►
Description
This is the fifth meeting of the 2021-2022 Interim. Please see 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.
All videos are intended for personal use and are not intended for use in commercial ventures or political campaigns.
Closed Captioning is Auto-Generated and is not an official representation of what is being spoken.
A
Welcome
back
from
lunch
folks,
I
hope
everybody
got
what
they
needed
to
nourish
yourselves
for
the
next
part
of
this
day.
Today
we
are
going
to
start
off
after
lunch
here
with
our
first
afternoon,
presentation
item
number
10
presentation
on
food
security
for
children
in
nevada.
A
B
We
can
okay,
my
name
is
sarah
rogers,
I'm
the
nutrition
unit,
deputy
chief
with
the
nevada
division
of
public
and
beautiful
health.
I'm
here
to
talk
a
little
bit
about
food
security
for
children
in
nevada,
food
security
means
the
ability
of
a
person
to
access
enough
food
for
an
active
and
healthy
lifestyle.
B
The
office
of
food
security's
mission
is
to
effectively
improve
the
quality
of
life
and
health
of
nevadans
by
increasing
food
security
throughout
the
state.
The
guiding
principles
of
the
office
of
food
security
include
incorporate
economic
development
opportunities
into
food
security
solutions,
use
a
comprehensive,
coordinated
approach
to
ending
hunger
and
promoting
health
and
nutrition,
rather
than
just
providing
emergency.
Short-Term
assistance
focus
on
strategic
partnerships
among
all
levels
of
government
communities,
non-profit
organizations,
including
foundations,
private
industries,
universities
and
research
institutions,
use
available
resources
in
a
more
effective
and
efficient
way,
implement
research-based
strategies
to
achieve
measurable
results.
B
B
B
They
meet
four
times
per
year,
they're
tasked
with
identifying
priorities
in
food
security
tasked
with
implementing
the
food
security
in
nevada,
nevada
plans
for
action,
and
they
have
21
cross-sector
members.
B
B
B
Some
food
insecurity,
household
characteristics
overall
households
with
children
had
a
substantially
higher
rate
of
food
insecurity
at
14.8
percent
than
those
without
children,
which
is
8.8
among
households
with
children
married
to
couple
families
had
the
lowest
rate
of
food
insecurity
at
9.5
percent.
I
mean
this
is
from
2020.
B
This
is
feeding
america
data
in
all
50
states
in
all
50
states
and
washington
dc.
The
estimated
rate
of
child
food
and
security
is
higher
than
the
rate
of
overall
food
insecurity.
B
B
B
As
of
april
2020,
there
were
201
985
children,
ranging
from
zero
to
18
on
snap
benefits
and
that
number
has
decreased.
As
of
april
2022,
1
800,
one
185
432
children
are
currently
enrolled
in
snappy
from
ages
0
to
18.
B
The
majority
of
those
children
are
in
the
age
range
between
6
and
12.,
that
73
1099
and
then
the
pandemic,
ebt
or
pedt
was
developed
as
a
response
to
the
pandemic,
and
it
is
for
children,
ages,
4
to
22
in
grades
pre
pre-k
to
12.
in
2021
to
2022
school
year.
More
than
96
million
dollars
and
pb
pgbt
benefits
were
issued
to
approximately
330
000
nevada
children,
which
is
less
than
2020
to
2021
school
year,
where
approximately
340
million
in
pedt
benefits
were
issued
to
approximately
396
000
nevada
children.
B
B
Women,
infants
and
children
participation
between
march
and
april
2020,
the
greatest
increase
among
what
wick
participation
type
was
seen.
This
was
among
pregnant
women
and
children.
Participants
during
the
height
of
the
pandemic,
wick
saw
an
increase
in
participation,
but
an
overall
decrease
in
actual
food
redemption.
C
B
There
were
improvements
made
in
snap
shopping,
but
not
improvements
made
in
wick
shopping,
such
as
online
shopping
capabilities,
wake
appointment
requirements
and
clinics
started
to
open
back
up,
requiring
them
to
come
back
in
person,
which
does
require
more
follow-up.
To
maintain
benefits.
Also,
weight
benefits
are
not
monetary,
they
are
prescription
style
benefits.
B
B
Less
than
half
of
the
women
and
children
who
are
eligible
to
participate
in
wic
actually
participate.
All
of
the
children
in
the
zero
to
five
range
who
are
participating
in
snap
are
objectively
eligible
to
participate
in
wic
and,
as
you
can
see,
from
the
the
chart
on
the
previous
slide,
that
was
around
sixty
thousand
children.
Zero
to
five
are
participating
in
snap
and
as
of
april
2022,
forty
thousand
four
hundred
and
eighty
nine
zero
to
five
year
olds
are
participating
in
wic.
So
there
is
a
disparity
there.
B
B
The
cova
19
pandemic
has
led
to
an
unprecedented
increase
in
food
security
and
need
for
nutrition
services
statewide
and
nationally.
According
to
feeding
america.
Nevada
is
projected
to
rank
eighth
nationally.
Regarding
rates
of
projected
food
insecurity
in
2020
versus
2018,
six
nevada
counties
experienced
more
than
a
30
percent
experience
more
than
a
30
increase
in
food
insecurity,
from
2018
to
2020,
as
counties
being
douglas
elko
lion
story
wash
show
and
clark
county
clark.
County
experienced
the
largest
increase
of
food
and
security
from
12.8
percent
to
20.1
percent
in
2020.
B
B
Overall,
there
is
an
increase
in
program
utilization
between
march
and
may
2020
such
as
food
bank
donation
distributions,
snap
and
then
department
of
agriculture,
programming,
snap
and
wick
waivers
were
required
to
continue
to
serve
in
the
participants.
Throughout
the
pandemic,
there
was
identified
technology
advancements
that
wick
needs
to
continue
to
work
on
to
serve
their
population.
B
B
B
We
are
in
the
process
right
now
of
conducting
focus
groups
with
state
community
partners,
community
and
community
members.
The
strategic
plan
will
advise
the
office
of
good
security
and
policy
recommendations
for
state
food
security
efforts.
We
have
our
first
strategic
planning
meeting,
which
is
held
in
person
that
will
be
taking
place
in
carson
city
on
may
24th
and
is
open
to
all
food
security
stakeholders.
A
Thank
you
so
much,
mrs
rogers.
Are
there
any
questions
from
the
committee
on
this
particular
presentation?
I
can't
see
you
in
zoom
or
southern
nevada.
So
please,
let
me
know
if
you
have
a
comment
or
question
all
right.
I
do.
Can
you
talk
a
little
bit
about
what
the
biggest
differences
are
between
wic
and
snap
programs.
B
Yeah,
so
I'm
I'm
more
well
versed
in
wic
as
wic
is
part
of
our
nutrition
unit.
But
wic
is
a
program
that
is
open
to
pregnant
women
or
pregnant
parents.
B
Postpartum
parents,
breastfeeding
parents
to
a
year
breastfeeding
or
six
months,
postpartum
if
they're
not
breastfeeding,
and
children
zero
to
five
years
old
or
up
to
their
fifth
birthday.
The
income
eligibility
for
wic
is
a
little
bit
higher
than
snap,
but
the
requirements
to
maintain
benefits
on
wic
is
a
little
bit
more.
B
It
requires
a
little
bit
more.
We
got
you
have
to
do
at
least
quarterly
nutrition
education.
They
do
individual,
targeted
nutrition,
ed,
provide
breastfeeding
support,
breast
pumps
to
moms
in
need,
and
it's
a
prescription
style
food
package.
So
on
average
I
believe
the
actual
cost
of
a
wic
food
package
comes
out
about
35
per
individual.
B
Of
course,
it's
a
little
bit
higher
if
it's
a
lot
higher.
If
we
are
providing
formula
on
their
package
and
snap
is
monetary
benefits,
so
they
have
more
options
and
ability
to
purchase
a
wider
variety
of
foods
where
wic
foods
are
mainly
eggs.
Low-Fat
dairy
products,
some
cheeses,
yogurts,
cereal,
hot
cereal,
cold,
cereal.
A
Okay,
I
was
thinking
about
the
slide
where
you
talked
a
little
bit
about
that
there's,
a
disparity
and
who
accesses
wic
versus
who
accesses
snap,
and
I
was
wondering
if
we
could
kind
of
just
see
what
the
difference
was
and
what
was
provided
and
maybe
dive
into
what
those
disparities
look
like.
How
do
people
apply
for
wic
versus
snap?
Are
they
through
the
same
application
process
or
are
they
separate
programs.
B
No
they're
separate,
we
do
get
wic
referrals
through
the
division
of
welfare,
so
if
someone's
going
to
apply
for
snap
and
the
division
of
welfare
identifies
that
they
could
also
qualify
for
wic,
we
do
have
a
relationship
with
snap
where
we
do
get
those
referrals,
but
the
participant
would
have
to
call
their
closest
local
wic
agency
and
apply
separately
and
it's
a
certification
appointment.
So
they
are
required
to
have
a
heightened
weight
taken
depending
on
the
type
of
participant.
If
it's
a
pregnant
woman
or
child,
we
do
require
iron
to
be
taken.
B
A
I'm
not
seeing
any
unmute
yourself
if
you
would-
and
I
missed
you
all
right
well,
thank
you,
miss
rogers.
So
much
for
the
presentation
appreciate
your
work.
We
will
go
ahead
and
close
that
agenda
item
and
move
on
to
the
next
presentation,
which
is
also
you
so
we're
going
to
talk
about
in
this
next
item.
The
overview
of
childhood
obesity
in
nevada's.
Please
miss
rogers,
go
ahead.
B
B
The
clinical
diagnosis
of
childhood
obesity
is
falling
at
or
above
the
95th
percentile,
which
is
based
off
of
a
calculation
of
the
individual's
height
and
weight
national
obesity
prevalence
from
2017
to
2018.
19.3
percent
of
children
were
considered
obese.
Obesity
rates
for
children
and
adults
has
been
at
a
steady
increase.
Childhood
obesity
rates
are
lower
than
those
of
adults,
but,
as
we
can
see
from
this
graph,
they
follow
similar
trends.
B
And
chronic
disease
in
nevada
obesity
is
the
most
prevalent
chronic
disease
in
nevada
at
28.7.
However,
it
is
lower
than
the
national
average,
which
is
31.9
percent.
B
And
youth,
obesity
and
nevada,
the
percentage
of
youth
who,
whose
bmi
qualifies
them
as
obese,
continues
to
increase
over
the
long
term
in
2019
youth
obesity
increased
from
11.4
in
2013
to
12.3
percent
in
2019
compared
to
the
percentage
of
the
national
ob
youth
obesity
in
2019,
which
falls
at
15.5
percent
youth.
Obesity
trends
show
a
significant
gender
disparity.
B
According
obesity,
among
kindergarteners,
according
to
the
nevada
kindergarten
health
survey
over
the
years,
the
percentage
of
kindergartners
whose
bmi
qualifies
them
as
obese,
has
decreased
from
21.4
in
2015
to
18.7
in
2020.,
the
percentage
of
children
classified
as
overweight
has
increased
over
time
from
10.6
in
2015
to
13.2
percent
in
2020.
B
An
obesity
prevalence
among
two
to
four
year
olds,
nevada,
children,
childhood
obesity
trends
among
children.
Each
two
to
four
years
who
are
enrolled
in
the
special
supplemental
nutrition
program
for
women,
infants
and
children,
show
a
statistically
significant
decline
in
2018,
which
is
11.7
percent,
of
which
participants
had
obesity,
which
is
a
decline
from
13.8
percent
in
2008.
B
Nevada
childhood
obesity
trends
by
sex,
among
which
participants
show
statistically
significant
disparities.
Again.
