MINUTES OF MEETING

      ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

 

      Sixty-seventh Session

      January 21, 1993

 

 

 

The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at 1:15 p.m., Thursday, January 19, 1993, in Room 330 of the Legislative Building, Carson City, Nevada.  Exhibit A is the Meeting Agenda, Exhibit B is the Attendance Roster.

 

 

COMMITTEE MEMBERS PRESENT:

 

      Ms. Jan Evans, Chairman

      Mrs. Vivian L. Freeman, Vice Chairman

      Ms. Kathy M. Augustine

      Ms. Marcia de Braga

      Mr  James A. Gibbons

      Mr. Dean A. Heller

      Mr. William A. Petrak

      Ms. Gene W. Segerblom

      Ms. Stephanie Smith

      Mr. Louis A. Toomin

     

 

 

COMMITTEE MEMBERS ABSENT:

 

      Mr. Wendall P. Williams

 

GUEST LEGISLATORS PRESENT:

 

      None

 

STAFF MEMBERS PRESENT:

 

      Kerry Carroll Davis, Research Analyst

 

OTHERS PRESENT:

 

      See attached attendance roster (EXHIBIT B).

 

John Sarb, Administrator, Division of Child and Family Services, addressed the committee.  The duties and functions of the division's four operating units were reviewed (EXHIBIT C).  Mr. Sarb stated he believed the division should operate on the basis of intervening sooner and intervening when children were younger.  Children should be kept with their families whenever possible, be returned to their home as quickly as possible or alternatively found a permanent home via adoption.  Not only was it better for the child but less expensive to do it right the first time, therefore an assessment of needs was particularly important.  The future would require sufficient treatment capacity to serve children in custody.  Issues in corrections have been outlined in a study of the Juvenile Justice System.  Resources would need to be developed in Clark and Washoe County. 

 

Mr. Toomin asked what the division budget was for the '91 biennium.  Mr. Sarb indicated the division did not exist in 1991, however, the proposed budget for the next biennium was $57 million.  Mr. Toomin inquired if it would be possible to get information regarding the incarceration numbers.  Mr. Sarb said definitely.

 

Ms. Augustine questioned how long children in foster care were separated from their families.  Mr. Sarb responded 18 months to two years. 

 

Mr. Petrak inquired if the division contacted other members of the family, such as grandparents, when recruiting potential parents to adopt children.  Mr. Sarb replied any time the division had a child for adoption they first contacted relative resources.   Mr. Petrak also asked what the daily cost was to maintain a person in Caliente.  Mr. Sarb responded $25,000 annually.

 

Ms. Smith questioned what type of children were being incarcerated.  Mr. Sarb indicated the worst children typically do not attend school.  They are incarcerated for the same type of offenses adults are placed in prison.  However, there are many children incarcerated for relatively minor offenses.  Ms. Smith asked what the associated costs were if foster care parents chose to adopt.  Mr. Sarb responded there was no fee to adopt special needs children.  Also, there were two subsidy programs which helped pick up some of the associated costs.

 

Mrs. Segerblom asked what happened to the children in Boulder City after the home was closed.  Mr. Sarb explained two cottages were closed while five remained open.  It was no problem to find placements for the affected children.  Mrs. Segerblom asked if the division had children in St. Jude's.  Mr. Sarb responded yes.

 

Mr. Heller asked what impact the governor's reorganization would have on the division.  Mr. Sarb indicated the division was relatively untouched.  A bill would be introduced to codify the changes the director had made.

 

Deanne Blazzard, President, Foster Parents of Southern Nevada, discussed several important issues (EXHIBIT D).  Additionally, Ms. Blazzard stated foster parents were required to attend training to maintain their license, however, due to budget constraints the quality of the training was inadequate.  Ms. Blazzard stressed the fact that children were left in substitute care far too long and needed to be placed in a permanent home. 

