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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/
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A
B
A
Well,
we
were
having
problems
with
that
down
here
as
well,
so
bps
is
their
way
to
get
those
up
and
running
for
us.
Okay,
we
can
see
them
now.
D
D
A
I
can't
see
on
doom.
Okay,
do
we
have
technical
services
down
in
grant
sawyer?
Who
could
help
us
out
here.
B
I
did
see
it.
This
is
dr
freeman.
I
did
see
it
for
a
moment.
We
also
could
share
the
slides
from
our
technical
assistants,
dr
freeman
and
dr
pitt.
Luck.
I'm
not
sure
what
you
prefer.
D
D
It's
and
now
it
isn't
but
go
ahead.
A
A
committee
we
have
access
to
this
on
the
what
the
legislative
website
on
today's
meeting
page.
So,
if
you
would
like
to
follow
along
there,
while
we
are
figuring
out
how
to
get
this
up
and
running,
that
would
be
great
and
I'm
going
to
just
ask
that
we
go
ahead
and
proceed
since
we
still
have
a
little
bit
of
an
agenda
ahead
of
us.
B
Sure
thing
this
is
dr
freeman:
I'm
going
to
actually
ask
samantha
to
share
her
screen
and
I'll
just
go
ahead
and
get
started
while
she's
doing
that.
Thank
you
samantha.
So
this
is
dr
freeman,
dr
megan
freeman
again
for
the
record,
and
thank
you
for
having
us
to
discuss
the
crisis
system
for
children
in
nevada.
B
So
I
just
briefly
wanted
to
talk
a
little
bit
about
988
to
just
do
a
quick
refresher
and
then
we
will
I'll
turn
it
over
to
dr
andrew
freeman.
He'll
talk
a
little
bit
more
in
detail
about
our
programming
here
in
nevada.
B
So
988
was
discussed
at
the
february
meeting,
but
we
will
definitely
want
to
do
a
quick
refresher
because
it
can
be
a
little
bit
confusing
and
overwhelming.
It
is
a
big
change,
so
I
will
do
a
very
quick
refresher
and
then,
if
there
are
questions
at
the
end
or
if
we
can
send
in
any
information
after
the
meeting,
please
let
us
know
next
slide.
B
B
If
you've
ever
taken
psychology
101,
then
you
probably
have
learned
about
the
deinstitutionalization
movement
of
the
1960s.
This
occurred
in
the
context
of
the
civil
rights
movement.
There
were
several
several
contributing
factors,
including
the
introduction
of
the
first
generation
antipsychotic
medications
as
a
treatment
option
for
adults
and
a
belief
that
mental
institutions
were
inhumane.
B
B
The
hope
is
that
988,
which
is,
of
course
backed
by
a
federal
mandate,
will
help
all
states
move
towards
greater
investment
in
mental
and
behavioral
health
care.
The
goal
of
every
contact
with
the
988
system
will
be
to
find
the
right
level
of
care
for
the
individual
or
family
in
distress,
whether
that
be
support
through
a
hotline
call
or
a
warm
handoff
to
psychiatric
care
and
all
of
the
different
options
in
between
next
slide.
B
You'll
hear
more
in
a
bit
about
our
children's
mobile
response
and
stabilization
program,
which
we
call
mcrt,
which
is
considered
a
national
gold
standard
program
and
crt,
does
operate
a
24
7
hotline,
but
because
its
purpose
is
to
access
services,
it
does
not
quite
fit
the
definition
of
a
crisis
call
center.
There
aren't
staff
dedicated
to
simply
resolving
concerns
over
the
phone,
which
is
what's
required
at
a
crisis
call
center.
B
So
with
the
integration
with
the
98
system,
the
children
system
will
better
achieve
this
touch
point.
What
we're
currently
lacking,
but
building
are
crisis
receiving
and
stabilization
centers.
So
dr
andrew
freeman
will
provide
some
more
detail
on
those,
but
we
want
these
centers
to
serve
the
function
that
the
emergency
departments
are
currently
serving.
So
the
crisis
receiving
and
stabilization
centers
will
provide
a
crisis
assessment
by
behavioral
health
staff,
immediate
stabilization
and
linkage
to
the
next
appropriate
level
of
care.
B
So
we
do
have
some
proposals
and
ideas
in
the
pipeline
for
how
to
stand
these
up
here,
and
we
have
a
couple
of
pilot
programs
or
community
partners
who
are
providing
this
service
and
we
hope
to
be
able
to
implement
it
more
widely
as
part
of
our
children's
crisis
system
model.
Soon.
Next
slide.
B
During
the
2021
legislative
session,
substantial
progress
was
made
in
laying
the
groundwork
for
a
best
practice
crisis
system
in
nevada,
for
both
children
and
adults.
Thanks
to
the
hard
work
of
many
partners,
some
of
whom
are
on
this
committee,
and
here
today,
nevada
was
one
of
the
first
states
to
pass
legislation.
C
Hello,
my
name
is
for
the
record.
My
name
is
dr
andrew
freeman,
also
known
as
mr
dr
freeman,
and
I
am
currently
the
temporary
manager
of
our
children,
child
adolescent,
mobile
crisis,
response
team
in
las
vegas
and
reno,
and
I
support
the
rural
and
frontier
mobile
crisis
teams
offered
through
the
division
of
public
and
behavioral
health
as
well.
C
Our
goal
is
to
interrupt
care
pathways.
Our
goal
is
to
meet
youth
and
families
when
they
are
having
urgent,
mental
or
behavioral
health
problems,
meeting
them
where
they
are
in
the
community,
not
making
them
come
to
us,
but
we
go
to
them
and
and
then
to
try
to
interrupt
the
escalation
of
care
pathways
and
expense.
That
comes
with
that.
So
we
are
trying
to
provide
family
driven
culturally
sensitive
care
to
the
families
in
their
homes
as
much
as
possible.
C
C
C
What
we're
seeing
in
the
national
988
conversation
is.
The
model
is
coming
out
of
an
adult
based
model
that
is
running
effectively
in
other
jurisdictions,
like
maricopa
county
in
arizona,
the
state
of
georgia,
among
other
places
where
they
have
a
very
effective
crisis.
Now,
implementation
that
diverts
adults
from
higher
levels
of
care
in
nevada,
we're
in
the
opposite
situation.
C
C
Is
that
external
consultants
estimate
that,
in
clark
county
alone,
we
should
be
doing
between
3
800
and
4
000
responses
a
year
for
children
and
adolescents,
and
so
we
have
to
take
our
entire
system
and
double
it
just
to
meet
the
needs
within
clark
county
and
so
so.
There's
a
lot
of
growth
and
potential
for
this
to
to
really
change
how
children
and
adolescents
access
services
our
backbone
of
the
service
is
a
hotline.
C
If,
if
a
family
wants,
if
a
youth
needs
services,
they
call
the
hotline
and
the
hotline
our
hotline,
we
operate
24
7.,
we
share
it
throughout
the
state
and
and
we've
gotten
substantially
busier
over
the
course
of
the
pandemic.
C
C
C
So
if
your
house
catches
fire,
you
pick
up
the
phone,
you
call
9-1-1
and
the
fire
department
comes
and
they
put
out
the
fire
in
your
house
and
then
they
leave
they
don't
pull
up
to
your
house.
Call
your
homeowner's
insurance
policy
and
ask
if
prior
authorization
is
necessary
and
what
paperwork
do
they
need
to
send?
C
C
We
need
a
robust
system
that
allows
for
all
payers
to
contribute
to
the
system
that
way
we
can
serve
every
single
child
or
adolescent
in
the
state,
regardless
of
their
personal
family's
ability
to
pay
for
that
service
or
not
and
to
access
us.
Like
I
said,
all
you
have
to
do
is
call
our
hotline
for
historical
reasons.
We
have
a
las
vegas
number
and
a
reno
number.
The
reality
is,
it
brings
into
the
same
place.
The
same
people
answer
the
phone
and
we
centrally
dispatch
once
we
dispatch.
C
What
we
are
trying
to
do
is
create
the
safest
environment
possible
in
the
family,
for
the
youth
that
is
in
crisis
kind
of
one
of
our
fundamental
beliefs
is
that
when
a
child
is
in
crisis,
their
parent
is
in
crisis
as
a
parent
of
a
foreign
and
eight-year-old,
when
my
children
are
struggling,
I'm
struggling,
and
so
what
we're
trying
to
do
in
that
initial
crisis
response
is
a
period
of
de-escalation
and
then
a
crisis
assessment
to
do
an
appropriate
determination
of
level
of
care.
That's
necessary
along
with
that
and
that's
driven
by
safety.
C
Do
we
think
we
can
comfortably
reasonably
keep
this
child
safe
at
home
with
their
parents,
and
the
answer
is
about
almost
nine
out
of
ten
times
eighty-seven
percent
of
the
ten
eighty-seven
percent
of
time?
The
answer
that
question
is
yes:
through
intensive
safety
planning
and
follow-up
services,
we
can
keep
a
youth
safe
at
home
and
divert
from
having
to
go,
spend
time
in
emergency
department
or
go
to
a
psychiatric
hospital.
C
Our
referral
patterns
vary
depending
on
where
you
are
in
the
state
in
las
vegas,
we
were
instituted
primarily
to
help
with
emergency
departments,
help
our
our
emergency
department
partners
with
the
psychiatric
boarding
crisis
they're
experiencing,
and
so
we
continue
to
serve
emergency
departments
as
a
large
proportion
of
our
our
our
visits.
We
also
serve
clark
county
school
district
and
help
help
with
our
charter
schools,
our
private
schools
as
well.
C
But
when
we
think
about
the
988
system,
the
988
system
is
predicated
on
this
kind
of
triage
level
of
care.
So
if
we
call
the
hotline,
the
hotline
will
handle
80
of
calls
without
doing
anything
else.
They'll
simply
talk
to
the
person
on
the
phone
and
so
they'll
take
20
of
those
calls
and
dispatch
mobile
crisis
teams.
C
C
We
do
a
lot
less
of
this
idea
of
care,
traffic
control
or
care
coordination
over
our
hotline.
We've
started
to
do
it
a
little
bit
more
to
to
keep
up
with
the
demand.
That's
that
we're
experiencing,
but
we
really
want
to
get
professionals
to
the
family
to
support
the
family
as
quickly
as
possible.
So
that
way
we
can
make
sure
that
we
can
ensure
appropriate
levels
of
care
being
provided
over
the
next
couple
years.
C
We're
going
to
see
kind
of
a
bridge
from
what
we're
currently
doing
to
what
we,
what
we
will
need
to
be
doing
to
function
within
the
988
system
in
july,
there'll
be
four
numbers
that
a
person
could
call
if
their
child
is
in
crisis.
There's
always
911,
which
we
we
discourage
as
much
as
we
can,
because
a
person,
a
law
enforcement
officer
is
not
who
we
want
responding
to
a
child
in
crisis.
C
C
We
have
work
to
do
to
get
there.
We
have
to
invest
in
our
technology
within
our
team
so
that
we
can
interoperate
with
the
988
care
traffic
control
center,
appropriately,
feasibly
and
well.
Part
of
this
is
also
creating
a
safer
environment
for
our
mobile
teams.
So
when
our
teams
go
out
into
the
field,
we
are
working
on
investing
in
mobile
technology
that
allows
us
to
geo-locate
them
at
all
times.
It
allows
the
teams
to
check
in
and
out
and
have
safety
checks
online
through
their
via
their
phones.
C
C
We
can
from
our
kind
of
central
location
we
can
get
to
most
of
las
vegas
within
30
minutes.
In
reno
metropolitan
area.
We
can
be
most
places
within
30
minutes.
Our
our
rural
frontier
teams,
respond
by
telehealth,
are
usually
connected
with
a
family
in
under
15
minutes.
If
we
wanted
to
have
people
in
person,
though,
that
becomes
substantially
more
difficult,
because
now
we're
talking
about
very
large
geographic
stretches
that
we'd
have
to
travel,
that
is
on
the
plate.
C
We
are
working
on
solutions
to
that,
including
through
community-based
partnerships
with
our
ccbhcs,
as
well
as
proposed
multi-county
in
the
rural
frontier
regions.
There's
a
proposed
multi-county
mobile
crisis
response
team
county
supported,
but
we
send
a
master's
level
clinician
and
a
psychiatric
caseworker
who's,
a
bachelor's
level,
paraprofessional
and-
and
the
idea
here
is,
we
can
wrap
you
in
services
from
day
one.
So
we
have
our
licensed
master's
level.
Clinician
taking
care
of
the
mental
health
behavioral
health
medically
related
needs,
while
our
caseworker
is
taking
care
of.
C
When
we
think
about
what
do
we
do
with
youth?
After
what?
What
do?
We
recommend
six
out
of
ten
youth
we're
going
to
keep
internally
for
a
period
of
crisis,
stabilization
internal
to
our
team,
where
we
see
them
about
twice
a
week
for
45
days
between
in
the
last
year
during
the
pandemic,
our
diversion
rate
has
decreased
some
due
to
the
lack
of
access
to
community-based
services
that
moved
online
into
telehealth
and
those
are
starting
to
turn
back
on.
C
So
our
diversion
rate
is
moving
back
to
our
historical
number
of
about
87,
but
but
we
will
refer
about
15
to
18
of
youth,
to
psychiatric
hospitals.
When
we
do
this,
we
facilitate
that
that
care.
We
we
seek
out.
We
we
contact
the
hospitals,
we
find
the
youth
of
bed
and
we
facilitate
getting
the
youth
to
that
hospital
for
about
one
in
five
youth,
we
refer
back
to
an
existing
community
provider,
and
if
we
can,
we
work
with
the
family
to
get
them
back
to
that
community
provider
faster
when
possible.
C
When
that's
not
possible,
we
can.
We
will
continue
to
provide
check-ins
to
make
sure
everything
is
okay,
even
if
that
is
two
weeks
from
now
when
they
see
their
psychiatrist
or
their
nurse
practitioner
or
their
therapist,
and
occasionally
families
will
say.