The
percentage
difference
of
obese
wic
participant
boys
two
to
four
years
old,
is
higher
than
the
percentage
of
obese
girls
from
12.9
of
girls
to
14.6
percent
of
boys
classified
as
obese
in
2008
and
then
at
10.8
percent
of
girls
to
12.6
percent
of
boys
classified
as
obese
in
2018.
B
In
2018,
the
highest
percentage
of
unhealthy
weight
status
was
among
american
indian
alaska
native
children,
which
was
18.1
percent,
were
overweight,
15.2
percent
high
weight
for
length
and
12.2
percent
were
obese.
The
second
highest
was
among
hispanic
children.
Just
16.1
percent
were
overweight.
Fourteen
point
five
percent
were
obese
and
twelve
point.
Five
percent
had
a
high
weight
for
length.
B
Just
some
summary,
the
highest
rate
of
youth
and
childhood
obesity
by
gender
is
among
nevada
boys,
youth
obesity
increased
from
eleven
point
four
percent
to
thirteen
to
twelve
point
three
percent
from
2013
to
2019.
nevada,
with
childhood.
Obesity
decreased
from
13.8
in
2008
to
11.7
percent
in
2018.,
in
nevada,
in
nevada,
wick,
american,
indian
alaska,
native
and
hispanic
children
had
the
highest
rates
of
obesity
compared
to
ethnicities.
B
B
B
Nurses
were
reassigned
to
covet
specific
tests,
they
are
currently
under
understaffed
and
they
don't
have
the
ability
to
collect
all
the
height
and
weight
data
that
they
need
to.
There's
also
absences
in
school
closures
that
reduce
the
ability
to
collect
this
information.
Since
the
start
of
the
pandemic.
B
Then
the
obesity
status
of
zero
to
four
year
olds,
the
wic
data
was,
is
most
used
and
the
most
reliable
nevada
wic
serves
approximately
twelve
thousand
one
to
five
year
olds,
which
is
a
small
percentage
of
nevada's
entire
one
to
five-year-old
population
wic
also
provides
individualized
nutrition,
education
and
supplemental,
nutritious
foods,
which
has
shown
to
improve
the
vmi
status
of
children,
participating
wic
versus
those
not
participating
in
wic.
So
it's
not
a
good
measure
to
compare
or
represent
the
state
as
a
whole
and
body
mass
index.
B
B
And
then
some
successes,
our
chronic
disease
prevention
and
health
promotion
program
is
currently
in
the
process
of
updating
the
strategic
plan
they're
on
a
similar
path.
As
you
mentioned,
for
a
food
security,
strategic
plan
they're
a
little
bit
behind
in
the
process,
they
started
a
little
bit
later,
but
so
far
we've
gotten
some
great
responses
and
feedback.
Again.
This
strategic
plan
will
help
to
update
the
chronic
disease
priorities
and
identify
efforts
across
the
state.
B
Some
potential
opportunities
for
childhood
obesity
would
be
to
increase
the
availability,
availability
of
measured
data,
standardize
and
fund
school
height
and
weight
data
collection
efforts
prior,
provide
culturally
appropriate
inclusive
destigmatized
weight
education,
encourage
participation
in
federal
nutrition
programs
and
provide
mandatory
or
have
mandatory
physical,
physical
education
and
physical
activity
in
schools.
B
A
Thank
you
for
the
presentation.
Are
there
any
questions
from
the
committee
on
this
particular
information?
I
am
not
seeing
grant
sawyer
or
our
virtual
folks.
So
if
you
have
a
question,
please
go
ahead
and
mute
yourself
and
let
me
know
don't
see
anybody
coming
up
for
questions.
So
thank
you
so
much
for
the
data.
A
I
do
want
to
just
point
out
that
I
appreciate
the
on
your
challenges
slide,
pointing
out
that
the
bmi
measure
by
itself
should
not
be
used
to
guide
prevention
and
mana
management
efforts,
and
I
would
be
interested
in
what
kind
of
solutions
or
proposals
or
or
programs
you
have
in
place
to
ensure
that
that's
not
the
case
and
that
we're
moving
forward
with
really
holistic
models
of
of
prevention
and
management
for
for
folks,
because
everybody
is
different.
So
that's
not
necessarily
something
you
have
to
answer
today.
A
Anything
we
can
do
to
help.
We
let
us
know,
please,
okay,
well,
thank
you
again.
So
much
for
your
presentations
today,
miss
rogers.
We
appreciate
you
being
here
we'll
go
ahead
and
move
on
to
our
next
agenda
item
our
agenda
item.
12
is
access
to
child
care,
successes
and
challenges.
A
We
have
carissa
machado.
I
am
sorry
if
I
said
that
incorrectly,
okay
with
the
agent
she's,
the
agency
manager
for
child
care
and
development
programs,
please
introduce
yourself
and
proceed
when
you're,
ready.
C
Okay,
can
you
see
the
presentation
we
can?
Thank
you
awesome
wonderful
good
afternoon
committee
members.
My
name
is
carissa
loper
machado.
I
am
the
agency
manager
for
the
child
care
and
development
program
for
the
nevada,
division
of
welfare
and
supportive
services.
Thank
you
for
inviting
me
to
present
today
to
discuss
nevada's
efforts
to
address
the
challenges
in
our
child
care
system.
C
Oh,
I'm
sorry,
I'm
trying
to
move
my
slide
there.
We
go.
The
federal
relief
funds
and
further
investments
from
governor
sislek
are
allowing
nevada
to
make
system
changes
and
investments
intended
to
create
long-term
improvements,
as
well
as
immediate
stabilization
of
the
industry.
Nevada's
child
care
and
development
program
is
housed
in
the
division
of
welfare
and
supportive
services
of
the
department
of
health
and
human
services.
We
are
the
lead
agency,
administering
the
child
care
and
development
block,
grant
and
associated
child
care
and
development
fund,
which
funds
child
care
subsidies
for
nevadans,
as
well
as
other
programming.
C
We
provide
high
quality
programming
to
ensure
a
safe,
stable
and
healthy
start
for
all
nevada
children.
We
collaborate
with
diverse
stakeholders,
including
the
division
of
public
and
behavioral
health
for
child
care,
licensing,
the
nevada
department
of
education
and
their
office
of
early
learning
and
development,
a
multitude
of
community
partners
and
local
municipalities
to
foster
successful
and
healthy
communities.
C
C
The
changes
we
have
made
to
date
include
efforts
to
support
nevada's
families,
as
well
as
our
child
care
provider
network.
First,
we
have
increased
the
income
eligibility
for
a
household
to
qualify
for
a
child
care
subsidy
from
130
percent
of
the
federal
poverty
level
to
now
85
percent
of
the
state's
median
income.
This
essentially
has
doubled
the
amount
a
household
can
earn
monthly
and
be
eligible
for
a
child
care
subsidy,
something
like
1500
dollars
a
month
for
a
household
of
four
to
three
thousand
dollars
a
month.
C
As
for
an
example,
this
change
increases
access
to
the
subsidy
program
and
affordability
for
more
nevada
families.
Another
key
policy
change
that
improves
access
and
affordability
is
the
allowance
of
education
and
training
without
associated
work.
C
As
an
accepted
purpose
of
care
for
participation
in
the
child
care
subsidy
program,
so
restrictive
implementation
of
older
policies,
which
were
implemented
when
our
budgets
were
much
much
smaller,
even
before
normal
federal
increases
in
the
block
grant
award,
may
be
preventing
nevadans
from
being
able
to
finish
their
education
or
attend
a
vocational
training
program
if
they
also
need
access
to
child
care.
The
federal
block
grant
rules,
allow
us
to
define
and
include
education
and
training
as
a
purpose
of
care,
and
we
have
now,
as
of
this
month,
expanded
that
ability
back.
C
The
final
subsidy
program
policy
change
intended
to
improve
access
and
affordability
families
is
to
expand
the
amount
of
subsidy
coverage
to
targeted
subpopulations,
which
must
be
approved
by
the
federal
administration
of
children
and
families
which
awards
the
block.
Grant
we've
been
successful
in
receiving
approval
to
add
two
additional
targeted
populations
for
whom
we
can
cover
100
subsidy
with
no
required
copay
in
nevada.
C
The
subsidy
program
is
administered
on
a
sliding
scale
fee,
as
in
many
other
states,
families
are
required
to
pay
a
co-pay
based
on
their
household
income
and
which
is
a
federal
requirement
of
subsidy
participation
as
well.
Unless
you
have
these
approved
subpopulations
in
nevada,
the
currently
approved
sub
populations
are
listed
there
on
the
slide,
including
our
new
employees,
of
nevada
families
that
participate
in
the
temporary
assistance
for
needy
families
program
children
involved
with
child
protective
services
or
in
the
foster
care
system
and
children
who
are
experiencing
homelessness
in
nevada.
C
The
populations
we
are
adding
are
listed
here,
including
public
and
civil
servants,
essential
to
nevada's
economic
recovery.
So
I
would
include
school
district
employees
and
staff,
for
example,
state
of
nevada
employees,
other
county
employees,
who
already
meet
the
income
eligibility
level
we
may
now
be.
We
can
now
help
them
with
a
100
subsidy
coverage.
C
We
are
also
have
added
individuals
attending
a
substance,
use
disorder,
treatment
or
recovery
program
through
nevada,
the
nevada
division
of
public
and
behavioral
health
and
are
actively
meeting
and
partnering
with
our
behavioral
health
partners
in
the
substance
event,
substance,
abuse
prevention
and
treatment
partners
and
their
care
providers
to
assist
individuals
in
those
treatment
programs
to
receive
child
care
when
they
need
that
to
do
so,
we
are
also.
We
also
know
that
expanding
access
is
not
effective
if
we
are
not
also
lifting
up
nevada's
child
care
providers
in
the
child
care
workforce.
C
Rates
for
seeing
an
infant
have
increased
anywhere
from
six
to
well.
Excuse
me
four
to
about
seven
dollars
per
day
based
on
the
quality
rating
cycle,
and
that
is
different
for
each
child
in
an
infant
setting
or
a
toddler
setting
a
pre-kindergarten
setting
or
a
school-aged
child.
So
you
can
see
there
there's
a
large
range
of
providers
and
how
their
rates
are
calculated.
C
The
we
are
also
in
the
process.
I
do
apologize.
I
move
that
too
soon
we
are
in
the
process
of
conducting
the
2022
market
rate
survey.
You
may
have
just
heard
us
say
it's
the
2018
market
rate
survey.
That's
the
last
one
we
have.
We
are
working
with
children's
cabinet
actively
to
conduct
the
2022
market
rate
survey
and
we'll
have
a
much
better
look
at
today's
cost
of
providing
child
care
for
our
child
care
providers
across
the
state
of
nevada
very
soon
by
this
summer.
I
expect,
by
july.
C
Now
we
are
doing
a
lot
more
with
the
ar
the
american
rescue
plan,
act,
award
dollars
and
the
investments
that
have
already
been
provided
to
us.
So
I
will
try
to
go
through
these
as
quickly
as
I
can,
but
I
did
ask
patrick
for
at
least
15
minutes.
Knowing
this
would
get
comprehensive.
C
There
are
the
child
care
stabilization
grants.
This
is
over
200
million
dollars
in
direct
stipends
that
have
been
provided
to
child
care
providers
for
up
to
six
months,
as
budget
would
allow
for
supporting
their
operations.
They
needed
to
use
that
to
support
both
keeping
on
a
workforce,
supporting
their
staff
with
either
bonuses
or
training
and
development
coverage,
or
other
staff
supports,
as
well
as
supporting
families.
C
We
have
also
been
working
to
help
not
just
centers
or
large
providers,
but
individual
staff
through
the
early
childhood
educators
staff,
stipend
project,
which
is
providing
financial
incentives
to
child
care
providers
who
are
active
members
of
the
nevada
registry,
which
is
currently
required
for
all
staff
who
work
in
a
licensed
environment,
and
they
just
need
to
be
working
in
a
qualified
program
at
their
time
of
application.
