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Description
This is the third meeting of the 2021-2022 Interim. Please see the agenda for details.
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
Videos of archived meetings are made available as a courtesy of the Nevada Legislature.
The videos are part of an ongoing effort to keep the public informed of and involved in the legislative process.
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A
Welcome
to
the
third
meeting
of
the
joint
interim
standing
committee
on
health
and
human
services,
we're
going
to
go
ahead
and
call
the
role
first
for
those
members
attending
virtually.
Would
you
please
turn
on
your
cameras
and
respond
when
you
hear
your
name,
miss
rowe,
please
call
the
roll
senator
hardy.
B
A
Here
and
chair
peters-
and
I
am
here-
please
go
ahead
and
mark
assemblyman
haven
when
he
arrives
as
present.
I
believe
he
was
just
running
a
few
minutes
late
before
we
get
started
with
public
comment.
I
want
to
just
take
a
moment
for
us
to
have
some
silence
for
the
folks
and
the
ukraine
who
are
dealing
with
the
atrocities
to
their
country
and
and
think
on
them
for
just
a
minute.
If
we
would
please.
A
A
This
particular
area
of
focus
and
our
agenda
today
can
be
very
personal
to
folks,
and
I
appreciate
the
emotions
that
come
up
from
the
discussion.
This
is
a
heavy
issue
and
I
want
to
respect
what
comes
up
for
us
in
this
area.
So
please,
let
me
know
if
you
need
to
step
away
at
any
point,
depending
on
the
time
we
need
for
the
first
part
of
the
agenda.
A
We
are
planning
to
take
a
lunch
break
around
noon
and
I
believe
that
there
should
be
lunch
available
for
you
down
in
grant
sawyer,
and
we
have
lunch
available
up
here
for
me
and
staff.
A
I
didn't
I
didn't
know
what
comma
right?
Okay,
I'm
gonna
go
over
some
housekeeping
we're
doing
a
little
bit
of
a
different
forum
here
today
with
three
different
locations,
so
just
to
keep
things
clean.
I
want
to
remind
folks,
please
silence
all
of
your
electronic
devices,
especially
cell
phones
and
laptops
during
the
meeting
for
members
joining
online.
Please
also
mute
your
microphones
when
you
are
not
speaking
but
leave
your
camera
on,
so
we
can
ensure
we're
maintaining
a
quorum
and
know
who's
present
at
all
times.
A
Additionally,
I
ask
our
presenters
on
the
zoom
video
call
to
leave
your
cameras
off
and
microphones
muted.
Until
I
call
up
the
agenda
item
under
which
you
are
presenting,
or
I
will
direct
any
questions
to
you,
the
zoom
call
has
a
chat
feature.
However,
this
feature
is
only
to
be
used
for
technical
assistance.
Any
links
or
information
that
you
would
like
to
share
during
your
presentation
should
be
stated
verbally
on
the
record,
and
those
links
can
also
be
sent
to
staff
to
disseminate.
A
A
A
If
you
do
not
testify,
you
may
also
want
to
sign
in
so
there's
a
record
of
who
is
interested
in
this
particular
topic
and
in
the
event,
the
committee
needs
to
contact
you
later
when
testifying
in
person.
Please
turn
the
microphone
on
to
speak
and
off
to
listen.
We
have
listeners
and
viewers
in
las
vegas
and
online.
We
are
recording
this
meeting
and
it
will
be
available
on
the
legislature's
website.
A
We
will
have
a
public
comment
period
at
the
beginning
and
end
of
the
meeting
public
comment
is
limited
to
three
minutes
per
speaker.
In
addition
to
testifying
in
person,
members
of
the
public
may
provide
public
comment
in
four
different
ways,
all
of
which
are
listed
on
the
agenda.
You
can
provide
com
public
comment
by
calling
669-900-6833.
A
A
A
With
that
we'll
go
ahead
and
move
on
to
public
comment,
public
comment
will
be
limited
to
three
minutes
per
speaker
staff.
Will
each
we'll
time
each
speaker
during
public
comment
to
ensure
everyone
has
a
fair
opportunity
to
speak?
We
also
ask
that
you
do
not
repeat
what
is
pre.
What
a
previous
commenter
stated,
an
additional
additional
opportunity
to
make
public
comment
will
be
available
at
the
end
of
the
meeting.
We
will
start
the
public
comment
from
those
in
the
physical
locations
and
then
move
to
public
comment
from
anyone
who
has
called
in.
A
D
I
am
so
grateful
that
you
are
taking
up
this
very
important
topic
today.
I
am
the
statewide
family
network
director
for
nevada
pep
and
a
certified
family
peer,
specialist
nevada
pep
is
the
statewide
family
network
designated
by
samhsa
to
support
families
of
children
and
youth
with
mental
health
care
needs.
D
I
am
the
mother
of
two
young
men
who
grew
up
here
in
nevada
who
both
have
behavioral
and
health
care
and
mental
health
care
needs,
and
we
just
continue
to
support
families
to
ensure
that
they
have
somebody
who
has
walked
that
walk
and
can
walk
alongside
them
to
support
them
in
whatever
way
they
need.
So.
Thank
you
very
much.
A
Thank
you,
miss
frost,
it's
great
to
see
some
familiar
faces.
Are
there
additional
folks
in
las
vegas?
Who
would
like
to
come
up
for
public
comment?
I
am
not
seeing
anybody
approach
the
diocese,
in
which
case
we
will
move
on
to
our
virtual
or
call
in
public
comment
broadcast
and
production
services
or
bps
staff
will
interact
with
those
making
public
comment
to
facilitate
participation
in
the
meetings.
Bps.
Please
add
the
first
caller
with
public
comment
to
the
meeting.
E
F
Today
you
will
hear
several
policy
suggestions,
many
of
which
pediatricians
at
the
nevada
aap
support
through
me.
My
members
are
asking
that
you
prioritize
three
in
particular,
later
school
start
times
stronger
gun
laws
and
state
support
for
the
pediatric
access
line,
I've
detailed
all
three
in
my
written,
submitted
public
comment
earlier
today.
F
The
nevada
aap
currently
has
280
members,
most
of
whom
are
board
certified
pediatricians.
Both
primary
and
specialty
care
members
also
include
pediatric
nurse
practitioners,
physician
assistants,
pediatric
residents
and
medical
students,
all
of
whom
live
and
work
in
nevada
and
have
dedicated
their
professional
lives
to
the
health
of
all
children.
Thank
you.
E
A
We
will
go
ahead
and
move
on
to
close
public
comment
and
move
on
to
agenda
item
three
approval
of
meeting
minutes
for
the
meeting
on
january
20th
2022..
Now
these
meeting
minutes
are
substantial.
They
are
verbatim
minutes
and
I
staff
has
reviewed
them
multiple
times
for
accuracy
and
content.
Members
of
the
committee.
Are
there
any
questions
regarding
the
minutes.
A
Oh,
thank
you
so
much
seeing
no
other
questions
I
senator
hardy
has
moved
to
approve
the
minutes.
Is
there
a
second.
A
H
A
I
A
A
Eric
robbins,
our
principal
deputy
legislative
council
for
our
committee
will
go
ahead
and
review
these.
These
proposed
regulations.
J
J
From
the
state
board
of
pharmacy
r067-21
from
the
board
of
environmental
health
specialists,
r076-21
of
the
board
of
occupational
therapy,
r118-21
of
the
board
of
medical
examiners
and
r126-21
from
the
state
board
of
health,
the
first
three
of
those
regulations-
r04021,
r06721
and
r07621-
have
all
been
adopted
by
the
agencies
and
are
awaiting
final
hearing
by
the
legislative
commission.
So
they
will
be
heard
at
the
next
meeting
of
the
legislative
commission,
which
has
not
yet
been
scheduled.
J
The
last
two
regulations
are
118-12
and
r126-21
have
not
yet
been
adopted,
and
they
will
still
have
hearings
with
with
the
adopting
or
the
proposing
agencies.
A
Thank
you,
mr
robbins.
Are
there
any
questions
from
the
committee
regarding
these
regulations.
G
Titus
go
ahead,
so
I
just
thank
you.
I
just
want
to
make
a
comment.
We
don't
really
have
to
have
them
come
up,
but
but
I
want
to
acknowledge
the
state
board
of
pharmacies
regulation
where
they're
changing
the
terminology
to
section
one
to
to
using
the
term
reciprocity
without
having
to
show
the
actual
documentation.
So
I
appreciate
that.
I
think
that
we
need
to
this
access
to
care
and
some
of
the
stuff
that
we're
doing
is
so
important
by
expanding
this
this
process
of
licensure
to
to
expedite
it.
A
A
Which
begins
our
presentations
agenda
item
5
is
an
overview
of
nevada's
children's
mental
and
behavioral
health
surveillance
data.
I
just
want
to
thank
staff
for
the
suggestion
of
starting
with
the
data
first
before
we
dive
into
the
discussion
of
actions
on
the
ground
and
potential
actions
in
the
future.
A
K
K
Thank
you
again,
dr
megan
freeman,
for
the
record.
Thank
you
so
much
for
having
me
here
today
on
this
agenda
in
this
particular
agenda
item,
as
well
as
the
state
children's
behavioral
health
authority.
I
am
thrilled
that
we
will
spend
most
of
today
discussing
the
needs
of
children
and
families.
K
K
K
In
this
case,
it
would
be
mental
illness
or
behavioral
health
need,
so
in
increasing
awareness
and
improving
understanding
about
the
struggles
and
the
needs
of
those
living
with
behavioral
health
conditions.
We
are
working
to
break
down
that
stigma
and
reinforce
the
idea
that
behavioral
health
is
a
critical
piece
of
overall
wellness.
K
K
Statistically,
a
number
of
us
in
this
room
or
on
zoom
at
the
meeting
today,
either
struggle
with
our
own
behavioral
health
or
we're
supporting
a
loved
one
who
does,
but
very
few
of
us
here
would
probably
be
willing
to
stand
up
and
identify
ourselves
as
such
in
a
public
forum
next
slide.
K
But
87
percent
of
americans
agree
that
having
a
mental
health
disorder
is
nothing
to
be
ashamed
of.
So
why
are
we
so
reluctant
to
share
this
information
with
others?
If
it's
what
we
believe
so
the
goal
for
those
of
us
working
in
the
behavioral
health
space
is
for
it
to
be
as
acceptable
to
seek
treatment
for
a
mental
or
behavioral
health
need,
as
it
is
to
tell
your
friends
or
your
boss
that
you
went
to
the
doctor
to
get
your
thyroid
checked
or
because
you
sprained
your
ankle
next
slide.
K
The
answer
is,
more
than
two-thirds
childhood
trauma
places
a
person
at
risk
for
a
number
of
negative
outcomes,
not
only
as
children
but
also
as
an
adult.
So
this
includes
chronic
health
conditions
as
well
as
premature
death,
and
these
are
public
health
level,
exposure
statistics,
outcomes
and
prevention
opportunities.
K
K
So
this
is
my
last
thought,
thought
slide
for
the
day.
You
might
already
think
about
this
a
lot,
but
I'm
going
to
pause
for
just
a
moment
to
give
everyone
a
minute
to
reflect
on
this
intentionally
this
morning.
Who
haven't
you
seen
in
a
long
time
that
you
miss
because
of
the
pandemic?
K
What
routines
were
disrupted
that
you
never
had
a
chance
to
pick
back
up
what
life
events
or
milestones?
Do
you
or
your
children
miss
out
on
and
do
you
feel
that
anything
good
has
come
into
your
life
or
there
have
been
any
positive
changes
either
personally
for
you
or
for
our
society
because
of
the
pandemic.
K
So
I
asked
you
to
reflect
on
your
pandemic
experience
partially,
because
I
think
it's
important
for
all
of
us
to
do
that
from
time
to
time
and
partially,
because
it's
impossible
to
talk
about
behavioral,
health
or
wellness
right
now.
Without
acknowledging
the
impact
of
the
pandemic,
the
pandemic
has
had
a
ripple
effect
across
systems
where
we
all
have
our
own
individual
experience
of
the
pandemic
and
we're
coping
with
our
own
struggles
related
to
that,
and
then
we
all
live
within
multiple
systems
that
have
also
been
impacted.
K
So
for
most
people
that
includes
a
family
system,
your
employer,
a
system
of
health
care
providers
that
you
depend
on
to
keep
you
healthy
and
and
functioning
at
your
best
and
a
support
system
of
friends
and
acquaintances
that
you
rely
on
for
social
support
and
almost
everyone,
I
know,
has
experienced
disruptions
in
all
of
these
systems.
So
so
think
about
that.
K
For
yourself
as
an
adult
and
then
for
children,
the
impact
has
been
magnified
because
outside
their
family
system,
the
biggest
system
they
rely
on
to
ensure
they're
keeping
on
track
with
healthy
development
is
their
school
system
or,
if
they're,
a
young
child.
A
child
care
provider,
they
experienced
sudden
disruptions
in
these
systems
as
well
as
in
many
cases,
sudden
isolation
from
extended
family
or
caregivers.
K
They
relied
on
like
grandparents
or
regular
babysitter
or
nanny
and
at
the
same
time,
their
parents
or
caregivers
were
likely
experiencing
one
or
many
pandemic-related
stressors
like
financial
instability,
food
insecurity,
housing
instability,
they
may
have
been
working
from
home.
There
were
school
and
child
care
center
closures
that
were
very
obviously
widespread,
and
then,
of
course,
there
was
illness.
K
So,
whereas,
typically
in
a
disaster
or
emergency,
we
would
move
through
a
series
of
well-defined,
relatively
well-defined
coping
stages
from
initial
impact
through
response
and
recovery.
There's
fairly
well
understood,
emotional
reactions
and
milestones
at
each
phase
for
an
individual
and
for
a
community.
The
covenanting
pandemic
has
been
more
of
a
circular
experience,
so
every
time
we
think
we've
made
our
way
through
a
phase.
Something
else
happens,
there's
a
new
variant
or
something,
and
the
whole
thing
starts
over.
K
K
K
Excuse
me,
the
goal
of
the
survey
is
to
produce
near
real-time
data
on
the
social
and
economic
effects
of
cobit
19.,
so
the
recent
data
from
the
cdc,
the
most
recent
data
I
could
get-
was
the
week
of
january
26
through
february
7th
of
this
year.
That
data
demonstrates
that
nevadans
are
not
doing.
Okay,
we
are
ranked
fourth
in
the
nation,
and
37
of
adults
are
reporting,
symptoms
of
anxiety
or
depression,
that's
more
than
one
in
three
and
and
ranking.
K
Fourth
in
this
case
is
not
a
good
thing
so
check
on
your
friends
check
on
your
neighbors,
your
family
check.
In
with
yourself
it's.
It
is
okay
to
not
be
okay.
K
Moving
on
to
the
available
data
on
children
and
adolescents,
this
is
data
from
a
meta-analysis
published
in
2021.
It
shows
the
impact
of
the
pandemic
on
children
and
youth
globally.
So
one
in
five
children
and
adolescents
globally
are
currently
experiencing
clinically
significant
symptoms
of
anxiety
and
one
in
four
are
experiencing.
Clinically
significant
symptoms
of
depression,
next
slide.
K
As
ms
mcallister
noted
during
the
public
comment,
a
state
of
emergency
in
children's
mental
health
was
officially
declared
in
october
2021
by
the
organizations
listed
here.
The
reasons
cited
in
the
proclamation,
including
the
ongoing
pandemic
physical
isolation,
uncertainty,
fear
and
grief
that
children
are
experiencing,
as
well
as
a
45
increase
in
the
number
of
pediatric
self-injury
and
suicide
cases
seen
at
children's
hospitals
during
the
time
period
of
january
june
2021
compared
to
the
same
time
period
in
2019..
K
So
this
declaration
reflected
escalating
concerns
among
professionals
everywhere
due
to
trends
that
have
been
seen,
and
these
same
trends
are
being
seen
in
nevada
following
president
biden's
state
of
the
union
address
on
march
1st,
which
I'll
talk
about
in
a
minute
where
he
specifically
referenced
children's
mental
health.
The
american
academy
of
pediatrics
is
now
calling
on
the
biden
administration
to
declare
the
children's
mental
health
emergency
a
national
public
health
emergency.
K
So
this
declaration
by
these
groups
urged
policymakers
to
take
several
actions,
including
increasing
federal
funding,
to
improve
access
to
services.
K
K
K
K
So
moving
on
to
a
little
bit
of
data
in
terms
of
the
baseline
of
where
we're
at,
as
we
think
about
making
changes
that
align
with
national
priorities,
I'm
sure
that
you've
probably
heard
that
we
rank
51st
overall
for
mental
health
as
well
as
51st
for
youth
mental
health.
According
to
the
organization
mental
health,
america,
they
publish
an
annual
report
with
rankings
and
break
down
the
rankings
in
several
different
ways.
So
this
is
excuse
me.
This
has
been
the
case
on
their
annual
report
for
the
past
several
years.
K
The
rankings
are
based
on
different
factors,
including
the
prevalence
of
behavioral
health
disorders
and
access
to
care.
We
also
have
a
local
organization
called
the
children's
advocacy
alliance
that
does
annual
rankings
on
children's
metrics.
They
recently
produced
a
special
children's
mental
health
report
card,
which
also
indicated
that
we
have
substantial
room
for
growth
in
our
system
in
order
to
meet
the
needs
of
children,
youth
and
families.
K
Slide
with
regard
to
school-based
behavioral
health,
despite
the
fact
that
we've
made
significant
recent
gains,
there's
been
a
ton
of
hard
work
by
department
of
education
and
our
local
school
districts,
but
we
are
still
quite
far
off
from
the
recommended
targets
for
school
support
professionals,
including
social
workers,
psychologists
and
counselors
next
slide
in
terms
of
providers
available.
Overall,
throughout
the
public
and
private
behavioral
health
systems,
we
again
fall
quite
far
short
of
the
recommended
targets
when
it
comes
to
licensed
behavioral
health
professionals
in
nevada.
