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Description
This is the fourth 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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The videos are part of an ongoing effort to keep the public informed of and involved in the legislative process.
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A
Welcome
all
to
the
fourth
meeting
of
the
joint
interim
standing
committee
on
health
and
human
services.
First
of
all,
I'd
like
to
take
a
moment
to
thank
all
of
the
staff
who
came
in
early
this
morning.
It
is
raining
cats
and
dogs
in
reno,
and
it
is
slow
going
out
there.
So
thank
you
so
much
for
being
here
early
enough
to
get
us
started
this
morning.
I
apologize
for
my
tardiness
took
me
a
little
longer
to
get
through
the
valley
than
I
anticipated.
A
B
B
D
B
B
A
I'm
going
to
go
ahead
and
make
a
couple
of
house
keeping
announcements.
We've
been
doing
this
for
a
little
while,
but
just
in
case
you
haven't
had
another
committee
this
month
we're
going
to
go
through
some
of
this
first
I'd
like
to
remind
everyone
to
please
silence
all
of
your
electronic
devices,
especially
cell
phones
and
laptops
during
the
meeting.
Everyone
is
using
laptops
to
keep
track
of
notes
and
keep
track
of
their
personal
all
of
the
stuff
we
use
personally
to
ensure
that
we're
paying
attention
and
taking
all
of
our
required
notes
for
the
meetings.
A
So
please
excuse
us
for
looking
down
at
that
for
members
joining
online.
Please
mute
your
microphones
when
you
are
not
speaking
but
leave
your
camera
on,
so
we
can
maintain
that
quorum
and
know
when
you
are
present.
Additionally,
I
ask
our
presenters
on
the
zoom
video
call
to
leave
your
cameras,
often
microphones,
muted,
until
I
call
up
the
agenda
item
under
which
you
will
present
or
if
I
direct
any
questions
to
you.
The
zoom
video
call
has
a
chat
feature.
However,
this
feature
is
only
to
be
used
for
technical
assistance.
A
A
An
item
may
be
removed
from
the
agenda,
and
discussion
of
an
item
on
this
agenda
may
be
delayed
at
any
time.
The
committee
members
materials
can
be
found
on
or
the
committee's
meeting
materials
can
be
found
on
the
nevada
legislature's
website.
You
can
also
sign
up
for
electronic
notifications
related
to
any
activities
on
the
committee's
website.
If
you
wish
to
testify
in
person,
please
sign
in
at
the
table
by
the
door
in
either
building
and
leave
a
business
card.
A
If
you
do
not
testify,
you
may
also
want
to
sign
in
so
there's
a
record
of
who
is
interested
in
a
particular
topic
in
the
event
that
the
committee
needs
to
contact
you
later
when
testifying
in
person.
Please
turn
the
microphone
on
to
speak
and
off
to
listen,
because
we
have
others
listening
to
and
viewing
the
meeting
in
las
vegas
and
online.
A
We
will
have
a
public
comment
period
at
the
beginning
and
end
of
the
meeting
public
comment
is
limited
to
three
minutes
per
speaker
to
ensure
everyone
has
an
opportunity
to
talk
in
addition
to
testifying
in
person.
Members
of
the
public
may
provide
public
comment
in
four
different
ways,
all
of
which
are
listed
on
the
agenda.
You
can
provide
public
comment
by
calling
669-900-6833.
A
And
then
pressing
the
pound
sign
when
prompted
for
a
participant
id,
please
press
pound
again,
you
can
also
provide
written
public
comment
by
emailing
comments
to
the
committee
email
address
or
mailing
or
faxing
written
comments
to
the
research
division.
You
can
find
the
phone
and
fax
numbers
email,
addresses
and
mailing
addresses
on
the
agenda
with
that.
We
will
go
ahead
and
move
on
to
public
comment.
A
As
stated
before,
public
comment
will
be
limited
to
three
minutes
per
speaker
staff.
Will
time
each
speaker
during
public
comment
to
ensure
everyone
has
a
fair
opportunity
to
speak.
We
also
ask
that
you
do
not
repeat
what
is
a
previous
commenter
has
stated.
An
additional
opportunity
to
make
public
comment
will
be
available
at
the
end
of
the
meeting.
A
A
F
A
Thank
you,
broadcast
and
production
services
will
interact
with
those
making
public
comment
to
facilitate
participation
in
the
meeting
bps.
Can
you
add
the
first
color
to
the
public
comment
line?
A
A
Time,
thank
you
so
much.
There
will
be
another
opportunity
at
the
end
of
the
meeting
for
public
comment.
If
those
if
there
are
folks
who
would
like
to
do
that
during
the
meeting
and
would
like
to
call
in
at
that
time,
we're
going
to
go
ahead
and
move
on
to
agenda
item
3
approval
of
the
minutes
for
the
meeting
on
february
17
2022
members
of
the
committee.
Are
there
any
questions
regarding
the
minutes.
A
There's
dr
titus
had
made
him
has
made
a
motion
to
approve
the
minutes.
Is
there
a
second
second?
A
I
believe
that
was
senator
harris.
A
Thank
you
so
much.
Are
there
any
comments
or
discussion
on
the
motion
before
we
vote
wave
me
down
all
right,
all
in
favor,
say
aye.
A
G
The
four
regulations
we
have
today
are
lcb
file:
number
r007-21
of
the
state
board
of
pharmacy
r062-21
of
the
state
board
of
health,
r06
of
the
speech,
language,
pathology,
audiology
and
hearing
aid,
dispensing
board
and
r028-22
of
the
board
of
medical
examiners,
and
we
have
representatives
of
the
state
board
of
pharmacy
state
board
of
health
and
the
speech
language
pathology
board
available
virtually,
and
we
have
a
representative
of
the
board
of
medical
examiners
here
with
us
in
carson
city.
To
answer
any
questions
that
members
of
the
committee
may
have.
A
Thank
you
so
much,
mr
robbins.
I
just
want
to
remind
the
committee
that
this
is
informational.
Only
staff
informed
you
about
the
status
in
the
regulatory
process
of
the
regulations
that
we
are
now
considering,
and
I
believe
none
of
them
have
been
approved
by
the
agencies
that
are
bringing
these
regulations,
so
there
are
still
opportunities
for
public
input
at
this
time.
H
So
I'd
like
to
just
start
an
order
and
start
with
the
r07-21
state
board
of
pharmacy
regulations.
A
G
H
So
just
I
just
need
some
clarification
and
maybe
a
a
a
reason
why
the
oncology
group
practice
is
being
identified
as
needing
a
kind
of
specialty
line.
H
There
are
many
group
practices
out
there
in
my
office
previously
we'd
have
medicines
that
were
locked
up
considered,
you
know
dangerous
medications,
narcotics,
etc,
and
there
would
be
several
people
in
the
office
and-
and
so
we
didn't
in
my
mind
and-
and
I
think
we
need
clarification
or
I
do
anyway
need
a
separate
designation
as
this
oncology
group
practice.
So
could
you
just
explain,
maybe
briefly
what
prompted
this
to
be
identified
as
needing
a
special
clarification?
G
Dave
wiese
for
the
record,
so
practitioners
do
two
things
they
administer
and
then
they
they
also
allow
to
dispense
similar
to
a
pharmacy
or
a
pharmacist.
We're
not
talking
about
the
administration.
So
all
the
doctors,
like
your
to
your
prep
point
if
they
have
a
shared
inventory
of
drugs.
That's
not
what
we're
talking
about
today,
we're
just
talking
about.
G
If
they're
going
to
actually
dispense
them,
put
a
label
on
it,
counsel
the
patient
and
give
the
patient
a
bottle
of
medicine
to
take
home,
they
have
to
get
a
separate
license
to
do
that
from
the
state
of
dispensing
license
and
currently
the
law,
because
they're
all
individuals
require
that
inventory
to
be
separate.
The
oncologists
petitioned
the
board
and
we're
in
the
middle
of
the
process
of
hopefully
approving
this,
where
their
drugs
are
very
expensive.
G
If
they
all
had
to
have
ten
thousand
dollar
bottle
of
drug,
then
they
have
to
have
a
hundred
thousand
dollars,
so
they
were
hoping
that
the
board
will
allow
them
to,
for
just
the
dispensing,
be
able
to
put
those
together.
So
we're
not
talking
about
your
typical
practice.
This
is
a
dispensing
practitioner.
G
A
Thank
you
so
much.
I
believe
you
have
a
question
on
the
next
regulation
as
well.
Are
they?
Oh,
I'm
sorry.
Are
there
any
other
questions
on
this?
We're
just
going
to
go
through
them,
one
at
a
time.
So
does
anybody
else
have
members
of
the
committee
have
questions
on
regulation
r007-21
for
the
state
board
of
pharmacy?
A
A
Is
there
a
representative
from
the
state
board
of
health
available?
I
believe.
G
H
Thank
you,
madam
chair,
and
I
know
that
there
are
others
who
have
questions
I'll,
keep
mine
brief
and
on
the
fee
structure.
I'm
just
curious
as
to
how
and
again
there's
other
on
the
policy
itself
will
be
questions
I'm
sure,
but
on
the
fee
structure,
how
did
you
arrive
at
that
particular
fee
and
when
I
looked
at
the
litany,
the
laundry
list
of
fees
that
you
have
in
there
and
I
just
needed
some
clarification
on
how
you
established
what
you
did.
G
That
was
our
existing
fee
for
our
obstetric
centers,
so
I
really
just
left
it
the
way
it
is.
I
don't
know
how
it
was
originally
established,
but
it
was
our
existing
regulatory
fee,
and
so
we
just
left
it
the
same.
H
A
G
Thank
you,
madam
chair,
on
the
freestanding
birthing
center.
I
look
at
all
of
the
things
that
deal
with
everything
being
built,
I'm
concerned
about,
and
I
guess
I
stop.
I
only
see
oxygen
being
able
to
be
used
on
the
newborn.
Is
there
some
other
allowance
made
for
making
sure
that
the
newborn
is
appropriately
treated?
G
Yes,
senator
assembly
bill
287
required
us
to
align
our
regulations
with
one
of
the
standards
listed.
One
of
those
standards
was
the
commission
for
the
accreditation
of
birth
centers.
So
we
did
adopt
that
by
reference.
It's
the
indicators
of
compliance
with
standards
for
birth.
Centers
is
a
very
extensive
coverage
of.
J
G
And
it
really
outlines
all
of
the
requirements,
so
you
don't
see
those
actually
in
the
regulations
because
they
were
adopted
by
reference,
so
they're
already
adopted.
Oh
I'm,
sorry
they're
in
pardon
me
no,
they
are
not
adopted.
They
were
put
in
the
right
proposed
regulations
to
be
adopted
by
reference.
If
the
board
of
health
does
happen,.
J
G
Which
has
not
occurred
yet
it
is
scheduled
to
occur
in
june.
So
what
section
is
that
referenced
in.
G
And
yes,
letitia
mother,
for
the
record
section
six
talks
to
being
accredited
by
the
commission
for
accreditation
and
then.
K
G
G
G
G
A
Thank
you
so
much
for
the
questions
and
just
as
a
follow-up,
would
you
mind
sending
that
information
to
staff
and
staff
will
distribute
it
to
the
committee,
so
we
all
have
access
to
that
and
we
can.
We
can
also
add
that
to
the
meeting
webpage
for
the
publix
information.
A
A
Okay,
I
think
we're
good
to
go.
Thank
you
so
much
for
being
here,
we
look
forward
to
seeing
how
these
regulations
are
heard
by
the
board,
we're
going
to
go
ahead
and
move
on
to
the
next
set
of
regulations
for
questions
as
r064-21
from
the
speech,
language,
language,
pathology,
audiology
and
hearing
a
dispensing
board.
Do
we
have
someone
on
zoom
from
that
board?
I
believe.
A
G
Morning,
chair
and
members
of
the
committee,
my
name
is
jennifer
pierce
for
the
record.
I'm
the
executive
director
of
the
speech-language,
pathology,
audiology
and
hearing
aid
dispensing
board.
A
H
So,
thank
you,
madam
chair,
and
thank
you
for
being
here
today,
so
I
know
how,
in
this
particular
regulation
that
it
was
started
through
our
last
session,
when
we
passed
a
bill
regarding
professional,
licensure
and
we'd,
cut
back
across
the
board
from
15
hours
to
10
hours,
and
that
this
board
is
now
just
following
what
the
direction
was
from
the
legislative
process.
H
My
question
for
you
is:
are
you
going
to
allow
or
are
they,
how
do
they
get
this
this
hour
of
cme
or
ceus
or,
however,
you
define
it
in
the
speech
path
world?
H
G
Sure
so
our
continuing
education
rules
sort
of
will
blanketly
be.
Will
it
will
blanket
accept
certain
activities
from
different
affiliated
organizations
like
the
american
academy
of
audiology,
the
american
speech,
language,
hearing
association,
etc,
and
then
we
also
allow
for
any
courses
directly
related
to
the
profession
done
through
a
university
school
district
etc,
and
I
think
we're
finding
that
this
is
so.
G
So
the
recommendation
to
include
the
cultural
diversity
and
cultural
competency
hours
came
directly
from
asha,
which
is
the
accrediting
body
for
most
of
our
slps
and
can
also
be
for
audiologists,
although
we
don't
have
quite
as
many
and
they
are
changing
their
regulations,
they
currently
require
30
hours
in
a
three-year
period
and
their
new
requirement
for
continuing
certification
will
be
one
hour
of
ethics
and
two
hours
of
continuing
or
cultural
competency.
G
There
are
quite
a
few
courses
online
that
people
take
and
so
we're
comfortable
believing
that
there
are
lots
of
opportunities,
and
our
rules
are
flexible
enough
at
this
point,
that
somebody
can
find
related
content
to
the
requirement
for
cultural
diversity,
training.
H
Follow-Up
medicare,
so
so
just
clarification,
then,
because,
as
a
physician,
we
have
to
do
that
also.
So,
if
you'll
have
your
own,
the
ideologist
or
speech
path
will
have
their
own
classes
on
cultural,
competency
or
related
things.
Or
will
you
you're
not
I'm
hearing
that
you're
going
to
be
developing
something
or
something's
already
developed,
as
opposed
to
having
a
healthcare
class
so
to
speak?
That
covers
it?
Is
there
some
uniqueness
for
the
speech
path
that
would
need
to
be
included
in
the
ones
you're
developing.
G
No,
no,
no,
and
for
the
record
jennifer
pierce
from
the
audiology
speech
pathology
board.
G
We
are
not
developing
anything
specifically,
but
our
our
current
requirements
around
continuing
education
are
are
fairly
broad,
so
somebody
could
go
find
training
in
cultural
diversity
that
would
likely
meet
the
requirement
for
us
and
it
would
not
need
to
be
specific
to
speech
language,
pathology
or
audiology,
but
there
are
audiology
online,
for
example,
is
an
online
training
database
that
many
of
our
practitioners
use
for
quite
a
lot
of
their
training,
and
there
are
opportunities
to
do
ethics
and
cultural
competency
ces
through
there
great.
H
A
A
I'm
not
seeing
anybody
wave
me
down.
Thank
you
so
much
for
being
here.
We
will
go
ahead
and
move
on
to
our
next
set
of
regulations,
r028-22
of
the
board
of
medical
examiners,
and
I
believe
we
had
someone
in
person.
Thank
you
available
for
our
questions.
I
know
that
dr
titus
has
a
question,
but
please,
let
me
know
if
you
have
a
question
of
other
committee
members,
please
go
ahead.
H
Thank
you,
madam
chair,
and
again
do
we
have
somebody
from
oh,
we
do
at
the
table.
Thank
you
so,
looking
through
this,
I
I'm
concerned.
We
already
have
a
limited
amount
of
healthcare
providers
getting
people
to
to
work
in
doctor's
offices,
nurse
practitioners,
office
and
all
providers
offices-
there's
not
enough
of
us
and
so
now,
having
requirement
of
a
patient
attendant
to
be
there
in
addition
to
everything
else
we
have
to
have
in
the
office.
I
just
have
some
concerns
about
that.
H
Having
practiced
many
many
years
way
many
years-
and
I
just
know
that
sometimes
you
just
have
to
go
in
and
you
have
to
to
examine
a
patient,
you
have
to
take
care
of
them
and
not
only
always
having
that
extra
body
to
be
there.
So
I'm
wondering
how
this
is
going
to
be
enforced.
H
M
Okay,
sarah
bradley
deputy
executive
director
for
the
record
of
the
nevada
state
board
of
medical
examiners.
Well,
the
regulation
as
drafted
does
have
a
exception
for
emergency
care.
So
in
an
emergency
situation
it's
also
limited.
It's
not
in
every
patient
encounter.
It's
patient
encounters
where
there's
a
visual
or
physical
inspection
of
genitalia,
rectum
or
breast
of
a
patient
or
other
kinds
of
basically
more
invasive
procedures
in
those
areas
of
the
body.
M
So
it's
not
every
single
visit
most
it's
our
understanding
and
there's
been
some
conversation
because,
as
you
can
imagine,
we
we
receive
complaints
about
this
a
lot,
and
so
I
I
mean
the
intent
is
really
to
require
that
this
person
be
in
the
room
when
these
things
occur
and
that
their
name
is
noted
in
the
record,
and
that
way
it's
clear
who
was
there.
M
We
got
some
of
this
language
from
the
federation
of
state
medical
boards,
some
guiding
gutting
language,
and
I
guess
I
would
just
say
I
mean
frankly
it's
an
issue
that
we're
struggling
with
how
to
best
protect
the
public,
and
we
have
some
situations
where,
when
we
have
a
complaint
come
in,
we
have
two
physician
members
and
a
public
member
that
review.
You
know
our
investigative
complaints
and
you
know
they
will
say.
I
think
it's
standard
yeah.
M
You
should
always
have
someone
present,
and
so
that's
what
they're
saying,
and
so
my
thought
and
our
concern
is
well,
let's,
let's
codify
that,
then
in
the
regulation,
we
don't
enforce
it.
Currently,
we
recommend
it
frequently
when
we
do
get
complaints
regarding
unwanted
touch
and
improper
things
we
so
we
often
recommend
it.
We
haven't
been
requiring
it
unless
it's
a
disciplinary
case,
and
sometimes
we
then
do
it.
M
But
what
we've
been
hearing
anyway,
at
least
I
have
as
a
staff
member
for
two
and
a
half
years
at
the
board,
is
that
you
know
the
the
board.
Physicians
are
saying
this
is
standard.
You
should
have
someone
present
when
you're
doing
this.
Now
we
have
not
done
a
workshop
or
a
public
hearing
on
it
yet,
and-
and
I
I'm
as
you
are
expecting
you
get
a
lot
of
comments,
you
know
this
person
doesn't
obviously
have
to
be
a
physician.
M
I
would
say
they're
more
like
an
m.a
potentially
position,
but
I
agree
with
you.
We
know
there's
work,
staff
shortages,
so
I
don't
know
what
comments
we're
going
to
get.
The
intent
is
not
to
make
things
harder.
The
intent
is
to
I
think,
put
into
the
law.
What
at
least
I
have
heard
from
multiple
physicians
on
the
board
is
already
the
standard
of
practice
when
these
things
are
done.
H
So,
thank
you
for
that
follow-up
manager.
So
so
I
was
a
member
of
the
board
of
medical
examiners
and
in
in
the
90s,
late,
90s
and
and
again
I
was
part
of
the
investigative
committee
and
we
look
at
charts
and
complaints
et
cetera
and
in
my
own
practice
again
you
would
have
that
standard
of
care
where,
if
some
gonna
be
exam,
my
assistant
would
be
in
the
room
with
me
and
other
times.
I
wouldn't
have
one
in
so
especially
say:
I'm
doing
a
breast
exam
on
a
female.