C
That
has
so
far
received
more
than
4
000
applications,
of
which
more
than
half
have
been
completely
vetted
through
the
nevada
association
for
the
education
of
young
children,
who
is
working
with
us
to
make
sure
staff
are
aware
of
this
and
are
applying
and
we've
paid
a
thousand
dollar
staff
stipends
to
over
800
staff
so
far
with
more
reimbursements
in
the
works.
C
We're
also
supporting
what
we,
what
is
now
titled
the
nevada,
strong
start
child
care
services
center
and
was
early
on
being
dubbed
a
shared
services
hub
for
child
care
providers.
So
you
may
have
heard
that
language
as
well,
but
basically
what
this
is
is
a
a
provider
resource
center,
a
one-stop
shop,
if
you
will,
for
child
care
providers
to
access
resources
to
help
them
run
their
business,
improve
their
business
access.
C
Website
development
etc,
and
we
have
a
variety
of
partners
and
services
listed
here
that
are
working
with
us.
There
are
physical
locations
in
las
vegas
that
is
that
opened
in
february
of
2022.
You
may
have
seen
the
grand
opening
for
that
it
was
televised.
We
had
nevada's
delegation
and
governor
sissel
act
there
and
it
was
a
very
exciting
event
and
we
will
be
having
a
grand
opening
in
for
the
reno
location
in
late
june.
C
We
expect
they
are
right
now
furnishing
the
the
building
and
everything
there
is
also
a
virtual
center
and
that
virtual
center
is
live
and
is
bringing
to
nevada
providers
more
than
2
000
resources,
guidebooks
toolkits
policy
suggestions
documents
they
can
use
within
their
own
business,
etc
to
assist
child
care
providers
in
providing
quality
services
and
improving
their
services.
C
The
partners
included
here
are
wonder
school,
which
is
a
private
in
private
entity,
working
with
us
to
provide
website
development,
as
well
as
assist
providers
in
achieving
all
of
the
health
safety
and
child
development
trainings
that
they
need
to
be
successful
in
providing
child
care.
Kendall
and
katherine
ken
is
an
important
partner.
C
We
have,
of
course,
the
quality
rating
and
improvement
system,
nevada,
the
nevada,
children's
cabinet
las
vegas
urban
league.
We
have
the
community
health
worker
program,
which
is
focusing
on
an
early
education,
early
childhood
education
certification
process.
Those
chws
will
be
housed
in
both
the
north
and
the
south
to
help
providers
and
families
navigate
their
various
social
determinants
of
health
from
the
child
care
setting
and
really
provide
that
holistic.
C
As
chair
peters,
mentioned,
holistic
type
of
service
and
care.
Additionally,
we
have
an
early
childhood
substitute
network
which
helps
our
licensed
providers,
get
a
substitute
if
they
have
a
teacher
call
out
for
a
day
or
two.
So
that's
a
great
network
that
helps
the
the
whole
state
be
connected
to
educators
that
are
ready
and
willing
to
come
and
help.
C
There's
now
the
capital
expansion
grant
that
the
governor's
office
very
graciously
gave
us
not
gave
us
but
allowed
30
million
dollars
of
the
federal
relief
funding
to
come
out,
and
the
interim
finance
committee
approved
for
us
so
that
pre-application
phase
is
live
right
now
licensed
child
care
providers
and
other
service
providers
in
the
early
intervention
space
for
children.
Youth
with
special
healthcare
needs
are
able
to
apply
for
an
amount
that
has
not
been
capped
at
this
time,
we're
just
taking
in
applications.
C
So
this
30
million
dollars.
We
expect
to
help
a
significant
portion
of
child
care
providers,
expand
their
capacity
renovate
to
expand
capacity,
etc.
It
is
for
construction
costs
only
and
then
the
other
support
programs
I've
talked
about
are
helping
us
round
out
the
supports
we
can
provide
to
the
child
care
system,
we're
working
on
infant
toddler,
slot
expansion.
C
This
is
another
way
to
help
stabilize
providers
and
allow
them
to
expand
the
slots
available
for
infant
and
toddler
care,
which
we
know
there's
a
dearth
of
compared
to
pre-kindergarten
and
other
care
and
we're
working
on
background
check
fee
assistance.
C
This
is
sometimes
a
barrier
to
getting
people
into
the
workforce
quickly
and
we
can
work
with
our
licensing
partners
and
partners
at
the
department
of
public
safety
to
ensure
child
care
workers
and
that
we're
going
through
that
process
as
streamlined
as
possible
still
accurately
and
comprehensively,
but
seeing
where
we
can
streamline
that
and
help
providers
pay
for
their
workforce
to
get
those
background
checks
done,
because
sometimes
that
is
a
barrier
for
that.
C
Lower
wage
workforce,
there's
also
business
consultations
and
that's
also
through
the
shared
services
hub
in
helping
providers,
access
loans
or
other
improvements,
financial
assistance
that
would
help
them
expand
capacity
or
improve
their
child
care
business.
Otherwise
there
is
a
child
care
provider.
Action
committee,
which
is
bringing
together
all
of
these
state
and
resource
support
partners,
along
with
the
provider
community,
those
providing
care
in
our
licensed,
centers,
etc,
to
come
together
and
and
have
discussions.
So
we
can
hear
directly
what
providers
need
from
us
to
provide
child
care
services
and
expand
child
care
services.
C
We
want
to
encourage
people
to
enter
the
child
care
and
early
education
and
development
field,
so
we
can
develop
a
robust
workforce
and
a
great
pipeline,
a
career
pipeline
for
people
that
they
want
to
enter
into,
knowing
that
child
care
is
a
huge
need
of
impacting
the
economy
overall,
which
will
require
child
care
workers
as
well.
C
So
we
also
have
family
supports,
along
with
the
expanded
subsidy
eligibility
and
other
things
I
already
discussed
that
were
subsidy
program
changes.
We
are
partnering
with
the
children's
cabinet
to
operate
an
education
outreach
campaign
that
is
meant
to
statewide
in
ensure
everyone
is
informed
of
all
of
these
system
and
policy
improvements.
We
are
making
to
impact
the
child
care
system
to
improve
access,
increase
access,
improve
affordability
and
lift
up
our
provider
system.
C
We
have
parent
leader
engagement,
so
just
like
we're
trying
to
ensure
we're
doing
better
at
communicating
with
and
hearing
from
our
child
care
providers.
We
want
that
from
parents
as
well
and
we're
working
with
a
variety
of
partners,
including
the
division
of
child
and
family
services
and
others
on
special
needs.
Consultation
for
infants
and
early
childhood
mental
health
to
ensure
families
are
supported
there
and
also
that
providers
receive
the
trainings
and
support
they
need
to
help
all
children
and
provide
care
to
all
children.
A
Thank
you
so
much
for
the
presentation
really
exciting
work
being
done
in
this
space.
I
just
want
to
remind
the
committee
that
this
kind
of
this
kind
of
information
is
not
maybe
not
typical
of
our
committee-
that,
because
of
the
the
way
this
committee
was
formed,
we
have
taken
on
child
care
and
child
welfare
issues,
and
I
wanted
to
expand
on
that
because
really
child
care
is
about
family,
health
and
family
stability,
and
that
is
our
charge.
A
D
Thank
you,
madam
chairs,
so
do
they
just
I
mean
I'm
talking
about
a
family
or
a
provider.
Do
they
just
call
you
with
the
number?
That's
on
the
bottom
of
your
slide,
and
then
your
office
tells
them
what
their
options
are,
where
they
can
go
and
what
they
can
do
is
there
somewhere
where
they
can
find
all
these
opportunities.
C
Yes,
thank
you,
dr
hardy
chair
through
you,
that,
with
on
the
nevadachildcare.org
website
for
providers
and
parents
can
find
assistance,
it
is
not
calling
the
state
office.
C
We
do
work
with
two
child
care
resource
and
referral
centers,
so
that
is,
the
children's
cabinet
serves
northern
and
rural
nevada
in
las
vegas
urban
league
serves
the
clark
county
and
some
of
the
rural
southern
nevada
area,
and-
and
I
can
ensure
that
the
committee
receives
that
information,
but
also
if
anyone
were
searching
for
subsidy
assistance,
no
matter
what
website
they
end
up
on,
they
will
be
referred
to
the
correct
organization
that
helps
them.
A
Thank
you,
dr
hardy.
That
is
a
good
point.
Thank
you
for
that
url.
We
can
send
folks
there
as
they
come
up
kind
of
along
those
lines.
Are
providers
able
to
to
suggest
that
their
that
their
parents
go
through
that
channel
or
caregivers
go
through
those
channels
to
determine
eligibility,
or
is
that
really
a
burden
on
the
parent
and
caregiver,
and
also,
please
feel
free
to
go
straight
to
members
of
the
committee
and
remember
to
introduce
there
to
say
your
name
for
the
record.
C
You
chair,
carissa,
loper
machado,
for
the
record.
Yes,
we
work
with
the
children's
cabinet
in
urban
league.
I'm
sorry,
I
I
got
caught
up
in
forgetting
my
name
and
I
forgot
your
question.
A
No,
the
question
was:
are
providers
encouraged
to
recommend
that
their
parents
go
to
that
website?
Thank
you.
C
So
there
is
a
direct
carissa,
loper
machado
agency
manager.
For
the
record,
there
is
a
direct
referral
link
between
our
welfare
and
supportive
services
offices
and
those
who
do
the
temporary
assistance
for
needy
families
or
supplemental
nutrition
assistance
program
and
medicaid.
They
can,
I
believe,
through
the
access
system
say
they
also
need
child
care
assistance
and
there
is
a
direct
referral
link
that
comes
from
our
site
at
welfare
over
to
directly
some
folks
at
urban
league
and
children's
cabinet,
and
I
recently
asked
those
partners
how
that
referral
process
works
for
them.
A
A
We're
going
to
go
ahead
and
close
the
agenda
item
and
move
on
to
our
next
agenda
item,
which
is
we
have
a
couple
of
folks
presenting.
So
this
is
going
to
be
two
presentation
agenda
item
on
the
an
overview
of
early
childhood
development,
adverse
childhood
experiences
and
improving
health
outcomes
for
children
in
nevada.
A
First,
we'll
hear
an
overview
of
early
childhood
development
and
adverse
childhood
experiences
from
representatives
of
the
children's
cabinet,
followed
by
ways
to
improve
health
outcomes
for
children
in
nevada
and
policy
considerations
by
representatives
of
the
children's
advocacy
alliance
plea.
We
have
our,
I
think
our
children
cabinet
children's
cabinet
representative
here
in
carson
city.
Please
go
ahead
and
introduce
yourself
and
begin
when
you're
ready.
E
E
So
much,
I'm
here
with
my
colleague,
denise
tanata,
who
is
joining
in
person
in
the
in
las
vegas,
and
I'm
going
to
go
over
some
basics
on
early
childhood
development,
focusing
on
the
early
learning
brain
science
and
then
denise
is
going
to
talk
about
system
improvements
and
a
grant
that
we
have
with
the
health
resources
services
agency
known
as
hersa.
E
The
connections
of
both
genes
and
experiences
shape
the
developing
brain.
So
you
have
what
you
bring
in
from
nature
and
then
what
is
nurtured,
the
cognitive,
emotional
and
social
capabilities,
they're
they're,
interrelated
and
intertwined
throughout
our
lifetimes,
and
we
know
that
experiences
are
critical
in
the
outcomes
that
we
all
have
as
as
humans,
and
we
know
that
children
that
are
in
toxic
stress
environments,
it
actually
weakens
their
brain
architecture
and
the
developing
brain.
E
Then
we
have
it
can
lead
to
lifelong
problems
in
learning,
behavior,
physical,
mental
health
and
we
all
end
up
paying
the
price
fivefold
later
on
in
life.