K
K
So,
to
summarize,
at
this
point,
we've
discussed
the
exacerbation
of
mental
health
need
due
to
the
pandemic,
a
system
that
was
inadequate
to
meet
the
needs
prior
to
the
pandemic,
significant
behavioral
health,
workforce
shortages
that
predate
the
pandemic
and
we're
also
currently
experiencing
nationwide,
a
record
number
of
folks
leaving
the
healthcare
field
which
includes
behavioral
health
care.
So
one
of
the
consequences
of
this
is
that
we've
had
a
greater
than
average
number
of
youth
going
into
behavioral
health
crisis
and
seeking
care
in
the
emergency
department.
K
In
addition
to
the
emergency
department,
children
and
families
experiencing
behavioral
health
crisis
have
been
contacting
the
state
children's
mobile
crisis
response
team
at
an
increased
rate
since
the
onset
of
the
pandemic.
Thankfully
dhhs
was
recently
granted
american
rescue
plan
funding
to
temporarily
expand
mobile
crisis
in
order
to
meet
the
need.
Although
the
team
does
continue
to
work
at
or
close
to
capacity
and,
of
course,
we'll
talk
more
about
crisis
services
in
detail
later
today.
K
K
Additionally,
educators
and
school
staff
are
leaving
their
jobs
in
record
numbers
and
those
who
have
stayed
are
worried.
They're
stressed
they're
burned
out,
so
any
parents,
caregivers
or
educators,
who
are
in
the
room
or
watching
online.
I
see
you,
I
acknowledge
your
struggle.
I
am
a
parent
to
what
you
are
going
through
right
now
is
completely
normal.
It's
not
easy
to
fill
any
of
these
roles
on
a
good
day
and
two
years
into
a
global
pandemic.
This
is
an
extra
tall
order.
K
K
K
A
A
A
It's
made
things
very
difficult,
especially
as
a
child
without
resources,
I
have
turned
into
a
functional
adult,
but
I
still
deal
with
it
regularly.
I
also
in
the
last
year
or
so
have
realized
that
I
have
lived
with
undiagnosed
adhd.
A
K
This
is
dr
freeman
for
the
record,
chair
peters.
I
just
want
to
thank
you
so
much
for
sharing
that
with
us.
I
know
that
it
is
incredibly
scary
to
share
something
like
that
with
just
one
person
in
a
forum
like
this,
and
I
want
to
thank
you
for
your
incredible
bravery.
This
is
how
we
break
down
the
stigma
and
build
the
system
that
we
need
to
do
exactly.
A
Well,
I
want
to
extend
a
thank
you
to
all
of
the
folks
who
are
working
in
this
area
and
for
the
support
that
you
are
creating
for
this
generation
of
kiddos,
and
I
hope
that
parents
who
are
watching
watch
out
for
access
to
those
and
take
advantage
of
them
as
you
can
your
children
need
them
and
need
your
help
getting
to
them
and
without
without
parents
who
can
help
them
or
other
adults
who
can
help
children,
it's
really
difficult
to
have
and
find
access
to
those
kinds
of
care
and
support
all
right.
A
A
I
Thank
you,
and
by
my
process
what
I'll
usually
do
I
usually
raise
my
hand
in
the
using
the
raised
hand
button,
and
just
in
case
you
don't
see,
I
may
start
doing
like
this,
but
thank
you
trippiness.
I
want
to
say
first
of
all,
thank
you
for
sharing
your
story.
I
I
think
that
it's
very
important
that
those
of
us
who
are
in
public
service
and
to
whatever
the
degree
is
that
people
think
we've
been
successful.
I
think
that
it's
important
for
people
to
know
that
we
struggle
I
I
was
not
diagnosed
with
my
adhd
went
undiagnosed.
I
guess
I
should
say
up
until
I
started
my
master's
program
and
always
thought
not
weird,
but
just
knew.
I
was
different
and
there's
always
an
amusement
park
going
off
in
my
head.
I
I
tell
people,
and,
and
so
just
trying
to
focus
sometimes
is-
is
a
challenge,
but
I've
learned
how
to
do
some
of
those
things
doctor.
I
just
want
to
thank
you
for
the
report
that
you
gave
a
couple
of
questions,
and
these
are
themes
that
I
have
addressed
in
other
committee
meetings,
not
just
during
the
interim,
but
also
during
this
session.
I
I
know
that
covet
had
a
an
adverse
effect
on
children
in
general
and
on
families
in
general,
but
the
complications
in
the
exacerbation
which
have
confronted
members
of
bipolar
communities
is
inescapable
when
we
think-
and
it's
not
just
people
of
color,
I'm
thinking
about
especially
those
in
indigenous
communities,
and
it
has
been
my
lament
since
we
started
talking
and
tackling
some
of
the
vicissitudes
of
covet
in
the
special
session
under
20
that
we
have
not.
I
At
least
I
have
not
seen
programs
that
have
been
designed
specifically
and
culturally
sensitive
to
the
needs
of
those
communities,
for
example,
whatever
mental
and
emotional
health
services
that
are
available
in
communities
of
color.
You
can't
it
can't
be
something
one
over
the
world
call
call
the
county
and
they'll
direct
you
to
someone
as
someone
who's
been
black
all
of
her
life.
We
just
started
believing
mental
health
services
ten
minutes
ago.
So
I'm
not
going
to
go
to
someone
that
I
don't
know
and
and
and
making
it.
I
You
know
something
as
anonymous
and
even
in
some
ways
innocuous
as
go
someplace
to
talk
to
someone
about
something,
that's
not
going
to
happen.
So
that
would
be
the
first
one,
the
second
one
that
I'll
say
is
that
we
we
did
pass
some
legislation,
a
couple
pieces
of
legislation.
Both
bills
were
mined.
One
was
in
2017,
where
we
passed
a
bill
requiring
the
secretary,
the
state
superintendent
of
education,
to
provide
another
column
next
to
the
star
rating
for
schools
that
listed
the
social
determinants
and
what
that
was
supposed
to
do.
I
It
was
designed
for
to
alert
us
as
legislators
and
other
agencies
such
as
ghhs,
to
know
that
these
are
some
places
where
we
need
targeted
support,
and
so,
when
you
stop
and
you
look
at
the
effects
of
cobit
and
you
look
at
especially
in
bipod
communities
where
there
have
been
generational
deaths
in
one
family.
That,
I
believe,
is
the
social
determinant.
When
you
you
look
at
what
the
fallout
from
the
opioid
abuse,
that's
the
social,
social
determinant
and
and
and
that
is
across
social,
economic,
social,
economic
spectrum.
I
But
it
has
been
more
prevalent
if
you
will
in
some
of
our
more
rural
communities
and
that
we
don't
talk
about
because
in
the
frontier
communities
we,
you
know,
people
are
usually
thought
of
as
rugged,
and
we
can
do
this,
but
that
such
is
not
the
case
so
number
one.
What
if
anything,
have
we
done
or
what
are
we
planning
to
do
to
make
sure
that
services
are
targeted?
Specifically,
I
I
get
the
general,
but
I'm
speaking
about
some
things
that
we
have
to
do
with
greater
specificity.
I
If
we're
going
to
come
out
of
this
hole
for
bipod
communities
and
then
how
are
we
using
the
information
that
we're
receiving
from
the
covet
numbers
to
push
forward
to
the
department
of
education
to
say
these
are
some
of
the
things
that
need
to
be
included
in
the
star
rating
and
and
along
those
same
lines?
I
Is
the
suicide
prevention
bill
and
the
the
number
escapes
me
now,
I
believe,
was
266,
but
I
I
can't
be
sure,
but
in
2019
the
suicide
prevention
bill
required
that
all
schools-
and
it
was
it
was
to
be
developed
at
the
local
level-
would
would
develop
some
system
of
education
so
that
everyone
who
was
in
contact
with
students
that
stu
that's
teachers,
staff,
administrators,
cafeteria
workers,
everybody
would
be
trained
in
understanding
some
of
the
basic
some
of
the
basic
red
flags.
I
If
you
will
for
suicide
ideation,
because
now
that
we're
back
in
school,
everyone
hollered
about
let's
get
them
back
in
school,
but
now
we're
back
in
school,
and
you
have
students
who
are
dealing
with
this
stuff
and
they're
dealing
with
it
in
a
congregational
aspect
and
that
that
cannot
not
be
easy
and
mad.
I'm
sure
if
you're
just
indulging
those
are
the
first
three
questions
but-
and
I
just
want
to
say
these
last
two
and
then
I'll
be
quiet.
The
other
one
that
we
don't
talk
about.
I
A
lot
are
lgbtq
youth
and
it's
not
just
the
lgbtq
youth
who
identify
themselves
as
such.
But
it's
it's
it's
youth
who
are
in
same-gendered
families
or
in
families
that
the
composition
doesn't
look
like,
leave
it
to
beaver,
and
so
we've
got
it.
We've
got
to
deal
with
that.
Then
we
have
our
seasoned
citizens,
who
the
isolation,
if
you
will
has
been,
has
exacerbated
their
loneliness,
and
I
don't
think
it
is
coincidence
that
in
nevada
we
have,
if
not
number
one
we're
number
two
on
completion
of
suicide
by
seniors.
I
And
last
but
not
least,
is
there
anything
that
we
have
done
to
work
with
department
of
veterans,
administration
or
with
department
of
defense,
with
some
of
the
military
bases
that
are
in
our
communities
to
make
sure
that
military
families,
these
these
sorts
of
things,
are
being
addressed
for
military
families
as
well,
because,
unlike
when
I
was
overseas,
all
the
schools
were
on
base
and
so
that
community
was
there.
I
I'm
gonna
turn
my
my
camera
off
because
the
the
internet
is
unstable
when
it's
on,
but
I'm
still
here,
okay
and
I'm
listening.
Thank
you,
madam
chair.
A
A
A
lot
of
your
questions
were
questions
that
I
also
have
not
just
for
dr
freeman,
but
for
some
of
our
other
presenters
as
we
move
through
the
agenda
today.
So
I
would
ask
miss
dr
freeman.
If
you
have
any
particular
comment
related
to
the
questions,
senator
spearman
has
brought
up,
and
I
would
also
ask
that
our
other
presenters
who
are
here
today
consider
some
of
those
in
their
presentations
as
they
discuss
the
particulars
of
what
they're
here
to
talk
about.
So,
dr
freeman,
please,
please
go
ahead.
If
you
have
responses.
K
Sure
this
is
dr
fermin
for
the
record,
through
you,
chair,
peters,
to
senator
spearman.
Thank
you
so
much
for
raising
these
important
issues.
One
of
the
we'll
talk
more
about
system
of
care
later
today
and
we'll
we'll
define
what
that
means,
as
a
philosophy
and
as
an
approach
to
children's
behavioral
health
services.
K
But
one
of
the
underlying
values
is
culturally
and
linguistically
appropriate
services,
and
I
think
that
it's
easy
to
sort
of
put
a
check
mark
and
say:
oh
yeah,
like
we
train
our
staff
on
that
and
we
have
a
policy,
and
so
like
we're
doing
you
know
cultural
competence
or
whatever,
and
obviously
that's
not
the
solution.
I
I
felt
like
you
were
peeling
an
onion
while
you
were,
while
you
were
talking
and
at
every
layer
I
was
like.
Oh
man
like
we
need
to
be
doing
more.
K
Oh,
we
need
to
do
more
on
that
and
it's
all
very
complex
and
it's
intersectional
right.
So
some
children
and
families
are
going
to
fit
into
all
of
the
the
specialized
populations
that
you
just
mentioned.
K
So,
while
this
is
an
area
that
we're
extraordinarily
committed
to
hhs
has
been
committed
to
diversity,
equity
and
inclusion
and
has
had
some
some
special
initiatives
related
to
that
recently,
it's
something
where
you
know
you've
never
arrived,
you're,
never
culturally
competent,
and
I
can
say
that
in
terms
of
providing
specialized
services
for
these
populations,
that
is
absolutely
something
that
we
need
to
work
harder
at
and
we
need
to
consider
the
impact
of
the
pandemic
and
the
intersectionality,
like
I
said
so,
there's
absolutely
room
for
growth
here
and
hopefully
you
will
be
willing
to
work
with
us,
because
some
of
your
thoughts
and
ideas
were
just
incredibly
valuable.
A
A
Thank
you,
senator
senator
hardy
has
a
question
and
assemblywoman
gorlo
also
has
a
question.
We
we
do
have
quite
a
stacked
agenda
at
this
point,
so
I
want
to
encourage
that
these
questions
be
specific
to
the
data
that
was
presented
by
dr
freeman
and
that
other
questions
may
be
answered
by
some
of
our
other
presenters
down
the
line.
A
E
I
come
from
a
medical
model
and
I
think
one
of
the
challenges
that
we
have
is
being
judgmental
on
people
who
quote
unquote
may
have
a
perceived
weakness
and
the
reality
is.
These
are
real
entities
that
have
treatments
and
then
it's
up
to
us
to
make
affordable
and
available
the
treatments
that
exist
and,
over
and
above
everything,
else
the
hope
that
parents
and
children
can
have
that
we
can
help.
E
I
think
one
of
the
challenges
that
we've
had
that
I'm
not
sure
you
mentioned,
is
much
as
the
screen
time
issues
that
we
used
to
complain
about
and
then
what
we
did
is
we
magnified
them
when
we
sent
the
kids
home
with
their
tablets,
and
so
it
wasn't
unanticipated
that
we
would
have
problems
and
sure
enough.
We
have.
E
But
again,
I
think,
there's
hope
and
I
think
the
medical
model
working
with
the
behavioral
model
almost
goes
hand
in
glove
on
this,
and
I,
I
suspect,
you're,
seeing
the
need
for
the
medical
model
as
leanne
mcallister
was
probably
alluding
to
when
she
talked
about
the
pediatricians.
Thank
you,
madam
chairman,.
K
This
is
dr
freeman
for
the
record.
I
will
just
briefly
say
that
integrating
behavioral
health
services
into
primary
care
is
an
extraordinarily
effective
strategy
and
works
very,
very
well
elsewhere,
and
it's
absolutely
something
that
we
should
be
keeping
towards
the
top
of
our
our
to-do
list
as
a
strategy.
A
Thank
you,
dr
fuhrman.
I
absolutely
agree.
I've
had
a
number
of
friends,
family
members
and
colleagues
over
the
the
last
two
years,
who
have
successfully
addressed
some
of
their
behavioral
health
issues
through
their
primary
provider,
and
I
think
that
that
has
really
opened
a
door
to
folks
thinking
that
there's
something
larger
going
on
with
them
and
not
having
to
kind
of
dissect.
What
that
looks
like
instead,
have
it
be
more
holistic
and
accessible
assemblywoman
gorlo.
Please
go
ahead
with
your
question.
F
Thank
you
very
much
chair
peters,
and
I
will
try
to
make
my
question
brief.
I'm
looking
at
slide,
19
and
very,
I
guess,
really
unsurprised
at
how
short
we
are
on
behavioral
health
providers
twice
as
many
school
counselors
were
short
3.7
times
for
school
psychologists
and
35
times
for
social
workers.
F
K
Dr
freeman,
for
the
record,
through
you,
chair,
peters,
to
assemblywoman
gorlo.
Thank
you
for.
A
K
Thank
you
chair,
dr
freeman,
for
the
record
could
probably
talk
about
this
for
like
a
couple
of
hours,
so
I'll
just
keep
it
brief,
which
is
we
need
to
start
with.
We
need
to
start
with
the
pipeline,
so
we
want
to
we
want
to,
and-
and
some
of
these
initiatives
are
are
already
happening
happening-
we're
doing
some
great
work
already
here
in
nevada.
K
We
want
to
work
with
institutes
of
higher
education
to
more
closely
integrate
the
systems.
We
want
to
make
sure
that
folks
know
that
working
in
public
service
or
working
in
the
schools
is
a
great
option
to
give
them
the
the
baseline
skills
that
they
would
need
to
make
that
transition
provide
practicum
opportunities
so
that
the
transitions
can
be
really
seamless,
but
we
also
need
to
better
incentivize
working
in
those
settings.
K
We
need
to
invest
more
in
recruitment
retention
and
compensation
for
the
folks
doing
this
work
and
it
doesn't
have
to
be
strictly
salary.
I
think
that
student
loan
forgiveness
is
a
hugely
under
leveraged
strategy
and
there's
other
things
that
we
can
be
doing
it's,
but
it
will
take
a
very
comprehensive
approach
to
grow
our
workforce.
We
have
to
really
show
folks
the
benefits
of
coming
into
these
types
of
careers.
A
A
Please
take
your
time
and
think
about
yourself
also
as
we
go
through
this
topic.
I
know
that
it's
already
bringing
things
up
for
me.
A
I
I
don't
know
many
people
who
haven't
lived
through
their
teen
years
and
lost
a
friend
due
to
cert
to
substance
abuse.
So
you
guys
I'm
gonna,
pull
myself
together.
I
promise
please
go
ahead.
A
We
have
two
presenters
under
this
agenda
item
we'll
first
hear
from
on
the
youth,
suicide
trends
and
prevention
efforts
from
misty
von
allen
and-
and
she
is
online
hello,
she's
also
with
the
office
of
suicide
prevention,
and
then
we
will
hear
from
the
safe
voice
program
at
the
nevada
department
of
education
from
christy
mcgill,
the
director
of
the
office
for
a
state
and
respectful
learning
environment.
A
Our
first
first
topic
under
this
is
the
youth,
suicide,
trans
and
prevention
efforts
presented
by
missy,
misty
von
allen.
Please
go
ahead
misty
when
you're,
ready
and
good
to
see
you.
H
H
We
try
and
build
a
team
that
is
willing
to
walk
this
talk,
and
it's
really
important
that
people
can
normalize
these
experiences
because
I
don't
know
a
person
who
hasn't
been
touched
in
some
way
or
other
by
covid
and
then
the
stressors
that
are
ongoing
and
if
they
aren't
feeling
feeling
the
stress
and
strain
they
sure
as
heck
know.