No
thank
you
and
very
rarely.
We
will
have
instances
where,
where
nobody
in
the
in
the
response
thinks
additional
services
are
necessary.
C
C
They've
got
a
lot
of
growth
to
do
when
we
talk
about
children's
mobile
crisis,
we're
talking
about
a
period
of
de-escalation,
a
time-intensive
de-escalation,
where
we
perform
a
comprehensive
crisis
assessment,
and
we
try
to
do
this
without
law
enforcement
present,
and
it's
not
because
we
dislike
law
enforcement.
It's
because
we
think
that
law
enforce
enforcement
are
better
served,
keeping
the
community
safe
and
allowing
mental
health
to
be
handled
by
mental
health
professionals
in
the
adult
model.
C
It's
it's
a
very
rapid,
fast
crisis
triage
and
it
and
a
large
chunk
of
it
will
be
handled
with
law
enforcement
co-response
through
most
teams
or
cit
crisis
intervention
trained
officers,
and
so
we're
trying
to
shift
who
is
going
where
to
provide
appropriate
care
in
the
adult
model.
We
we
would
move
fast.
We
would
move
an
adult
to
services
very
very
rapidly
and
let
those
net
that
next
service
pick
up
care
as
rapidly
as
possible.
C
C
That
requires
a
substantial
expansion
in
staffing
that,
as
a
state
provided
direct
service,
we
probably
will
not
be
able
to
meet
that
need.
So
we
are
partnering
with
our
ccbhcs,
our
certified
community
behavioral
health
centers
to
train
their
staff,
how
to
respond
and
how
to
provide
the
gold
standard
response
to
children
and
adolescents,
as
well
as
adults.
C
C
C
C
C
C
C
We
respond
when
somebody
calls
us
not
when
we
have
it
available
in
our
schedule,
and
so
what
we've
done
over
the
years
is.
We
have
bootstrapped
our
system
and
we
have
made
do
what
we
need
is
a
fairly
substantial
investment
in
upgrading
our
technology,
to
keep
our
team
safe
to
increase
efficiency
and
to
get
people
to
where
they
need
to
be
faster.
C
C
C
We
are
starting
to
lay
the
groundwork
to
start
exploring
co-response
models
so
that
we
can
have
a
a
true
paraprofessional
with
the
clinician
instead
of
a
fault,
a
fully
trained
and
paid
case
worker,
and
then
we
also
need
to
kind
of
increase
the
robustness
of
our
casework
training.
One
of
the
things
that
we've
been
working
on
is
figuring
out.
C
What
exactly
are
the
limits
of
a
paraprofessional
within
the
current
medicaid
nevada,
medicaid
policies
and
procedures,
as
well
as
licensing
laws
and
roles,
so
that
we
can
maximize
our
use
of
lower
level
providers
at
the
end
of
the
day?
One
of
the
critical
pieces
is
that
the
30
to
60
days
after
a
child
goes
through
crisis
is
the
critical
period
where
recurrence
is
most
likely,
and
so
that
is,
where
kind
of
we
think
start
thinking
about
our
crisis.
Stabilization.
C
C
When
you
are
sick,
when
your
ear
hurts,
you
don't
need
the
full
power
of
an
emergency
department,
but
you
may
need
to
go
see
a
physician
or
a
physician
like
practitioner
like
a
physician's
assistant
or
nurse
practitioner
to
get
ear
drops
or
a
prescription
or,
and
they
may
diagnose
you
and
see
you
and
say
no.
You
actually
do
need
to
go
to
emergency
department
and
because
you're
having
a
heart
attack,
not
in
your
ache.
Hopefully
that
doesn't
happen,
but
but
they
do
have
that
capability.
C
A
crisis
stabilization
unit
for
children,
adolescents,
has
to
kind
of
follow
the
same
basic
mobile
crisis
principles.
They
need
to
accept
everybody,
regardless
of
ability
to
pay.
They
need
to
be
able
to
accept
everybody
and
not
require
medical
clearance.
First,
so
we
don't
want
a
situation
in
which
we
send
you
to
the
emergency
department
for
an
emergency
department
to
say
you
are
medically
stable
and
then
send
you
to
the
csu.
C
C
They
committed
a
crime
potentially
or
a
community
member
was
concerned
for
them
and
called
9-1-1
because
they
didn't
know
who
else
to
call
to
be
able
to
rapidly
drop
a
youth
off,
and
the
goal
is
that
the
law
enforcement
could
drop
the
youth
off
in
five
minutes
or
less
when
we
get
this
fully
up
and
running.
That
is
the
hope
versus
law.
Enforcement
can
regularly
spend
hours,
dropping
a
youth
off
an
emergency
department,
and
so
this
is
a
way
of
kind
of
diverting
and
changing
the
flow
through
the
system.
C
C
C
So
we
now
cover
about
50
of
the
youth
that
we
see
in
las
vegas
are
are
paid
for
through
medicaid
as
a
mechanism,
but
this
still
leaves
about
a
third
of
our
youth
who
have
private,
typically
employer-based
or
health
care.
Exchange-Based
insurances
that
do
not
support
the
mobile
crisis
system,
even
though
they
access
it.
C
The
second
big
policy
area
is
workforce
development
we've
seen
over
and
over
from
dr
the
other
doctor,
dr
megan
freeman,
slides
to
start
us
off
and
through
the
school
slides
that
we're
short
mental
health
providers.
There's
there's
no
way
to
to
say
that
besides,
we
need
more
mental
health
providers,
that
that
is,
we
are
missing
people
from
the
system
policy
level
consideration
on.
How
do
we
expand
our
base
of
mental
health
providers
is
critical,
whether
it's
through
thinking
through
can
our
can.
C
C
C
And
then
kind
of
the
the
very
last
thing
is
is
when
we
start
talking
about
the
system
of
care
that
children
adolescents
need.
We
are
simply
missing
parts
of
the
system.
We
don't
have
intensive
in-home
services.
We
don't
really
have
very.
We
have
a
very
small,
very
small
sliver
of
peer-operated
respite
care,
but
but
functionally
it
does
not
exist
for
for
most
of
the
youth
in
the
state
of
nevada,
and
we
don't
have
enough
short-term
residential
facilities
that
are
varying
levels
of
care.
C
We
have
identified
a
partner
and
we're
working
on
helping
them
get
set
up
so
that
we'll
at
least
have
one
to
get
us
going
in
the
very
near
future,
but
we
also
are
short,
just
acute
psychiatric
beds
for
particularly
for
northern
and
rural
nevada
and
then
kind
of
thinking
through
that
crisis
level
of
care.
Most
kids,
like
I
said,
9
out
of
10
kids.
Just
about
mobile
crisis.
We
can
get
them
safe.
We
can
keep
help
them
stay
safely
and
thrive
in
their
home
environments.
C
For
one
out
of
ten
kids,
they
go
to
an
acute
psychiatric
hospital
for
a
subset
of
those
youth.
They
then
need
follow-up
care,
we're
short
those
beds
within
the
state.
We
don't
have
robust
intermediate
care
facilities
or
psychiatric
residential
treatment
facilities.
These
are
facilities
that
for
youth,
who
are
not
so
acute
as
needing
24,
7
high
level
care
in
an
acute
psychiatric
hospital,
but
they're
not
quite
to
a
place
where
they're
ready
to
go
back
home.
A
Thank
you
so
much.
I
especially
appreciate
your
last
slide
there,
showing
kind
of
our
gaps
and
places
where
we
can
work.
I
made
quite
a
number
of
notes
about
why
these
are
not
places
that
we've
effectively
been
able
to
encourage
our
private
industry
sector
to
move
into.
A
A
Will
go
into
questions
committee?
Are
there
any
questions
in
las
vegas
or
on
the
zoo.
D
Thank
you
so
much.
Thank
you
for
that
presentation.
It
was
very
informative.
I
I
guess
I'm
going
to
start
with
the
easy
question:
how
do
we
get
this
going?
24
7
all
across
the
state,
and
I
say
that
joking
I
know
that's
the
very
hard
question
but
in
earnest
I
I
do
want
to
if
we
have
an
opportunity
to
sit
down
and
come
up
with
a
roadmap
to
get
this
done
for
both
children
and
adults
all
across
the
state,
24
7
within
the
next
whatever's
feasible
right
five
years
I
mean
it'd
be
great.
D
If
we
could
do
it
tomorrow,
could
you
just
I-
and
I
know
you
spoke
to
it
a
little
bit,
but
could
you
just
highlight
you
know
some
of
the
obstacles
is
it
money
is,
is
the
biggest
obstacle?
Staffing
are
those
two
and
are
those
you
know
the
same
thing?
How
do
we
really
get
jump
started
on
on
expanding
this
so
that
it's
as
effective
as
it
can
be.
E
Hi,
thank
you
for
the
question
for
the
record
cindy
pitlock,
dr
cindy
pitlock.
I
serve
as
the
administrator
for
the
nevada
division
of
child
and
family
services.
That
is
an
excellent
question.
We
are
working
directly
with
the
governor's
office
in
the
governor's
finance
office
and,
of
course,
through
director,
which
richard
whitley
to
pursue
these
opportunities
to
secure
arpa
funding
to
solidify
and
expand
our
mobile
crisis
unit.
C
So
this
is
dr
andrew
freeman
for
the
record
to
rapidly
expand.
We
are,
we
need
to
expand
our
provider
base
and
then
we
also
have
never
tried
to
be
very
honest.
We
we
set
out
when
we
set
up
our
rural
frontier
mobile
crisis
team.
The
goal
was
to
provide
telehealth
to
the
rural
frontier
region,
because
we
didn't
think
we
would
be
able
to
get
in
person
because
it's
a
very,
very
large
area,
with
the
transition
to
the
988
system.
C
One
of
the
key
partners
that
is
coming
online
are
the
ccbhc's,
the
certified
community
behavior
health
centers.
They
are
required
to
stand
up
mobile
crisis
teams.
They
have
a
much
greater
reach
throughout
the
state
than
we
do
as
those
teams
turn
on,
as
as
they
stand
up
as
we
teach
them.
How
to
do
mobile
crisis
really
well,
how
we
kind
of
help
them
and
partner
with
them.
C
C
It's
a
population
of
a
couple
hundred
people
hours
from
the
next
population
center,
and
so
we
may
always
be
in
a
situation
where,
for
some
parts
of
our
very
frontier
region,
parts
of
the
state
we
may
be
telehealth
based
for
a
place
like
elko,
that's
still
considered
rural,
we
are,
they
have
a
ccbhc
that
ccbhc
is
actually
one
of
farther
along
and
standing
up
there
mobile
crisis
teams
than
many
of
our
other
ccbhcs.
C
So
we
just
we
need
to
continue
to
kind
of
partner
with
those
groups
and
stand
those
up.
The
other
piece
of
this
is
exploring
kind
of
alternate
models,
so
so
kind
of
the
gold
standard
model
is
the
clinician
and
the
caseworker
or
the
clinician
and
a
family
peer
support,
specialist
show
up
in
person
what
other
states
have
done,
particularly
in
their
rural
regions.
C
Oklahoma
is
a
really
good
example
of
this
is
that
they
deploy
a
caseworker
and
a
family
peer
support
specialist
in
person,
and
they
telehealth
the
clinician
in
so
that
way
in
a
region
like
las
vegas,
where
we
have
more
clinicians
than
say
elko
or
perrump
that
that
we
can
still
be
in
person
in
providing
the
service.
So
so
I
think,
what's
left
on
the
plate
is,
is
expanding
the
services.
C
D
Thank
you
for
that
and
madam
sheriff,
I
may
just
have
an
additional
question.
Thank
you.
D
I
know
we're
focused
on
children
in
in
this
particular
meeting
today,
but
I've
been
working
on
corrections,
issues
and
a
lot
of
what
I
hear
is:
we've
got
people
who
are
just
having
mental
health
issues
staying
in
jail
for
90
days,
just
waiting
to
get
a
competency
hearing,
and
could
you
talk
a
little
bit
about
how
this
model
might
be
used
once
we
stand
knight,
988
up
to
possibly
divert
some
of
those
folks
from
going
into
the
system,
once
they've
kind
of
had
an
interaction
with
police
officers,
I
mean:
is
there
that
ability
there?
D
C
Setting
now
become
a
law,
a
law
enforcement
setting
they
now
in
most
places
the
county
jail
is
the
single
largest
provider
of
mental
health
services
in
that
county,
and
so
the
idea
here
is
instead
of
calling
9-1-1,
we
call
988
instead
of
a
law
enforcement
officer
with
handcuffs
a
gun,
a
taser,
a
badge
showing
up
and
doing
what
they
know
how
to
do
a
a
crisis
response
team
shows
up
and
engages
and
provides
appropriate
service,
and
so,
if
we
can-
and
the
goal
is
to
divert
we
for
adults,
particularly
it's
diversion
away
from
criminal
resources,
kind
of
our
criminal
system,
our
legal
system
for
children-
it's
it's
both
diverting
away
from
the
legal
system,
but
also
keeping
children
at
home
in
their
families
as
much
as
possible.
A
Thank
you,
senator
did
dr
titus
also
have
a
question.
F
Yes,
thank
you,
madam
chair.
Thank
you
for
your
presentation.
Thank
you.
Thank
you
for
your
presentation.
What
you're
doing
both
dr
freeman's
on?
I
just
a
couple
comments
and
an
observation.
First
question
on
you
testified
or
presented
that
the
crisis
hotline
was
open
from
nine
to
eight
in
the
north.
Is
that
correct.
C
The
hot
the
this
is
dr
andrew
from
the
crisis
hotline
is
open,
24,
7
365..
We
answer
it
primarily
out
of
las
vegas,
so
it
it
is
always
open.
You
can
call
that
number
and
you
should
be
able
to
get
a
hold
of
us
unless
we're
having
technical
difficulties.
Okay,.
C
Yes,
so
our
response
teams
are
in
person
responses
in
las
vegas.
We
have
team.