Mrs. Segerblom asked if there was a limit on how many children a foster home could have.  Ms. Blazzard believed the limit was six children.  Also, there were people willing to adopt older children.

 

Mr. Toomin inquired as to what was meant by specialized training.  Ms. Blazzard explained many children were drug addicted at birth; therefore foster parents needed up-to-date information on how to cope on a daily basis.  Mr. Toomin asked if the emphasis was on psychological training.  Ms. Blazzard said yes with some special needs as far as medical training and learning disabilities.  Mr. Toomin asked if foster parents were provided with the child's medical records.  Ms. Blazzard responded no, not usually.

 

Mr. Petrak inquired what happened to foster children when they reach age 18.  Ms. Blazzard said after graduation there were some independent living programs but on the whole they were left on their own.

 

Dr. Eric Albers, Associate Professor, UNR School of Social Work, commented on issues specific to the Division of Child and Family  Services (EXHIBIT E).  Dr. Albers also submitted a copy of his research study which identified factors that influenced the length of time children remained in foster care (EXHIBIT F).

 

Ian Curley, Juvenile Probation Officer, spoke to the committee regarding juvenile sex offenders stressing appropriate placement and treatment (EXHIBIT G).  Nevada had a twelve bed program in Las Vegas which was inadequate to meet the current need.  Mr. Curley introduced Ms. Leslie Mieras, Therapist, who discussed the assessment of sex offenders which was important not only to identify the level of risk but to obtain valuable information about victims as well.  Ms. Mieras stressed the need to provide continuum care in order to treat these offenders.

 

Mrs. Freeman asked Mr. Curley how the county interfaced with the state in identifying the need for treatment.  Mr. Curley explained that once the offender was evaluated the appropriate treatment program was then pursued.  Ms. Mieras added the only program was in southern Nevada.  A similar program in northern Nevada had been shut down due to budget cuts.  Previously, offenders were sent out of state for treatment.

 

Mr. Toomin asked if an offense actually had to take place before an individual was considered a sex offender.  Ms. Mieras replied yes, there had to be some charges and some records to review before an assessment could be conducted. 

 

Ms. Smith commented these offenders either wind up in jail or on the street and there was nothing in between.  Ms. Mieras confirmed the statement.

 

Shelia Leslie, Executive Director, Children's Cabinet, handed out a packet of information for the committee's review (EXHIBIT H).  She discussed increases in child abuse cases and substitute care.  Ms. Leslie described the Family Preservation Program and compared its cost with foster care and correctional care.

 

Mrs. Segerblom asked how often the authorities intervened before a child was taken away from the parents.  Ms. Leslie indicated in some drastic cases the authorities had never been called.

 

Mr. Toomin inquired what the success rate was for the prevention program.  Ms. Leslie indicated an 88 percent success rate in keeping the family out of the system.

 

Jerry Zadny, Administrator, Mental Hygiene and Mental Retardation briefed the committee on the work of his division (EXHIBIT I) and handed out an information sheet that identified legislative initiatives (EXHIBIT J).

 

Mr. Heller asked what the increase had been in the number of cases during the last few years.  Dr. Zadny replied there had been a decrease, especially in the case of rural clients, due to reduction of staff.

 

Mrs. Freeman inquired how close the division was in meeting the needs of the state.  Dr. Zadny replied it depended on how the need was defined.  His division only treated the serious mentally ill.  Mrs. Freeman asked how the program helped people released from the Mental Health Institute who returned to jail.  Dr. Zadny indicated there were mental health case managers, services through a medication clinic, and a day training program.  However, some individuals were resistent to these services.  The division was trying to set up a screening system that would identify substance abuse persons in post mental health care and deflect them away from jail and into appropriate treatment services.  Mrs. Freeman inquired how that type of program would be implemented.  Dr. Zadny explained law enforcement officers receive training from the staff at Lakes Crossing to properly identify  mental illness.  If an individual was thought to be mentally ill he was taken to a hospital for a physical exam to rule out other problems.  Also there was staff located within the jail system.