Someone
who
is,
I
need
to
clarify
if
my
powerpoint
is
properly
being
displayed.
E
E
K
H
There
we
go.
Thank
you,
everyone,
good.
I
appreciate
your
patience
with
that.
No
no
amount
of
practice
seems
to
work,
so
I
am
the
suicide
prevention
coordinator
and
division
of
public
and
behavioral
health,
and
I
have
been
in
this
position
since
2005.,
so
I
have
had
the
opportunity
to
see
the
challenges
nevada
has
gone
through
when
it
comes
to
mental
health
and
suicide,
where
we
were
at
the
top
of
the
low
highest
rates
in
the
nation
and
that
started
to
change
in
2001.
So
I'm
going
to
give
you
an
example
of
the
2020
statistics.
H
Dr
freeman
did
a
beautiful
job
of
setting
the
foundation
and
the
national
trends
happening.
So
our
latest
members
about
60
000
people
in
the
united
states
took
their
life
to
suicide.
It
is
the
first
time
suicide
deaths
have
been
bumped
out
of
the
top
ten
nationally
and
for
nevada.
We
dropped
into
the
ninth
leading
cause
of
death
in
nevada.
I
think
kovid
pushed
that
back
out.
The
number
of
dustin
kovitz
firearms
continue
to
be
the
leading
method
of
suicide,
nationally
52.8
percent
and
nevada
61.7.
H
When
we
had
a
focus,
reducing
access
to
lethal
means
program,
we
reduced
our
suicide
firearms
deaths
down
to
52,
almost
the
national
average,
and
then
culture
changed
circumstances,
changed
covet
happened
and
firearm
purchases
increased
mental
health,
stressors
increased,
and
so
you
can
see
the
dramatic
impact
on
firearm
suicide
deaths
up
to
61
every
11
minutes.
Someone
takes
their
life
in
the
united
states
for
nevada,
we're
currently
the
state
with
the
13th
highest
rate
in
the
nation.
H
This
is
only
the
third
time
we
have
been
out
of
the
top
ten,
but
what
I
think
is
remarkable
thirteenth
is
still
tragically
high
and
every
loss
to
suicide
is
tragic,
but
you
heard
dr
freeman
with
our
workforce
challenges
and
access
that
were
51st
on
report
cards
and
f's
on
report
cards.
Yet
our
suicide
rates
in
nevada
have
maintained,
steadiness
or
even
decreased
in
2018.
We
were
the
only
state
in
the
nation
that
decreased
now.
I
know
we
had
a
long
way
to
go,
but
we're
headed
in
the
right
direction.
H
Second,
leading
cause
of
death
for
ages
8
to
44
for
the
past
several
years.
It
was
the
leading
cause
of
death
for
our
young
people,
so
that
has
moved
up
a
bit
and,
as
senator
spearman
mentioned,
our
elders
definitely
have
one
of
the
highest
rates
in
the
nation
and
over
the
decades
we
probably
have
the
highest
rate,
but
currently
for
2020.
We
are
the
fourth
highest
rate
that
has
continuously
been
a
challenging
population
to
get
support
and
resources
to
combat
this
suicide
crisis.
H
We
lose
more
people
to
suicide
than
homicides
and
car
crashes
combined,
and
that
has
always
been
the
case
so
focusing
on
our
youth
zero
to
17.
We
wanted
to
show
you
data
from
2010
to
2020,
because
in
2020
there
was
a
moment
in
time
where
there
were
several
deaths
by
suicide
in
a
very
short
amount
of
time,
and
we
we
received
national
attention.
The
spotlight
was
on
a
certain
region
and
people
called
it
an
epidemic.
I
wanted
you
to
notice.
Our
two
highest
years
were
2011
and
2018.
H
2011,
I
think
we
can
deduce,
was
probably
linked
to
contagion,
media
contagion
linking
it
to
bullying
a
direct
line
when
we
learn
how
to
safe
message
and
safe
media
reporting
that
that
starts
to
reduce
2018.
I
am
not
certain
that
90
of
that
increase
came
in
clark
county,
and
I
wonder
I
can
only
speculate
on
the
impact
of
the
october
when
mass
silence
may
be
having
a
major
impact
on
the
community
as
a
whole
as
it
must
have,
but
we
we
can't
link
that
directly.
H
As
you
see,
2019
and
2020
are
relatively
similar
with
16
losses
and
17,
and
then
preliminary
data
for
2021
looks
to
be
about
same
with
around
18
deaths
that
we
need
to
confirm
that
and,
as
you
can
notice,
the
national
rate
has
been
steadily
increasing
for
our
youth
as
well,
where
nevada's
kind
of
all
over
the
place
and
part
of
that
is
to
look
at
the
years.
13
2013
2014.
It
does
have
a
link
to
social
media
and
on
screen
time.
Absolutely
that
has
huge
impact
on
our
data.
H
H
We
have
the
hispanic
latino
population
coming
with
about
30
percent
of
suicide
deaths,
so
we
are
paying
attention
to
those
changes
in
race
and
ethnicity.
It's
really
important
black
and
african
american
is
also
seeing
some
increases
that
we
want
to
pay
attention
to,
but
these
are
losses
to
suicide,
and
I
think
what
we
really
want
to
want
to
focus
on
are
the
suicide
behaviors,
the
ideations,
where
I
think
some
of
the
cultural
impacts,
the
race
racial
impact
will
be
profound.
H
With
method,
absolutely,
as
I
mentioned,
firearms
are
a
huge
piece
of
this.
When
we
look
at
our
youth,
much
more
male,
youth
use,
firearms
and
females,
we
see
hanging
strangulation,
suffocation
in
current
data
breaking
it
down.
It
was
almost
50
50
from
our
child
fatality
review
data,
so
we
know
one
of
the
most
profound
programs
that
can
impact
suicide
rates
in
our
youth
are
reducing
access
to
lethal
means,
and
we
have
focused
on
this
during
covid,
with
with
coveted
relief
funding.
H
H
I
wanted
to
bring
this
up.
As
I
mentioned,
we
shared
suicide
death
data,
but
where
we're
really
seeing
the
impact-
and
I
know
our
hospitals
and
our
emergency
departments
and
pediatricians-
I'm
hearing
this
so
much-
the
emergency
department
visits
the
inpatient
care
are
increasing,
especially
for
our
youth
ages.
10
to
17..
H
Lgbtq
senator
spearman
brought
this
up.
We
just
do
not
have
sufficient
data
on
this
across
the
board.
I
think
the
most
recent
information
I
can
find
nationwide
is
2016
and
it's
just
not
good
enough.
Culture
and
climate
have
changed,
but
we
do
know
for
lgbtq
populations
and
youth.
The
high
rates
of
suicide
attempts
and
ideation
double
those
that
are
non-soji
for
transgender
youth
and
individuals.
H
41
had
said
they
attempted
suicide,
that's
more
than
double
those
that
are
non
of
the
non-smoking
community
and
we
have
to
find
better
ways
to
connect
these
youth
to
the
resources
and
support
research
has
shown
if
a
young
person
comes
out
as
lgbtq
and
receives
support.
H
Resources,
love
and
respect
that
reduces
their
risk
for
suicide
and
other
mental
health
challenges
if
they
come
into
a
community
or
population
where
it's
unsafe,
with
discrimination,
rejection,
bullying
dramatically
increases
suicide
rates,
so
I
know
there
were
bills
to
focus
on
this
education
and
we
just
cannot
take
our
eyes
off
of
this.
We
need
to
develop
the
safe
spaces,
and
the
department
of
education
has
done
a
beautiful
job
with
the
office
of
safe
and
responsible
learning
environment.
H
Incredible
work
that
we
we
need
to
keep
increasing,
building
this
connection
and
building
the
safe
places
with
respect
for
our
sergey
youth
part
of
our
relationship,
dr
freeman
mentioned
the
bridging
of
divisions
and
departments.
Working
together
is
so
so
important
across
agencies
via
public
and
private
entities.
H
H
Part
of
that
wonderful
partnership
is
with
extra
relief
funding
department
of
education
afforded
the
office
of
suicide
prevention
to
hire
our
first
youth
suicide
prevention
coordinator,
a
remarkable
opportunity
to
really
focus
in
on
our
youth
needs,
and
one
of
the
products
of
that
will
be
to
develop
a
youth
suicide
prevention
strategy.
We
do
have
youth
strategies
in
our
overall
state
plan,
but
we
want
to
hone
in
on
the
immediate
needs,
with
real-time
data
and
partnering,
with
the
department
of
education
and
dcfs.
H
Division
of
child
and
family
services
is
really
imperative
to
that
success,
so
training,
family
and
youth
voice.
As
you
hear
those
with
with
experience
guide
us,
we
need
those
voices
to
help
us
develop
the
plan.
We
need
equity
and
diversity
to
develop
culturally
relevant
and
appropriate
plans
and
strategies
and
programs.
H
We
hired
a
safe
messaging
expert
with
part
of
the
project
aware
funding,
and
this
person
comes
with
experience
and
incredible
knowledge
on
how
to
share
our
messages
in
a
safe
and
healthy
way,
how
to
listen
to
the
youth
voice
and
gather
those
messages
from
our
young
people.
I
know
they
are
are
having
many
struggles
with
covet
and
after
covid,
but
I'm
telling
you
this
generation
wants
to
talk
about
mental
health
and
mental
wellbeing
and
suicide.
H
As
I
mentioned,
the
office
of
suicide
prevention
is
gathering
information
through
surveys
on
what
the
staff
is
needing,
what
they
already
know,
what
they're
seeing
so
that
we
can
develop
specific,
appropriate
district
training
plans
that
will
really
meet
the
needs
of
the
staff
and
the
families
and
even
peer-to-peer
programs
for
those
youth.
We
followed
the
multi-care
system
of
support,
and
this
kind
of
is
an
example
of
what
that
would
be
and
how
our
work
fits
into
that
we
have
the
basic
foundation.
H
H
Another
project
they
have
it's
not
necessarily
for
use
carrying
contacts
will
help
in
that
transition
from
care
in
an
emergency
department
or
inpatient
care
into
their
community
and
family
with
support
as
they
work
through
their
recovery
and
safety
plan.
So
I
just
wanted
to
shout
out
that
teen
life
the
becoming
and
then
our
regional
behavioral
health
policy
boards
have
developed
incredible
resources.
Parents
guide
to
youth
mental
health
in
nevada.
How
scary
it
is
when
they
need
to
take
their
their
young
person
to
the
emergency
department
or
inpatient
care?
H
H
Dr
freeman
covered
this
very
well,
so
I'm
not
going
to
go
into
great
depth,
but
I
just
wanted
to
connect
you
to
the
links
on
this
and
then
also
a
couple
weeks
ago.
There
was
a
blueprint
for
use
suicide
prevention
that
was
developed
with
the
american
foundation
for
suicideology,
sorry,
the
american
foundation
for
suicide
prevention
and
the
american
academy
pediatrics,
and
it's
an
online
toolkit
with
incredible
resources.
H
I
presented
to
renowned
pediatricians
recently
and
it
had
come
out
that
day
and
I
think
those
healthcare
providers
who
are
are
definitely
seeing
the
increases
in
youth
showing
up
with
that
high
anxiety,
depression
and
thoughts
of
suicide.
This
can
be
a
really
beneficial
tool
in
line
with
the
health
care
that
came
up
from
several
of
you.
H
Nevada
has
had
our
zero
suicide
initiative
going
for
several
years
now
they
are
in
their
second
round.
They
just
completed
their
second
round
2.0
of
a
learning
community
where
several
entities,
48
individuals,
attended
a
weeks-long
collaborative
learning
opportunity
for
health
care
improvement
around
suicide,
safer
care,
dr
freeman,
is
absolutely
right.
This
is
one
of
the
most
effective
ways
to
reduce
our
suicide
risk.
Our
suicide
behaviors
is,
is
that
holistic
approach,
so
it's
not
all
on
the
health
care
providers
or
those
hospital
systems.
The
community
has
to
be
that
wrap
around
as
well.
H
A
A
Okay,
I
I
just
want
to
point
out
for
folks
who
are
watching
and
or
listening
that
the
links
that
were
presented
by
miss
vaughn
allen
are
on
our
legislative
website.
This
meeting
page
under
agenda
item
six
youth
suicide
trends
and
prevention
efforts
they
are
can
be
found
linked
within
this
pdf.
So
if
you
are
interested
in
looking
more
at
some
of
those
resources,
they
are
available
there.
A
G
Yeah,
thank
you.
Thank
you,
madam
chair.
A
couple
questions
I
see
on
your
the
one
presentation
where
you
talked
about
the
nami
western
nevada,
warm
line
and
carrying
contacts,
and
you
and
you
gave
a
number
there,
I'm
wondering
about
the
status
in
coordination
with
the
988
hotline
and
just
worried
that
we
have
so
many
numbers
out
there.
G
Will
that
number
be
directed
directly
linked
to
a
988
number
and
perhaps
then
it
will
be
automatically
switched
over
there
or
it
can
be
transferred
there
when
somebody
calls
so
that
they
get
as
we
use
the
term
and
healthcare
warm
handoff
from
that
that
line,
and
then
I
have
it
follow
up.
If
I
might
please
thank.
H
You
thank
you
assemblywoman
titus,
misty
allen
for
the
record,
a
great
question,
but
the
interoperability
challenges
with
988
are
are
being
worked
out
and
that's
a
very
important
question.
I
will
need
to
get
back
to
you
on
that
answer.
Typically,
nami
deals
with
mental
health
challenges,
isolation,
recovery
with
mental
health,
and,
if
there's
a
crisis
of
suicide,
they
would
transfer
it
to
the
national
suicide
prevention.
Lifeline
988
will
begin.
H
Suicide,
safer
care
is
really
crucial.
So
that
is
being
built,
nevada
is
probably
ahead
of
most
states
in
the
nation.
We
have
some
funding
to
support
that
effort
and
the
the
dhhs
team
has
been
working
on
this
for
years.
So
we
are
definitely
poised
to
be
a
leading
charge
in
this
with
crisis
support
systems
of
nevada.
G
Thank
you
for
that.
Definitely
looking
forward
to
moving
forward
with
that
988
another
question
I
have,
and
I
don't
have
an
observation,
these
the
concern
you
presented:
the
suicide
at
ratio
between
men
and
women
or
boys
and
girls
type
of
thing,
the
youth
categories
and
different
different
categories
that
you
broke
down.
G
H
Thank
you,
dr
titus
misty
allen.
The
ratio
nationally
is
women
attempt
three
times
per
one
male.
Typically,
the
lethality
is
due
to
the
access
of
lethal
means
like
firearms
or
hanging.
H
A
Thank
you
and
thank
you,
miss
allen.
I
believe
that
dr
freeman
may
be
talking
a
little
bit
more
about
that
transition
to
988
during
her
crisis
services
presentation.
So
we
look
forward
to
hearing
more
about
that.
Are
there
any
other
questions
for
miss
allen?
Oh
yes,
go
ahead.
Miss
miss
allen.
H
Thank
you,
sir
peter.
I
had
a
note
here
to
address
senator
spearman's
question.
She
asked
wonderful
questions
and
we
do
have
some
answers
that
I
didn't
leave
it
into
my
powerpoint,
but
as
far
as
service
members
veterans
and
their
families,
we
have
some
incredibly
wonderful
partnerships
with
the
department
of
veterans
services.
H
It's
comprised
of
veteran
serving
organizations-
veterans,
spouses,
my
my
co-lead
she's,
actually,
the
lead.
Sarah
hogue
from
the
department
of
veterans
services
is
a
military
spouse,
so
we
have
great
wisdom
and
experience
with
her
and
we
have
been
brought
into
national
presentations
when
they
have
the
service
member
veterans,
family
policy,
academies
for
other
states
coming
on
board
and
nevada
has
been
brought
in
to
present
as
the
subject
matter
experts,
so
we're
really
proud
of
where
we
are
going
as
a
team.
H
As
dr
fema
mentioned,
those
cross-department
partnerships
are
such
a
bridge
to
much
more
effective
care
as
far
as
indigenous
communities
and
the
bypass
populations
dhhs
and
a
wonderful
resource.
Social
entrepreneurs
has
held
several
town
hall
discussions
in
clark
county
around
suicide
and
african-american
black
communities
down
there
and
recently,
with
the
hispanic
latino
latinx
communities.
H
We
have
so
much
more
work
to
do,
and
most
of
that
work
is
about
listening
hearing
the
needs
from
the
specific
community
members,
what
they're,
seeing
and
really
learning
what
is
working
for
them.
Currently,
we
also
have
been
working
with
the
native
american
communities
and
what
I,
what
I
noticed
even
in
crisis,
is
they
have
the
resources,
they
have
the
answers
and
we
can
come
in
as
support
in
the
crisis.
We
can
come
in
with
hopefully
funding
resources
or
opportunities,
but
I
find
our
role
to
be
boosting
up
those
elders.
H
The
community
I'm
working
with
is
bringing
in
a
gona
in
a
few
weeks,
which
is
a
gathering
of
native
americans
and
it's
a
beautiful
starting
point
to
address
grief
and
loss
and
prepare
the
community
for
healing
and
prevention,
so
definitely
huge
gaps
that
we
are
trying
to
do
better
and
support
the
communities
who
are
doing
it
correctly,
who
are
doing
successfully
successful
work
with
suicide
prevention.
Mental.
A
Thank
you
miss
allen,
and
I
just
want
to
point
out
that
last
session
we
did.
I
worked
extensively
on
a
bill
with
dr
woodard
to
address
that
issue
of
the
suicide
attempt
data
and
obtaining
that,
and
hopefully
those
regulations
will
get
us
more
access
to
that
data
and
allow
us
to
see
kind
of
that
whole
picture
as
we're
looking
at
as
at
suicide
attempts
and
where
to
address
those
those
issues
and
the
other
piece
is.
