2017 Children’s Legislative Briefing Book Legislative Briefing Book.pdf · While this book will not cover all of the issues our children face, it ... Overview of the Nevada Children’s

2017

CHILDREN’S LEGISLATIVE

BRIEFING BOOK

Acollaborativeeffortbetween:

2017

Children’sLegislative Briefing Book

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2017Children’sLegislativeBriefingBook

ThisbriefingbookwaspreparedbytheChildren’sAdvocacyAlliance(CAA)andtheNevadaInstituteforChildren’sResearchandPolicy(NICRP).WewouldalsoliketothankthefollowingorganizationsthroughoutNevadawhohavemade

contributionstothebriefingbook.

Baby’sBountyChildren’sCabinet

Children’sHeartCenterFosterKinship

GeorgetownUniversityHealthPolicyInstituteCenterforChildrenandFamiliesImmunizeNevada

NevadaChildren’sMentalHealthConsortia’sNevadaMaternalandChildHealthCoalition

NevadaOfficeofSuicidePreventionNevadaPartnershipforHomelessYouthNevadaTeenHealthandSafetyCoalition

SouthernNevadaHealthDistrictTheUniversityofNevadaLasVegasMentalandBehavioralHealthCoalition

Children’sAdvocacyAlliance5258S.EasternAve.#151 3500LakesideCt.#209

LasVegas,NV89119 Reno,NV89509(702)228-1869

www.caanv.org

NevadaInstituteforChildren’sResearchandPolicyHomeofPreventChildAbuseNevadaSchoolofCommunityHealthSciences

UniversityofNevada,LasVegas4505MarylandPkwy

LasVegas,NV89154-3030 (702)895-1040Fax(702)895-2657

nic.unlv.edu

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"Therecanbenokeenerrevelationofasociety'ssoulthanthewayinwhichittreatsitschildren."

—NelsonMandela,FormerPresidentofSouthAfrica

ThepurposeofthisLegislativeBriefingBookistoprovideasnapshotofsomeofthemostpressingissues

facingNevada’schildreninordertoassistadvocatesandpolicymakersincreatingpositivechangesto

improvethelivesofNevada’schildren.Whilethisbookwillnotcoveralloftheissuesourchildrenface,it

isintendedtohighlightsomeoftheareasinwhichstatepolicymighthaveanimpact,particularlyinthe

areasofeducation,health,andsafety.Thisbookisacompilationofstatisticsandpolicy

recommendationsfromacrossthestate,withcontributionsfrompractitioners,agencies,organizations,

individualsandotherswhoworkwithandadvocateforthewell-beingofchildreninNevada.Special

Issuebriefsareincludedinseveraloftheareastohighlighttopicsofspecialinterest,includingspecific

recommendationsforpolicychangeatthestatelevel.Inaddition,thisbookisalignedwiththe2016

NevadaChildren’sReportCardwhichgradestheStateofNevadaonspecificindicatorsineachofthese

areas.ItisimportanttonotethatthereareinstanceswhereNevada’sindicatorhasimproved,butour

rankhasgonedown(duetootherstate’simprovingmorethanNevada).Becausethegradesarebased

onNevada’srank,thismayresultinalowergrade,despiteimprovementsontheindicator.

Diligenteffortsneedtobemadeduringthe2017LegislativeSessiontoimprovepolicies,proceduresand

servicesforNevada’schildren.Whilewehaveseenimprovementinsomeareas,Nevadahascontinually

beenrankedasoneofthemostdeficientstateswhenitcomestostatisticsregardingchildrenandsocial

policy.Giventhecurrenteconomicstrainsonourstate,itisvitallyimportanttofocusonpreventingcuts

tonecessaryprogramswhilelookingaheadtoseewhatimprovementscanbemade.Althoughmost

advocatesandpolicymakerswouldliketocreatepoliciesthatprovideimmediateresults,itisimportant

torealizethateffectivesocialchangetakestime.Assuch,emphasisshouldbeplacedondeveloping

quality,comprehensivesystemsandimplementingevidence-basedpreventivestrategies.

Thankyouforyoursupport–togetherwecanimprovethelivesofallofNevada’schildren!

DeniseTanata TaraPhebusExecutiveDirector ExecutiveDirectorChildren’sAdvocacyAlliance NevadaInstituteforChildren’sResearch&

Policy,UNLV

Table of Contents

4

Overview of the Nevada Children’s Report Card 6

Education 7

School Readiness 9

Special Issue: Child Care Background Checks 11

Special Issue: Child Care Subsidies 13

Special Issue: Child Care Tax Credits 17

Special Issue: License Exempt Child Care 19

Special Issue: Quality Rating Improvement Systems (QRIS) 21

Special Issue: High Quality Workforce for High Quality Early Learning 23

Student Achievement 25

High School Completion 26

Funding 28

Special Issue: Funding for Pre-K Education 29

Health 31

Access to Healthcare 33

Special Issue: Emergency Albuterol Inhalers 35

Special Issue: CHIPRA for Lawfully Residing Immigrant Children 37

Prenatal and Infant Health 39

Special Issue: Diaper Assistance for Families 41

Immunizations 43

Childhood Obesity 45

Special Issue: Body Mass Index (BMI) Survey 47

Table of Contents

5

Dental Health 50

Mental Health 51

Sexual Health 54

Safety 56

Child Maltreatment 58

Special Issue: TANF for Fictive Kin Providers 60

Special Issue: LGBTQ Youth in Out-of-Home Care 63

Special Issue: Child Welfare Funding 66

Special Issue: Child Welfare Data System 68

Youth Homelessness 71

Juvenile Violence 73

Child Deaths and Injury 75

Special Issue: Safe Haven 77

Special Issue: Health & Safety Requirements for Recreation Programs 79

Substance Abuse 81

Appendix: Source Data for Nevada Children’s Report Card 83

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2016NEVADACHILDREN’SREPORTCARDStateOverallGrade:D

TheChildren’sReportCardispublishedbiennially,andhighlightswhereNevadaranksincomparisontootherstatesinregardtochilddevelopmentindicatorsandbehaviors.TheinformationiscompiledbytheChildren’sAdvocacyAlliance(CAA)utilizingcurrentnationaldataandstatisticsandprovidesaplatforminwhichtoeffectivelyadvocateforpolicychangesthatbenefitNevada’schildrenandfamilies.TheChildren’sReportCardisausefultoolthatcanhelpstrengthenthesystemsthatsupportthewell-beingofNevada’schildrenandtheirfamilies.Italsoprovidesinsighttohelpidentifypotentialpolicychangesandupdatesthatcankeepkidssafeandhelpthemgrow.ItisimportanttonotethatthereareinstanceswhereNevada’sindicatorhasimproved,butourrankhasgonedown(duetootherstate’simprovingmorethanNevada).BecausethegradesarebasedonNevada’srank,thismayresultinalowergrade,despiteimprovementsontheindicator.*EconomicWell-Beingisanewsectioninthe2016ReportCardandreflectsadditionalindicatorsthatimpactHealth,SafetyandEducation.

2016SummaryofGrades

EDUCATION:F SchoolReadiness F StudentAchievement F HighSchoolCompletion F Funding F*ECONOMICWELL-BEING:D- Employment D- Housing D Poverty C- Income F+

HEALTH:D AccesstoHealthCare F- Prenatal/InfantHealth C- Immunizations D ChildhoodObesity B- DentalHealth F MentalHealth F SexualHealth D+SAFETY:D+ ChildMaltreatment C- YouthHomelessness D JuvenileViolence D+ ChildDeaths&Injuries C- SubstanceAbuse C- HowGradesareDetermined:ByStateRanking(WhereAvailable)

1-3=A+ 11-13=B+ 21-23=C+ 31-33=D+ 41-43=F+4-7=A 14-17=B 24-27=C 34-37=D 44-47=F8-10=A- 18-20=B- 28-30=C- 38-40=D- 48-51=F-

Education 2017

“A good education helps us make sense of the world and find our way in it.”

- Mike Rose

Education Overview1. School Readiness

2. Student Achievement

3. High School Completion

4. Funding

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EDUCATIONOVERVIEWNevadaChildren’sReportCardGrade:F

Investinginqualityeducationaffordsourchildrenwithcriticalskillsandtoolstoprovideforthemselvesandfortheirfuturefamiliesbyincreasingtheirabilitytocreateopportunitiesforemployment,reducingthespreadofcommunicablediseases,reducingmotherandinfantmortality,andimprovingoverallhealth.Additionally,anincreaseintheyearsofeducationouryouthreceivehasbeenshowntolowertherateatwhichyouthenterthecriminaljusticesysteminadulthood.1In2015,theGovernorproposedandtheNevadaStateLegislaturepassednearly30billsaimedatimprovingNevada’seducationsystem.Theseincludedexpansionoffull-daykindergartenandZoomschools,establishmentofVictoryschools,reorganizationoftheClarkCountySchoolDistrictandnumerousotherpoliciesaimedatimprovingtheinfrastructureandqualityofeducationinNevada.Whiletheresultsofthesereformsremaintobeseen,Nevada’seducationsystemremainslargelyunderfundedandthusstrugglestoprepareallstudentstobesuccessfulintheirendeavorsposthighschool.ThereareseveralareaswithineducationwhichneedimprovementandcontributetotheOverallChildren’sEducationGradeofF,whichthestatereceivedonthe2016Children’sReportCard.Detailsineachoftheseareasareprovidedinthesectionsbelowinadditiontorecommendationstomakeimprovementsinthestate.Theseareasinclude:1. SchoolReadiness2. StudentAchievement3. HighSchoolCompletion4. Funding

1"TheStateofAmerica'sChildren®2014Report."Children'sDefenseFund,n.d.Web.30Aug.2016.<http://www.childrensdefense.org/library/state-of-americas-children/>.

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1. SCHOOLREADINESS NevadaChildren’sReportCardGrade:FTheschoolreadinessgradeisbasedonpreschoolenrollment,availability,andspendingpercapita.Nevadaiscurrentlyranked50thinthenationforpreschoolenrollmentwithonly32.8%of3-and4-yearoldsenrolled.Ofthe32.8%ofenrolledstudents,only12%areenrolledinstatepreschool,specialeducationorHeadStartprograms.2Lowenrollmentisdueinparttostatespendingonpreschool,whichiscurrently$46.35percapitainNevada,comparedtothenationalaverageof$773.63.3EverychildinNevadadeservestheopportunitytoenterschoolreadytolearn.Nevadaisinneedofacomprehensiveearlychildhoodsystemthatsupportsfamiliesbymakingsuretheyhavehighqualityoptionsfortheirchildren'searlycareandlearning—whethertheirchildrenspendtheirdaysathome,informalchildcare,orwithfamilyandfriends.Providingchildrenwiththerightstartwillleadtolessinterventionandremediationinlatergrades–ultimatelyresultinginincreasedratesofgraduationandsuccessinadulthood.Experiencesduringthefirstfiveyearsofachild’slifearecrucialtotheirdevelopmentandcanbeindicativeoffuturesuccessduetoearlybraindevelopmentandgrowth.Forexample,inthefirstfewyearsofachild’slife,700newneuralconnectionsareformedeverysecond.Theseconnectionsaredependentuponaninteractionofgenesaswellasthechild’senvironmentandarethebasestructureswhichallfuturelearning,behavior,andhealtharedependentupon.4Giventhatachild’sdevelopmentisquiteextensiveduringthefirstfewyearsoflife,itisvitalthattheyareexposedtohighqualityearlylearningexperiences.

2TheNationalInstituteforearlyEducationResearch,“TheStateofPreschool2015”http://nieer.org/sites/nieer/files/2015%20Yearbook.pdf#/-1/(2015)3Ibid.4CenterontheDevelopingChild-HarvardUniversity,“FiveNumberstoRememberAboutEarlyChildhoodDevelopment”http://developingchild.harvard.edu/resources/multimedia/interactive_features/five-numbers/

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“Severaldecadesofresearchclearlydemonstratethathighquality;developmentallyappropriateearlychildhoodprogramsproduceshort-andlong-termpositiveeffectsonchildren'scognitiveandsocialdevelopment.Specifically,childrenwhoexperiencehigh-qualitystablechildcareengageinmorecomplexplay,demonstratemoresecureattachmentstoadultsandotherchildren,andscorehigheronmeasuresofthinkingabilityandlanguagedevelopment.Highqualitychildcarecanpredictacademicsuccess,adjustmenttoschool,andreducedbehavioralproblemsforchildreninfirstgrade.Studiesdemonstratethatchildren'ssuccessorfailureduringthefirstyearsofschooloftenpredictsthecourseoflaterschooling.Agrowingbodyofresearchindicatesthatmoredevelopmentallyappropriateteachinginpreschoolandkindergartenpredictsgreatersuccessintheearlygrades.”5

RECOMMENDATIONSFORIMPROVEMENT:• Increaseaccesstohighqualityearlychildhoodeducationforallchildren-birththrough

kindergarten-inNevada.o Increasestatefundingtowardsubsidyprograms.CurrentlyNevadaisonlyserving4%

oftheeligiblepopulation.Thehighcostofearlychildhoodeducationprogramsisabarrierinthecommunity.IncreasesinsubsidywouldincreaseaccessforNevada’smostvulnerablechildren.

o Inaddition,currentmarketratesshouldbeusedtodeterminesubsidyreimbursements.TheChildCareDevelopmentandBlockGrant(CCDBG)mandatesthatstatesreviewthecurrentmarketrateeverytwoyears,butdoesnotrequirestatestosetthereimbursementratebasedontheresults.Nevadamustlegislativelymandatesettingthereimbursementratetothemostrecentmarketrateeverytwoyearstoensureequalaccesstoqualityearlychildhoodeducationprograms.

• Continuetosupportinvestmentsinprogramsthatassessqualityofcare,suchastheSilverStateStarsQualityRatingImprovementSystem.o Requirechildhoodsubsidiestobeusedatchildcareprogramsparticipatinginthe

NevadaSilverStateStarsQualityRatingandImprovementSystem(QRIS)toensurechildrenarereceivinghighqualitycare.Currently,childcaresubsidiesmaybeusedatanylicensedprogramand,insomeinstances,unlicensedhomes.Theseprogramsmaydomoreharmthangoodtoachild’sdevelopmentiftheydonotpromoteasafeandenrichingenvironment.

AdditionalinformationisavailableintheEarlyEducationandCareImperativesforNevadadevelopedbytheNevadaEducationfortheAssociationofYoungChildren.6

5TheNationalAssociationfortheEducationofYoungChildren,“ACallforExcellenceinEarlyEducation,”http://www.naeyc.org/policy/excellence6NevadaAssociationfortheEducationofYoungChildren2017PublicPolicyAgendahttps://nevaeyc.org/policy/

“Thefirstfiveyearshavesomuchtodowithhowthenext80turnout.”-BillGatesSr.,Co-ChairoftheBillandMelindaGatesFoundation

EDUCATION2017

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SCHOOLREADINESS–SPECIALISSUE

ChildCareBackgroundChecks

InNevada,anyindividualworkingatalicensedchildcarefacilitymustpassacomprehensivebackgroundandpersonalhistorycheck.TheymustalsocompleteachildabuseandneglectscreeningthroughtheStatewideCentralRegistryfortheCollectionofInformationConcerningtheAbuseorNeglectofaChild(CANSCheck).Thepersonalhistoryandbackgroundcheckisusedtodetermineifanindividualhasanyfederalorstateconvictionsofthefollowingcrimes:(a) Murder,voluntarymanslaughterormayhem;(b) Anyotherfelonyinvolvingtheuseofafirearmorotherdeadlyweapon;(c) Assaultwithintenttokillortocommitsexualassaultormayhem;(d) Sexualassault,statutorysexualseduction,incest,lewdness,indecentexposureorany

othersexuallyrelatedcrime;(e) Abuseorneglectofachildorcontributorydelinquency;(f) Aviolationofanyfederalorstatelawregulatingthepossession,distributionoruseofany

controlledsubstanceoranydangerousdrugasdefinedinchapter454ofNRS;(g) Abuse,neglect,exploitation,isolationorabandonmentofolderpersonsorvulnerable

persons,including,withoutlimitation,aviolationofanyprovisionofNRS200.5091to200.50995,inclusive,oralawofanyotherjurisdictionthatprohibitsthesameorsimilarconduct;or

(h) Anyoffenseinvolvingfraud,theft,embezzlement,burglary,robbery,fraudulentconversionormisappropriationofpropertywithintheimmediatelypreceding7years.7

TheCANScheckshowsanycasesofabuseandneglectthathavebeensubstantiatedbyachildwelfareagencywithinthestateofNevada,notallofwhichleadtoacriminalconviction.Thispotentiallyallowsanindividualfromanotherstate,whohasasubstantiatedinstanceofabuseorneglect,tomovetoNevadaandworkwithchildreninachildcarefacility.ThestatecurrentlyhasnomechanismtodoaCANScheckforthestatesthattheindividualhaspreviouslylived.Tohelpremedythisissue,theChildCareandDevelopmentBlockGrant(CCDBG)–Congressionallyreauthorizedin2014–requiresallstatestoconductadditionalbackground,personalhistoryandCANSchecksforallemployeesofalicensedchildcarefacilityineachstatewheresuchstaffmemberhasresidedduringthepreceding5years.7"NRS:CHAPTER432A-SERVICESANDFACILITIESFORCAREOFCHILDREN."N.p.,n.d.Web.30Aug.2016.<https://www.leg.state.nv.us/nrs/NRS-432A.html>.

SubstantiatedAbuseorNeglect

The findings are classified as “Substantiated,” meaning that

a report made pursuant to NRS 432B.220 was

investigated and that credible evidence of the abuse or

neglect exists.

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“Severaldecadesofresearchclearlydemonstratethathighquality;developmentallyappropriateearlychildhoodprogramsproduceshort-andlong-termpositiveeffectsonchildren'scognitiveandsocialdevelopment.Specifically,childrenwhoexperiencehigh-qualitystablechildcareengageinmorecomplexplay,demonstratemoresecureattachmentstoadultsandotherchildren,andscorehigheronmeasuresofthinkingabilityandlanguagedevelopment.Highqualitychildcarecanpredictacademicsuccess,adjustmenttoschool,andreducedbehavioralproblemsforchildreninfirstgrade.Studiesdemonstratethatchildren'ssuccessorfailureduringthefirstyearsofschooloftenpredictsthecourseoflaterschooling.Agrowingbodyofresearchindicatesthatmoredevelopmentallyappropriateteachinginpreschoolandkindergartenpredictsgreatersuccessintheearlygrades.”5

RECOMMENDATIONSFORIMPROVEMENT:• Increaseaccesstohighqualityearlychildhoodeducationforallchildren-birththrough

kindergarten-inNevada.o Increasestatefundingtowardsubsidyprograms.CurrentlyNevadaisonlyserving4%

oftheeligiblepopulation.Thehighcostofearlychildhoodeducationprogramsisabarrierinthecommunity.IncreasesinsubsidywouldincreaseaccessforNevada’smostvulnerablechildren.

o Inaddition,currentmarketratesshouldbeusedtodeterminesubsidyreimbursements.TheChildCareDevelopmentandBlockGrant(CCDBG)mandatesthatstatesreviewthecurrentmarketrateeverytwoyears,butdoesnotrequirestatestosetthereimbursementratebasedontheresults.Nevadamustlegislativelymandatesettingthereimbursementratetothemostrecentmarketrateeverytwoyearstoensureequalaccesstoqualityearlychildhoodeducationprograms.

• Continuetosupportinvestmentsinprogramsthatassessqualityofcare,suchastheSilverStateStarsQualityRatingImprovementSystem.o Requirechildhoodsubsidiestobeusedatchildcareprogramsparticipatinginthe

NevadaSilverStateStarsQualityRatingandImprovementSystem(QRIS)toensurechildrenarereceivinghighqualitycare.Currently,childcaresubsidiesmaybeusedatanylicensedprogramand,insomeinstances,unlicensedhomes.Theseprogramsmaydomoreharmthangoodtoachild’sdevelopmentiftheydonotpromoteasafeandenrichingenvironment.