I
have
teams
on
24
7
365.
in
the
reno
metro
area
for
most
of
washoe
county.
We
have
teams
on
seven
days
a
week
from
9
am
to
8
pm
in
our
rural
and
frontier
region.
We
have
rural
frontier-based
teams
monday
through
monday,
through
friday,
nine
to
eight.
F
So,
just
to
be
clear,
though,
when
I
have
this
issue-
and
I
brought
this
up
at
our
one
of
our
rafc
meetings
regarding
the
crisis
hotline
for
covid
when
it
was
identified
in
my
quad
county-
I'm
I'm
the
county
health
officer
in
in
my
rural
county,
and
they
had
this
and
it
was
listed
as
a
crisis
hotline
for
cobin
19,
and
I
called
it
one
day
just
to
see
what
the
response
was
going
to
be-
and
I
said
well
we're
sorry
you're
called
after
hours.
F
You
know
you
can't
get
us
and
call
back
on
monday
and
I
was
like
whoa
if
you're
going
to
be
identified
as
a
crisis
hotline.
C
Yes,
ma'am,
and
this
is
dr
entrepreneur.
Yes,
we
answer
the
phone
24
7
365.,
our
our
technology
is,
like
I
said
earlier,
is
bootstrapped
and
it
is
up
98
of
the
time.
But
when
you're
talking
24
7
365
98
is
not
quite
good
enough.
So
we
are
actively
investing
in
upgrading
our
phone
service
so
that
we
can
be
up
like
gmail
or
outlook
is
and
we're
up
99.9
of
the
time
or
something
so.
F
Okay,
so
so
just
I'm
an
old
doc,
and
I've
also
been
in
this
legislative
process
now
and
on
this
particular
committee
for
four
terms,
and
we
hear
about
the
term
no
wrong
door
and
we've
been
talking
about
2-1-1
for
a
long
time
and
it
will
the
988
replace
211
or
just
augment
201,
because
one
of
the
goals
of
the
211
service
is
to
be
able
to
get
people
to
the
right
spot.
And
again.
I
worry
that
we're
throwing
around
a
whole
bunch
of
numbers
and
how
do
you
educate
a
community
not
to
dial
9-1-1?
C
This
is
dr
andrew
freeman
for
the
record,
so
so
dr
stephanie
woodard,
through
dpbh,
is
leading
the
988
implementation
initiative
for
the
state
for
the
division
of
behavioral
of
public
and
behavioral
health.
I
am
involved
in
many
of
those
98
meetings.
One
of
the
goals
is
to
get
the
phone
numbers
to
work
together.
So
that
way,
if
you
call
911
and
it's
a
behavioral
health
or
mental
health
crisis
that
they
connect
you
to
988,
there
are
multiple
models
being
explored.
F
Great,
thank
you,
and
so
I
sit
on
the
on
the
legislative
representative
on
our
northern
nevada,
behavioral
health
care
board
and
have
been
since
its
inception,
and
we
continue
to
talk
about
the
legal
holds
on
on
not
only
adults
but
on
youth.
Also-
and
you
mentioned
when
you
have
your
mobile
crisis
about
when
you
respond
in
person
and
diverting
as
a
as
a
doc
of
thousands
of
thousands
of
hours
in
emergency
rooms,
where
I
have
filled
out
those
forms
and
trying
to
find
a
place
for
these
folks
to
go.
F
Ideally,
it's
nice
to
divert
them
from
emergency
rooms
where
you
can
get
them
to
either
to
care
or
you
can
defuse
a
situation,
and
one
of
the
concerns
with
during
these
legal
processes
is
that
medical
clearances.
You
mentioned,
I
believe,
in
your
presentation
about
not
needing
that
medical
clearance,
and
so
I
haven't
really
seen
actually
that
legislation
has
has
happened.
Although
we
were
working
on
on
our
policy
board
to
probably
clarify
that
you,
the
mobile
crisis
team,
could
perhaps
do
the
basic
medical
clearance.
F
C
C
I
believe
are
being
set
through
medicaid
policy,
so
so
medicaid
is
setting
the
standards
of
care
for
expectations
of
what
will
be
provided
as
a
billable
service,
and
that
is
the
way
that
we're
implementing
the
no
medical
clearance
and
again,
the
the
goal
of
a
crisis
stabilization
unit,
is
to
function
like
an
urgent
care
so
that
I,
as
a
mobile
crisis
team,
could
bring
a
youth
there
if
necessary,
or
a
youth,
could
walk
through
the
doors
and
receive
care
without
having
to
call
me
first
or
call
988.
First.
F
Thank
you
for
that.
However,
one
of
my
concerns
is
that
without
some
medical
provider
or
some
ability
to
perhaps
this
youth
has
low
blood
sugar,
so
they're
acting
out
because
they've
overdosed,
perhaps
they're.
Actually
the
mental
health
crisis
is
related
to
a
medical
problem.
F
B
Thank
you.
This
is
dr
megan
freeman,
dr
titus.
We
can
get
you
the
requirements
for
crisis
stabilization
centers,
but
there
is
requirement
for
nursing
on
site
and
I
believe
there
needs
to
be
a
medical
director.
I
don't
want
to
tell
you
the
wrong
thing,
but
there
are.
F
Great
thank
you.
I
know
these
are
hard
questions
and
I'm
not-
and
I
know
that
not
everybody
at
the
table
has
all
the
answers.
Nor
certainly
wouldn't
pretend
that
that
I
do
up
here,
but
these
are.
These
are
concerns
that
we
have,
as
we
address
this
moving
forward,
I'm
highly
supportive
of
the
mobile
crisis
going
to
the
scene
diverting
these
folks,
young
or
old,
where
they
need
to
go,
not
just
the
youth
but
across
the
spectrum
on
who
who
they
are
and
married
to
a
retired
sheriff.
F
A
Thank
you
doctor.
I
kind
of
want
to
ask
a
question
along
the
same
lines
related
to
access,
like
general
access
to
some
of
these
additional
resources
that
you
outlined
in
your
presentation
so
and
dr
pitlock.
A
I'm
grateful
that
you're
here
and
for
your
statement
about
the
joint
efforts
that
are
ongoing
to
address
some
of
these
dynamic
issues,
but
I'm
particularly
interested
in
how
we
can
help
ensure
that-
and
my
computer
just
froze
on
me,
so
I
can't
get
to
the
slide,
but
how
how
we
can
help
get
private
industry
or
other
entities
involved
in
some
of
these,
these
services
that
we
really
need
available
to
our
our
youth.
These
include
our
peer
support
ins
in
service
housing,
housing,
stuff.
I'm
sorry!
A
I
don't
have
them
in
front
of
me
now
because
internet,
but
you
had
a
whole
list
of
things
that
that
we
don't
have
enough
of
right
services.
We
don't
have
enough
of
who
are
our
partners
who
do
we
need
to
be
reaching
out
to,
and
what
can
we
be
doing
to
pull
them
in
and
make
sure
that
we?
We
are
encouraging
those
industries
to
to
place
themselves
in
nevada.
E
Thank
you,
chair
peters.
This
is
cindy
pitlock
for
the
record
administrator
of
division
of
child
and
family
services.
Excuse
me,
so
that's
a
great
opportunity
for
me
to
give
a
pitch
to
our
provider
summit
that
we're
going
to
be
having
in
april
and
I'm
sorry
that
the
exact
date
escapes
me,
but
we'll
make
sure
that
we
push
that
date
out.
E
The
purpose
of
that
provider
summit
that
we're
coordinating
with
and
through
the
governor's
office
is
to
really
bring
a
huge
array
of
partners
to
the
table
to
talk
about
our
service
array,
where
the
gaps
are
in
that
service
array
and
hopefully
partner
with
those
businesses
and
entities
and
stakeholders
that
may
be
may
be
able
to
help
us
fill
those
gaps.
Of
course,
the
conversations
that
we've
been
having
all
day
today
tie
into
the
sustainability
piece
right.
We
want
to
make
nevada
a
great
place
to
live
and
work.
E
We
want
to
have
medicaid
rates
that
are
sustainable
as
an
ongoing
concern
for
these
businesses
that
need
to
keep
their
doors
open.
We
need
to
have
a
robust
workforce
in
order
to
be
able
to
fill
the
needs
as
we
bring
these
businesses
in
with
these
various
specialty
areas
that
we're
talking
about.
So
you
can
see.
E
It
really
ties
all
into
one
big
package,
and
I
thank
you
for
that
question,
but
we
are
definitely
looking
at
the
whole
system
of
care
finding
out
where
those
gaps
are
and
inviting
players
to
the
table
to
help
us
fill
those
gaps.
And
I
know
that
was
a
very
general
answer,
but
but
I
hope
that
I
steered
it
somewhat
for
you
we're
also
again
looking
at
the
opportunities
for
arpa
funding
to
get
these
things
up
and
running
and
seed
these
opportunities,
and
then
we
then
need
to
together
work
on
the
sustainability
piece.
A
That
would
be
our
intensive
in-home
services,
peer-operated
respite
care,
short-term
residential
facilities
with
varying
levels
of
care,
and
I
don't
I
think
that
those
go
beyond
our
need
for
with
with
children,
children's
behavioral
health.
A
I
could
see
these
expanding
into
women's
behavioral
health
and
being
a
model
for
other
behavioral
health,
demographics
and
hope
that
we
get
to
see
some
great
models
come
out
of
your
efforts,
but
whatever
we
can
do
to
help,
please
keep
us
posted
and
if
you
could
get
us
the
date
of
that
that
event,
I
think
some
of
us
would
love
to
be
able
to
come
and
listen
to
hear
how
how
stakeholders
are
feeling
about
your
proposals.
E
Chair
peter
cindy
pitlock
for
the
record,
yes,
absolutely
and
while
we're
having
a
provider
summit
that
is
highlighting
youth
and
families,
we're
also
looking
at
filling
the
service
array
gaps
throughout
our
populations
of
of
health.
So
excuse
me,
our
summit
will
not
be
focusing
solely
on
children
and
families,
but
throughout
the
lifespan
as
well.
So
I
really
see
this
as
a
great
opportunity
to
bring
all
of
us
together
for
this
very
important
day
and
we'll
make
sure
that
we
get
that
information
out
to
you.
A
A
We
have
a
couple
of
folks
in
the
room
up
here
in
carson
city
today
to
present
on
this
issue:
do
you
guys
have
folks
on
the
on
the
zoom
or
down
in
las
vegas
as
well
on
zoom
great?
We
have
a
couple
of
folks
on
zoom
as
well
we'll
go
ahead
and
let
you
introduce
yourselves
and
please
proceed
when
you're
ready.
G
Thank
you,
I'm
dr
elaine
brown
and
I
serve
as
the
chief
psychologist
for
aging
and
disability
services
division
developmental
services.
I
have
with
me
deputy
administrator
jessica
adams,
along
with
deputy
administrator
ricky
robb
and
health
program
manager.
Samantha
jaime
do
we
have
our
slides
up
here
that.
G
G
I'll
start
by
what
is
meant
by
youth
with
disabilities,
and
one
of
the
things
I'll
emphasize
is
we're
talking
about
youth
first.
So
if
we're
talking
about
all
children,
all
youth,
it's
it
will
include
youth
with
disabilities,
and
this
is
important
for
informing
policy
and
public
health
in
determining
sort
of
the
scope
of
need.
As
we
build
our
children's
services.
G
G
G
G
G
G
Youth
with
intellectual
and
developmental
disabilities
have
a
higher
rate
of
behavioral
health
disorders
compared
to
youth
not
identified
with
disabilities.
These
estimates
can
range
from
30
to
50
percent
of
youth.
I
mean
that's
a
huge
variability
and
it
often
depends
on
how
you're
defining
disabilities,
how
you're
defining
the
behavioral
health
disorders,
but
there
is
definitely
a
need
there
for
for
these
youth
and
for
their
families.
G
G
Children
with
intellectual
and
developmental
disabilities
are
more
likely
to
experience,
adverse
childhood
or
more
likely
to
have
adverse
childhood
experiences.
Parental
separation
does
sexual
abuse.
The
research
also
supports
that
adolescents
with
intellectual
and
disabilities
will
experience
the
same,
precipitating
factors
that
are
known
to
negatively
impact
the
behavioral
health
for
youth,
but
they
experience
more
of
them.
G
G
For
youth
with
disabilities,
it
can
be
somewhat
helpful
to
know
about
the
increased
risk,
so
there
are
some
types
of
disabilities
that
are
associated
with
increased
risk
for
behavioral
health
conditions
and
I'll.
Just
briefly
give
some
examples
for
youth
who
have
down
syndrome
around
30
percent
of
young
children.
Young
children
have
some
type
of
behavioral
difference,
in
other
words,
some
barriers
to
participating
in
their
family
and
social
life
and
community
life.
G
G
H
Good
afternoon
I'm
jessica
adams,
the
deputy
administrator
for
adsd
over
developmental
services
on
zoom.
We
also
have
with
us
ricky
robb,
who
is
the
deputy
over
both
nevada
early
in
intervention
and
the
autism
treatment
program,
as
well
as
some
samantha
heimi
who's,
the
manager
for
the
atap
program.
H
H
It's
no
cost
to
the
family,
it's
all
in
their
natural
setting,
and
they
really
do
provide
several
different
types
of
services
from
service
coordination
to
occupational
therapy
speech
therapy,
basically
anything
that
that
that
youth
may
need
to
hopefully
overcome
any
any
developmental
delay
that
that
they
have
so
that
they
can
graduate
at
three
and
no
longer
need
need
services
from
us.
H
H
H
H
We
have
nurses
that
can
help
when
we
get
some
of
those
kids
that
might
be
medically
fragile,
and
then
we
do
have
some
levels
of
services
that
are
given
by
contracted
provider
agencies
that
are
really
meant
to
try
to
keep
that
child
in
the
family
home
and
get
them
services
that
are
really
needed
for
their
for
their
idd.
H
H
We
have
tried
very
hard
to
get
some
national
agencies
to
come
into
the
state
to
work
with
us,
and
we've
heard
two
two
two
reasons
I
I
know
you
were.