We
know
that
positive
early
childhood
experiences
are
critical
in
supporting
our
our
our
children's
development
and
how
we
support
our
parents
in
supporting
children
through
the
services
we
provide
it's
essential.
E
So
quickly
on
the
screen,
we
are
all
born
with
the
with
the
neurons
we're
ever
going
to
have
that
what
the
brain
growth,
what
when
we
refer
to
brain
growth,
we're
referring
to
the
connections
that
are
being
made
between
these
neurons
and
those
connections
are
called
synapses
and
they
are
stimulated
by
the
type
of
early
childhood
experiences
that
the
children
have
and
the
interactions
that
children
have-
and
this
is
true
for
both
positive
and
negative
experiences
and
that's
important
to
remember.
E
It's
essential
that
we
all
understand
this
and
we
really
have
to
shift
the
culture
and
the
thinking
of
how
we
raise
our
children
and
support
our
parents
through
this
critical
developmental
time
and
as
the
brain
makes
all
these
connections.
That's
what
builds
the
brain
and
that's
what
we
refer
to
brain
growth.
E
That's
what
we're
referring
to
so
just
quickly,
synapses,
here's,
the
rapid
period
of
growth,
you
you
lose
it,
you
use
it
or
you
lose
it
so
and
that's
what's
getting
reinforced,
so
here's
an
image
of
a
newborn
and
then
one
month,
three
months,
you
see
the
rapid
connection
happening
six
months,
one
year,
two
years.
Look
how
dense
that's
getting
four
years!
Six
years,
all
of
these
passageways
that
you're
seeing
between
these
neurons,
those
are
experiences
formed
over
and
over
and
over
again
both
positive
and
negative,
important
to
remember
and
then
in
about
six
years.
E
What
starts
to
happen
is
called
pruning
and
it's
a
natural
process.
And
what
happens
is
those
connections
then
that
are
no
longer
being
continually
reinforced?
Those
connections
start
pruning
in
the
away
the
child's
brain
says.
You
know,
I
don't
really
use
that
anymore.
It's
not
my
experience
anymore.
It's
you
know,
I'm
not
going
to
build
that.
Those
connections
in
my
brain
again
important
to
remember
for
both
positive
and
negative
experiences.
E
Brain
growth
does
not
happen
without
relationships.
Relationships
are
absolutely
critical.
We're
born
as
social
human
beings,
we're
born
with
this
desire
to
reach
out
and
interact
connect
with
eye
contact
to
coo,
to
be
responded
to
to
cry
to
be
fed
a
bottle
to
change
a
diaper
because
we
are
social
beings
and
these
social
cues
are
critical
for
communication
in
early
childhood.
E
E
So
children
learn
in
and
from
relationships.
Learning
does
not
happen.
Absence
a
relationship
and
it's
important
that
we
all
we
all
know-
and
we
say
this
over
and
over
again-
that
the
first
teachers
of
a
child,
mother,
father,
essential
or
other
caregiver,
an
infant-
must
be
in
a
nurturing
and
affectionate
relationship
with
a
caring
adult.
In
order
for
that
positive
development
to
occur
in
social,
realms,
emotional,
mental,
physical
and
then
cognitive
and
it's
well-rounded,
you
know
we,
you
don't
just
teach
to
cognitive
or
you
know,
abcs
without
other
social
emotional
growth
happening.
E
At
the
same
time,
you
can't
pick
how
we
learn
apart.
It's
all
integrated
and
through
that
learning
stress
is
normal
and
and
positive
stress
response
is
normal,
and
this
is
characterized
by
you
know
brief
increases
in
heart
rate,
elevated
hormone
levels
in
things
that,
like
first
day
of
school
or
getting
an
immunization.
These
are
normal
things
where
you
know
we
get
a
little
elevated
stress
response,
but
there's
a
loving
caregiver
there
to
buffer
the
response.
E
E
These
are
they're
a
little
more
prolonged,
longer
lasting
difficulties
such
as
the
loss
of
a
loved
one,
a
natural
disaster
or
a
really
frightening
injury
like
being
bit
by
a
dog.
You
know
in
early
childhood
if
the
activation
of
that
stress
response
is
time
limited
and
buffered
by
positive
relationships,
then,
and
the
child
adapts
that
the
brain
and
other
organs
recover
from
that
stress.
E
So
children
experience
a
couple
episodes
of
tolerable
stress,
but
as
long
as
they're
buffered,
by
loving
caring
folks
in
in
the
child's
life
they're
they're
easily
overcome,
and
then
the
third
type
is
toxic
stress
response
and
a
toxic
stress
response
occurs
when
a
child
experiences
strong,
frequent
and
prolonged
adversity,
such
as
physical,
emotional
abuse,
chronic
neglect,
caregiver
substance,
abuse,
mental
illness,
exposure
to
violence
and
accumulated
burdens
of
family
economic
hardship.
We
heard
a
number
of
them
today.
E
So
later,
health
problems-
I
mentioned
heart
disease,
diabetes
in
substance,
abuse
in
an
of
the
the
person
experiencing
the
toxic
stress
themselves
and
depression.
But
research
also
indicates
that
supportive,
responsive
relationships
with
caring
adults,
as
as
early
in
life
as
possible,
can
prevent
or
reverse
these
damages.
E
E
E
It
creates,
wear
and
tear
on
our
in
our
systems
and
on
our
health
and
the
reason
why-
and
I
love
this
analogy-
it
would
be
the
same
effect
as
revving
your
engine,
your
car,
for
an
entire
week,
think
of
the
strain
and
the
stress
that
would
have
on
an
engine
giving
that
that
much
fuel
and
adrenaline
is
going
through
that
system.
So
that's
what's
happening
when
we
talk
about
toxic
stress
and
I
did
get
these
copyrighted
by
the
way
these
images.
E
So
there's
like
I
said
it's,
it's
not
it's
not
a
death
sentence.
If,
if
children
experience
toxic
stress
for
those
that
have
experienced
multiple
aces,
there's
a
wide
range
of
responses
that
can
help
including
therapy
mediation,
physical
exercise,
spending
time
in
nature
and
others.
E
And
one
of
the
programs
that
the
children's
cabinet
is
involved
with
we
have
been
for
years
is
improving
our
early
childhood
comprehensive
system.
E
The
children's
cabinet
wrote
a
competitive
grant
for
health
resources
services
agency
to
address
this
comprehensive
system
that
our
children
and
families
need
for
optimal
development,
and
I'm
going
to
turn
it
over
to
my
colleague,
denise
tanata,
because
through
building
a
stronger
system
for
our
children
and
families,
we
can
address
toxic
stress.
We
can.
We
can
ensure
that
sixteen
percent
of
our
children
don't
experience
three
plus
factors
that
can
lead
to
three
plus
aces
that
can
lead
to
toxic
stress.
D
F
Good
afternoon
my
name
is
denise
tanata.
I
am
the
early
childhood
comprehensive
systems
director
at
the
children's
cabinet,
as
marty
mentioned
we
last
year
the
u.s
health
resources
and
service
administration
hersa
through
their
maternal
and
child
health
program,
released
the
early
childhood
comprehensive
systems,
health
integration
grant
opportunity
and,
in
collaboration
with
numerous
state
agencies
and
private
partners,
the
children's
cabinet
submitted
an
application,
and
we
were
one
of
20
states
that
were
awarded
this.
F
The
purpose
of
the
hersa
early
childhood
comprehensive
systems.
Health
integration
grant
is
to
build
integrated,
maternal
and
early
childhood
systems
of
care
that
are
equitable,
sustainable,
comprehensive
and
inclusive
of
the
health
system,
and
that
promote
early
developmental
health
and
family
well-being
and
increase
family
centered
access
to
care
and
engagement
of
the
prenatal
to
three-year-old
population,
and
this
initiative
places
a
very
strong
emphasis
on
equity,
particularly
around
ensuring
that
family
leadership
and
engagement
are
there
for
decision
making
throughout
the
system.
D
Me
ma'am:
this
is
kim
with
broadcast
and
production
services
we're
just
now
seeing
your
your
s.
A
F
Thank
you
again
for
the
record
denise
tanata.
The
next
slide
shows
the
partner
agencies
and
organizations.
Those
who
are
listed
here
are
those
who
provided
a
letter
of
support
for
our
grant
and
participated
in
the
development
of
the
grant.
You
can
see
multiple
state
agencies,
as
well
as
private
partners
throughout
the
state
of
nevada.
F
F
F
Next
I'll
go
over
the
goals
and
objectives
of
the
grant,
so
the
hersa
eccs
health
integration
initiative
includes.
D
F
Okay
again
for
the
record,
this
is
denise
tanata,
so
we
have
five
overarching
goals.
Goal
number
one
is
to
increase
state
level,
infrastructure
and
capacity
in
nevada
to
strengthen
statewide,
maternal
and
early
childhood
systems
of
care.
Our
objectives
under
this
goal
one
is
to
create
the
early
childhood
comprehensive
systems.
F
Director
position,
which
is
the
position
I
currently
hold,
also
establishing
the
position
of
an
early
childhood
comprehensive
systems,
parent
engagement
coordinator,
so
we've
hired
miss
ashley,
dynes,
who's,
doing
that
work,
statewide
and
that's
a
position
that
it's
actually
co-funded
through
the
hersa
grant
and
then
also
through
the
division
of
welfare
and
supportive
services
with
the
arp
funds.
And
so
that's
one
of
the
collaborative
initiatives
that
we
have
to
do.
The
parent
engagement,
we're
also
long-term
goal,
is
to
establish
a
governor's
office
for
early
childhood
in
the
state
of
nevada.
F
Additionally,
we
are
coordinating
the
development
of
a
unified
prenatal
to
three
strategic
plan
in
alignment
with
our
nevada
early
childhood
advisory
council
next
slide
goal:
three
is
to
increase
the
capacity
of
health
and
early
childhood
systems
in
nevada
to
deliver
and
effectively
connect
families
to
a
continuum
of
services
that
promote
early
developmental
health
and
family
well-being.
Beginning
prenatally,
here,
one
of
our
main
projects,
as
was
mentioned
by
miss
loper
and
the
previous
presentation,
is
we
have
developed
the
early
childhood
community
health
worker
program,
which
actually
started
last
month.
F
Goal
number
four
is
to
identify
and
implement
policy
and
financing
strategies
that
support
the
funding
and
sustainability
of
multi-generational
preventive
services
and
systems
for
the
prenatal
to
3
population
in
nevada.
As
I
previously
mentioned,
we're
in
the
process
of
conducting
a
fiscal
analysis
in
that
process.
We're
also
looking
at
policy
priorities.
What
is
it
that
we
need
to
do
to
change
policies,
practice
practice,
alignment
between
different
state
agencies,
systems,
as
well
as
private
partners,
to
streamline
access
to
programs
and
services
that
meet
the
needs
of
children
and
families.
F
The
last
goal
is
to
increase
state
level
capacity
to
advance
equitable
and
improve
access
to
services
for
underserved
prenatal
to
three
populations.
With
this
we
are
doing
health.
Take
health
equity
data
analysis,
we're
looking
at
how
we
can
enhance,
collect
both
collection
and
utilization
of
cross-sector
data,
particularly
looking
at
how
we
can
make
sure
that
we
have
disaggregated
data
looking
at
race,
ethnicity,
geography
across
those
systems.
F
We
have
integrated
a
lot
of
these
goals
and
objectives
into
our
early
childhood
advisory
council
and
have
established
subcommittees
that
align
with
each
of
these
five
goals.
I
also
wanted
to
mention
that
under
the
equity
piece,
we've
talked
a
lot
about
the
emphasis
on
parent
leadership
and
engagement
in
decision
making
process.
F
We've
recently
restructured
our
state
nevada,
early
child
advisory
council
to
align
with
these
goals
and
objectives,
including
those
five
subcommittees.