H
I
wouldn't
have
necessarily
have
that
my
assistant
in
the
room.
She
could
be,
he
or
she
could
be
doing
other
things,
and
so
I
mean
I.
H
I
just
think
that,
because
it
was
a
the
provider's
discretion
and
again,
the
standard
of
care
would
be
to
have
somebody
there
in
certain
situations
if
the
provider,
just
like
you
said
to
codify
this,
has
me
a
little
bit
concerned
and
I'll
be
very
curious
to
see
what
the
comments
are
when
you
do
go
out
and
have
this
public
hearing
on
this
as
providers
in
general,
across
the
board
in
practices,
especially
in
rural
areas,
where
we
just
don't
sometimes
you're
the
only
person
in
the
little
clinic
in
austin
and
now
to
have
that
second
person
who's
trying
to
answer
the
phone,
and
now
they
have
to
be
in
the
room.
H
I
just
I'm
really
concerned,
and
there
would
be
certainly
time
certain
where
I
felt
I
would
go
out
and
get
my
m.a
or
the
nurse
to
be
in
that
room
with
me,
but
it
was
at
my
discretion
as
a
provider
and
so
to
put
this
into
to
codify
this.
As
you
use
the
term.
I
I
just
have
some
concerns
about
it,
but
will
certainly
I
understand
it's.
Just
a
proposed
regulation
you're
going
to
be
doing
hearings
on
this
and,
what's
best
but
again,
I
agree
it's
standard
of
care
when
possible,
but
gosh.
H
Sometimes
that
just
doesn't
happen
so
to
propose
disciplinary
issues.
If
somebody
doesn't
do
that,
I
just
think
it's
setting
healthcare
providers
up
so-
and
I
understand
you
know
protecting
patients,
that's
what
I've
done.
My
whole
life.
So
just
that's
where
my
concern
is.
Thank
you.
M
Sarah
bradley
deputy
executive
director
for
the
board
just
just
to
respond
quickly,
I
mean
I
think
we
we
aren't
going
to
be
just
to
clarify.
I
don't
anticipate
that
we're
going
to
be
going
out
and
looking
at
charts
in
offices
and
inspecting
for
this
really
most
likely
it's
going
to
be
a
tool.
When
we
get
a
complaint,
we
then
look
in
the
patient
record
and
say
well,
who
is
the
patient
attendant
and
when
there
wasn't
a
patient
attendant?
Maybe
that's
a
way
to
kind
of
help
curb
some
of
this
inappropriate,
touching
and
appropriate
action.
M
So
you
know
our
intent.
Is
I
mean
I
I
just?
We
don't
have
the
resources
to
inspect
every
office
and
look
at
all
the
records,
but
but
I
think
from
that
perspective,
because
a
lot
of
times
now,
as
you
can
imagine,
we
have
he
said
she
said
situations
or
she
said
she
said-
or
you
know
whatever
it
might
be,
and
you
know
we
can't
always
take
action,
we
don't
want
people
to
ever
be
hurt,
and
so
this
way
at
least
they're
required
to
put
something
in
the
record.
M
If
we
get
a
complaint,
we
can
at
least
see
who
is
in
the
record,
maybe
interview
that
person
talk
to
that
person
and
they
can
say.
Oh
no,
you
know
I
this
there's
nothing
here
so
that
at
least
gives
us
another
investigative
tool
and
then,
if
someone
is
routinely
not
following
this
reg,
I
think
that
gives
us
disciplinary
a
disciplinary
tool
that
you
know
again
maybe
can
help
stop
the
bad
people
from
doing
the
bad
things.
A
The
idea
of
consent
has
been
something
we've
talked
about
in
this
legislative
body,
at
least
the
two
terms
that
I've
served
and-
and
we
have
had
a
hard
time
figuring
out
what
that
means
for
everybody
right,
there's
and
then
this
brings
up
the
idea
of
patient
consent
to
another
observer
in
the
room
and
what
does
that
mean
for
the
patient
and
and
then
also
patients,
knowledge
of
their
rights
and
their
ability
to
understand
or
their
their
their
that
their
knowledge
base
of
understanding
what
their
rights
are
to
ask
for
and
someone
in
the
room
to
ensure
that
things
are
fine
and
then
also
I'm
thinking
about.
A
So
I
think
this
is
a
really
interesting
discussion
and
I
imagine
you
will
get
a
lot
of
a
lot
of
comment
and
I
hope
that
you
do
and
I
think
that
the
conversation
around
what
consent
means
in
all
places
of
our
lives
is
really
an
important
piece
for
us
to
to
take
very
seriously
in
statute
and
regulation.
So
are
there
any
other
questions
from
the
committee?
Oh,
I
see
doc
hardy's
hand
is
raised
in
the
committee
room.
Is
there
anybody
who
would
like
to
ask
a
question?
A
G
Thank
you,
madam
chair
appreciate
it.
So
one
of
the
things
that
sometimes
we
forget
is
this
is
the
kind
of
thing
that
protects
the
doctor
as
much
as
it
does
the
patient.
So
the
doctor,
you
know
it.
Let's
say
there
is
a
complaint
made
and
the
doctor
says
no.
I
had
somebody
in
the
room
with
me
that
protects
the
doctor
every
bit
as
much
as
it
protects
the
patient.
G
Now,
if
the
doctor
happens
to
be
male
and
the
female
is
the
patient,
you
know
dr
titus.
She
probably
has
an
advantage
over
me
when
she's
doing
an
exam
or
over
any
male
physician.
G
So
has
there
been
any
differentiation
in
the
board
of
the
federal
board
of
or
any
other
place
that
looks
at
the
1
versus
99
or
whatever
it
is?
Complaints
has
has
that
come
up
in
these
discussions
at
all
as
far
as
gender
to
gender,
gender,
not
to
gender.
M
Sarah
bradley
deputy
executive
director
for
the
nevada
state
board
of
medical
examiners
for
the
record
we've
discussed
it.
The
board
discussed
it
even
so
this
this
regulation,
so
we
normally
as
staff,
come
up
with
some
potential
ideas
based
on
things
that
we're
seeing
and
or
things
that
the
board
has
requested.
So
at
the
march
board
meeting
the
board
did
review
this
and
talk
about
it,
and
I
expected
them
to
maybe
bring
this
topic
up,
but
they
seemed
comfortable
with
requiring
it
regardless
of
gender.
M
At
least
that
was
the
sense
I
got
at
the
meeting
and
a
couple
board
members
when
they
said
that
to
me
I
will
tell
you
from
the
complaint
perspective.
I've
seen
most
of
the
complaints
are
female
patients
complaining
about
an
improper
touch
by
a
male
physician.
However,
we've
had
male
and
male
complaints,
I'm
not
aware
of
female
and
female
complaints,
and
so
just
given
you
know
the
changing
landscape
and
and
trying
to
make
sure
everyone's
accommodated.
I
guess
our
thought
was.
M
You
know
an
improper
action
can
happen
from
anyone,
and
so,
if
we're
going
to
do
this-
and
so
that's
at
least
where
we
started
with
this-
you
know
you're,
right
and,
and
I
mean
as
a
female
patient
myself.
I
I
understand
the
difference
between
going
to
you
know.
M
Providers
of
you
know
my
my
same
gender
versus
male,
so
you
know
it's
an
interesting
topic.
I
I'm
expecting.
There
will
be
a
lot
of
conversation
and
then
also
too
just
to
address
something
that
the
chair
mentioned.
We
were
trying
to
be
cognizant
too,
of
having
another
person
in
the
room,
because
this
is
sort
of
a
sensitive
situation,
and
so
we
do
have
it
in
there
that
you
know
the
patient
and
we
want
them
to
be
informed
of
this.
The
patient
can
say.
No,
I
don't
want
you
know,
I'm
fine.
M
I
don't
want
to
you
know
another
person
in
there.
Let's
just
be
a
little
more
private,
because
I
do
think
that's
up
to
them,
but
I
guess
our
thought
was
at
least
for
now
we're
proposing
a
third
party,
be
there.
I
know
male
physicians,
at
least
in
my
personal
experience,
always
do
that
and
and
then
there
are
some
that
don't,
and
I
think
those
are
the
ones
that
we
get
the
most
complaints
about.
M
I
guess,
and
so
we're
trying
to
to
just
sort
of
make
sure
that
everybody
knows
this
should
be
done
rather
than
just
recommending
it,
because
when
we
recommend
it
we're
saying,
if
you
do
this,
you
probably
won't
get
future
complaints,
but
we're
not
really
addressing
whether
or
not
something
bad
did
occur.
It's
it's
hard
because
again
we're
also
saying
in
here
that
the
chaperone,
the
patient
attendant.
You
know
they
have
to
report
things
to
the
board
directly.
M
You
know,
and
so
they're
kind
of
there
more
for
the
patient,
which
I
think
is,
is
good
and
that's
part
of
our
intent.
Anyway.
It's
an
interesting
role
because
we
want
them
to
also
know
in
here.
You
know
what
the
scope
of
the
encounter
should
be.
What
should
this
exam
entail
right?
Because
how
would
you
know
something
improper
is
going
on?
If
you
don't
know
what
the
exam
should
be,
so
we're
trying
to
address
everything
we
can
and
again
I'm
I'm
looking
forward
I've
not
scheduled
yet
the
workshop
or
public
hearing.
M
We
actually
just
got
this
draft
back.
I
want
to
say
within
the
last
two
weeks
and
we
submitted
it
in
march,
so
it
was
a
very
fast
turnaround.
We
haven't
had
time
to
schedule,
but
obvious.
You
know
our
plan
is
to
definitely
take
whatever
feedback
we
get
and
try
to
refine
and
have
what
we
can
to
protect
the
public.
The
best
we
can,
I
mean
that's
our
goal.
G
So
if
I
may,
I
guess
this
would
be
a
confession.
Now
I
don't
remember
this.
First
of
all,
this
bill
started
out
as
a
pelvic
exam
bill,
and
I
don't
remember,
as
a
family
physician
ever
getting
somebody
in
the
room
for
me
to
do
a
rectal
exam
checking
for
a
prostate
or
getting
a
guayax
stool.
I
mean
I
don't
remember
ever
doing
that,
so
what
you
just
did
with
your
testimony.
Is
you
open
that
up
for
male
physicians
to
always
have
an
attendant
there?
G
M
M
Sarah
bradley
deputy
executive
director-
this
is
not
regarding
a
bill.
This
is
a
regulation
that
the
board
is
bringing
forth
on
its
own,
given
complaints
and
issues
that
we
we
see.
So
this
is
not
related
to
a
bill.
I
know
what
you're
talking
about.
There
was
a
bill
regarding
pelvic
exams
and
other
exams
and
emergency
situations,
but
but
that
didn't
that
did
not
cause
us
to
bring
this
we're.
Bringing
this
independently
to
try
to
address
concerns
that
we
see.
A
G
So
this
is,
this
is
going
to
be
quote-unquote
an
investigation
if
it
gets
if
it.
If
the
complaint
goes
to
the
board,
that
somebody
did
something
that
I
don't
think
was
right.
It
goes
to
the
board.
The
board
says.
Yes,
the
record
shows
that
somebody
was
there
with
the
doctor
when
the
doctor
did
whatever
he
she
was
supposed
to
do.
Does
that
complaint
now
qualify
for
an
investigation
like
all
the
complaints
heretofore
have
happened
recently.
So
now
the
doctor
has
to
say
he
she
was
investigated
on
all
of
the
national
database.
Things.
M
Sarah
bradley
deputy
executive
director
for
the
nevada
state
board
of
examiners
for
the
record.
This
does
not
change
the
board's
investigative
process.
So
when
a
complaint
is
received,
it's
reviewed
if
it's
it
within
the
board's
jurisdiction,
it's
it's
opened
as
an
investigation
and
an
allegation.
Letter
will
be
sent
to
the
physician
and
and
that's
generally,
when
we
ask
for
the
records
and
then
those
records
would
be
showing
us
the
patient
attendance
name
in
you
know
and
again
it
gives
us
a
witness
potentially
to
talk
to.
M
It,
helps
us
in
our
investigation
and
it
helps
the
physician
or
the
physician
assistant
in
the
investigation
as
well.
So
so
no,
the
intent
is
not
to
change
the
process
for
investigations
at
all.
With
this
regulation,
it's
really
just
to
kind
of
I
think
aid
investigations
regarding
an
improper
touch
when
that's
alleged.
M
Sarah
bradley
deputy
executive
director,
could
you
repeat
that
question?
I'm
sorry.
G
M
Okay,
generally,
so
it
depends
in
the
because,
when
the
complaint
is
received,
sarah
bradley
sorry,
deputy
executive
director
for
the
record,
but
when
the
complaint
is
received,
the
licensee
gets
a
letter
saying
that
there's
been
an
allegation
made
and
they're
given
30
days
to
respond
and
provide
records,
and
so
there's
some
time
for
them
to
respond.
M
Then
there's
time
for
board
staff
to
review,
and
then
all
complaints
are
put
on
an
investigative
committee
agenda
which
meets
quarterly,
and
so
it
would
kind
of
depend
on
you
know
when,
when
the
allegation
letter
went
out
and
what
it
meant
meeting
it
gets
on,
I
mean
if
it's,
if
it's
something
where
there's
clearly
nothing
there.
It's
reviewed.
Oh,
it's
also
reviewed
by
the
medical
reviewer.
M
I
mean
it
can
be
closed
in
a
matter
of
a
few
months,
but
sometimes
it
takes
longer.
Depending
on
how
long
the
doctor
takes
to
respond.
There
are
some
that
we
we
have
to
request
multiple
times
for
response
and
then
also
there
are
times
that,
just
when
the
timing
of
it,
we
get
it
just
before
our
investigative
committee,
and
so
it's
going
to
have
to
wait.
M
At
least
three
months-
and
it's
really
up
to
the
investigative
committee
because,
depending
on
what
maybe
the
records
show
and
other
things,
they
may
ask
for
a
peer
review,
and
so
even
if
this
is
the
only
allegation
initially
made,
the
investigative
committee
could
could
want
to
expand
it.
So
it's
not
always,
I
would
say,
as
cut
and
dry
as
you're
proposing-
and
you
know-
and
so
I
would
say
a
few
months
to
potentially
a
year
would
be
the
time
frame
for
the
investigation.
M
A
Thank
you
miss
bradley
and
thank
you
senator
hardy
for
your
interest
in
this
topic.
As
this
is
not
the
hearing
for
this,
I
would
just
encourage
you
to
get
the
hearing
date
when
it
gets
scheduled,
and
I
think
these
questions
are
great
questions
to
bring
up
to
the
to
the
board
as
they
consider
this
regulation
we're
going
to
go
ahead
and
move
on
to
our
next
agenda
item.
Thank
you
again,
miss
bradley
for
your
responses
today.
A
J
Thank
you
good
morning
and
thank
you,
chair
peters,
and
the
members
of
the
committee
for
inviting
us
to
speak
with
you
all.
Today
we
will
be
presenting
on
child
and
family
well-being,
child
maltreatment,
prevention,
child
welfare
and
youth
and
young
adult
homelessness
for
the
record.
I'm
jill
jordy
a
senior
policy
specialist
with
the
national
conference
of
state
legislatures.
J
J
We
will
give
a
brief
overview
of
ncsl,
discuss,
high-level
themes
around
child
and
family
well-being,
including
child
maltreatment,
prevention,
give
an
overview
of
child
welfare
and
foster
care
trends
and
talk
about
trends
and
data
surrounding
youth
homelessness
in
nevada.
Finally,
we'll
wrap
up
by
connecting
back
to
what
research
suggests.
Children
and
their
families
need
to
thrive.
J
The
national
conference
of
state
legislatures
is
a
bipartisan
organization
serving
legislators
and
legislative
staff
in
america's
50
states
territories
and
washington
d.c.
The
organization
creates
opportunities
for
lawmakers
and
staff
to
share
knowledge
and
ideas,
so
they
can
enact
laws
and
policies
to
improve
the
lives
of
their
constituents.
J
Ncsl
also
ensures
states
have
a
strong,
cohesive
voice
in
the
federal
system,
with
a
strong
belief
in
the
importance
of
the
legislative
institution.
Ncsl
knows
that
when
states
are
strong,
our
nation
is
strong
now
I'll
hand
it
off
to
my
colleague
heather
wilson
to
talk
about
child
and
family
well-being
in
the
context
of
the
child
welfare
system.
E
Thank
you,
joe
good
morning,
chair
members
of
the
committee
heather
wilson,
with
ncsl
national
conference
of
state
legislatures
for
the
record.
Today,
I'm
going
to
start
talking
about
some
key
national
themes
and
trends
and
messages
that
we're
seeing
throughout
the
child
welfare
field.
One
is
child.
Well-Being
is
inextricably
linked
to
parental
well-being.
Children
do
better
when
their
parents
do
better
two
that
this
work
is
interdisciplinary
and
the
issues
are
intersectional.
E
E
Next
prevention,
contr
occurs.
Excuse
me
on
a
continuum.
Child
welfare
systems
and
agencies
across
the
nation
are
actively
working
to
move
upstream
to
prevent
child
abuse
and
neglect.
This
work
is
generational
and
happens
on
a
continuum
to
disrupt
the
cycle
of
generational
trauma
for
families
and
finally,
data
trends
reveal
that
families
of
color
are
disproportionately
represented
across
child
welfare
systems,
so
racial
disproportionality
occurs
at
nearly
every
major
decision-making
point
across
the
child
welfare
continuum,
from
reports
to
screened-in
cases
to
out-of-home
placements.
E
E
So,
to
help
prevent
some
of
these
traumas
and
to
support
families,
the
center
for
the
study
of
social
policy
established
a
research-based
approach
to
strengthening
families
and
identified
five
interrelated
protective
factors.
That
studies
show
are
related
to
decreased
likelihood
of
child
abuse
and
neglect,
as
well
as
to
the
promotion
of
family
strengths
and
optimal
child
development.
E
Those
factors
include
concrete
supports
in
times
of
need.
Families
need
stability
in
housing
in
food
in
transportation
and
health
care,
knowing
that
you
are
able
to
care
for
your
children
significantly
reduces
anxiety.
Another
protective
factor
is
knowledge
of
parenting
and
child
development,
really
understanding
the
unique
aspects
of
child
development,
implementing
developmentally
and
contextually
appropriate
best
parenting
practices.
E
Successful
parenting
really
fosters
psychological
adjustment
as
well
as
helps
children,
succeed
and
thrive.
Next
parental
resilience,
managing
both
general
life
and
parenting,
stress
and
functioning
well
when
faced
with
stressors
challenges
or
adversity
stress,
can
make
it
harder
to
parent
effectively,
so
helping
parents
develop
resilience,
helps
children
thrive.
E
E
So
when
we
look
at
a
prevention
continuum,
particularly
in
the
child
welfare
space,
we're
talking
about
primary
secondary
and
tertiary
prevention,
you
may
be
familiar
with
these
from
public
health
form,
so
in
primary
prevention.
We're
talking
about
education
and
policies
that
are
for
an
entire
population
to
prevent
trauma
and
to
prevent
maltreatment
are
system
supports,
so
those
identified
with
risk
factors
to
entering
into
our
systems,
and
some
of
these
interventions
include
public
health
or
diversion
programs
and
some
child
welfare.
E
Voluntary
interventions,
and
this
is
really
to
mitigate
risk
factors
and
promote
family
protective
factors,
and
next
is
tertiary
prevention.
So
this
is
deeper
end
prevention,
so
working
with
children
and
families
who
have
already
experienced
harm
to
mitigate
the
impact
of
that
harm
and
to
prevent
future
harm.
J
Thank
you
jilliorty
for
the
record
for
this
section
of
our
presentation.
We'll
start
with
a
look
at
how
the
nevada
data
from
2020
compares
to
national
averages.