AdditionalinformationisavailableintheEarlyEducationandCareImperativesforNevadadevelopedbytheNevadaEducationfortheAssociationofYoungChildren.6

5TheNationalAssociationfortheEducationofYoungChildren,“ACallforExcellenceinEarlyEducation,”http://www.naeyc.org/policy/excellence6NevadaAssociationfortheEducationofYoungChildren2017PublicPolicyAgendahttps://nevaeyc.org/policy/

“Thefirstfiveyearshavesomuchtodowithhowthenext80turnout.”-BillGatesSr.,Co-ChairoftheBillandMelindaGatesFoundation

EDUCATION2017

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ChildCareBackgroundChecks

InNevada,anyindividualworkingatalicensedchildcarefacilitymustpassacomprehensivebackgroundandpersonalhistorycheck.TheymustalsocompleteachildabuseandneglectscreeningthroughtheStatewideCentralRegistryfortheCollectionofInformationConcerningtheAbuseorNeglectofaChild(CANSCheck).Thepersonalhistoryandbackgroundcheckisusedtodetermineifanindividualhasanyfederalorstateconvictionsofthefollowingcrimes:(a) Murder,voluntarymanslaughterormayhem;(b) Anyotherfelonyinvolvingtheuseofafirearmorotherdeadlyweapon;(c) Assaultwithintenttokillortocommitsexualassaultormayhem;(d) Sexualassault,statutorysexualseduction,incest,lewdness,indecentexposureorany

othersexuallyrelatedcrime;(e) Abuseorneglectofachildorcontributorydelinquency;(f) Aviolationofanyfederalorstatelawregulatingthepossession,distributionoruseofany

controlledsubstanceoranydangerousdrugasdefinedinchapter454ofNRS;(g) Abuse,neglect,exploitation,isolationorabandonmentofolderpersonsorvulnerable


(h) Anyoffenseinvolvingfraud,theft,embezzlement,burglary,robbery,fraudulentconversionormisappropriationofpropertywithintheimmediatelypreceding7years.7

TheCANScheckshowsanycasesofabuseandneglectthathavebeensubstantiatedbyachildwelfareagencywithinthestateofNevada,notallofwhichleadtoacriminalconviction.Thispotentiallyallowsanindividualfromanotherstate,whohasasubstantiatedinstanceofabuseorneglect,tomovetoNevadaandworkwithchildreninachildcarefacility.ThestatecurrentlyhasnomechanismtodoaCANScheckforthestatesthattheindividualhaspreviouslylived.Tohelpremedythisissue,theChildCareandDevelopmentBlockGrant(CCDBG)–Congressionallyreauthorizedin2014–requiresallstatestoconductadditionalbackground,personalhistoryandCANSchecksforallemployeesofalicensedchildcarefacilityineachstatewheresuchstaffmemberhasresidedduringthepreceding5years.7"NRS:CHAPTER432A-SERVICESANDFACILITIESFORCAREOFCHILDREN."N.p.,n.d.Web.30Aug.2016.<https://www.leg.state.nv.us/nrs/NRS-432A.html>.

SubstantiatedAbuseorNeglect


a report made pursuant to NRS 432B.220 was


neglect exists.

Substantiated Abuse or Neglect


a report made pursuant toNRS 432B.220 was


neglect exists.

SCHOOL READINESS – SPECIAL ISSUE

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ThereauthorizedCCDBGalsorequiresbackgroundandpersonalhistorychecksandCANSchecksforlicense-exemptproviderscaringforchildrenonNevada’schildcaresubsidyprogram.Additionally,itallowsforstatediscretionrelatingtoindividualswhohaveaviolationofanyfederalorstatelawregulatingthepossession,distributionoruseofanycontrolledsubstanceoranydangerousdrug.AccordingtotheOfficeofChildCare–AnOfficeoftheAdministrationforChildrenandFamilies–thelawprovidesflexibilityforStatesinregardtoindividualsdisqualifiedduetoafelonydrugoffense.TheState,atitsoption,mayallowforareviewprocessthroughwhichtheStatemaydetermineanindividualstilleligibleforemployment.8Recommendations:NevadashouldtakethenecessarystepstocomeintocompliancewithCCDBGbackgroundcheckrequirements.Thisincludes:• Requirechildcarelicensingtocompletefullstateandfederalbackgroundandpersonal

historychecks,aswellasstatebasedchildabuseandneglectregistrychecksinNevadaandeachstatewheresuchstaffmemberresidedduringthepreceding5years,asapplicableforeverylicensedproviderandalllicense-exemptproviderswhoparticipateinNevada’schildcaresubsidyprogram.

• Reviewcurrentregulationsrelatedtoindividualswhohaveaviolationofanyfederalorstatelawregulatingthepossession,distributionoruseofanycontrolledsubstanceoranydangerousdrug.Pendingreview,createaprocessthroughwhichtheStatemaydetermineifanindividualiseligibleforemploymentatalicensedchildcarefacility.

Formoreinformationonthistopic,pleasecontact:Children’sAdvocacyAlliance702-228-18695258SouthEasternAve,Suite151,LasVegas,NV891193500LakesideCt,Suite209,Reno,NV89509www.caanv.org

8"CCDFReauthorizationFrequentlyAskedQuestions."OfficeofChildCare:AnOfficefortheAdministrationforChildren&Families,n.d.Web.30Aug.2016.<http://www.acf.hhs.gov/occ/resource/ccdf-reauthorization-faq>.

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ChildCareSubsidiesIn2014,theChildCareandDevelopmentBlockgrant(CCDBG)–alsoknownastheChildCareDevelopmentFund–wasreauthorizedforthefirsttimesince1996.Historically,theCCDBGaimedtoreducethehighfinancialburdenofchildcareonworkingparentsbyprovidingasubsidytooffsetaportionofthecosts.• TheaveragecostofcareinlicensedcentersinNevadarangesfrom$10,324foraninfant

to$8,792forpreschoolers(age3-5).9• Asingleparentwithaninfantandpreschoolermaking$1,674.17amonth(100%of

poverty)wouldhavetospend95%oftheparent’sincomeoncenter-basedcare.Ifthesamefamilyreceivedchildcaresubsidy,theparentwouldreceiveanaverageassistanceamountof$14,105($7,930forinfantsand$6,175forpreschoolers–basedoncurrentreimbursementrates).Thiswouldstillrequirethesingleparenttocoverthe$5,011difference,whichis25%oftheirannualincome.

• Afamilywithaninfantandpreschoolermaking$4,041.67amonth(200%ofpoverty)wouldhavetospend39%oftheirincomeoncenter-basedcarefortheirchildren.10

InNevada,childcaresubsidiesareprovidedtofamilieswithchildren–uptoage12–livinginpoverty–upto85%ofNevada’smedianincome.Therearetwotypesofsubsidiesprovidedtofamilies,mandatoryanddiscretionary.MandatorysubsidiesareprovidedtochildrenwhohaveaparentparticipatingintheNewEmployeesofNevada(NEON)Program;thestateisrequiredtoprovidesubsidiestoallNEONfamilieswhoapply.Discretionarysubsidiesareprovidedtoallothereligibleat-riskfamiliesbaseduponavailablefunding.Sinceitsreauthorization,theCCDBGhasbroadeneditsfocustonotonlyassistparentswithfunding,butalsotoensurethechildrenwhoreceivethesubsidiesattendhighqualityearlylearningprograms.Toaccomplishthis,thereauthorizationaddedmanynew–andlargelyunfunded–mandates.Thesemandatesincludeissuesrelatedtosafety,qualityimprovements,eligibilityrequirements,generalprocesses,andpayments.Overall,thefollowingfourmandateswilllargelyaffecttheState’schildcaresubsidyprogramgoingforward:

9CalculationprovidedfromtheChildren’sCabinet2015ChildCareMarketPrice&ReferralSurvey,unpublisheddata.10Accordingtothe2015FederalPovertyGuidelines,http://ccf.georgetown.edu/wp-content/uploads/2015/01/2015-Federal-Poverty-Guidelines.pdf

CostComparisons• $61,081:MedianFamilyIncome

(withchildrenundertheageof18)

• $10,324.:AnnualaveragecostforinfantcentercareinNevada

• $8,792:AnnualaveragecostforpreschoolcentercareinNevada

• $6,943:AverageannualcostofUNLV/UNRtuitionforanin-state

undergraduatestudent

Cost Comparisons• $61,081: Median Family Income

(with children under the age of 18)• $10,324: Annual average cost for

infant center care in Nevada• $8,792: Annual average cost for

preschool center care in Nevada• $6,943: Average annual cost of

UNLV/UNR tuition for an in-state undergraduate student


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I. ProtectionforWorkingParents

UndertheProtectionforWorkingParentsmandate,therewasarenewedfocusonensuringstabilityforchildrenandfamiliesreceivingsubsidy.Theact:• Extendsthetimeframeinwhichafamilyisre-determinedforeligibilityfrom3-months

to12-months(Sec.N.i.l)11• Requiresthestate,duringtheredeterminationperiod,totakeintoaccountparents

irregularfluctuationsinearnings(Sec.N.i.ll)12• Establishes–beforeterminationofbenefits–agraduatedphase-outofcareforfamilies

whoseincomedoesnotexceed85%ofthestatemedianincome(Sec.N.i.v).13Eachofthesemandatesensuresthatonceafamilyqualifiesforcaretheywillcontinuetoreceiveaportionofthesubsidyinperpetuity.

II.PaymentPractices

ThePaymentPracticesmandateworkstoalleviatestressonproviderswhoservechildrenreceivingsubsidyassistance.Thismandaterequiresthestatetoamendthewayitcalculatesaprovider’sreimbursementrate.Priortothereauthorization,Nevadareimbursedaproviderbasedonthenumberofdaysthatachildactuallyattended.Thisplacedadditionalstrainonaprovider,astheydedicateaslottothechildwhetherornottheyactuallyattended.Thenewmandaterequires:

The State… to implement enrollment and eligibility policies that support the fixedcostsofprovidingchildcareservicesbydelinkingproviderreimbursementratesfromaneligiblechild’soccasionalabsencesduetoholidaysorunforeseencircumstancessuchasillness.(Sec.S.ii)14

Bytyingreimbursementpaymentratestodaysscheduled,childcaresubsidypaymentswillbecomemorepredictableforproviders.Andasaresult,hopefullyincreasingthenumberofqualityproviderswhowillacceptsubsidyreimbursements.

III.PaymentRates

Nevadacurrentlysetsitsproviderreimbursementratesat2004marketratelevels.Thishasforcedmanyfamiliesreceivingsubsidytouselowerquality–andoftentimescheaper–care;astheycouldnotaffordtocoverthedifferencebetweenwhatsubsidywouldpayandwhatqualitychildcarecosts.Toremedythisproblem,thenewmandaterequires:

TheState…tocertifythatpaymentratesfortheprovisionofchildcareservices…aresufficienttoensureequalaccessforeligiblechildrentochildcareservicesthatarecomparabletochildcareservicesintheState.(Sec.4.A.i)

11"S.1086-113thCongress(2013-2014):ChildCareandDevelopmentBlockGrantActof2014."Congress.gov.N.p.,n.d.Web.30Aug.2016.<https://www.congress.gov/bill/113th-congress/senate-bill/1086>.12Ibid.13Ibid.14 Ibid.

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Tocomplywiththisnewrequirement,Nevadamayberequiredtoupdateitsreimbursementratesfrom2004marketratestothemostcurrentrates.15Thefollowingtableshowstheneededdailyincreaseinsubsidypaymentsperchildifmarketratesareupdated.

CHILDCARECENTERS Washoe Clark Car-Doug Rural

Infants

CurrentReimbRate(2004) $35.00 $31.00 $29.00 $27.0012-201575thPercentileRate

$43.59 $48.00 $39.19 $35.75

2015/2004RateDifference

$8.59 $17.00 $10.19 $8.75

Toddlers


$39.58 $42.00 $35.85 $32.50


$9.58 $14.00 $11.85 $10.50

Pre-K


$34.00 $39.87 $31.50 $36.00


$8.00 $16.87 $7.50 $14.00

DuringthemonthofSeptember2015,Nevadaprovidedchildcaresubsidiesto3,210familieswhichallowedatotalof5,711childrentoattendchildcare.Thiswasdoneatacostof$1,967,341.91forthemonth.IfNevadawouldhavepaid2015marketratesforthesamemonthandservedthesamenumberofchildrenandfamilies,itwouldhavecostthestateapproximately$2,826,648–anincreaseof$859,306.Overthecourseofayear,forNevadatoincreasethechildcaremarketratesto2015ratesandservethesamenumberoffamiliesitwouldcostanadditional$10.3milliondollars.

IV.CompliancewithStateLicensingRequirements

ThereauthorizedCCDBGgrantalsosetanewrequirementforthestatetocertifythatlicense-exemptchildcareproviderswhoservechildrenonsubsidyarenotendangeringthehealth,safety,ordevelopmentofthechildrentheyserve(Sec.F.ii).16Tosatisfythisrequirement,thestatemustnowconductbackgroundchecksandon-siteinspectionsforallprovidersreceivingsubsidy.Thisrequirementwillcreatetheneedfor15OnJune13,2016,theAdministrationforChildrenandFamiliesoftheU.S.DepartmentofHealthandHumanServicessentalettertotheNevadaDepartmentofHealthandHumanServicessaying,“Theycontinuetobe concernedthatNevada’sratesmaynotallowforequalaccess.”https://www.acf.hhs.gov/sites/default/files/occ/nevada_stplan_pdf_2016.pdf. 16"S.1086-113thCongress(2013-2014):ChildCareandDevelopmentBlockGrantActof2014."Congress.gov.N.p.,n.d.Web.30Aug.2016.<https://www.congress.gov/bill/113th-congress/senate-bill/1086>.

Page15CHILDCARECENTERS Washoe Clark Car-Doug RuralInfants CurrentReimbRate(2004) $35.00 $31.00 $29.00 $27.00

12-201575thPercentileRate

$43.59 $48.00 $39.19 $35.75


$8.59 $17.00 $10.19 $8.75

Toddlers CurrentReimbRate(2004) $30.00 $28.00 $24.00 $22.0012-201575thPercentileRate

$39.58 $42.00 $35.85 $32.50


$9.58 $14.00 $11.85 $10.50

Pre-K CurrentReimbRate(2004) $26.00 $23.00 $24.00 $22.0012-201575thPercentileRate

$34.00 $39.87 $31.50 $36.00


$8.00 $16.87 $7.50 $14.00

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WagesforEarlyChildhoodCareandEducationProfessionalsinNevada1LicensedCenterWages2

AverageStarting Average MedianReportedtoNVRegistry

Aids $8.20 $8.65 $9.50Teachers $9.96 $10.75 $11.00Directors $15.53 $17.53 $14.00

1"2014Demographics:EarlyEducation&Care&OutofSchoolPrograms."TheChildren'sCabinet(n.d.):n.pag.Web.<http://www.childrenscabinet.org/wp-content/uploads/2014-Demographics-Report.pdf>.2ExcludesHeadStart&Pre-KWages

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approximately10newstaffmembersandadditionalresourcestoconductthechecksandinspectionsstatewideatacostofover$560,000annually.17

Recommendations:

Thesefournew–largelyfederallyunfunded–mandateshaveplacedfurtherstrainonNevada’schildcaresubsidyprogram.Priortotheimplementationofthesemandates,Nevadaonlyserved3.21%18ofitseligiblepopulation.Withoutasubstantialinvestmentintheprogram,Nevadawillserveevenlessofitsworkingfamilies.Thesesamefamilieswillthencontinuetostruggletoprovidefortheirchildrenwhilespendingupto39%oftheirincome,solely,onchildcare.Somefamiliesmayalsochoosetoleavetheworkforcealtogether,causingadditionalstrainsonNevadaeconomyandothersocialsafetynetprogramssuchasSupplementalNutritionAssistanceProgram(SNAP),HomelessnessandUrbanDevelopment(HUD)program,andtheTemporaryAssistanceforNeedyFamilies(TANF)program.

Specificrecommendationsinclude:• Provideadditionalfundingtoincreasethepercentageofeligiblechildrenservedbysubsidies,includingthosechildrenunder13yearsofagewholiveatorbelow75%ofNevada’smedianincomeinsingle-earnermoms,single-earnerdadsordualearnerhouseholdstoallowthemtowork,seekemployment,orattendschool/vocationaltraining.

• RequirechildhoodsubsidiestobeusedatchildcareprogramsparticipatingintheNevadaSilverStateQualityRatingandImprovementSystem(QRIS)toensurechildrenarereceivinghigh-qualitycare.Currently,childcaresubsidiesmaybeusedatanylicensedprogramand,insomeinstances,unlicensedhomes.Theseprogramsmaydomoreharmthangoodtoachild’sdevelopmentiftheydonotpromoteasafeandenrichingenvironment.

• Ensurethatchildcaresubsidiesareavailableforbiologicalandfosterfamiliestosupporttheneedforhighqualitycareforparents/fosterparentswhoworkorareinschool.Thelowsubsidyreimbursementrateandrequirementforfosterparentstopaytheoverageplacesadditionalburdensonthesefamilies.Kinshipcaregiversarealsobeingdeniedeligibilityfromreceivingbothchild-onlyTANFandchildcaresubsidiesfortheirrelative’schildrentheyarefostering.

Formoreinformationonthistopic,pleasecontact:Children’sAdvocacyAlliance702-228-18695258SouthEasternAve,Suite151,LasVegas,NV891193500LakesideCt,Suite209,Reno,NV89509 www.caanv.org 17EstimatesprovidedbyChildren’sCabinetandLasVegasUrbanLeague. 18CalculationprovidedfromtheChildren’sCabinet2015ChildCareMarketPrice&ReferralSurvey,unpublisheddata.

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ChildCareTaxCreditsInNevada,over63%ofchildrenages0-5liveinfamilieswhereallavailableparentsareintheworkforce.Theseworkingparentsfacethechallengeoffindingqualitychildcaretheycanafford.Currently,theaverageannualcostofchildcareinlicensedcentersinNevadarangesfrom$10,324foraninfantto$8,791forpreschoolers(age3-5).Thesehighcostscauseasignificantfinancialburdentoworkingfamilies,especiallythoseinpoverty.Today,afamilywithaninfantandpreschoolermaking$4,041.67amonth(200%ofpoverty)wouldhavetospend39%oftheirincomeoncenter-basedcarefortheirchildren.19Thehighcostofchildcareisduetoitbeingamarketdrivenservice:providersofferservicesforaprice;consumerschooseamongthoseservicesandpaytheprice.20

• Theaveragechildcarecentergenerates87%ofitsrevenuefromparenttuition,whiletheaverageinstitutionofhighereducationgeneratesonly35%fromtuitionandfees.21

Thiscauseslower-incomefamiliestousethecheaperandoftentimeslowerqualitycarethattheycanafford.Tohelpreducethisfinancialburden,Nevadaprovideschildcaresubsidiestofamilieswithchildrenuptoage12livinginpovertyupto85%ofNevada’smedianincome.Unfortunately,Nevadacurrentlyservesonly3.21%oftheseeligiblelow-incomefamilies–thelowestpercentageinthenation–duetoalackofstatewideinvestment.22Thishascausedmanyparentstoleavetheworkforceorenrolltheirchildrenincheaperandoftenlowerqualitycare.Anotheropportunitytoincreaseinvestmentsinearlylearningprogramsoutsideofadditionalstateinvestmentsisthroughtaxcredits.AccordingtothePartnershipforAmerica’sEconomicSuccess,“Allocatingfundsviathetaxsystemaffordstheopportunitytouseanalreadyexistinginfrastructuretoadministerresources.Indeed,theInternalRevenueService(IRS)isuniquelyqualifiedtoadministerauniversal,income-related,market-basedbenefitsuchasECEfinancialincentives.”Therearemanybenefitstousingtaxcreditsasanearlychildhoodeducationfinancingstrategy.Taxcreditsare:partofafamiliarsystem,non-stigmatizing,relativelystableandnon-controversial,andconductivetotheuseofnontraditionalECEfundingstreams.23

19 According to the 2015 Federal Poverty Guidelines, http://ccf.georgetown.edu/wp-content/uploads/2015/01/2015-Federal-Poverty-Guidelines.pdf 20Stoney,Louise,andAnneMitchell.UsingTaxCreditstoPromoteHighQualityEarlyCareandEducationServices#2(n.d.):n.pag.PartnershipforAmerica'sEconomicSuccess,20Nov.2007.Web.<http://www.earlychildhoodfinance.org/downloads/2007/StonMitch_UsingTaxCreditsPromoteServices_2007.pdf>.21 Stoney,Louise,andAnneMitchell."CanWeUseTaxStrategiestoHelpFinanceEarlyCareandEducation?"EarlyChildhoodFinance,n.d.Web.30Aug.2016.<www.earlychildhoodfinance.org/.../TaxStrategiesCall_Resources_2006.doc>. 22 Calculation provided from the Children’s Cabinet 2015 Child Care Market Price & Referral Survey, unpublished data. 23 Blank,Susan,andLouiseStoney.TaxCreditsforEarlyCareandEducation:FundingStrategyforaNewEconomy(2011):n.pag.Web.<http://opportunities-exchange.org/wp-content/uploads/OpEx_IssueBrief_Tax_Final1.pdf>.

