and
then
also
potentially
expanding
it
in
washington.
Clark
counties
as
well.
R
It's
court-ordered
outpatient
treatment
for
individuals
with
mental
illness,
who
may
or
may
not
have
come
into
contact
with
the
criminal
justice
system
and
really
trying
to
get
them
treatment
so
that
they
are
diverted
from
law
enforcement
interactions.
Criminal
justice
interactions
and
also
unnecessary
hospitalizations
aot
is
different
from
specialty
courts
because
we
don't
have
to
wait
for
these
people
to
get
brought
into
the
criminal
justice
system.
We
don't
have
to
wait
for
charges
to
occur.
R
We
can
see
that
these
people
are
having
frequent
hospitalizations
or
calls
to
law
enforcement
etc
and
really
get
them
the
help
they
need
before
they
go
in
further.
We
also
believe
that
this
program
is
important.
An
important
part
of
our
system
in
addressing
racial
disparity,
minority
populations
are
already
at
greater
risk
of
harm
and
death
with
law
enforcement
interactions
and
are
over
represented
in
the
criminal
justice
system.
R
Likewise,
people
with
mental
illness
are
also
at
greater
risk
of
harm
and
death
in
interactions
with
law
enforcement
and
again
are
also
over
represented
in
the
criminal
justice
system.
We
really
see
aot,
as
acting
as
a
mechanism
to
assist
individuals
with
mental
illness
by
working
to
stabilize
them
in
the
community
by
getting
them
treatment
that
they
need.
R
The
importance
of
these
diversion
programs
was
really
made
clear
to
me.
I
worked
at
lakes
crossing
as
an
intern
for
a
while,
and
there
was
one
story
that
stuck
with
me.
There
was
a
black
woman
that
was
running
naked
down.
The
street
psychotic
got
arrested
was
brought
into
jail,
spit
on
an
officer
and
was
charged
with
a
felony
for
assault
against
an
officer.
R
R
So
what
we've
done
with
assisted
outpatient
treatment?
Is
we
created
a
clear
and
transparent
process
for
individuals
so
that
they
know
how
to
apply
for
it?
We've
enabled
community
providers
to
provide
aot
and
that's
really
exciting,
because
right
now,
only
the
state
can
provide
these
services
through
funding.
We
believe
that
aot
can
get
reimbursable
or
reimbursed
through
insurance,
really
making
it
a
sustainable
program,
and
then
you'll
see
here
that
it
clearly
identifies
the
target
population
for
assisted
outpatient
treatment.
R
Okay,
the
third
one
out
of
five
we're
almost
there,
so
we
clarified
conditional
release
conditional
release
is
a
process
for
people
who
are
court
ordered
into
inpatient
psychiatric
units.
You
know,
there's
usually
that
six-month
court
order
hospitals
often
will
see
you
they'll
stabilize
some
of
these
individuals
and
they'll
just
know
that
these
individuals
are
at
higher
risk
for
deteriorating
upon
discharge.
R
So
some
of
these
hospitals
will
keep
these
people
for
the
whole
court
order,
because
it's
going
to
be
an
unsafe
discharge,
they
can't
they
have
to
hold
on
to
them.
But
unfortunately,
at
the
end
of
the
six
months
the
individual
is
stable.
They
don't
meet
criteria
for
an
additional
court
order,
so
they
have
to
be
discharged
and
sometimes
that
discharge
ends
up
looking
a
little
bit
like
a
cliff.
In
terms
of
you
know
the
coordination
and
community
providers.
R
This
allows
hospitals
to
discharge
people
earlier
if
they're
able
to
set
up
certain
conditions,
so
the
person
may
need
to
agree
to
continue
to
go
to
treatment.
Have
a
community
provider
supervise
them,
or
you
know
just
check
in
on
them,
make
sure
that
they're
doing
well
and
then
provide
that
agreement
to
the
courts.