These
data
are
from
the
2020
child
maltreatment
report
that
was
released
by
the
children's
bureau
earlier
this
year.
While
some
states
have
already
reported
2021
data,
2020
is
the
most
recent
year
that
we
have
access
to
data
across
a
majority
of
states.
J
J
J
J
When
child
abuse
or
neglect
has
an
investigation
that
is
substantiated,
there
is,
and
there
is
determined
to
be
an
immediate
threat
of
harm
to
the
child.
Foster
care
is
one
of
the
most
well-known
types
of
intervention
when
a
child
is
taken
into
state
custody
foster
care
refers
broadly
to
when
a
child
is
taken
into
state
custody
and
placed
with
a
foster
parent
or
family.
J
J
There's
been
an
important
shift
in
many
foster
care
systems
to
promote
reunification
of
families,
so
that
children
can
be
safely
reunited
with
their
biological
parents,
rather
than
remaining
in
state
custody
for
extended
periods
of
time,
in
both
nevada
and
in
the
united
states.
More
broadly,
the
majority
of
children
entering
foster
care
are
under
the
age
of
five
years
old
and,
as
my
colleague
heather
mentioned,
most
of
these
are
under
the
age
of
two
from
this
table.
J
You
can
see
that
both
across
the
nation
and
in
nevada,
the
majority
of
removals,
involve
neglect
and
in
nevada
neglect
was
listed
as
a
reason
for
removal
in
89
of
those
cases
in
2020.
This
makes
it
important
for
policymakers
and
practitioners
to
understand
neglect
and
its
role
in
the
removal
of
children
from
their
families.
J
You
can
also
see
here
that
in
nevada,
during
2020,
parental
incarceration
and
parental
substance
abuse
are
listed
as
reasons
for
removal
in
more
than
10
percent
of
cases
for
parental
incarceration.
This
is
higher
than
the
national
average
and
for
parental
substance
abuse.
This
is
lower
than
the
national
average.
J
Next
I'll
briefly
cover
three
major
pieces
of
federal
legislation
that
impact
state
policy
surrounding
child
welfare
and
child
maltreatment
prevention.
The
first
is
capta
the
child
abuse
prevention
and
treatment
act.
This
was
enacted
in
1974
and
provides
federal
funding
and
guidance
to
states
in
support
of
prevention,
assessment,
investigation,
prosecution
and
treatment
activities.
J
Capta
also
provides
grants
to
public
agencies
and
non-profit
organizations,
including
indian
tribes
and
tribal
organizations
for
demonstration
programs
and
projects.
There
is
currently
a
reauthorization
under
consideration
by
congress.
The
next
is
the
child
indian
child
welfare
act.
This
was
enacted
in
1978
to
protect
the
best
interests
of
native
children
and
remove
this
and
promote
the
stability
and
security
of
tribes
and
families
by
establishing
minimum
standards
for
the
removal
of
native
children
and
placement
of
native
children
in
homes
which
could
reflect
the
unique
values
of
native
cultures.
J
J
J
Recently,
a
number
of
states
have
been
revisiting
this
on
regarding
things
like
separating
poverty,
from
neglect
as
a
reason
for
removal
or
to
add
things
like
parental
substance
abuse
that
impairs
a
parent's
ability
to
care
for
their
child.
J
J
K
Thank
you
jill
and
thank
you
all
for
being
here.
As
mentioned,
my
name
is
cameron
rifkin
and
I
am
a
policy
associate
with
ncsl.
I
am
here
to
talk
a
little
bit
about
youth
and
young
adult
homelessness.
K
So
nationally
there
are
over
34
000
youth
ages,
18
to
24
experiencing
homelessness
each
night.
This
does
disproportionately
affect
people
of
color
and
lgbtq.
K
Youth
nevada
has
one
of
the
highest
rates
of
unaccompanied
youth
homelessness
depending
on
the
year
it
kind
of
ranges,
but
recent
data
has
shown
that
nevada
ranks
fourth
for
unaccompanied
youth,
experiencing
homelessness
and
first
for
unsheltered,
unaccompanied
youth.
So
current
data
shows
that
570,
unaccompanied
youth
are
on
the
streets
in
nevada
each
night
in
southern
nevada,
specifically
youth,
make
up
22
percent
of
the
total
population
experiencing
homelessness.
The
national
average
is
6.54
percent.
K
K
Potential
strategies
that
policymakers
have
explored
and
enacted
in
recent
time
include
drop-in
centers.
These
have
shown
to
have
better
outcome
for
youth
experiencing
homelessness,
including
higher
educational
attainment.
Stabilized
housing
and
improved
health
drop-in
centers
usually
involve
areas
where
youth
can
come
to
charge.
Electronics
get
a
hot
meal,
perhaps
use
the
restroom
shower.
K
Another
is
consent
and
access
to
records
and
health
care,
specifically
access
to
their
vital
records
and
medical
care
without
parental
consent,
and
this
is
to
reduce
administrative
barriers
and
limit
the
red
tape
that
you
experience,
while
they're
homeless.
So
nevada
recently
did
pass
a
piece
of
legislation
related
to
this
health
care
access
for
unaccompanied
homeless
minors
without
parental
consent.
K
K
Additionally,
these
family
unification
program
vouchers
are
extended
to
parents
or
caregivers,
who
are
at
immediate
risk
of
losing
custody
of
their
children
due
to
housing
stability.
So
if
their
housing
situation
is
the
primary
cause
for
the
removal
of
children,
they
are
also
eligible
to
receive
these
particular
vouchers.
K
There
was
one
in
2021
and
a
pair
in
2019.
The
one
in
2021
requires
the
consideration
of
the
effects
of
homelessness
in
suspending
or
expelling
a
student
from
school,
so
a
student's
housing
status
must
be
taken
into
consideration
before
they
are
removed
from
school.
In
2019
there
was
a
piece
of
legislation
that
requires
schools
to
assist
students
experiencing
homelessness
and
students
in
foster
care,
with
earning
full
or
partial
credit
for
their
coursework
again.
K
The
final
piece
in
2019
was
dedicated
to
post-secondary
school,
so
those
first
two
pieces
were
focused
more
on
k-12
education
and
this
final
piece
as
dedicated
to
creating
the
position
of
the
liaison
for
post-secondary
education
for
homeless
pupils.
So
that's
a
little
bit
more
focused
on
post-secondary
achievement
with
that,
I
will
be
passing
it
back
to
my
colleague,
heather
wilson,
to
close
us
out.
Thank
you
all
again
for
listening.
E
Today,
you
are
going
to
hear
a
lot
of
really
hard
data
points
and
statistics
throughout
the
day.
So
I
want
you
to
remember
the
hopeful
and
prevent
preventative
efforts
that
we
tools
and
policies
and
practices
and
programs
that
we
have
to
support
children
and
families
before
they
experience
harm
and
to
mitigate
the
impact
of
that
harm.
E
E
E
If
you
have
any
follow-up
questions
that
we
don't
have
time
for
today
and
then
some
of
the
resources
that
we
used
during
our
presentation
that
you
should
all
have
access
to
as
well
as
other
helpful
info
pieces
of
information,
and
with
that
I
will
turn
it
back
to
the
chair
and
be
happy
to
answer
any
questions.
A
That
you
might
have
thank
you
so
much.
Thank
you
for
that
presentation.
I
really
appreciate
in
all
of
our
meetings.
We
have
started
with
a
baseline
and
I
think
that
that's
really
important
for
us
to
understand
and
I'll
be
on
the
same
page
about
what
the
efforts
that
are
occurring
in
our
state
look
like
compared
to
the
baseline
data.
A
I
think
we
we
do
have
some
time
for
questions,
but
I
want
to
just
extend
that.
A
lot
of
the
upcoming
presentations
will
talk
about
nevada,
specific
programs
and
agencies
that
are
dealing
with
these
issues,
and
they
may
be
more
more
likely
to
answer
your
questions
in
in
an
effective
way
for
policy
building.
If
you're
interested
in
this
this
area,
I
will
take
a
couple
of
questions,
but
we
will
move
on
to
the
next
agenda
item
shortly.
Dr
titus
has
a
question
up
here
and
carson.
A
If
other
folks
have
questions,
please
raise
your
hand
or
turn
your
mic
on
when,
when
it
is
time
going.
H
K
Yes,
so
in
southern
nevada,
specifically
of
all
of
the
people
experiencing
homelessness,
22
of
those
people
experiencing
homelessness
are
youth
ages.
18
to
24.
the
national
average
is
6.5
0.4.
K
H
But
maybe
you
could
send
us
all
of
us
and
to
the
staff
and
they
can
get
it
to
us,
some
where
we
can
find
the
data
or
the
charts
on
any
particular
trends,
and
if
because
I'm
curious
about
where
the
homelessness
is
scattered
throughout
nevada,
if
22
percent
of
people
experience
homelessness
in
southern
nevada,
our
youth,
maybe
we
need
to
see
kind
of
a
relative,
because
that's
a
point
in
time
number
and
or
have
we
always
been
number
one
on
our
unaccompanied
youth,
not
sheltered,
and
so
I'd
like
to
have
some
more
information
on
those
kind
of
statistics,
because
it's
only
relevant
at
one
point
and
it
it
would
help
me-
and
I
think
maybe
members
of
the
staff-
and
maybe
after
your
presentation,
the
state
people
will
be
able
to
give
us
some
better
data
on
what's
the
trend
in
nevada.
H
K
Dr
titus,
thank
you
for
that.
I'm
and
cameron
rivkin
for
the
record.
I
apologize
for
that
policy
associated
mcsl.
Yes,
I
I
would
agree
to
defer
to
some
state
experts
later
on
in
this
call
to
provide
a
little
bit
more
insight.
I
I
do
believe
they're
hyperlinked
in
in
the
presentation,
so
you'll
get
a
copy
of
that.
K
The
studies
we
located
were
by
unlv,
the
united
states,
interagency
council
on
homelessness
and
then
the
nevada
homeless
alliance,
who
I
think
is
that
that
specific
data
point
that
you're
referring
to-
and
I
from
our
initial
research
understand
that
there
is
a
heavier
concentration
in
southern
nevada
compared
to
the
rest
of
the
state
and
compared
to
national
averages
as
well.
A
Thank
you
for
the
question
and
I
do
believe
that
we'll
get
some
of
those
answers
today,
but
there
are
other
resources
out
there,
such
as
the
nevada
homeless
alliance,
that
I
believe
staff
would
be
more
than
happy
to
help
connect
you
with
on
those
statistics
and
information.
If
you'd
like
to
follow
up
on
that.
Are
there
any
other
questions
from
the
committee
before
we
move
on
to
the
next
agenda
item
and
presentation,
I
do
not
see
any.
G
Thank
you
chair
and
I'm.
I
was
surprised
by
the
data.
It's
the
foster
care
reasons
for
removal
slide,
and
I
the
data
indicate
that
and
reasons
for
removal
we're
well
below
the
national
average
on
parental
substance
abuse,
which
seems
inconsistent
with
that.
We
have
generally
higher
rates,
I
think
of
substance
abuse
and
also
that
the
neglect
rate
is
much
higher.
J
Through
the
chair,
thank
you,
dr
orton
liquor
for
that
question.
I
know
from
national
national
perspective.
Sometimes
parental
incarceration
can
be
included
in
that
definition
of
neglect,
and
so
it
would
come
down
to
how
those
cases
are
classified
by
agency
personnel
and
for
nevada.
Specifically,
I
would
defer
to
agency
personnel
who
would
be
better
able
to
answer
that
question
of
how
those
cases
are
classified.
A
Thank
you
for
that
response,
and
I
do
believe
that
we
will
have
a
presentation
in
a
little
while
from
cps.
So
hopefully,
let's
hold
that
question.
We
can
ask
them
about
those
stan
those
statistics
as
well.
Are
there
any
other
questions
from
the
committee
before
we
move
on
not
seeing
any?
So
if
I
missed
you,
please
pop
your
microphone
on.
Let
me
know
otherwise
we
will
move
on.
A
Thank
you
so
much
to
our
folks
from
ncsl,
really
appreciate
you
being
here
and
providing
us
with
this
kind
of
baseline
and
ideas
to
start
us
off
on
our
presentations.
For
today.
We
appreciate
you
being
here.
Thank
you
all
right.
We're
going
to
move
on
to
agenda
item
6,
which
is
our
presentation
on
the
family.
First
prevention
services,
act
of
2017,
which
relates
to
family
services
and
foster
care
and
its
implementation
status
in
nevada.
A
It
looks
like
we
have
some
folks
in
south
in
southern
nevada.
To
do
this
presentation,
I
did
not
see
who
exactly
it
was
so
I
apologize
please
introduce
yourself
and
proceed
when
you're
ready.
I
F
Today,
we
will
be
discussing
an
overview
of
the
family.
First
prevention
services
act.
The
family's
first
prevention
services
act,
benefits
to
nevada
families,
the
funding
specific
to
families.
First,
prevention
services
act
any
requirements
we
have
to
abide
by
for
families
first,
as
well
as
families.
First,
prevention
services
act,
implementation
status
in
nevada
next
slide.
Please.
F
Next
slide,
please
family's
first
prevention
services
act,
bipartisan
budget,
bill
of
2018,
highlighted
specific
requirements
placed
on
out
of
home
placements
prevention
services
and
care
of
older
youth
with
out
of
home
placements
title
4e
federal
funding
payments
were
no
longer
allowed
to
be
used
beyond
two
weeks
for
residential
child
care
facilities.
With
the
exception
of
specialized
care
settings
and
populations,
the
family
foster
homes
will
now
need
to
meet
new
federal
standards
in
order
to
be
recognized
as
family
foster
homes
with
prevention
services.
F
F
F
Some
other
requirements
for
family
first
prevention
services
act
requires
the
documentation
of
youth
who
previously
were
in
foster
care.
The
responsibility
of
ensuring
prevention
services
activities
do
not
increase
the
juvenile
justice
population
and
that
background
check
requirements
are
enacted
as
well.
Next
slide,
please,
with
the
various
changes
in
family
first
prevention
services
act.
There
are
still
some
areas
that
have
not
changed.
The
title:
4e
continues
to
remain
a
federal
retirement
program,
specific
to
children
involved
in
foster
care
and
who
meet
the
financial
eligibility,
require
criteria.
F
Title
4e
still
allows
for
administrative
and
training
dollars
to
assist
with
costs
and
states
are
still
required
to
spend
their
money
fund.
Excuse
me
spend
their
own
funding
to
provide
support
to
child
welfare,
including
prevention
services,
expenditures.
There
are
still
some
exceptions
to
families.
First,
such
as
it
does
not
represent
new
money.
It
instead
allows
the
ability
to
utilize
family
service
prevention
services,
act,
federal
funds
to
be
more
accessible
to
children,
youth
and
families.
F
Our
state
still
will
have
to
continue
to
submit
plans
to
the
children's
bureau
and
track
entitlements
and
expenditures,
and,
last
but
not
least,
title
4e
is
a
last
resort.
Payer
medicaid
funding
should
be
utilized
prior
to
the
use
of
title
4e
funding
next
slide:
the
ability
to
access
federal
prevention
service
dollars
states
must
adhere
to
the
following
stipulations.
F
They
must
have
an
approved
five-year
prevention
plan,
adhere
to
the
residential
child
care
and
qualified
residential
treatment
provider
standards
ensure
at
least
50
percent
of
services
provided
to
the
population,
served
meet.
The
definition
of
well-supported
services
and
services
provided
are
trauma
and
form.
The
services
chosen
by
the
states
must
be
evaluated
if
their
designation
is
promising,
supported
or
well-supported
practices.
F
Unless
the
states
receive
a
federal
waiver
of
requirements,
the
prevention
services
must
be
available
for
up
to
12
months
at
a
time
to
children
and
youth
who
are
candidates
for
foster
care
and
or
pregnant
or
parenting.
Children.
Youth
in
foster
care,
children
and
youth
who
receive
prevention.
Services
must
have
a
prevention
plan
in
place
that
identifies
the
specific
prevention
strategy
for
the
child
to
remain
at
home
or
with
ken
caregiver
giver
and
a
list
of
services
planned
to
be
provided
are
also
needed
to
be
documented
to
ensure
the
success
of
prevention
strategy
next
slide.
F
Next
slide
here
are
some
of
the
benefits
to
nevada.
It
allows
more
flexibility
to
claim
additional
federal
funds
for
prevention
services,
administrative
costs,
as
well
as
training
costs.
It
also
provides
a
framework
to
expand
services
and
focus
on
providing
them
in
a
family-based
setting
when
an
out-of-home
placement
is
needed.
F
In
fiscal
year,
2019
nevada
reported
a
functional
reimbursement
rate
of
25,
based
on
the
number
of
children
and
families
eligible
in
the
services.
The
requirements
vary
by
components
of
families
first,
but
most
require
additional
plans
to
be
submitted
and
approved
to
the
children's
bureau,
and
additional
reporting
of
data
is
also
needed.
F
F
Some
activities
are
optional
and
others
are
mandatory
that
we
have
to
meet
next
slide.
Please
at
this
present
moment,
the
state
of
nevada
division
of
child
and
family
services
have
worked
towards
the
following
families:
first
requirements:
we
have
submitted
for
final
review
to
the
children's
bureau
of
proof
of
foster
care
for
youth
as
an
automated
letter,
and
we
are
working
with
the
agencies
to
ensure
the
letter
is
provided
to
all
youth
in
foster
care.
F
F
Last
but
not
least,
we
have
submitted
to
the
children's
bureau
for
final
review.
Our
electronic
system
that
meets
the
requirements
of
the
electronic
interstate
case
processing
system
next
slide.
Please,
the
family.
First
prevention
services
act
focuses
on
the
fight
on
the
below
candidates
for
foster
care,
children
and
youth
at
imminent
risk
of
entering
foster
care
who
can
remain
safely
at
home
or
in
kinship
with
services
who
one
is
in
present
or
impending
danger,
and
or
has
one
or
more
of
the
identified
negative
family
conditions,
but
not
necessarily
meeting
present
or
impending
danger
criteria.
F
F
F
The
important
drivers
to
implementation
include
that
we
focus
on
training
and
workforce
supports
public
and
private
partnerships
that
we
presently
hold
and
continue
to
build
data
collection
and
analysis,
continuous
quality
improvement
and
involving
our
evaluation
teams
involving
and
engaging
our
stakeholders.
Internal
and
external,
developing
a
clear
communication
plan.
Interagency
collaboration
and
leadership
support
next
slide.
Please
our
current
activities
as
it
relates
to
our
prevention
services
plan
include
reviewing
and
revising
the
process
for
care
planning
and
safety
reviews
for
children,
youth
and
families
that
are
not
being
served
in
the
child
welfare
agencies.
F
We
are
finalizing
the
list
of
evidence-based
practices
that
we
will
include
in
our
title:
4e
prevention
services
plan.
We
are
presently
working
with
providers
to
develop
installation
implementation
and
sustainability
plans
for
evidence-based
practices,
and
we
are
fine.
And
finally,
we
are
collaborating
with
nevada
partnerships
to
develop
training
for
public
and
private
workforce
families
and
other
stakeholders
on
key
components
of
families.
First,
prevention
services
act
next
slide.
Please
our
next
steps.
F
Presently
we
are
planning
to
resubmit
our
title
4e
plan
and
title
4e
prevention
plan
to
the
children's
bureau
for
final
review
and
potential
approval.
We
are
currently
reviewing
our
cost
allocation
plans
and
we'll
be
updating
these
to
align
for
resubmission
to
the
children's
bureau
in
conduct,
in
conjunction
with
our
other
two
plans.
F
A
Thank
you
so
much
for
that
overview.
Dr
rice
really
interesting
work
going
on
and
I
have
I
have
questions,
but
I'm
sure
my
committee
does
as
well,
so
I'm
going
to
go
ahead
and
start
with
committee
questions.