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ChildCareTaxCreditsInNevada,over63%ofchildrenages0-5liveinfamilieswhereallavailableparentsareintheworkforce.Theseworkingparentsfacethechallengeoffindingqualitychildcaretheycanafford.Currently,theaverageannualcostofchildcareinlicensedcentersinNevadarangesfrom$10,324foraninfantto$8,791forpreschoolers(age3-5).Thesehighcostscauseasignificantfinancialburdentoworkingfamilies,especiallythoseinpoverty.Today,afamilywithaninfantandpreschoolermaking$4,041.67amonth(200%ofpoverty)wouldhavetospend39%oftheirincomeoncenter-basedcarefortheirchildren.19Thehighcostofchildcareisduetoitbeingamarketdrivenservice:providersofferservicesforaprice;consumerschooseamongthoseservicesandpaytheprice.20

• Theaveragechildcarecentergenerates87%ofitsrevenuefromparenttuition,whiletheaverageinstitutionofhighereducationgeneratesonly35%fromtuitionandfees.21

Thiscauseslower-incomefamiliestousethecheaperandoftentimeslowerqualitycarethattheycanafford.Tohelpreducethisfinancialburden,Nevadaprovideschildcaresubsidiestofamilieswithchildrenuptoage12livinginpovertyupto85%ofNevada’smedianincome.Unfortunately,Nevadacurrentlyservesonly3.21%oftheseeligiblelow-incomefamilies–thelowestpercentageinthenation–duetoalackofstatewideinvestment.22Thishascausedmanyparentstoleavetheworkforceorenrolltheirchildrenincheaperandoftenlowerqualitycare.Anotheropportunitytoincreaseinvestmentsinearlylearningprogramsoutsideofadditionalstateinvestmentsisthroughtaxcredits.AccordingtothePartnershipforAmerica’sEconomicSuccess,“Allocatingfundsviathetaxsystemaffordstheopportunitytouseanalreadyexistinginfrastructuretoadministerresources.Indeed,theInternalRevenueService(IRS)isuniquelyqualifiedtoadministerauniversal,income-related,market-basedbenefitsuchasECEfinancialincentives.”Therearemanybenefitstousingtaxcreditsasanearlychildhoodeducationfinancingstrategy.Taxcreditsare:partofafamiliarsystem,non-stigmatizing,relativelystableandnon-controversial,andconductivetotheuseofnontraditionalECEfundingstreams.23

19 According to the 2015 Federal Poverty Guidelines, http://ccf.georgetown.edu/wp-content/uploads/2015/01/2015-Federal-Poverty-Guidelines.pdf 20Stoney,Louise,andAnneMitchell.UsingTaxCreditstoPromoteHighQualityEarlyCareandEducationServices#2(n.d.):n.pag.PartnershipforAmerica'sEconomicSuccess,20Nov.2007.Web.<http://www.earlychildhoodfinance.org/downloads/2007/StonMitch_UsingTaxCreditsPromoteServices_2007.pdf>.21 Stoney,Louise,andAnneMitchell."CanWeUseTaxStrategiestoHelpFinanceEarlyCareandEducation?"EarlyChildhoodFinance,n.d.Web.30Aug.2016.<www.earlychildhoodfinance.org/.../TaxStrategiesCall_Resources_2006.doc>. 22 Calculation provided from the Children’s Cabinet 2015 Child Care Market Price & Referral Survey, unpublished data. 23 Blank,Susan,andLouiseStoney.TaxCreditsforEarlyCareandEducation:FundingStrategyforaNewEconomy(2011):n.pag.Web.<http://opportunities-exchange.org/wp-content/uploads/OpEx_IssueBrief_Tax_Final1.pdf>.


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Therearefourtypesoftaxcreditsthatcouldbeusedtosupportearlylearning:241. ConsumerTaxCredits–adirectreductioninthetaxliabilityofanindividualwho

purchases(consumes)aparticularproductorservice.Consumertaxcreditscanfunctionasmarket-basedstrategytoreinforceameritgood.

2. BusinessInvestmentTaxCredits–adirectreductioninthetaxliabilityofasoleproprietororcorporationtooffsetcostofinvestinginthebusiness.

3. ContributionandCommunityInvestmentTaxCredits–reducesthetaxliabilityofanindividualorbusinessthatmakesacontributionto,orinvestmentin,anotherbusiness.Thesetaxcreditsaretypicallyusedtoraiserevenuefornon-profitentitiesand/orbusinessesthatproduceameritgood.

4. JobDevelopment/OccupationalTaxCredits-accruedtoemployeeswhoworkinatargetedindustrywhoareeligibleforspecialtaxbreaks.

Recommendations:ItisourrecommendationthatNevadacreatechildcaretaxcreditsforbusinessesthateitherprovideorgivesupporttotheiremployeesaroundearlylearningresourcesordonatetoanestablishedearlychildhooddevelopmentfund.25Theseearlychildhoodtaxcreditsshouldbe:26

• SystemBuilding–thestrategyshouldbeintegratedwiththeNevada’sQualityRatingandImprovementSystemandchildcaresubsidiesandadvancethestate’slargerECEsystembuildingapproach.

• AccessibletoTaxpayers–thetaxcreditshouldbeeasytouse,anditshouldberefundable–orifnot,thetaxpayershouldbeabletoapplysomeorallofittotaxesowedinthefuturetaxyears.

• FinanciallyRewarding–thepercentageofthetaxcredit,thestate’saggregatedallocationforthecredit,andtheamountofeligibleexpensesshouldbesignificantenoughtopromoteparticipation.

• Trackable–thetaxcreditshouldproducemeasurableresultsthatarecollectedandpromotedyearafteryear.

Formoreinformationonthistopic,pleasecontact:Children’sAdvocacyAlliance702-228-18695258SouthEasternAve,Suite151,LasVegas,NV891193500LakesideCt,Suite209,Reno,NV89509www.caanv.org 24Stoney,Louise,andAnneMitchell.UsingTaxCreditstoPromoteHighQualityEarlyCareandEducationServices#2(n.d.):n.pag.PartnershipforAmerica'sEconomicSuccess,20Nov.2007.Web. 25 Withoutastate-incometax,providingtaxcreditstoparentsand/oremployeeswouldbeadifficultoption. 26 Blank,Susan,andLouiseStoney.TaxCreditsforEarlyCareandEducation:FundingStrategyforaNewEconomy(2011):n.pag.Web.<http://opportunities-exchange.org/wp-content/uploads/OpEx_IssueBrief_Tax_Final1.pdf>.

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LicenseExemptChildCareParentshavemanyoptionswhenlookingforchildcarefortheirchildren.InNevada,therearefivedifferenttypesofchildcareproviders.Theseincludestate-basedcare(statepreschoolprograms),familyhomecare(5-6non-relatedchildren),grouphomecare(7-12non-relatedchildren),childcarecenter(13ormorechildren),andlicense-exemptproviders(1-4non-relatedchildren).Whenaparentsendstheirchildrentoalicensedprovider–state-based,familyhome,grouphomeorcenterbased–theyhavetheassurancethateveryindividualinthefacilityhasreceivedacompletepersonalhistory,background,andchildabuseandneglectchecks.Thesechecksensurethatindividualsarenotallowedtoworkwithchildreniftheyhavearecordofthefollowing:

(a) Murder,voluntarymanslaughterormayhem;(b) Anyotherfelonyinvolvingtheuseofafirearmorotherdeadlyweapon;(c) Assaultwithintenttokillortocommitsexualassaultormayhem;(d) Sexualassault,statutorysexualseduction,incest,lewdness,indecentexposureorany

othersexuallyrelatedcrime;(e) Abuseorneglectofachildorcontributorydelinquency;(f) Aviolationofanyfederalorstatelawregulatingthepossession,distributionoruseof

anycontrolledsubstanceoranydangerousdrugasdefinedinchapter454ofNRS;(g) Abuse,neglect,exploitation,isolationorabandonmentofolderpersonsorvulnerable


(h) Anyoffenseinvolvingfraud,theft,embezzlement,burglary,robbery,fraudulentconversionormisappropriationofpropertywithintheimmediatelypreceding7years.

License-exemptproviders(unlesstheyreceivechildcaresubsidyfunding)arenotsubjecttotheserequirements.Thus,leavingthepotentialforindividualswithahistoryofsexual,physicalabuseorneglectofachild,amongothercrimes,tobeleftalonewiththesechildren–placingtheminharm’sway.A2005study,FatalitiesandtheOrganizationofChildCareintheUnitedStates,1985–2003,foundthatlicensedchildcaremayalsooffersafercareasaresultofchildcarelicensing’smanysafetyrequirementssuchbeingrequiredtolockuphazardoussupplies,coverelectricaloutlets,andtakebasicsafetycourses.27

27Wrigley,Julia,andJoannaDerby."FatalitiesandtheOrganizationofChildCareintheUnitedStates,1985-2003."AmericanSociologicalReview70(2005):n.pag.Web.<http://www.asanet.org/sites/default/files/savvy/images/members/docs/pdf/featured/Oct05ASRWrigleyDreby.pdf>.


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Additionally,Nevada’sDepartmentofHealthandHumanServices’ChildCareLicensingProgramdoesnothavetheabilitytoprovideoversightoraccessfinesforprovidersviolatingchildcareregulationsandstatutes–apartfromrequestingalawenforcementagencytochargetheproviderwithamisdemeanor.From2013-2015,ChildCareLicensingrespondedto68complaintsforprovidersservingtoomanychildrenwhileoperatingalicense-exemptchildcare.28Ofthese68complaints,18ofthesecomplaintsweresubstantiated–theproviderswereservingmorethantheirallotted4children–with5beingrepeatoffenders.29Apartfromnotifyingtheprovidersthattheyarebreakingthelaw,thereisnothingelseChildCareLicensingcando.Thisgiveslicense-exemptproviders’littleincentivetocomeintocompliancewithcurrentlawandplacesthechildrenatahigherriskofinjuryordeath.Recommendations:

1. RequireallchildcareprovidersthatreceivemonetarycompensationfortheirservicestoreceiveabackgroundcheckthroughtheStateofNevada’sChildCareLicensingProgram(intheDivisionofPublic&BehavioralHealth,DepartmentofHealth&HumanServices)iftheyregularlyprovidecareforfewerthanfivenon-relativechildren,withoutthepresenceofparents,outsidethechild’shome.• “Regularly”isdefineddifferentlybydifferentstates.Wedonotwanttobeoverly

burdensomeforpeoplehelpingfriendstemporarily.Forexample,onestatedefines“regularly”asmorethan6hoursaday4daysaweekformorethan3consecutiveweeks.

• Backgroundchecksshouldalsoberequiredforallemployeesandvolunteersthatprovidedirectcare,aswellaseveryresidentage18orolderlivingintheprovider’splaceofbusiness.

• Backgroundchecksmustbeupdatedatleastonceeveryfiveyears.• Apersonmaynotprovidechildcareforcompensationtonon-relatedchildreninNevada

iftheiftheydonotpassacompletepersonalhistoryandbackgroundcheckandaChildAbuseandNeglectcheck.

2. AuthorizetheChildCareLicensingProgram(DPBH,DHHS)toimposeanadministrative

fineuponlicense-exemptproviderscaringformorethantheallowednumberofchildren(thisenforcesthecurrentlaw).Theyshouldbeabletoimposeafineforanyviolation,includingforproviderswholackacurrentbackgroundcheckandthosecaringformorethantheallowednumberofchildreninthelicense-exemptcategory.

Formoreinformationonthistopic,pleasecontact:Children’sAdvocacyAlliance702-228-18695258SouthEasternAve,Suite151,LasVegas,NV891193500LakesideCt,Suite209,Reno,NV89509 www.caanv.org

28Intotal,ChildCareLicensingrespondedto100complaintsregardingunlicensedchildcarefacilitiesservingtoomanychildren.32ofthesecomplaintsfoundthattheindividualwasnotprovidingchildcareintheirhome.29NumberscompiledbytheChildren’sAdvocacyAllianceviaChildCareLicensingcomplaintreports.

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QualityRatingImprovementSystems(QRIS)AQRISisasystematicapproachtoassess,improve,andcommunicatethelevelofqualityinearlycareandschool-ageprograms.Similartoratingsystemsforrestaurantsandhotels,QRISawardsqualitystarratingstoearlycareandschoolageprogramsthatmeetasetofdefinedprogramstandards.ThesesystemsprovideanopportunityforStatestoincreasethequalityofcareforchildren,increaseparents’understandinganddemandforhigherqualitycare,andincreaseprofessionaldevelopmentofchildcareproviders.AQRIScanalsobeastrategyforaligningcomponentsoftheearlycareandschool-agesystemforincreasedaccountabilityinimprovingqualityofcare.30Tohelpincentivizechildcareproviderstoimprovetheirquality,inJuly2013,NevadalaunchedtheNevadaSilverStateStarsQualityRatingandImprovementSystem(QRIS).TheQRISwascreatedtoestablishastandardtomeasureandimprovethequalityofearlychildhoodprogramsandeducatefamilies,providers,andthecommunity.31AsofMay2016,atotalof147centershaveappliedtoparticipateintheprogram.Byparticipating,centersreceive:technicalassistance(TA)andtrainingfromcoacheswhodevelopaqualityimprovementplanforthecenters;visitfromtheircoachforupto10hourspermonthtoevaluateprogress,provideonsiteTAandtrainstaff;aone-timeinitialqualityimprovementgrant($4,000-$8,500)baseduponlicensedcapacity;advancementbonusatrenewal;andeligibilityforincreasedchildcaresubsidyratesof6,9,or12%dependingontheirfinalstarratinglevel. Thestarratingsareawardedbaseduponanonsitequalityassessmentanddocumentationinfourqualitycategories:Policies&Procedures,Administration&StaffDevelopment,Health&Safety,andFamilies&Community.32AsofMay2016,forty-twocentersthroughoutNevadawereratedwiththeSilverStateStarsQRIS.Morethan50%ofthecentersthatparticipatedintheQRISprogramwereabletoimprovetheircareandbecomequalityearlylearningprograms.Whiletheprogramsthatareattwo-starsarestillworkingtomeethighqualitystandards,itshouldbenotedthattwo-star

30 NationalChildCareInformationCenter,2009.QRISdefinitionandstatewidesystems.http://nccic.acf.hhs.gov/pubs/qrs-defsystems.html.31Vision/Mission.NevadaSilverStateStarsQRIS,n.d.Web.30Aug.2016.<http://www.nvsilverstatestars.org/mission-and-vision>.32Note:TheQRISstarleveldefinitionsarecurrentlyunderreviewandmayundergorevisionsin2017.


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programsarestillgoingaboveandbeyondminimumrequirementsrequiredbyChildCareLicensing.

NumberandPercentageofCentersReceivingEachStarLevelRatingMay2016

FiveStars 7 17%FourStars 4 10%ThreeStars 11 26%TwoStars 19 45%OneStar 1 2%TotalNumberofratedCenters 42 100%TheSilverStateStarsQRISiscontinuingtoworkwithchildcareproviderstoimprovethequalityofcareinNevada.Priorto2016,SilverStateStarsQRISworkfocusedonimprovingthequalityoflicensedchildcareproviders.ThisqualityinitiativehassincebeenexpandedandnowincludesratingscalesforFamilyChildCareandpublicpre-Kprograms.Currently,theSilverStarsQRISisworkingtoincludetheTribalModelchildcare.ThisexpansionishelpingfamiliesgainaccesstohighqualitycarefortheirchildreninNevada.Unfortunately,theabilityofprogramstoparticipateislimitedduetolackoffunds.AsofMay2016,thereisawaitlistof50centerstobecomepartoftheSilverStateStarsQRISprogram.Recommendations:NevadacurrentlylackstheappropriateresourcesforfullparticipationinQRISforalltypesofchildcareproviders.Statewideexpansionshouldbeimplementedonagradualbasis,withcontinuedassessment,evaluationandimprovementtofurtherrefinetheprocess.Furtherfundingisneededtoincreasethenumberofparticipatinglicensedchildcarecenters,familychildcare,licensedexempt,districtmodelandtribalchildcare.Effortsshouldalsobemadetoincludeappropriateresourcesformarketingandoutreachtoensurethatparentsareawareofandunderstandthestarratingsystem.Uponstatewideimplementation,directalignmentbetweenQRISandchildcaresubsidyreimbursementswillensurethatstatefundsarebeingusedbothefficientlyandeffectivelytoprovidethehighestlevelofqualitycareandeducationtoourstate’smostvulnerablechildren. AdaptedfromtheNevadaSilverStateStarsWebsite,http://www.nvsilverstatestars.org/


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HighQualityWorkforceforHighQualityEarlyLearningInNevada,63.6%ofchildrenhaveallavailableparentsintheworkforce.33This,combinedwithanimprovedunderstandingofthepositiveimpactsofhigh-qualityearlylearning,havecausedanincreaseddemandforhigh-quality,affordablechildcareandearlyeducationprograms.Childrenarerapidlydevelopingandlearningintheirfirstfiveyearsoflife,layingthefoundationforlatersuccess.Duringthistime,itiscrucialthatchildrenbeexposedtohighqualityearlylearningexperiencestoincreasetheirachievementinschoolandbeyond.Researchindicatesthatthemostcriticalcomponentofchildcarequalityistheteacher-childrelationship.34AsNevadabuildsthenecessaryinfrastructuretoincreaseearlyeducationservices,itisimportantthatacomprehensiveplaniscreatedtohelpsupportandtrainteachers.Currently,mostprofessionalswithintheearlylearningworkforceearnlowwages,often,regardlessoftheirtrainingorlevelofeducation.Someindividualswithintheearlychildhoodeducation(ECE)communityaremakingatorneartheFederalpovertylineandqualifyforwelfareprograms.Theselowwagesmakeitdifficultforindividualsinthisworktotakecareoftheirownfamilies

WagesforEarlyChildhoodCareandEducationProfessionalsinNevada35LicensedCenterWages36



Overall,suchlowpaylimitstheabilityofthisgrowingfieldofeducationtoenticeandretainstaff-especiallythosewithhigherlevelsofeducation.Thelimitedsupportstoprovidelivablewagesanddevelopmentprogramsleadtoanincreasedturnoverwhichiscostlytoprograms.In2014inNevada,theturnoverrateforcenter-basedstaffwas16%.37Thisturnovercanhaveanimpactonchildren’slearning.Researchillustratesthatchildrenbenefitfrombeingenrolledincenterswithlowerturnover.38Thisstabilityallowsforchildrentoengageinincreasedpositive33"2014Demographics:EarlyEducation&Care&OutofSchoolPrograms."TheChildren'sCabinet(n.d.):n.pag.Web.<http://www.childrenscabinet.org/wp-content/uploads/2014-Demographics-Report.pdf>.34Shonkoff,JackP.,andDeborahPhillips.FromNeuronstoNeighborhoodstheScienceofEarlyChildhoodDevelopment.Washington,D.C.:NationalAcademy,2000.Print.35"2014Demographics:EarlyEducation&Care&OutofSchoolPrograms."TheChildren'sCabinet(n.d.):n.pag.Web.<http://www.childrenscabinet.org/wp-content/uploads/2014-Demographics-Report.pdf>.36ExcludesHeadStart&Pre-KWages37"2014Demographics:EarlyEducation&Care&OutofSchoolPrograms."TheChildren'sCabinet(n.d.):n.pag.Web.<http://www.childrenscabinet.org/wp-content/uploads/2014-Demographics-Report.pdf>.38"High-QualityEarlyLearningSettingsDependonaHigh-QualityWorkforce."DepartmentofEducation&DepartmentofHealthandHumanServices,2016.Web.30Aug.2016.<http://www.acf.hhs.gov/ecd/high-quality-early-learning-settings-depend-on-a-high-quality-workforce>.