Our
goal
is
to
align
and
coordinate
systems,
as
well
as
policy
to
better
serve
children
and
families,
ultimately
resulting
in
improved
outcomes
and
reducing
the
need
for
more
costly
interventions
past
the
early
childhood
years.
F
A
D
E
Dr
hardy,
thank
you
for
the
question
marty
elquis
for
the
record.
I
am
not
a
medical
doctor,
so
I
do
not
know
the
difference
between
effective
dna.
I
just
know
the
you
know.
The
research
as
I
read
it,
and-
and
I
can
get
back
to
you
harvard
center
for
the
developing
child-
is
a
largely
the
source
that
I
go
to
on
anything
regarding
toxic
stress
and
brain
development,
as
well
as
university
of
washington
center
for
brain
sciences.
E
D
K
Thank
you,
madam
chair,
and
I
thank
you
dr
hardy,
because
I
too
was
going
to
ask
the
question
that
about
what
changes
our
dna-
and
I
was
just
curious
about
what
resource
you
had
for
that
and
if
you
could
forward
any
document
that
you
saw
that
would
change
or
d
that
that
dna
was
actually
changed
by
behavior
modification
or
intervention.
I'd
be
very
curious
to
see
where
that
documentation
is
the
second
just
more
of
a
question.
H
Child
psychology
and
all-
and
I
would
just
observe
that
we
certainly
have
come
a
long
way
from
the
1940s
in
bf
skinner.
In.
A
So
true,
dr
titus,
I
was
actually
admiring
your
presentation
and
the
discussion
about
our
neurons
and
synapses.
It
is
essentially
the
the
presentation
I
give
my
children
when
they
say
they
don't
want
to
go
to
school
or
eat
healthy
foods,
or
they
want
to
give
up
on
the
thing
that
they
think
is
hard,
because
that
is
how
we
learn
is
building
those
synapses,
so
yeah
we're
on
the
same
page.
A
Are
there
any
other
questions
from
the
committee?
I
cannot
see
the
committee
in
las
vegas,
so
assemblywoman,
gorlo
and
assemblyman
haven.
If
you
have
questions,
please
unmute
yourself,
otherwise,
I
think
we
will
move
on
to
the
next
portion
of
this
presentation
and
that
will
be
on
health
outcomes
for
children
and
policy
considerations.
Thank
you.
So
much
again
for
your
presentation.
Today
we
have
dr
tyler
gardner,
I
believe,
and
and
some
of
her
fellow
colleagues
with
the
children
advocacy
alliance,
to
talk
about
this
particular
issue.
J
Good
afternoon
and
thank
you,
chair
peters
and
committee,
I'm
annette
dawson
owens
with
the
children's
advocacy
alliance.
We
appreciate
the
opportunity
to
come
and
share
with
you
today
over
the
course
of
this
interim
session.
You
have
no
doubt
heard
a
number
of
startling
statistics
and
outcomes
for
children
and
families
here
in
nevada,
as
we
think
about
all
that
has
been
shared
or
will
be
shared.
I'm
reminded
of
a
quote
by
marion
wright
edelman
that
states.
The
question
is
not
whether
we
can
afford
to
invest
in
every
child.
J
We
will
also
hear,
from
our
strong
start,
prenatal
to
three
initiatives:
director
jamel
nance,
who
will
share
about
a
collective
effort
underway
to
transform
conditions
for
children,
particularly
leveraging
a
number
of
investments
that
you
have
even
recently,
perhaps
supported
whether
it
be
home,
visiting
infinite
early
childhood
mental
health
leveraging
community
health
workers,
improving
maternal
outcomes.
There
is
something
that
can
be
done
to
change
the
trajectory
for
our
children
and
we
implore
you
to
do
so.
J
In
keeping
with
this
commitment
each
year
we
publish
a
number
of
reports
to
aid
others
in
conceptualizing
and
addressing
the
state
of
our
children
and
families
in
nevada.
Today,
this
presentation
will
have
a
message
that
will
highlight
key
findings
related
to
health
and
other
areas,
leveraging
those
resources
next
slide.
Please,
you
will
hear
about
a
number
of
reports,
including
our
kids
count
2021
data
book,
which
will
have
another
release
in
august
of
this
year.
J
You
will
hear
a
recent
pandemic
report,
a
special
report
talking
about
the
latent
effects
of
the
pandemic
and
highlight
a
few
pain
points
for
children
and
families
during
covid.
We
will
also
share
our
routine
but
insightful
children's
report
card.
The
main
takeaway
is
that
we
are
in
this
together,
so
we
would
love
to
partner
with
each
of
you
in
not
only
sharing
these
key
resources,
but
also
supporting
your
efforts
to
craft
sound
policy
decisions
for
children.
J
Next,
please,
as
we
stated,
we
will
talk
about
the
kids
count,
data
book
of
2021,
our
nevada,
children's
mental
health
report
card
our
pandemic
report
and
our
children's
report
card.
All
of
these
resources
can
be
found
on
our
website
in
their
entirety.
We
anticipate
all
the
data
in
our
reports,
however,
may
actually
be
worse
postcoded.
J
So
we
start
by
highlighting
the
kids
count
book
2021,
noting
that
anuta
data
book
again
will
be
released
in
august,
but
where
nevada
is
currently
ranked
45th
overall,
we
are
41st
in
economic
well-being,
46
in
education,
44th
in
family
and
community,
and
next
slide.
Please
a
little
more
positive
you
can
see
here
we
are
ranked
34th
in
health.
However,
we
failed
or
got
worse
in
low
birth
weight
and
children
and
teens
who
are
overweight
or
obese.
We
did
make
gains
with
regard
to
children
without
mental
health
insurance,
as
well
as
children
and
teen
deaths.
J
J
J
Next
slide
nevada
has
a
17
percent
lack
of
consistent
access
to
food
or
food
insecurity,
while
the
national
average
was
14
next
slide.
Please,
this
slide
shows
that
nevada
was
ahead
of
the
national
average,
with
26
of
individuals
feeling
the
effects
of
depression
compared
to
the
national
average
of
21.
J
Next
slide,
please,
this
slide
shows
the
national
effect
of
racial
disparities
across
across
such
areas
as
not
having
enough
food
not
being
able
to
pay
your
mortgage
on
time,
not
having
health
insurance
and
feeling
depressed
or
hopeless.
Again,
we
need
to
pay
attention
to
the
disparities
that
exist
between
different
groups
related
to
race.
J
J
J
Immunizations
went
up
to
a
c
minus
childhood.
Obesity
was
a
c
minus.
As
this
grade
dropped.
Dental
health
was
at
f,
minus
and
decreased
mental
health
was
a
c
and
decreased
sexual
health
increased
to
a
c
next
slide.
Please
in
the
state
of
nevada,
the
rate
of
uninsured
children
was
eight
percent
versus
six
percent
in
the
united
states
and
we're
rated
45th
in
the
country.
Next
slide,
however,
due
to
coba,
19
numbers
have
doubled
and
8
million
americans
lost
employer-sponsored
health
insurance
with
persons
of
color
being
disproportionately
impacted
again.
We
are
in
this
together.
J
Some
of
the
data
is
startling,
but
there
is
a
path
forward
that
you
will
hear
about
relating
to
early
investments,
as
well
as
the
prenatal
to
three
policy
roadmap,
an
opportunity
to
change
the
trajectory
for
our
nevada
children
through
policy.
I
will
now
turn
the
time
over
to
my
colleague,
jenelle
nance,
who
is
the
strong
start,
prenatal
degree
initiative.
L
Thank
you
annette
and
thank
you
all
for
all
the
presenters
that
have
given
such
great
information
today.
Hopefully
this
will
kind
of
bring
it
all
around
full
circle,
so
here
in
nevada,
I'm
sure
you've
heard
the
term
strong
start
in
many
different
entities.
Strong
start
was
coined
as
a
campaign
for
community
outreach.
That's
aimed
at
mobilizing
parents,
educators
advocates
community
and
business
leaders
to
make
quality
early
childhood
experiences
a
priority
in
the
state.
L
Children's
advocacy
alliance
is
the
backbone
organization
that
supports
the
strong
start
coalition.
The
prenatal
to
three
initiative
is
an
initiative
that
is
supported
by
the
pritzker
children's
foundation,
so
that
is
something
that
we
have
worked
diligently
together
with
with
a
plethora
of
community
partners
and
business
leaders
to
really
move
this
initiative
forward.
The
coalition
is
broken
down
by
the
implementation
of
three
work
groups
to
support
the
policy
and
resources
that
produce
the
best
outcomes
for
young
children
and
families.
L
So
those
three
work
groups
include
the
strong
start,
prenatal
to
the
free,
maternal
and
child
health
work
group,
the
community
health
workers
and
home
visiting
work
group,
as
well
as
the
early
learning
child
care
work
group
and
some
of
which
are
on
this
call
today.
So
we
are
excited
to
be
able
to
speak
to
this
initiative.
L
Some
of
our
goals
in
the
strong
start
coalition
include
having
an
additional
two
thousand
two
hundred
and
fifteen
infants
and
toddlers
that
fall
below
two
hundred
percent
federal
poverty
level
to
utilize,
well,
child
services
under
the
12-month
continuous
eligibility
of
medicaid.
So
this
is
something
that
has
come
up
as
a
reoccurring
initiative
that
we
want
to
support
is
that
12-month
continuous
eligibility
of
medicaid?
L
We
also
hope
to
add
an
additional
thousand
five
hundred
pregnant
people
below
the
200
percent
federal
poverty
level
on
medicaid
that
receive
and
utilize
postpartum
care
services
through
medicaid
expansion.
So
again,
looking
at
the
12-month
continuous
eligibility
for
those
parents
and
then
in
addition,
we
hope
to
add
at
least
450
infants
and
dollars
below
the
federal
poverty
level,
200
percent
having
more
access
to
quality
child
care
through
the
establishment
of
450
contracted
child
care,
subsidy
slots
of
three
four
and
five
star
centers,
meaning
that
there
are
of
high
quality
child
care
providers.
L
So
again
we
talked
about
how
child
care
is
giving
us
that
holistic
approach
to
health,
not
just
the
child,
but
of
the
family
to
buffer.
Some
of
those
disparities
that
we
see
in
those
adverse
early
childhood
experiences.
L
Okay,
so
if
you
have
the
luxury
of
participating
in
our
winter
policy
summit,
we
have
the
opportunity
to
have
dr
osborne
present
on
the
prenatal
to
three
policy
impact
roadmap
that
we
have
been
heavily
utilizing
as
a
research-based
model
to
discuss
some
of
those
policy
goals
that
have
the
best
outcomes
for
our
children
and
families.
And
so
I
won't
go
through
all
eight.
But
we
have
highlighted
three
of
those
policy
goals
that
we
would
like
to
continue
to
hone
in
on.
As
we
move
forward.
L
So
three
of
the
outcomes
that
we
have
really
pulled
out
as
things
that
we
are
truly
highlighting
here
today,
is
access
again.
Families
having
access
to
necessary
services
like
we
talked
about
today
through
community
health
work
through
health
care
services,
also
reduced
administrative
burden.
I
know
that
there
have
been
some
movement
with
the
medicaid
eligibility
requirements
to
recertify
identification
of
needs
and
connection
to
services
again
through
our
community
health
workers
and
home
visitors,
parents
ability
to
work.
L
I
know
we
talked
about
this
a
lot
during
the
pandemic
when
we
were
heavily
into
it
about
families
needing
to
return
back
to
work,
but
that
also
entails
our
child
care
providers
being
sustainable
and
being
able
to
have
the
resources
that
they
need
to
continue
to
keep
the
doors
of
our
child
care
providers,
open
and
parents
being
able
to
find
sustainable
work
as
they
have
family
friendly
work
environments
that
allow
them
to
take
that
six-month
leave.