If
there
are
some,
please
raise
your
hand
or
let
me
know
on
your
mic.
A
If
I'm
not
seeing
you
I'm
gonna,
go
ahead
and
ask
my
question:
then:
can
you
so
I'm
trying
to
get
my
my
my
mind
around
where
implementation
is
and
you
gave
a
brief
overview,
but
can
you
speak
a
little
bit
to
the
status
of
implementation
and
some
of
the
metrics
of
value
that
are
that
you're
using
to
to
ensure
that
these
are
like
implementation
is
bringing
value
to
the
state?
F
F
Barriers
to
that
is
really
truly
understanding
the
direction
that
the
federal
government
is
guiding
us
towards
in
the
larger
picture,
as
we're
communicating
the
families
first
prevention
services
act
is
a
large
change
in
in
certain
areas
and
being
able
to
identify
various
areas
that
we
have
to
implement,
such
as
the
qualif.
Excuse
me,
the
qrtps,
the
quality
residential
treatment
program,
excuse
me,
qrtps
and
where
we're
able
to
get
those
up
and
running
and
implemented.
F
So
that
takes
time
as
well
as
we're
working
with
our
jurisdictions
to
get
those
implemented
so
more
behind
the
scenes
on
our
infrastructure
side
of
getting
it
created
before
we
can
actually
implement
it
for
it
to
be
beneficial
to
our
families.
It's
where
we're
presently
at
also
obtaining
approval
through
the
children's
bureau
is
another
barrier
as
we're
working
with
the
court
improvement
program
to
get
administrative
court
rules
in
place
in
order
to
be
sure
we're
aligned
with
qrtps.
I
The
record
this
this
is
cindy
pitlock,
administrator
of
the
division
of
child
and
family
services,
so
this
is
a
really
tough
concept.
This
family's
first
concept
to
wrap
our
minds
around,
but
at
the
at
the
end
of
the
day,
the
bottom
line
is
it's
prevention
services
for
families
to
keep
them
out
of
foster
care
or
advancing
in
our
system.
I
Huge
lifts,
staffing
wise
at
the
end
of
all
of
this
at
the
light
at
the
end
of
the
tunnel,
is
we'll
have
an
awesome
program
of
prevention
across
the
state
of
nevada
that
will
align
with
federal
requirements
and
also
give
the
state
a
robust
funding
mechanism
for
these.
These
prevention
type
programs,
but
it
truly
is
a
huge
lift
staff
wise
for
the
division,
and
thank
you
for
hearing
our
presentation
today.
A
Thank
you
for
that.
I
actually
was
going
to
ask
about
how
staffing
how
you
were
feeling
about
your
staffing
ability
to
meet
these
metrics
and
goals.
I've
been
thinking
a
lot.
This
is
not
isolated
to
your
division.
A
lot
about
how
we
ensure
that
our
state
agencies
are
are
staffed
sufficiently
to
meet
the
goals
of
our
state,
our
growing
population
and
our
growing
state
needs.
A
I
Thank
you,
chair
peters,
for
the
record.
This
is
cindy
pitlock.
Yes,
you
we're
we're
all
really
in
the
same
boat
and
and
we
all
realize
that
the
staffing
struggles
are
immense.
I
think
at
my
division.
We
run
right
now
at
about
a
36
vacancy
rate.
So
if
you
really
look
at
that
in
context,
the
potential
of
one
third
of
the
division's
work
may
not
be
getting
done
unless
it's
getting
done
outside
of
hours
over
time
and
and
stretching
our
staff
beyond
the
limits
that
that
they
can
handle.
I
So
we
have
to
certainly
be
transparent
about
our
challenges.
Fortunately,
I
have
a
committed
staff
that
is
doing
everything
in
their
power
to
step
up
to
get
families
first
implemented
we're
considering
leaning
more
in
on
our
technical
assistance
contract
and
also
maybe
bringing
in
some
extra
help
as
we
can
and
director
whitley
is
absolutely
invested
in
families
first
and
its
success
and
has
agreed
in
every
way
to
partner
with
me
to
make
sure
that
we
succeed.
But,
yes,
the
challenges
are
immense
staff
is,
is
exhausted
at
best,
but
we
will
march
forward.
I
This
is
a
great
program
for
the
state
of
nevada
and
the
youth
of
of
the
state
of
nevada,
and
ultimately,
we
want
to
prevent
advancing
into
a
higher
level
of
services,
and-
and
this
is
part
of
that
that
build
so.
We
are
also,
of
course,
in
the
middle
of
budget
build,
and
we
know
that
the
sustainability
of
families
first
needs
to
be
wrapped
into
that,
and
we're
working
closely,
of
course,
with
the
director's
office
and
and
all
of
our
stakeholders
to
collaboratively.
I
A
Thank
you
so
much.
I
really
feel
for
where
you're
at
I
think,
especially
for
regulatory
agencies
that
have
that
quality
control
metric.
It
is
very
difficult
to
ensure
you
have
enough
staff
to
meet
those
needs
which
are
the
most
immediate
right,
ensuring
that
our
student,
our
children,
are
safe
in
the
places
that
they're
placed
that
they're
getting
the
resources
they
need
at
that
place,
let
alone
trying
to
develop
a
brand
new
implementation
program.
So
we
really
kudos
and
thank
you
for
your
service
in
doing
this
and
getting
this
program
stood
up.
A
I
hope
that,
as
we
move
forward
that,
if
there
are
policy
needs
that
you
have
from
us,
you
submit
recommendations
for
our
committee
to
consider.
We
really
are
looking
to
support
you
in
this
effort.
Keeping
kids
and
families
whole
is
a
huge
part
of
our
goal.
I
think
in
this
committee.
So
thank
you
so
much
for,
for
what
you're
doing
are
there
any
other
questions
from
the
committee
on
this
presentation?
A
A
Agenda
item
eight
is
our
overview
of
commercially
sex
sexually
exploited
children
in
nevada.
This
is
another
one
of
those
topics
that
can
get
pretty
heavy.
What
did
I
miss
something?
A
A
D
Okay
committee,
apparently
I'm
technologically
troubled
here
and
committee
for
having
us,
come
I'm
going
to
provide
you
a
brief
overview
of
nevada's
child
welfare
system,
we'll
touch
a
little
bit
upon
on
the
funding
child
protective
services,
foster
care
and
independent
living
for
youth
nevada's.
Child
welfare
system
is
determined
by
population
concentration.
D
The
largest
concentrations
which
are
clark
county
and
which
are
washoe
county,
provide
their
own
child
welfare
services.
These
services
are
provided
through
a
block
grant
that
is
appropriated
by
the
legislators,
and
they
are
also
provided
an
incentive
grant
to
help
provide
those
child
welfare
services
in
their
urban
counties.
D
See
if
I
can
not
sure
if
this
one's
mine
specialized
foster
care.
A
Great,
are
you
able
to
see
it
on
virtually
dr
oren
licker
or
dr
hardy,
or
senator
donate
vice
chair
of
antoniote.
D
Thank
you,
lori
jackson,
for
the
record,
this
allocation
and
these
incentive
grants
help
the
urban
counties
to
provide
child
welfare
services
within
their
county.
Child
welfare.
Normally,
I
think,
is
known
as
child
protective
services
more
collequilly
as
cps,
although
there
is
much
more
to
do
with
child
welfare
than
just
cps.
D
D
This
particular
journey
can
take
them
through
with
us
providing
services
and
leaving
their
homes,
or
it
can
necessitate
with
us
having
a
more
a
stronger
intervention.
If
no
safety
services
can
keep
the
child
in
the
home,
as
you
can
see
on
the
next
slide,
it
starts
with
child
protective
services.
If
we
have
to
take
protective
custody.
D
Protective
custody
is
a
legal
proceeding
that
is
overseen
by
the
nevada,
revised
statute.
432B,
it
is
defines
what
we
are,
what
is
necessary
for
us
to
do
for
families
and
children
to
get
them
reunified
within
their
home,
which
is
always
our
primary
mandate.
It
also
has
specific
timelines,
which
you
can
see
in
the
brief
overview
for
the
child
welfare
court
process.
D
D
These
calls
are
entered
into
our
unity
system,
which
is
our
sakwa
system,
which
is
our
federally
mandated
child
welfare
database.
These
calls
can
be
handled
in
one
of
three
ways.
Information
only
means
it
doesn't
meet
a
statutory
requirement
for
investigation
or
assessment.
This
may
be
something
as
simple
as
a
neighbor
calling
and
saying
they
hear
their
neighbor's
child
crying
differential
response
is
determined
to
address
a
more
lack
of
resources
situation
where
maybe
a
loss
of
a
job
has
impaired
a
family's
ability
to
pay
their
heating
bill
in
winter,
so
their
house
is
cold.
D
D
Referrals
are
then
referred
to
a
child
protective
services
worker.
This
slide
is
a
particular
interest
that
I
want
the
committee
to
take
a
look
at
at
2020..
We
know
the
pandemic
had
far-reaching
effects
on
many
states,
and
many
agencies
for
cps
intake
referrals,
both
here
and
nationally
calls
dropped
almost
10
percent
over
that
time
period.
That
was
when
children
were
out
of
school
were
not
seen
by
medical
providers
were
not
enrolled
or
participating
in
community
events
and
that
families
were
in
their
bubble.
So
even
relatives
and
family
members
did
not
see
them.
D
The
severity
in
nature,
I
believe
in
the
other
presentation
there
was
a
question
about
neglectful,
treatment
or
physical
injury.
These
are
the
two
defined
in
statute
that
a
parent
can
be
found,
substantiated
for
and
to
briefly
answer
the
question
that
was
asked
around
substance
abuse.
There
are
many
factors
that
go
into
assessing
substance,
abuse
that
happen
before
a
child
is
removed
from
a
home,
some
of
which
are
the
severity
of
the
substance
being
abused.
D
If
we
do
have
to
remove
a
child
and
there
aren't
safety
factors
or
a
way
to
safety
plan
with
the
family,
then
the
child
will
go
into
foster
care.
Foster
care
is
defined
as
a
temporary,
short-term
placement
to
address
the
safety
effects
or
the
safety
factors
that
are
requiring
that
child
not
to
be
in
their
home.
It
was
never
intended
to
be
a
long-term
solution
to
family
issues.
D
D
D
The
next
slide
focuses
on
licensed
foster
homes.
D
Another
effect
of
the
pandemic
was
that
across
the
board,
if
you
look
at
the
top
line,
where
it
says
statewide
and
it
says,
licenses
you'll
see
that
there's
a
decrease
of
foster
care
licensed,
foster
care
providers
or
homes
across
the
state
during
this
period,
but
it's
really
marked
during
2019
and
2020,
where
possible,
placements
and
bed
availability
was
decreased
throughout
the
entire
state.
This
affected,
both
the
urban
areas,
also.
D
D
D
These
were
calculated
or
figured
out,
based
on
looking
at
removal
rates,
the
removal
of
specialized
of
children
that
required
specialized
homes
like
multiple
sibling
groups
and
based
on
the
number
of
homes
we
currently
had.
So
you
can
see
that
for
each
of
the
district
offices,
district
2
is
carson,
douglas
lion
and
story
counties.
They
are
three
of
our
more
populous
counties,
with
lying
being
the
county
that
is
actually
increasing
and
is
the
third
largest
county
now
in
the
state.
D
D
D
Our
independent
living
program
is
funded
three
different
ways:
two
federal
grants-
one
is
the
chafee
independent
living
grant
and
the
other
is
the
educational
and
training
voucher
grant.
The
additional
grant
is
the
faffi,
which
is
the
funds
to
assist
former
foster
youth,
help
fund
those
programs
for
youth
to
attain
skills
for
self-sufficiency.
D
You
can
see
some
of
the
supportive
services
that
our
community
providers
provide
for
our
youth
is
obtaining
high
school,
geds
or
diplomas.
It
can
be
as
easy.
It
can
be
as
mundane
as
calling
to
figure
out
how
to
do
laundry
and
how
not
to
turn
things
pink
so
they
provide
these
services.
It
would
be
of
note,
though,
for
the
committee
to
realize
that
these
children
form
lifelong
connections
to
these
workers
and
that
they
will
reach
out
long
past
the
age
of
21.
D
D
The
division
did
have
some
successes
and
accomplishments.
The
committee
will
notice
many
of
them
our
successes,
our
accomplishments
and
even
our
challenges
that
I'll
speak
about
in
just
a
moment
revolve
around
removing
children
in
foster
care
we
have
created.
Washoe
county
has
implemented
two
years
ago,
the
safe
babies
court
team.
It
is
an
amazing
program
that
is
in
multiple
states,
that
is
to
address
factors,
safety
factors
that
require
children,
especially
young
children,
to
be
removed
from
their
home
of
origin.
We
know
that
removal
at
any
ages
causes
trauma,
but
for
younger
children
it
can
develop.
D
D
D
D
It
is
limiting
the
amount
of
drive
time
that
my
four
licensing
workers,
because
I
have
four
licensing
workers
for
15
counties-
have
to
engage
in
so
they're
able
to
limit
that
windshield
time
and
it
has
decreased
our
postage
costs,
because
this
is
something
where
they
can
take
pictures
of
documents
and
upload
it
to
binti.
It's
an
app
that
they
can
download
and
it
is
very
easy
to
use.
Since
many
of
our
potential
foster
homes
are
somewhat
older
and
not
as
tech
savvy.
D
We
also
have
a
dedicated
website.
We've
included
the
the
link
for
you
all
if
you'd
care
to
look
at
it.
It
shows
my
for
licensing
workers,
recruiter
and
supervisor
as
a
team,
and
it
provides
the
information
frequently
asked
questions
a
place
to
download
forms,
so
they
that's
where
potential
homes
can
go
and
current
phone
homes
can
go
in
order
to
obtain
those
without
having
to
try
and
get
a
hold
of
a
licensing
worker.
D
As
I
said,
a
referral
for
child
welfare
is
the
first
contact
that
comes
in
from
a
call.
We
have
a
dedicated
in
intake
unit,
because
that
is
the
most
important
decision
that
gets
made
is
whether
something
is
assigned
or
not,
and
the
information
that
they
provide
us
helps
us
to
make
better
decisions
on
what's
assigned
and
what
is
more,
diverted
to
differential
response
or
not
assigned
the
division
is
undergoing
a
or
contracting
to
have
an
actuarial,
foster
care
rate
completed
to
update
our
rates.
They
were
last
updated
in
2006..
D
There
were
some
high
points,
even
after
the
pandemic.
We
we
did
56
adoptions
in
2021
and
we're
currently
at
31
adoptions
in
2022.
Those
are
children
that
are
now
in
their
permanent
living
situation
and
out
of
the
child
welfare
situation,
higher
level
of
care
was
developed
to
monitor
children
and
youth
that
were
coming
in
and
out
of
residential
foster
treatment
centers
to
provide
them
the
supports
that
they
need,
when
they're,
coming
back
and
being
placed
in
specialized,
foster
homes
or
regular
foster
homes,
and
our
clinical
services
are
amazing.
D
They
provide
therapeutic
and
consultative
services
to
our
four
district
offices
to
our
satellite
offices
to
every
child.
They
staff
every
child
within
those
offices
and
also
to
courts
when
they
have
a
clinical
question
as
well
as
providers
within
the
rural
counties
who
are
maybe
not
as
proficient
at
understanding
trauma
and
child
welfare.
D
But
we
are
not
without
our
challenges
and
again,
the
loss
of
foster
homes
for
all
of
us
throughout
the
state
has
been
somewhat
devastating
for
the
rural
child
welfare.
We
are
limited
in
the
amount
of
foster
care
trainings
we
can
provide.
They
are
required
to
go
through
the
licensing
process
and
it's
a
required
element,
but
because
I
I
have
that's
only
being
able
to
be
provided
by
my
supervisor,
myself
or
my
manager,
we're
limited
in
the
amount
of
trainings
that
we
can
provide.
D
We've
seen
an
increase
in
the
request
for
interstate
compact
for
the
placement
of
children.
It's
also
known
as
an
icpc.
That
is
a
process
where
children
in
other
custodies
stay
in
other
states.
Custodies
can
be
placed
in
nevada,
with
a
relative
or
with
an
adoptive
family.
Where
we
go
out,
we
make
sure
that
that
home
is
safe.
We
do
a
home
study
and
then
we
monitor
that
placement
for
that.
D
For
that
other
state,
as
they
do
for
us,
our
legislative
council
bureau
partners
have
completed
an
audit
and
found
that
we
utilize
relatives
whenever
possible
and
but
there's
not
a
lot
of
structure
or
the
same
amount
of
structure
that
we
have
for
licensed
foster
homes.
So
we
are
implementing
some
more
structure
around
that
we
are
providing
training
to
our
relative
foster
homes
or
fictive
kin
foster
homes
through
kinship
navigator.
D
They
have
a
training
specifically
for
relatives,
because
it
is
a
dual
role,
where
you're
providing
safety
for
a
child,
but
you're
also
dealing
with
your
family
member
and
and
you're
trying
to
we're
trying
to
reunify
with
that
family
member
there
are
limited.
I
think
you've
heard
that
maybe
in
the
other
presentation
that
there
are
limited
transitional
placements
for
independent
living,
youth
or
extended
foster
care
youth.
D
One
of
the
struggles
is
while
we
do
have
hud
vouchers
right
now.
Housing
throughout
the
state
is
incredibly
difficult
to
locate
and
very
expensive.
So
it's
very
difficult,
even
with
a
voucher,
to
find
a
place
that
you
can
rent
our
vouchers
at
the
most.
Are
they
pay
a
portion
of
the
rent
for
that
individual
or
for
that
youth?
D
D
We
can't
we're
doing
the
contract
for
the
actuarial
study
because
we
believe
that
that
will
also
help
us
to
in
obtain
more
foster
homes.
Since
our
rates,
our
base
rates
are
low,
but
also
our
ancillary
rates
and
those
are
things
like
clothing
allowances
and
things
like
that.
We're
utilizing
the
kinship
navigator
to
provide
relative
and
fictive
kin
training.
We
do
use
contractors
to
meet
the
needs
of
our
our
foster
care
population
when
we
need
to.
D
We
are
revising
our
procedures
to
provide
better
oversight
to
our
relative
and
better
support
to
our
relative
infective
ken
homes.
D
We
are
working
with
aging
and
disability
services
on
dual
licensing
for
intellectual
and
developmentally
developmentally
dis,
disabled
or
and
autistic
youth
to
increase
placements,
and
we
are
also
collaborating
with
carson
tahoe
hospital
for
expansion
of
their
mallory
center
to
take
acute
minors,
as
we've
seen
it's
problematic
with
the
closure
of
one
of
the
psychiatric
hospitals
in
reno,
and
there
aren't
others
available
within
the
rural
counties
such
as
elko
orlando.
Everyone
has
to
come
either
to
carson
or
to
reno.
D
N
Okay,
thank
you.
Miss
jackson.
Thank
you,
chair
members
of
the
committee
for
having
us
here
today
for
the
record
ryan
gustafson
division
director
with
washoe
county
human
services
agency.
I
will
be
fairly
brief.
I
just
have
a
couple
of
slides
it's
going
to
focus
on
the
successes
and
accomplishments
for
washer
county
human
services
agency,
child
welfare,
as
well
as
some
areas
that
we
continue
to
have
challenges
in
and
continue
to
to
work
towards.
N
So
some
of
the
successes
in
in
fy
21
we
were
able
to
reunify
more
than
250
children
back
to
their
families.
We
were
also
able
to
provide
clinical
assessment
and
services
to
nearly
850
children
and
family
members.
N
We
were
able
to
finalize
87
adoptions
in
fiscal
year,
21
in
washoe,
county
and
with
kovid.