You
were
asking
last
time
why
we
can't
get
agencies.
The
two
reasons
that
we
have
personally
heard
is
our
rates,
so
within
developmental
services,
our
rate
currently
is
24
an
hour.
That's
not
very
much
money
when
you're
talking
about
what
somebody
needs
to
be
doing
in
these.
H
In
these
family
homes,
a
rate
study
was
completed
not
long
after
the
last
legislative
session
ended.
It
was
mostly
based
on
data
from
2019,
since
2020
covid
data
got
skewed
everything
and
it
did
found
it
found.
An
overall
rate
increase
of
26.9
per
percent
was
needed
across
all
of
our
services.
H
The
other
reason
that
we
hear
that
providers
are
having
difficulty
coming
into
our
state
is
they're
worried
about
finding
workers
and
it's
not
just
those
direct
staff
that
go
out
to
the
to
the
homes.
It's
trying
to
find
some
of
the
licensed
professionals.
H
H
As
I
said,
we
do
serve
life
span
about
77
percent
of
our
population
are
adults.
Many
of
those
adults
are
living
in
their
own
homes,
they're
living
in
24-hour
settings,
and
so
essentially,
if
we
don't
have
staff
working
with
them,
it
means
they're
going
to
be
homeless
and
not
have
anyone
there
to
help
them.
So
staff
does
get
sent
to
those
settings
at
at
this
point,
because
the
staffing
is
so
bad.
H
We
just
heard
a
lot
about
the
mobile
crisis
teams.
We
have
been
doing
a
lot
of
work
with
dcfs
and
trying
to
pair
with
them.
I
have
not
had
conversations
with
them
about
the
mobile
crisis
teams
yet
so
I
think,
there's
a
really
good
opportunity
at
this
point
in
time
for
us
to
pair
with
them
and
make
sure
that
we
have
some
specialized
training,
see
if
there's
an
a
need,
maybe
for
somebody
who
has
an
idd
background
to
sit
on
those
on
those.
H
You
know
teams
so
that
we
make
sure
that
people
are
getting
the
right
services
when
one
of
those
those
you
know,
teams
goes
out
and
say
the
child
has
id
idd.
Excuse
me
respite
care.
All
of
the
respite
care
in
the
state
right
now,
for
the
most
part,
is
a
self-directed
model,
meaning
we
we
give
money
to
a
family
and
say:
go
find
your
own.
Your
your
own
care.
H
H
There
are
some
states
that
have
added
a
child
carrier
supplement
to
their
home
and
community-based
waiver
in,
in
order
to
incentivize
providers
to
take
kids
that
have
special
needs,
so
that's
something
that
our
state
could
also
be
looking
at
and
then
the
crisis
prevention
planning,
as
you
heard
all
of
our
services,
do,
have
service
coordination
with
it.
So
we
try
our
best
to
plan
for
crises,
but
when
we
have
a
lack
of
services
to
send
people
to
it's
limiting
as
to
what
we
are,
we
are
able
to
do
now.
H
And
then
for
the
next
slide,
you're
going
to
hear
later
about
the
system
of
care
with
dcfs
our
biggest
push
within
the
system
of
care
is
that
kids
with
idd
are
a
part
of
that
we
are
really
lacking.
I
mean
again
you
just
heard
from
from
dcfs
about
the
lack
of
of
beds
for
residential
treat
treatment.
Centers
hospitalization.
H
There
are
even
fewer
beds
in
this
state
that
will
take
kids
with
idd,
so
we
have
often
kids
end
up
going
out
of
state
if
they
need
that
level
of
stabilization
and
then
once
that
stabilization
happens,
we
have
even
fewer
settings
for
them
to
come
back
to
so
we
have
been
working
with
dcfs
washer
county
clark,
county,
our
child
welfare
agencies,
some
of
the
advocates
and
legal
agencies
across
the
state
to
figure
out.
How
do
we
make
appropriate
24-hour
placements?
Whether
they
are
they
are?
H
H
H
H
H
H
Those
service
coordinators
carry
a
lower
case
load.
There
is
a
full-time
licensed
psychologist
and
mental
health
counselor
that
works
with
with
those
families
and
teams,
so
they
they
really
get
a
lot
more
services
from
us
to
be
able
to,
hopefully
learn
skills
and
better
keep
their
child
in
their
own
home.
A
Thank
you
so
much
for
that
information
sounds
like.
There
are
a
couple
of
things
that
we
can
knit
together
from
just
these
presentations
we've
had
today,
which
is
great
and
encouraging
that
we
are
bringing
people
into
the
right
space
to
talk
to
each
other,
and
I
hope
that
that
continues
outside
of
the
walls
of
this
room
as
well,
and
also
want
to
extend
that
we're
here
to
help
connect
you,
if
you
need
a
space
to
do
that,
I'm
more
than
happy
to
do
that.
Are
there
any
questions
from
the
committee
on
this
presentation.
A
We
do
have
two
additional
agenda
items
to
get
to
and
public
comment.
So
I,
if
we
can
keep
these
questions
brief,
please
feel
free
to
reach
out
through
either
our
staff
or
through
these
this
office,
in
particular,
for
additional
questions.
If
you
have
them,
but
I
will
entertain
a
couple
of
questions
now,
I
hear
someone's
mic
on
and
clark.
F
F
Thank
you,
madam
chair.
I
have
a
question
how
many
nevada
children
are
currently
housed
out
of
state
for
mental
health
issues.
H
Jessica
adams,
for
the
record,
I
do
not
have
the
number
of
all
mental
health
youth
out
of
state,
I
believe,
within
those
that
are
open
to
the
regional
centers.
We
have
roughly
nine
to
ten,
but
I
would
have
to
get
you
the
exact
number,
but
if
you
ask
dcfs
or
the
other
counties,
they
may
have
some
other
kids
that
they
know
of.
F
Great,
thank
you
I
mean.
Perhaps
our
staff
could
look
at
that
too,
and
perhaps
dps
it
just
could
help
with
that
too,
and
get
an
overall
number
of
what
that
reality
is.
Second,
how
long
does
it
take
to
train
somebody?
We
hear
all
the
time
about.
We
don't
have
enough
staff,
we
don't
have
enough
staff,
we
don't
have
enough
professionals
for
somebody
to
actually
make
a
difference.
What's
the
you
know,
one
of
the
things
I'm
looking
at
is
a
doc
with
short
dogs,
we're
showing
of
nurses,
there's
a
national
network
right
now.
F
Looking
at
national,
it's
called
a
national
health
career
network
that
that
has
access
to
these
professionals
throughout
our
nation.
I'm
just
wondering
if
we're
what
solutions
are.
Are
we
coming
up
with
and
perhaps
in
the
interest
of
time
you
you
may
follow
up
with
that
where's
the
solutions?
Here's
you
know
we're
talking
about
inspiring
more
healthcare
professionals,
we're
talking
about
again
a
national
network,
we're
talking
about
career
development.
You
know,
competency
standards
for
employee,
all
those
things
that
we
list
and
I'd
like
to
hear
from
these
different
agencies.
F
Perhaps
that
presented
today.
Where
are
the
solutions,
and
we
can
complain
all
day
long,
but
it
would
be
nice
to
know
how
long
it
takes
to
train
somebody
and
how
we're
solving
this
problem,
because
I
keep
hearing
that
it's
just
always
a
lack
of
personnel.
So
you
don't
have
to
answer
that
right
now,
unless
you
have
a
quick
answer,
but
otherwise
I'd
love
to
have
some
follow-up
on
that.
Thank
you,
madam
chair.
H
Just
adams
for
the
record,
so
I
I
do
believe
that
if
we
can
move
forward
with
our
rate
study,
that
would
help
quite
a
lot
the
way
that
those
rates
were
developed.
It
was
to
make
it
into
an
actual
ongoing
job,
including
health
benefits
and
pto,
and,
like
all
of
those
sorts
of
things,
that
many
of
these
people
don't
don't
currently
get
as
far
as
training
goes,
we
are
looking
at
multiple
different
ways
to
try
to
increase
training.
H
A
Thank
you.
I
appreciate
that
response
as
well.
It
was
one
of
the
questions
that
I
had,
which
is
a
follow-up
item.
If
you
don't
mind
and
if
you
already
have
this
in
the
works,
that's
also
fine,
but
you
said
that
the
26
increase
from
the
2019
rate
study
is
not
sufficient.
Can
you
send
us
a
memo
of
stating
some
rationale
about
what
you
expect
that
to
be?
A
It
doesn't
have
to
be
definitive,
but
just
what
you
expect
it
to
be,
so
we
can
start
talking
about
it
and
thinking
about
it,
and
I
also
serve
on
the
ifc
and
also,
I
think,
most
of
actually
most
of
the
committee
does.
So,
if
you
send
it
to
all
of
us,
then
you
get
a
double
down
on
on
that
particular
information.
A
So
I
had
two
follow-up
items.
If
you
would
thank
you.
Are
there
any
other
questions
for
these
presenters
today?
Seeing
none?
Thank
you.
So
much
for
being
here
really
appreciate
your
presentation
and
hope
we
can
continue
working
together
to
further
these
I'm
going
to
go
ahead
and
move
us
on
to
agenda
item
11.
A
A
I
apologize,
but
I
hope
we
can
get
in
the
information
that
we
need
during
that
period
of
time
I
have
ellen
richardson
adams,
she's,
the
chair
of
the
statewide
children's
mental
health
consortia
and
dan
musgrove,
who
is
the
chair
of
the
clark
county,
children's
mental
health
consortium
he's
available
to
answer
questions
as
we
have
them
so
miss
richardson
adams?
Are
you
available
to
present
hello?
Thank
you.
G
As
you
have
heard
today,
children's
behavioral
health
is
a
top
priority
within
nevada.
Thank
you
for
this
opportunity
to
speak
on
behalf
of
the
consortiums
who
have
dedicated
many
years
to
strengthening
systems
of
care.
Family
focused
supports
and
respectful
and
individualized
services
for
our
children
and
adolescents
within
nevada,
nrs,
433b,
33
and
335
establishes
the
mental
health
consortia
based
on
county
or
regional
populations
and
outlines
the
memberships
and
its
missions.
G
Currently
nevada
has
three
regional
consortias
clark,
county
washoe
county
and
one
representing
the
rural
communities
by
statute.
Each
region
submits
their
10-year
strategic
plan
and
annual
status
reports
and
budget
requests
to
dhhs
the
statewide
children's
behavioral
health
consortium
provides
statewide
governance
and
guidance
related
to
children's
services.
G
It
is
constructed
of
regional
members
and
stakeholders
to
provide
a
voice
for
families
and
children
for
an
array
of
timely
services.
In
the
least
restrictive
environments,
systems
of
care
and
financing
of
services
for
quality
care
are
also
reviewed.
In
addition,
the
group
provides
cooperation
and
consultation
with
the
regional
behavioral
health
boards
and
the
commission
on
behavioral
health
with
dpbh
and
dcfs.
G
The
statewide
role
is
to
be
the
voice
of
the
regional
consortia,
consortias
and
elevate
priorities
in
unison,
while
currently
only
the
regions
are
listed
in
statute.
There
was
an
effort
on
behalf
of
the
consortium
last
last
session,
to
establish
the
statewide
consortium
through
ab273
sponsored
graciously
by
assemblywoman
gorlo,
while
the
bill
did
not
make
it
through
the
legislative
process.
The
presenters
appreciated
the
opportunity
to
attempt
to
memorialize
the
statewide
consortium.
G
G
A
Thank
you
so
much
for
that
in
that
presentation,
as
well
as
this
list,
if
you
can,
if
the
committee
would
like
to
review
the
handout
it
is
on
our
website
on
today's
meeting,
and
it
is
it's
detailed
and
I
would
encourage
you
to
look
at
that
as
I
will.
Are
there
any
questions
from
the
committee
on
this
particular
item.
A
Fantastic,
we
were
looking
up
the
bill
number
that
was
referenced
and
are
still
in
the
process
of
the
process.
A
A
Great
and
my
understanding
is
that
there
was
a
fiscal
note
on
that,
which
is
what
caused
it
to
not
make
it
through
the
process.
So
that
is
definitely
something
that
we
can
continue
talking
about.
If
it's
of
interest
to
folks,
I
would
encourage
you
to
to
reach
out
and
work
with
our
fiscal
staff
as
well
as
the
funding
body,
and
I
would
like
to
thank-
oh
I'm
sorry,
mr
musgrove.
He
had
requested
that
he
had
the
opportunity
to
respond
to.
I
think,
a
previous
question
that
was
made
earlier
in
the
meeting
today.
D
Madam
chair,
I
am
here
and
thank
you
so
much
dan
musgrove,
I'm
the
outgoing
chair
of
the
clark
county,
children's
mental
health
consortium
and,
as
many
of
you
know,
been
working
in
this
area
of
concern
for
a
very
long
time.
Actually,
I've
been
working
in
mental
health
issues
since
senator
hardy
was
in
local
government.
So
that's
how
long
I
just
I
just
felt
it
was
important,
as
you
can
see
all
of
our
priorities
statewide.
D
I
think
it's
important
that
we
stress
that
you
know
clark
county,
especially,
but
it's
happening
in
washington.
It's
happening
in
the
world
is
in
an
absolute
crisis.
Right
now,
you've
heard
all
day
about
lack
of
of
adequate
funding.
You
heard
of
lack
of
of
folks
that
can
help
us.
You
know
staff
that
as
skilled
to
to
assume
a
lot
of
the
positions
we
don't
have
enough
private
folks
in
the
state.
D
We
don't
have
enough
state
facilities,
and
but
I
want
to
stress
that
from
the
governor's
office
on
down,
everyone
is
aware
of
it
and
working
so
very,
very
hard,
whether
it's
the
governor's
office,
whether
it's
director
whitley,
whether
it's
administrator,
pitlock
doctors,
freeman
at
all
clark,
county
and
and
all
the
folks
who
work
in
this
area.