R
So
we
really
see
this
as
like
a
discharge
plan
on
steroids
in
a
lot
of
ways
to
really
try
to
help
those
people
have
a
more
smooth
transition
into
the
communities,
so
the
rural
communities
would
love
that
there's
often
times
where.
Suddenly,
this
person
just
appears
in
the
community
and
no
one
knows
about
it,
no
one
knows
what
the
appointment
time
is
or
what
not
and
they
just
watch
the
deterioration
again
in
the
urban
counties.
This
was
a
big
one
for
judge
jaeger.
R
You
know
she
is
the
court
that
facilitates
the
holds
for
20
different
hospitals.
She
often
watches
those
hospitals
recreate
the
wheel
over
and
over
again
with
these
people
that
are
coming
in
and
out
of
treatment,
and
so
she
thinks
that
this
will
help
the
court
be
able
to
better
coordinate
those
individuals.
R
R
The
fourth
major
change
was
in
the
youth
mental
health
crisis
hold
process.
Really
there
were
some
pretty
small
changes,
but
I
think
they
have
a
big
impact.
R
The
first
was
that
we
clarified
and
changed
the
time
hospitals
detained
a
youth,
detaining
a
youth
must
notify
a
parent
or
legal
guardian
of
holding
a
youth
under
a
hold
in
the
current
law.
It
says
that
hospitals
need
to
notify
the
parents
within
24
hours,
of
the
youth
being
brought
into
an
inpatient
psychiatric
hospital.
R
No
parent
wants
to
be
notified
at
that
place.
What
the
stakeholders
actually
wanted
was
for
the
parent
to
be
notified
within
24
hours
of
detainment
and
actually
with
our
amendment,
we're
shorting
that
to
eight
hours,
and
we
think
that
that's
totally
doable,
because
any
youth
that's
being
brought
into
a
hospital
without
parental
oversight.
R
The
first
call
that
they're
gonna
be
making
is
trying
to
find
the
parent.
The
second
change
that
we're
making
is
creating
a
mechanism
for
youth
to
be
released
from
a
mental
health
crisis
hold
to
parents
if
the
guardian
or
parent
agrees
to
treatment
or
accepts
physical
custody
of
the
youth.
There's
going
to
be
times
where
the
youth
is
still
in
crisis,
so
you
can't
decertify
the
hold,
but
it's
still
safe
to
give
the
youth
back
to
the
parent,
so
we're
really
just
trying
to
shore
up
parent
rights
here.
R
Finally,
we
made
a
change
to
chemical
restraint.
This
was
brought
forth
in
large
part
by
dr
raven,
and
dr
lisa
duret
also
worked
on
this,
as
well
as
the
other
stakeholders.
It's
really
just
updating
our
definition
of
chemical
restraint
to
modern
innovations
and
practices
and
new
fda
approved
uses
of
medications.
R
So
I
think,
even
though
that
sounds
scary
in
our
bill,
it's
actually
a
pretty
non-controversial
piece
of
it.
Finally,
we
have
our
proposed
amendments.
Like
senator
raddy
was
saying
with
the
washoe
board,
we
got
our
bill
submitted
and
didn't
have
that
much
time
for
turnaround
with
lcb.
So
there's
a
lot
of
technical
cleanup
that
we're
doing.
R
We
also
addressed
change
requests
from
a
lot
of
stakeholders
and
we
agree
with
those
changes,
and
we
have
also
added
an
additional
amendment
that
develops
and
clarifies
cross
county
transfer
process
and
mandates
court
notification
when
patients
are
transferred
from
one
facility
to
another.
This
has
been
an
ongoing
concern
for
quite
a
while
with
stakeholders,
again
patients
getting
lost
in
the
county
transfer
process.
R
You
know,
and
so
we're
really
trying
to
establish
a
timeline
for
you
know
when
those
patients
are
transferred
and
what
happens
in
the
next
county
etc,
and
that's
it
so
I'm
happy
to
take
any
questions.
If
you
have
any.