We
were
sort
of
forced
and
sort
of
took
advantage
of
the
opportunity
to
pivot
and
create
a
virtual
training
platform
for
incoming
foster
parents
successfully
successfully
piloted
two
community-based
emergency
homes,
and
we
launched
a
number
of
campaigns,
including
a
fostering
campaign,
a
suicide
prevention
campaign,
safe
sleep
campaign
and
human
and
human
trafficking
campaign.
N
And
next
slide
again,
we
do
also
have
some
opportunities
to
improve.
I
won't
read
everything.
That's
on
on
there
and
just
kind
of
hit
the
highlights:
we've
seen
a
decrease
in
mental
health
services
in
the
last
year
and
in
washoe
county.
I
think
that's
really
statewide
in
washington
county
we've
been
hit
particularly
hard
as
well,
most
notably
the
closure
of
one
of
our
two
acute
psychiatric
hospital
facilities.
N
Ab387
legislation,
which
is
called
collaborative
pathways,
now
came
about
last
session
with
the
goal
of
keeping
children
from
coming
into
child
welfare
care
unnecessarily
to
get
services,
that's
taking
us
some
time
to
get
off
the
ground
and
to
implement
as
well
reimbursement
rates
for
mental
health
and
behavioral
health
services
have
continued
to
be
low,
which
result
in
a
decrease
in
service
options
for
children
in
child
welfare.
This
includes
foster
care
rates
as
well.
N
We
had
some
court
activity
that
was
backlogged
and
sort
of
slowed
down,
multiple
processes
that
was
in
part
mostly
in
part
due
to
covid
and
again
that
impact
some
of
our
processes.
Fortunately,
that
is
starting
to
resolve
itself,
as
as
we
continue
to
move
through
covet
and
past
it,
and
finally,
we
in
washoe
county,
we
have
some
fairly
significant
transportation
issues
that
continue
to
grow.
N
That's
particularly
within
the
school
district,
creating
difficulties,
keeping
children
in
their
schools
when
they
come
into
care,
which
we
all
know,
that's
really
important,
to
keep
kids
in
their
home
schools
and
so
transportation
around
the
county
in
the
washoe
area
has
been
exceptionally
difficult
over
the
last
really
year
in
particular,
and
with
that,
I
think
that
I
will
push
it
over
to
clark
county.
I
think
we
have
some
representation
down
there
to
take
on
the
next
section.
O
Yeah
good
morning,
chair
peters
and
members
of
the
committee,
tim
burch,
human
services
administrator
for
clark,
county
nevada
responsible
for
the
department
of
family
services-
next
slide,
please.
So
our
format
will
echo
that
of
mr
gupsterson
in
washable
county.
We
wanted
to
keep
this
succinct
for
you
and
give
you
an
opportunity
to
ask
us
questions,
but
we
do
want
to
take
a
moment
to
highlight
the
enormous
efforts
of
our
staff
and
the
things
they've
accomplished
and
dealing
with
these
difficult
situations.
O
Our
southern
nevada
children's
advocacy
center,
which
got
an
echo
award
in
2019,
has
continued
its
efforts
by
serving
1
848
children.
These
are
our
young
people
who
have
been
experiencing
sexual
assault
and
have
come
through
our
system
to
receive
forensic
interviews
in
conjunction
with
law
enforcement
and
sncac.
O
O
We
have
been
able
to
work
with
our
partners
on
the
on
the
adult
side
of
service
continuum
and
social
service
and
house
72
families
in
emergency
hotel,
motel
situations
that
has
kept
over
193
children
just
since
december.
Out
of
the
child
welfare
system,
those
children
would
otherwise
come
into
our
emergency
shelter
at
child
haven
and
been
brought
into
the
child
warfare
system.
We've
additionally
used
those
beds
to
reunify
12
children
and
families
back
together
that
we've
had
to
use
those
because
the
family
unification
program,
those
fup
vouchers
you
heard
about
earlier.
O
We
have
done
a
really
good
job
with
our
local
housing
authority
and
maintaining
a
hundred
percent
lease
up
on
those.
So
we
need
more
vouchers
and
we
need
more
housing
opportunities
for
our
families.
Prior
to
the
pandemic,
we
worked
with
legal
aid
of
nevada.
O
We
worked
with
other
community
partners
and
we
implemented
a
kind
of
a
sibling
bill
of
rights
to
make
sure
siblings
are
placed
together
whenever
possible,
and
we're
able
to
report
to
you
that
less
than
three
percent
of
our
sibling
groups
right
now
are
placed
separately
due
to
lack
of
placement
homes.
Those
are
primarily
due
to
treatment
needs
of
of
those
individual
children.
O
Additionally,
you've
heard
talk
about
placing
with
family
and
how
important
that
is.
47
percent
of
clark
county's
placements
are
with
kinship
providers,
and
that
is
that
far
exceeds
the
national
average.
I
wish
it
brings
us
to
our
kin
gap
and
guardianships
to
make
sure
that
those
relationships
were
supported.
Financially,
we
doubled
the
amount
of
kin-cap
guardianships
in
2021
over
2020.
O
commercially
sexually
exploited
children
or
c-sec.
That,
obviously,
is
something
that's
transitioning
from
a
justice
model
to
that
of
a
victim
model,
and
that
is
rolling
over
to
child
welfare.
We
have
assessed
this
last
year
over
398
children
that
are
at
risk
of
being
trafficked.
O
O
Over
550
adoptions
were
finalized
in
clark
county
this
last
year,
which,
even
despite
the
pandemic,
exceed
our
five-year
average.
On
that
I
do
not
on
the
slide,
I
do
want
to
recognize
the
efforts
our
staff
have
done
around
the
age
of
foster
youth.
Again,
you
heard
that
alarming
number
around
unaccompanied
homeless
youth
18
to
24
in
our
community.
O
About
a
decade
ago,
the
department
of
social
service
took
over
the
asia
foster
youth
program.
We
just
completed
a
10-year
look-back
study
with
university
of
nevada
las
vegas
and
showed
that,
through
the
support
services
that
we've
offered
less
than
two
percent
of
that
population
has
become
homeless
over
that
time
frame,
which
is
in
stark
contrast
to
a
national
average
of
about
25
next
slide,
so
moving
from
highlights
to
again
opportunities
for
improvement
and
growth.
O
Obviously,
you
all
know
years
ago,
the
system
was
de-bifurcated
and
and
pushed
down
an
opportunity
for
clark,
county
and
in
washington
county
to
provide
both
ends.
Investigation
and
permanent
services
to
adoption
and
the
block
grant
was
formulated
at
that
time
to
make
the
counties
whole,
we
have
grown
dramatically
since
that
time.
O
I
believe
we've
had
one
bump
in
about
2015
in
that
block
grant
we
anticipate
this
coming
fiscal
year
to
have
to
deal
with
a
29
million
dollar
structural
deficit
to
keep
up
with
growth
of
our
system
and
make
sure
that
our
families
and
children
are
safe,
the
foster
care
rates
we
already
talked
about
earlier.
O
I
don't
want
to
gloss
over
the
our
commercial
welfare
responsibility
for
the
c-sec.
These
commercially
sexually
supported
children.
These
we
right
now
have
a
115
day
rate
for
a
higher
level
of
care
specialized,
foster
care
agencies.
When
we
talk
to
other
communities
who
are
doing
the
work
with
the
csec
youth,
they
can
be
up
to
three
times
require
three
times
many
resources
to
be
invested
in
them
to
have
successful
outcomes
and
that
transition
from
a
justice
community
to
a
child
welfare
model
has
not
yet
been
funded.
O
O
It's
one
of
the
questions
earlier
was
why
so
many
neglect
cases
in
nevada
compared
to
the
national
average.
We
code
when
a
child
has
removed
from
an
adult
caregiver
who
is
not
receiving
mental
health
treatment
and
is
unable
to
care
for
a
child
that
goes
into
our
system
as
a
neglect.
So
that's
one
of
the
contributing
factors
there.
O
We
also
recognized
that
in
the
last
session
that
we
were
charged
with
beginning
to
tracking
the
number
of
children
who
were
surrendered
into
our
system
for
via
ab387
the
collaborative
pathways
program
this
year,
we've
already
had
over
80
young
people
where
parents
have
brought
them
into
our
system
and
surrendered
them
because
they
were
unable
to
provide
for
the
children's
mental
health.
That
puts
us
on
track
right
now
for
well
over
120
for
the
entire
year.
O
To
that
regard,
we
do
definitely
want
to
thank
the
interim
finance
committee
for
the
1.9
million
dollars
of
american
rescue
plan
act
dollars
that
helped
us
fund
and
make
sure
I
quote
this
correctly
interim
care
facility
for
intellectually
developmentally
delayed
children,
so
an
icf
for
idd
that
the
board
of
county
commissioners
just
ratified
the
contract
with
a
provider
a
tuesday's
morning's
meeting,
and
we
look
to
stand
that
program
up
in
may
and
we're
thankful
for
all
the
support.
O
We
just
want
to
educate
the
medicaid
rates.
I
think
it
was
the
main
topic
of
a
lot
of
the
conversation
at
the
governor's
healthcare
conference
that
we
went
to
earlier
this
week
and
dealing
with
providers
as
we
challenged
them
to
help
step
in
and
work
with
us
to
expand
the
systems
of
care
for
our
families
and
children.
O
That
was
obviously
a
major
speaking
point
from
them
back
to
us
is
that
the
reimbursement
system
needs
to
be
re-examined
there
and
again,
we
do
want
to
make
sure
that
we
highlight
the
the
efforts
that
all
the
teams
have
done
around
the
family's
first
prevention
services
act
to
spend
several
years
of
planning
and
moving
up
that
ball
down
the
field.
O
One
of
the
things
we
are
concerned
about
is
without
front
end
investment.
A
lot
of
our
providers
they've
built
their
service
models
around
the
system,
as
is
the
ability
to
pivot
and
wait
to
get
reimbursed,
is
a
is
a
business
cost
they're
not
yet
able
to
undertake.
So
we're
worried
about
the
service
provider
community
not
being
able
to
keep
pace
with
the
change
and
our
government
service
provider
model.
O
P
Thank
you,
mr
burch,
and
good
morning,
madam
chair
and
the
committee,
my
name
is
kimberly.
Abbott,
I'm
a
team
chief
with
the
children's
attorneys
project
at
the
legal
aid
center
of
southern
nevada,
I'm
also
a
certified
child
welfare
specialist.
P
We
serve
nevada
and
clark
county
residents
in
a
wide
variety
of
areas.
However,
the
one
of
our
largest
programs,
which
is
the
most
relevant
to
today's
discussion,
is
our
children's
attorneys
project.
It's
now
more
than
20
years
old
we
have
29
staff
attorneys
and
a
small
army
of
several
hundred
pro
bono
volunteers,
and
with
that
we
represent
every
child
coming
into
foster
care
in
clark
county.
P
P
They
help
ensure
that
children
with
disabilities
in
our
system
are
getting
appropriate
education
services,
and
we
are
very
grateful
that
recently,
the
ifc
approved
a
funding
increase
that
we
believe
will
allow
us
to
triple
the
amount
of
children
served
through
that
program.
So
we're
very
excited
about
that
opportunity.
As
we
move
forward.
P
The
slide
next
slide,
please,
the
slide
has
some
of
the
highlights
of
our
programs.
One
of
the
things
we're
very
proud
of
is
that
we
have
four
certified
child
welfare
law
specialists
on
staff.
We
only
have
a
handful
in
nevada,
maybe
seven
or
eight
total,
so
we're
very
excited
to
be
able
to
provide
that
expertise
to
the
clients
that
we
serve.
P
I
want
to
highlight
for
a
moment
just
a
couple
of
our
future
goals.
We
hope
to
continue
to
be
able
to
collaborate
with
our
stakeholders
to
make
improvements
to
our
system
areas
where
we
like
to
see
some
improvements
are
trump
having
a
more
trauma
informed
system,
a
more
family-centric
system
and,
as
mr
burch
talked
about
a
more
robust
and
fully
developed
array
of
mental
health
services
for
our
youth.
I
know
that
this
is
a
topic
that
this
committee
spent
hours
hearing
about.
P
Last
month,
but
we
cannot
underscore
the
importance
of
fixing
our
gaps
and
further
developing
this
system,
because
the
needs
of
our
youth
are
not
being
met
as
we
currently
sit
here.
So
we
were
grateful
to
be
part
of
the
the
governor's
summit
earlier
this
week,
but
we
certainly
still
have
a
lot
of
work
to
collaborate
and
do
together
what
I'd
like
to
do.
Lastly,
is
just
to
spend
a
minute
trying
to
kind
of
talk
to
you
a
little
bit
about
the
human
face
of
the
foster
care
system.
P
So
if
you'll
indulge
me,
if
you
could
imagine
just
for
a
moment
that
you
are
a
newborn
coming
into
this
incredible
world,
taking
your
first
few
breaths
of
life
and
with
those
breaths
you're
met
with
pain
and
discomfort
because
you're
in
withdrawal,
because
your
mom
used
heroin
during
her
pregnancy,
you
spend
your
first
few
days
on
morphine
in
the
picu
and
hopefully
we
found
a
foster
family
to
come
start
visiting
you
and
forming
a
bond
with
you.
P
Now
imagine:
you're
a
three-year-old
you're
found
cold
dirty
hungry
and
barefoot
wandering
around
an
apartment
complex
on
boulder
highway.
Your
parents
are
passed
out,
drunk
and
they're
about
to
be
arrested
for
child
endangerment.
You
go
to
childhaven
our
shelter,
while
the
department
is
looking
to
locate
some
relatives
now.
Imagine
you're
six
years
old
you're
in
the
it's,
the
middle
of
the
night
and
you're,
with
a
cps
worker
who's,
desperately
trying
to
reach
grandma
to
come,
get
you
your
mom
is
in
the
back
of
an
ambulance.
P
P
P
P
I
tell
you
these
stories
not
to
depress
you,
but
because
these
are
the
realities
of
the
children
that
we're
dealing
with
in
the
foster
care
system
for
the
lucky
ones.
Approximately
half
were
able
to
locate
relatives
in
fictive
kin,
so
they
could
go
somewhere
known
to
them,
but
for
approximately
the
other
half
they
go
to
foster
care
and
what
that
means
is
they're
going
to
live
with
strangers.
P
So
I
ask
you
to
imagine
for
just
a
minute
what
that
feels.
Like
for
them,
they're
in
a
new
unfamiliar
place
where
the
rules
and
the
whole
setup
may
be
very
different
than
anything
they've
ever
experienced,
the
rest
of
the
family
may
not
look
like
you.
They
may
speak
a
different
language
than
you.
They
may
practice
a
different
religion
than
you
were
raised
in
they
may
cook
food,
that's
very
different
from
what
you
like,
or
what
you're
used
to
pretty
much
life.
P
Sometimes
this
path
is
straight
and
short,
but
way
too
many
times.
It's
long
windy,
full
of
bumps
detours
and
twists
and
turns
so,
as
you
make
decisions
and
consider
policies
potentially
impacting
the
lives
of
these
children,
we
offer
our
organization
to
provide
feedback
answer.
Questions
inform
you
in
any
way
we
can
from
the
perspective
of
the
children
that
we
serve,
because,
after
all,
they
are
the
intended
beneficiaries
of
our
system.
Thank
you
very
much.
A
Thank
you
all
so
much
for
the
presentation
that
was
touching,
miss
abbott
the
description
of
the
cases
that
you
guys
see
the
scenario
that
children
are
put
into.
It's
like
a
worst
nightmare.
I
think
for
a
lot
of
parents
right.
This
will
become
a
regular
thing.
You
guys,
I'm
just
gonna
cry
at
every
meeting.
Okay,
I
have
some
questions
particularly
related
to
some
of
the
audits
that
lcb
has
done
related
to
your
divisions
and
the
foster
facilities
that
we've
seen
either
close
or
been
on
unconditional.
A
G
G
So
I'm
wondering
if
you
mean
both
or
one
more
than
the
other,
that
is
more
family-centric
in
the
sense
of
when
you
do
a
placement
try
to
place
with
a
relative
or
family-centric
in
the
sense
that
do
more
to
keep
the
kids
with
the
family
that
I
read.
Some
jurisdictions
are
criticized
for
being
too
quick
to
remove
a
child
from
a
family
and
that
maybe
we
need
to
be
more
family-centric
in
that
way
and
then
other
jurisdictions
are
too
slow
to
remove
children
from
their
families.
P
Thank
you
for
the
question
and
for
the
record
kimberly
abbott
with
the
children's
attorneys
project
at
legal
aid
center.
I
think
I
meant
it
in
both
and
in
a
variety
of
ways,
one.
You
will
see
from
some
of
the
information
that
mr
burch
presented.
I
think
we're
making
strides
on
some
of
these
things.
The
increase
in
the
kinship
placements
and
the
high
number
we
have
compared
to
other
states
in
the
country,
I
think,
is
a
fantastic
development.
P
Additionally,
we've
now
have
the
ability
to
do
our
kin
gap
guardianships,
which
are
paid
guardianships,
which
give
families
other
options.
That
has
been
fantastic
and
it
has
been
something
that's
been
catching
on
and
that
we've
been
turning
to
more,
I
think
for
so
long.
We
looked
at
the
option
of
either
we
get
a
parent
help
and
they
step
up
and
do
what
they
need
to
do
or
we
terminate
their
rights
and
it
was
an
either
or
guardianship
gives
us
something
that's
a
little
bit
in
the
middle,
because
it
allows
the
family
to
decide.
P
P
I
think
the
problem
is
then,
when
we
find
them
our
we're
desperate
to
find
a
placement,
and
so
we
ask
if
they
could
take
the
child
and
if
they
have
reason-
and
they
say
no-
we
kind
of
move
on
to
the
next
person,
but
we
don't
stop
on
all
the
time
and
say,
but
how
can
you
still
be
a
support
to
this
family?
How
can
you
still
be
a
connection
to
this
child?
Do
you
grandma?
Do
you
still
want
visits,
even
though
you
can't
necessarily
take
placement?
P
It
happens
in
some
cases,
but
I
don't
think
systematically.
It
happens
enough
and
then,
of
course,
as
you
referenced
with
families,
first
trying
to
keep
the
family
together.
If
we
can,
of
course,
I
think
we
always
have
work
to
get
upstream
and
to
provide
additional
services
and
supports
to
the
family.
So
we
can
have
less
removals
because
we
all
agree.
I
think
that
when
we
remove
a
child
from
the
home,
it's
traumatic
and
detrimental,
although
it
may
be
necessary,
it
doesn't
change
the
fact
that
it's
traumatic
and
detrimental
to
the
child.
P
I
also
think
supporting
kin
placements.
We
can
get
them
licensed,
but
it
takes
time
to
get
them
licensed.
Other
states
have
moved
to
situations
where
they
pay
first
license
later.
We
don't
start
payments
until
after
their
license.
So
you
know
when
we
take
a
a
grandma
who's
on
a
fixed
income
and
we
drop
two
teenage
boys
in
her
lap
who
are
gonna,
eat
her
house
out
of
house
and
home
in
the
first
five
minutes,
they're
there
plus
they're
gonna
outgrow
their
shoes,
every
five
minutes
right.
P
A
C
D
A
A
What
can
we
do
to,
and
I
I
hear
you
about
reimbursement
rates
and
that
is
across
the
board
right,
assessing
reimbursement
rates,
and
I
was
listening
to
the
radio
on
my
way
in
today
and
we're
seeing
that
ra,
like
really
increasing
pay,
is,
is
being
seen
as
one
of
the
best
ways
to
fight
some
of
the
losses
we've
been
seeing
over
the
last
couple
of
years,
so
that
that's
definitely
out
there.
But
I,
I
wonder
licensing
wise
and
also
just
outreach
wise.