D
But
you
know
state
government
moves
very
slowly
and
it's
concerning
to
us
that
a
number
of
these
programs
still
have
funding
sources
that
could
potentially
go
away
and
like
whether
it's
tobacco
funds
for
mobile
crisis,
the
arpa
dollars
that
we're
using
to
backfill
some
of
these
programs-
and
we
need
the
help
of
the
legislature
to
really
support
the
governor
and
the
executive
staff
and
as
they
build
their
budgets
right
now,
to
look
at
augmenting
these
programs
from
top
to
bottom,
because
there
are
families
that
are
willingly
and
unwillingly
turning
their
kids
over
to
to
child
protective
services,
because
they
have
no
way
of
dealing
with
the
issues
that
their
children
are
going
through.
D
It's
it's
tragic.
I
know
a
number
of
legislators
are
joining
in
in
the
weekly
meetings
that
we
have
the
monthly
meetings
that
talk
about
child
haven
and
what
the
employees
they
are
going
through.
But
that's
not
just
in
clark.
It's
statewide,
where
we
just
don't
have
facilities
and
places
that
dr
freeman
andrews
talked
about
so
eloquently
about
the
continuum
of
care
and
how
we
handle
crisis.
D
But,
more
importantly,
how
do
we
prevent
folks
from
getting
into
crisis
in
the
first
place,
giving
parents
and
families
the
support
they
need,
and
so,
as
someone
who's
worked
in
this
a
long
time,
I
just
thank
the
chair
for
taking
this
long
day
to
talk
about
children's
mental
health,
for
sharing
her
own
story
and
and
making
this
such
a
an
integral
issue
that
this
interim
needs
to
look
at
then
be
prepared
to
really
work
on
hard
during
the
next
regular
session.
So,
thank
you,
madam
chair.
Thank
you.
D
A
Thank
you,
mr
musgrove
really
appreciate
you
and
the
work
that
you've
put
in
on
this
area
and
look
forward
to
continuing
to
work
towards
better
nevada
for
our
kiddos.
A
I
also
want
to
take
a
point
of
personal
privilege
to
just
kind
of
reflect
back
on
my
earlier
sharing
about
my
own
story
with
mental
health
and
and
just
expressed
that,
after
sharing
that
I
received
multiple
messages
from
people
in
and
out
of
different
areas
of
my
life,
who
shared
that
they
have
also
dealt
with
mental
or
behavioral
health
and
that
they,
I
guess
I
want
to
share
that
because
you're
not
alone,
none
of
us
are
alone
it's
hard
to
talk
about
the
things
that
we
go
through,
especially
when
it's
vulnerable,
but
I
think
it's
important
that
we
share
with
each
other
to
ensure
that
we
create
these
networks
and
the
conversation
that's
so
necessary
to
have
about
ensuring
our
communities
are
a
whole
and
taken
care
of,
and
that
the
supports
are
there
to
make
sure
everybody
gets
what
they
need.
A
A
A
Well,
thank
you
so
much
again
today
for
for
presenting
on
on
this
issue
and
on
the
the
consortiums
really
appreciate
your
work
and
look
forward
to
continuing
on
the
conversation,
we're
going
to
go
ahead
and
move
into
agenda
item
12
today,
and
this
is
a
longer
one,
but
I
think
really
necessary
for
us
to
talk
about
right
now
where
agenda
item
12
is
regarding
transition
to
a
system
of
care
model
in
nevada,
community
based
services
and
supports
for
children
and
youth
to
address
their
mental
and
behavioral
health
needs.
I
So
I
think
that's
me,
my
name
is
elizabeth
manley
liz
manley
and
I'm
a
senior
advisor
for
health
and
behavioral
policy
at
the
institute
for
innovation
and
implementation
at
the
university
of
maryland
school
of
social
work,
and
I
provide
technical
assistance
and
consultation
across
the
country,
specifically
around
children's
behavioral
health
systems
design
and
how
to
organize
financial.
The
financial
systems
policy
practice
all
kinds
of
things.
I
I've
been
at
this
work
for
about
four
and
a
half
years,
and
prior
to
that,
I
was
the
assistant
commissioner
for
new
jersey's
children's
system
of
care,
which
is
an
integrated
system
of
care
that
allows
for
services
and
supports
for
children
with
moderate
and
complex
behavioral.
Health
needs
in
intellectual
and
developmental
disabilities
and
substance
use
challenges.
I
New
jersey
has
full-time
24,
7
access
to
mobile
response
and
stabilization.
She
heard
from
dr
freeman
nevada
is
working
very
hard
to
get
there.
They
also
have
access
to
high
fidelity
wraparound,
which
is
intensive
care
coordination
and
all
kinds
of
other
things
that
we'll
talk
about
here
today.
I'm
happy
to
take
questions
at
the
end
after
we
work
through
some
of
these
really
foundational
elements
that,
I
think
might
be
helpful
next,
please,
the
next
slide,
please
so
for
me,
it's
really
important
just
to
set
the
context
and
the
context.
I
It
really
is
that
what
works
best
is
anything
that
increases
the
quality
and
number
of
relationships
in
a
child's
life.
It's
the
people,
nuts
programs,
that
change
people,
but
what's
really
important
in
this
idea,
is
that
we
need
skilled,
trained
adults
to
actually
be
able
to
help
young
people
with
some
of
the
challenges
that
they're
that
lie
before
them,
in
particular,
as
we
move
from
out
of
the
challenges
kovid
and
some
of
the
other
national
conflicts
that
are
happening
at
this
time.
I
Next
slide,
please,
for
me
it's
about
language,
I'm
just
gonna
move
really
quickly
through
this,
and
just
let
you
know
that
one
of
the
low-hanging
fruit
and
systems
transformation
really
starts
in
the
way
that
we
think
about,
and
talk
about,
young
people
and
their
families.
One
of
the
the
most
powerful
tools
in
our
tool
belt
is
the
ability
to
level
of
the
table
and
have
parents
sit
with
professionals
that
they
make
decisions
about,
what's
going
to
happen
for
their
family
as
we
bring
in
communities
to
help
solve
some
of
these
major
challenges.
I
So
you'll
hear
me
through
the
course
of
today's
presentation,
really
talk
a
lot
about
the
role
of
homey
community-based
services
and
the
role
of
ensuring
that
adults
know
what
to
do
and
how
to
do
it
in
order
to
help
their
own
children
and
to
help
their
communities
to
be
able
to
heal.
But
we
want
to
start
by
talking
about
children,
youth
and
young
adults.
I'm
really
important
for
us
to
just
understand
that.
I
That's
a
level
setter
for
a
lot
of
systems,
transformation
and
I'll
just
bring
your
attention
to
one
other
word
in
here,
and
that
is
the
difference
between
between
treatment
and
treatment,
interventions
and
placement.
This
idea
of
where
a
child
puts
their
head
on
the
pillow
is
incredibly
important
for
for
states
to
organize
around
treatment
interventions
being
effective
interventions
and
not
just
trying
to
find
a
safe
place
for
a
young
person
to
sleep
at
night.
I
Next
slide,
please
so
I
I
want
to
talk
briefly
about
olmstead
and
I'm
certainly
happy
to
take
questions
later
about
olmstead,
but
what's
really
important
about
olmsted
is
that
it
is
a
supreme
court
decision
that
basically
says
that
an
individual
has
a
right
to
live
in
the
community
and
be
provided
services
and
supports
that
are
necessary
in
order
to
meet
their
needs.
I
It's
also
important
is
that
to
know
is
that
that
impacts,
children
as
well,
the
children's
rights
can
be
violated
if
they
are
not
in
the
right
service
in
the
right
time
for
the
right
duration
and
we
can
meet
the
needs
for
many,
if
not
a
majority
of
young
people
in
their
homes
and
communities,
and
we've
demonstrated
this
work,
certainly
not
just
in
new
jersey
but
in
other
states
across
the
country.
I
One
other
id
one
other
thought
about
almost
that
I
just
wanted
to
say
is
that
olmsted
many
states
have
really
addressed
almost
dead
challenges
through
the
framework
of
systemic
care.
I
Next
slide,
please:
I
wanted
to
talk
a
bit
about
residential
interventions
and
where
they
fit
one
of
the
challenges
that
states
and
communities
have
around
residential
interventions
is
they
tend
to
think
that
they
sit
really
outside
of
the
idea
of
the
other
services
and
services
and
supports
in
the
in
the
array
and
what's
important
about
residential
interventions
when
they're
most
effective
and
impactful
residential
best
practices
is
when
you
all
there's
a
couple
of
really
core
components
that
are
important.
One.
I
Is
that
there's
a
ton
of
oversight
and
that
oversight
has
is
not
just
about
following
the
rules,
it's
about
moving
towards
best
practices
and
making
sure
that
we
learn
the
lessons
from
practice-based
evidence
as
we
see
young
people
do
well
and
and
what
interventions
have
been
helpful
in
them
for
them
to
do?
Well.
So
that's
one
really
important
thing.
In
order
to
do
oversight,
you
actually
have
to
have
a
group
of
people
who
know
and
understand
what
residential
best
practices
are.
I
They
have
to
be
trained
and
skilled
and
able
to
coach
and
teach
those
residential
partners.
That's
number
one
number
two.
It's
also
important
to
have
the
connection
to
home
and
community-based
services,
in
other
words,
young
people
who
are
in
residential
intervention
really
are
continually
to
be
connected
to
their
families,
they're
connected
to
their
communities
and
they're
connected
in
the
aftercare
or
the
next
steps,
while
they're
still
in
a
residential
intervention.
I
So
these
important
concepts
are
really
it's
necessary
to
understand
how
they
fit
within
the
system
of
care
framework
in
order
to
fix
it
in
order
to
make
sure
that
young
people
get
what
they
need
and
I'll
give
you
a
couple
of
examples
of
what's
really
important
in
this
conversation.
I
One
is
that
we
understand
the
scope
and
draft
of
the
number
of
young
people
who
are
in
residential
two
that
we
understand
how
long
they
are,
whether
they're
in
state
or
out
of
state,
whether
they
return
home
quickly
and
what
the
outcomes
look
like.
The
data
and
the
ability
to
share
that
data
and
to
share
the
stories
of
young
people
is
important
too.
We
want
to
make
sure
access
is
available
to
a
whole
population
of
of
young
people.
They
don't
have
to
touch
on
a
child
welfare
system.
I
Residential
interventions
are
the
most
costly
part
of
any
service
array
in
any
state
is
where
you
put
the
money,
and
if
we
want
to
that
money
to
pay
dividends
in
the
long
run,
we
need
to
make
sure
that
we're
really
have
the
right
children
in
those
residential
interventions
and
that
those
residential
interventions
are
fully
supported
with
the
best
evidence
available
in
order
to
provide
the
best
care
available
next
slide.
Please
system
of
care
is
really
about
values,
and
it's
it's.
How
we
make
decisions
about
where
we're
going
to
put
resources?
I
How,
where
we're
going
to
put
our
where
we're
going
to
support
relationships,
how
we're
going
to
spend
time
putting
things
together
for
young
people
and
their
families.
But
it
also
says
that
we
value
what
young
people
and
their
families
tell
us
both
from
a
peer
support
perspective
from
an
advocacy
advocacy
perspective,
but
also
at
the
table
in
which
the
decisions
are
made.
That
leadership
and
governance
are
part
of
the
the
way
in
which
oversight
happens,
and
that
governance
happens
both
at
a
state
level.
I
But
it
also
happens
at
a
local
level
and
that
these
two
components
of
governance
are
incredibly
important.
To
ensure
appropriate
feedback.
Loops
are
in
place
that
there's
transparency
around
data,
that
there's
transparency
around
gaps
and
services
and
how
we're
going
to
solve
the
problem
of
getting
what
young
people
need
at
the
time.
They
need
it
for
the
duration
if
they
need
it,
that
we're
culturing
linguistic
competent
and
that
there's
an
equity
piece
to
this.
I
It
includes
services
and
supports
like
an
in-home
therapist,
evidence-based
practices
like
functional
feminine
therapy
or
multi-systemic
therapy,
there's
a
whole
service
array
that
can
be
that's
important
as
part
of
this
work
and
that
we're
meeting
the
sense
of
urgency
with
the
sense
of
urgency
when
families
are
beginning
to
experience
or
watch
as
their
child
is
experiencing
changes
in
their
behavior.
I
What
happens
is
that
parent
begins
to
experience
some
worry
and
some
anxiety
around
that
we
want
to
meet
that
parent's
sense
of
urgency
with
the
same
sense
of
urgency
that
they
feel
that's
trauma
informed
and
that
there's
intensive
care
coordination
in
order
to
manage
and
and
and
work
with,
young
people
and
their
families.
This
is
a
really
important
concept
that
that
sometimes
is
misunderstood,
how
it
works
and
how
important
it
is
in
systems
transformation
and
then
certainly
the
data
and
the
outcomes
next
slide.
Please.
I
Now
this
is
the
definition
of
systemic
care,
and
I'm
just
going
to
say
two
things
about
this
slide.
One
is
that
we
really
want
a
comprehensive
spectrum
of
effective
services
that
is
well
coordinated
and
that
there's
a
a
real
important
focus
on
meaningful
relationships
that
and
we're
spending
time
and
attention
around
building
those
meaningful
relationships
to
help
young
people
and
their
families
next
slide.
I
This
is
the
historic
challenges
within
states,
and
I
see
this
in
many
of
the
states
that
I
work
in
this
was
certainly
new
jersey's
story
before
we
started
the
systems
reform
in
2000,
and
that
is
the
lack
of
home
and
community-based
services.
This
idea
that
we're
going
to
focus
on
medical
model-
we,
you
know
the
patterns
of
util
utilization,
don't
take
into
account,
what's
happening
in
the
just
in
disproportionality,
that
there
are
poor
outcomes.
I
We
spend
a
lot
of
money
on
very
poor
outcomes
in
a
lot
of
this.