A
A
This
last
session
we
passed
a
bill
waiving
fees
for
tuition
for
native
american
students
in
the
state
of
nevada
and
I'm
hoping
that
that
access
will
encourage
more
and
more
of
those
community
members
to
engage
in
higher
education
related
to
the
medical
industry
and
ensure
that
they
have
representation
that
they
feel
confident
and
comfortable
reaching
out
to,
but
also
is
competent
and
available
to
be
at
the
table
that
I
have
historically
been
left
out
of.
So
I
look
forward
to
seeing
how
that
turns
out.
A
For
those
folks,
senator
spearman
in
the
chat
says
thanks
misty.
Are
there
any
other
questions
from
the
committee
at
this
moment?
If
not,
we
will
move
on
to
miss
mcgill
and
her
presentation
all
right.
We
have
christy
mcgill
here
for
nde,
safe
voice
program.
That
said,
thank
you.
Miss
allen,
the
the
department
of
education
safe
voice
program,
which
we
heard
extensively
about,
I
believe
in
the
2019
legislative
session.
So
I'm
looking
forward
to
this
update
from
christy
or
ms
mcgill.
Thank
you.
So
much
for
being
here,
please
go
ahead
when
you're
ready.
L
Thank
you,
christy
mcgill,
I'm,
the
director
of
the
office
of
safe
and
respectful
learning
for
the
nevada
department
of
education,
and
I'm
here
today,
oh
good,
the
powerpoint's
up,
I'm
here
today
to
talk
about
safe
voice,
which
is
simply
one
way
that
kids
can.
Our
students
can
express
their
concerns
either
about
themselves
or
others
around
school
safety
issues.
L
L
L
L
Also,
it
is
a
way
our
students-
and
I
would
be
remiss
if
I
didn't-
have
gratitude
towards
our
students
during
the
pandemic,
because,
when
school
shut
down,
they
made
sure
that
their
peers
were
safe
and
our
students
continued
to
use
the
program
and
not
only
report
on
themselves
but
on
their
friends
who
they
noticed
on
instagram
or
something
of
that
sort
that
we're
having
some
real
difficulties.
So
in
that
way,
we
really
felt
blessed
to
have
this
program
up
and
going.
It
is
anonymous
and
confidential,
which
is
a
really
good
thing.
L
L
So
again,
this
is
monitored.
24
7
by
our
department
of
public
safety,
if
it
is
a
public
safety
event,
we
also
dps
brings
in
local
law
enforcement
or
the
school
resource
officers
depending
upon
the
district,
to
make
sure
that
there
is
a
quick
and
safe
response
to
each
one
of
these
tips,
especially
if
they're
elevated
on
school
safety.
L
When
school
is
not
in
session,
safe
voice
is
still
live,
and
so
we
work
really
hard
with
the
districts
to
make
sure
that
that
system
or
that
ecosystem
of
support
is
around
24
7..
We
are
also
currently
working
with
some
of
our
community,
especially
around
the
mobile
crisis
teams,
to
come
into
the
system
as
well.
To
help
with
this.
For
two
reasons,
one
is
those
off
hours.
L
So
we're
working
with
dr
freeman
as
we
speak,
to
see
if
we
can
embed
the
mobile
crisis
team
into
safe
voice
as
well,
so
that
they
are
an
integral
partner
with
our
districts
and
schools
to
be
able
to
to
respond
to
some
of
these
tips
again
safe
voice.
It
is
one
way
that
we
promote
our
students
to
express
themselves
around
school
safety,
but
it
is
not
the
only
way
and
again
we
really
look
at
anonymity
and
confidentiality,
and
we
always
promote
our
students
to
have
those
relationships
with
their
teachers
and
school
counselors.
First.
L
So,
if
they're
at
school,
we
always
promote
them
going
to
talk
with
their
trusted
adult
but
they're
in
a
place
that
they
don't
have.
That
or
many
of
this
generation
feels
really
comfortable
texting
over
picking
up
a
phone
and
talking
and
they'll
tell
us,
like,
I
couldn't
say
the
words
out
loud,
but
I
could
text
it
and
so
that
component
of
safe
voice,
it
is
the
main
way
the
students
interact
with
the
platform
is
through
text
and
not
through
the
phone.
L
So
I
want
to
refer
you
to
the
blue
line.
That
was
the
first
year.
It
was
in
the
exception,
so
you
can
see
that
most
of
our
students
did
use
it
indeed
for
bullying
and
so
bullying
and
then
of
course,
next
was
suicide
thrusts,
and
then
we
had
the
pandemic.
So
as
you
see
in
2020
that
the
most
popular
tip
that
the
students
used
to
report
in
safe
voice
was
suicide
threats,
so
that
was
either
they
were
worried
about
themselves
or
they
were
worried
about
each
other
and
their
peers.
L
Again,
just
a
big
shout
out
to
our
students,
who
I
think,
really
attempted
to
take
good
care
of
each
other
during
the
pandemic,
as
you
can
see,
as
the
students
went
back
to
school,
the
suicide
threats
became
less
popular
and
part
of
that
again.
This
is
an
ecosystem
approach
is
that
we
hope
that
when
the
students
return
to
school
that
there
was
earlier
intervention,
so
it
didn't
get
to
this
point
and
that
things
like
bullying
or
concerns
were
could
be
addressed
earlier.
L
I
do
also
want
to
point
out
that,
as
you
can
see
this
year
and
as
you've
probably
heard
that
this
year
has
been
difficult
for
our
teachers,
school
counselors,
school,
psychs,
school
social
workers
and
as
you
can
see,
the
planned
school
attacks
really
climbed
in
use
for
this
year
alone.
So,
as
you
heard,
I'm
sure
a
lot
have
been
the
social
media
in
the
news,
and
this
just
created
more
chaos
and
stress
in
our
schools,
as
as
the
schools
tried
to
respond
to
each
one
of
these
as
they
came
through.
L
L
And
that's
it
for
my
presentation.
If
there's
any
questions.
G
Thank
you.
So,
ms
mcgill,
thank
you
for
your
presentation,
always
good
to
see.
You
you've
certainly
been
engaged
for
a
long
time
and
these
issues
I
drove
down
to
las
vegas
this
week
for
several
meetings
and
I'm
staying
at
my
step-daughter's
house,
and
we
had
a
conversation
the
first
evening.
G
We
got
here
about
the
increase
in
these
planned
attacks
on
students
at
both
of
my
granddaughter
schools,
especially
the
junior
high,
and
I'm
quite
alarmed
by
that
that
it's
real
it
gets
taken
down
from
social
media
or
fast,
but
but
those
those
are
realities
that
that
my
grandchildren
and
people's
children
and
other
folks
as
grandchildren
are
live
living
with,
and
it
it's
not
just
located
here
in
clark
county,
but
it
seems
to
be
pretty
dramatic
in
clark
county
based
on.
G
I
think
that
definitely
the
population
there's
more
students
here,
so
ratio
wise
and
I'm
just
concerned
about
you
can
identify
them,
but
is
there
any
kind
of
a
plan?
Is
there
any
kind
of
intervention,
because
what
I'm
hearing
is
that
the
teachers
are
can't
intervene,
there's
really
no
intervention.
The
teachers
are
frightened
here
themselves
about
intervening
and
I'm
just
wondering
if
that's
being
addressed.
A
L
Yes,
each
school
and
district
have
plans
in
place
to
address
planned
school
attacks,
but,
as
you
can
see,
the
frequency
puts
a
lot
of
strain
on
the
schools
themselves,
and
so
I
do
have
two
members
from
or
two
representatives
from
our
largest
districts
here
with
me
for
the
next
presentation
that
can
kind
of
go
into
more
detail
of
what
some
of
that
would
look
like
at
the
school
levels.
But
yes,
they
all
have
plans
to
address
this.
L
L
We
were
doing
listening
sessions
for
the
entirety
of
this
week
from
our
school
system
and
one
of
the
clear
ass
that
kept
coming
out
over
and
over
again
is.
We
need
more
adults
in
the
buildings
with
all
of
this
turnover,
our
schools
are
not
sufficiently
staffed
and
so
you're,
seeing
some
of
the
results
of
that.
L
So
that
is
the
kind
of
the
overwhelm
yes
there's
things
in
place.
Yes,
there's
strategies,
our
districts
do
really
well
in
that.
But
again,
if
we
don't
have
enough
people
in
the
buildings,
these
don't
go
off
as
well
as
we'd
hope
for
the
number
of
safe
voice
tips.
I
can
definitely
send
a
chart
to
all
of
you
to
kind
of
show
exactly
how
many
safe
voice
tips
happen
across
months
across
dates.
We
can
definitely
differentiate
that
they're
in
the
thousands.
L
So
again,
one
of
the
drawbacks.
We
love
the
system
that
this
gives
voice
to
our
students
and
it
also
does
create
a
significant
workload
for
our
school
staff,
which
most
of
them
are
really
happy
to
engage
with
us.
They
would
rather
talk
about.
I
mean
they
really
love
the
kids.
They
would
rather
address
the
issues
than
not,
but
it
does
get
again
without
the
number
of
school
personnel
in
our
buildings.
G
So
I
I
hear
what
you're
saying
I
think
that's
one
of
the
realities
is
that
there's
not
enough
adults
in
the
room,
but
there's
not
enough
adults
in
the
room,
and
so
that
that
is
the
reality
for
right
now
and
that
sometimes
takes
a
while
to
resolve
one
of
the
things
that
just
an
observation
that
I'm
seeing
instead
of
engaging
the
kids
that
may
intervene
and
and
break
up
a
fight,
all
the
kids
that
I
have
seen
on
this
and
and
from
what
I'm
hearing
everybody
pulls
out
their
cell
phone
and
videos
the
event
nobody
gets
involved,
everybody's
just
standing
there,
standing
there,
putting
it
on
their
cell
phones,
and
perhaps
one
of
your
your
solutions
might
be
to
to
engage
the
community
of
the
students
around
that.
G
You
know
you
have
to
do
more,
sometimes
than
just
film
it,
so
just
a
thought
so
anyway.
Thank
you.
Thank
you
for
what
you're
doing.
Thank
you.
Manager.
A
L
Christy
mcgill
for
the
record.
Again
we
have
our
districts
coming
up,
so
they'll
be
able
to
tell
you
the
specifics
of
what
it
looks
like,
but
each
school
in
each
district
has
responses
to
suicide
threats
which
look
at
really
trying
to
either
work
with
community
providers
or
our
school-based
providers
to
stabilize
the
students
so
that
they
are
safe
and
that
they
can
return
to
their
their
school
studies
as
soon
as
possible.
L
L
But
again,
when
I
look
at
the
response
to
the
safe
voice
tips
of
what
the
schools
are
doing,
there's
an
overwhelming
sense
of
care
for
the
students
and
they
really
do
try
to
engage
the
community
partners
to
make
sure
that
that's
those
students
are
safe.
A
mobile
crisis
is
key
to
this,
obviously
in
those
stabilization
plans,
and
why
we
really
support
our
partners
in
the
mobile
crisis
not
only
coming
into
safe
voice
but
really,
and
they
do
already
so
much
work
with
our
schools,
but
even
strengthening
that.
What
does
that
look
like?
L
What
does
it
look
like
to
be
co-located?
What
does
it
look
like
to
share
resources
and
supports,
and
we
really
feel
like
that,
may
be
the
next
step
and
really
providing
that
ecosystem
of
support
that
our
students
need.
A
Thank
you
for
that.
I
know
when
I
was
when
I
was
a
student
in
nevada.
We
had
a
peer
mediation
program
that
I
I'm
not
sure
how
effective
they
found
it
to
be,
or
if
it's
still
in
effect
at
this
point,
but
I'd
be
curious
to
see
if
our
schools
still
have
those
in
place.
If
that's
unique
to
each
individual
school,
I
believe
ours
was
set
up
by
the
student
council
as
an
effort
to
reduce
student
violence
against
each
other.
At
the
time
anyways.
A
A
I'm
not
seeing
any,
and
I
apologize
if
I
miss
you,
okay,
we're
going
to
go
ahead
and
move
on
to
our
next
agenda
item,
which
is
agenda,
item
7
trends,
prevention
and
treatment,
efforts
related
to
substance
use
disorder
in
youth.
We'll
have
three
presentations
under
this
agenda
item
the
first
we'll
examine
trends,
the
second
we'll
review
prevention
efforts
and
the
final
presentation
will
highlight
challenges
and
opportunities
related
to
substance,
use
disorder,
treatment
in
youth.
A
M
Thank
you,
chair
peters,
dr
clements,
noel,
for
the
record.
I
am
the
co-principal
investigator
of
the
youth
risk.
Behavior
survey.
Whoops.
Sorry,
I
didn't
share
my
screen.
M
Yeah
we're
we're
running
with
the
well.
Thank
you
for
inviting
me.
I
am
going
to
present
on
behavioral
health
issues
as
a
whole.
I
think
dr
freeman
did
a
nice
job
of
introducing
this.
You
really
can't
understand
the
trends
and
substance
use
without
understanding
the
trends
of
mental
health
and
all
other
aspects
of
youth
lives.
So
I'm
going
to
jointly
present
some
misinformation,
but
I
think
I
have
plenty
of
time
to
do
so.
M
I
do
want
to
thank
our
partners.
We
have
a
great
deal
of
support
from
the
nevada
department
of
education,
the
division
of
nevada,
division
of
public
and
behavioral
health,
the
nevada
statewide
coalition
partnership,
school
district
superintendents,
their
district
staff,
definitely
all
the
school
principals
and
administrators
and
the
teachers,
and
certainly
the
students
and
their
families.
M
M
M
M
We
also
do
a
sample
of
all
tribal
schools
in
oversample
in
that
population
and
what's
unique
in
nevada,
is
we
also
include
our
middle
schools
and
today
I
would
like
you
to
pay
very
close
attention
to
our
middle
school
data,
because
we
need
to
be
upstream
and
working
with
youth
at
a
younger
age,
so
we're
very
fortunate
to
have
the
funding
to
be
able
to
include
middle
school
students
in
our
survey
we
do
work
with
districts
and
in
2019
we
administered
the
survey
with
either
active
or
passive
parental
permission.
M
I
think
this
certainly
has
helped
us
administer
the
survey
at
a
time
that
was
very,
very
stressful
for
schools
and
it
will
only
get
easier
in
the
future.
We
use
a
cluster
random
sampling
design.
I
won't
go
into
details,
but
just
know
that
we
weight
the
data
to
make
sure
that
it
accounts
for
any
non-response
bias,
and
so
that
our
estimates
are
reflective
of
the
communities
in
which
we
sample
and
that
we
can
compare
over
time.
M
We
do
weight
our
data
in
our
state
at
a
district
and
regional
level
and
these
regions
align
with
our
our
coalition
partnerships,
and
it
also
ensures
that
we
can
present
regional
data
without
identifying
the
school.
We
never
want
to
identify
a
school,
and
in
some
of
these
counties
we
might
only
have
one
school
that's
available.
M
M
M
M
This
dotted
area
here
in
2011.
We
did
not
have
I'm
sorry.
Those
dates
are
off
there,
but
in
2011
we
did
not
have
weighted
data.
Unr
took
over
data
collection
in
2013
and
we've
had
weighted
data
since
then,
if
we
look
at
just
our
full
comprehensive
nevada
sample-
and
we
compare
what
was
happening
from
2017
to
2019,
you
see
that
alcohol
use
in
cannabis
use
is
pretty
stable,
as
we
saw
even
in
the
10-year
graph
with
cannabis.
M
Turning
to
the
middle
school
data
middle
school
youth
are
so
young
that
it
is
important
to
look
at
lifetime
use
as
well
as
past
30
day
use.
We
see
that
use
of
alcohol
was
stable.
We
did
see
a
significant
increase
in
use
of
cannabis
in
in
lifetime
in
the
middle
school
sample
from
9.9
percent
to
13.4
percent.
M
There
was
a
continued
decline
in
cigarette
smoking,
but
it
was
not
significant
and
we
saw
the
same
increase
that
we
saw
in
the
high
school
sample
with
e-vapor
product
use.
We
did
see
an
increase
in
lifetime,
non-medical,
prescription,
pain,
medicine
use
and
when
I
say
non-medical,
the
instructions
are
using
it
without
a
prescription
or
in
a
way
that
was
not
advised
by
a
doctor
and
that
increased
from
6.8
percent
to
10.3
percent.
M
In
terms
of
past
30-day
use,
we
saw
an
increase
in
alcohol
use,
so
this
is
alcohol
use.
In
the
past
30
days
again
we
saw
a
significant
increase
in
past
30-day
cannabis
use
from
5.2
percent
to
7.9
percent
past
30-day
use
of
cigarettes
was
extremely
low
in
both
years
and
identical
2.5
percent
that
same
increase.
We
saw
in
lifetime
use
and
in
the
high
school
sample
we
saw
with
past
30-day
e-vapor
product
use.
M
M
If
we
look
at
the
long-term
trends
and
focusing
on
in
particular
the
past
10
years,
we
did
see
a
very
significant
increase
and
this
would
be
the
percent
of
youth
who
felt
sad
or
hopeless,
and
I
think
it
was
almost
every
day
for
two
or
a
week,
two
or
more
weeks
in
a
row
where
it,
it
inhibited
their
ability
to
do
things,
and
we
see
that
that
increased
from
30
percent
to
42.5
percent
in
2019.
M
M
M
looking
closely
at
those
just
that
last
two-year
period.
We
do
see
that
same
increase
and
it
was
significant
in
that
sort
of
depressive
symptoms
from
34.6
in
2017
to
almost
41
percent.
In
2019
and
again
you
see
that
all
of
the
suicide
ideation
suicide
plan
and
attempt
variables
remain
steady
in
that
time
period.
M
M
Nevada
has
a
state
added
question
trying
to
get
from
the
use
perspective,
whether
they're
getting
the
help
they
need,
and
so
this
would
be
when
they
feel
sad,
empty,
hopeless,
angry
or
anxious.