A
D
Larry
jackson,
for
the
record,
I
believe
one
of
the
ways
is-
and
it
was
in
some
of
our
presentations-
was
to
look
at
the
medicaid
rates
and
the
rates
of
reimbursement
at
the
at
how
medicaid
reimburses
and
the
timelines.
What
we
hear
is
that
compared
to
other
states,
it's
relatively
low
and
that
many
companies
or
facilities
or
have
to
wait
a
long
time
to
be
reimbursed.
D
So
I
think
that
that
is
also
something
that
could
be
looked
at
to
entice
more
agencies,
more
outreach
to
come
to
the
to
nevada,
to
experience
it's
very
beautiful
here
and
to
experience
opening
homes
and
services
here.
N
Ryan
gustafson
for
the
record
and
and
just
to
add
to
miss
jackson's
comments.
Some
of
the
facilities
and
agencies
that
we've
worked
with.
We
try
to
keep
kids
in
state,
obviously,
but
there's
not
there's
not
many
in-state
residential
programs
in
nevada.
I
think
I
can
probably
count
them
on
one
hand.
As
far
as
residential
treatment
programs,
some
of
the
out-of-state
facilities
have
actually
notified
us
that
they
won't
work
with
nevada
and
nevada
medicaid
because
of
timeliness
issues
and
reimbursement
issues.
N
I
I
think
that
finding
additional
ways
to
support
foster
families
and
and
to
obviously
get
additional
foster
families.
I
know
within
washoe
county
we
try
to
do
as
much
marketing
as
we
can.
We
try
to
you,
know:
team
with
community
agencies.
You
know
you
and
our
you
know
whomever
we
can
to
try
to
get
the
word
out
that
we
need.
N
We
need
families
and
we
need
individuals
to
you,
know,
foster
mentor
and
adopt
that's
sort
of
what
we
what
we
preach,
but
a
lot
of
these
kids
go
into
homes
and
they
need
additional
services.
Kids,
it
is
traumatic
for
kids
to
come
into
care
and
when
they
do
come
into
care
oftentimes,
you
know
that
that
that
can
come
with
some
weight
right,
the
loss
of
being
with
mom
and
dad
the
difficulties
of
going
in
with
strangers.
N
If
it
happens
to
be
foster
care,
so
some
of
those
kids
might
need
clinical
or
therapeutic
services
and
that
those
are
very
lacking.
I
had
referenced
as
well
that
we
lost
one
of
our
two
psychiat
psychiatric
hospitals,
so
when
kids
become
acute,
they
are
now
going
to
medical
hospitals
where
they're
waiting
to
get
a
bed
in
the
one
psychiatric
hospital
that
we
have
left
so
that
creates
backlogs
and
that
creates
difficulties
and
just
undue
stressors
for
kids
and
families,
but
getting
kids
involved
in
therapy.
N
Getting
them
involved
with
community-based
providers
is
important
and
it's
hard
to
do
because
many
of
them
are
back
logged
and
many
of
them
have,
quite
frankly,
caps
on
how
many
medicaid
clients
that
they'll
see
because
they
can
get
more
money
when
they
see
third
party
liability,
insurance,
clients
or
cash
pairs.
So
that
creates
difficulties.
I
know
one
thing
we
did,
which
you
are
all
probably
aware
of.
N
Back
in
2017
in
october,
we
opened
up
our
family
engagement
center,
which
one
of
the
goal,
which
was
really
sort
of
radical
and
new
country-wide,
and
one
of
the
reasons
we
did,
that
is,
we
wanted
our
foster
parents
and
our
biological
parents
to
be
able
to
be
able
to
be
in
a
really
a
home-like
environment.
N
That's
conducive
to
visiting
that's
conducive
to
building
relationships,
because
we've
come
to
the
realization
that
it's
it's
more
beneficial
for
the
biological
parents
to
have
a
good
relationship
with
the
foster
parents,
because
they
can
teach
each
other
a
lot.
And
then,
when
we
can
be
part
of
that
process
as
the
child
welfare
agency,
then
it
really
becomes
sort
of
like
that
that
three-pronged
system,
where
we
have
everybody
working
together
and
then
you're
in
a
very
homey
friendly
environment,
where
you
can
play
games
where
you
can
cook
together,
eat
together
those
things.
N
And
so
I
think,
if
you
can
find
new
and
unique
community-based
support
and
ideas
to
really
bolster
the
foster
parents
and
bolster
the
biological
parents
that
are
working
hard
to
get
their
children
back.
I
think
that's!
What's
really
key
into
making
the
system
successful.
O
Tim
burke
for
the
record
from
clark
county.
I
just
want
to
highlight
that
we
we
do
work
with
community
services
agencies,
I'd
like
to
highlight
a
foster
kinship
actually,
as
an
agency
homegrown,
with
the
assistance
and
leadership
of
dr
ali
caliendo,
which
is
actually
grown
into
a
national
model
and
and
her
program
is
under
review
to
land
in
that
national
clearinghouse
for
ffpsa.
O
So
the
investments
do
work
when
we're
able
to
make
them.
I
think
we
beat
the
drum
on
on
needing
more
investment
quite
thoroughly.
I
do
want
to
thank
we're
always
looking
for
businesses
to
come
in
and
help
incentive
a
lot
of
times.
We
hear
that
employees
potential
fast
parents
have
time
difficulty
taking
time
off
of
work
to
go
to
all
the
hearings
and
things
that
happen
during
business
hours
that
there
need
to
be
a
part
of
to
be
a
foster
parent
in
there,
so
asking
employers
to
incentivize
in
some
way.
O
Some
leave
banks
for
those
their
employees
to
get
involved
in
this
way
is,
is
a
really
really
meaningful
thing
and
something
we
mentioned
to
our
partners
and
I'd
be
remiss.
If
I
didn't
think
some.
You
know
major
local
partners,
like
the
las
vegas
raiders
and
the
little
knights
that
have
stepped
in
and
done
things
as
small
as
show
up
at
at
community
events
to
as
large
as
recording
welcome
videos
for
our
virtual
foster,
parent,
trainings
and
out
of
a
relationship
with
some
players
who
they
themselves
have
gone
through,
foster
care.
O
So
I
think
the
willingness
to
support
is
there
is
so.
I
think
one
of
the
things
we've
asked
in
the
past
is
also
there's
been
great
campaigns
statewide
for
things
like
home
means,
nevada
and
other
things.
A
statewide
demonstrated
commitment
to
foster
parent
recruitment
through
through
that
level
of
campaign
and
messaging
really
helps
because
we,
as
agencies
are,
are
dependent
upon
the
niceties
of
strangers
and
community
partners
to
help
us
with
a
lot
of
that
marketing
and
messaging,
because
it's
just
not
something
that's
built
into
our
budgets.
P
P
Sure
kimberly
abbott
for
the
record,
dr
pitlock,
reminded
me
of
an
important
support.
We
actually
spent
a
long
time
talking
about
this
at
the
provider
summit
earlier
this
week.
One
way
that
we
can
support
families
both
foster
parents
and
relative
caregivers
is
to
have
a
robust
respite
system.
P
It's
important
that
our
caregivers
take
care
of
themselves
and
have
a
chance
to
take
a
break,
so
they
don't
get
burnt
out.
So
they
don't
turn
away
from
this
work,
and
so
supporting
a
robust
system
to
ensure
they
have
access
to
appropriate
respite
is
another
way
to
ensure
that
we
have
quality
caregivers.
A
A
Is
one
thing
right,
because
that
is
a
medical
service,
but
cooking
laundry
service
general
cleaning
services
for
these
families
to
make
sure
that
they're
getting
those
basic
needs
met
while
they're
caring
for
the
kids
and
their
emotional
needs
during
the
time
that
they're
in
those
families
and-
and
that
might
be
a
part
of
that
suggestion
of
how
do
we
market
that
it's
not
really
foster
parents,
we're
looking
for
it's
a
foster
community,
we're
looking
for
right,
it's
a
community!
That's
there
to
support
the
families,
it's
a
community!
A
H
I
think
thank
you,
madam
chair,
just
real
quick,
especially
in
the
rules.
I've
been
on
this
health
care
committee
now
for
four
sessions.
Eight
years
about
and
and
foster
care
has
been
a
issue
the
entire
time
over
this
process.
H
One
of
the
bills
that
was
passed
several
years
ago
that
I
was
very
concerned
about
was
the
amount
of
training
that
a
foster
parent
has
to
go
through
and
some
of
the
sensitivity,
training
and
all
of
those-
and
I
was
concerned
at
the
time
that
it
may
put
further
barriers
into
getting
more
foster
families
willing
to
step
up,
especially
in
the
rural
areas.
I
would
I'm
glad
to
hear
there's
some
virtual
training
so
folks
out
in
fallon
or
out
and
dire
or
wherever
it
may
be,
because
it's
not
just
related
to
our
urban
areas.
H
I
mean
it's
throughout
the
state.
Is
the
issue
can
get
that
training?
So
how
have
we
seen
any
decrease
in
the
number
of
families
willing
to
be
foster
parents,
since
we
added
the
amount
of
requirements
for
training.
D
Laurie
jackson
for
the
record,
I've
not
specifically
seen
decreases
because
of
training.
Usually
our
families
are
asking
for
additional
trainings
like
around
trauma
around
how
to
truly
understand
this
child's
needs.
Our
mental
health,
because
they've
not
experienced
these
mental
health
needs.
What
we
have
seen
I
and
I
will
defer
to
my
colleagues,
but
what
we
have
seen
in
the
model
home
standards
that
were
passed
was
there
was
a
requirement
for
a
flu
shot,
and
there
was,
I
believe
we
still
have
a
requirement
for
tuberculosis.
It's
little
things
like
that.
That
are
a
little
bit
intrusive.
D
So
in
our
rural
communities,
who
are
not
always
on
board
with
getting
specific
immunizations,
the
flu
shot
seemed
to
be
somewhat
of
a
barrier,
and
I
think
that
was
seen
throughout
our
throughout
our
jurisdictions.
It
was
one
more
mandate,
but
I
have
not
seen
that
that
training
requirement
has
been
a
barrier
to
getting
families.
If
anything,
I
think
they
enjoy
it.
They
make
connections
to
other
families
and
we
at
the
rules
are
actually
looking
to
increase
our
post
training.
So
once
you're
licensed,
we
want
to
give
you
very
specific
trainings
for
the
children.
D
H
And
that
might
be
virtual,
then
some
of
that
training
that
they
would
have,
because
I
think,
that's
just
critical,
not
having
to
drive
in
and
have
that
ritual
and
then
just
to
follow
up
on
that
is
there
again
in
the
rules,
especially
but
even
in
urban
areas.
Is
there
some
leeway
when
you
there's
a
crisis,
this
child
has
to
get
out
of
the
home
type
of
thing
to
take
them
into
a
family
member
that
hasn't
been
trained.
H
So
do
you
allow
for
that
because
they
haven't
looked
at
the
foster
system
yet,
but
they
you
need
a
place
for
this
this
child.
Do
you
take
them
into
homes
without
the
training?
If
it's
a
relative,
do
you
have
some
sort
of
a
leeway
on
that.
D
Yes,
ma'am
laurie
jackson
for
the
record.
We
we
prefer
to
place
with
family
members,
whether
you're
licensed
or
not.
We
do
offer
licensing
to
them
once
placement
has
occurred.
While
we
go
to
the
homes
we
take
the
child,
we
see
the
home.
We
have
some
safety
measures
in
place
so
that
we're
just
not
sending
a
child
to
a
family
member,
but
we
see
that
home.
We
talk
to
that
family
member.
We
explain
our
process
to
them
and
what's
going
on
and
usually
that
it
may
be
a
somewhat
more
lengthy
process
than
they're
anticipating.
D
They
always
think
things
can
sort
of
maybe
be
solved
in
a
couple
of
weeks
and
that's
not
always
the
case.
So
we
have
we.
That
is
always
our
first
response.
We
do
refer
them.
There
is
a
joint
program
that
came
out
with
a
department
of
welfare
so
that
if
a
family
member
or
fictive
kin
takes
a
child
and
they
they
meet
the
income
level,
they
can
get
some
payment,
while
they're
going
through
the
licensing
process
and
and
just
to
clarify.
I
don't
think
that
I
was
clear.
D
A
Thank
you
for
your
questions.
Are
there
any
other
questions
from
the
committee
that
I
missed?
I'm
not
seeing
any
at
the
moment
saying
I.
I
continue
to
have
audit
related
questions,
but
I
think
we
could
probably
go
over
those
during
when
we
meet
end
session
and
talk
about
what
the
status
of
some
of
those
issues
are
and
the
status
of
things
like
your
actuarial
study
on
rates
that'll
be
really
interesting
to
hear
about,
and
I
think
medicaid
is
going
through
some
actuarial
analysis
as
well.
A
A
We
are
going
to
move
on
to
agenda
item
8,
which
is
the
overview
of
commercially
sex
sexually
exploited
children
in
nevada
say
that
three
times
fast,
we
have
bridget
duffy
here,
I
think
probably
in
las
vegas
there.
She
is
to
present
on
this
issue.
Please
go
ahead
and
introduce
yourself
and
begin
when
you're
ready.
C
C
Okay,
so
again,
thank
you,
chair
peters
and
members
of
the
committee.
C
I
bridget
duffy
for
the
record,
and
I
am
presenting
to
you
today
the
overview
of
the
evolution
of
our
state's
policy
for
the
commercial
sexual
exploitation
of
children
in
nevada
and
presenting
it
as
a
as
our
past,
our
present
and
our
potential
future.
C
I
want
you
all
to
know
my
professional
title
may
make
you
wonder
why
I'm
the
one
presenting
today
I
was
basically
volunteered,
so
I
run
the
division
for
the
clark
county
da's
office
that
oversees
children
that
are
in
foster
care
and
in
the
juvenile
justice
system,
and
these
children
often
fall
within
this
this
realm
of
of
being
our
sexually
exploited
children.
But
I
am
an
active
part
of
our
statewide
commissions
regarding
the
the
treatment
and
prevention
and
and
services
to
these.
C
These
children
and
I've
been
doing
that
since
2015
and
I've
been
an
active
part
of
the
legislation.
So
I
think
I
was
selected
despite
the
fact
that
it's
odd,
maybe
that
a
prosecutor
is
presenting
this,
because
I
have
that
very
long,
extensive
history
of
our
past,
our
present
and
and
now
going
into
our
future.
C
So
I
have
just
a
few
slides
to
show
you
and
then
I'll
take
questions,
but
I'm
not
going
to
go
too
far
in
depth
in
this,
because
you
heard
a
lot
about
the
family.
First
prevention
act
earlier
today.
Our
treatment
of
our
children
that
fall
within
this
sexual
exploitation
has
a
lot
to
do
with
the
federal
laws
that
have
come
about
in
2014.
C
C
That
was
not
occurring
for
all
children
in
the
state
of
nevada
because
and
only
was
occurring
for
children
that
were
in
the
foster
care
system
at
some
level.
So
in
2014
the
federal
act
came
out
and
said
we
needed
to
start
transitioning
all
children
who
fall
within
this
category
to
the
child
welfare
system.
C
We
there
were
a
lot
of
children
that
were
identified
by
police
for
solicitation
of
prostitution
and
they
were
arrested,
detained
and
charged
and
adjudicated
for
those
offenses
in
the
delinquency
system.
C
So
then
the
2015
session
came
and
we
had
a
bill
ab153.
It
was
our
version
in
nevada
of
a
safe
harbor
law,
so
it
ended
up
being
codified
at
62c
240..
So
at
that
time
a
collaboration
of
community
partners
came
together
and
determined.
We
were
ready
as
a
state
to
ensure
that
we
were
not
adjudicating
or
for
those
who
don't
aren't
familiar
with
that
term.
That
would
be
familiar
and
criminal
would
be
finding
guilty.
We
call
it
adjudication
in
juvenile,
for
solicitation
of
prostitution
or
for
prostitution.
C
So
our
version
of
the
safe
harbor
law
then
would
allow
the
district
attorney's
office
to
still
file
the
charge
it
allowed
for
the
child
to
still
be
arrested
and
detained
for
the
charge,
but
we
were
not
able
to
formally
adjudicate
the
child
for
the
charge,
so
they
were
not
found
guilty
of
it.
We
were
only
allowed
to
supervise
and
provide
services
at
that
point,
and
only
for
those
two
acts.
C
The
court
could
still
order
out
of
home
services
and
out
of
community
placements
in
the
best
interest
of
the
child.
The
court
may
still
issue
all
orders
for
the
compliance
with
recommended
services,
meaning
he
could
still
order
a
child
or
he
or
she
could
still
order
the
child.
You
have
to
do
this,
and
if
you
don't
do
it,
then
your
your
consequences
could
become
greater
and
then
at
18
there
was
an
automatic
dismissal,
so
it
was
not
on
the
juvenile
record
at
18.
C
If
the
child
wasn't
complete
or
the
young
adult
wasn't
completed,
services,
the
young
adult
could
agree
to
stay
under
court
jurisdiction
longer,
but
that
again
was
up
to
that
young
adult
who
turned
18.
and
at
the
end
of
the
2015
session,
there
was
still
no
funding
for
safe
and
appropriate
housing
for
these
victims.
C
when
we
moved
that
effective
date
to
july
of
2022,
it
was
because
we
still
didn't
have
that
housing
option.
So
if
we
remove
the
housing
option
of
detention,
which
is
absolutely
not
appropriate
for
this
population
of
victims,
we
still
didn't
have
the
build
up
of
what
was
truly
needed
within
our
state
ab151,
which
is
very
special
to
me,
because
it
was
one
that
I
drafted
out
of
my
own
brain
concept.
C
It
was
a
little
odd
and
also
seemed
in
some
cases,
be
punishing
parents,
even
though
they
were
not
really
involved
in
it.
So
we
were
successful
in
addressing
the
legislature
and
the
lcb
to
create
this
standalone
statute
that
you
all
now
have
to
put
anything
you'd
like
to
with
regard
to
our
child
victims
of
sex
trafficking.
C
So
in
this
ab-151
it
is,
has
mandate
mandated
reporting
requirements.
So
now
anybody
who
is
a
mandated
reporter
of
child
abuse
and
neglect
if
they
have
reasonable
cause
to
believe
that
a
child
is
a
victim
of
commercial
sexual
exploitation.
They
are
required
to
call
in
a
report
to
the
intake
unit
of
the
child
welfare
agency.
C
C
It
requires
a
cross
report
to
law
enforcement,
so
we
can
hopefully
identify
the
trafficker
and
once
again,
there
was
no
funding
to
support
this
new
responsibility
on
child
welfare
agencies,
but
they
are
doing
it
and
I
think
we
heard
administrator
birch
mention
that
they
have
a
caseload
of
about
398
children,
since
the
child
welfare
agency
has
taken
on
this
role
in
clark
county.
C
So
in
2019,
when
we
go
back
to
sb
293,
it
started
out
as
a
very
aggressive
bill
that
mandated
what
type
of
housing
we
needed
mandated
that
housing
lay
in
the
responsibility
of
the
child
welfare
agency
and
ultimately,
with
the
stakeholders
discussing
it.
It
was
determined
we
really
needed
to
make
sure
we
were
building
up
the
correct
housing
for
these
victims,
and
so
this
interim
2020.
C
We
started
this
statewide
coalition
that
was
discussing
all
of
these
all
of
these
needs
involving
housing
as
well
as
service
services
and
potential
legislation,
so
that
coalition
started
three
subcommittees:
our
local
task
force
subcommittee
and
multi-disciplinary
team
subcommittee,
external
engagement,
funding
data
and
sustainability.