A
lot
of
these
states
that
there's
rigid
financing
structures
with
one
of
the
challenges
is:
how
do
you
fix
those
rigid
financing
structures
and
then
how
do
we
actually
bring
stakeholders
aboard?
And
how
do
we
train
all
of
the
adults
who
are
going
to
touch
on
their
child's
life?
All
of
these
things
are
important
in
consideration
next
slide.
Please,
and
this
is
how
we
get
to
transformation.
We
look
at
policy,
the
population
of
focus.
I
The
frontline
practice
shifts
I'm
not
going
to
spend
a
lot
of
time
on
this,
but
it's
important
to
know
that
the
front
line
has
to
change
right.
We
need
clinicians
to
think
differently
about
children,
youth
and
young
adults.
We
need
a
frontline
staff
to
change
and
I'll
make
some
some
comments
about
that
later,
but
it's
just
important
to
know
that
there
are
shifts
in
all
parts
of
the
system.
I
At
the
end
of
the
day,
people
begin
to
think
differently
about
the
work
and
how
they
provide
the
work,
and
that
includes
how
they
pay,
how
they
build,
how
they
talk
about
it,
how
young
people
are
diagnosed,
how
the
assessment
tools
are
used.
All
of
those
things
shift
in
a
true
system
of
care.
Next,
one
really
the
most
important
thing
on
this
slide
is
you
want
to
move
from
a
fragmented
service
delivery
system
to
a
coordinated
service
delivery?
I
That's
going
to
help
you
anticipate
where
and
when
you
have
you're
going
to
have
challenges
and
put
the
resources
in
those
places.
One
quick
example
means
that,
when
there
is
a
natural
disaster,
as
there
was
in
in
new
jersey,
when
superstorm
sandy
hit,
we
knew
exactly
where
to
put
those
resources
in
order
to
meet
the
needs
for
young
people
to
stave
off
the
behavioral
health
tsunami
that
we
saw
coming
after
the
impact
of
super
storm
sandy.
What
good
systems
of
care
do?
What
good
and
modern
systems
do?
I
Is
they
actually
not
only
allow
you
to
deal
with
the
day-to-day?
They
allow
you
to
get
ahead
of
curve
on.
What's
going
to
happen
later
next
step,
please,
the
system
of
care
is
first
and
foremost
a
set
of
values
and
principles.
It
says
that
we
are
going
to
honor
our
children
and
families
and
their
voice
and
we're
going
to
we're
going
to
have
those
children
families
at
our
table.
It
also
says
that
we're
going
to
we're
going
to
meet
their
needs
with
the
right
services
at
the
right
time
for
the
right
duration.
I
That
includes
a
comprehensive
service
array.
We
do
not
make
children
fail
up
or
fail
down
in
services
before
they
get
what
they
need.
In
other
words,
when
children
need
a
residential
intervention,
we
might
get
that
for
them
when
they
need
outpatient.
We
get
that
for
them,
but
in
order
to
do
that
well
and
to
ensure
that
we're
making
sure
that
it
is
the
right
service
at
the
right
time.
I
There
are
many
steps
in
between
there
that
have
to
happen
that
these
systemic
care
is
trauma,
informed
and
understands
the
impact
of
trauma
not
just
on
the
child,
but
on
the
family
and
on
the
community
that
it
pushes
for
partnerships
that
there's
good
care
coordination
that
happens
so
that
everyone
is
on
the
same
page
and
there's
a
coordinated
plan
for
what's
going
to
happen
next.
I
All
of
these
things
are
incredibly
important
when
we
talk
about
what
a
system
of
carry
is,
but
the
other
thing
that
it
does
is
it
allows
us
all
as
a
workforce
to
move
in
the
direction
together,
we
have
a
vision
of
where
we're
going
to
go.
We
speak
the
same
language.
We
coordinate
across
disciplines
to
ensure
young
people
get
what
they
need
without
having
to
move
for
one
direction
or
another
to
go
down
the
street
in
order
to
get
those
services
next
slide.
Please.
I
I
When
I
talk
about
mobile
response,
and
that
is
because
nationally,
what
we
know
is
that
parents
think
that
they
have
to
be
in
a
different
point
in
order
to
ask
for
assistance
and
help,
and
that
professionals
believe
that
young
people
have
to
wait
longer
in
order
to
access
services
and
so
in
a
family
driven
care.
We're
talking
about
when
the
parent
picks
up
the
phone
ask
for
help,
we're
going
to
send
it
and
provide
that
care,
that's
necessary
for
them
at
the
time
that
they
need
it
in
the
place
that
they
choose
next
slide.
I
So
youth
guide,
it
means
that
we're
going
to
have
young
people
sitting
at
our
table.
That
means
all
young
people
are
going
to
at
our
table
that
they're
going
to
help
us
make
decisions
for
what
is
in
their
best
interest,
because
they're
going
to
guide
us
to
which
they're
ready
for
when
they're
ready
for
it
and
how
they're
ready
for
the
interventions
that
are
necessary
for
them
in
order
to
get
to
the
highest
level
of
their
own
potential.
I
I
I
do
want
to
spend
just
a
minute
talking
about
why
it's
important
to
have
a
customized
service
array
for
children,
youth
and
young
adults,
and
that
adults
really
require
different
things
when
it
comes
to
meeting
their
needs
and
from
a
mental
health
perspective.
As
an
example
in
the
world
of
mobile
response,
we're
talking
about,
you
know
a
place
to
contact.
We
want
young
people
not
only
to
call.
We
want
their
ability
eventually
for
them
to
be
able
to
to
text
if
that's
what's
necessary
in
order
for
us
to
be
able
to
assist
them.
I
I
We
want
young
people
to
stay
in
their
own
homes,
schools
and
community,
and
we
think
it's
really
important
for
all
folks
who
are
working
with
children,
youth
and
young
adults
to
understand
not
only
what's
going
on
for
that
child,
but
also
is
happening
for
their
parent
and
their
caregiver
next
slide,
and
it's
really
important
when
you
transform
your
behavioral
health
system
to
think
about
not
just
one
reform
or
one
part.
I
We
wanna
reform
all
of
the
the
parts
that
feed
into
right,
so
using
medicaid
as
a
vehicle
for
long-term
sustainable
change
is
important
because
they're,
the
largest
provider,
the
largest
health
insurer
in
any
particular
state,
and
so
we
want
to
use
that
medicaid
and
health
reform
to
be
able
to
make
differences
for
young
people
and
their
families,
but
also
the
family
parks
plan.
I
We
want
to
connect
the
dots
between
what's
happening
for
medicaid
and
what's
going
on
in
the
family
first
plan,
we
want
to
use
things
like
alternatives
to
detention
and
restorative
justice
practices
in
the
juvenile
justice
world
to
connect
the
dots
and
educational
reforms
as
well.
So,
in
other
words,
we
really
want
to
create
win-win
wins
across
the
system
to
ensure
young
people
get
what
they
need
without
having
to
touch
on
other
systems
that
they
don't
necessarily,
and
so
the
question
becomes.
Why
are
outcomes
so
poor
and
cost
so
high?
I
Well,
there's
a
couple
of
things
to
know
right.
A
siloed
approach
to
to
service
delivery
is
really
problematic.
It
just
is
because
you're
paying
costs
over
here
you
don't
have
good
assessment.
You
don't
know
if
you're
providing
the
right
service,
there's
not
good
coordination
around
whether
or
not
it's
working
for
the
young
person.
We
don't
have
good
feedback
loops
and
we
don't
have
the
data
that
tells
the
story
and
that's
a
very
expensive
way
to
provide
care
right.
I
They
need
it,
no
more,
no
less
and
that
they're
going
to
move
to
the
highest
level
of
their
potential
so
really
important
for
us
not
to
only
recognize
how
much
does
it
cost
us
in
the
day?
But
how
much
does
it
cost
us
over
time?
If
we're
young
people
to
be
in
the
wrong
intervention?
And
then
what
is
the
impact
on
that
young
person
over
time
next
slide?
Please.
I
Next
in
2013,
samson
and
cms
actually
sent
a
joint
bulletin
to
to
the
children's
behavior
health
directors
across
the
country.
I
actually
happened
to
be
the
children's
behavioral
health
director
at
the
time
in
new
jersey,
and
this
did
land
on
my
desk
and
they
in
the
the
joint
bulletin.
They
basically
said
we
think
in
every
medicaid
plan,
every
child
should
have
who
meets
the
criteria
who
needs
these
services.
I
If
you
will
should
have
access
to
intensive
care
coordination
using
wraparound,
they
should
have
access
to
peer
and
youth
peer
support
services,
intensive
in-home
services,
respite
mobile
response
and
stabilization
flex,
funds
and
trauma-informed
systems
and
evidence-based
treatments
to
address
trauma
that
that
was
all
laid
out
in
that
letter,
and
it's
really
important
to
know
all
of
these
things
can
be
available
through
medicaid
right
medicaid
can
support
this
work.
Moving
forward
next
slide,
please
and
the
homie
community
based
services
include.
I
Would
you
already
have
many
of
these
core
components,
as
as
we
heard
from
dr
freeman
today,
around
homey
community-based
services,
care
coordination,
on-site
face-to-face
therapeutic
response,
and
we
would
argue
that
we
want
on-site
therapeutic
response,
100
percent
of
the
time
that
parent
picks
up
the
phone
asks
for
help
that
we
should
send
it
that
the
access
should
be
24
7,
because
parents,
when
they
learn
that
the
behavioral
health
system
is
not
responsive,
then
they
don't
call
back
and
they
wait
a
long
time
before
they
pick
up
the
phone
and
ask
for
help.
I
So
all
of
these
things
become
really
important
in
terms
not
just
in
what
you're
trying
to
provide
in
the
moment,
but
the
message
you're
trying
to
deliver
to
the
parents
and
the
caregivers
who
you're
trying
to
serve
next
slide
that
mobile
response.
These
are
the
core
components
of
a
system
of
care.
There's
a
single
point
of
access,
there's
mobile
response
and
stabilization
intensive
care
coordination
with
wraparound
as
its
practice
model
to
fidelity
and
that
youth
and
peer
support
next
slide.
I
Please
and
that
intensive
in-home
services
support
those
foundational
or
grounding
components
that
high
fidelity,
wrap
around
mobile
response
and
stabilization
youth
and
peer
support,
really
important
parts
of
this
work,
and
then
the
intensive
in-home
supports,
which
may
actually
shift
and
change
as
the
system
grows
and
develops.
What
doesn't
change
is
the
need
for
mobile
response
and
stabilization,
the
need
for
intensive
care
coordination,
the
need
for
youth
and
peer
support.
I
So
all
these
other
things
shift
and
change
within
the
service
way,
but
they
need
to
be
available
within
the
within
the
service
array
in
order
to
meet
the
needs
of
children,
youth
and
families.
Next
slide,
please
single
point
of
access
means
that
we're
going
to
answer
the
phone
24
7.
parent
has
an
issue
challenge
we're
going
to
pick
a
phone
we're
going
to
answer
that
call
we're
going
to
provide
what
is
necessary,
we're
going
to
come.
I
If
that's
it,
we're
going
to
come
if
a
parent
asks
for
help
that
all
calls
are
answered,
that
the
parent
and
caregiver
calls
and
the
team
goes,
and
then
we're
going
to
begin
to
collect
information
right
from
there
right
in
a
single
electronic
record
that
can
help
us
communicate
across
teams
that
can
communicate
across
the
system.
Next
slide
mobile
response
and
stabilization
just
a
quick
overview,
because
you've
already
heard
quite
a
bit
about
it
today.
I
But
it's
really
important
to
know
that
mobile
response
and
stabilization
is
the
first
step
in
systems,
transformation,
the
availability
of
mobile
response
and
stabilization
24
7
the
availability
of
specifically
trained
teams-
and
that
means
you
know
I.
I
would
argue
that
you
can.
You
can
use
bachelor's
prepared
folks
as
part
of
your
teams.
Certainly,
youth
and
certainly
peer
support
partners
can
be
part
of
those
teams,
and
we
see
that
in
second
generation
mobile
response
and
stabilization,
but
it
is
the
face
to
face
that
is
really
important
within
the
work
next
slide.
I
Please
and
the
goal
of
mobile
response
and
stabilization.
I
just
want
to
leave
this.
You
know
make
sure
that
you
we
enter.
This
point
is
that
we
meet
the
sense
of
urgency
that
parents
feel
with
a
sense
of
urgency,
because
if
the
system
moves,
when
parents
are
feeling
that's
insurgency,
then
parents
actually
can
do
more
of
this
work
than
we
think
that
they
can
and
that
more
young
people
can
be
served
in
their
own
homes,
schools
and
communities
than
we
think
can
next
slide.
I
Please
mobile,
responsive
stabilization
has
the
homey
community-based
services
there's
all
of
these
components.
We
feel
really
important,
but
we're
not
going
to
spend
too
much
time.
We
want
to
get
the
next
slide.
Please,
because
I
do
want
to
talk
about
care
management
care
coordination
is
something
that
is
necessary
in
order
to
transform
in
in
in
nevada,
it's
important
to
know
what
care
coordination
is,
what
it
does
and
why
it's
so
incredibly
important.
I
Many
people
just
think
it's
wrap
around
and
wrap
around
is
important,
but
how
wraparound
is
provided
and
the
context
of
what
should
provide
it
and
who
does?
It
is
equally
as
important
as
the
intervention
itself.
In
other
words,
intensive
care
coordination
is
a
grounding
principle
of
systems
reform
and
when
care
coordination
is
done
well,
it
transforms
communities
to
become
part
of
the
solution.
Next
slide,
please
so
next
slide.
If
you
could
just
push
that
this
yeah.
Thank
you
there's
a
couple
different
ways
to
think
about
intensive
care
coordination.
I
But
what
we
know
from
the
evidence
is
that
stand-alone,
conflict-free
care
coordination
entities
have
the
best
results
and
we
see
that
in
louisiana
and
new
jersey,
the
two
two
states
that
have
standalone
conflict-free
intensive
care
coordination-
in
other
words,
what
those
organizations
do
is
that
they
only
provide
care
coordination
and
they
connect
the
dots
within
the
community
to
ensure
young
people
get
what
they
need.