A
Thank
you
so
for
members
of
the
committee,
I
want
to
acknowledge
that
this
is
a
long
bill
with
a
long
set
of
amendments,
34
pages
to
be
exact,
and
so
what
what
I'm
my
intent
would
be
is
to
go
ahead
and
have
some
questions
here
today
and
then
I'm
gonna
encourage
miss
flood
to
reach
out
to
each
of
you
to
see
if
you
want
any
one-on-one
time
to
kind
of
go
through
to
be
able
to
match
up
the
amendments
with
the
bill,
and
then
I
wanted
to
let
you
know
that
our
legal
counsel,
mr
robbins,
is
also
meeting
with
the
bill
sponsors
to
go
through
the
amendments
to
make
sure
that
what
they're
proposing
legally
makes
sense,
and
so
there's
still
some
more
work
to
be
done
there.
A
So
we'll
be
coming
back
with
more
information
on
this
one.
But
I
also
want
you
to
it's
a
relatively,
not
relatively
it's
a
very
complex
issue,
with
a
long
bill
with
a
lot
of
amendments.
So
I
encourage
you
to
find
the
time
to
meet
with
jessica
if
you
haven't
already
already
so
with
that
I'll
go
ahead
and
open
it
up
for
questions.
O
Thank
you
so
much
chair
ready.
My
question
is
for
miss
flood
and
it
circles
around
section
22,
and
you
know
kind
of
dovetailing
with
that
story
that
you
mentioned
of
the
the
young
woman
who
was
you
know
in
a
mental
health
crisis
and
ended
up
being
charged
for
assault?
Is
there
some
way
or
do
you
or
do
you
have
any
concerns
that
when
a
peace
officer
comes
to
kind
of
effectuate,
you
know
this
order?
O
I'm
guessing
people
especially
aren't
going
to
be
willing
to
go
that
the
police
officer
at
that
time
because
of
some
scuffle
or
some
issue
may
end
up
deciding
to
take
them
to
jail.
Instead.
Are
there
any
safeguards
around
ensuring
that
the
person
is
actually
going
to
enter
into
the
mental
health
system?
At
that
point,
or
will
peace
officers
still
be
able
to
essentially
decide
to
arrest
them
because
they're
being
too
aggressive
or
or
whatever
the
case
may
be,.
R
Thank
you,
senator
dallas.
That
actually
is
not
something
that
is
contemplated
in
the
law
and
we'd
be
happy
to
work.
On
that
with
you
to
see,
however,
we
can
make
sure
that
that
person
does
track
into
the
mental
health
system.
I
Absolutely
chair
callers
wishing
to
testify
in
support
of
the
bill.
Please
press
star,
9
now
to
take
your
place
in
the
queue
once
again
to
testify
in
support.
Please
press
star,
9.
I
I
L
L
Sorry
about
that,
it
took
me
a
minute
to
unmute
good
evening,
chair
ratty
members
of
the
committee
for
the
record.
My
name
is
katie
ryan,
k-a-p-I-e
ryan,
and
I
am
system
director
of
nevada
government
relations
for
dignity,
health,
saint
rose
dominican.
I
have
provided
a
letter
of
support
to
the
committee
on
behalf
of
saint
rose
and
I
just
wanted
to
briefly
say
again
how
proud
we
are
to
be
a
part
of
the
statewide
mental
health
crisis
working
group
for
the
last
two
interim
sessions.
I
N
Good
evening,
this
is
kendra
birchie,
k-e-n-d-a,
birchie,
b
e
r
t
s
c,
h
y
and
I'm
with
the
washoe
county
public
defenders
office
good
evening
senate,
and
I
want
to
start
by
thanking
the
sponsor
of
this
bill.
My
office
was
part
of
the
working
group
that
helped
to
work
on
this
bill
in
order
to
ensure
that
we
are
cleaning
up
the
language
regarding
our
individuals
who
are
involved
in
involuntary
commitment
hearings.