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*"2014Demographics:EarlyEducation&Care&OutofSchoolPrograms."TheChildren'sCabinet(n.d.):n.pag.Web.<http://www.childrenscabinet.org/wp-content/uploads/2014-Demographics-Report.pdf>.**ExcludesHeadStart&Pre-KWages


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interactionandactivitieswiththeirteachers.Ontheoppositeend,achildenrolledinacenterwithhighstaffturnovercanseenegativeeffectswiththeirsocial-emotionalandbehavioraldevelopment.Highstaffturnovercaninfluencetheoverallprogramcultureandhaveanimpactonthequalityofservices.Thereisanationalandlocalpushtoincreasethequalityofcareandeducationbeingprovidedinearlylearningcenters.Withthispush,therehavebeencallsforhighereducatedteachersinECEclassrooms.InNevada,theNevadaReady!PreschoolDevelopmentGrantrequiresaminimumofabachelor’sdegreeinECEtoqualifytoteachinagrantfundedclassroom.Unfortunately,thereisaverylimitedquantityofearlylearningprofessionalswithhigherlevelsofeducationandthisisunlikelytochangeunlesstheannualearningsfortheseteachersincrease.Childcareandearlylearningprograms,unlikeK-12educationprograms,relyonfeesandtuitionfromfamiliestooperatetheirearlylearningcenters.Theaveragecentergenerates87%ofitsrevenuefromparenttuition,whiletheaverageinstitutionofhighereducationgeneratesonly35%fromtuitionandfees.39Unlesscentersincreasetheirfeesandtuition,limitingaccesstothemostat-riskchildrenandfamilies,thereisnowayforthesecenterstoincreasethewagesoftheiremployeesorprovideincentivesforobtaininghigherlevelsofeducation.Toassistwithhigherwages,thestateneedstoincreasefinancialsupportforchildcareandearlylearningprofessionals.Withoutthestate’sintervention,earlylearningprofessionalswillremainatorclosetothepovertylineandhavenoincentivetoincreasetheireducationalattainment,unlessitistoleavetheECEworkforce.

Recommendations:

Nevadaneedstoincreasefinancialsupportforchildcareandearlylearningprofessionals.Thestateshouldsubsidizeteachers’monthlywagestohelplifttheearlylearningprofessionalsoutofpovertyandattractnewtalenttothecareerpath.Tohelpencourageeducationalattainment,thestatecantierthewagesubsidesbasedonlevelofeducationorprofessionaldevelopment.Formoreinformationonthistopic,pleasecontact:Children’sAdvocacyAlliance702-228-1869 5258EasternAve,Suite151,LasVegas,NV891193500LakesideCt,Suite209,Reno,NV89509 www.caanv.org

39Stoney,Louise,andAnneMitchell."CanWeUseTaxStrategiestoHelpFinanceEarlyCareandEducation?"EarlyChildhoodFinance,n.d.Web.30Aug.2016.<www.earlychildhoodfinance.org/.../TaxStrategiesCall_Resources_2006.doc>.

LicensedChildCare-HighestEducationalAttainment

LessthanaHighSchoolDiploma 42%HighSchoolDiploma 19%SomeCollege 19%Associate’sDegree-ECE 3%Associate’sDegree-Other 3%Bachelor’sDegree-ECE 3%Bachelor’sDegree-Other 8%PostgraduateDegree-ECE 1%PostgraduateDegree-Other 2%

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14.90%

20.00%

9.60%13.30%

UninsuranceRateforAllKidsinNevada

UninsuranceRateforLatinoKidsinNevada

Figure1.UninsuranceRatesforChildreninNevada2013 2014



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2. STUDENTACHIEVEMENTNevadaChildren’sReportCardGrade:F

Thestudentachievementgradeisbasedupon4thgradereadingscores,8thgrademathscores,andpostsecondaryparticipation.Althoughtherearemultipleassessmentstomeasurethereadingandmathindicators,theNVChildren’sReportutilizestheNationalAssessmentofEducationalProgress(NAEP)inefforttoassesshowNevadacompareswithotherstates.Accordingtothe2015NAEP,thepercentageof4thgraderswhoareproficientatreadinghasdeclinedfrom34%in2013to29%in2015.Similarly,8thgradersproficientinmathdeclinedfrom30.3%to26.1%in2015.Nevadaremainsnearthebottomofbothrankings,45thforreadingand42ndformath.40Nevadaranks50thoverallforpostsecondaryparticipation,withjust40.1%ofyoungadultsenrolledinpostsecondaryeducationorwithadegree,comparedtothenationalaverageof55.2%.41Asdiscussedintheprevioussection,studentachievementisdependentonthequalityofcarepriortoprimaryschoolenrollmentaswellaswithinprimaryschool.AccordingtotheU.S.DepartmentofEducation(2011),first-timekindergartners'fallreadingskillsdifferedbasedontheirprimarycarearrangementsintheyearpriortoenteringkindergarten.Specifically,childrenwhohadnotreceivedanynon-parentalcareonaregularbasisandthosewhoseprimarycarearrangementwashome-basedwitharelativehadlowerfallreadingscoresthanchildrenwhoattendedhome-basednonrelativecare,attendedcenter-basedcare,orhadmultiplecarearrangements.Thesepatternsemergedformathabilitiesaswell.Learningtoreadandwriteareessentialskillstobesuccessfulinschoolandinlife.Itisimperativethatstudentsareprovidedanopportunitytoachievetheirfullpotentialduringtheirearlyandprimaryyearsinordertoensurethelikelihoodtheygraduatefromhighschool.Whenourschoolslacktheresourcestoproperlyeducateourstudents,thecommunityatlargewillexperiencetherelatednegativeoutcomes.RECOMMENDATIONSFORIMPROVEMENT:

• Continuesupportforadditionalprofessionaldevelopmentforteachersatallgradelevelstoincreasetheirabilitytoofferqualityinstructiontostudents.

• Reduceclassroomsizesinallgradessoteachershavemoretimetodedicatetoindividualizedstudentimprovement.

• Increasefundingforallschoolsinordertoincreasepayforqualityteachers.Itisimportanttokeepqualifiedteachersintheclassroom.

• Ensurethatchildrenreceivesupportsearlybyprovidinghighqualityearlyeducationprogramssothatchildrenenterschoolreadytolearn.

• Continueprogramsthatsupportat-riskyouthwithadditionalsupportinreading&math.

40"NevadaStateHighlights2016."(2016):n.pag.EducationWeek,26Jan.16.Web.<http://www.edweek.org/media/ew/qc/2016/shr/16shr.nv.h35.pdf>.41Ibid.

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3. HIGH SCHOOL COMPLETION Nevada Children’s Report Card Grade: F The high school completion grade is based upon high school dropouts (teens age 16 to 19 who are not in school and have not yet graduated), as well as high school graduation rates. Nevada’s dropout rate is 4%42, ranking Nevada 15th (with 21 other states) in 2014 – showing steady improvement with the highest ranking yet seen in Nevada. In order to grade Nevada by national rank, data for the high school graduation indicator is based upon the class of 2012 – which was 60%.43 However, more recent data from the Nevada Department of Education shows a cohort graduation rate of 70.77% for the class of 2015, showing steady improvement over the past several years.44 The percentage of young adults ages 18–24 with a high school diploma or an equivalent credential is a measure of the extent to which young adults have completed a basic prerequisite for many entry-level jobs and for higher education. The graph below shows high school diploma attainment by race across the country.

Percentage of young adults ages 18–24 who have completed high school by race and Hispanic origin, 1980–201345

Much like the graph above, Nevada has deep disparities in graduation rates. Students who are Black or Hispanic have a graduation rate of 55.5% and 66.7% in Nevada, respectively, thus showing that Nevada’s trend mirrors that which is occurring across the US.46 42 "Teens Ages 16 to 19 Not in School and Not Working." KIDS COUNT Data Center from the Annie E. Casey Foundation. N.p., n.d. Web. 30 Aug. 2016. <http://datacenter.kidscount.org/>. 43 "Nevada State Highlights 2016." (2016): n. pag. Education Week, 26 Jan. 16. Web. <http://www.edweek.org/media/ew/qc/2016/shr/16shr.nv.h35.pdf>. 44 “Nevada Report Card” Nevada Department of Education, http://www.nevadareportcard.com/ 45 "America's Children in Brief: Key National Indicators of Well-Being, 2016." Childstats.gov. N.p., n.d. Web. 30 Aug. 2016. <http://www.childstats.gov/americaschildren/ed_fig.asp#ed4 (2015)>. 46 “Nevada Report Card” Nevada Department of Education, http://www.nevadareportcard.com/

In addition, there are other groups who have disparate graduation rates including those eligible for free or reduced price lunch (52.32%), English Language Learners (26.36%), and those with an Individualized Education Program (22.71%).47 According to a report by the National Dropout Prevention Center, there are many factors that influence the dropout rate which include: chronic or mental illness, early marriage, low occupational aspirations, need for autonomy, sexual involvement, pressures to seek employment, change in educational services or placement, school dissatisfaction, having siblings that dropped out, and substance abuse.48 Each of these factors represents a point of intervention that can be targeted to reduce risk associated with high school dropouts in Nevada. Identifying and addressing the reasons Nevada’s students drop out will help improve overall graduation rates. Reducing the dropout rate is also advantageous for the State. Individuals lacking a high school diploma are more likely to face unemployment, rely on government cash assistance, food stamps, and housing assistance, and to cycle in and out of the prison system. 49 Research conducted by Dr. Tiffany G. Tyler and Dr. Sandra Owens from the University of Nevada, Las Vegas suggests that increasing the 2010 graduation rate by half would result in Nevada seeing gains of $64,844,808 in earnings, $155,366,635 in vehicle and home purchases, 405 new jobs supported, and receiving $53,317,331 in lost revenue.50 This evidence shows that high school completion is not simply a concern for the school systems , but for the community overall. RECOMMENDATIONS FOR IMPROVEMENT:

Increase funding to support additional professional development for teachers at all grade levels to increase their ability to offer quality instruction to students.

Reduce classroom sizes in all grades so teachers have more time to dedicate to individualized student improvement.

Increase funding for all schools in order to increase pay for quality teachers. It is important to keep qualified teachers in the classroom.

Increase support services for youth and families to address other factors associated with low graduation and dropout rates including youth homelessness, poverty, physical, mental and behavioral health needs, and participation in high risk behaviors.

47 Ibid. 48 Hammond, C., Linton, D., Smink, J., & Drew, S, “Dropout Risk Factors and Exemplary Programs. Clemson, SC: National Dropout Prevention Center, Communities in Schools, Inc” (2007) http://dropoutprevention.org/resources/major-research-reports/dropout-risk-factors-and-exemplary-programs-a-technical-report/ 49 Tyler, T. G. and Owens, S., edited by Dmitri N. Shalin.,“High School Graduation and Dropout Rates,” http://cdclv.unlv.edu/healthnv_2012/index (2012) 50 Tyler, T. G. and Owens, S., edited by Dmitri N. Shalin.,“High School Graduation and Dropout Rates,” http://cdclv.unlv.edu/healthnv_2012/index (2012)

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In addition, there are other groups who have disparate graduation rates including those eligible for free or reduced price lunch (52.32%), English Language Learners (26.36%), and those with an Individualized Education Program (22.71%).47 According to a report by the National Dropout Prevention Center, there are many factors that influence the dropout rate which include: chronic or mental illness, early marriage, low occupational aspirations, need for autonomy, sexual involvement, pressures to seek employment, change in educational services or placement, school dissatisfaction, having siblings that dropped out, and substance abuse.48 Each of these factors represents a point of intervention that can be targeted to reduce risk associated with high school dropouts in Nevada. Identifying and addressing the reasons Nevada’s students drop out will help improve overall graduation rates. Reducing the dropout rate is also advantageous for the State. Individuals lacking a high school diploma are more likely to face unemployment, rely on government cash assistance, food stamps, and housing assistance, and to cycle in and out of the prison system. 49 Research conducted by Dr. Tiffany G. Tyler and Dr. Sandra Owens from the University of Nevada, Las Vegas suggests that increasing the 2010 graduation rate by half would result in Nevada seeing gains of $64,844,808 in earnings, $155,366,635 in vehicle and home purchases, 405 new jobs supported, and receiving $53,317,331 in lost revenue.50 This evidence shows that high school completion is not simply a concern for the school systems , but for the community overall. RECOMMENDATIONS FOR IMPROVEMENT:

Increase funding to support additional professional development for teachers at all grade levels to increase their ability to offer quality instruction to students.

Reduce classroom sizes in all grades so teachers have more time to dedicate to individualized student improvement.

Increase funding for all schools in order to increase pay for quality teachers. It is important to keep qualified teachers in the classroom.

Increase support services for youth and families to address other factors associated with low graduation and dropout rates including youth homelessness, poverty, physical, mental and behavioral health needs, and participation in high risk behaviors.

47 Ibid. 48 Hammond, C., Linton, D., Smink, J., & Drew, S, “Dropout Risk Factors and Exemplary Programs. Clemson, SC: National Dropout Prevention Center, Communities in Schools, Inc” (2007) http://dropoutprevention.org/resources/major-research-reports/dropout-risk-factors-and-exemplary-programs-a-technical-report/ 49 Tyler, T. G. and Owens, S., edited by Dmitri N. Shalin.,“High School Graduation and Dropout Rates,” http://cdclv.unlv.edu/healthnv_2012/index (2012) 50 Tyler, T. G. and Owens, S., edited by Dmitri N. Shalin.,“High School Graduation and Dropout Rates,” http://cdclv.unlv.edu/healthnv_2012/index (2012)

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4. FUNDINGNevadaChildren’sReportCardGrade:F

Thefundinggradeisbasedontheamountofmoneyallocatedperpupilinthestate,aswellasstudent-teacherratios.Perpupilexpendituresarecalculatedforgradespre-kindergartenthrough12thgradeinpublicelementaryandsecondaryeducation.51InNevada,actualperpupilexpendituresforthe2013-2014fiscalyearwere$8,414comparedto$11,000nationally.52Nevada’srankingof46thinthiscategoryhaschangedlittlesincethelastreportcard.Nevada’slowperpupilexpenditurecauseshighstudent-teacherratios.Nevadaranks47thinthenationforstudent-teacherratioswithanaverageratioof20.6comparedto16.1nationally.53In2015,Nevada’sLegislaturevotedtochangeNevada’sfundingformulawhichcouldincreasethestate’srankinginfutureyears.ThechangestothefundingformulatookconstructivestepstomodernizeTheNevadaPlanforSchoolFinance–whichwasfirstcreatedin1967–throughthepassageofSenateBill508.Thebill:54

• Adjustedthemethodusedtoconductthestudentenrollmentcount;• Revisedandrepealedtheholdharmlessprovision;• Clarifiedthebasicsupportguarantee;• Maderevisionstotheequityallocationmodel;• Requiredthestatetoimplementorphase-inweightedfundingforspecialeducation,

Englishlanguagelearners,at-risk(highpoverty),andgiftedandtalented(GATE);• Createdacontingencyaccountforspecialeducationservices;• MadechangestothespecialeducationplacementInteragencyPanel;• Mandatedkindergartenpupilstobefullyfundedtosupportfulldaykindergartenforall

students;and• Changedrequirementsforthebiennialbudgetsubmittal.

RECOMMENDATIONSFORIMPROVEMENT:• Nevadashouldmakealargercontributiontotheeducationofourchildrenbyincreasing

thebaseperpupilexpenditure.

• Nevadashouldrevisethefundingformulatoincorporatefundingforpreschoolstudents.

51TheperpupilamountusedinthisanalysistakesintoconsiderationcategoricalfundsallocatedtoeducationandthefundingfromtheNevadafundingformula.52“PublicEducationFinances:2014”U.S.CensusBureau,http://census.gov/content/dam/Census/library/publications/2016/econ/g14-aspef.pdf53Glander,Mark.SelectedStatisticsfromthePublicElementaryandSecondaryEducationUniverse:SchoolYear2013-14.FirstLook(n.d.):n.pag.NationalCenterforEducationalStatistics.Web.<http://nces.ed.gov/pubs2015/2015151.pdf>.54NevadaLegislativeWebsite,78thLegislativeSession.SenateBill508.http://www.leg.state.nv.us/Session/78th2015/Bills/SB/SB508_EN.pdf

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4. FUNDINGNevadaChildren’sReportCardGrade:F

Thefundinggradeisbasedontheamountofmoneyallocatedperpupilinthestate,aswellasstudent-teacherratios.Perpupilexpendituresarecalculatedforgradespre-kindergartenthrough12thgradeinpublicelementaryandsecondaryeducation.51InNevada,actualperpupilexpendituresforthe2013-2014fiscalyearwere$8,414comparedto$11,000nationally.52Nevada’srankingof46thinthiscategoryhaschangedlittlesincethelastreportcard.Nevada’slowperpupilexpenditurecauseshighstudent-teacherratios.Nevadaranks47thinthenationforstudent-teacherratioswithanaverageratioof20.6comparedto16.1nationally.53In2015,Nevada’sLegislaturevotedtochangeNevada’sfundingformulawhichcouldincreasethestate’srankinginfutureyears.ThechangestothefundingformulatookconstructivestepstomodernizeTheNevadaPlanforSchoolFinance–whichwasfirstcreatedin1967–throughthepassageofSenateBill508.Thebill:54

• Adjustedthemethodusedtoconductthestudentenrollmentcount;• Revisedandrepealedtheholdharmlessprovision;• Clarifiedthebasicsupportguarantee;• Maderevisionstotheequityallocationmodel;• Requiredthestatetoimplementorphase-inweightedfundingforspecialeducation,

Englishlanguagelearners,at-risk(highpoverty),andgiftedandtalented(GATE);• Createdacontingencyaccountforspecialeducationservices;• MadechangestothespecialeducationplacementInteragencyPanel;• Mandatedkindergartenpupilstobefullyfundedtosupportfulldaykindergartenforall

students;and• Changedrequirementsforthebiennialbudgetsubmittal.

RECOMMENDATIONSFORIMPROVEMENT:• Nevadashouldmakealargercontributiontotheeducationofourchildrenbyincreasing

thebaseperpupilexpenditure.

• Nevadashouldrevisethefundingformulatoincorporatefundingforpreschoolstudents.

51TheperpupilamountusedinthisanalysistakesintoconsiderationcategoricalfundsallocatedtoeducationandthefundingfromtheNevadafundingformula.52“PublicEducationFinances:2014”U.S.CensusBureau,http://census.gov/content/dam/Census/library/publications/2016/econ/g14-aspef.pdf53Glander,Mark.SelectedStatisticsfromthePublicElementaryandSecondaryEducationUniverse:SchoolYear2013-14.FirstLook(n.d.):n.pag.NationalCenterforEducationalStatistics.Web.<http://nces.ed.gov/pubs2015/2015151.pdf>.54NevadaLegislativeWebsite,78thLegislativeSession.SenateBill508.http://www.leg.state.nv.us/Session/78th2015/Bills/SB/SB508_EN.pdf

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FUNDING–SPECIALISSUE

FundingforPre-KEducationThefirstfiveyearsofachild’slifearecrucialtotheiroveralldevelopment,makingthisacriticalpointforstrategicinvestments.Researchshowsthatpreschoolisaneffectiveearlyinterventionmethodthatcreateslastingacademicandsocialimpact.Long-termstudiesofvaryingpreschoolprogramshavefoundsignificantbenefitsincluding:55

• Higherlevelsofverbal,mathematical,andintellectualachievement;• Greatersuccessatschool,includinglessneedforspecialeducation,lessgraderetention,

andhighergraduationrates;• Lowerunemploymentandhigherearnings;• Betterhealthoutcomes;• Lesswelfaredependency;• Lowerratesofcrime;and• Greatergovernmentrevenuesandlowergovernmentexpenditures.