And
again.
I
think
it
has
that
time
period
to
the
question
in
2017,
over
half
55
percent
of
the
youth
said
they
are
not.
They
rarely
get
the
help
they
need,
they
never
or
rarely
get
the
help
they
need,
and
that
was
very
similar
in
2019.
M
So
you
know,
I
think
we
saw
this
in
our
earlier
presentation
by
dr
freeman.
This
is
part
of
the
you
know.
The
access
to
services
for
youth
is
one
of
the
reasons.
Nevada
ranks
so
low,
and
I
think
the
youth
are
are
feeling
this
as
well.
M
So
I
want
to
point
out
something
very
important
before
I
show
the
middle
school
data
in
2019,
we
made
a
decision
after
consulting
with
a
number
of
stakeholders,
including
missy
von
allen
and
others
who
really
want
to
evaluate
the
effects
of
their
initiatives
at
the
school
district
level,
and
to
do
that
a
lifetime
variable
doesn't
really
help
because
you
don't
know
when
these
things
occurred,
and
so
a
past
12-month
variable
is
much
more
sensitive.
M
M
This
is
lifetime,
but
the
blue
bar
is
2019,
so
they're
not
directly
comparable
because
2019
we're
focusing
on
the
past
year.
M
Even
with
that
restricted
time
period,
you
see
that
there
was
an
increase
in
feeling,
sad
or
hopeless,
and
again
this
is
you
know,
for
most
days
of
the
week
for
two
or
more
weeks
that
interfered
with
their
activities.
M
21.22
reported
suicide
ideation
in
the
past
12
months,
whereas
previously
it
was
about
21
in
in
lifetime.
12.9
percent
had
made
a
suicide
attempt.
8
had
attempted
suicide
and
19
reported
non-suicidal
self-harm.
So
all
of
these
indicators,
typically,
we
will
see
much
higher
prevalence
and
lifetime
indicators.
M
The
fact
that
we
are
seeing
similar,
if
not
higher,
in
prevalence
with
our
past
12-month
indicators,
suggests
that
for
middle
school
students,
these
these
indicators
were
trending
in
the
wrong
direction,
leading
up
to
the
pandemic.
So
we're
going
to
be
watching
the
middle
school
sample
very
closely.
I
know
there
was
a
question
earlier.
I
think
I
can't
remember.
I
think
it
was
assembly
woman,
dr
titus,
regarding
suicide
rates
and
yes
in
our
both
our
middle
school
and
high
school
sample.
It
is
higher
in
our
female
population.
M
It
was
particularly
high
in
our
middle
school
sample
at
10.9
percent
had
attempted
a
females
attempted
suicide
in
the
last
year,
compared
to
5.4
of
males
and
similar
to
what
we
saw
with
the
high
school
sample
about
half
of
the
youth
do
not
feel
like
they're
getting
the
help
they
need
and
that
didn't
improve
from
2017
to
2019..
M
I
added
this
slide.
It's
not
in
your
deck.
I
will
I
will.
I
can
send
you
the
full
report,
but
this
was
a
question
that
I
believe
senator
spearman
had
asked.
We
do
assess
both
sexual
identity
and
gender
identity
in
our
high
school
survey.
Only
this
is
just
one
slide.
Speaking
to
one
of
the
questions
around
suicide
attempts.
M
M
We
assessed,
I
think
it's
seven
different
adverse
childhood
experiences:
sexual
abuse,
physical
abuse,
verbal
abuse,
which
is
an
ongoing.
It's
an
indicator
of
ongoing
verbal
abuse
in
the
household
witnessing
domestic
violence,
household
mental
illness
and
household
substance,
use
and
you'll
see
the
prevalence
is
a
bit
higher
in
the
high
school
sample.
That's
simply
because
they're
older,
so
they've
had
more
time
to
to
witness
adverse
childhood
experiences
and
we
have
created
a
a
score
in
some
of
our
reports
and
some
of
our
publications.
M
And
if
we
look
at
the
relationship
between
adverse
childhood
experience,
exposure
and
just
then
this
is
just
one
set
of
indicators-
suicidal
behaviors.
In
the
past
12
months,
you
see
a
very
clear
graded
relationship
as
the
number
of
aces
increases,
so
in
the
blue,
we
have
zero
aces
in
the
green.
We
have
one
ace
purple
two
aces
and
that
high
ace
category
three
or
more
aces.
You
see
that
the
prevalence
of
suicide
ideation
increases
substantially,
and
this
is
very
significant.
M
With
38.5
of
youth
who
experienced
three
or
more
aces,
you
know
reporting
suicide
ideation
in
the
past
12
months,
33.7
of
youth,
with
with
three
or
more
aces
experienced,
had
made
a
suicide
plan
in
the
past
12
months
and
20
percent
had
actually
made
an
attempt
in
the
past
12
months,
so
definitely
a
subpopulation
where
we
want
to
focus
our
prevention
efforts
and
dr
freeman
spoke
to
this
as
well:
a
need
for
trauma-informed
services
throughout
our
school
system,
but
also
working
a
lot
closer
with
our
families.
M
We
see
a
similar
pattern,
it's
actually
stronger
and
we
always
see
this
in
our
data
where
aces
tend
to
have
a
stronger
impact
on
the
younger
youth,
so
in
the
middle
school
sample.
If
you
look
at
the
suicide
ideation
in
the
past
12
months,
over
half
of
the
youth
with
three
or
more
aces
had
had
thought
about
committing
suicide.
In
the
last
12
months,
34.7
percent
in
the
high
ace
category
had
made
a
plan
and
over
a
quarter
had
attempted
suicide
in
the
past
12
months.
M
Similar
dose-response
relationship
or
graded
relationship
with
all
of
our
substance
use
indicators.
This
is
just
an
example
of
some
of
our
indicators
for
past
30
days.
A
significant
increase
as
the
number
of
aces
increase,
so
does
the
prevalence
of
cigarette
use
vaping
alcohol
use
marijuana
use,
I
could
show
you
prescription
pain,
medication,
injection,
drug
use.
All
of
the
indicators
follow
the
same
pattern.
M
And
I
don't
yeah,
I
think
that
was
the
middle
school
sample
high
school
sample
and
then
here's
the
middle
school
sample.
Again
you
see
that
very,
very
strong
impact
with
the
middle
school
sample
and
all
of
these
indicators.
E
Yeah.
Thank
you
for
this
very
helpful
presentation
and
a
couple
things.
I
was
curious
about
on
the
substance
abuse
numbers:
do
you
have
data
on
frequency
of
use
that
I
gather
those
are?
Did
you
use
drugs
at
some
point
in
the
substance
in
the
past
30
days?
Do
you
also
have
data
on
how
whether
we're
seeing
changes
in
high
frequency
of
use?
M
Yeah
we
do
we,
we
look
at
the
frequency
of
use
within
that
time
period,
so
this
is
just
dichotomized,
so
often
we'll
look
at
use,
20
or
more
days,
which
is
nearly
every
day
and
we're
definitely
going
to
be
looking
at
that
in
the
2021
data.
M
I
also
want
to
look
very
closely
and
this
speaks
to
another
another
question
earlier:
whether
there
are
health
disparities
and
what
we're
seeing
so
for
some
youth,
the
stay-at-home
orders
may
have
been
protective
because
youth
were
with
their
families.
Their
families
had
the
ability
to
stay
home
with
them.
There
was
less
access
to
substance
use
in
some
situations.
M
In
other
situations.
You
know
the
families
do
not
have
that
ability.
A
lot
of
our
frontline
workers
and
people
who
had
to
go
to
work,
work,
multiple
jobs
and
youth
were
actually
didn't,
have
the
support
of
the
schools
and
were
left
at
home
and
in
their
communities,
and
I've
done
some
other
work
in
this
area.
So
we'll
be
looking
at
really
closely
to
see
whether
there's
health
disparities
in
the
substance
use
patterns.
But
yes,
we
do
look
at
frequency,
abuse,
okay,.
E
E
E
M
Yeah
we
we
have
a
sense
that
there
is
some
substitution
for
alcohol
use
for
cannabis,
use,
marijuana
use
in
both
the
younger
population
and
the
high
school
population.
We
do
see
our
our
trends
are
similar
to
the
nation.
M
Our
you
know,
are
it's
only
a
one
year
period
right
from
2017
to
19.,
but
our
middle
school
trends
in
cannabis
use
are
similar
to
what
we're
seeing
nationally,
where
the
8th,
graders
and
12th
graders
prior
to
the
pandemic
had
an
increase
in
frequent
use
of
marijuana,
and
we
didn't
see
that
in
the
older
groups.
M
So
there
are
early
there's
some
indicators.
We
need
to
be
watching
that
very
early
population,
because
their
initiation
patterns
may
be
different
from
what
we're
seeing
in
the
high
school
youth
who
may
be
substituting
different
things.
The
downward
trend
in
overall
in
alcohol
use
and
smoking
cigarettes
is
very
similar
to
the
rest
of
the
nation.
A
Thank
you
for
the
question.
Can
I
ask
about
illicit
substances
which
are
not
listed
in
your
slides,
and
can
you
talk
a
little
bit
about
what
those
look
like
if
you
have
trends
and
if
you
don't
why.
M
Yeah,
so
we
didn't
our
so
well.
First
of
all,
listed
substances
is
kind
of
a
you
know.
These
are
young
adolescents,
so
they're
all
illicit
substances
for
them.
But
if
we
look
at
methamphetamine,
we
have
indicators
of
methamphetamine,
cocaine,
use
injection
drug
use.
Generally,
our
rates
are
very
low
and
have
been
stable,
so
we
have
not
seen
increases
in
any
of
those
indicators.
Heroin
use,
as
I
noted
we
did,
have
the
we
our
high
school
sample.
A
I'm
not
seeing
any
come
up
so
we'll
move
on
to
our
next
presentation.
Thank
you
so
much
dr
clements
noel.
Our
next
presentation
was
on
the
statewide
epidemiology,
organizational
work
group
and
the
multidisciplinary
prevention
advisory
committee.
We
have
a
couple
folks,
elise,
monroy
and
jamie
ross.
I
hope
I
said
that
right
to
to
present
on
this
particular
issue.
I
will
go
ahead
and
let
you
begin
when
you're
ready.
C
Awesome.
Thank
you,
chair,
peters,
wonderful,.
C
Thanks
jamie
great
work,
hello
committee,
my
name
is
elise
monroy
and
I
am
the
chair
elect
of
the
statewide
epidemiological
organization
work
group
which
we
lovingly
refer
to
as
the
so
because
that's
a
mouthful
next
slide.
C
The
sow
works
to
advise
them
to
advise
the
multi-disciplinary
advisory
committee
or
the
mpac
which
jamie
will
present
on
next
and
the
safta
advisory
board
and
other
programs
and
grants
in
within
dpvh
the
so
meets
at
least
quarterly,
and
while
these
groups
made
specifically
to
advise
sapta's
groups
and
grants,
the
epi
profile
that
the
so
advises
on
the
data
is
used
far
and
wide.
Actually
many
of
the
presentations
that
you
heard
from
today,
both
misty
allen's
presentation
and
dr
clements
knowles
hold
data
from
the
epi
profile.
C
So
it's
a
great
service
to.
I
think
the
state
and
public
health
and
behavioral
health
so
means
to
advise
on
an
epi
profile.
C
So
this
profile
told
us
as
misty
and
others
alluded
to
today,
that
while
we
know
that
historically,
suicide
is
the
leading
cause
of
death
for
adults
in
state
of
in
the
state
of
nevada,
there
is
now
a
need
to
track
and
monitor
risks
of
suicide
for
youth
or
young
adults,
and
the
last
thing
I'll
point
to
with
the
so
is
oh
next
slide.
Jamie
sorry
is
the
diverse
makeup
of
groups
that
advise
and
provide
insight
to
the
development
of
the
epi
profile,
so
included
with
this
presentation
is
an
attachment.
C
I
believe
it's
for
this
agenda
item
seven,
I
think
it's
attachment
b,
so
membership.
C
You
can
see
really
the
diverse
range
of
perspectives,
professionals
and
experts
that
advise
on
the
development
and
creation
of
the
so,
and
I
think
that
this
really
diverse
range
of
experts
and
expertise
really
provides
for
a
well-rounded
profile
as
we're
picking
which
indicators
and
data
to
look
at.
C
But
I
think
what
now
our
work
with
the
so
hands
directly
off
to
the
mpac,
who
you
will
hear
from
next
with
jamie
ross
to
talk
about
how
they
are
taking
the
data
in
the
profile
that
we
are
putting
together
and
then
turning
that
and
translating
that
into
action.
Amy
go
ahead.
N
Thank
you
very
much.
Can
everyone
hear
me
we
can.
Thank
you
yep
wonderful
good
morning.
My
name
is
jamie
ross.
I
am
the
co-chair
of
the
multidisciplinary
prevention
advisory
committee,
which
we
also
lovingly
call
mpac,
because
we
have
so
many
acronyms
in
our
field,
so
just
to
touch
the
so
finds
the
data.
Does
the
epic
epidemiology
really
translates
the
data
into?
What
does
this
mean
and
then
they
give
us
a
beautiful
package
and
we
review
the
data
so
that
we
can
guide
priorities
for
actual
prevention
work
happening
in
the
state.
N
So
we
take
this
wonderful
high-level
data
and
really
make
it
granular
to
determine
the
priorities.
As
with
everything
in
our
community,
we
we
would
always
want
to
be
evidence,
informed
data
driven,
and
so
this
is
how
we
do
that
work.
N
The
youth
risk
behavior
survey,
which
you
heard
dr
clements
knowles,
give
a
presentation
on
is
where
the
majority
of
this
data
does
come
from,
and
we
focused
on
magnitude,
time,
trends,
comparisons
and
severity,
and
really
what
that
means
is
magnitude
is,
of
course,
how
big
the
problem
is
and
then
time
trends
is,
is
it
going
up?
Is
it
going
down
et
cetera?
I
I'm
sure.
N
After
watching
what
dr
clements
knowles
said,
you
have
an
idea
of
where
this
is
going:
comparisons
to
other
areas
of
the
state
and,
of
course,
national
and
then
severity.
So
consequence
data
and
this
process
follows
the
samsa
strategic
prevention
framework
model,
the
goal
of
which
is
to
prioritize
one
to
three
substances
based
on
all
of
these
data,
so
that
the
resources
that
are,
of
course
very
limited,
can
go
to
the
areas
that
are
most
at
need.
N
So
this
is
the
actual
document,
and
these
were
the
indicators
that
were
prioritized,
so
the
impact
decided
that
anything
that
had
a
five
or
a
four
in
overall
store
score.
Unsurprisingly,
these
are
marijuana
and
cannabis,
or
marijuana
or
cannabis,
vaping
products,
alcohol,
prescription,
drugs
and
cigarettes.
N
So
we
will
move
on
to
the
next
slide
and
that
really
goes
into
more
of
the
details.
So
these
are
the
final
priorities
for
the
group.
One
of
the
issues
that
I
think
dr
orrin
licker
hit
on
and
dr
clements
knowles
spoke
on
in
depth-
is
that
30-day
use
versus
lifetime
use,
something
that
we
have
seen
is
lifetime
uses
overall,
a
less
good
indicator
than
30-day
use,
although
more
important
for
our
middle
schoolers,
so
that
got
taken
out
and
middle
school
students.
N
N
The
other
thing
I
want
to
mention
is:
we
know
the
limitations
of
this
data.
A
lot
of
this
data
is
from
2019
and
we
are
currently
in
2022,
and
we
have
seen
significant
changes
in
the
trends
so
and
the
data,
unfortunately,
as
always,
is
lagging
behind
a
little
bit
so
definitely
continuing
to
carefully
monitor
fentanyl,
pressed
pills,
kratom,
etc.
N
So
then,
from
all
of
those
great
priorities,
we
move
on
to
what
is
actually
happening
in
each
individual
communities,
so
each
coalition
in
the
state
listed
here
there
is
a
coalition
that
covers
every
county
in
the
state.
We
focus
on
those
issues
directly
in
our
communities.
I
work
at
the
pact
coalition.
We
focus
on
clark
county
and
to
be
able
to
take
that
data
and
utilize
it
in
our
communities
is
incredibly
important
and
to
further
tie
all
of
this
in.
I
think
this
is
something
that
was
also
in
the
mpac
report.
N
All
of
this
is
publicly
available
on
the
dpbh
website
and
something
I
find
interesting
is
this
funding
source,
so
we've
spoken
on
the
three
or
four
substances
that
seem
to
be
emerging
over
and
over
in
all
of
these
presentations
and
then
the
funding,
the
very
pretty
big
green
section
of
this
is
actually
funding
specific
to
opioids
or
opioid
heavy,
that
teeny
tiny
little
piece
that
fifty
thousand
dollars
at
the
very
top
that
is
specific
to
alcohol,
and
I
think
one
of
the
big
priorities
is
that
the
drugs
that
are
most
affecting
our
youth
are
not
really
called
out.
N
Very
much
in
this
opioids
are
one
of
many
issues
in
our
community.
Other
ways
we
end
up
having
to
work
is
to
leverage
the
funding
that
we
have
with
opioids
to
work
building
systems,
basically
on
the
back
of
these
opioid
dollars,
and
that
really
doesn't
translate
into
sustainable
systems.
N
It
creates
some
issues
and
most
all
of
this
funding
here
is
federal
dollars.
Very
little
of
it
is
state
general
or
state
generated
dollars.
So
most
of
this
is
prescriptive
from
the
federal
government.
We
understand
that
that
is
definitely
an
issue
that
continues
to
affect
our
community.
N
You
heard
dr
clements
knowles
speak
about
senate
bill
69,
which
created
the
passive
consent
of
the
youth
risk
behavior
survey.