Just
for
this
committee's
information,
we
represented
2185
individuals
just
this
past
year,
so
in
2020
in
involuntary
commitment
hearings.
N
Also,
I
want
to
just
mention
with
senator
harris's
example
and
ms
blood's
example.
Unfortunately,
that
is
something
that
happens
more
often
than
not
where
there
are
times
that
individuals
and
or
involved
in
a
mental
health
crisis
end
up
going
into
jail
rather
than
into
the
mental
health
treatment
facilities.
N
I
would
just
note
that
section
11
regarding
the
definitions
for
when
someone
is
to
be
involved
in
involuntary
commitment.
The
intent
is
not
to
expand
and
rather
capture,
more
people,
and
so
that
is
something
that
we'll
be
following
closely
with.
If
this
bill
does
become
law,
just
to
make
sure
that
we
are
really
focusing
on
those
individuals
of
need.
I
would
also
note
that
we
are
very
happy
with
the
way
that
the
assisted,
outpatient
treatment
program
is
dealt
with
in
this
law.
We
know
that
it
are
in
this
bill.
N
I
K
The
comments
that
ms
burchie
made
nacj
thinks
that
this
is
a
good
bill,
a
strong
framework.
I
I
L
A
For
the
secretary
for
the
record,
I
don't
think
it
was
very
easy
to
hear
her
name,
so
that
would
have
been
john
hall
from
the
federal
hospital
partners
correct.
Thank
you
assembly,
one
go
ahead,
bps.
I
A
I
I
I
I
I
A
Madam
go
ahead
so
we're
going
to
take
joanne
malay,
who
is
with
us
from
the
department
of
behavioral
and
public
health
in
the
video
call?
Yes,
thank.
O
You
chair
ratty
for
the
record
again
joanne
malay.
Thank
you
for
the
opportunity
to
participate
in
sb
70..
The
division
of
public
and
behavioral
health
is
neutral
on
this
bill.
We
did
submit
a
fiscal
note
based
on
introductory
language.
I
am
I'm
not
sure.
I
don't
believe
that
got
posted
quite
yet,
but
I
did
there's
some
previous
language
in
section
11.
That
was
permissible
as
names
and
stamps
are
the
only
aot,
currently
programs,
and
that
position
would
fall
to
us
without
additional
staff
and
other
essentials.
O
A
A
Fantastic,
so
assemblywoman
titus
did
you
want
to
make
any
closing
remarks?
Yes,.
S
Thank
you,
madam
chair,
and
I
appreciate
everybody's
patience.
We've
gone
a
long
time
with
this
committee
hearing
and
especially
with
the
two
bills
that
are
so
very
important
bill.
So
I
appreciate
you
hearing
them
early
on
in
the
session,
so
we
can
get
these
right,
so
we
can
get
these
amendments
forward
and
get
these
bills
moving
moving
through,
and
I
just
wanted
to
thank
jessica
and
ali
for
being
involved
and-
and
I
appreciate
all
the
hard
work
everybody's
been
doing.
Thank
you
very
much.
A
Thank
you,
so
I
wanted
we're
going
to
go
ahead
and
close
the
hearing
on
sb-70.
I
wanted
to
commend
the
both
of
the
behavioral
health
policy
boards
for
wrangling
a
lot
of
stakeholder
engagement,
starting,
I
know
with
both
boards
well
over
a
year
year
and
a
half
ago
to
to
solicit
ideas
to
work
through
these
processes
to
continue
to
work
on
the
bills
from
when
they
were
submitted
in
september
up
until
the
literally
moments
before
the
meeting.
A
It
was
a
lot
of
stakeholder
engagement
from
a
lot
of
different
angles,
and
so
I
I
appreciate
I
want
to
commend
nelson
narajo
from
the
2017
session
for
having
the
wisdom
to
see
that
having
these
community
boards
would
be
a
good
mechanism
for
having
local
stakeholder
engagement
to
bring
us
great
ideas.
So
thank
you
to
all
of
you
for
that.