C
So
each
of
those
I
have
a
little
bit
on
each
of
those
subcommittees,
and
so
the
local
task
force
and
mdt
subcommittee
coordinated
the
interagency
approach
to
assessment
service
planning
and
case
management.
That
is
all
in
the
best
interest
of
our
children.
If
we
are
all
working
together
at
one
table
talking
about
the
same
child,
so
it's
not
in
various
silos
re-traumatizing
that
victim
and
making
sure
that
we
have
smooth
services
entering
for
that
child.
C
C
We
also
in
external
engagement,
we're
making
recommended
recommended
changes
to
nevada
211,
for
more
accessibility
for
survivors
and
families
and
providers
and
funding,
and
that
meant
a
requirement
found
within
last
year,
2021
session
sb,
143
funding
and
sustainability.
We
developed
a
comprehensive
statewide
csec
database,
we're
working
now
with
unlv
partners
and
looking
at
other
management
information
systems
to
connect
with
our
csec
case
management
systems.
C
It
took
the
work
from
the
2020
interim.
It
recognized
that
we
needed
a
continuum
of
care
for
our
victims
and
survivors.
It's
not
just.
We
need
one
thing:
there
are
different
levels
of
trauma
and
treatment
throughout
this
survivor's
journey,
our
victim's
journey
to
survivor
and
that
we
needed
to
make
sure
that
we
were
implementing
that
continuum
of
care.
One
very
significant
piece
that
was
determined
to
be
within
that
continuum
of
a
care
was
a
creation
of
our
creating
the
foundation
for
a
receiving
center.
C
C
It
moves
the
implementation
of
sb
293,
which
I
just
talked
about
earlier,
and
this
is
a
typo
on
my
slide.
So
don't
get
all
excited.
We
are
not
moving
it
to
it.
In
july
1st
of
2022,
it
got
kicked
to
july
1st
of
2023,
and
that
would
be
the
no
detainment,
no
adjudication
section
of
sb
293
and
once
again,
at
the
end
of
the
2021
session,
we
did
not
receive
any
funding
toward
any
housing
or
toward
the
staffing
the
needs
of
the
child
welfare
agencies
to
screen
and
assess
these
victims
for
services.
C
C
Many
of
them
come
from
recommendations
of
a
shared
hope
report
card
and
for
those
of
you
who
are
not
familiar
with
the
shared
hope
report
card,
it's
a
national
organization
that
looks
at
each
state
and
grades
it
a
through
f
on
their
response
and
treatment
of
child
sex
trafficking,
victims,
so
nevada.
I
have
it
with
me
here.
C
I
know
you
can't
see
me
because
my
power
points
up,
but
you
can,
if
you're
down
south,
we
had
an
f
for
the
2021
report
card,
so
the
statewide
coordinator,
esther
rodriguez
brown
and
I
reached
out
to
shared
hope,
international
to
talk
to
them
about
rf
and
when
we
were
concluded
talking
to
them
going
case
line
by
line
as
to
what
we
saw
and
some
of
the
things
that
I
think
we
could
have,
we
really
already
do
that
they
just
misinterpreted.
C
I
think
we
moved
up
to
a
pretty
solid
d
from
the
f
because
they
did
not
understand
our
statutes
again.
This
is
a
national
organization
and
they're,
not
you
know
trained
in
understanding
how
we
interpret
our
statutes.
So
I
think
we
moved
up
to
it
to
a
d
that
still
isn't
really
great
right
and,
and
it
actually
we've
come
a
long
way.
I
will
say:
we've
come
a
really
long
way
and
and
definitely
further
than
a
d.
C
So
there
was
a
shared
hope
report
card
years
ago
and
all
the
states
started
getting
a's
and
b's
and
and
moving
up
so
then
they
moved.
They
moved
it
out
and
said:
okay,
we
can
do
better
and
that
that's
you
know,
of
course
we
can
do
better.
We
can
always
do
better,
so
the
so
the
goal
line
kind
of
moved.
So
we
we
didn't,
we
haven't
been
to
flunky
forever.
We
actually
did
really
well
and
now
they've
moved
it,
and
now
we
need
to
progress.
C
So
some
of
the
recommendations
on
my
next
slide
are
recommendations
of
the
shared
hope
report
card
for
legislative
changes
and
and
the
stakeholders
among
these
coalition
groups
have
decided
that
these
they
would
like
me
to
present
these
to
you
so
possible
legislation,
mandate,
the
creation
of
multidisciplinary
teams
to
collaborate
and
prevent
additional
trauma
for
our
victims
and
survivors.
C
We
are
actively
working
right
now
on
the
shell
of
that
legislation.
Within
a
legislative
subcommittee,
there
are
foundations
within
statute
already
for
multi-disciplinary
teams
around
issues
that
impact
our
children
and
families
within
our
statute,
so
that
one
we
are
hoping
will
be
an
easy
fix
to
mandate
that
that
team.
C
Right
now,
in
clark
county,
we
are
already
screening
children
that
are
coming
into
the
system,
either
juvenile
justice
or
child
welfare.
It
is
just
not
statutorily
mandated
that
we
do
so.
I
am
unfamiliar
with
what
the
rest
of
the
state
is
currently
doing.
I
know
that
we
have
talked
about
everybody
in
the
state
using
the
same
screening
tool
and
hopefully
that
will
be
rolled
out.
C
The
next
one
is
to
create
stronger,
safe,
harbor
statutes.
There
are
so
many
versions
of
safe
harbor
statutes
across
the
country.
It
would
definitely
be
a
policy
decision
among
members
to
decide
where
they
wanted
to
take
the
state
of
nevada,
ensure
the
extension
of
foster
care
to
cover
young
adults
aged
21
to
age
21.
C
in
2019
and
in
2021.
There
were
two
bills
that
were
addressing
this
very
issue.
I
put
them
for
reference
for
you
there.
I
think
we
are
moving
in
that
direction.
We
just
need
to.
We
need
a
little
more
technical
assistance.
I
think
in
the
state
extend
the
ability
to
testify
by
alternative
means
to
all
victims
under
the
age
of
18.,
so
a
child
who
is
a
victim
of
sex
trafficking
right
now,
who
is
16
or
above
does
not
have
the
alternative
to
testify
the
the
ability
to
testify
by
alternative
means.
F
D
Definition
of
child
abuse
and
neglect
under
nrs
432
b,
but
I
also
work
with
some
people
who
would
work
with
the
county
and
was
talking
a
little
bit
to
them
and
was
stating
that
that
would
be
a
problem,
because
that
would
require
cps
people
to
work
with
pimps
and
potentially
even
family
members.
A
C
Yes,
thank
you
for
the
question:
assemblywoman
gorlo
bridget
duffy
for
the
record.
Actually,
that
is
not
too
much
of
a
difficult
fix.
I
will
say
so
currently
in
the
court
improvement
realm
through
the
nevada
supreme
court.
We
are
working
on
on
legislation
and
one
of
those
pieces
of
legislation
is
actually
to
add
to
the
definition
of
sexual
exploitation
within
nrs432b
commercial,
sexual
exploitation.
C
So
that
would
then
apply
to
parents,
guardians
or
persons
responsible
for
a
child's
welfare
who
commercially
sexually
exploit
a
child
only
to
them
and
and
sometimes
parents
are
responsible
for
those
things.
So,
unfortunately,
so
sometimes
they
are
so
it's
not.
It
is
something
that
we
are
missing
within
within
nrs432b,
it's
something
that
was
also
brought
out
by
shared
hope.
C
We
do
have
sexual
exploitation
listed
as
a
definition
of
child
abuse
in
nrs432b,
but
there
are
some
who
believe
that
that
doesn't
go
as
far
enough
to
to
capture
commercial
sexual
exploitation
of
a
child
and
it
it
would
only
then
apply
to
those
parents
who
do
it
or
guardians.
C
A
H
Thank
you,
madam
chair,
and
miss
duffy.
Thank
you
for
your
presentation,
your
continual
advocacy
of
the
youth
in
nevada,
so
much
appreciated.
I
just
have
to
kind
of
go
back
to
your
last
statement
on
some
ways
to
improve
this,
and
you
mentioned
legalized,
prostitution,
and
so
did
you
say,
eliminating
legalized
prostitution
in
nevada
as
one
of
your
goals
or
one
of
your
solutions.
C
H
Yeah,
so
so
just
I
just
want
to
focus
on
that
for
a
little
bit
for
as
a
county
health
officer
in
lyon,
county
in
a
county
who
has
legalized
prostitution
and
where
I
have
been
in
and
inspected
the
brothels
here
in
our
county
wondering
what
data
you
have,
that
there
is
a
expansion
of
childhood
or
in
our
legal
brothels
in
the
state
of
nevada.
C
Again,
thank
you
for
the
question.
Assemblywoman
titus
bridget
duffy
for
the
record,
so
I'm
gonna,
I'm
gonna
do
my
best.
I
wish
I
had
my
partners
from
up
north
with
me
from
awaken,
because
this
has
been
a
long
conversation
with
them
over
the
years.
C
So
one
of
the
recommendations
from
shared
hope
included
that
elimination,
because
of
the
message
that
it
sends
because
it's
bleeding
over
into
our
illegal
and
starting
with
our
children
that
are
being
trafficked
in
the
streets
and
then
bringing
them
up
and
then
into
the
legal
houses
of
prostitution,
that
if
we
can
get
rid
of
that
stigma
that
it's
okay
at
all
to
buy
sex,
then
we
would
be
assisting
our
children
that
are
being
picked
up
on
the
streets.
C
And
I
I
really
am
not
the
best
one
to
talk
about
about
the
specific
issues
as
I.
This
is
one
that
our
advocates
that
we
work
with
in
the
collaborations
across
the
state.
Although
I
I
do
agree-
and
I
agree
to
put
it
in
the
slide
as
a
as
one
of
the
bold
recommendations
that
the
group
has
coming
forward.
H
Great
thank
you
because
I,
I
would
argue
that
perhaps
in
clark
county
in
washer
county,
you
see
that
perhaps
more
and
I'm
just
concerned
that
by
that
broad
statement
to
eliminate
all
there
may
actually
be
an
increase
in
illegal
trafficking,
and
I
just
have
some
concerns.
So
there's
there's
much
further
dialogue
that
has
to
happen
with
that
and
that
statement
just
kind
of
caught
me
by
surprise.
So
thank
you
for
that.
Thank
you.
Manager.
A
A
A
We
have
some
folks
from
rite
of
passage.
I
don't
they're
not
up
here,
so
I
assume
that
they're
either
online
or
in
las
vegas,
but
please
introduce
yourself
and
proceed
when
you're
ready.
B
A
We
can
see
the
slides
in
the
north.
Are
there,
can
you
guys
see
them
in
the
south
and
on
the
virtual
screams.
B
Thank
you
for
going
out,
okay.
Well,
thank
you
very
much
for
inviting
us
to
testify
today
and
participate
in
this
we're
going
to
talk
about
the
intersection
between
homelessness
and
commercially
sexually
exploited
children.
My
name
is
lawrence
howell
for
the
record.
I'm
the
chief
administrative
officer
for
rite
of
passage.
B
The
right
of
passage
is
a
is
a
long-standing
nevada.
Non-Profit
has
been
working
with
kids
for
over
35
years,
we
provide
shelter,
outpatient,
foster
care
and
residential
treatment
to
a
teenage
youth
that
are
victims
of
commercial
sexual
exploitation.
B
We
consider
them
partners
and
we
collaborate
with
every
single
one
of
them
from
dcfs
to
clark
county
members
of
the
committees
and
the
commissions.
We
we
sit
on
those
committees
and
those
commissions
with
them,
and
it's
clear.
We
are
one
part
of
a
very,
very
big
issue
and
we're
just
happy
to
be
here
and
happy
to
answer
any
questions
that
you
may
have.
B
I'm
just
going
to
do
the
introduction
hand
it
over
to
our
director
of
our
las
vegas
program
to
present
a
few
things
and
then
answer
questions
for
you
guys.
So
in
las
vegas
we
serve
youth,
c-sec
victims
in
a
shelter
and
in
an
outpatient
environment
and
drop-in
center.
B
We
have
a
safe
house
for
six
youth
in
clark
county,
but
we
went
to
d.c
for
the
funding
and
we're
the
only
youth
program
in
the
state
of
nevada
selected
to
receive
funding
for
that
and
the
the
facility
opened
up
about
a
year
ago
and
is
going
really
really
well.
So
I
think
that
mikaya
will
speak
more
about
that
also,
so
we're
going
to
transition.
Now
to
makaya
swain,
who
is
the
director
of
the
embracing
project
and
the
racing
project,
is
our
las
vegas
hub
of
services
for
homeless
and
sexually
exploited
youth.
B
She
is
the
director
of
the
program
she's,
a
long-time
advocate
on
the
streets
in
the
community,
with
the
kids
really
fighting
for
sexually
exploited,
youth
and
and
homeless,
youth
and
everything
that
we're
talking
about
today.
So
with
that,
I
will
hand
it
over
to
makaya
and
I
will
drive
the
slides
as
she
directs.
L
Thank
you.
Can
everyone
hear
me?
Okay,
we
can
thank
you
for
the
record.
My
name
is
makaya
swain.
I
am
the
director
of
the
embracing
project
here
in
las
vegas,
just
a
little
bit
of
an
overview
of
some
of
the
services
and
then
we'll
get
into
the
topic
at
hand.
We
do
offer
wrap-around
trauma-informed
services
for
youth
victims
and
survivors
of
interpersonal
violence,
not
just
sex
trafficking,
also
sexual
assault,
molestation
domestic
violence
and
any
other
interpersonal
violence
that
the
kids
may
have
experienced.
L
We
have
three
sides
to
our
program.
We
have
our
sexually
supported
youth
program,
which
is
focused
on
the
sexual
exploitation
of
children.
We
have
our
mentoring
program,
which
functions
more
as
a
prevention
program,
focusing
on
connecting
teens
any
kids
between
12
and
18,
with
either
individual
mentoring
or
group
mentoring,
and
then
we
have
as
long
as
mentioned
our
housing
program
for
six
youth
that
is
c-sec
specific.
L
We
we
focus
a
lot
on
court
advocacy
court
accompaniment
when
kids
are
going
to
testify
individual
advocacy
in
the
community.
I'm
sure,
as
you
can
imagine,
children
who
have
been
exploited
do
have
difficulty
advocating
for
themselves
and
the
needs
that
they
have
and
also
being
taken
seriously
by
adults
around
them
because
of
their
age
and
some
of
the
things
in
their
history.
L
In
our
drop-in
centre,
we
are
central
to
las
vegas
we're
in
the
downtown
area.
We
picked
this
location
on
purposefully,
because
before
before
we
had
our
first
drop
in
centre,
youth
were
traveling
all
around
clark
county
to
receive
services.
They
would
receive
some
things
in
north
las
vegas,
some
things
in
the
east,
some
things
in
the
middle
and
they
were
getting
around
primarily
on
the
bus,
as
they
lack
supportive,
adult
figures
in
their
life
that
will
help
them
with
transportation.
L
We
do
a
lot
of
family
support
because
it
is
an
a
total
family
issue
and
then,
in
order
for
us
to
have
the
best
outcomes,
we
do
need
to
identify
support
systems
that
might
be
blood
related
family
or
that
might
be
their
chosen
family
to
make
sure
that
once
they
do
exit
our
program
once
they
are
finished
with
services.
Here
they
have
people
around
them
who
are
going
to
support
them
in
the
needs
that
they
have.
L
We
have
a
ccsd
approved
school
here.
We
we
operate
through
the
adult
education
program,
which
has
been
absolutely
fantastic.
You'll
you'll
see
that
a
lot
of
the
services
that
we
provide
to
kids
were
born
out
of
need.
Originally,
we
did
just
start
with
bsd
and
psr
services,
but
as
we
got
more
and
more
kids
in
the
program,
we
noticed
more
and
more
needs
coming
up.
L
So
as
the
needs
grew
and
as
we
were
struggling
to
find
other
service
providers
to
fulfill
those
needs,
we
expanded
our
programming
and
adjusted
to
to
meet
the
needs
of
the
kids
that
we
work
with,
and,
I
will
say,
kids
a
lot,
but
they
are
12
to
20
21.
So
you
know
big
kids,
but
I
will
refer
to
them
as
kids.
We
have
like.
I
said
we
have
our
school
here.
L
What
we
were
noticing
one
was
that
we
had
a
lot
of
the
kids
in
the
program
were
at
our
drop-in
center
during
the
day
when
they
were
supposed
to
be
in
school,
and
so
we
addressed
the
issue
with
them
and
asked
them
what
was
going
on
in
school,
and
they
were
just
having
a
lot
of
trouble
functioning
in
a
traditional
school
environment.
L
L
Some
of
the
kids
were
still
under
the
hands
of
the
their
traffickers,
so
they
would
sleep
in
class,
get
in
trouble,
things
would
happen
in
school,
there
was
fighting
and
they
just
they
really
liked
the
resources,
internal
resources
and
external
resources
to
be
successful
in
a
traditional
school.
So
we
brought
the
school
into
our
program
and
we've
seen
at
the
moment
we've
seen
about
25
kids
graduate
through
our
school.
L
We
should
have
some
more
graduates
this
year
as
well,
which
would
be
fantastic,
and
it's
just
it's
a
really
great
environment
for
them
to
be
in
because
they
can
attend
school,
but
if
they
need
a
break,
if
they
need
a
nap
if
they
need,
if
they're
having
a
bad
day,
and
they
need
to
cry
they
can
they
can
do
that,
and
we
have
great
teachers
here,
we're
always
assigned
special
education
teachers.
L
For
the
most
part,
the
majority
of
the
kids
we
work
with
would
qualify
for
an
iep,
however
they're,
not
in
school,
long
enough
to
actually
get
assessed
for
an
iep,
so
that
school
has
been
the
school's,
been
fantastic.
We
actually
have
school
today,
so
it
might
get
a
little
bit
loud
behind
me.
L
We
we
also
have,
of
course,
basic
necessities:
clothing,
hygiene,
food
things
that
kids
need
just
just
to
survive,
because
if
we
can
provide
them
here
it
it
saves
them
from
having
to
go
out
and
and
look
elsewhere
for
those
basic
necessities
and
at
the
end
of
the
day
when,
when
we're
speaking
about
kids
from
families
that
don't
have
extensive
resources
when
it
comes
to
things
like
hygiene
products
and
clothing
and
things
school
supplies.
L
When
we're
given
the
choice
to
provide
a
roof
over
our
heads
and
food
or
get
things
like
hygiene
items
and
clothing
and
school
supplies,
we're
going
to
choose
the
things
like
shelter
and
food.
So
we
do
have
those
basic
needs
here.
We
also
do
a
lot
of
job
readiness,
whether
that's
resume,
building
interview
skills
where
we're
really
teaching
and
and
helping
to
educate
kids
on
how
they
can
function
in
in
a
world
that
is
jobs
and
and
working
in
establishments
and
businesses
and
working.
L
You
know
filing
taxes,
all
of
those
things
that
come
that,
where
they're
not
necessarily
taught
in
school
they're,
certainly
not
taught
those
things
on
the
streets.
So
it's
transitioning
kids
from
where
they
were
before
and
how
they
think
about
money
and
working
and
things
like
that
into
okay.
Let's
look
at
careers
and
things
that
you
can
do
and
get
you
qualified
for
for
jobs
here
in
in
vegas
or
elsewhere.
L
If
they
choose
to
move,
we
do
a
lot
of
life
skills,
education,
that's
working
on
communication
skills,
social
skills,
identifying
we
we
do
have
to
do
a
lot
of
work
on
identifying
toxic
or
violent
relationships
or
relationships
that
aren't
very
unhealthy.
L
For
the
most
part,
many
of
the
kids
we
work
with,
and
for
and
I
will,
with
this
caveat
in
in
2020,
we
did
serve
121
sexually,
exploited
youth.