I
They're
also
responsible
for
building
part
of
the
service
array
to
ensure
young
people
get
intensive,
in-home
services
at
the
time
they
need
it
for
the
duration,
there
are
other
models
like
ohio
is
currently
building
model
in
which
there
is
care
coordination
in
in
a
in
a
care
management
entity,
but
it's
not
a
standalone,
but
they
have
built
firewalls,
and
we
do
believe
that
ohio
is
going
to
be
successful
in
their
implementation.
I
We
also
know
that
illinois
has
is
working
on
this
work.
We
know
massachusetts
has
done
this
work
so
is
oklahoma.
Oklahoma
has
has
some
practice
models
that
may
actually
be
helpful
for
nevada
in
terms
of
trying
to
figure
out
how
to
get
intensive
care
coordination
available
to
the
young
people,
who
really
need
it
next
slide.
Please
there's
tier
court
care
coordination
that
really
look
at
multiple
populations
and
can
serve
multiple
populations
and
there's
a
couple
ways
to
think
about
that
right.
I
There's
you
know
the
new
jersey
model
is
that
all
populations
are
served
within
a
care
management
entity,
whereas
delaware
they're
served
in
two
different
places.
There
are
pros
and
cons
to
both
models,
but
we're
happy
to
talk
through
it.
I
What
is
important
is
that
young
people,
with
both
moderate
and
complex
behavioral
health
needs
their
needs,
are
managed
within
the
model
that
says
we're
going
to
coordinate
the
care
to
ensure
young
people
get
what
they
need
next
slide,
and
this
is
just
another
way
of
thinking
about
tiered
care,
coordination
right
and
just
real
quickly.
I
We
really
want
to
look
at
the
flexibility
in
serving
more
populations.
So
as
an
example,
new
jersey
uses
intensive
care
coordination
not
only
to
manage
young
people
with
modern
and
complex
behavioral
health
needs,
but
to
manage
young
people
who
have
intellectual
and
developmental
disabilities
to
ensure
that
they
get
what
they
need
when
they
need
it,
so
really
important
way
of
thinking
about
that
next
slide.
Please-
and
this
is
just
our
partners
right.
I
Our
partners
are
child
welfare,
juvenile
justice,
family
courts,
education
systems,
but
one
of
the
things
I
did
want
to
say
around
this
in
particular,
is
what
you
don't
want.
Is
your
child
welfare
system
to
have
to
build
its
own
behavioral
health
system?
We
don't
want
juvenile
justice
to
build
its
own
behavioral
health
system.
You
want
a
behavioral
health
system
that
serves
young
people
who
touch
on
child
welfare,
but
those
services
can
can
be
coordinated
and
and
can
continue
whether
they
stay
in
the
child.
Welfare
system
or
not.
I
The
family
doesn't
have
to
touch
on
child
welfare
or
access
care
same
thing
with
juvenile
justice,
so
really
important
way
of
beginning
to
think
about.
When
and
how
young
people
touch
on
on
services
and
supports
next
slide,
and
then
it's
important
to
plan
from
the
beginning
right,
so
we
want
to
make
sure
that
you're
moving
towards
long-term
sustainability
and
that
you're,
using
all
of
the
things
that
are
necessary
in
order
to
get
there
right.
If
you're
going
to
build
a
system
of
care,
you
want
it
to
work
from
the
beginning.
I
So
we
want
to
think
what
is
it
going
to
look
like
in
in
one
year
in
two
years
and
five
years
in
10
years,
and
I
can
tell
you
as
somebody
who
was
on
the
ground
in
new
jersey
in
2000,
when
the
concept
paper
was
published.
If
you'd
asked
me
that
we
would
be
here
today,
I
don't
know
that
I
would
have
said
yes,
but
I
was
certainly
hopeful
that
we
would
and
we
not
only
met
the
needs
in
the
in
the
vision
paper
that
was
published
in
2000.
I
So
this
is,
this
is
new
jersey
and
what
I
put
the
bridge
in
there.
So
you
can
see
we
want
to
connect
the
dots
we
want
to
keep
young
people
in
their
homes,
schools
and
communities.
That's
really
important
work
and
the
way
to
do
that
really
is
to
connect
right.
It
is
a
connection
connection
to
community
making
sure
that
schools
are
working
with
the
in-homes
work,
making
sure
that
people
are
coordinating
across
practices
across
silos.
We
want
to
pull
those
silos
down
whenever
possible.
Next
slide.
I
Please-
and
these
are
our
partners,
we
can
move
to
the
next
one
and
this
one's
for
you.
So
you
know
that
community
engagement
is
a
primary
driver
of
systems
reform.
In
other
words,
the
communities
help
us
figure
out
how
to
heal
young
people
and
their
families
next
slide.
I
I
do
want
to
talk
real
quick
about
data.
There
really
is
important
to
be
able
to
collect,
share
and
help
communities
understand
the
data
right,
so
we
want
to
basically
collect
information.
That's
going
to
help
us
know
how
the
system
is
doing,
how
our
young
people
improving
right.
Can
we
see
that?
Can
we
see
that
access
is
taken
care
of?
Can
we
see
that
utilization
is
making
sense,
so
the
data
collection
component
of
this
is
important.
Excellent
and
different,
used
user
uses
of
data
really
is
in
plan.
I
For
me,
from
my
perspective,
I
want
it
for
planning
to
help
communities
understand
what
I
need
for
accountability,
to
make
sure
that
we
are
accountable
to
the
young
people
and
to
their
parents.
To
ensure
access
is
happening,
that
they're
getting
the
best
service
and
by
the
way
that
we're
getting
the
the
best
practices
in
place
in
a
way
that
makes
sense
next
slide.
Please.
I
I
just
want
to
throw
some
leadership
strategies
at
you,
because
I
think
it's
important
in
this
moment
in
time
right
to
really
think
about
what
do
you
want
it
to
look
like
for
young
people
today,
five
years
and
20
years
down
the
road,
and
so
a
couple
things
that
are
important
one
is.
It
is
really
important
to
have
a
vision
of
what
you
want
it
to
look
like
to
believe
that
young
people
can
be
served
in
their
home.
I
Schools
and
community
means
that
we
have
to
actually
be
brave
and
move
resources
in
a
way
that
sometimes
might
be
challenging,
but
is
really
important
for
us
to
do
that.
One
and
then
we
need
to
communicate
that
vision
and
make
sure
everybody
knows
that
that
vision
is
moving.
New
jersey
was
brave
enough
to
put
its
very
bad
data
into
into
its
concept
paper,
so
that
we
could
see
what
improvement
was
going
to
look
like
that.
We
want
to
find
champions
and
those
champions
are
all
over
your
state.
I
We
want
to
be
flexible
and
nimble
in
in
the
way
that
we
build
these
systems
so
that
we
can
adjust
as
we
need
to
in
order
for
things
to
work,
and
one
thing
we
really
need
to
understand
is
that,
if
you're
going
to
do
this
work,
that
people
are
going
to
have
to
change,
grow
talk
to
each
other
and
be
partners
within
the
work
next
slide.
I
I
A
Thank
you
so
much.
Thank
you
so
much
miss
manley.
I
just
wanted
to
extend
my
appreciation
for
you
presenting
on
this
issue
area
and
we
do
have
a
couple
questions.
So
I
hope
you
hang
out
until
the
end
of
this
next
presentation,
but
I'm
going
to
go
ahead
and
ask
dr
freeman
to
proceed
with
this
portion
of
the
presentation
and
then
we'll
do
questions
after.
B
Thank
you
chair
and
thank
you
so
much
liz
for
joining
us
today.
We
really
appreciate
your
expertise.
This
is
dr
megan
freeman
for
the
record.
I
currently
service
the
state's
children's
behavioral
health
authority
next
slide
next
slide,
so
I
want
to
start
again
like
I
did
this
morning,
just
by
going
big
picture
for
a
minute.
I
know
we're
running
short
on
time
and
I
really
appreciate
everybody
sticking
with
us
through
the
end
of
this
long
day.
B
B
We
want
to
shift
our
thinking
from
the
ways
in
which
individuals
with
disabilities
are
different
and
what
accommodations
we
could
make
for
a
child's
limitations
or
impairments
into
thinking
about
what
barriers
exist
within
society
that
prevent
that
person
from
developing
to
their
fullest
potential.
And
how
can
we,
as
a
society,
look
at
social
barriers
that
we
may
be
able
to
remove
in
order
for
them
to
have
full
access
to
society
and
fully
enjoy
their
rights?.
B
The
important
question
for
children
with
disabilities,
including
children,
living
with
mental
and
behavioral
health
needs,
is
not
whether
but
how
they
can
be
fully
included
as
members
of
their
families,
schools,
communities
and
society.
These
are
some
foundational
principles
that
were
decided
globally
some
time
ago,
and
they
actually
very
closely
reflect
the
foundational
principles
of
the
system
of
care,
but
doing
things
in
the
best
interest
of
the
child
and
family.
B
B
The
department
of
health
and
human
services
is
committed
to
ensuring
that
every
nevadan
has
the
opportunity
to
achieve
their
best
possible
quality
of
life.
We
do
have
a
behavioral
health
community
integration
plan,
which
was
published
several
years
ago,
we're
right
now,
updating
it
to
reflect
current
needs,
and
the
plan
was
created
with
the
goal
of
building
a
behavioral
health
system
that
maximizes
community
integration
and
discourages
unnecessary
use
of
higher
levels
of
care.
B
B
So
as
we
look
at
the
development
of
our
service
array,
if
we
start
over
essentially
where
we
want
to
be
where
we
have
a
well-established
model,
we
know
how
to
do
something.
We
have
adequate
capacity
to
serve
everyone
who
needs
to
be
served
and
there's
sustainable
funding,
we're
getting
good
outcomes.
We
want
to
continue
doing
these
things
as
we
are
doing
them
looking
here
at
the
lower
intensity,
end
of
the
service
array
and
then
on
the
next
slide,
samantha
the
higher
intensity
end.
B
We
don't
have
really
any
services
that
I
think
we
can
fully
put
in
this
category.
I
am
happy
to
be
proven
wrong.
If
anybody
here
disagrees,
please
let
me
know
during
questions
or
please
anybody
watching
feel
free
to
contact
me
back
channel.
I
would
love
to
be
wrong
about
this,
but
I
think
in
most
cases,
when
we
look
at
our
service
array,
we're
missing
one
or
more
critical
pieces
of
this
capacity
funding
we
haven't
maybe
yet
haven't
developed
a
model
here
so
go
on
to
the
next
slide.
Please.
B
Here
we
have
services
that
we
know
how
to
do
it,
but
we
may
need
to
further
expand
it
like
into
rural
or
frontier
or
other
areas.
We
might
need
implementation
support,
we
may
not
have
adequate
capacity
or
sustainable
funding
or
some
other
kind
of
support
is
needed.
I
also
would
put
respite
care
here.
I
didn't
put
it
on
the
side,
but
we've
been
talking
about
that
today
and
I
would
put
that
here.
B
B
This
is
just
the
higher
intensity
end
of
that
service
array.
I
put
988
here
just
because
we're
still
starting
and
as
we
discussed
earlier
today
when
we
start
this,
it
will
be
an
iterative
process
of
figuring
figuring
out
what
pieces
are
good,
what
pieces
do
we
need
to
tweak
and
then
the
expansion
so
that
it's
implemented
more
like
the
best
practice
family
peer
support
is
an
incredibly
important
part
of
the
service
array
and
it's
currently
not
a
medicaid
billable
service,
although
we
are
doing
some
work
in
that
area,.
B
B
This
is
the
part
of
the
service
array
where
significant
work
remains,
or
we
may
be,
overcoming
barriers.
I
put
project
aware
here
as
well
as
trauma,
informed
schools
more
generally,
primarily
because
we
don't
have
uptake
statewide
yet-
and
this
is
such
a
critical
part
of
what
we're
doing.
We
really
need
to
see
this
used
more
widely.
The
the
work
that
is
being
done
in
project
aware
is
absolutely
amazing,
and
we
want
to
take
it
more
broadly.
B
B
This
is
where
we
can
serve
high-risk
youth
youth,
who
are
at
risk
of
going
into
higher
levels
of
care.
They
may
be
at
risk
for
involvement
with
juvenile
justice
or
child
welfare.
If
we
can
implement
these
services
at
scale,
we
can
prevent
a
lot
of
youth
from
having
to
leave
their
home
and
get
services
somewhere
where
they
may
not
get
the
best
outcomes.
We
want
them
to
learn
the
skills
that
they
need
in
their
natural
environment.
B
Types
of
treatment
for
youth
who
need
to
be
in
a
residential
treatment,
environment,
special
populations
which
I've
put
here
and
will
come
up
later.
I
would
consider
to
be
things
like
that.
Dr
brown
and
her
team
spoke
about
earlier.
The
dual
needs
youth
who
have
severe
emotional
disturbance
and
intellectual
disabilities.
B
B
B
Again,
there
are
some
services
here
that
we're
doing
really
really
well,
such
as
the
school-based
behavioral
health
services
multi-tiered
systems
of
support,
but
when
we
look
at
those
tier
three
services
where
youth
need
individualized
interventions,
where
we
want
to
provide
them
with
traditional
therapy
services
on-site
at
school,
that's
where,
although
some
parts
of
the
system
are
built
out,
well
some
parts
we
still
need
to
put
more
attention
to.
B
I
do
want
to
talk
about
fed
availability
briefly,
because
this
is
a
topic
that
comes
up
frequently
with
respect
to
nevada.
This
is
also
an
issue
elsewhere,
right
now,
outside
of
our
state,
for
for
lots
of
reasons,
but
using
recommendations
provided
in
a
recent
paper
from
which
is
coming
out
of
a
panel
of
global
experts
with
respect
to
acute
psychiatric
hospital
beds,
so
not
residential
treatment.