It
also
institutionalized
the
prevention
coalitions
and
something
else
is
it
encouraged
schools
to
create
a
list
of
evidence-based
prevention
programs
which
really
encourages
that
all
areas
of
prevention,
programming
in
the
state
of
nevada
are
moving
towards
being
evidence-based,
and
we
wouldn't
want
to
finish
this
presentation
without
giving
you
some
gaps
and
some
needs.
N
If
you
look
at
the
continuum
of
care,
there
is
more
money
available
for
what
we
call
primary
prevention,
which
is
either
for
parents
who
are
raising
children
who
are
not
currently
using
drugs
or
people
who
young
people
who
have
never
used
drugs.
And
then
we
focus
on
what
we
call
secondary
prevention,
which
is
folks
who
are
at
risk
or
currently
using,
but
do
not
have
a
diagnostic,
do
not
meet
diagnostic
criteria
and
then
early
intervention
for
those
folks.
And
then
we
move
into
harm
reduction,
treatment
and
recovery.
N
And
of
course
it
is
a
lovely
wheel
and
there's
very
little
funding
for
early
intervention.
Most
of
the
funding
that
comes
into
our
state
is
for
primary
prevention
and
then
the
other
issue
we're
having
is
funding
not
tied
to
a
substance.
To
give
you
an
idea.
The
last
time
the
state
legislature
came
together
to
fund
specific
issues
around
a
substance
was
the
first
time
we
had
our
meth
crisis
and
obviously
meth
has
not
gone
away.
N
But
and
again,
when
we
tie
these
drugs
to
a
substance,
then
we
have
to
be
much
more
creative
in
how
we're
going
to
create
these
systems
to
solve
these
problems.
Thank
you
so
much.
This
is
my
contact,
information
and
elise,
and
I
are
open
for
questions
from
the
audience
or
from
the
members.
Thank
you.
A
A
I
am
not
sure
yes
senator
spearman,
please
go
ahead.
I
Yeah,
I'm
sorry,
I
don't
know
if
a
cinnamon,
dr
orlando
had
his
hand
up
first
but
I'll
acquiesce
to
him.
If
that's
the
case.
A
Please
proceed
senator
dr
orrin
licker
will
be
next.
I
Okay,
so
I
guess
the
first
question
would
be
related,
so
we
we've
consistently
had
had
issues
around
funding
to
combat
substance,
abuse
for
the
larger
population,
but
particularly
when
it
comes
to
adolescence.
Is
there?
Are
there
any
plans
to
use
part
of
the
opioid
settlement?
That's
going
that
will
be
administered.
I
think
it's
going
directly
to
the
ag's
office
and
then
he
has
put
in
place
a
a
group
of
people
who
will
further
identify
areas
where
it
needs
to
be.
I
That
would
be
the
first
one
and
the
second
one
would
be-
and
I
put
in
the
chat
here-
the
bill
that
authorizes
the
state
board
of
education
to
look
at
ace.
I
C
Hi
senator
spearman-
this
is
elise
monroy
for
the
record.
I
will
go
ahead
and
try
my
hand
at
that
one.
So
you
had
mentioned
the
settlement
funds
so
through
senate
bill
390,
the
state
has
developed
the
fund
for
resilient
nevada,
which
is
how
dollars
are
going
to
be
funneled
into
communities
and
to
counties.
C
I
actually
was
kind
of
doing
double
duty
today,
because
the
advisory
committee
which
I
sit
on,
I
was
the
attorney
general's
appointee
on
that
committee
met
this
morning
and
we
got
an
overview
of
the
one
nevada
agreement
which
explains
kind
of
how
funds
are
going
to
come
to
the
state
through
the
attorney
general's
office,
go
to
counties
and
municipalities
and
then
to
the
department
of
health
and
human
services,
and
the
advisory
committee
that
I
sit
on
is
currently
working
through
a
needs
assessment
process
to
identify
what
some
of
our
communities
needs
are,
with
a
focus
on
kind
of,
historically
marginalized
and
health
equity,
to
ensure
that
as
we're
building
out
using
these
dollars
right
that
are
coming
in
from
a
settlement
to
meet
gaps
that
have
been
long,
long
time,
gaps
in
our
community
around
these
services.
C
I
C
So
as
it
relates
to
the
work
on
the
so
we
don't
engage
directly
with
the
office
of
minority
health
and
equity,
but
that's
something
that
is
really
easy
for
us
to
change.
So
we
can
start
engaging
with
tina
and
her
team
and
jamie.
I'm
not
sure
if
you
work
with
them
with
the
impact.
Sorry
at
least
monroy
for
the
record.
N
Thank
you
for
the
reminder,
jamie
ross
for
the
record,
and
yes,
we
with
the
mpac
do
not
work
with
the
minority,
the
office
of
minority
health
and
equity,
but
I
do
believe
elise.
It
was
at
the
acrn
meeting
that
they
act.
They,
along
with
the
minority
health
equity
coalition,
both
presented
on
some
of
the
work
that
they're
doing,
and
they
were
intimately
involved
with.
The
ace
is
that
is
that
you
sit
on
that.
I
just
remember
listening
in,
is
that
your
recollection
as
well?
N
I
Thank
you
and
madam
chair
last
question,
because
I
it
occurs
to
me
that
the
dollars
that
we
have,
if
there's
more
capacity,
building
and
collaboration
we
can
stretch
and
then
there's
some
areas
that
nomi
would
be
able
to
identify.
That
may
not
be
on
your
radar
and
verse
advice.
So
just
a
suggestion.
There.
N
Thank
you
very
much
jamie
ross
for
the
record.
A
Thank
you
so
much
for
the
question
senator
and
the
responses
ms
monroy
and
miss
ross,
dr
orrin
licker.
Please
go
ahead
with
your
question.
E
N
Jamie
ross
for
the
record,
I
can
definitely
speak
to
that.
I
agree
with
you
wholeheartedly
that
adverse
childhood
experiences
and
addressing
the
trauma
our
youth
and
adults
are
experiencing
is
incredibly
important
in
reducing
our
risk
factors,
not
just
for
substance
misuse
but
for
all
other
negative
negative
outcomes.
N
But
in
my
field
we
call
that
upstream
prevention,
let's
build
fences
as
opposed
to
pulling
people
out
of
the
river
once
they've
fallen
in,
and
I
think
that
that
is
incredibly
important
and
definitely
something
that
those
of
us
who
are
in
the
field
of
prevention
are
incredibly
passionate
about.
And
I
am
hopeful
that
the
decisions
made
at
all
levels
of
funding
include
as
much
focus
on
really
giving
students
giving
parents
more
tools
in
their
toolbox,
giving
them
the
ability
to
be
safe
and
healthy.
N
In
their
communities,
because
we
know
that
that
is
an
incredibly
important
factor,
also
just
a
small
plug,
the
numbers
have
actually
just
gone
up
in
the
federal
that
I
have
read
and
that
is
for
every
dollar
spent
on
prevention.
We
save
18
in
treatment
and
incarceration
so
just
a
little
plug.
A
Thank
you
for
that
question.
I
was
wondering
something
very
similar
and
I'm
glad
that
we're
approaching
the
subject
and
those
numbers
are
are
incredible
when
we're
talking
about
the
amount
of
funding
that
goes
into
these
kinds
of
programs
and
then
what
we
can
expect
to
see
on
the
other
side
of
that
it's
hard
in
a
bi-annual
budget
cycle
to
be
able
to
look
towards
those
kinds
of
benefits,
but
it's
important
to
keep
in
mind
as
we
talk
about
really
the
the
risk
and
the
cost
and
benefits
to
our
communities.
A
A
I
am
not
seeing
any
so
I
will
thank
you
guys
for
being
here
on
and
presenting
on
this
issue
and
we'll
move
on
to
the
next
portion
of
our
presentation
on
substance
use
disorder,
treatment
in
youth
challenges
and
opportunities.
A
We
have
mark
diesel,
cohn
a
senior
project
manager
center
for
the
application
of
substance
use
technology
at
university
of
nevada.
Please
go
ahead,
mr
diesel
cone
and
correct
my
my
saying
of
your
last
name.
If
it
was
incorrect.
O
O
Okay,
mark
dislocated
for
the
record,
I
I
do
want
to
thank
you,
assemblywoman
peterson,
for
sharing
your
story
at
the
beginning
very
very
important.
My
brother
is
in
recovery
over
20
years.
He
almost
died
about
22
years
ago
and
he's
been
clean.
That
long
and
I
just
want
to
say
that
treatment
does
work
and
it's
important
for
people
to
share
our
stories.
O
O
It
was
the
bureau
of
alcohol
and
drug
abuse
when
I
worked
a
long
time
ago,
and
then
I
moved
over
to
cassette
and
have
been
here
ever
since
cassette
started,
doing
sapta
certification
for
prevention,
coalitions,
primary
prevention
and
treatment
programs
in
2006,
and
actually
when
I
first
came
over
to
sapta
in
1998,
that's
what
I
did.
I
did
a
certification
of
programs.
O
Now
we
have
an
excellent
understanding
of
the
treatment,
continuing
continuum
in
nevada,
as
we've
been
certifying
programs
for
a
very
long
time.
Since
1998
at
least
my
experience
has
been
so.
The
following
information
is
just
a
snapshot
of
adolescent
treatment
in
nevada,
sapta
has
adopted
the
american
society
of
addiction,
medicine,
asam's,
division
criteria
under
nevada,
administrative
code
458
for
the
continuum
of
care
in
nevada.
It's
a
nationally
recognized,
evidence-based
approach
to
developing
a
strong
continuum
of
care
for
substance,
use
disorders,
treatment
and
also
co-occurring
disorder
treatment.
O
O
There
are
three
level
3.1
and
or
3.5
certified
residential
adolescent
treatment
providers,
one
in
elko
and
two
in
las
vegas.
As
you
can
see,
nevada
has
limited
access
to
adolescent
residential
treatment
options,
statewide
more
on
this
in
a
minute,
so
funding
for
adolescents
treatment
and
I'm
gonna
pick
up
a
little
bit
on
those
opioid
dogs.
I
can
add
some
you
know
enhancements
to
that.
O
So
I
do
thanks
jamie
for
excellent
presentation
related
to
preventions
and
the
issues
in
nevada
and
funding
related
to
funding
and
reimbursement
options
for
state
for
sapta
certified
providers,
s-u-d-c-o-d
substance
use
disorders,
co-occurring
disorders,
provide
providers
must
be
sapta
certified
and
either
co-occurring
capable
or
enhanced
to
enroll
in
provider
type
17
215
with
medicaid,
and
that
provider
type
is
specific
to
both
sud
and
cod.
It
is
not
for
mental
health
only
which
would
be
like
a
provider
type
14..
O
Additionally,
sapta
utilizes,
the
substance,
abuse
prevention
and
treatment,
block,
grant
to
fund
residential
types
of
services,
room
and
board
so
forth,
and
so
on.
Typically,
outpatient
services
are
covered
by
provider
type
17
215
under
medicaid
jamie
made
a
good
point.
There's
a
lot
of
dollars
being
spent
on
on
from
the
federal
level
on
opioids,
but
in
the
last
round
actually
samsha
included
stimulants
along
with
opioids.
O
So
some
of
those
dollars
now
are
being
utilized
for
not
just
opioids
but
they're,
also
being
utilized
for
stimulant
treatment,
prevention,
so
forth
and
so
on,
and
there
is
word
that,
because
samsung
understands
that
there
are
other
problems
other
than
opioids
in
the
country
that
they're
actually
thinking
of
including
alcohol
as
well,
so
that
those
sor
dollars
strategic
opiate
response
dollars
that
come
from
the
feds
to
the
state.
They
are
looking
at
expanding
their
reach.
As
far
as
going
beyond
opioid
treatment.
O
There
are
other
providers
that
are
not
required
to
be
staff
to
certified
in
the
state.
In
these
cases,
oversight
is
limited
and
these
providers
typically
take
private
insurance
or
private
pay.
Okay,
so
there
are
people
outside
of
the
certified
providers,
but
they
are
not
receiving
any
medicaid
dollars
or
any
block
grant
dollars
from
the
state.
O
I
want
to
talk
a
little
bit
about
certified
community
behavioral
health,
centers
and
youth.
Cassatt
is
part
of
a
team
made
up
of
the
bureau
of
healthcare
quality
compliance,
medicaid,
sapta
and
cassette,
which
oversees
this
project.
There
are
nine
ccbhcs
that
fall
under
provider
type,
17
188,
which
is
specific
to
ccbhcs
and
six
additional
ccbhcs
that
are
funded
directly
from
sansha
samson
being
the
substance,
abuse
and
mental
health
services
administration.
O
O
It
is
noted
that
ccbhcs,
under
this
samsung
project
only
provide
outpatient
services,
not
residential
services
services
that
the
ccbhcs
provide
are
24
7
mobile
crisis
teams,
outpatient
treatment
that
would
be
like
level
one
and
2.1
medication,
assisted
treatment
both
for
substance
use
issues,
but
also
for
behavioral
health,
psychiatric
rehabilitation
and
basic
skills,
training,
targeted
case
management,
peer
support
services
and
assertive
community
treatment,
services
and
teams.
O
O
Two
of
our
ccbhcs
are
also
federally
qualified
health,
centers
fqhcs,
and
we
have
two
additional
ones
that
are
applying
for
fqhcs
as
we
speak,
and
just
a
note
because
I
it
was
brought
up
earlier
and
it
doesn't
necessarily
specific
to
ccbhc's,
though
they
would
need
to
provide.
This-
is
that
I
do
work
with
indigenous
people
in
the
state
of
nevada,
helping
them
with
getting
enrolled
in
provider
type
47,
which
is
something
under
for
native
american
populations,
indigenous
people,
so
they
can
bill
for
medicaid
for
substance
use
and
mental
health
services.
O
Okay,
so
let's
talk
a
little
bit
about
some
of
the
challenges
related
to
treating
youth
and
adolescence
in
the
state
of
nevada,
with
a
basic
understanding
of
the
treatment
continuum.
Here
are
some
of
these
challenges.
There
is
a
workforce
issue
in
the
valley
and
right
now,
it's
very
competitive
regardless,
if
you're
treating
adults
or
adolescents.
O
So
that's
one
of
the
challenges
there.
If
there
are
not
enough
clinicians
that
have
the
competencies
to
provide
adolescent
treatment,
it
is
very
specialized
level
of
service,
especially
when
you
get
into
the
world
of
substance,
use,
treatment
and
co-occurring
treatment.
It
even
becomes
more
specialized,
so
we
do
have
a
limited
workforce.
That's
able
to
actually
provide
treatment
at
a
level
of
competency
that
would
be
required.
Adolescent
treatment
is
specialized
and
takes
more
intense
treatment
over
longer
periods
of
time
to
be
successful.
O
O
O
Another
thing
that
you
have
to
think
about
with
working
with
adolescents
is
the
developing
brain
and
they're,
especially
in
early
adolescence.
Females
used
for
different
reasons
in
males.
Vice
versa
and
treatment
providers
really
need
to
know
what
they're
doing
related
to
screening
assessment
and
making
sure
that
those
individuals
get
the
individualized
care
that
they
need.
O
O
O
So
in
in
many
ways
there
are
really
no
limitations
related
to
policy,
as
there
is
a
continuum
of
care
with
a
means
to
pay
for
services
provider
type
17
215
is
an
example
of
a
reimbursement
mechanism
for
sud
and
cod
for
adolescent
treatment.
The
growing
number
of
ccbhcs
is
critical,
as
these
providers
are
required
to
provide
treatment
to
adolescents,
and
it
is
very
much
supported
by
samsha.
O
This
creates
competition
and
encourages
ccbhc
to
provide
more
expansive
treatment
options,
including
adolescent
care.
What's
nice
about
the
ccbhcs,
is
they
do
not
have
a
choice
related
to
providing
services
to
children,
adolescents?
They
are
required
to
do
it
and
have
the
staff
to
be
able
to
do
it
versus
maybe
just
a
standard
sapta
certified
program
where
they're
not
necessarily
required
to
provide
those
services.
O
Helping
providers
establish
strong
referral
relationships
with
schools,
law
enforcement
and
other
stakeholders
is
critical,
so
part
of
our
safta
certification
is
we
provide
technical
assistance
to
treatment
providers
and
we're
always
trying
to
encourage
them
to
reach
out
to
school,
counselors
work
with
juvenile
justice
so
forth,
and
so
on
to
build
a
very
clear
referral
connection
between
those
entities
and
themselves
and,
lastly,
actually
two
two
things
to
finish
with
education.
Opportunities
to
build
competency
for
counselors
will
encourage
expansive
expansion
of
services
to
you
and,
lastly,
education
opportunities
related
to
adopting
and
implementing
evidence-based
practice
is
critical.
O
A
provider
simply
can't
revise
their
adult
program
to
treat
adolescents.
They
must
develop
a
person-centered
care
based
on
age
and
developmental
stage
and
again
going
back
to
working
with
adolescents
with
substance
use
or
co-occurring
disorder.
Diagnosis
is
a
developing
brain
and
the
ability
to
take
that
into
account
when
they're
screening
assessing
and
then
treating
and
then
the
other
critical
piece
here
is
family
therapy
again,
which
is
a
specialized
level
of
service
and,
if
you're
not
doing
family
therapy
as
part
of
treatment
adolescence,
your
outcomes
decrease
significantly.
A
A
I
am
not
seeing
questions
from
the
committee.
I
had
a
question
related
to
that
last
bit
that
you
talked
about
of
the
family
therapy
and
the
impact
that
has
on
success
rates
of
treatment.
Can
you
talk
a
little
bit
about
the
challenges
of
creating
that
kind
of
a
program
and
system
for
families.
O
Very
good
question:
what's
really
critical,
and
I
really
share
this
with
anybody
providing
adult
or
adolescent
treatment,
but
especially
adolescent
treatment,
is
that
you
need
to
attempt
to
engage
the
family
throughout
the
continuum
of
care
right.