L
L
That's
something
we
are
definitely
interested
in
and
just
being
able
to
support
our
families,
not
both
in
the
work
environment,
but
also
in
the
opportunity
to
return
to
work
with
that
connection,
to
child
care
and
again
having
equitable
health
and
birth
opportunities
so
connecting
families
to
services
like
we
talked
about
today,
that
produce
the
best
outcomes
for
health
and,
again
just
to
highlight
a
few
points
for
the
policy
road
map
again
looking
at
where
we
rank
in
relation
to
other
states,
and
although
this
data
is
not
favorable,
I
think
it's
important
that
we
highlight
that
there
are
specific
areas
here
that
we
have
moved
forward
in.
L
However,
we
still
have
a
ways
to
go.
Looking
at
the
percentage
of
low-income
women
that
are
uninsured,
falling
at
the
27.6
and
ranking
40
amongst
other
states,
also
looking
at
eligible
families
with
children
under
18,
not
receiving
snaps.
So
again
we
look
at
those
ones
who
are
maybe
eligible,
but
not
yet
receiving
services,
and
so
our
big
mission
is
to
really
increase
that
utilization
of
services
that
we
know
is
so
important
to
our
children
and
families.
L
All
right
so
policy
opportunities,
we
work,
we
work
really
hard
with
our
partners
to
determine
what
policies
really
impact
children
and
families,
and
not
just
research-based
but
really
honing
in
on
those
community-based
organizations.
Our
state
partners
to
really
refine
our
policy
priorities,
and
so
at
this
point
we
we
are
really
highlighting
equity
in
all
policies.
L
All
right.
Any
questions.
A
Thank
you
so
much
for
the
presentation
today.
Are
there
any
questions
from
the
committee
on
these
presentations
or
this
presentation?
I
am
not
seeing
any.
Thank
you
so
much
for
the
information
and
for
being
here
today.
We
really
appreciate
you
and
your
time
and
thank
you
again
for
your
slides
on
the
kind
of
your
policy
summaries.
We.
We
appreciate
that
and
we'll
be
looking
at
those
issues,
all
right,
we're
going
to
go
ahead
and
close.
A
This
agenda
item
and
move
on
to
our
next
agenda
item
item
14
early
intervention
services
for
children,
birth
to
three
years
of
age,
from
the
perception
of
a
provider
we
have
invited
foundation
for
positively
kids
to
present.
Today
on
this
topic,
we
also
have
rob
burns.
Who
is
the
president
of
the
early
intervention
community
provider
association
available
for
questions
after
the
presentation?
M
Good
afternoon
good
afternoon,
madam
chair
and
members
of
the
committee,
my
name
is
paula
hammack,
I'm
the
chief
strategy
officer
for
the
foundation
for
positively
kids.
My
colleagues
at
the
table
with
me
today
are
jennifer
lagana.
Vice
president
for
early
intervention
services
for
foundation
for
positively
kids
and
rob
burns
president
president
of
the
early
intervention
community
provider
association,
we
do
have
a
powerpoint,
I'm
going
to
try
to
get
it
up.
It
looks
like
I
need
to
have
a
password
to
get
in,
so
maybe
I
can
get
some
technical
assistance.
A
M
M
M
M
Thank
you
again
for
the
record,
paula
hammock,
with
foundation
for
positively
kids.
We
also
provide
two
pediatric
clinics.
As
I
said
earlier,
we
also
provide
behavioral
health
services
for
youth
0
to
17
years
of
age.
We
also
provide
a
social
skills
program
for
children,
0-5
that
may
or
are
on
the
autism
spectrum.
We
are
currently
working
on
being
becoming
credentialed
as
an
aba
program
through
nevada
medicaid,
and
we
also
are
in
the
process
of
becoming
accredited
as
a
home
health
program
with
achc.
M
Some
statistical
information
and
I
won't
go
through
all
of
it
because
it's
pretty
easy
to
read,
I
believe,
but
we
have
been
a
community
provider
of
early
intervention
since
2009
we
are
currently
servicing
as
the
writing
of
this
powerpoint,
we
were
at
220.
Today
we
are
at
225
children
with
60
awaiting
evaluation
based
on
the
children.
We
serve
the
most
common
service.
They
need
is
speech.
You
can
see
that
we
average
about
250
visits
a
month
for
speech
therapy
pk,
positivity
kids
has
three
full-time
speech,
therapists
and
one
part-time
speech
therapist.
M
I
always
like
to
start
with
the
challenges,
and
then
we
can
end
on
a
positive
note.
I
think
that's
always
best,
but
some
of
the
challenges
that
we
have
in
early
intervention,
which
I'm
sure
is
not
new
information
to
you
all-
is
that
the
current
computer
system
that
is
utilized
by
ei
is
outdated
and
not
user
friendly.
It
is
a
case
management
system
that
does
not
incorporate
billing
processes
thus
requires
the
same
information
to
be
entered
into
two
different
systems
making
for
duplic
duplicative
work.
M
Since
the
pandemic,
it
has
become
increasingly
difficult
and
to
hire
qualified
staff
that
are
willing
to
return
to
a
home-based
setting,
which
is
not
just
something
that
pk
is
experiencing.
I
think
that's,
overall,
this
is
a
larger
issue,
as
we
are
now
being
forced
to
compete
with
other
corporate
employers
who
are
seeking
similar
qualified
applicants
and
have
the
financial
means
to
offer
bonuses
or
higher,
have
higher
hourly
rates,
and
that's,
for
example,
like
our
speech
pathologists,
they
are
in
high
demand,
as
is
well
as
our
occupational
therapists
and
physical
therapists.
M
M
As
stated
earlier,
early
early
intervention
services
are
provided
to
children
between
zero
to
three
years
of
age,
and
once
they
are
three,
they
are
transitioned
over
to
providers
that
service
the
age
range
of
three
to
five
clark
county
school
district
is,
is
primarily
the
primary
one
that
services
those
youth
we've
heard
that
a
lot
of
times
children
fall
through
the
cracks.
Though,
that
is
anecdotal
information.
We
don't
have
any
way
to
track
it
because
we're
not
the
service
provider,
something
maybe
to
consider
in
the
future,
is
if
ei
was
extended
to
five
years.
M
We
may
be
able
to
meet.
Excuse
me
if
ai
was
extended
to
five
children's
needs,
maybe
better
met
before
becoming
school
age.
Again
you
heard
presentation
about
brain
development
and
those
zero
to
five
years
are
critical
and
so
for
kids
to
be
dropped
off
at
the
age
of
three
to
another
transition
that
may
or
may
not
be
able
to
service
them.
It
would
be.
It
would
behoove
us
to
consider
maybe
moving
to
a
zero
to
five
for
early
intervention
services.
M
M
We
have
developed,
we
have
developed
our
own
internal
ei
audit
process
thanks
to
miss
lagana,
and
we
are
also
an
active
member
of
what
we
call
polit
positively
kids
quality
assurance
program,
improvement
committee,
which
we
are
always
looking
to
improve
our
processes
during
the
pandemic.
M
One
of
the
positives
that
did
come
out
of
that
was
that,
as
we
were
providing
telehealth
services,
it
assisted
our
staff
in
strengthening
their
parenting
coaching
skills
because
it
was
having
to
do
through
be
done
through
telehealth,
and
so
we
were
not
necessarily
in
the
home.
So
really
coaching
up
our
parents
to
provide
the
service
pk
continues
to
maintain
a
strong
relationship
with
the
state
ei
representatives,
and
we
are
committed
to
collaborating
with
the
state
and
community
partners
to
ensure
that
the
children
we
serve
are
getting
the
best
care
possible.
M
We
are
hopeful
that
over
the
next
few
years
we
will
be
able
to
expand
services.
We
can
we
can
provide
to
the
children
we
serve
going
forward,
hopefully
in
the
realms
of
maybe
we're
hoping
to
launch
a
pediatric
skilled
nursing
facility,
and
we
are
considering
looking
into
providing
medical
day
care
for
these
kids
that
are
medically
fragile.
M
A
Thank
you
so
much,
and
I
appreciate
you
bringing
your
challenges
and
then
ending
on
a
success.
Note.
We
always
like
to
celebrate
our
successes
in
this
state,
but
our
job
at
the
legislature
is
really
to
take
on
those
challenges
and
find
solutions
and
help
enable
our
partners,
both
at
the
state
and
in
our
private
sector,
on
ensuring
that
we're
providing
services
where
they
need
to
be
provided.
A
So
I
appreciate
again
this
your
challenges
slide,
especially
so
we
can
start
to
work
on
some
of
those
solutions.
Are
there
any
questions
from
the
committee
on
this
one?
I
believe
michelle
miss
gorlow,
assemblywoman
gorlo
has
a
question.
Please
go
ahead.
K
Thank
you,
madam
chair,
and
I'm
just
for
transparency.
I
actually
work
at
positively
kids.
However,
I
do
not
work
directly
with
the
early
intervention
program,
but
I
wanted
to
talk
a
little
bit
about
the
children
that
are
being
seen,
what
kind
of
delays
that
you're
seeing
and
also
the
children
that
are
awaiting
evaluation.
K
D
D
They
would
have
to
come
in
with
a
med,
a
diagnosed
medical
condition
which
that's
called
falls
under
the
category
of
auto
eligible,
or
we
also
have
the
category
of
informed
clinical
opinion.
So
there
are
times
when
children
don't
necessarily
meet
the
other
three
criteria,
but
the
team
really
feels
like
this
child
would
benefit
from
the
services
or
that
the
family
really
would
benefit
from
our
support
most
of
the
children
that
we
see
come
in
with
developmental
delays,
and
that
can
be
in
any
of
the
five
areas
of
development.
D
A
Thank
you
assemblywoman.
I
just
wanted
to
ask
mr
burns.
Did
you
have
anything
you'd
like
to
add
from
the
perspective
of
the
provider
association
on
this
topic
area.
K
Thank
you,
madam
chair
and
members
of
the
subcommittee,
it's
a
pleasure
to
be
here
with
you
guys
today,
and
it's
good
to
be
back
in
public
view
out
of
the
house
and
seeing
each
other
do
what
we
can
to
kind
of
make
this
situation
better
for
the
children
and
their
families.
I'd
simply
echo
the
presentation
slide,
I
believe,
number
four.
K
In
terms
of
the
trade
associations,
the
trade
association
represents
all
the
community
providers,
with
the
exception
of
one
both
in
the
north
and
the
south
here
in
the
state
of
nevada,
and
I
think
that
there
are
two
critical
points
here
brought
out
in
this
slide
in
particular
that
we
could
certainly
benefit
from
the
state's
help
and
it's
the
critical
staff
shortages
in
terms
of
staff.
Hiring
retention
is
going
to
be
a
huge
one.
K
K
We
just
aren't
able
to
do
and
then
I
think
that
the
staff
retention
in
our
side
and
our
programs
are
then
compromised
and
then
lastly,
I'd
advent
that
we
have
to
make
sure
that
we
are
adequately
funded
so
that
we
can
continue
to
service
the
children,
because
after
covet,
it's
our
opinion
that
our
child
find
efforts
will
increase
and
we'll
see
more
of
a
need
and
a
greater
need
as
we
move
forward
in
post
covert
years.
So
I
appreciate
the
opportunity
to
address
this
body
and
thank
you.
A
Thank
you
so
much.
Thank
you
for
being
here
today
appreciate
the
perspective.
Are
there
any
other
questions
from
the
committee
from
the
provider
perspective
presentation?
Well,
thank
you
all
for
being
here.
We
really
appreciate
your
your
presentation
and
time
in
our
committee
and
we
will
go
ahead
and
close
that
agenda
item
and
move
on
to
our
next
agenda.
Item
item
15.:
this
is
the
early
intervention
services
system
in
nevada,
assisting
in
the
children's
development
between
birth
and
three
years
of
age.
We
have
some
folks
up
here
in
northern
nevada.