So
at
the
time
of
their
intake,
which
is
their
first
day,
we
take
them
through
a
comprehensive
intake
and
ask
them
about
their
lives.
L
So
at
that
time,
49
of
those
kids
did
identify
as
either
having
witnessed
or
experienced
domestic
violence
and
in
addition
to
that,
another
quarter
of
the
kids
had
experienced
dating
violence
in
their
intimate
relationships
outside
of
the
relationship
with
the
with
the
trafficker.
L
So
when
we
speak
about
kids,
who
are
surrounded
by
violence
or
violent
families
or
just
chaotic
families
and
relationships,
they
have
a
lot
of
difficulty
identifying
what
a
healthy
relationship
is
and
that's
not
just
within
the
within
the
family
unit
or
within
dating
relationships.
It's
also
within
support
systems,
so
it
can
be
uncomfortable,
sometimes
for
kids,
when
they
first
start
the
program,
because
we
are
a
building
full
of
very
supportive
adults
who
who
are
looking
for.
You
know
healthy
relationships
with
the
clients
that
we
work
with.
L
L
Of
course,
we
do
a
lot
of
mentoring,
pro
modeling
social
behaviors.
We
do
have
kids
who
bring
their
kids
here,
so
we
we
assist
them
with
that,
making
sure
we're
getting
them
connected
with
the
proper
parent
education
and
just
really,
if
there
is
a
need
that
one
of
the
kids
has
here.
If
we
cannot
fulfill
it,
we
reach
out
to
our
partners.
We
have
fantastic
partners,
we
partner
with
signs
of
hope,
formerly
the
great
prices
centre,
family,
child
treatment
of
southern
nevada.
L
We
have
an
extensive
range
of
partners
that
really
we've
all
come
together
to
support
these
to
support
kids
as
best
as
we
can.
We
do.
Also.
As
I
mentioned,
we
do
work
with
the
whole
family.
So
we
have
a
parent
support
group
for
parents
who
have
sexually
exploited
children.
So
we
do
have
a
parent
support
group,
but
we
also
do
parent
education
and
and
to
connect
between
homelessness
and
sexual
exploitation
as
I've.
L
Given
you
a
little
bit
of
a
picture
that
we
we
work
with
the
kids
that
we
work
with
79
of
the
kids
that
we
work
with
worked
with
in
2020
at
the
time
of
the
intake
identified
that
they
had
run
away
at
least
once,
and
that
was
only
at
least
once,
and
that
was
from
ranging
from
three
days
till
we
had
one
young
lady
who
had
been
a
runaway
for
two
years
and
she
had
actually
lived
in
california
in
the
tent
city
and
that's
where
she
lived
for
two
years
at
the
age
of
15..
L
So
we
talk
about
runaway,
they
are
it's
an
unsafe,
it's
unsafe
for
children
to
be
on
the
streets
looking
for
shelter
and
that's
when
a
lot
of
sexual
exploitation
can
occur.
One
of
the
very
underreported
forms
of
sexual
exploitation
is
youth,
who
are
engaging
in
survival.
Sex
survival,
sex,
meaning
exchanging
sex
for
anything.
That
is
a
basic
necessity.
L
L
L
So
there's
that
it
creates
a
very
large
imbalance
of
power,
as
I
said
not
always
considered,
sea
sec,
and
it
is
a
very,
very
underreported
already.
Trafficking
itself
is
very
underreported,
because
some
victims
and
survivors
do
have
difficulty
identifying
themselves
as
themselves
as
being
victimized,
but
also
have
difficulty
reaching
out
and
letting
other
people
know
that
things
are
happening
to
them.
L
That
could
be
considered
victimization,
because
there
is
a
lot
of
still
a
lot
of
stigma,
a
lot
of
shame
and
a
lot
of
victim
blaming
with
trafficking,
despite
all
the
education
despite
the
documentaries.
Despite
all
these
things
that
we
as
a
community
and
the
public
have
access
to.
There
is
still
a
lot
of
shame,
shaming
of
victims,
which
creates
a
situation
where
they
may
not
feel
safe
or
like
they
can
trust
anyone
to
report
the
crimes
that
that
are
occurring
and
it
also
it
it.
L
L
We
all
of
these
things
are
happening
in
one
child
at
one
time
and
again,
as
I
said,
mental
health
issues
as
well.
So
if
you
can
imagine
putting
all
of
these
issues
into
one
child,
the
push
and
pull
factors
for
trafficking
are
just
tremendous,
a
lot
of
our
objectives.
Here,
as
I
said,
our
programs
were
born
out
of
need.
L
So
when
we
established
the
safe
house
for
c-sec
children,
it
was
brought
out
of
need.
We
had
youth
here
in
our
program,
who
were
maybe
being
kicked
out,
maybe
running
away
from
a
situation
where
there
was
violence
in
the
home.
We
we
had
a
about
in
2020,
we
had
about
60
of
the
kids
identified
as
experiencing
sexual
assault
or
molestation,
either
in
the
home
or
on
the
streets.
L
These
are
the
situations
they're
trying
to
get
away
from,
and
sometimes
these
are
the
situations
that
they
end
up
back
in
when
they
are
when
they
do
not
have
safe
shelter.
So
when
we
created
that
house,
it
was
to
an
an
extension
of
the
programming
that
was
already
working
for
the
kids.
It
was
to
surround
them
with
comfort
to
help
make
them
feel
safe
to.
L
Let
them
know
that
it
was
okay
to
be
there
in
their
own
individual
selves
and
to
be
accepted
by
people
in
the
community
and
to
let
them
know
there
is
still
a
really
big
place
for
you
in
our
community.
So
we
did
create
that
house
right
now.
We
have
four
young.
L
Ladies
in
the
house,
we
have
had
a
total
I'm
estimating
here,
but
we
have
had
a
total
of
11
kids
go
through
the
house,
many
of
whom
have
transitioned
over
into
their
own
independent
living
situation,
whether
that's
in
an
apartment
of
their
own
or
they've
transitioned
into
a
more
permanent
housing
program.
L
Escaping
me
now,
but
we
do
work
with
a
lot
of
the
homeless
youth
programs.
Here,
because
again
we
have
a
program
of
six
beds.
Six
beds
is
not
enough,
and
when
you
hear
richard
talk
about
funding
and
things
like
that,
the
funding
is
is
not
there
and
it
is
needed.
We
have
right
now,
four
kids.
In
there
we've
identified
many
more
who
need
housing
and
they
do.
We
have
children
who
are
currently
receiving
services
from
us
who
are
in
child
haven
who
are
in
the
homeless,
youth
shelters.
L
We
have
young
adults
who
are
currently
in
the
the
at
the
adult
shelters.
So
there
is
a
very
large
need
for
this,
so
as
we
that
is,
one
of
our
objectives
is
to
increase
our
capacity
for
providing
that
safe
and
stable
transitional
housing
for
the
children
and,
of
course,
our
goal
and
our
always
our
objective
is
to
provide
services
that
meet
the
individual
needs
of
the
youth.
L
Although
we
have
kids,
who
might
have
been
in
similar
situations
and
even
children
who
might
have
been
exploited
by
the
same
person,
their
needs
are
very,
very
different
and
it
does
require
us
to
adapt
to
each
individual,
and
that
is
the
care
that
they
deserve.
So,
as
I
said,
we
have
individual
group
and
family
therapy.
We
have
four
therapists
at
the
moment,
who
are
all
very,
very
well
versed
in
trauma,
but
also
the
issues
of
sea,
sick
substance,
abuse,
domestic
violence
and
a
host
of
other
issues
as
well.
L
We
do
a
lot
of
crisis
intervention,
as
I
spoke
about
before
kind
of
the
the
profile
of
the
kids
that
we
work
with.
There
is
a
lot
of
crisis
situations
that
come
up.
They
do
not
have
a
lot
of
coping
skills
as
we
think
about
them
in
the
traditional
sense.
L
They
do
have
a
very
high
threshold,
unfortunately,
for
suffering
as
at
the
hands
of
adults
usually
and
for
violence,
but
they
do
not
have
a
lot
of
coping
skills
to
deal
with
a
lot
of
the
issues
that
come
up
in
regular
team
life.
That
is
relationships
that
is
disagreements
with
parents.
A
lot
of
these
regular
type
issues
they
they
do
not
have
the
carbon
skills
or
de-escalation
skills
to
deal
with
those
issues.
L
So
we
do
a
lot
of
crisis
intervention
not
only
with
the
kids,
but
we
also
partner
with
signs
of
hope
to
our
man
or
lady.
If
you
will
the
24
7
human
trafficking
hotline,
the
alert
hotline
here,
which
is
an
in-person
response
to
identified
victims
of
human
trafficking,
so
we
do
partner
with
them
to
operate
that
hotline
again.
This
is
crisis,
intervention,
we're
interacting
with
victims
and
survivors
on
what
could
be
possibly
one
of
the
worst
nights
of
their
life.
L
It
does
take
a
lot
of
de-escalation
and
a
lot
of
just
being
with
them
in
the
moment
and,
of
course,
the
follow-up
that
comes
from
that
as
well.
As
I
said,
we
have
our
school
program
here.
We
do
need
obviously
right
now.
We
are
doing
two
days
a
week
which
is
working
for
a
lot
of
the
kids,
but
we
will
eventually
need
to
expand
that
to
more
availability.
We
will
need
some
more
nights.
L
We'll
need
early
mornings
because
we
we
are
working
with
teens
who
have
kids,
have
jobs,
have
other
responsibilities,
and
they
do
need
that
expansion
of
that
school
program,
material
resources,
anything
that
kids
might
need
that
are
basic
necessities.
We
try
to
have
on
hand
here
at
our
dropper
centre.
Everything
that
we
have,
that
is
material
is
donated.
L
Our
girl
circle
program
is
part
of
our
prevention
program,
so
that
is
our
group
mentoring
for
kids,
who
are
just
starting
to
to
get
into
trouble,
starting
to
become
system
involved
or
people
are
noticing
that
they're
having
difficulties
empowering
classes.
We
we
adapt
to
the
time.
So
we
we
create
a
lot
of
classes,
like
I
said
around
healthy
relationships,
budgeting
managing
money,
also
around
kind
of
what
money
means
to
the
kids
we
work
with.
L
We
do
a
lot
of
classes
around
that
photography
class,
we're
really
trying
to
find
things
that
that
bring
the
kids
joy.
Unfortunately,
a
lot
of
the
kids
we
work
with
when
we
ask
them
what
are
some
things
that
you
enjoy
doing?
They
don't
have
a
lot
of
things
that
they
enjoy
doing.
They
don't
have
a
lot
of
regular
teen
experiences
when
we
talk
about
hobbies
and
sports,
and
things
like
that,
so
we
try
to
introduce
them
to
as
many
things
as
possible.
L
L
We
have
one
girl
who
really
likes
to
crochet
that
she
didn't
know
how
to
crochet,
but
we
do
try
to
introduce
them
to
as
many
positive
activities
as
possible
and
then
that
employment
support
I'm
sure,
as
you
can
imagine,
children
who
don't
have
extensive
resources
and
and
don't
come
from
families
with
significant
resources
they
they
are
looking
for
jobs
at
15
and
16
and
getting
into
the
workforce.
So
we
we
do
support
them.
L
In
that
we
we
do
a
lot
of
resume
building
practicing
interview
skills
going
with
them
down,
so
they
you
know
standing
on
the
outside
of
the
store.
While
they
go
inside
to
ask
the
hiring
manager
just
a
lot
of
support
in
that
way
and
then
helping
them
with
clothing
once
they
do
find
a
job
helping
them
with
their
taxes.
We,
as
I
said,
everything
that
we
have
here,
was
born
out
of
the
need
and
and
what
the
kids
were
requesting
and
what
the
needs
that
they
had.
L
That
is
what
we
do
and,
yes,
that
is
off.
If
anyone
has
any
questions,
please
let
me
know.
B
Yeah
I
just
wanted
to,
can
you
guys
hear
me?
Okay,
the
best
example
I
can
give
on
where
homelessness,
youth,
homelessness
and
and
seasick
those
issues
collide.
Was.
Last
year
we
had
a
young
lady
who
was
constantly
asking
for
bus
passes,
which
we
provided
the
embracing
project
and
when
we
finally
dug
into
why
she
needed
a
bus
pass
because
she
was
being
exploited.
She
did
not
feel
safe
in
in
shelters
that
were
offered
to
her.
So
she
was
sleeping
on
the
bus
at
night,
and
so
she
would
get
on
the
bus.
B
She
would
tell
the
bus
driver
I'll
be
in
the
back.
I'm
going
to
go
to
sleep.
The
bus
drivers
had
an
agreement
to
just
leave
her
alone,
and
it
was
so
sad
and
so
disheartening.
When
we
found
out
about
that,
she
was
surviving.
She
was
doing
whatever
she
could
to
survive
because
she
had
no
place
to
live.
She
was
homeless,
and
so
once
we
found
that
out,
we
we
connected
her
with
other
community
resources
that
were
safe
and
that
really
got
us
motivated
to
get
the
safe
house
started
for
situations
like
that.
B
Where
you
discover
something
today
and
you
need
to
deal
with
something
tonight,
and
so
now
we
have
that
house,
it's
called
canyon
view,
shelter
and
canyon
view
is
there
for
that
type
of
situation
while
we
work
on
something
more
permanent,
so
that
being
said,
thank
you
very
much.
I,
like
I
said
before.
We
we
partner
and
collaborate
with
just
about
everybody
who
has
spoken
today
and
and
who's
gonna
speak
it's
a
big
big
issue
and
we're
very
proud
to
be
part
of
this
group.
That's
doing
something
about
it.
A
Thank
you
for
the
presentation.
I
have
a
quick
question:
how
many
nights
on
average
do
you
have
a
person
in
your
safe
house
in
during
one
stay?
What's
the
average
stay?
Look
like
there
because
you
said
it's
six
beds
right.
B
Right,
it's
six
beds,
it
could
it
could?
It
really
varies
depending
on
the
and
the
needs
of
the
child.
We've
had
one
young
lady's
been
there
for
five
months,
and
we
have
some
kids
that
are
there
for
five
days
and
we
have
we
had
one
that
was
there
less
than
five
hours.
So
it
really
just
depends
on
the
needs
of
that
individual
kid.
A
Wow,
okay:
are
there
any
questions
from
the
committee
on
this
issue?
I'm
not
seeing
vegas.
So
if
you
have
a
question,
please
pop
on
your
microphone
and
say
me
well
really
interesting
program.
It
sounds
like
what
what
your
big
look
to
the
future
is
to
expand
and
be
able
to
offer
more
beds,
and
maybe
more
community
partnerships
to
ensure
that
we
have
places
for
long-term
places
for
those
kids
to
go.
A
H
B
We
actually
have
26
sexually
exploited
youth
girls
in
that
program,
right
now,
under
a
nevada
prtf
license,
because
there
was
no
real
place
to
to
put
it,
and
so
last
year
we
got
it
licensed
as
a
prtf
psychological
residential
treatment
facility
and
the
girls.
There
are
we're
really
trying
to
build
a
continuum,
so
we
have
the
drop-in
center
and
then
we
have
the
safe
house,
and
now
we
have
a
prtf
for
the
girls
that
are
really
traumatized
really
need.
B
Intensive
therapy
that
place
is
is
very
effective
as
remote
in
the
mason
valley
there
and
you
know,
with
30
or
less
girls
there.
We
can
really
provide
a
lot
of
intensive
services
and
then
hopefully,
transition
them
back
to
the
community
through
the
drop-in
center
or
to
a
whole
new
community,
depending
on
their
individual
needs.
H
B
People
they're
not
they're,
mostly
nevada,
mostly
nevada,
girls.
Right
now,
but
like
we
have
a,
we
have
a
program
for
sexually
exploited
youth
in
hawaii,
and
we
have
one
in
the
los
angeles
county
area
and
sometimes
the
victims
need
to
get
out
of
where
they're
at
to
get
away
from
the
people
that
are
exploiting
them.
So
we
actually
have
two
girls
from
hawaii
in
yarrington
and
there's
a
couple
of
california
girls
that
we
sent
to
hawaii
to
really
create
some
distance
between
them
and
the
situation.
B
H
And
last
question:
if
I
might
so
so
in
in
the
one
in
mason
valley,
you
said
you
have
26
gals
there
now
and
what's
your
capacity.
B
It's
licensed
for
50,
but
we're
very,
very
selective
in
who
we
take
and
the
services
that
they
need.
So
right
now,
we've
got.
We
have
a
waiting
list
of
youth
that
need
to
get
in
and
but
we're
we're
at
26,
because
right
now
that's
what
the
mill
you
can
safely
handle.
A
B
A
D
Lori
jackson,
social
services
manager
for
rural
child
welfare.
Thank
you.
I'm
going
to
talk
a
little
bit
about
specialized
or
treatment,
foster
care,
and
it's
a
very
quick
overview
of
what
those
services
are.
As
you
can
see,
we're
going
to
talk
a
little
bit
about
what
a
higher
level
of
care
is,
the
criteria
for
that
the
training
and
then
the
challenges
specialized,
foster
care
can
also
be
known
as
treatment,
foster
care,
specialized,
foster
care
or
advanced
foster
care
is
our
the
rural
child
welfare
version
of
specialized
foster
care.
D
D
We
use
a
system
of
care
approach
in
these
specialized
foster
homes
with
specialized
training.
They
are
specialized
training
in
together
facing
the
challenge,
which
is
a
specific
program
that
duke
and
penn
universities
were
able
to
develop
and
I'm
sorry
I
slide
whoever's
working
the
slides.
I
think
you
can
go
one
more.
Thank
you.
D
D
D
Specialized
foster
karen
and
the
staff
in
specialized
foster
care
are
providing.
The
train
are
provided
the
together
facing
the
challenge,
training
that
these
homes
have.
This
training
is
geared
toward
the
foster
care
provider.
It
has
an
ancillary
benefit
to
the
job
to
the
child,
because
that
foster
care
provider
is
has
a
coach
that
they
work
with.
That
is
a
supportive
and
involved
relationship
between
that
coach
and
that
foster
parent.
It
uses
effective
behavior
management
strategies
and
it's
a
supportive
and
involved
relationship
between
foster
parents
and
youth
in
their
care.
D
D
The
challenges
and
strategies
I
won't
go
over
again.
I
went
over
them
in
the
last
presentation.
I
think
you've
heard
it
about
three
times
now.
We
specialized
foster
homes
were
a
little
more
immune
than
family
foster
homes
at
loss.
We
didn't
lose
as
many
of
them,
but
we
don't
have
enough
to
begin
with
so
the
behavioral
issues
that
we
were
seeing
coming
out
of
the
pandemic.
In
my
first
presentation
I
talked
a
little
bit
about.
There
were
less
calls,
but
those
calls
were
much
more
severe
and
there
was
much
more
trauma
involved.
D
A
So
much
are
there
any
questions
from
the
committee
on
the
brief
presentation
on
this
issue.
All
I
see
is
senator
donate.
So
if
you're
in
clark
county,
please
go
ahead
and
unmute
yourself,
I'm
not
hearing
any
questions
today
on
this.
Thank
you.
So
much
for
being
here
really
appreciate
what
you
do
and
your
program.
A
That
is
a
good
place
for
us
to
break
for
lunch.
I
believe
there
is
lunch
in
clark,
county
and
here
as
well,
and
we
can
discuss
which
room
it
is
we're.
Gonna
do
30
minute
lunch.
We're
gonna,
do
a
30
minute
lunch
since
food
is
in
the
building.
Sorry
for
those
who
are
virtual.
A
I
hope
you
brought
lunch
to
work,
but
we
will
we
will
go
ahead
and
recess
and
be
back
here
at
like
1
15..
Thank
you
so
much.