So
too
often,
what
happens
is
that
when
you
start
off
the
family
is
very
resistant
to
getting
involved
right,
and
so
the
goal
is:
is
that
use
motivational,
interviewing
kinds
of
approaches?
O
Try
to
engage
the
family
at
different
points
throughout
the
continuing
treatment
to
get
them
involved?
So
I
think
that's
one
of
the
key
factors
and
then
really.
I
think
that
treatment
providers
need
to
start
with
the
starting
point
of
families
have
to
be
involved.
So
if
they
build
a
program
and
they
have
staff
that
are
competent,
that
you
will
see
an
increase
of
family
engagement,
because
I've
seen
programs
that
are
committed
to
it
and
the
families
are
involved.
O
And
then
I
see
programs
that
are
less
indicated,
it's
much
less
part
of
their
whole
philosophy
and
they
have
a
harder
time.
So
I
think
the
key
is
is
that
it
needs
to
be
very
much
integrated
into
your
treatment
and
that
you
need
to
do
it
across
the
continuum
and
get
anybody
involved.
That's
a
part
of
the
family
unit.
It
may
not
be
the
mom
and
dad
it
could
be
grandparents.
It
could
be
other
significant
others
that
you
want
to
draw
on
as
well.
So
don't
just
look
at.
N
A
O
A
Those
are
really
really
important
numbers.
I
think
I
think
about
the
opportunities
families
have
and
some
of
the
limitations
that
exist
for
families
and
engaging
in
in
in
these
treatment
scenarios
and
the
availability
of
sick
time
paid
leave.
Those
kinds
of
things
are
real
inhibitors,
I
believe
for
for
family
members
being
able
to
be
as
involved
as
we
would
like
them
to
be
not
just
in
in
this
particular
issue,
but
across
the
board
for
behavioral
behavioral
health
for
students
and
children
and
youth.
O
Absolutely
so,
the
ccbhcs
are
actually
required
to
have
peer
support
specialists
on
staff
or
through
contract,
which
is
really
enhanced.
I
believe
treatment,
really.
What
we
in
the
past
before
pure
support
specialists
is
that
you
would
get
somebody
through
treatment,
they'd
be
doing
really
well
and
then
they
would
get
discharged
and
it
was
almost
like
they
fell
off
a
cliff,
but
the
pure
support
specialist
can
come
up
alongside
them
before
treatment
ends
and
provide
a
warm
handoff
into
the
recovery
community.
O
And
so
what
we're
seeing
is
an
increase
in
outcomes
because
in
longevity
of
recovery,
because
these
peers
come
alongside
and
really
bring
people
into
the
communities,
a
licensed
clinician,
you
know
can't
do
that
warm
handoff
and
take
somebody
to
a
support
group,
because
it
would
be
unprofessional
under
the
licensing
board.
But
with
a
peer.
A
O
It
does
no,
it
doesn't,
and-
and
that's
the
other
critical
thing
is
ccbacs-
are
actually
required
to
provide
both
peer.
E
O
To
the
client,
but
also
to
the
families
right
as
well
and
be
able
to
get
them
in
connection,
get
them
connected
to
resources
again,
while
the
individual
is
a
treatment
not
at
the
end
right,
so
whether
it
be
outlander
or
other
types
of
support
groups
for
those
individuals
to
get
involved
in
we're
really
working
on
that
as
well
the
ccbhc's.
O
You
know
it
was
a
heavy
lift
for
ccbhcs
and
they
may
they've
come
a
long
way
and
there's
a
long
ways
to
go.
But
you
know
we,
because
we
have
such
oversight
of
them.
Leadership
of
dr
woodard,
for
example,
we're
they're
moving
in
the
right
direction,
and
we
see
a
lot
of
these
things
really
becoming
more
and
more
implemented
and
integrated
into
the
community
and
and
those
services
becoming
more
wide-ranging,
including
the
family,
dynamic
and
the
services
that
they
get.
A
Thank
you
so
much.
I
don't
see
any
other
questions
coming
from
the
committee
unless
I'm
missing
you,
oh
okay,.
O
I
Yeah,
thank
you
and
I
just
had
a
real,
quick
question.
That
is,
you
know.
The
the
recurring
theme
in
all
of
these
reports
appears
to
be
there's
the
the
connectedness
between
individual,
the
individual,
that
is
quote
in
treatment
and
then
the
family.
So
the
question
would
be
this:
are
there
any
requirements
for
family
systems,
therapy
training
or
maybe
ceus
or
perhaps
merging
that
with?
And
I'm
thinking
about
it?
Similarly,
auditor's
comment
about
we're,
treating
which
we're
treating
the
symptoms
and
nothing
cause.
I
So
in
all
of
the
training
that
that
people
that
are
working
in
this
space
do
they
do
they
ever
look
at
anything
like
family
systems,
training
because
there's
a
presenting
problem
and
then
there's
a
larger
issue
with
the
environment
in
which
the
person
that
we're
treating
is
coming
out
of,
and
if
you
don't
address
that,
then
we
simply
you
know
kind
of
put
a
band-aid
on
it.
Send
the
person
back
into
that
environment
and
the
same
thing
happens
over
and
over
again,
absolutely.
O
O
So
all
the
licensing
boards
and
we
have
several
in
the
state
of
nevada,
require
clinicians
to
practice
within
their
scope
of
work.
Typically,
that's
more
of
a
generalist
kind
of
thing.
O
So,
when
you
get
into
other
kinds
of
specialization
like
treating
families
or
doing
substance,
use
treatment
so
forth
and
so
on,
you
are
required
to
have
a
certain
portion
of
your
continuing
education
every
two
years
in
those
specialty
areas
right,
so
one
of
my
specialty
areas
is
sud,
which
means
I
think
I
have
to
have
at
least
15
ceus
every
two
years
in
that
particular
specialty
area.
O
For
me
to
say
that
I
can
actually
do
that
and
practice
in
that
other
ways
that
you
gain
expertise
other
than
just
the
education
part
is
that
you
get
clinical
supervision
from
somebody
who
is
an
expert
so
whether
you're,
an
intern
working
towards
your
license
or
you're
already
licensed-
and
you
want
to
you
know-
build
competency
in
a
particular
specialty
area.
It's
really
important
for
that
commission
to
find
a
a
licensed
person
that
can
provide
that
supervision
for
them.
I
know
that
I
got
some
of
my
family
therapy
experience
early
on.
O
In
my
career,
because
I
did
joint
therapy
with
a
marriage
and
family
therapist
as
an
lcsw,
he
kind
of
took
me
on.
I
did
joint
therapy
with
him
and
that's
how
I
built
competency
too,
so
traditional
continuing
education,
finding
ways
to
be
supervised,
finding
a
mentor
to
help
you
develop.
Those
competencies
all
are
extremely
important
goals
for
somebody
who
wants
to
develop
a
specialty
area.
I
Thank
you,
madam
share,
with
your
indulgence,
just
one
more
question.
I
know
we've
got
a
number
of
community
partners
that
are
available,
particularly
in
the
faith-based
community,
not
for
proselytizing,
but
but
you
know
adjacent
to
what
the
professional
license
licensing
boards
do.
So,
if
we're
not,
is
there
any
opportunity
for
that
and
and
while
I've
got
while
I've
got
the
mic,
just
I'm
I'm
not
on
I'm.
I
I
don't
have
my
camera
on
all
the
time
because
I'm
having
some
international
issues
and
if
I
keep
it
on,
then
I'm
going
to
be
going
to
get,
kicked
off
and
try
to
sign
on
again
kicked
off.
But
but
I
am
here
for
the
record-
I
am
here
and
I
also
put
into
the
chat
a
couple
of
bills
that
I
spoke
about
earlier
senate,
bill
204
and
senate
bill
267
and
I
believe
we
had
both
of
those
in
2019
session
yeah.
I
think
we
had
both
of
them
in
2019
sessions.
I
So
that's
that's
just
some
context
for
everybody.
So
that's
why
I
am
the
faith-based
faith-based.
Partnerships
are
the
ones
that
I'm
I'm
thinking
about,
that
that
that
helps
us
to
extend
the
opportunity
to
do
what
we
do
without
having
all
the
money
to
do
what
we,
what
we
need
to
do.
O
Absolutely
you
know,
faith-based
organizations
are
a
critical.
You
know
stakeholder
and
and
again
we
don't
sometimes
on
the
treatment
side,
remember
to
out,
provide
to
reach
out
to
faith-based
communities
and
have
them
help
us,
and
you
know
we
can
help
each
other.
They
refer
people
to
to
the
treatment
system.
The
treatment
system
also
refers
back
to
the
faith-based
organization
because
of
the
support
that
they
provide,
and
we
know
that
any
kind
of
structure
support
you
know
12-step
or
other,
especially
in
the
faith-based
world,
actually
increases
outcomes
significantly.
O
So
I
really
glad
that
you
brought
that
up.
We
cassetta
actually
did
an
initiative
for
an
organization
down,
in
los
angeles
about
10
years
ago,
related
to
faith-based
where
we
were
helping
them
with
some
evidence-based
practice
stuff
and
they
were
helping
us
on
our
end,
and
so
that
is
an
incredible
thing
to
do,
and
I
do
tell
treatment
providers
that
you
know
I
I
mentioned
juvenile
justice
and
other
kinds
of
entities
in
the
community.
I
should
have
mentioned
also
faith-based
communities
as
well.
A
Thank
you
so
much
for
the
question
senator
and
thank
you,
mr
dislike
appreciate
your
your
presentation,
information
and
advocacy
in
this
area.
Are
there
any
other
questions
from
the
committee?
I
am
not
seeing
any
so
we
are
going
to
go
ahead
and
move
on
to
our
next
agenda
item.
Thank
you.
Mr
discipline,
appreciate
you
being
here.
Thank
you
agenda
item
eight
we're
gonna
get
through
this
and
then
break
for
lunch
after
this
agenda.
Item
no
pressure.
A
This
agenda
item
is
related
to
the
implementation
efforts
of
behavioral
supports
in
schools
through
the
multi-tiered
system
of
support
framework,
we're
going
to
again
invite
director
mcgill
to
the
table
and
her
it
looks
like
catherine
louden
will
also
be
presenting
with
her.
Please
go
ahead,
get
set
up
and
proceed
when
you're
ready.
A
L
Good
afternoon
christy
mcgill
office
of
safe
and
respectful
learning
environments-
I'm
here
today
just
to
talk
quickly
about
the
health
supports
in
schools,
especially
one
systematic
approach
that
we
call
multi-tiered
systems
of
support.
I
am
joined
by
two
of
our
professionals
in
our
districts,
both
at
clark,
county
and
washoe
county.
That
will
be
able
to
kind
of
fill
in
a
little
more
detail
about
what
they
are
doing
for
supports
around
behavioral
health
services.
L
So
just
really
quickly:
nevada
department
of
education
has
there's
two
pots
of
money
and
one
the
the
largest
pots
go
down
to
the
districts
themselves,
that
around
the
recovery
dollars
and
the
districts
can
decide
where
to
place
those
dollars
that
best
meet
their
needs
and
then
there's
a
smaller
pot
of
money
at
the
state
level
that
looks
at
systems
approach,
and
so
nde
worked
with
its
districts
and
key
partners
in
dhhs
to
look
at
what
could
we
do
to
provide
additional
funding
to
help
our
districts
recover?
L
So
we
looked
at
including
additional
dollars
for
school-based
mental
health
professionals.
We
set
aside
7.5
million.
This
is
on
top
of
what
districts
could
set
aside
as
well
with
their
with
their
ether
dollars.
On
top
of
that,
we
looked
at.
How
do
we
strengthen
because
one
of
the
things
we
learned
through
the
pandemic
was
that
schools
that
had
intact
multi-tiered
systems
of
support
fared
a
little
bit
better
when
getting
supports
out
to
children,
and
I
can
share
those
results
with
you
soon,
and
so
we
looked
at.
How
do
we
deepen
that?
L
So
we
did
put
in
some
coaches
that
the
districts
could
hire
to
allow
those
people
to
come
in
and
really
support
the
schools
who
wanted
to
deepen
their
multi-tiered
systems
of
support.
They
could
do
that.
We
also
looked
at
restorative
training,
support
again
the
2021
legislation
looked
at.
How
do
we
move
away
from
suspensions
and
expulsions
and
be
able
to
teach
behavior
instead
of
punish
behavior,
and
so
we
looked
at
trainings.
This
was
a
big
gap.
L
And
then
we
also
looked
at
safe
voice
program
enhancements,
especially
around
many
of
our
after
hour,
calls
are
answered
by
our
law
enforcement
officers.
So
how
do
we
mix
that
with
mobile
crisis?
How
do
we
really
make
sure
that
there's
a
holistic
response
to
these
well
checks
on
after
hours,
and
so
we're
looking
at
rolling
that
project
out
soon
as
well?
L
L
We
really
want
to
make
sure
that
teachers
do
not
feel
like
they're
independent
and
facing
some
of
these.
These
struggles
that
their
student
may
be
having
so
that
there's
teams
involved
also
problem
solving
around
data
to
really
make
sure
that
our
districts
are
empowered.
We
have
washoe
county
here.
Who
is
one
of
the
leaders
of
really
how
do
they
empower
their
schools
and
database
decision
making
and
then
look
at
systematic
implementation
and
progress
monitoring.
L
What
we
really
strive
for
is
that
it's
not
enough
just
to
put
in
the
behavioral
health
supports
for
students,
but
we
really
want
to
make
sure
that
we
have
a
system
that
can
progress,
monitor
and
to
make
sure
those
interventions
are
actually
working
and
then
tiered
continuum
of
support.
A
lot
of
times
is
what
people
think
about
when
they
think
about
mtss
or
multi-tiered
supports,
and
this
is
about
differentiation.
L
The
goal
is
really
trying
to
get
supports
and
interventions
to
students
early
and
to
make
sure
that
they
have
as
soon
as
they
have
signs
of
struggle
that
they
have
those
supports
ready
for
them
and
so
we're
not
catching
them
in
special
education
or
three
years
down
the
line
or
when
they
enter
safe
voice
as
really
struggling
with
their
behavior
health.
It
also
really
stresses
on
tier
one,
and
this
is
something
that
our
schools
do
really
well
tier.
L
One
is
good
strong,
preventative
instruction
and
good
instruction
across
the
board
to
all
of
the
students,
and
so
that
is
where
our
teachers
come
in
our
school
counselors
and
then
regular
screening,
evidence-based
interventions.
So
this
is
the
system
around
mtss
and
of
course
it
focuses
on
equity,
because
if
you
have
a
system
that
differentiates
support
and
interventions
when
students
and
staff
need
them,
then
you
create
more
of
a
system
that
is
equitable.
L
I
put
this
here
in
for
you
guys,
just
for
your
notations
and
and
reading
enjoyment,
that
kind
of
goes
through
the
different
tiers
that
you
guys
can
refer
back
to,
but
again,
just
like
the
public
health
model
tier
one,
two
and
three,
the
universal
supports
for
all
students,
targeted
interventions
for
students
at
risk,
and
then
individualized
supports
for
a
few
students
and
that's
where
some
of
the
clinical
work
can
come
in
and
our
school-based
health
can
help
support
that.
L
L
And
again,
I
just
put
this
in
here
for
your
quick
reference
to
kind
of
look
at
the
types
of
trainings
that
are
unr
technical
assistance
center
and
again,
I
should
really
preface
that
our
office
is
quite
small.
We
wouldn't
be
able
to
do
any
of
this
work
without
our
partners,
and
one
of
the
key
partners
to
mtss
is
unr.
L
So
these
are
the
trainings
that
a
school
and
district
would
go
through
if
they
so
selected
to
use
the
multi-tiered
systems
of
support,
which
also
helps
them
meet
the
requirements
around
nevada's
integrated
systems
that
was
also
put
into
place.
I
believe
two
legislative
sessions
ago,
so
just
real
quickly.
I
wanted
to
end
on
some
positive
notes
that
when
schools
do
this
with
fidelity,
we
do
see
improved.
L
We
do
see
improved
climate
for
teachers
and
then
also
improved
student
outcomes.
So
here
you
can
see
that
one
of
the
goals
is
to
try
to
tackle
the
issue
of
teachers
feeling
and
school
counselors
and
everything
out
that
there's
too
much
on
their
plate
and
so
really
looking
at.
How
do
we
look
at
one
system,
multiple
practices,
not
multiple
systems
with
multiple
practices,
and
it
feels
very
overwhelming
we
haven't
got
this
down
yet
obviously,
but
this
is
one
of
the
things
that
we
are
working
for.
L
We
have
found
in
schools
that
are
implementing
with
fidelity
that
it
does
seem
to
reduce
that
feeling
of
being
overwhelmed
and
some
student
outcomes
again
you'll
notice.
Some
really
large
data
swings
on
the
outcomes
because,
of
course,
of
the
pandemic,
but
what
you'll
also
notice
is
that
many
of
our
mtss
schools
that
are
implementing
with
fidelity
are
also
schools
that
are
have
exhibited
either
are
a
title
one
or
are
struggling
in
some
sorts,
and
so
they're
doing
this.
L
So
I
went
through
that
very
quickly
because
I
wanted
to
allow
some
time
for
our
districts
to
talk
about
the
behavioral
supports
and
what
they're
doing
during
this
time
as
well
as
noted,
I
believe
it
was
dr
freeman
that,
despite
some
of
the
ratios
and
nevada
has
not
met
its
ratios
on
school,
counselors,
school,
social
workers
and
and
school
psychologists
that
so
this
workload
during
the
pandemic
became
a
lot,
and
so
we
are
striving
to
better
those
ratios
and
working
with
dhhs
closely.
L
One
of
those
ways
is
to
look
at
medicaid
and
instead
of
using
educational
funds
for
those
tier
three
services
which
we're
doing
a
lot
of
is
to
bring
in
that
medicaid
dollars
to
offset
that.
What
we
hope
is
that
this
results
in
a
larger
budget
for
schools
to
purchase
more
people
to
come
into
the
schools,
school
psych,
school,
counselors,
school
social
workers
and
that
to
better
those
ratios.