N
N
Great
thank
you
good
afternoon,
madam
chair
and
members
of
the
committee
for
the
record.
My
name
is
ricky
robb,
I'm
the
deputy
administrator
for
children's
services
with
aging
and
disability
services
and
to
start
our
presentation
today
will
be
fatima
taylor,
who
is
our
program
manager
in
our
southern
region?
So
I'm
going
to
turn
it
over
to
fatima.
G
Good
afternoon
and
thank
you
for
the
opportunity
to
present
today
for
our
powerpoint
presentation
today,
we
will
take
you
through
our
overview
of
early
intervention
services,
so
this
is
a
collaborative
effort
between
aging
and
disability
services.
Division
fatima,
my
apologies
for.
N
A
Thank
you.
Yes,
we
have
these
resources
both
available
online
and
there
should
be
printed
copies
that
you
can
grab
in
the
room
there
with
you.
Please
proceed
when
you
are
ready.
G
This
presentation
today
is
a
collaboration
with
the
ida
part
c
office
in
aging
and
disability
services.
Early
intervention
services
and
presenting
with
me
today
is
dr
laurie
ann
molina,
the
ida
part
c
coordinator,
sarah
horstmann
kloger
health
program
manager
with
nevada,
early
intervention
services
and
ricky
robb,
deputy
administrator
aging
and
disability
services
division
for
our
agenda.
Today,
the
presentation
will
include
a
general
overview
of
the
early
intervention
system,
successes
and
challenges
in
meeting
child
health
outcomes
and
critical
employee
shortages.
G
G
G
G
G
G
I
Dr
marie
and
melina
level
here
for
the
record,
I'm
the
clinical
program
planner
one
and
part
c
coordinator
for
the
individuals
with
disabilities
education
act
idea,
part
c
office,
as
fatima
had
presented.
Our
target
population
is
from
birth
to
three
years
with
the
or
disabilities,
and
here,
for
you
is
further
represented
representativeness
within
our
population
during
december
2021.
I
I
I
I
Next
we
have
the
idea
part
c
office,
which
is
the
lead
agency
providing
general
supervision
and
regulatory
oversight
of
the
comprehensive
early
intervention
services
system
in
nevada.
We
receive
formula,
grant
funding
and
federal
oversight
from
the
united
states
department
of
education
office
of
special
education
programs
osep.
I
We
have
offices
in
carson
city
and
las
vegas
and
we're
pleased
to
collaborate
statewide
with
the
aging
and
disability
services
division,
which
provides
the
day-to-day
operations
of
early
intervention
services
throughout
nevada
adsd
overseas
and
manages
service
delivery
and
service
agreements.
They
are
the
system
point
of
entry
spo
for
all
referrals
to
the
system.
I
D
Thank
you
laurie
anne.
This
is
sarah
horstman
plogger
health
program
manager,
3
of
nevada,
early
intervention,
services,
aging
and
disability
services
division,
as
fatima
had
mentioned
before.
In
slide
three,
we
have
an
array
of
early
intervention
services
that
we
provide
in
the
state,
and
some
are
listed
for
you
here
in
this
slide,
and
we
do
like
to
point
out
that
services
for
children
who
are
eligible
are
no
cost
to
families
and
are
provided
in
a
child's
natural
environment.
D
D
D
Additionally,
the
state
regional
offices
exclusively
serve
children
or
the
most
medically
fragile
infants
and
toddlers,
as
well
as
some
non-part
c
related
programs
and
services,
such
as
our
captor
program,
which
was
mentioned
in
a
previous
presentation.
Child
abuse
and
protection
treatment
act,
as
well
as
a
screening
and
monitoring
program
that
we
have
within
the
state
that
are
for
children
who
may
have
been
released
from
the
nicu
without
significant
medical
needs,
also
potential
fetal
alcohol
syndrome.
D
Suspicions,
in
addition
to
also
potential
neonatal
sorry,
gotta,
get
going
to
get
my
notes
here,
neonatal
abstinence
syndrome.
So
we
have
both
of
those
services
that
the
state
holds
and
at
any
time,
if
any
of
those
children
under
our
captor
or
screening
and
monitoring
program
should
show
more
significant
concerns.
A
family
has
the
right
to
refer
to
part
c
for
full
assessment
and
eligibility
determination.
I
Dr
marianne
molina,
here
for
the
record
once
again
we're
proud
to
share,
highlights
of
successes
occurring
in
our
early
intervention
services
system
during
covit
19.
Our
system
ensured
the
continuity
of
services
to
families
with
the
use
of
alternative
service
methods
such
as
telehealth
services
allowed
under
osip
and
medicaid.
I
I
Another
highlight
is
regarding
our
american
rescue
plan
funds,
which
are
being
allocated
with
consideration
of
data-driven
needs
and
stakeholder
input
within
our
ei
system,
including
a
new
data
system
which
was
addressed
by
our
colleagues
from
positively
kids
in
their
presentation
immediately.
Prior
to
this
presentation,
a
system
study
to
further
identify
system
needs
and
solutions,
and
training
and
professional
development
for
the
retention
and
career
growth
of
early
intervention
personnel.
I
I
This
option
extends
services
to
a
child
who
previously
received
ei
services
until
the
beginning
of
the
school
year,
following
the
child's
third
birthday,
with
parental
consent
and
according
to
idea,
regulations
osep
provides
state
incentive
grants
sig
to
these
states
that
elect
to
offer
part
c
services
beyond
age.
Three
under
idea
at
this
time,
early
intervention
is
legislated
for
the
birth
to
three
years
population.
I
N
Thank
you,
lori
ann
again
for
the
record.
My
name
is
ricky
robb,
deputy
administrator
for
aging
and
disability
services,
children's
services
based
on
the
information
shared
by
the
community
partners,
the
nevada,
early
intervention,
community
partners,
trade
association,
known
as
the
trade
association
going
forward
and
the
state
programs.
It
has
been
determined.
All
early
intervention
programs
are
continuing
to
experience
short
critical
shortages
in
both
direct
and
indirect
staffing.
N
Due
to
these
challenges,
it
also
results
in
it
could
result
in
a
corrective
action
from
osep,
and
it
also
could
put
us
potentially
with
the
wait
list
which
we
have
not
seen
in
many
years.
So
our
goal
is
to
find
a
way
to
eliminate,
eliminate
this
critical
shortage
and
be
able
to
serve
our
populations
appropriately
due
to
the
critical
shortages
for
developmental
specialists.
What
we
call
a
ds
there
have
been
multiple
requests
to
modify
the
current
requirements
of
the
early
intervention,
educational
endorsement.
N
The
next
slide
please
slide.
13
we're
excited,
so
we
will
be
ending
on
a
really
good
note,
which
is
something
that
we've
been
waiting
for
for
quite
some
time.
The
the
funds
of
the
arpa
funds
through
usap
actually
afforded
us
to
be
able
to
work
on
two
initiatives
that
we've
been
working
for
working
towards
for
many
years,
a
system
analysis
which
started
with
a
analysis
of
our
rate
study.
As
you
all
remember,
from
our
last
legislative
session,
we
really
did
talk
about
rates
and
what
did
that
look
like
for
a
comprehensive
provider?
N
The
the
study
has
begun.
We've
got
the
initial
data
that
was
presented
to
the
trade
association
as
well
as
the
comprehensive
community
providers
last
friday,
and
so
we're
now
in
that
phase
of
public
comment,
so
they're
working
towards
that
public
comment
and
that
will
close
june
3rd
and
then
the
hma
study.
Sorry,
I
just
totally
forgot
to
introduce
who's
doing
that,
so
the
burns
and
associates
are
actually
the
group
through
health
management
associates
who's.
N
Conducting
that
study,
as
a
third
party
we've
been
able
to
work
with
them
to
provide
the
information
for
the
state
providers
as
well
as
the
comprehensive
community
providers.
So
far
we
do
have
an
initial
draft
of
that
study
and
again
that
was
presented
last
friday
may
13th,
and
we
look
forward
to
that
public
comment
period
to
ensure
that
we
have
all
the
information
before
that
final
analysis.
N
N
It
does
impact
service
delivery
when
the
system
must
enforce
a
rotation
hold
on
parent
choice.
Parent
choice
is
what's
required
by
osep
and
as
that
federal
law,
it's
also
the
right
thing
to
do.
When
we
are
allowing
a
family
to
choose
which
provider
they
would
go
to
in
the
past.
We
have
found
that
when
we're
not
at
that
50
50
caseload,
split
that
we
have
to
artificially
stop
that
parent
choice
and
take
a
program
out
of
rotation,
which
is
typically
those
community
providers
which
is
not
in
supportive
of
that
parent-choice
model.
N
And
so
it's
really
important
for
us
today
to
share
with
you
that
that's
an
impact
to
the
service
and
to
the
child
and
to
the
family,
if
they're
not
able
to
have
their
choice
of
the
community
provider
or
the
state
provider
they'd
like
to
have
their
child
receive
services
so
ensuring
that
we're
within
compliance
with
osep.
We
would
like
you
to
hear
that
request
as
we
move
forward
and
when
we
go
into
the
next
legislative
session.
N
The
great
thing
is:
we've
learned
many
lessons
already
and
we're
only
at
the
beginning
stages
of
the
analysis
and
through
this
we've
learned
how
different
our
state
is,
that
nevada
is
structured
very
differently
from
other
states
for
early
intervention
services.
One
of
those
differences
is
how
we
are
structured
with
the
part
cidea
office,
aging
and
disability
services,
our
quality
assurance
and
the
nevada
early
intervention
system
as
a
whole.
We're
in
different
divisions,
so
there
are
times
that
that
division
actually
separates
us
in
the
alignment
of
our
funding
compliance
as
well
as
our
service
delivery.
N
So
again,
those
are
just
items
to
keep
in
mind
as
we're
moving
forward
with
our
analysis
as
well
as
when
we
move
into
our
the
next
phase
through
the
legislature.
The
second
initiative
is
another,
exciting
initiative
that
many
of
you
already
know
about
that.
We've
been
working
on
I've
been
with
the
program
for
almost
five
years.
N
N
A
A
Are
there
questions
for
for
this
presenter
today?
I
believe
michelle
gorlo,
miss
gorilla,
has
a
couple
of
questions.
Please
go
ahead.
K
Thank
you
very
much,
madam
chair,
you
know
first,
I
kind
of
want
to
share
that
early
intervention
means
a
lot
to
me,
not
only
because
I
do
for
transparency
reasons.
K
You
know
I
work
for
positively
kids,
but
my
own
son
was
referred
to
early
intervention
when
he
was
about
two
and
I'm
really
excited
to
hear
that
you
guys
don't
have
a
wait
list,
because
when
he
was
referred
there
was
a
wait
list
and
he
actually
aged
out
before
he
was
able
to
get
any
services
and
even
today,
as
he's
almost
16,
I
can
still
see
some
of
his
speech
issues
that
sometimes
I
wonder,
would
they
have
been
corrected
if
he
had
speech
therapy
early
on
he's
fine,
but
you
know
as
a
mom,
you
always
kind
of
wonder
those
things.
K
So
that
didn't
make
me
think
when
I
would
look
at
the
auto
eligibility.
I
noticed
that
one
of
the
criteria
was
a
27
week
pre-term.
My
son
happened
to
be
36
weeks
pre-term.
G
Thank
you
for
the
question
fatima
taylor
for
the
record
for
auto
eligible
kids
about
that
long
ago,
and
that's
my
memory.
So
excuse
me,
if
it's
not
that
great,
but
for
preemies
it
was
the
27
weekers,
but
for
the
32
weeks,
if
there
was
still
concerns
and
they
didn't
come
out,
they
wouldn't
have
been
auto
eligible.
What
we
could
have
done
informed
clinical
opinion
to
make
the
child
eligible.
If
there
were
concerns.