ForNevada’smostat-riskstudents,highqualityearlychildhoodeducationcanbethedifferencebetween entering kindergarten ready to learn or entering 18 months behind their affluentpeers.56Thebenefitsofpreschoolgobeyond theclassroomand intoadulthood.Thepositiveimpactofpreschoolforanindividualtranslatestoalargereturnoninvestment(ROI)forsociety.Childrenwhoattendpreschoolare less likelytoneedcostlyservices,suchasanextrayearofschooling,welfareassistance,orajailbed.Additionally,childrenwhoattendpreschoolaremorelikelytobeemployedandhaveahighersalary-enablingthemtocontributegreaterearningstothecommunity.SomecommunitieshaveseenaROIashighas$7foreverydollarinvestedinPre-K.57 Despitetheprovenbenefitsofinvestmentintohighqualityearlychildhoodeducationprograms,Nevadahaslimitedfundsforthestatepreschoolprogram.Evenwiththechangesmadetothefundingformulain2015,theNevadaPlandoesnotguaranteefundingforearlychildhoodeducationfornon-specialeducationstudents.TheNevadaStatePreschoolProgramiscurrentlyfundedbyexternalcategoricaldollarsallowingittobeeasilyreducedoreliminated.TheStatehasyettoincreasefundingforthisexternalcategoricalprogrambuthasinstead

55Lynch,G.Roberts.2004.“ExceptionalReturns:Economic,Fiscal,andSocialBenefitsinEarlyChildhoodDevelopment.”EconomicPolicyInstitutehttp://www.unicef.org/lac/spbarbados/Finance/Global/exceptional_returns_ECD_2004.pdf56“KindergartenReadiness”EarlyEdgeCalifornia.http://www.earlyedgecalifornia.org/our-issues/kindergartenreadiness/index.html57Heckman,James,SeongHyeokMoon,RodrigoPinto,PeterA.Savelyev,andAdamYavitz.2009.“TherateofreturntotheHighscopePerryPreschoolProgram.”JournalofPublicEconomics,Vol.94,pp.114-128.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145373/

FUNDING – SPECIAL ISSUE

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decreasedfunding.In2001,theNevadaStatePreschoolProgramwasfundedat3.5milliondollarsandtodayitisfundedat3.3milliondollars.Currently,Nevadaranks42ndforstatespendingpercapitaamongstatesthatofferpreschoolprograms,investing$46.35perchildcomparedtothenationalaverageof$773.63.Fortunately,theNevadaStatePreschoolProgramhashadindirectfundingtohelpincreaseaccessforyoungchildren.Duringthe2015LegislativeSession,thelegislaturedidincreasefundstoZoomSchools,createdtheVictorySchoolsprogramandapprovedthematchrequirementforthePreschoolDevelopmentGrant.WhileNevadahasnotdirectlytakenstepstoincreasestatepreschoolfunding,theseinvestmentswillhelptoincreaseaccesstopreschoolprograms;but,theyarealsonotguaranteedfromyeartoyear.Thesecategoricalinvestmentsarestepsintherightdirection,butNevadaneedstostartlookingatlong-term,sustainablefundingforitspreschoolprograms.Recommendation:InordertostabilizefundingandincreaseaccesstotheNevadaPreschoolProgram,theNevadaPlanshouldberevisedtoincludeperpupilfundingforpreschoolprograms.Inadditiontofundingforpreschoolstudents,Nevadaneedstoensuretheyarealsoprovidingfundstocreatespaceforadditionalclassrooms,aswellastosupporttotrainandretainedqualifiedearlychildhoodteachers.


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decreasedfunding.In2001,theNevadaStatePreschoolProgramwasfundedat3.5milliondollarsandtodayitisfundedat3.3milliondollars.Currently,Nevadaranks42ndforstatespendingpercapitaamongstatesthatofferpreschoolprograms,investing$46.35perchildcomparedtothenationalaverageof$773.63.Fortunately,theNevadaStatePreschoolProgramhashadindirectfundingtohelpincreaseaccessforyoungchildren.Duringthe2015LegislativeSession,thelegislaturedidincreasefundstoZoomSchools,createdtheVictorySchoolsprogramandapprovedthematchrequirementforthePreschoolDevelopmentGrant.WhileNevadahasnotdirectlytakenstepstoincreasestatepreschoolfunding,theseinvestmentswillhelptoincreaseaccesstopreschoolprograms;but,theyarealsonotguaranteedfromyeartoyear.Thesecategoricalinvestmentsarestepsintherightdirection,butNevadaneedstostartlookingatlong-term,sustainablefundingforitspreschoolprograms.Recommendation:InordertostabilizefundingandincreaseaccesstotheNevadaPreschoolProgram,theNevadaPlanshouldberevisedtoincludeperpupilfundingforpreschoolprograms.Inadditiontofundingforpreschoolstudents,Nevadaneedstoensuretheyarealsoprovidingfundstocreatespaceforadditionalclassrooms,aswellastosupporttotrainandretainedqualifiedearlychildhoodteachers.


Children’sHealth

“To keep the body in good health is a duty, otherwise we shall not be able to keep our mind strong and clear.”

- Buddha

Children’s Health Overview1. Access to Healthcare

2. Prenatal and Infant Health

3. Immunizations

4. Childhood Obesity

5. Dental Health

6. Mental Health

7. Sexual Health

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CHILDREN’SHEALTHOVERVIEWNevadaChildren’sReportCardGrade:D

EverychildinNevadashouldhavetheopportunitytogrowuphealthy,fromtheprenatalperiodthroughyoungadulthood.Tobehealthy,childrenandfamiliesneed:

• Highqualityandon-timeprenatalcare.• Accesstohighquality,affordablehealthcare,includingoralhealthandmentalhealth.• On-time,recommendedchildhoodimmunizations.• Accesstofoodthatsupportsgoodnutrition,includinganadequatesupplyoffruitsand

vegetables.• Communitiesthatprovideasafeplacetorunandplay,offeringampleopportunitiesfor

physicalactivity.• Accesstoinformationtomakehealthydecisionsregardingnutrition,physicalactivity,

chronicdiseaseprevention,avoidanceofriskybehaviorsandoverallwell-being.Everychilddeservesahealthystartinlifeandaccesstoqualityhealthcare.Neglectingachild’sbasichealthcareneedscancontributetohealthproblemsandhighercostsastheygrow.Itisalsoimportantthatchildrenreceivenecessaryon-time,affordablecare.Toooften,familiesforegopreventativecareandtreatmentsduetolackofmedicalcoverageandthehighcostofcare.Thereareseveralareasofchildren’shealthwhichneedimprovementandcontributetotheOverallChildren’sHealthGradeofD,whichthestatereceivedonthe2016Children’sReportCard.Detailsineachoftheseareasareprovidedinthesectionsbelowinadditiontorecommendationsforimprovementinthestate.Theseinclude:

1. AccesstoHealthCare2. PrenatalandInfantHealth3. Immunizations4. ChildhoodObesity5. DentalHealth6. MentalHealth7. SexualHealth

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1. ACCESSTOHEALTHCARENevadaChildren’sReportCardGrade:F-

FortheNevadaChildren’sReportCard,theaccesstohealthcaregradeincludesthepercentageofchildrenwithouthealthinsurance(Nevadaranks48th),58thosewhohaveaqualitymedicalhome(Nevadaranks50th),59andpatienttoproviderratios,inwhichNevadaranks48th.60Whilealloftheseindicatorsarekeytoensuringaccesstoqualityhealthcare,thosechildrenwithadequatehealthinsurancearefarmorelikelytoreceivethepreventativecarenecessaryforhealthydevelopment.Theratesofuninsuredchildreninthenationcontinuetodecline.However,despitethisdecline,Nevadacontinuestorankinthebottomstateswhenitcomestoprovidinghealthcareinsurancecoverageforchildren.Approximately10%ofNevada’schildrenhavenohealthcareinsurancecoverage,whichisnearlydoublethenationalrateof6%.61Therearealsodisparitiesinhealthcareinsurancecoverage,seenbothinthenationandinourstate.Hispanicchildrenarethemostlikelygroupinthenationtobeuninsuredwithanaverageof9.7%in2014.InNevada,13.3%ofchildrenwhoareHispanicareuninsuredwhich,despitebeingasignificantimprovementfromthepreviousyear,isstillthe9thhighestpercentageinthecountry.62Additionally,Nevadalawstillrequiresa5yearwaitperiodforlawfullyresidingimmigrantchildren–delayingaccesstohealthinsurancecoverageforthousandsofchildreninNevada.StateswiththeHighestUninsuredRates63

2013 2014

National 7.1% 6.0%

Alaska 11.6% 11.4%

Texas 12.6% 11.0%

Arizona 11.9% 10.0%

Nevada 14.9% 9.6%

Utah 9.5% 9.4%

58 Alker, Joan and Chester, Alisa. Children’s Health Insurance Rates in 2014: ACA Results in Significant Improvements Oct. 2015. http://ccf.georgetown.edu/wp-content/uploads/2015/10/ACS-report-2015.pdf 59 “NSCH Profiles” Data Resource Center for Child & Adolescent Heath. http://childhealthdata.org/browse/snapshots/nsch-profiles?geo=30&rpt=16 60 “2015 State of Physician Workforce Data Book. Center for Workforce Studies. November 2015. http://members.aamc.org/eweb/upload/2015StateDataBook%20(revised).pdf 61 Alker, Joan and Chester, Alisa. Children’s Health Insurance Rates in 2014: ACA Results in Significant Improvements Oct. 2015. http://ccf.georgetown.edu/wp-content/uploads/2015/10/ACS-report-2015.pdf 62 Schwartz, Sonya, Chester, Alisa, Lopez, Steven, Vargas Poppe, Samantha. Historic Gains in Health Coverage for Hispanic Children in the Affordable Care Act’s First Year. http://ccf.georgetown.edu/wp-content/uploads/2016/01/CCF-NCLR-Uninsured-Hispanic-Kids-Report-Final-Jan-14-2016.pdf 63 Alker, Joan and Chester, Alisa. Children’s Health Insurance Rates in 2014: ACA Results in Significant Improvements Oct. 2015. http://ccf.georgetown.edu/wp-content/uploads/2015/10/ACS-report-2015.pdf


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1. ACCESSTOHEALTHCARENevadaChildren’sReportCardGrade:F-

FortheNevadaChildren’sReportCard,theaccesstohealthcaregradeincludesthepercentageofchildrenwithouthealthinsurance(Nevadaranks48th),58thosewhohaveaqualitymedicalhome(Nevadaranks50th),59andpatienttoproviderratios,inwhichNevadaranks48th.60Whilealloftheseindicatorsarekeytoensuringaccesstoqualityhealthcare,thosechildrenwithadequatehealthinsurancearefarmorelikelytoreceivethepreventativecarenecessaryforhealthydevelopment.Theratesofuninsuredchildreninthenationcontinuetodecline.However,despitethisdecline,Nevadacontinuestorankinthebottomstateswhenitcomestoprovidinghealthcareinsurancecoverageforchildren.Approximately10%ofNevada’schildrenhavenohealthcareinsurancecoverage,whichisnearlydoublethenationalrateof6%.61Therearealsodisparitiesinhealthcareinsurancecoverage,seenbothinthenationandinourstate.Hispanicchildrenarethemostlikelygroupinthenationtobeuninsuredwithanaverageof9.7%in2014.InNevada,13.3%ofchildrenwhoareHispanicareuninsuredwhich,despitebeingasignificantimprovementfromthepreviousyear,isstillthe9thhighestpercentageinthecountry.62Additionally,Nevadalawstillrequiresa5yearwaitperiodforlawfullyresidingimmigrantchildren–delayingaccesstohealthinsurancecoverageforthousandsofchildreninNevada.StateswiththeHighestUninsuredRates63

2013 2014

National 7.1% 6.0%

Alaska 11.6% 11.4%

Texas 12.6% 11.0%

Arizona 11.9% 10.0%

Nevada 14.9% 9.6%

Utah 9.5% 9.4%

58 Alker, Joan and Chester, Alisa. Children’s Health Insurance Rates in 2014: ACA Results in Significant Improvements Oct. 2015. http://ccf.georgetown.edu/wp-content/uploads/2015/10/ACS-report-2015.pdf 59 “NSCH Profiles” Data Resource Center for Child & Adolescent Heath. http://childhealthdata.org/browse/snapshots/nsch-profiles?geo=30&rpt=16 60 “2015 State of Physician Workforce Data Book. Center for Workforce Studies. November 2015. http://members.aamc.org/eweb/upload/2015StateDataBook%20(revised).pdf 61 Alker, Joan and Chester, Alisa. Children’s Health Insurance Rates in 2014: ACA Results in Significant Improvements Oct. 2015. http://ccf.georgetown.edu/wp-content/uploads/2015/10/ACS-report-2015.pdf 62 Schwartz, Sonya, Chester, Alisa, Lopez, Steven, Vargas Poppe, Samantha. Historic Gains in Health Coverage for Hispanic Children in the Affordable Care Act’s First Year. http://ccf.georgetown.edu/wp-content/uploads/2016/01/CCF-NCLR-Uninsured-Hispanic-Kids-Report-Final-Jan-14-2016.pdf 63 Alker, Joan and Chester, Alisa. Children’s Health Insurance Rates in 2014: ACA Results in Significant Improvements Oct. 2015. http://ccf.georgetown.edu/wp-content/uploads/2015/10/ACS-report-2015.pdf

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Goodhealthiskeyforacademicachievement.Childrenwithhealthcareinsurance,whohavegreateraccesstoregularmedicalcare,haveaneasiertimefocusingduringclass,participatemoreinactivitiesandarenotabsentfromschoolasoften.Accesstohealthcareinsurancewillsavethelivesofmanychildren.In2008,oneoftheleadingcausesofnaturalchilddeathsinthenationwasatreatablechronicillness.Ofthechildrenwhodieeveryyear,itisestimatedthatroughly37.8%ofthemcouldhavebeensavediftheyhadhealthinsurance.64Inaddition,childrenwhoarebornunderweightbecauseofvariouscausessuchaslackofprenatalcareandpre-birthstress,havean80%chanceofbeinginaspecialneedsprograminschool.65Asweimprovehealthinsurancecoveragerates,itisimportanttonotethataccesstohealthcaredoesnotendwithaninsurancecard.Havingadequatemedicalprovidersisalsokeytoensuringaccesstoappropriatemedicalcareforchildren.Asindicatedabove,Nevadaranks48thinpatienttoproviderratiosatarateof69.8per100,000providers.66Toattractandretainproviders,Nevadashouldfurthersupportmedicaleducationinitiatives,revisereciprocityprotocolsandupdateMedicaidreimbursementratestoreflectactualprovidercosts.RECOMMENDATIONSFORIMPROVEMENT:

• ContinuetoexpandoutreachprogramstoincreaseenrollmentamongeligiblechildrenandfamiliesinMedicaidandNevadaCheckUpprograms.

• ContinuetoimplementtheAffordableCareActinfull,whiledevelopingoutreachtothecommunitytoeducatethepubliconitsprovisionsandeffects.

• IncreaseprovidersandmedicalservicesinNevadatoincreaseaccesstocare.• ReviseMedicaidreimbursementratestobettersupportprovidercosts,enablingmore

providerstoacceptMedicaidpatients.• Reviewreciprocitypoliciesforvarioustypesofmedicalproviderstoencourage

experiencedproviderstocometoNevada.• Removethe5yearwaitingperiodforlawfullyresidingimmigrantchildrentoenrollin

NevadaCheckUp.

64Abdullah,Zhang,Lardaro,Black,Colombani,Chrouser,Pronovost,&Chang(2010).Analysisof23millionUShospitalizations:uninsuredchildrenhavehigherall-causein-hospitalmortality.JournalofPublicHealth,32(2),236-244.http://www.ncbi.nlm.nih.gov/pubmed/1987542065NevadaBusinessSummitonEarlyChildhoodInvestments.NevadaInstituteforChildren’sResearchandPolicy;nic.unlv.edu/files/NBS%20on%20Early%20Childhood%20Investment.pdf66“2015StateofPhysicianWorkforceDataBook.CenterforWorkforceStudies.November2015.http://members.aamc.org/eweb/upload/2015StateDataBook%20(revised).pdf

“Unless someone like you cares a whole awful lot, nothing is going to get better.

It’s not.” ― Dr. Seuss

“Unless someone like you cares a whole awful lot, nothing is going

to get better. It’s not.”– Dr. Seuss

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ACCESSTOHEALTHCARE-SPECIALISSUE

EmergencyAlbuterolInhalersAccordingtotheNationalHeart,Lung,andBloodInstitute,asthmaaffectspeopleofallages,butitmostoftenstartsduringchildhood.67Justover1outof12childrenintheUnitedStateshavebeendiagnosedwithasthma.68TheeffectofasthmaiscompoundedbyNevada’sdryclimate,dust&quicktemperaturechanges–resultinghighasthmarates.InNevada,Asthmaisthemostcommonmedicalconditionforchildrenenteringkindergartenand24%ofhighschoolersreportedhavingasthma.69Intotal,anestimated4,036Nevadanchildrenhavebeendiagnosedwithasthma.70Whileinschool,thesechildrenwithasthma,whetherdiagnosedorundiagnosed,areat-riskofhavinganasthmaticattack.In2010,3outof5childrenwhohaveasthmahadoneormoreasthmaattacksintheprevious12months.71Thesymptomsinclude72:w

• Coughing• Wheezing• ChestTightness• Shortnessofbreath

Theseattackscanbemitigatedbytheuseofanalbuterolinhaler.Butwithoutaninhaler,dependingontheseverityoftheattack,thesechildren’ssymptomsmayworsenandbecomealife-threateningemergency.In2015,therewereatotalof10,301visitstoaNevadaemergencyroomwhereAsthmawastheprinciplediagnosis–includeschildandadultvisits.73Unfortunately,childrendonotalwayshaveaninhaleravailableforuse.Thismaybeduetothembeingundiagnosed,notowninganinhaler,leavingitathome,orbecauseitisbroken,orempty.Thelackofowninginhalersalsodisproportionatelyaffectsminoritychildrenandchildrenlivinginpoverty.AccordingtotheNevadaStateAsthmaControlPlan:

“Minoritychildrenandchildreninpovertyhaveagreaterburdenfromasthmacomparedwithwhite,moresocioeconomicallyadvantagedchildren,andthe

67“WhoIsatRiskforAsthma”NationalHeart,Lung,andBloodInstitute.https://www.nhlbi.nih.gov/health/health-topics/topics/asthma/atrisk68“AsthmaFacts”CenterforDiseaseControlandPrevention.http://www.cdc.gov/nchs/fastats/asthma.htm69“NevadaStateAsthmaControlPlan.”DepartmentofHealthandHumanServices:DivisionofPublicandBehavioralHealth.70MoonieS,LucasJA.Nevada2011-2014ChildhoodAsthmaPrevalenceStatewideReport.UniversityofNevada,LasVegasandNevadaDivisionofPublicandBehavioralHealth,NevadaStateDepartmentofHealthandHumanServices.April201671“AsthmaStatistics”AmericanAcademyofasthma&Immunologyhttp://www.aaaai.org/about-aaaai/newsroom/asthma-statistics72“AsthmaSigns”NationalHeart,Lung,andBloodInstitute.https://www.nhlbi.nih.gov/health/health-topics/topics/asthma/signs73MoonieS,LucasJA.NevadaEmergencyRoom–AsthmaasPrincipleDiagnosis.UniversityofNevada,LasVegasandNevadaDivisionofPublicandBehavioralHealth,NevadaStateDepartmentofHealthandHumanServices.April2016

AsthmainNevada:

• 7.5%ofkindergartenersinNevada

reportedhavingasthma.

• 24%ofHighSchoolersinNevada

reportedhavingasthma.

• 20%ofchildrenintheU.S.have

reportedhavingoneormoreasthma

attacksintheprevious12months.

Asthma in Nevada• 7.5% of kindergarteners in Nevada reported

having asthma.• 24% of high school students in Nevada

reported having asthma.• 20% of children in the U.S. have reported

having one or more asthma attacks in the previous 12 months.

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samechildrenarelesslikelytoreceiveadequatetreatmentandtohavefamilyorcommunitysupportfortheirasthmamanagement.”