So
I'm
going
to
turn
it
over
to
our
clark
county,
which
I
believe
is
miss
director
weirs
there.
L
He
is,
and
also
joe
roberts,
who
runs
the
crisis
intervention
team.
There.
P
Good
afternoon
for
the
record,
bob
weirs,
director
of
psychological
services,
clark,
county
school
district,
I'll
just
share
for
a
minute
or
two
and
then
I'll
ask
joe
to
share
and
see
if
we
can
help
answer
some
questions
as
the
director
of
psychological
services,
I
have
direct
oversight.
I
have
oversight
responsibilities
for
all
of
our
licensed
school
psychologists,
providing
psychoeducational
services
across
our
schools
and
I'm
also
actively
involved
with
our
multi-tiered
systems
of
support
efforts
within
the
district.
So
one
of
my
our
specialized
sub
departments
is
our
crisis
response.
P
Team
joe
will
speak
to
that
and
some
of
their
responsibilities
and
and
roles,
but
also
our
department,
has
actively
supported
development
of
schools
that
follow
multi-tiered
systems
of
supports
and
positive
behavior
interventions
and
supports
with
some
collaboration
through,
as
director
mcgill
said,
the
the
university
of
nevada,
reno
pbis
technical
support
center.
So
we
were
up
to
approximately
over
100
schools
that
were
actively
pursuing
implementation
of
pbis
related
practices.
P
As
the
director
of
psych
services,
I
do
a
lot
of
communication
collaboration
with
other
departments,
key
people
related
to
health
and
behavior
behavioral
health.
We
have
active
engagement
in
collaboration
with
our
counselors.
Our
wraparound
services
that
include
social
workers
and
safe
school
professionals,
our
health
services,
school
nurses.
P
P
We
have
collaborative
activities
with
the
mobile
crisis
response
team,
the
harbor
and
so
on.
I'm
also
a
standing
member
of
our
district's
mtss
district
leadership
team.
So
for
we
are
moving
forward
step
by
step.
Just
this
past
december
2021,
we
passed
the
district
policy
more
formally
endorsing
mtss
practices
in
the
district.
So
that's
a
basic
overview.
P
I
can't
come
back
after
joe
introduced
himself.
There
were
so
some
of
the
questions
earlier
this
morning
that
we
can
provide
some
feedback
on
what's
happening
in
clark,
county
school
district,
but
we
very
much
are
aligned
with
mental
health
types
of
services
within
the
clark
county,
school
district,
joe.
B
Thank
you.
Bob
joe
roberts
director
of
clark,
county
school
district
crisis
response
team
for
the
record
to
address
some
of
the
questions
and
to
to
speak
to
director
mcgill's
points
there
regarding
behavioral
mental
health
supports
for
students
in
our
schools.
We
we
have
and
we
did
initiate.
B
B
Moving
forward
in
in
through
the
pandemic,
we
recognize
the
need
to,
while
we
were
close
to
still
have
access
to
our
school-based
intervention
team
staff,
schools
like
school
nurses,
school
social
workers
and
school
psychologists
in
the
district,
and
we
initiated
a
district-wide
effort
and
collaboration
with
building
principals
and
wrap-around
services,
psych
services,
school
police
and
whatnot
throughout
our
district
to
engage
in
what
we
coined
the
term
the
lifeline
project,
which
was
to
allow
students
to
initially
raise
their
hand
during
an
online
session
and
make
an
appointment
to
be
seen
at
a
school
site
for
crisis
support
and
coming
through
that
we
initially,
we
also
embarked
on
a
very
lengthy
and
involved
project
with
developing
a
screener
panorama
screener
and
we're
still
using
those
tools.
B
Today,
we
also
engaged
in
alert
monitoring
district
devices
for
students
who
were
expressing
suicidal
ideation
or
even
perhaps
considering
an
attempt,
those
types
of
things
through,
what's
known
as
or
coined
as
beacon
goguardian.
In
addition
to,
and
that
complemented
our
efforts
with
our
already
engaged
efforts
with
safeways.
B
So
we
were
able
to,
I
I
feel
and,
and
our
numbers
show
we
were
able
to
turn
the
tide
on
on
our
completed
suicide
rate
and
then
moving
beyond
that.
We
already
had
existing
partnerships
with,
say
the
harbor,
with,
as
bob
said,
the
mental
health
consortium
and
with
mobile
crisis
response
team,
but,
however,
coming
through
the
pandemic
and
during
the
pandemic,
we
solidified
even
more
so
those
relationships,
and
we
appreciate
our
partnerships
with
those
agencies.
B
As
far
as
other
efforts
are
concerned,
we
increased
our
level
of
training
for
suicide
prevention
to
all
of
our
staff,
in
the
district
and
and
also
too,
we
expanded
some
other
factors
or
some
other
key
components
like
our
suicide,
sos
curriculum
and
training
for
our
students,
grades
7-12,
and
we
can
answer
those
questions
more
specifically
in
the
next
piece
here.
Thank
you.
P
So
again,
bob
wears
for
the
record
director
of
psychological
services,
so
some
of
the
questions
earlier
joe
just
started
to
answer
that
I
believe
the
the
statue
with
senate
bill,
204
2019
required
increased
awareness,
training
relative
to
suicide
prevention,
warning
signs
indicators,
both
community
and
and
school
resources
and
basic
information.
We
included
basic
informational
procedures
so
for
the
past
two
years,
looking
at
compliance
with
senate
bill
204,
we
have
been
provided
to
offering
suicide
prevention,
training
to
administrative
staff,
licensed
staff
and
support
staff.
P
In
terms
of
the
earlier
question
about
developing
systems,
we
are
working
mightily
to
develop
infrastructure
for
multi-tiered
systems
of
supports
we're
playing
a
little
bit
of
catch
up
on
the
behavioral
side.
Of
course,
we're
looking
at
the
all-around
development
of
students,
academic,
behavior,
social,
emotional,
encompassing
behavioral
health.
We
are
building
infrastructure
coming
off.
The
pandemic
was
a
huge
impetus
for
us,
as
joe
mentioned,
through
the
lifeline
project,
to
develop
multi-disciplinary
leadership
teams
which
are
basically
problem
solving
teams
for
at-risk
students
so
to
complement
what
we
had
available
for
academics
for
kids.
P
So
we
are
moving
forward
with
developing
infrastructure
and
practices.
We
are
expending
mental
health.
Expanding
upon
mental
health
services
and
supports
recently
the
district
engaged
by
example
in
in
working
with
care
solas,
which
helps
us
facilitate
connecting
families
with
community
providers.
P
So
there
are
a
number
of
activities
that
are
going
on
and
and
core
county
is
in
the
process
of
developing
step-by-step
the
infrastructure
related
to
multi-tiered
systems
of
supports.
There
was
an
earlier
question
about
safety
procedures,
plans
and
also
specific
to
suicide
ideation
joe
answer
that
in
part
but
I'll,
try
to
add
to
that
information.
P
As
director
mcgill
mentioned,
schools
all
have
safety
plans
in
place.
We
have
a
plan
for
the
entire
district
for
large
crisis
events,
whether
that's
a
school,
a
group
of
schools
or
the
entire
district
emergency
management
department
helps
us
run
that
it
ties
into
all
elements
of
the
district
under
a
master
plan,
probably
the
best
example
of
the
last
time
that
was
fully
engaged
apart
from
the
pandemic.
Some
activities
was
the
october
one
tragedy
where
we
were
mobilizing
response
resources
relative
to
that
tragedy.
P
Each
of
the
schools
trained
every
year
on
safety.
They
go
through
soft
out
soft
lockdown,
hard
lockdown
evacuation
procedures
with
assigned
responsibilities
at
the
level
that
applies
to
all
facilities
in
clark,
county
school
district,
for
example.
I
work
at
a
centralized
office,
dr
beth
house
center,
I'm
on
the
safety
team.
My
responsibilities
specifically
are,
in
addition
to
helping
with
head
counts,
make
sure
everybody's
accounted
for
part
of
my
responsibilities
to
ensure
assess
whether
there
are
any
mental
health
needs
and
to
help
provide
and
coordinate
services
if,
in
fact,
they're
they're
needed
heightened
sensitivity.
P
I
I
believe
the
assemblywoman
mentioned
that
this
this
morning,
just
our
last
ccsd
board
of
school
trustees
meeting
specifically
had
an
agenda
item
that
was
talking
about
safety
issues.
So
there
are
plans
in
place,
there's
heightened
sensitivity,
and
the
district
continues
to
look
at
safety
issues
for
students
and
south
safety
for
all
students
and
staff
joe,
and
I
obviously
line
up
a
little
bit
more
deeply
with
the
mental
health
side.
So
we
have
a
comprehensive
what
we
generally
refer
to
as
the
suicide
intervention
protocol.
P
We're
just
talking
about
updating
our
risk
assessments.
Our
procedures
go
from
any
kind
of
question
or
concern
relative
to
a
student
through
intervention
through
a
screening
assessment
through
intervention
at
school
level,
up
to
the
few
cases
where
we
actually
need
to
help
facilitate
hospitalization
of
students
for
appropriate
assessment.
P
We've
done
a
very
good
job,
in
my
humble
opinion,
over
the
last
five
six,
eight
years
of
standardizing
those
procedures
making
sure
we're
clear
about
them
all
of
our
first
responders
at
the
school
level,
which
is
some
combination
for
a
given
event.
On
a
given
day
of
a
counselor
social
worker,
safe
school,
professional
nurse
psychologists
and
including,
of
course,
administrative
support.
P
All
those
people
when
they're
new
to
the
district
are
trained
in
our
suicide
intervention
protocol.
Procedural
steps,
forms
and
all
of
us
are
occasionally
receiving
refresher
courses
so
that
we
make
sure
that
we're
aware
of
what
our
responsibilities
are
so
from
the
suicide
ideation
side.
I
know
that
was
a
question
earlier
today.
I
do,
I
feel
again
from
my
professional
opinion
that
that's
well
established
well
standardized
and
it's
a
good.
It's
a
it's.
P
A
strength
of
the
clark
county,
school
district
challenge
of
the
district
obviously
is
to
move
more
proactively,
get
more
to
the
at-risk
kids
move
more
into
the
educational,
the.
What
are
we
doing
with
all
kids?
How
can
we
increase
awareness?
How
can
we
increase
that
so
across
the
board?
I
I
did
want
to
share
that.
We
are
making
progressive
steps
that
reflect
nevada
legislation
in
relation
to
increased
awareness
that
includes
training
with
students
and
staff.
P
We
are
do
have
a
mechanism
in
place
for
response
in
relation
to
suicide
ideation.
We
are
continuing
to
look
at
the
district
level
for
planning
and
support
for
schools,
as
so
that
we
can
progressively
ensure
that
we're
meeting
the
academic,
behavior
social,
emotional
and
including
behavioral
health
needs
of
kids.
So.
A
Thank
you
for
making
the
distinction
between
the
proactive
efforts
and
the
reactive
efforts.
It's
it's.
You
know
necessary
to
have
the
reactive
efforts
in
place,
but
the
proactive
pieces
are
what
we're
really
seeing
is
being
as
making
a
difference
to
our
students,
so
I
hope
that
our
focus
can
continue
to
be
in
that
space.
A
Q
Thank
you
very
much
for
the
record.
My
name
is
catherine
lowden.
I
coordinate
school
counseling
and
social
work
for
the
washoe
county
school
district.
Our
emerging
school
social
work
program,
washoe,
county
school
district,
has
an
department
headed
by
trish
shaffer,
who
also
heads
social,
emotional
learning.
Our
district
has
a
robust
website
with
lots
of
great
information
about
how
this
incredible
mtss
system
helps
with
data-based
decision-making
related
to
how
to
support
schools
and
students
in
an
individualized
fashion.
Q
Q
We
have
found
that,
due
to
the
lack
of
availability
of
supports
and
the
pipeline
to
success
for
these
critical
mental
health
personnels,
what
we
really
need,
in
addition
to
continued
sustained
funding
for
these
positions,
is
that
co-located
integrated
supports.
We
need
our
mental
health
professionals
and
our
substance
misuse
professionals
to
come
into
our
school
and
to
work
side
by
side
with
us,
and
that
is
something
that
we
have
been
implementing
and
working
collaboratively
toward.
Q
Q
Q
We
have
been
collaborating
with
our
northern
nevada
mental
health
consortium
and
I
have
contributed
to
their
recommendations
and
accessed
the
professionals
in
that
group,
and
we
are
project
aware
a
samsa
project
aware
school
district
and
we
appreciate
that
and
the
work
that
that
has
had
with
the
nevada
department
of
education
and
the
stakeholders
there.
Q
But
when
we
are
using
and
employing
strategies
to
prevent
suicide.
We
are
preventing
substance
misuse.
We
are
addressing
gangs,
we
are
addressing
so
many
things
in
the
field
of
prevention
related
to
violence
and
otherwise
that
I
think
we
could
learn
a
lot
from
that
work
and
some
of
the
prevention
work
that
the
center
for
application
of
substance,
abuse
technologies
and
others
have
put
into
place
for
us
to
benefit
from.
Q
Q
A
Thank
you.
Thank
you
for
the
the
presentation
on
how
things
are
going
in
our
largest
school
districts.
The
emergency
response
team
work
is
really
really
an
interesting
space.
I
get
to
do
it
with
hazardous
materials,
but
it's
it's
really
interesting.
When
you
dive
into
the
community
emergencies.
I
have
a
quick
question.
I
guess
it's
a
follow-up
question.
A
You
don't
need
to
respond
today,
but
I
would
like
to
from
both
counties,
get
any
kind
of
reporting
that
you
have
on
your,
as
ms
mcgill
pointed
out
in
her
presentation,
system,
implementation
and
progress,
monitoring
efforts.
So
if
you
have
quantifiable
or
even
qual
qualitative
indicators
of
how
successful
your
efforts
have
been
over
the,
I
would
say
last
five
year
period,
maybe
to
give
us
a
couple
years
before
the
pandemic.
That
would
be
great
to
see
and
then
with
that
I
will
open
it
to
committee
questions.
E
Q
Yes,
we
have
experienced
the
impacts
of
overdoses
that
occur
outside
of
school,
but
we
have
had
overdoses,
including
fentanyl,
on
our
campuses,
and
it
is
a
concern
we
have
taken
advantage
of
the
availability
of
narcan
and
and
collaborated
with
the
community
agencies
that
are
in
place
to
put
that
together.
Our
district
has
a
policy
through
our
director
of
school
nursing
and
we
are
implementing
that
currently
and
working
on
that
and
our
district's
policies
at
this
time.
Q
We
haida
had
a
presentation.
The
high-intensity
drug
agency
had
a
presentation
for
us
at
the
beginning
of
the
year
and
connected
us
with
some
resources
through
our
community
coalition
joined
together
in
northern
nevada,
and
then
we
collaborated
with
the
other
stakeholders
to
implement
that
in
our
schools.
B
Absolutely
joe
roberts
for
the
rector
record,
director
of
the
christ
response
team
and
while
I'm
not
actually
responsible
for
the
narcam
that
falls
in
line
with
our
ccsd
health
services,
we
have
had
fentanyl
overdoses
in
our
district.
We
have
employed
the
narcam
antidotes
or
antidotes.
B
A
G
Thank
you.
I
know
everybody's
anxious
to
go
to
lunch,
but
I
just
want
to
acknowledge
the
presentation
and
director
miguel
I
appreciate
and
the
folks
from
clark
and
washoe
county
from
what
I'm
looking
in
our
schedule.
G
From
what
I'm
understanding
teachers
are
afraid.
Teachers
are
retiring
and
I'm
wondering
if
at
some
point
we
can
get
a
presentation
or
if
you
already
have
done
this,
some
analysis
of
why
teachers
are
afraid
why
teachers
are
leaving
the
classroom
and
what
resources
do
the
teachers
have,
because
I
believe
it
all
ties
together.
G
I
believe
that
the
teachers
will
be
able
to
teach
better
if
they
feel
safe
themselves
and
students
will
be
able
to
learn
better
if
they
have
teachers,
and
so
I'm
just
wondering
I
hadn't,
heard
anything
engagement
with
teachers
in
this
particular
presentation
and
is
that
something
you're
looking
into?
Is
that
something
you've
done?
Are
you
doing
surveys
when
somebody
leaves
early
retirement
on
why
they're
retiring?
Because,
again,
what
I'm
hearing
and
it's
just
anecdotally-
and
I
try
to
I-
really
try
to
stay
away
from
just
antidotes.
G
L
Christy
mcgill
for
the
record
we
are
doing,
and
so
with
the
districts
doing,
and
we
can
have
that
data
for
you
when
we
start
getting
it
in
we're
doing
some
climate
surveys
with
the
teachers,
and
I
know
that
our
districts
are
doing
some
surveys
as
well,
so
those
have
not
been
concluded
yet,
but
we
can
get
that
we
did.
Do
the
well-being
survey
to
some
of
our
teacher
population
that
again
we
can
get
that
data
up
to
you
guys.
A
That
would
be
great
great
thank.
G
A
Thank
you,
and
I
I
appreciate
the
tie-in
to
workforce
and
and
behavioral
health
services,
and
even
just
support
services
in
schools
in
general,
and
it's
it's
interesting
to
see
how
our
committees
overlap
sometimes,
and
we
have
these
intersectional
issues
that
come
up
and
where
those
conversations
belong.
So
we
appreciate
the
follow-up
on
that
when
those
data
come
in.
Are
there
any
other
questions
from
the
committee
before
we
break
for
lunch?
A
I'm
not
seeing
any
thank
you
so
much
for
being
here
and
for
presenting
on
what
you're
doing
in
your
counties.
We
look
forward
to
some
of
those
follow-up
items
from
you
with
that,
I'm
going
to
go
ahead
and
have
us
break
for
lunch.
We're
going
to
do
hold
on
a
second.