 

Mr. Toomin asked when M.H/M.R. would be testifying in Ways and Means.  Dr. Zadny replied he did not know.

 

Mr. Petrak asked how many of the 138 mental health inpatients had alzheimer's disease.  Dr. Zadny explained organic conditions were not treated by M.H/M.R. facilities.

 

Ms. Augustine asked if M.H/M.R. dealt with the criminally insane.  Dr. Zadny indicated the prison system had their own mental health unit to deal with these cases.

 

Adrienne Cox, Division Supervisor, Child Haven, highlighted issues facing Clark County Juvenile Court Services.  Ms. Cox discussed the new family court, problems with the management information system, impact of increased population on the work load, evaluation of current programs, and collaboration efforts with other public agencies.  She indicated Clark County Juvenile Court Services was in support of increasing and localizing services for delinquent youth.  Community-based treatment programming made good sense.

 

Susan Meuschke, Executive Director, Nevada Network Against Domestic Violence, gave an overview of domestic violence problems, current programs, and gaps in services (EXHIBIT K).

 

Shawn Stainbrook, Client, Ormsby Association for Retarded Citizens, spoke to the committee regarding the help he had received from the program.  Mr. Stainbrook stated that he had been able to obtain a job and currently paid his own expenses.

 

Brian Lahren, Associate Executive Director, Washoe Association for Retarded Citizens, gave an overview of the Mental Health system.  Dr. Lahren stated although Mental Health and Mental Retardation both had strong inpatient service systems, previously conducted interim studies had determined adequately structured community-based care systems were also needed.  However, recent budget cuts had resulted in a reduction of staff.  Due to a statutory right to treatment none of the staff reductions came out of inpatient care, only outpatient services were affected.  As a result there was little ability to provide proactive intervention.  People were forced into crisis situations before they could avail themselves of services.  Case workers and day-training programs were minimally available.  A generic level of care was being provided.  Mental Retardation had a good work program and residential program but did not provide respite care.

 

John Sasser, representing Nevada Legal Services, handed out materials prepared by Gail Burks, Staff Attorney in the Las Vegas Office (EXHIBIT L).  The handout described the level of care available in the system prior to budget cuts and what levels were now missing.  The goal was to restore some of the higher priority services that were lost.  Mr. Sasser also commented on the Office of Protection and Advocacy which was a separate state office funded with federal dollars which advocated on behalf of mentally ill patients.  In most states this organization was independent, however, in Nevada it was a part of state government.  In order for this office to be truly effective it needed to be outside state government.

 

Mrs. Freeman asked if more money would be available for these issues with the advent of the new federal administration.  Mr. Sasser replied probably not in the immediate future.

 

Judyth Dailey, Patient, Nevada Mental Health Institute, described her treatment and subsequent recovery in the program.  She indicated although she received excellent care she was concerned about the staff shortages in certain areas and the closure of the geriatric unit.

 

Bob Hadfield, Executive Director, Nevada Association of Counties, reiterated there was no mental health system in rural Nevada.  The closure of those clinics left those areas without resources.  Some Nevada communities would never have the resources to replace eliminated state programs.  Mr. Hadfield also mentioned a large number of people did go to county jails that could be placed elsewhere.

 

Kathy Apple, Psychiatric Nurse, addressed the committee on behalf of the Commission on Mental Health and Mental Retardation.  Ms. Apple discussed the commission's concern for services to the mentally ill and mentally retarded (EXHIBIT M).

 

Dr. Zadny presented a video to the committee accompanied by a handout from the State Alliance for the Mentally Ill (EXHIBIT O).

 

There being no further business to come before committee, the meeting was adjourned at 4:00 p.m.

 

      RESPECTFULLY SUBMITTED:

 

 

                             

      CONNIE CAMPBELL

      Committee Secretary

??

 

 

 

 

 

 

 

Assembly Committee on Health and Human Services

January 21, 1993

Page: 1