Toimproveaccesstoasthmamedicationsinschools,theAmericanLungAssociationmadethefollowingrecommendations74:

• Stateandlocalofficialsmusteducateallschoolpersonnelonexistinglawsandpolicies,andclarifyexpectationsfortheirimplementation.

• Schools,asthmaadvocatesandhealthcareprovidersmustfacilitateparentandcaregiverengagementinthemanagementoftheirchild’sasthmaatschool.

• Schooldistrictsmustimplementstandardizedprotocolsandinstrumentsfortheassessmentofastudent’sreadinesstoself-carry.

• Schoolsmustprovideaccesstoback-upmedicationusingstandingordersforquick-reliefmedication.

Accesstoemergencyalbuterolinhalersprovidesasafeguardforchildrenwhodonothaveaccesstoaninhaler.ThislegislationwouldbesimilartoSenateBill453,passedin2013,which:allowedforaphysiciantoissueanorderforauto-injectableepinephrinetoapublicorprivateschool;requiredforpublicschoolstoobtainanorderfromaphysicianorosteopathicphysicianforauto-injectableepinephrinetomaintainthedrugattheschool;allowedaschoolnurseorotherdesignatedemployeeofthepublicorprivateschool,asapplicable,whohasreceivedtraininginthestorageandadministrationofauto-injectableepinephrinetopossessandadministerauto-injectableepinephrinetoapupilonthepremisesoftheschoolduringtheschooldaywhoisreasonablybelievedtobeexperiencinganaphylaxis;andrequiretraininginthestorageandadministrationofepinephrinetobeprovidedtodesignatedemployeesofapublicorprivateschool.75

Recommendations:• Mandateschoolstoprovideaccesstoback-upalbuterolinhalersusingstandingorders

forquick-reliefmedicationtobeadministeredbyatrainedprofessionalwithintheschool.Trainingshouldincludeassessmentforuseofinhalervs.epinephrine.

• Requireschooldistrictstoimplementstandardizedprotocolsandinstrumentsfortheassessmentofastudentneedforanemergencyinhaler.

• Workwithpharmaceuticalcompaniestoreducethefiscalburdenonschooldistrictspurchasingthemedication.

• Establishprotectionsfromliabilityforschoolsandmedicalproviderswritingtheprescriptions.

Formoreinformationonthistopic,pleasecontact:Children’sAdvocacyAlliance702-228-18695258SouthEasternAve,Suite151,LasVegas,NV891193500LakesideCt,Suite209,Reno,NV89509 www.caanv.org 74“ImprovingAccesstoAsthmaMedicationinSchools”AmericanLungAssociationhttp://www.lung.org/assets/documents/asthma/improving-access-to-asthma.pdf75“SenateBill453”77thNevadaLegislativeSessionhttp://www.leg.state.nv.us/Session/77th2013/Reports/history.cfm?billname=SB453

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ACCESSTOHEALTHCARE-SPECIALISSUE

CHIPRAforLawfullyResidingImmigrantChildrenNevadahasmadegreatstridesincoveringchildreninthelastfewyears.Uninsuranceratesforallchildrenfellfrom14.9%in2013to9.6%in2014forallchildren,andfrom20%in2013to13.3%in2014forLatinochildren(seeFigure1).However,uninsuranceratesstillremainmuchhigherthanthenationalaverageof6%forallkidsand9.7%forLatinokidsin2014.Tocontinuemakinggainsinhealthcoveragelevelsforchildren,Nevadahasanopportunitytodrawdownfederalfundstoprovidehealthcoveragetolawfullyresidingchildrenwhoarecurrentlyineligible.InNevada,onlyaveryspecificgroupof“qualified”immigrantchildrenarecurrentlyeligibleforNevadaCheckUp(theState’schildren’shealthinsuranceprogram)76andmosthavetowait5yearsbeforetheybecomeeligible.However,§214oftheChildren’sHealthInsuranceProgramReauthorizationActof2009(CHIPRA)allowsstatestocoverlawfullyresidingimmigrantchildrenwithouta5yearwaitingperiod.ThismeansthatlawfullyresidingimmigrantchildreninNevadawouldbeabletoreceivecoverageenablingthemtoaccessvitalmedicalcareassoonastheyareenrolled.AcceptingtheCHIPRAoptioncouldpotentiallyhelp7,000uninsuredchildrenlivinginNevada.To-date,31statesincludingtheDistrictofColumbiahavetakenuptheCHIPRAoptiontoliftthe5-yearwaitingperiod(seeFigure2).CHIPRA§214allowsNevadatodrawdownfederalfundstoprovidecoveragetolawfullyresidingchildrenwhoresideinfamilieswithincomesbelow200%offederalpovertylevel(FPL).InNevada,federalfundingwouldcover98.45ofthecostofNevadaCheckUp(theStateschildren’shealthinsuranceplan)throughFY2017.Inadditiontotheverylimitedfiscalimpactthatcoveringthesechildrenwouldlikelyhaveonthestate,thereisevidencethattake-upoftheCHIPRAoptionleadstoimprovedhealthoutcomesforlow-incomeimmigrantchildren.A2014studypublishedintheJournalHealthAffairsfoundthatimmigrantchildren’scoverage

76 The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA / welfare reform) of 1996 restricted immigrants eligibility for Medicaid and CHIP to a narrow group of qualified immigrants, many of whom have to wait five years before becoming eligible for coverage.

Page25

Page41

14.90%

20.00%

9.60%13.30%

UninsuranceRateforAllKidsinNevada

UninsuranceRateforLatinoKidsinNevada

Figure1.UninsuranceRatesforChildreninNevada2013 2014



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ratesincreasedby24.5%inthestatesthathadtakentheCHIPRAoptioncomparedtostatesthathadnotandthesestatesalsoreportedfewerinstancesofunmethealthcareneeds.77PotentialFiscalImplications:Removingthe5-yearwaitingperiodforlegallyresidingimmigrantchildrenwouldresultinanominalcosttothestateduetothe98.45%federalfundingmatchforNevada.EstimatesshowthatifNevadaelectstheCHIPRA§214optionforchildren,itwillcostthestatebetween$150,000and$300,000peryear.78However,thecosttotheStatemaybeevenlowerwhenconsideringtheamountNevadaalreadyspendsonEmergencyMedicaidforchildrenwhoarecurrentlyineligiblebasedonimmigrationstatus.Recommendations:Nevadashouldremovethe5-yearwaitingperiodforlegallyresidingimmigrantchildreninordertoprovideMedicaidandNevadaCheckUptomorechildreninthestate.


77 Brendan Saloner, Neel Koyawala, and Genevieve M. Kenney. “Coverage for Low-Income Immigrant Children Increased 24.5 Percent in States that Expanded CHIPRA Eligibility.” Health Affairs 33 (5): 832-839. 78 Estimate provided by the Georgetown University Center for Children and Families July 14, 2016.

SOURCE:(Georgetown(Center(for(Children(and(Families(and(Kaiser(Family(

Founda=on’s(Commission(on(Medicaid(and(the(Uninsured,(“Medicaid(

and(CHIP(Eligibility,(Enrollment,(Renewal(and(CostGSharing(Policies(as(of(

January(2016:(Findings(from(a(50GState(Survey”((January(2016).(

(

Figure'2:'States'Providing'Coverage'to'Lawfully'Residing'Children'

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AZ'

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2. PRENATALandINFANTHEALTHNevadaChildren’sReportCardGrade:C-

Theprenatal,infant,andchildhealthgradeisbaseduponthenumberofpregnantwomenreceivinglateornoprenatalcare,infantmortalityrates,andthepercentageoflowbirthweightbabiesinNevada.Nevadahasimprovedininfantandchildmortalityrates,decreasingfrom5.72%to5.1%,increasinginrankfrom18thin2014to13thin2016.Lowbirthweightbabiesalsoshowedaslightimprovement,droppingfrom8.2%to8%inthisreportingperiod.Themostsignificantstatisticalimprovementwasthepercentageofwomenreceivinglateornoprenatalcare,whichdroppedfrom11%in2012to9%in2014.79Prenatalcarereferscollectivelytothehealthservicesapregnantwomanreceivesbeforeababy’sbirth.Studieshaveshownthatprenatalcareisimportantaspotentialproblemsthatmayendangerthemotherorherbabyaremorelikelytobediscoveredandtreatedbeforebirth.Itisrecommendedthatawomanbeginsprenatalcareinherfirsttrimesterandcontinuesherprenatalvisitsonaregularbasisuntildelivery.80Babiesborntomotherswhoreceivednoprenatalcareare3timesmorelikelytobebornatalowbirthweightand5timesmorelikelytodiethanthosewhosemothersreceivedprenatalcare.81AccordingtotheCentersforDiseaseControlandPrevention,pretermbirthisthebirthofaninfantbefore37weeksofgestation.PretermbirthscosttheU.S.healthcaresystemmorethan$26billionin2005.82InNevadain2013,12.6%ofinfantswerebornpretermandthisratehasonlydeclinedslightlysince2003whentheratewas13.6%.83Duringthefinalstagesofpregnancy,infantsaregoingthroughthefinalstagesoforgandevelopmentwhichincludesthedevelopmentofthebrain,lungs,andliver.Ifdeliveredearly,theinfantcouldexperiencecomplicationsincludingorganfailure,breathingproblems,developmentaldelays,andareatahigherriskforinfantmortality.AccordingtotheMarchofDimes,lowbirthweightiswhenababyisbornweighinglessthan5pounds,8ounces.Whileinfantswithalowbirthweightmaynotexperienceanycomplications,itcancauseserious,immediatehealthconditionssuchasrespiratorydistress,bleedinginthebrain,patentductusarteriosus(acongenitalheartdefect),aswellaslongtermhealthconditionssuchasdiabetes,heartdisease,highbloodpressure,metabolicsyndrome,andobesity.Majorriskfactorsforlowbirthweightincludeprematurity,inadequatematernalnutrition,andsmoking.84InNevadain2015,8.0%ofinfantswerebornatalowbirthweight

79KidsCount,“BirthstoWomenReceivingLateorNoPrenatalCare,”http://datacenter.kidscount.org/data/tables/11-births-to-women-receiving-late-or-no-prenatal-care?loc=1&loct=2#detailed/1/any/false/36,868,867,133,38/any/265,266(July2015)80“PrenatalCareandInfantMortalityinNevada,”http://cdclv.unlv.edu/healthnv/prenatalcare.html(November5,2004)81OfficeonWomen’sHealth,U.S.DepartmentofHealthandHumanServices,“Prenatalcarefactsheet,”http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html?from=AtoZ82CenterforDiseaseControlandPrevention,“PretermBirth,”http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirth.htm(October30,2014)83MarchofDimes,“Peristats,”http://www.marchofdimes.org/Peristats/pdflib/999/pds_32_3.pdf(May30,2014) 84MarchofDimes,“Yourprematurebaby,”http://www.marchofdimes.org/baby/low-birthweight.aspx#(October2014)

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2. PRENATALandINFANTHEALTHNevadaChildren’sReportCardGrade:C-

Theprenatal,infant,andchildhealthgradeisbaseduponthenumberofpregnantwomenreceivinglateornoprenatalcare,infantmortalityrates,andthepercentageoflowbirthweightbabiesinNevada.Nevadahasimprovedininfantandchildmortalityrates,decreasingfrom5.72%to5.1%,increasinginrankfrom18thin2014to13thin2016.Lowbirthweightbabiesalsoshowedaslightimprovement,droppingfrom8.2%to8%inthisreportingperiod.Themostsignificantstatisticalimprovementwasthepercentageofwomenreceivinglateornoprenatalcare,whichdroppedfrom11%in2012to9%in2014.79Prenatalcarereferscollectivelytothehealthservicesapregnantwomanreceivesbeforeababy’sbirth.Studieshaveshownthatprenatalcareisimportantaspotentialproblemsthatmayendangerthemotherorherbabyaremorelikelytobediscoveredandtreatedbeforebirth.Itisrecommendedthatawomanbeginsprenatalcareinherfirsttrimesterandcontinuesherprenatalvisitsonaregularbasisuntildelivery.80Babiesborntomotherswhoreceivednoprenatalcareare3timesmorelikelytobebornatalowbirthweightand5timesmorelikelytodiethanthosewhosemothersreceivedprenatalcare.81AccordingtotheCentersforDiseaseControlandPrevention,pretermbirthisthebirthofaninfantbefore37weeksofgestation.PretermbirthscosttheU.S.healthcaresystemmorethan$26billionin2005.82InNevadain2013,12.6%ofinfantswerebornpretermandthisratehasonlydeclinedslightlysince2003whentheratewas13.6%.83Duringthefinalstagesofpregnancy,infantsaregoingthroughthefinalstagesoforgandevelopmentwhichincludesthedevelopmentofthebrain,lungs,andliver.Ifdeliveredearly,theinfantcouldexperiencecomplicationsincludingorganfailure,breathingproblems,developmentaldelays,andareatahigherriskforinfantmortality.AccordingtotheMarchofDimes,lowbirthweightiswhenababyisbornweighinglessthan5pounds,8ounces.Whileinfantswithalowbirthweightmaynotexperienceanycomplications,itcancauseserious,immediatehealthconditionssuchasrespiratorydistress,bleedinginthebrain,patentductusarteriosus(acongenitalheartdefect),aswellaslongtermhealthconditionssuchasdiabetes,heartdisease,highbloodpressure,metabolicsyndrome,andobesity.Majorriskfactorsforlowbirthweightincludeprematurity,inadequatematernalnutrition,andsmoking.84InNevadain2015,8.0%ofinfantswerebornatalowbirthweight

79KidsCount,“BirthstoWomenReceivingLateorNoPrenatalCare,”http://datacenter.kidscount.org/data/tables/11-births-to-women-receiving-late-or-no-prenatal-care?loc=1&loct=2#detailed/1/any/false/36,868,867,133,38/any/265,266(July2015)80“PrenatalCareandInfantMortalityinNevada,”http://cdclv.unlv.edu/healthnv/prenatalcare.html(November5,2004)81OfficeonWomen’sHealth,U.S.DepartmentofHealthandHumanServices,“Prenatalcarefactsheet,”http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html?from=AtoZ82CenterforDiseaseControlandPrevention,“PretermBirth,”http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirth.htm(October30,2014)83MarchofDimes,“Peristats,”http://www.marchofdimes.org/Peristats/pdflib/999/pds_32_3.pdf(May30,2014) 84MarchofDimes,“Yourprematurebaby,”http://www.marchofdimes.org/baby/low-birthweight.aspx#(October2014)

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whichisadecreasefromthepreviousreportingperiod,butrepresentsanincreasefrom7.2%in2003.85RECOMMENDATIONSFORIMPROVEMENT:

• Maternalandchildhealthservicesforprenatalcarethroughthepostpartumperiodneedtobeexpandedandmademoreaccessibleforallparentsincludingparentswithdiversebackgroundsand/orthosewhoareeconomicallychallenged.

• WhileeffortshavebeenmadetoestablishadditionalmedicalschoolsinNevada,aswellasreciprocityforlicensure,Nevadaneedstocontinuetosupporteffortstotrainandretainmedicalproviderslocallytoincreaseaccessandavailability,especiallyforspecialtycareproviders.

• Increaseoutreacheffortsandprogramsthatprovideeducationalandreferralservicestofamiliestoincreaseparticipationinpreventativecarepracticesandothernecessaryservices.

• Supporteffortstoimproveeducationandoutreachaboutfamilyplanningandinterconceptioncareaswellasearlyidentificationofpregnancyandenrollmentinearlyprenatalcare.

85America’sHealthRankings,UnitedHealthFoundation,“LowBirthweight,”http://www.americashealthrankings.org/Measures/Measure/NV/birthweight(2016)

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whichisadecreasefromthepreviousreportingperiod,butrepresentsanincreasefrom7.2%in2003.85RECOMMENDATIONSFORIMPROVEMENT:

• Maternalandchildhealthservicesforprenatalcarethroughthepostpartumperiodneedtobeexpandedandmademoreaccessibleforallparentsincludingparentswithdiversebackgroundsand/orthosewhoareeconomicallychallenged.

• WhileeffortshavebeenmadetoestablishadditionalmedicalschoolsinNevada,aswellasreciprocityforlicensure,Nevadaneedstocontinuetosupporteffortstotrainandretainmedicalproviderslocallytoincreaseaccessandavailability,especiallyforspecialtycareproviders.

• Increaseoutreacheffortsandprogramsthatprovideeducationalandreferralservicestofamiliestoincreaseparticipationinpreventativecarepracticesandothernecessaryservices.

• Supporteffortstoimproveeducationandoutreachaboutfamilyplanningandinterconceptioncareaswellasearlyidentificationofpregnancyandenrollmentinearlyprenatalcare.

85America’sHealthRankings,UnitedHealthFoundation,“LowBirthweight,”http://www.americashealthrankings.org/Measures/Measure/NV/birthweight(2016)


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PRENATALandINFANTHEALTH-SPECIALISSUE

DiaperAssistanceforFamiliesThecostofdiapersplacesahugefinancialburdenonNevada’smostat-riskfamilies.Infants,onaverage,useabout240diaperspermonthwhichcostsafamily–assumingtheycanpurchaseinbulk-approximately$78permonth.Atwoparentfamilywithaninfantmaking$2,226.64amonth(133%ofpoverty)86wouldspend3.5%oftheirmonthlyincomeondiapers.Forfamiliesreceivingpublicassistance,thiscostiscompoundedbythefactthatdiapersarelabelledasaluxuryitem,resultinginthemnotbeingcoveredbyTANF(TemporaryAssistanceforNeedyFamilies),FoodStamps(SNAPProgram),orWIC(SpecialSupplementalNutritionProgramforWomen,Infant,&Children).AstudybyYaleUniversity87foundthat30%ofmothersreportedthattheywereunabletoaffordtochangetheirchild’sdiapersasoftenastheywouldlike.To“stretch”theuseofdiapersmanyfamiliesreportedreusingdiapers–removingthediapers,dumpingouttheexcrementandthenplacingthesoileddiaperontheinfant–orleavingthesoileddiapersonlongerthantheyshould.Thispracticeleadstonegativehealthoutcomesforthechild–suchasurinarytractinfections(UTIs)–sometimesresultinginchronicUTIs–andseverediaperdermatitis(diaperrash).Alackofdiapersalsodirectlyaffectsthementalhealthofmothers.ThesameYalestudyfound,“diaperneedwasmorelikelyamongmothers[identifiedashaving]someformofmentalhealthneed”.Theuseofclothdiapersisnotanoptionformanylow-incomeworkingfamilies.Forthesefamiliestheabilitytosendtheirinfanttochildcareoftenrequiresprovidingdisposablediaperstothefacility.88Lowincomefamiliesalsostrugglewithwashinganddryingthedisposablediapers,aswashingmachinesanddryersarenotalwaysavailableforuseintheirhousingunits.

86Accordingtothe2015FederalPovertyGuidelines,http://ccf.georgetown.edu/wp-content/uploads/2015/01/2015-Federal-Poverty-Guidelines.pdf87“DiaperNeedandItsImpactonChildHealth”Pediatrics:OfficialJournaloftheAmericanAcademyofPediatrics.http://pediatrics.aappublications.org/content/pediatrics/early/2013/07/23/peds.2013-0597.full.pdf88NRS432aandNAC432adonotprohibittheuseofclothdiapersinchildcarefacilities.Manyfacilitieshavethisrequirementoutofconvenience,health,andsanitaryreasons.

ClothDiapersTheuseofclothdiapersisnotanoption

formanyfamiliesas:

• ChildCareFacilitiestypicallywillnot

acceptclothdiapers(duetohealth

andsanitaryreasons)andrequire

parentstoprovideasupplyof

disposablediapers.

• Washingmachinesanddryersarea

luxurythatmanylow-incomefamilies

cannotafford.

• Coin-laundromatsdonotallowcloth

diapers(duetohealthandsanitary

reasons).

Cloth DiapersThe use of cloth diapers is not an option for many families as:

• Child Care Facilities typically will not accept cloth diapers (due to health and sanitary reasons) and require parents to provide a supply of disposable diapers.

• Washing machines and dryers are a luxury that many low-income families cannot afford.