That's
that's
a
separate
issue,
acute
psychiatric
hospital
beds
for
youth
who
are
in
imminent
danger.
B
They
need
to
be
in
the
hospital
for
several
days
or
a
week
it
looks
like
we
are
experiencing
a
severe
shortage.
We
should
have
somewhere
between
30
and
60
beds
per
100,
000
youth,
and
we
have
between
13
and
15,
depending
on
how
you
look
at
it,
and
this
is
one
of
the
reasons
that
we
see
bottlenecks
in
them
in
the
emergency
department.
B
B
B
In
nevada,
we
do
have
some
statute
related
to
this,
so
there's
some
clear
legislative
intent.
This
is
regarding
the
purposes
of
the
division
of
child
and
family
services,
and
the
purposes
of
the
division
are
to
provide
a
comprehensive
system
not
only
for
juvenile
justice
and
child
welfare,
but
also
for
the
mental
health
of
children.
B
This
includes
ensuring
that
they're
placed
in
a
least
restrictive
environment
and
coordinating
and
providing
services
for
youth-
and
this
doesn't
necessarily
mean
literally
the
state-
provides
all
the
services
because,
as
we've
been
talking
about
today,
that's
clearly
not
a
good
strategy.
We're
not
going
to
be
able
to
meet
the
need,
but
it
is
the
responsibility
of
the
state
to
ensure
that
an
adequate
service
array
exists.
B
B
So,
just
a
little
bit
more
here
on
the
the
ways
that
this
touches
on
behavioral
health,
so
the
division
shall
establish
and
coordinate
a
system
for
diagnosis
and
assess
an
assessment,
referral
to
appropriate
services
and
care
coordination,
and
so
without
the
proper
infrastructure
oversight,
data
monitoring,
it
would
be
really
difficult
for
the
state
to
execute
this
area
of
the
legislative
intent.
This
is
this
is
a
big
ask.
B
B
B
Those
who
are
left
behind
to
carry
the
load
are
incredibly
burned
out
because
of
the
shortage
of
healthcare
professionals.
Overall,
and
I
found
an
interesting
statistic
while
I
was
researching
this,
this
goes
across
all
industries,
not
just
healthcare,
but
the
majority
of
those
leaving
jobs
in
2021
cited
mental
health
as
the
driver
and
for
quote
unquote
millennials.
B
That
was
two
out
of
three
folks
and
for
gen
z,
the
younger
generation
who's,
the
the
newer
generation
in
the
workforce.
That
was
four
out
of
five,
so
it's
80
percent
of
folks
saying
that
when
they
left
their
job,
the
reason
was
because
of
their
mental
health.
B
B
So
moving
on
to
where
we
go
from
here,
you've
heard
today
from
a
wide
range
of
folks
and
many
thanks
to
all
of
the
awesome
people
who
testified.
Today.
We
have
an
amazing
team
at
the
state
and
also
our
local
partners.
There's
a
tremendous
amount
of
really
good
work
happening
here,
like
dan
said,
to
support
children,
youth
and
families
were
supported
by
the
governor's
office
and
his
staff
were
supported
all
up
and
down
the
line.
We
also
do
still
have
a
lot
of
work
left
to
do.
B
When
we
look
at
the
service
array
from
a
30
000
foot
view,
we
can
see
that
we're
lacking
evidence
based
on
evidence,
informed
services
at
the
right
capacity
supported
by
sustainable
funding.
The
recommendations
are
at
least
one
of
the
recommendations.
To
start
addressing.
This
is
to
improve
data
collection
and
surveillance
efforts,
so
that
we
can
fully
understand
the
need.
This
is
the
first
step
in
creating
the
infrastructure
I've
been
talking
about
that
can
address
the
quality
and
completeness
of
the
service
array
and
will
also
inform
requests
for
funding
strategies.
B
B
B
B
This
will
allow
us
to
better
support
youth
who
are
at
risk,
which
includes
not
only
risk
for
a
higher
level
of
care,
but
also
involvement
in
the
juvenile
justice
system
or
the
child
welfare
system
and
in
the
event,
a
youth
does
need
higher
level
of
care.
This
is
another
area
of
our
system
where
we
have
significant
and
meaningful
gaps
which
again
has
come
up
earlier
today.
B
So
the
second
bullet
point
is
on
workforce
challenges,
which
I'm
sounding
like
a
broken
record.
At
this
point,
we've
discussed
potential
strategies
like
creating
a
pipeline
from
local
institutions
of
higher
education
and
explicitly
incentivizing
behavioral
health
care
work.
We
could
use
strategies
such
as
student
loan
repayment
or
even
cash
bonuses,
and
while
public
employees,
including
school
district
employees,
are
feeling
the
largest
salary
gap
with
the
private
sector
right
now,
it
would
be
beneficial
to
be
able
to
provide
incentives
and
bonuses
across
both
public
and
private
settings.
B
B
Can
you
go
to
the
next
one
samantha?
I
want
to
do
this
out
of
order,
so
this
is
not
the
questions,
the
one
there
you
go.
Yes,
this
is
just
the
the
final
point
that
I
wanted
to
make
liz
earlier
mentioned.
The
importance
of
oversight
in
ensuring
that
best
practices
are
delivered
and
youth
are
receiving
quality
care,
and
she
mentioned
that.
B
The
way
to
accomplish
this
is
by
having
a
dedicated
team
of
folks
attending
to
this
infrastructure,
and
you
also
heard
earlier
about
an
infrastructure
like
this
used
by
sapta
in
nevada
to
oversee
the
substance,
use
prevention
and
treatment
system.
Here
we
want
to
do
something
similar
to
what
zapda
has
done
for
substance,
use,
provider,
certification
and
treatment
for
children's
behavioral
health.
B
So
we
need
these
formal
mechanisms
for
oversight,
quality
assurance
and
quality
improvement.
We
don't
want
to
make
the
process
so
burdensome
that
providers
don't
want
to
participate
or
they
can't
meet
the
requirements,
but
we
do
need
to
strategically
monitor
certain
metrics
so
that
we
can
provide
training
and
technical
assistance
and
corrective
action
as
needed,
and
so
that
we
know
what's
happening
in
the
system.
B
But
we
don't
want
to
set
expectations
for
providers
without
providing
the
scaffolding
to
ensure
that
they
can
meet
the
expectations.
So
the
previous
slide
was
the
policy
and
oversight
side
of
the
house,
and
this
is
the
clinical
excellence
side
of
the
house
for
the
nevada,
children's
behavioral
health
authority
that
we
would
like
to
build.
A
Thank
you
again
for
presenting
on
this
really
important
issue.
I
really
appreciate
the
kind
of
outline
of
what
you
guys
are
thinking
about
and
I
look
forward
to
continuing
to
work
towards
what
it
is.
You
need
to
stand
this
up.
I
think
we
need
to
talk
about
the
funding
piece.
That's
a
very
like
separate
and
robust
conversation
that
we
should
be
having
as
well
as
what
infrastructure
do
you
need
in
addition
to
that
funding
piece
to
stand
up
this
type
of
model?
I
love
this.
A
Everything
that
you
are
discussing
related
to
the
transition
into
this
care
model
is
spot
on
for
me
and
my
experience
as
a
millennial
with
children
and
also
having
dealt
with
my
own
mental
and
behavioral
health
issues,
while
being
a
support
for
other
people
who
are
as
well.
So
I'm
very
excited
for
us
moving
in
this
direction
and
and
I'm
hoping
that
we
can,
we
can
tie
some
things
together
this
next
legislative
session.
So
I
look
forward
to
your
recommendations
on
bill
draft
requests.
A
I
have
a
question
for
you,
but
I'm
going
to
go
ahead
and
start
with
my
committee.
Are
there
questions
from
the
committee
based
on
this
pres,
these
two
presentations.
F
Go
ahead,
thank
you,
there's
a
lot
of
echo
here,
because
our
room
is
kind
of
empty,
but
I'm
still
here.
In
any
case,
I
just
a
quick
question.
I
first
thank
you
for
the
presentation.
F
I
do
think
that
there
has
to
be
a
change
and
we
certainly
have
to
augment
what
we're
doing,
and
I
recognize
that
we
are
on
a
policy
committee
and
that,
as
the
chair
pointed
out,
I
think
most
members
of
the
hhs
committee
are
also
on
the
money
committee.
The
interim
committee,
my
question
for
staff-
and
perhaps
I
could
give
it
to
us-
is
how
much
has
our
arc
funds?
F
How
how
many
dollars
of
our
arc
funds
have
actually
been
committed
to
our
mental
health
programs
and
I'd
like
to
see
where
the,
if
any
of
that
money's
been
spent
to
solving
some
of
these
issues
that
we
have
been
presented
over
this
long
this
this
day,
because
I
think
I'd
just
like
to
see
kind
of
that
total
and
maybe
staff
can
get
it
from
our
our
finance
folks.
So
thank
you,
madam
chair,
for
that.
A
That's
a
great
question,
dr
titus,
and
I
think
that
we'll
see
some
some
additional
information
on
that
during
the
next
ifc
meeting.
So
so
I
think
that
will
be
taken
care
of
in
the
money
committee
and
clarified
in
the
money
committee.
I
know
that's
a
little
ways
off,
but
we
should
expect
that
paperwork
to
come
in
anytime
between
now
and
probably
the
first
couple
weeks
of
april
for
us
to
review,
if
not
a
little
bit
later
than
that.
A
Are
there
other
questions
from
the
committee?
I
think
I've
got
three
of
you
left.
Thank
you
for
hanging
in
there.
Okay,
I'm
gonna
go
ahead
and
ask
my
question.
So
as
we
work
to
step
up
to
stand
up
this
type
of
system,
how
do
we
come
communicate
with
parents
and
work
to
destigmatize
the
ask
for
help?
A
A
I
Yeah
absolutely
so
I
think,
what's
important
is
first
of
all
making
sure
that
you
have
the
services
up
and
running,
because
you
don't
want
to
let
parents
down
right.
We
don't
want
to
do
that,
but
what
also
is
important
is
that
when,
as
you're
rolling
things
out,
you're
going
to
get
out
to
parent
groups
right
and
parent
you're
going
to
ask
parents
to
try
the
service
you're
going
to
ask
them
to
trust
you
right
in
in
the
work
and
as
you
move
out
parents
will
they
will
do
that
they'll
come
once.
I
They
have
a
good
experience.
Once
they've
experienced
as
an
example
you're
beginning
to
see
that
in
the
mobile
in
the
world
of
mobile
crisis
response
right,
parents
are
experiencing
the
service
they're
getting
they're
what
they
need
at
the
time.
They
need
it.
The
more
you
can
do
that,
the
more
you
can
demonstrate
to
to
parents
to
use
the
service,
but
one
other
thing
lesson
from
20
years
on
the
ground
is
that
you
have
to
continually
communicate
like
we
can't
let
it
go.
I
We
always
have
to
be
really
attentive
to
communicating
with
parents
with
schools
with
pediatricians
with
law
enforcement.
In
particular,
we
need
focused
attention
in
those
areas
because
when
parents
begin
to
experience
challenges,
they
talk
to
teachers,
guidance
counselors,
they
talk
to
pediatricians
and
they
come
across
law
enforcement
from
time
to
time.
So
we
want
everyone
working
on
the
same
page,
but
that's
really
how
you
do
it
slow,
easy
making?
Sure
parents,
you
know,
use
the
service
making
sure
you
advertise.
Sometimes
we
put
things
in
young
people's
backpacks
as
they
go
home.
I
A
I
agree
and
having
lived
in
nevada
all
my
life,
I
know
that
we
have
a
little
bit
of
a
tie
into
fierce
independence,
and
so
it's
it's
really
hard
to
break
through
that
in
our
communities,
but
finding
those
community
partners,
I
think,
is
really
key
and
then
keeping
them
engaged.
But
I
look
forward
to
seeing
how
we
do
that
and
if
we
need
to
maybe
make
a
robust
core
coordination
office
to
ensure
that
that's
happening
and
across
across
the
board
and
continuously,
as
you
said,
thank
you
so
much
for
that
response.
A
Are
there
any
other
questions
from
the
committee
on
this
presentation,
seeing
none
I'm
going
to
go
ahead
and
close
out
this
item.
Thank
you.
So
much
for
being
here
really
appreciate
you.
I
know
you're
you're
a
couple
of
hours
ahead
of
us,
so
thank
you
so
much
for
your
evening
today
and
thank
you,
dr
freeman,
for
all
of
the
information
provided
today
really
appreciate
you
being
here
and
with
that
we'll
move
into
our
last
agenda
item
today.
A
Public
comment,
we'll
start
with
public
comment
from
those
in
the
physical
locations.
I
have
one
person
here
in
carson
city
and
she's
not
coming
up
to
the
dias,
so
I'm
assuming
I
do
not
have
public
comment
here
in
carson
city.
Is
there
public
comment
in
las
vegas
and
also
as
a
reminder,
anyone
who's
coming
up
for
public
comment?
Please
clearly
state
and
spell
your
name
and
limit
your
comments
to
three
minutes.
Staff
will
be
timing,
the
speakers
to
ensure
that
everybody
has
a
fair
opportunity.
A
All
right
with
no
one
in
carson
city
and
no
one
in
las
vegas,
I
will
turn
to
broadcast
and
production
services.
Are
there
folks
on
the
line?
Actually,
let's
give
it
a
minute
to
see
if
folks
call
in,
I
know,
there's
a
delay
and
sometimes
it
takes
a
minute
to
call
in
so
we
will
give
it
a
minute
for
broadcast
services
to
see
if
anyone
calls
in
on
our
public
comment
line.
I
A
Right
well,
thank
you
all
for
hanging
in
there
for
a
long
day.
This
is
an
important
issue
for
the
state
of
nevada
and
especially
for
those
of
us
who
are
very
passionate
about
this
space.
So
I
appreciate
everyone
hanging
in
there
and
I
appreciate
all
the
folks
who
are
working
in
this
area.
Thank
you
so
much
for
your
time
and
effort
today
and
for
the
information
you've
provided.