K
Thank
you
and
if
I
could
ask
another
quick
question
chair,
please
go
ahead.
Please
go
ahead!
Okay!
Thank
you!
Since
we're
speaking
of
age.
I
really
liked
your
graphic
about
the
race
demographics
for
those
that
are
being
referred
to
early
intervention,
but
I
was
curious
about
at
what
age
are
children
being
referred
to
early
intervention
because,
as
we
know
the
earlier
the
better,
but
my
son
didn't
get
referred
to
until
he
was
two,
so
do
we
have
any
sort
of
an
age
breakout
on
when
these
children
are
being
referred?
Thank
you.
N
Ricky
wrapper
of
the
record.
Thank
you
for
that
question.
I
would
not
say
that
we
have
that
information
with
us
today,
but
we'd
be
happy
to
get
back
to
the
committee.
A
Thank
you
for
the
questions
and
thank
you
for
the
responses
today
in
that
follow
up.
If
you
don't
mind
sending
that
to
staff,
we'll
get
it
to
everybody
else
great.
I
I
had
one
more
question
for
you
to
kind
of
dive
in
a
little
deeper
on
the
workforce
issue.
You
mentioned
a
couple
of
things
of
wanting
to
explore
retention
and
recruitment
strategies,
but
do
you
have
any
any
ideas
at
this
point
or
or
partners
you're
working
with
on
establishing
what
those
might
be?
A
N
Thank
you
for
the
question.
Ricky
rob
for
the
record.
Well
we're
at
a
multi-level
at
this
point.
Some
of
them
are
state
provider,
state
providers
or
developmental
specialists.
So
obviously
we
have
mastered
levels,
some
doctorate
levels
and
then
they
are
also
required
to
have
an
educational
endorsement
which
is
specific
to
nevada
early
intervention
services.
N
That
is
one
piece
that
we
are
looking
at
because
we
get
them
and
at
about
two
years
they're
like
I
can't
make
the
three
year
cut
off,
and
so
we
are
working
with
lorien
and
her
team
with
part
c
to
determine
what
that
looks
like
if
there's
modifications
for
that,
so
we're
in
the
process
of
that
review
for
developmental
specialists.
The
other
challenge
is
that
many
of
them
are
contracted
and
those
are
our
speech
and
language
therapists.
Our
occupational
therapist,
as
well
as
our
physical
therapist,
with
that
group
they're,
all
specialty
therapists.
N
Unfortunately,
the
state,
as
well
as
our
community
providers,
are
not
able
to
compete
based
on
what
they're
able
to
make
either
within
a
school
district
or
the
hospitals,
and
so
that
obviously,
would
be
a
funding
opportunity
for
us
in
regards
to
what
that
might
look
like.
So
there's
many
things,
obviously,
that
we
could
look
at
when
it
comes
to.
N
N
So
right
now,
that's
our
specific
when
it
comes
to
therapies
and
then,
when
it
comes
to
developmental
specialists,
one
of
the
challenges
is
that
we
require
an
additional
if
they
don't
meet
the
criteria
when
they
come
in
there's
an
additional
up
to
three
years
for
them
to
meet
that
requirement,
and
I
would
put
it
out
to
my
colleagues
to
say
if
there's
additional
information
that
you
guys
would
like
to
provide.
Please
do
so.
Please
raise
your
hand.
I
For
retention
and
recruitment,
I
would
like
to
add
that
the
idea
part
c
office
offers
flexible
licensing
options
for
developmental
specialists
that
must
meet
their
three-year
professional
requirements.
We
provide
an
alternative
licensure
or
what
we
call
an
alternative
certification,
which
is
an
equivalent
of
the
department
of
ed
endorsement
in
early
childhood
developmental
delayed
for
aegis,
birth
37,
and
this
alternative
certification
provides
savings
for
developmental
specialists
on
licensing
fees
and
although
they
are
required
to
take
the
very
same
coursework
as
the
department
of
ed
requires.
I
I
Some
other
strategies
that
we're
utilizing
in
our
system
to
promote
retention
include
providing
professional
development
hours
at
no
cost
to
providers,
and
providers
may
use
those
hours
toward
licensure
renewals
with
the
department
of
education
or
with
our
ida,
part
c
office,
and
then
I'd
like
to
also
add
that
we're
also
incorporating
as
many
strategies
as
we
can
to
address
what
is
very
prevalent
in
this
field
of
public
service.
I
A
We
I
had
one
more
question
related
to
the
demographics
break
out.
I
just
flipped
to
that
page.
One
miss
gorlo
asked
her
question
and
this
number
of,
or
the
percentage
of
black
children
who
are
recommended
for
intervention
services.
Can
you
talk
a
little
bit
about
what
why
that
number
may
be
so
low?
It
just
seems
like
particularly
low
population
wise,
but
but
it
particular
like
just
especially
related
to
our
white
and
black
or
white
and
hispanic
populations
yeah.
If
you
have
anything
in
regard
to
that.
N
I
Chairman
peters
is
referring
to
the
slide
that
depicts
that
38
of
children
eligible
for
services
are
white,
37
hispanic
and
that
low
percentage
of
9
for
black
children,
as
well
as
for
those
lower
percentages
that
you
would
see
for
two
or
more
races,
asian
hawaiian,
pacific,
islander
native
american
and
american
alaskan-
and
I
do
not
have
that
data
with
me
at
this
time,
chairman
peters.
But
we
can
endeavor
to
locate
that.
For
you,
some
of
the
information
that
has
been
brought
to
us
is
that
these
ethnicities
and
races
are
historically
underrepresented.
I
Some
of
the
efforts
that
we
are
endeavoring
to
to
to
complete
to
increase
this
representativeness
includes
engaging
with
our
communities
in
various
events
such
as,
and
I
can
ask
my
adsd
colleagues
to
elaborate
further
on
this
because
they
are
actually
the
ones
I'm
involved
right
there
at
the
direct
level
with
the
community
and
with
families.
I
I
A
For
the
response
I
I
would
also
be
interested
if
you
have
any
demographic
breakdowns
of
your
providers
as
well
with
regard
to
raise
one
of
the
things
that
we've
heard
over
and
over
again
is
the
lack
of
representation
of
minority
health
care
workers
and
particularly
in
the
mental
and
behavioral
health
space.
So
I'd
just
be
curious
what
those
look
like
and
how
they
compare
to
the
representative
demographics
of
those
you
serve.
So
thank
you
for
that.
Follow
up.
If
you
have
it,
are
there
any
other
questions
from
the
committee?
A
I
do
not
see
any.
Thank
you
so
much
for
being
here
in
your
presentation.
We
really
appreciate
your
time
today
and
we
look
forward
to
seeing
some
of
these
ideas
come
to
fruition
in
session
we're
going
to
go
ahead
and
move
on
to
our
next
agenda
item.
This
is
our
final
presentation
for
the
day
agenda
item.
16
is
an
update
on
the
coronavirus
disease
of
2019
health
crisis.
A
H
Thank
you
so
much
chair,
peters
and
good
afternoon
to
my
colleagues
for
the
record.
I
am
senator
feminist,
representing
senate
desert
10
and
today,
I'm
presenting
the
second
update
on
the
kobe
19
health
crisis
interim
study
pursuant
to
senate
bill
201,
which
was
passed
during
the
2021
legislative
session.
H
Before
we
begin
of
course,
similar
to
last
time,
I
would
like
to
mention
that
there
is
a
handout
that
is
available
on
the
committee's
meeting
page
and,
as
stated
before,
chair
peters
appointed
me
to
lead
the
sb209
interim
study
efforts
during
the
january
20
20
to
20
2022
hhs
meeting,
and
as
I
summarized
during
our
last
meeting,
I
decided
to
hold
various
roundtable
discussions
with
relevant
stakeholders
for
each
of
the
interim
study
requirements
and
I
will
go
ahead
and
try
to
provide
as
much
updates
to
the
committee
meetings
over
the
coming
months.
H
H
In
terms
of
the
policy
recommendations,
which
is
probably
the
most
important
part
of
this
handout
on
page
two
of
the
handout
there's
a
summary
of
the
high
level
discussion
themes
that
has
been
provided
along
with
the
strengths
and
challenges
encountered
throughout
the
pandemic.
Some
highlights
for
you.
First,
the
greatest
strength
identified
was
the
resilience
of
workers
and
the
entities
serving
their
communities
and
second,
the
greatest
challenge
identified
as
a
critical
labor
shortage,
which
participants
said,
is
being
impacted
by
both
inflation
and
the
high
cost
of
child
care
transportation
to
work
and
housing.
H
Additionally,
policy
recommendations
were
also
summarized
on
page
two.
One
recommendation
highlighted
the
need
to
update
the
state's
process
for
moving
federal
funds
directly
to
those
in
need,
and
I
want
to
note
that
this
was
already
brought
up
during
the
first
roundtable
discussion
and,
of
course,
while
there
were
consistent
themes
identified
during
the
roundtable
discussion,
we
received
many
different
policy
recommendations
from
survey
respondents.
Therefore,
we
decided
to
go
ahead
and
outline
those
specific
recommendations
provided
in
the
addendum,
which
you
can
find
on
page
three
and
four
of
the
handout
chair
peters.
H
I
look
forward
to
sharing
the
final
updates
of
the
study,
our
next
meeting
or
our
next
round.
Roundtable
is
going
to
be
on
the
discussion
of
our
public
health
workforce
and
then
the
final
round
table
is
going
to
be
discussing
health,
equity
and
special
population
so
again
for
you,
chirp
eaters
and
any
other
community
members.
This
concludes
my
remarks
and
I'm
available
to
answer
any
questions
that
you
may
have.
A
Thank
you
so
much
vice
chair
donate,
really
appreciate
your
effort
and
work
in
this
space,
and
I
know
from
from
folks
that
have
have
an
interest
in
this
area.
We
really
appreciate
the
inclusion
and
discussions
that
are
quite
specific
and
pertinent
to
the
issues
at
hand.
So
thank
you
so
much
for
your
effort.
Are
there
any
questions
from
the
committee
related
to
this
update
today?
A
A
A
We
will
start
public
comment
with
those
in
the
physical
locations
and
then
move
to
public
comment
from
anyone
from
anyone
who
has
called
in.
There
is
no
one
in
the
room
up
here
in
carson
city,
no
one
coming
in
as
I'm
speaking
so
we're
going
to
go
ahead
and
see
if
anybody
in
las
vegas
would
like
to
come
to
the
podium
for
public
comment.
A
I'm
not
seeing
anybody
coming
up
in
las
vegas,
either
staff
in
our
broadcast
production
services.
Please
add
the
first
caller
to
our
public
comment
in
the
meeting.
We
may
need
to
give
this
a
couple
of
minutes,
because
I
know
there
is
a
lag,
so
I
will.
I
will
ask
for
bps
to
update
me
on
public
comment
line
in
about
one
minute.
A
D
Our
providers,
particularly
in
our
emergency
departments
and
toronto,
centers,
see
these
violent
victims.
Two-Thirds
of
victims
of
gun
violence
are
medicaid
patients
and
roughly
one-third
of
them
will
be
injured
again.
Without
intervention
hospital-based
violence,
intervention
programs
consistently
decrease
the
risk
of
being
re-injured
generally
generally
from
that
one-third
down
to
about
only
four
or
five
percent,
while
increasing
access
to
needed
services
such
as
primary
care
and
mental
health.
Intimate
partner
violence
is
also
a
huge
issue.
D
D
A
Thank
you
so
much
together,
I
will
because
of
travel.
I
will
be
attending
in
las
vegas
at
grant.
Sawyer,
barring
any
public
health
crisis
circumstances
and
lack
of
travel,
but
at
this
point
I
will
assume
to
be
down
there.
So
I
hope
to
see
my
colleagues
in
the
building,
if
you're
able
to
make
it
and
with
that
our
meeting
is
adjourned.