• Coin-laundromats do not allow cloth diapers (due to health and sanitary reasons)

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Thesefamiliesthencannotwashanddrythediapersatcoin-laundromatsastheydonotallowforthewashinganddryingofclothdiapersduetohealthandsanitaryreasons.Familieswhocanaffordtopurchasediaperssufferfrompriceinequality–lowincomefamiliespayupwardsoftwotothreetimesthepriceofdiaperscomparedtomiddletohighincomefamilies.Thisislargelyduetotheirinabilitytopurchasediapersinbulkatbig-boxstoresorthroughtheinternet–duetoalackoftransportation,cashfloworcredit.Thesefamiliesarealsoburdenedbythesalestaxtheypayondiapers.InNevada,thelowestsalestaxrateis6.850%.Thistaxprovidesanadditionalburdenonanecessitygoodforfamilies,astheypaymorethan$60ayearintaxesfordiapersalone.Recommendations:

• CreateachilddiaperfundtoprovidediaperstowomenwithinfantsparticipatingintheWomen,Infant,andChildren(WIC)program.Thisfundwouldprovideamonthly$50creditforparticipantstopurchasediapersfortheirinfant.Infiscalyear2015,therewasanaverageof17,415infantsinNevadaparticipatinginWIC.89

• Removethestatesalestaxondiapers.Thiswouldprovideallworkingfamilieswitharelieffrompayingtaxesonanecessarygood.90

• Encourageconveniencestoresandbusinessesinlow-incomeneighborhoodstoselldiapersinbulk.


89“WICProgramStatisticsandData”UnitedStatesDepartmentofAgriculture:FoodandNutritionService.http://www.fns.usda.gov/pd/wic-program90Thereisanestimated105,970childrenages0-2livinginNevada(2015AmericanCommunitySurvey).Assumingallofthesefamiliesspend$78permonthondiapers–$936annually–thepotentiallostnettaxrevenueis$6.8millionayear(64.12x105,970).

SalesTaxonDiapersAccordingtoa2014FiftyStateSurveyon

theSalesTaxTreatmentofDiapersbythe

NationalDiaperBankNetwork:

• Twelvestatesdonothaveasales

taxondiapers.

o Fiveofwhichdonothavea

salestaxingeneral.

o Theothersevenstateshave

exempteddiapersfrom

theirtax.

Sales Tax on DiapersAccording to a 2014 Fifty State Survey on the Sales Tax Treatment of Diapers by the National Diaper Bank Network: • Twelve states do not have a sales tax

on diapers. o Five of which do not have a sales

tax in general. o The other seven states have

exempted diapers from their tax.

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Thesefamiliesthencannotwashanddrythediapersatcoin-laundromatsastheydonotallowforthewashinganddryingofclothdiapersduetohealthandsanitaryreasons.Familieswhocanaffordtopurchasediaperssufferfrompriceinequality–lowincomefamiliespayupwardsoftwotothreetimesthepriceofdiaperscomparedtomiddletohighincomefamilies.Thisislargelyduetotheirinabilitytopurchasediapersinbulkatbig-boxstoresorthroughtheinternet–duetoalackoftransportation,cashfloworcredit.Thesefamiliesarealsoburdenedbythesalestaxtheypayondiapers.InNevada,thelowestsalestaxrateis6.850%.Thistaxprovidesanadditionalburdenonanecessitygoodforfamilies,astheypaymorethan$60ayearintaxesfordiapersalone.Recommendations:

• CreateachilddiaperfundtoprovidediaperstowomenwithinfantsparticipatingintheWomen,Infant,andChildren(WIC)program.Thisfundwouldprovideamonthly$50creditforparticipantstopurchasediapersfortheirinfant.Infiscalyear2015,therewasanaverageof17,415infantsinNevadaparticipatinginWIC.89

• Removethestatesalestaxondiapers.Thiswouldprovideallworkingfamilieswitharelieffrompayingtaxesonanecessarygood.90

• Encourageconveniencestoresandbusinessesinlow-incomeneighborhoodstoselldiapersinbulk.


89“WICProgramStatisticsandData”UnitedStatesDepartmentofAgriculture:FoodandNutritionService.http://www.fns.usda.gov/pd/wic-program90Thereisanestimated105,970childrenages0-2livinginNevada(2015AmericanCommunitySurvey).Assumingallofthesefamiliesspend$78permonthondiapers–$936annually–thepotentiallostnettaxrevenueis$6.8millionayear(64.12x105,970).

SalesTaxonDiapersAccordingtoa2014FiftyStateSurveyon

theSalesTaxTreatmentofDiapersbythe

NationalDiaperBankNetwork:

• Twelvestatesdonothaveasales

taxondiapers.

o Fiveofwhichdonothavea

salestaxingeneral.

o Theothersevenstateshave

exempteddiapersfrom

theirtax.


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3. IMMUNIZATIONSNevadaChildren’sReportCardGrade:D

TheimmunizationsgradefocusesonthepercentageofchildrenreceivingrecommendeddosesofDTaP,polio,MMR,Hib,hepatitisB,varicella,andPCVvaccinesbyage19to35months.Consideredbymanytobeoursociety’sgreatesthealthcareachievement,childhoodimmunizationsprovideapreventativemeasureagainstavarietyofoncecommondiseasessuchaspolio,measles,pertussis,meningitis,andmanymore.NevadachildrenhavelowerimmunizationratesthantheirnationwidecounterpartsandNevadaparentshavereporteddifficultiesinensuringtheirchildrenreceiveallCDCrecommendeddosesofvaccines.In2015,67.7%ofNevada’schildrenages19to35monthsreceivedtherecommendeddosesofDTaP,polio,MMR,Hib,hepatitisB,varicella,andPCVvaccinescomparedto71.6%nationwide.Nevadaranks37thinthepercentageofchildrenwhoreceivetheirrecommendedimmunizationsbyage19to35months.91

NevadaWebIZNevada’sImmunizationInformationSystem(IIS),NevadaWebIZ,continuestoseepositiveresultsfromtheimplementationofNevadaRevisedStatute(NRS)439.265.AsofJuly2016,thereare:

� 1,442Providers� 2,969Clinics� 14,739Users� 3,327,027PatientRecords� 35,109,391Vaccinations

However,therearestillprovidersnotusingNevadaWebIZtoitsfullestcapacity.Accurate,timely,and complete widespread use of Nevada WebIZ would reduce unnecessary immunizations;providebetterdatatoidentifyNevada’svaccinationgaps,especiallyduringperiodsofoutbreak;provide access for patient reminder/recall; facilitate patient use of theNevadaWebIZ PublicAccess Portal; and help providers bettermanage immunization inventory and administrationwithintheirpractice.

ChallengeswithImplementationofACAThechanginghealth caremarketplacecontinues to createchallenges for immunizationdelivery inNevadaandacrossthecountry.Physiciansinprivatepracticecontinuetoexperiencegreateconomicpressureasvaccinecostsriseandreimbursementratesshrink.Also,asthenumberofrecommendedvaccineshasincreased,someproviderssimplycannotaffordtostocktheincreasedinventory.Asaresult,moreprivateofficesarenolongeradministeringallvaccinesandendupreferringtheirpatients

91America’sHealthRankings,UnitedHealthFoundation,http://www.americashealthrankings.org/NV(2016)

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tolocalpublichealthandFederallyQualifiedHealthCenter(FQHC)sites.PrivatelyinsuredNevadansalsoutilizetheseclinicsforconvenience,becauseaccesstoaprimarycarephysiciancanbelimitedduetotheinabilitytoquicklygetappointments.Rankingat51st,NevadahasthelowestpercapitapublichealthfundingexpendituresintheU.S.at$4.10,whilethemedianper-capitaexpenditureis$33.50.92Unfortunately,duetothisandotherfactors,healthdistrictsandpublichealthclinicsitesarefacingbudgetstrainsandpersonnelcutsatthesametimetheirpatientloadsareincreasing.MedicaidExpansionNevada’sMedicaidexpansionhasbeenimmenselysuccessful;however,Nevadaisalreadyfunctioningwithinaphysicianshortageenvironment.Rankedas47th intermsofphysiciantopopulationratio,Nevadaneedsmore than2,900newdoctors to catchupwith thenational rateof physicians percapita.93ManyexistingphysiciansarereluctanttoseepatientscoveredbyMedicaid(ortoacceptnewpatientscoveredbyMedicaid)duetolowreimbursementrates,whichisalsotaxingthepublichealthandFQHCsites.Medicaid-coveredvaccinesaresuppliedtochildrenthroughtheVaccinesforChildren(VFC) Program and only the administration fees are reimbursable. The Centers forMedicaid andMedicareServices’(CMS)capforNevada’sadministrationfeeis$7.80/dose94and$22.57/doseisthemaximumallowableVFCadminfeefornon-Medicaidcoveredchildren.95ItisimportanttonotethatproviderscannotrefusetovaccinateaVFC-eligiblechildwithVFCvaccineduetotheparent/guardian’sinabilitytopaythevaccineadminfee.Nevada’simmunizationleadershipandstakeholderscontinuetoexpressconcernaboutthefragmentationofthevaccinedeliverysystem.RECOMMENDATIONSFORIMPROVEMENT:

• IncreaseaccurateandtimelyuseofNevadaWebIZstatewideinordertoreduceunnecessaryimmunizationsandfacilitateaccuratecoverageassessments.

• IncreaseavailabilityandaffordabilityofpublicandprivatevaccinesforchildreninNevada.

• IncreaseincentivesfordoctorstoacceptchildrencoveredbyMedicaidtoincreasetheavailabilityofprovidersforthesechildren.

• IncreaseprovidersandmedicalservicesinNevadatoincreaseaccesstocare.

92“InvestinginAmerica’sHealth:AState-ByStateLookAtPublicHealthFundingandKeyHealthFacts2016”.TrustforAmerica’sHealthhttp://healthyamericans.org/assets/files/TFAH-2016-InvestInAmericaRpt-FINAL.pdf93“PhysicianWorkforceinNevada:2016Edition”UNSOMHealthPolicyReport.http://medicine.nevada.edu/Documents/unsom/statewide/reports/Physician_Workforce_in_Nevada_2016_Edition_-_March_2016_-_FINAL.pdf94“NevadaMedicaidandNevadaCheckUpPharmacyManual”Catamaranhttps://www.medicaid.nv.gov/Downloads/provider/NV_Pharmacy_Manual.pdf95“RIN0938-AQ63”ARulebytheCentersforMedicare&MedicaidServices.FederalRegistryhttps://www.federalregister.gov/articles/2012/11/06/2012-26507/rin-0938-aq63#t-2

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4. CHILDHOODOBESITYNevadaChildren’sReportCardGrade:B-

Thechildhoodobesitygradeisbasedonthepercentageofchildrenbetweentheages10and17whoseBodyMassIndex(BMI)isatorabovethe85thpercentile(15%overweightand12.2%obese),thepercentageof9th-12thgradestudentsnotphysicallyactive5daysperweekfor60+minutes(49%),andthepercentageofchildrenwhodonotconsistentlyeatvegetables(7.2%).TherateofunhealthybodyweightamongchildrenandadolescentsintheUShastripledsincethe1980s.Forthefirsttimeinmorethan100years,children’slifeexpectancyisdecliningduetoanincreaseinobesity.Childrenwhoareoverweightorobeseareatasignificantlyhigherriskfordevelopingotherserioushealthconditionsincludingdiabetes,heartdisease,andhypertension.Americanobesityisbecominganepidemicthatcostmorethan$147billioninmedicalexpensesin2008.InNevada,theprevalenceofobesityinchildrencontinuestoincreaseinallagecategories,including2-4yearolds(42.7%increasefrom1989-2011)and10-17yearolds(50%increasefrom2004-2011).96Childrenwhoareobesearemorelikelytohaveashortenedlifespananddevelopavarietyofhealthproblems,includinghypertension,highcholesterol,liverdisease,orthopedicproblems,sleepapnea,asthmaandmoreoften,type2diabetes.Theyarealsopredisposedtobeobeseinadulthood.Researchindicatesthatphysicallyactiveandfitchildrentendtohavebetteracademicachievement,betterschoolattendance,andfewerdisciplinaryproblems.Childrenwhogetregularexercisemayhaveimprovedconcentrationandcognitivefunctioning.97• 12.2%ofNevadahighschoolstudentsareobeseand15%areoverweight.98• 31.5%ofkindergartenstudentsinNevadawerefoundtobeoverweightorobese.99• 18%of4th,7thand10thgradersinNevadaareoverweightand20%areobese.100InNevada,physicaleducationisnotrequiredinelementaryschools,andeventhoughitisarequirementforhighschoolgraduation,manychildrenseekandaregrantedwaivers.

96http://stateofobesity.org/states/nv/97TrostS.,“ActiveEducation:PhysicalEducation,PhysicalActivityandAcademicPerformance.AResearchBrief,”Princeton,NJ:ActiveLivingResearch,aNationalProgramoftheRobertWoodJohnsonFoundation.(Summer2009),Availablefromwww.activelivingresearch.org98“2015NevadaYouthRiskBehaviorSurvey,”(February2016)http://dhs.unr.edu/chs/research/yrbs99NevadaInstituteforChildren’sResearchandPolicy,“SummaryofFindings:HealthStatusofChildrenEnteringKindergarten:Resultsof2014-2015(YearSeven)NevadaKindergartenHealthSurvey,”(2015)http://nic.unlv.edu/files/KHS%20Year%207%20Report_Final_.pdf100“BMISummaryReportandRecommendations;NevadaStateHealthDivision,”(2010) http://www.leg.state.nv.us/Interim/75th2009/Exhibits/HealthCare/E052610C.pdf

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Substitutionsareallowedforothers,includingonlinecourseswherethereisnowaytoknowifphysicalactivityisactuallybeingincorporated.RECOMMENDATIONSFORIMPROVEMENT:• Enforcestateandlocalschoolwellnesspoliciesattheschoollevel.• Increasethenumberofphysicaleducationminutesinschools.Theconsensus

recommendationis150minutesperweekinelementaryschoolsand250minutesperweekinmiddleschools.

• Reducethenumberofphysicaleducationwaiversandsubstitutions.• Increaseopportunitiesforphysicalactivityandhealthyeatinginafter-schoolandchildcare

settings.• Increasethenumberofpublicplacesincludingworksites,parks,recreationandcommunity

centersthatofferhealthyvendingoptions.• Increaseavailabilityofaffordablehealthyfoodoptionsincommunities,particularly

communitieswithindesignated‘fooddeserts’andinlow-incomecommunities.• Ensuredevelopmentofasustainable,wellconnectedregionaltrailsystemsforphysical

activity,recreationandactivetransport.• IncreasethenumberofschoolsthatareparticipatinginSafeRoutestoSchoolsprograms,

whichwillencouragemoreactivetransportforchildrentoandfromschool.• SupporttheadoptionofCompleteStreets101policiesandtheadoptionofCompleteStreets

elementsintolocalplanningdocumentsatthestate,regionalandlocallevelsinordertomaketheenvironmentsaferforactivetransport.

• Supportadoptionofnutritionstandardsand/ormenulabelingeffortsinrestaurants,movietheatersandotherlocationsthatservemealsandsnackssothatparentscanmakeinformedandhealthychoicesaboutwhattofeedtheirchildrenwhenout.

• Dedicatesustainablefundingtosupportevidence-basedobesitypreventioneffortsbothinschoolsandincommunities.

• ReinstateBMISurveillanceinschoolssothatchildhoodobesityratescanbemonitored.ThiswastheonlysourceofactualmeasurementofBMIinNevadaanditexpiredin2015.

101FormoreinformationontheCompleteStreetspolicy,see:http://www.smartgrowthamerica.org/complete-streets

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CHILDHOODOBESITY-SPECIALISSUE

BodyMassIndex(BMI)SurveyObesityisamongthegreatestpublichealthchallengesofourtime.AccordingtotheCenterforDiseaseControlandPrevention(CDC),morethanonethirdoftheU.S.populationisobese;whichputsthoseindividualsatriskforanumberofmedicalconditions,includingheartdisease,stroke,type2diabetes,andcancer.102Togetherwithbeingoverweight,obesityisestimatedtobethesecond leading preventable cause of death killing about 300,000 Americans each year.103 Inadditiontothesehealthconcerns,obesityplacesahugeeconomicburdenonthestate.In2006,the estimated cost associated with treating overweight and obesity in Nevada was $337million.104Anevenmorealarmingtrendisthegrowingprevalenceofchildhoodobesity.From1980to2012,obesityratesforchildrenmorethantripled.Childhoodobesitycausesnumerousphysicalandmental health problems including heart disease, type 2 diabetes, asthma, sleep apnea,depressionandlowself-esteem,whichcouldalsohaveanegativeeffectonchildren’slearningabilitiesandacademicperformance.105Obesechildrenandadolescentsarealsomorelikelytobecomeobeseadults,whichfurtherincreasestheimpactofthisgrowingepidemic.106ThelatestNevadaKindergartenHealthStudy(2014-2015)conductedbytheNevadaInstituteforChildren’sResearchandPolicywithintheUNLVSchoolofCommunityHealthSciencesfoundthat31.5% of children entering kindergarten are already overweight or obese.107 As these ratescontinue to increase and threaten the quality of life of individuals, leaders in all levels ofgovernmentseekwaystoreversethetrends.In2010,theUnitedStatesSurgeonGeneralReginaM.Benjamincalledforanationwidegrassrootsefforttopreventobesity,focusednotonlyonpersonal choices and behaviors, but also on the characteristics of social and physicalenvironments. In hermessage, she highlighted the role of schools, among other settings, asplaying a critical role in preventing obesity and encouraged the implementation of schoolprogramspromotingphysicalactivityandhealthynutrition.108Oneofthelatestapproachesinaddressingobesitythathasgainednationalattentionisthebodymassindexmeasurementofstudentsinschools.

102“AdultObesityFacts”CentersforDiseaseControlandPreventionhttp://www.cdc.gov/obesity/data/adult.html103“Obesity:Facts,Figures,Guidelines”https://www.wvdhhr.org/bph/oehp/obesity/mortality.htm104“StrategicPlanforthePreventionofObesityinNevada.NevadaStateHealthDivisionBureauofCommunityHealth.September2006.http://www.gethealthywashoe.com/fb_files/reports_obesity_plan.pdf105“ObesityFacts”CentersforDiseaseControlandPreventionhttp://www.cdc.gov/healthyschools/obesity/facts.htm106Ibid107NevadaInstituteforChildren’sResearchandPolicy,“SummaryofFindings:HealthStatusofChildrenEnteringKindergarten:Resultsof2014-2015(YearSeven)NevadaKindergartenHealthSurvey,”(2015)http://nic.unlv.edu/files/KHS%20Year%207%20Report_Final_.pdf108Ibid.

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Bodymassindex(BMI)isestimatedasaperson’sweightdividedbytheirheightsquared(BMI=kg/m2,orBMI=lb/in2*703).WhileBMIisnotadirectmeasureofbodyfat,itdoescorrelatewithbodyfat,andiswidelyusedtoestimateaperson’sriskofweight-relatedhealthproblems.Thereareother,moresophisticatedmeasures,ofbodyfat,suchasskinfoldthicknessmeasurement,underwaterweighing,computerizedtomography(CT)andmagneticresonance imaging(MRI),buttheyaremuchmoreinvasiveandexpensivetoadminister.109BMIisthemostbasicandmostcommonwayofmeasuringbodyfatthat isalsoinexpensiveandeasytocalculate.Despite itslimitations,BMIhasshownresultscomparabletothemostaccuratemeasuresavailable,andhasbeenproventopredicthigherriskofchronicdiseaseandearlydeath.110

OnJune30,2015,therequirementforschooldistrictstocollecttheheightandweightdatafromarepresentativesampleofNevadanstudentsin4th,7th,and10thgradessunset.ThisinformationwasusedtocalculatetheaverageBMIforstudentsacrossthestateandwasusedforavarietyofpurposes,including:

• Describingtrendsinweightstatusovertime;• Identifyingdemographicgroupsathigherriskofobesity;• Increasingawarenessontheextentofobesityamongyouth;• Driving improvements in public policy and practice, as well as services aimed at

preventingandtreatingobesity;• Monitoringtheeffectsofnewandexistingprograms;and• Measuringprogresstowardsachievingspecificgoals.

Withoutthisinformation,Nevadamaystruggletoqualifyandcompetewithotherstateswhenapplyingforfederalfundingorphilanthropicgrants.Manygrantawards,suchasthosefundedbytheCentersforDiseaseControlandPrevention(CDC), increasinglyrequireproofthattheirresources are making a positive impact on public health. This would put further strains onNevada,which,accordingtoaTrustforAmerica’sHealthandRobertWoodJohnsonFoundationreport,ranked31stinthenationfortheamountoffundingreceivedbytheCDC.111SomeofthegrantsthathavebeenawardedtoNevadainthepast,whichusedBMIdatatoapplyforfunds,include:

• CDC grant funding the Communities Putting Prevention to Work (CPPW) initiativedesigned to tackle obesity and tobacco use throughout 50 different communities inNevada;112

• ThePartnershipstoImproveCommunityHealth(PICH)grant($2,650,555)awardedtotheSouthernNevadaHealthDistricttodrivedownchronicdiseasesinClarkCounty;113

109 “MeasuringObesity”HarvardT.H.Chan:SchoolofPublicHealthhttps://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/how-to-measure-body-fatness/110“WhyUseBMI?”HarvardT.H.Chan:SchoolofPublicHealthhttps://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/obesity-definition-full-story/111“ShortchangingAmerica’sHealth”RobertWoodJohnsonFoundationhttp://www.rwjf.org/en/library/research/2010/03/shortchanging-america-s-health.html112http://www.cdc.gov/nccdphp/dch/programs/communitiesputtingpreventiontowork/communities/profiles/both-nv_clark-county.htm113“Newsroom”SouthernNevadaHealthDistricthttp://southernnevadahealthdistrict.org/news14/092514-snhd-awarded-2-mil-to-drive-down-disease-in-clark-county.php

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Bodymassindex(BMI)isestimatedasaperson’sweightdividedbytheirheightsquared(BMI=kg/m2,orBMI=lb/in2*703).WhileBMIisnotadirectmeasureofbodyfat,itdoescorrelatewithbodyfat,andiswidelyusedtoestimateaperson’sriskofweight-relatedhealthproblems.Thereareother,moresophisticatedmeasures,ofbodyfat,suchasskinfoldthicknessmeasurement,underwaterweighing,computerizedtomography(CT)andmagneticresonance imaging(MRI),buttheyaremuchmoreinvasiveandexpensivetoadminister.109BMIisthemostbasicandmostcommonwayofmeasuringbodyfatthat isalsoinexpensiveandeasytocalculate.Despite itslimitations,BMIhasshownresultscomparabletothemostaccuratemeasuresavailable,andhasbeenproventopredicthigherriskofchronicdiseaseandearlydeath.110

OnJune30,2015,therequirementforschooldistrictstocollecttheheightandweightdatafromarepresentativesampleofNevadanstudentsin4th,7th,and10thgradessunset.ThisinformationwasusedtocalculatetheaverageBMIforstudentsacrossthestateandwasusedforavarietyofpurposes,including:

• Describingtrendsinweightstatusovertime;• Identifyingdemographicgroupsathigherriskofobesity;• Increasingawarenessontheextentofobesityamongyouth;• Driving improvements in public policy and practice, as well as services aimed at

preventingandtreatingobesity;• Monitoringtheeffectsofnewandexistingprograms;and• Measuringprogresstowardsachievingspecificgoals.

Withoutthisinformation,Nevadamaystruggletoqualifyandcompetewithotherstateswhenapplyingforfederalfundingorphilanthropicgrants.Manygrantawards,suchasthosefundedbytheCentersforDiseaseControlandPrevention(CDC), increasinglyrequireproofthattheirresources are making a positive impact on public health. This would put further strains onNevada,which,accordingtoaTrustforAmerica’sHealthandRobertWoodJohnsonFoundationreport,ranked31stinthenationfortheamountoffundingreceivedbytheCDC.111SomeofthegrantsthathavebeenawardedtoNevadainthepast,whichusedBMIdatatoapplyforfunds,include:

• CDC grant funding the Communities Putting Prevention to Work (CPPW) initiativedesigned to tackle obesity and tobacco use throughout 50 different communities inNevada;112

• ThePartnershipstoImproveCommunityHealth(PICH)grant($2,650,555)awardedtotheSouthernNevadaHealthDistricttodrivedownchronicdiseasesinClarkCounty;113

109 “MeasuringObesity”HarvardT.H.Chan:SchoolofPublicHealthhttps://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/how-to-measure-body-fatness/110“WhyUseBMI?”HarvardT.H.Chan:SchoolofPublicHealthhttps://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/obesity-definition-full-story/111“ShortchangingAmerica’sHealth”RobertWoodJohnsonFoundationhttp://www.rwjf.org/en/library/research/2010/03/shortchanging-america-s-health.html112http://www.cdc.gov/nccdphp/dch/programs/communitiesputtingpreventiontowork/communities/profiles/both-nv_clark-county.htm113“Newsroom”SouthernNevadaHealthDistricthttp://southernnevadahealthdistrict.org/news14/092514-snhd-awarded-2-mil-to-drive-down-disease-in-clark-county.php


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• $1.3milliongrant receivedby theLincyFoundation thatwasusedmainly to fund theHealthySchoolsProgram,whichaimstoimproveschoolsintheareasofnutrition,physicalactivityandstaffwellness.114

Althoughwedonotcurrentlyhaveanexactestimateofthetotalcostassociatedwithschool-basedBMImeasurementsinthestateofNevada,weanticipatethatallcostswouldfaroutweighthe benefits of implementing the program. For example, in 2014, NevadaWellness issued areportontheBMIDataCollectionStatusinNevadafortheperiodbetween2011and2012(duringthattimeonlytwocounties,WashoeandClark,conductedBMImeasurementsandonlyonasampleofstudents).ThereportprovidedthefollowingestimateannualcostsassociatedwithBMI data collection: $128,554 for equipment (one-time cost), $116,999 for labor (includingsalariesandtraining),and$870formaterials, foran initialcostof$246,423.115Deductingtheone-timecostofequipment,theaverageyearlycostwouldbe$117,879.Recommendations:The Nevada Legislature should mandate the annual collection of BMI data in school forsurveillancepurposes.Wealsorecommendthatlegislatorsensurethefollowingelements:

• Anonymity–Students’datamustbecollected,analyzed,andinterpretedanonymously,and without sharing individual children’s weight status to avoid potential negativeoutcomes,suchasaprivacybreach,bullying,orloweringofstudents’self-esteem.

• Privacy–Heightandweightmeasurementsmustbetaken inprivateandbyatrainedtechniciantoensurethatchildrendonotsufferanyadverseeffectsintheprocess.

• Opting-out–Parentsmustbenotifiedinadvanceaboutthemeasurementstakingplaceinschoolsandalsobegivenanopportunitytoopttheirchildrenoutoftheprogramiftheywishdonotwanttheirchildtoparticipate.


114 “StateReports:ProgressintheHealthSchoolsProgramNevada2012”AllianceforaHealthierGenerationhttps://schools.healthiergeneration.org/_asset/xk4xez/115“BMIDataCollectionInNevadaSchoolDistricts”ChronicDiseasePreventionandHealthPromotion:ObesityPreventionProgramhttp://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Boards/CWCD/Meetings/2014/Exhibit%20C%20BMI%20Data%20Collection%20Nevada%20School%20Districts.pdf

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5. DENTALHEALTHNevadaChildren’sReportCardGrade:F

Thedentalhealthgradeisbaseduponpreventativedentalhealthcarevisitsof9thto12thgradersinNevada.Nevadaranks29thinthenationforthepercentageof9-12thgradestudentswhohavehadapreventativedentalcarevisitwithinthepastyear.Currently,68.9%ofstudentshavehadadentistvisitinthepastyear,lessthanthenationalaverageof74.4%reportedfor2015,butupslightlyfrom68.3%in2013forNevada.Oralhealthplaysasignificantroleinoverallhealthandwellbeing.Itisintimatelyrelatedtothehealthoftheentirebodyandplaysavitalroleinoverallphysiology.Mountingevidencehasshowninfectionsinthemouthsuchasperiodontalgumdiseasetoincreasetheriskofheartdisease,increasetheriskofprematurelabor,anddisrupttheabilityofthebodytoregulatebloodsugarforpeoplelivingwithdiabetes.116Thefar-reachingeffectsoforalhealthdemonstratetheenormousimportanceofproperoralandpreventativehealthcareforpeopleofallages.

Accordingtothe2012BurdenofOralDiseaseinNevadareport,Nevadansexperiencemanyoraldiseasesingreaternumberthantheirnationalcounterparts.The2008Third-Grade“HealthySmile,HappyChild”reportfoundthatmorethan65%ofNevada’sthird-gradestudentshavetoothdecayincomparisontojust53%nationwide.117Further,significantlymoreadolescentsinNevadasufferwithuntreatedtoothdecaythantheirnationalcounterparts(28%vs.18%).TheseeffectsarecompoundedbythefactthatmanyNevadansreportexperiencingbarriersinaccessingproperpreventativedentalcare.Asmanyoraldiseasesareprogressiveandbecomemoredifficulttomanageovertime,thereexistsagreatneedtoimproveaccesstopreventativeandregulardentalcareforchildrenacrossallofNevada.

RECOMMENDATIONSFORIMPROVEMENT:• Developandfundoutreachandeducationprogramstopromotegooddentalhygiene

amongchildren,aswellasappropriatepreventativedentalvisits.• EnsurethatdentalcareisadequatelycoveredunderMedicaidandNevadaCheck-Up,

withreimbursementratesthatreflectprovidercosts.

116“TheBurdenofOralDiseaseinNevada,”http://nsla.nevadaculture.org/statepubs/epubs/31428002984595-2012.pdf(April2012)117OralHealthPublication–NevadaStateHealthDivision,“HealthySmile,HappyChild”(2008)http://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Programs/OH/Oral_Health_Program_Reports/Burdenoforaldisease2008.pdf

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5. DENTALHEALTHNevadaChildren’sReportCardGrade:F

Thedentalhealthgradeisbaseduponpreventativedentalhealthcarevisitsof9thto12thgradersinNevada.Nevadaranks29thinthenationforthepercentageof9-12thgradestudentswhohavehadapreventativedentalcarevisitwithinthepastyear.Currently,68.9%ofstudentshavehadadentistvisitinthepastyear,lessthanthenationalaverageof74.4%reportedfor2015,butupslightlyfrom68.3%in2013forNevada.Oralhealthplaysasignificantroleinoverallhealthandwellbeing.Itisintimatelyrelatedtothehealthoftheentirebodyandplaysavitalroleinoverallphysiology.Mountingevidencehasshowninfectionsinthemouthsuchasperiodontalgumdiseasetoincreasetheriskofheartdisease,increasetheriskofprematurelabor,anddisrupttheabilityofthebodytoregulatebloodsugarforpeoplelivingwithdiabetes.116Thefar-reachingeffectsoforalhealthdemonstratetheenormousimportanceofproperoralandpreventativehealthcareforpeopleofallages.

Accordingtothe2012BurdenofOralDiseaseinNevadareport,Nevadansexperiencemanyoraldiseasesingreaternumberthantheirnationalcounterparts.The2008Third-Grade“HealthySmile,HappyChild”reportfoundthatmorethan65%ofNevada’sthird-gradestudentshavetoothdecayincomparisontojust53%nationwide.117Further,significantlymoreadolescentsinNevadasufferwithuntreatedtoothdecaythantheirnationalcounterparts(28%vs.18%).TheseeffectsarecompoundedbythefactthatmanyNevadansreportexperiencingbarriersinaccessingproperpreventativedentalcare.Asmanyoraldiseasesareprogressiveandbecomemoredifficulttomanageovertime,thereexistsagreatneedtoimproveaccesstopreventativeandregulardentalcareforchildrenacrossallofNevada.

RECOMMENDATIONSFORIMPROVEMENT:• Developandfundoutreachandeducationprogramstopromotegooddentalhygiene

amongchildren,aswellasappropriatepreventativedentalvisits.• EnsurethatdentalcareisadequatelycoveredunderMedicaidandNevadaCheck-Up,

withreimbursementratesthatreflectprovidercosts.

116“TheBurdenofOralDiseaseinNevada,”http://nsla.nevadaculture.org/statepubs/epubs/31428002984595-2012.pdf(April2012)117OralHealthPublication–NevadaStateHealthDivision,“HealthySmile,HappyChild”(2008)http://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Programs/OH/Oral_Health_Program_Reports/Burdenoforaldisease2008.pdf


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6. MENTALHEALTHNevadaChildren’sReportCardGrade:D-

Thementalhealthgradeisbaseduponratesofmentalhealthtreatment,suicideattempts,andteensuiciderates.Nevadaranks49thinthenationfor overallratesofyouthmentalhealthtreatmentinwhichchildrenreceivedneededmentalhealthtreatmentorcounselinginthepast12months.WhileNevada’sattemptedsuiciderankdroppedfrom16thin2013to30thin2015,withasignificantincreaseinattempts–10.7%in2015comparedto6.8%in2013–ouractualsuicideratehasgonedownfrom3.88to2.29(per100,000childrenage0-18),increasingourrankfrom36thto16th.TheWorldHealthOrganizationlistsmentalillnessasthesinglemostcommoncauseofdisabilityinyoungpeopleworldwide.Despitethisfact,Nevadahascutitsmentalhealthfundingbudgetby28.1%since2009andhasoneofthelowestpercapitaratesofmentalhealthfundinginthenation.118Mentalhealthisanessentialpartofchildren’soverallhealth,withextensiveinfluenceonchildren’sphysicalhealthandtheirabilitytosucceedinschool,work,andsociety.119Inspiteofagrowingnationwideneedforageappropriateandevidence-basedmentalhealthinterventionsforchildren,fundingforchildren’smentalhealthcontinuestodecline.

• Halfoflifetimementalhealthdisordersstartbyage14.120• IntheUS,20%ofyouthages13-18livewithamentalhealthcondition.121• In2014-2015,inNevada,4.9%ofchildrenservedthroughtheStateMentalHealth

Agency(SMHA)metthefederaldefinitionsofaseriousemotionaldisorder(SED)whilealsohavingasubstanceabusediagnosis.122

• Itisestimatedthatonly7%ofyouthwhoneedservicesreceiveappropriatehelpfrommentalhealthprofessionals.123

Itisofgreatimportancetoappropriatelyaddressmentalhealthissuesinchildhoodandearlyadolescenceasmanydisordershavelife-longeffects.Theseincludenotonlypsychologicaleffects,butgreateconomiccostsforfamilies,schools,communities,andthestate.Whilethis

118NationalAllianceonMentalIllnessStateAdvocacy,“StateStatistics:Nevada”(2010)https://www2.nami.org/ContentManagement/ContentDisplay.cfm?ContentFileID=93507119TheStateofAmerica’sChildren,”http://www.childrensdefense.org/child-research-data-publications/data/2014-soac.pdf(2014)120NationalInstituteofMentalHealthReleaseoflandmarkandcollaborativestudyconductedbyHarvardUniversity,theUniversityofMichiganandtheNIMHIntramuralResearchProgram(releasedatedJune6,2005andaccessedatwww.nimh.nih.gov).121“MentalHealthFacts:Children&Teens”NationalInstituteofMentalIllnesshttp://www.nami.org/NAMI/media/NAMI-Media/Infographics/Children-MH-Facts-NAMI.pdf122Nevada2015MentalHealthNationalOutcomeMeasures(NOMS):SAMHSAUniformReportingSystemSAMHSAUniformReportingSystem(URS)OutputTables2015SAMHSAUniformReportingSystem(URS)OutputTables123AmericanPsychologicalAssociation,“Children’sMentalHealth,”http://www.apa.org/pi/families/children-mental-health.aspx

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economicburdenisgreat,thelife-longeffectsofundiagnosedmentalhealthdisordersarefar-reachingandforeveraffecttheabilityofyoungpeopletoestablishhealthyinterpersonalrelationships,succeedinschool,andbecomeapartoftheworkforce.Inaddition,researchshowsthat“thehighrateofcomorbiditybetweendrugusedisordersandothermentalillnessesarguesforacomprehensiveapproachtointerventionthatidentifiesandevaluateseachdisorderconcurrently,providingtreatmentasneeded.”124Nevadaconsistentlyhasoneofthehighestyouthsuicideratesinthecountry.125In2014,suicidewasthesecondleadingcauseofdeathfor15to24yearoldNevadans,witharateof15.02suicidesforevery100,000youth.Thenationalaveragerateforthesameagegroupwas11.55per100,000.126Comparingyouthages10-24,Nevadaranksjustabovethenationalaverageof8.51withaNevadarateof10.50per100,000.TheNevadaYouthRiskBehaviorSurvey(YRBS)for2015foundthat17.7%ofhighschoolstudentshadseriouslyconsideredattemptingsuicide,15.8%ofhighschoolstudentsmadeasuicideplan,and9.8%ofhighschoolstudentsactuallyattemptedsuicide.127AccordingtotheClarkCountyChildren’sMentalHealthConsortiumAnnualPlan,allschoolchildrenneedaccesstoscreeninganduniversalbehavioralhealthpromotionactivities.Thefindingsfromtheassessmentsineachsystempointtotheneedtodevelopasystemthatsupportschildrenandfamiliesinawaytoavoidentranceintopublicservicesystems,suchaschildwelfare,juvenilejusticeandspecialeducation.128Byprovidingpubliceducationenvironmentsthatsupportwellnessthroughbehavioralhealthpromotionactivities,manychildrencouldavoiddeeperinvolvementinthepublicservicesystems.Allchildrenhavetherighttolivehealthylivesanddeserveaccesstoappropriateandeffectivementalhealthcare.Itisimportanttoaddressthetremendousamountofunmetneedandimprovethestateofchildren’smentalhealthcareinNevada.Mentalhealthpromotionwithincommunitiesandschoolsaswellasscreeningforearlydetectionofyouthwhoareatriskforsuicideareworkingandareimperativetopreventingyouthfromattemptingandtakingtheirownlives.RECOMMENDATIONSFORIMPROVEMENT:

• Accelerateeffortstopromoteawarenessandhelp-seekingbehaviorsamongyouthintheeducationsystem,aswellasscreeningandearlyinterventiontoidentifybehavioralhealthdisordersbeforethereisacrisis.

124NationalInstituteofDrugAbuseResearchReportSeries.Comorbidity:AddictionandOtherMentalIllnesses.NIHPublicationNumber10-5771RevisedSeptember2010125NevadaOfficeofSuicidePrevention126“Web-basedInjuryStatisticsQueryandReportingSystem,2014Data,”http://www.cdc.gov/injury/wisqars/(2014)1272015NevadaHighSchoolYouthRiskBehaviorSurveyReporthttp://dhs.unr.edu/Documents/dhs/chs/yrbs/2015-YRBS-Reports/2015-Nevada-HS-YRBS-Final.pdf128ClarkCountyChildren’sMentalHealthConsortium,“10YearStrategicPlan.”(2010)http://dcfs.nv.gov/uploadedFiles/dcfsnvgov/content/Meetings/CCCMHC%20Status%20Report%202015%20EXPANDED-FINAL-2-23-15.pdf

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economicburdenisgreat,thelife-longeffectsofundiagnosedmentalhealthdisordersarefar-reachingandforeveraffecttheabilityofyoungpeopletoestablishhealthyinterpersonalrelationships,succeedinschool,andbecomeapartoftheworkforce.Inaddition,researchshowsthat“thehighrateofcomorbiditybetweendrugusedisordersandothermentalillnessesarguesforacomprehensiveapproachtointerventionthatidentifiesandevaluateseachdisorderconcurrently,providingtreatmentasneeded.”124Nevadaconsistentlyhasoneofthehighestyouthsuicideratesinthecountry.125In2014,suicidewasthesecondleadingcauseofdeathfor15to24yearoldNevadans,witharateof15.02suicidesforevery100,000youth.Thenationalaveragerateforthesameagegroupwas11.55per100,000.126Comparingyouthages10-24,Nevadaranksjustabovethenationalaverageof8.51withaNevadarateof10.50per100,000.TheNevadaYouthRiskBehaviorSurvey(YRBS)for2015foundthat17.7%ofhighschoolstudentshadseriouslyconsideredattemptingsuicide,15.8%ofhighschoolstudentsmadeasuicideplan,and9.8%ofhighschoolstudentsactuallyattemptedsuicide.127AccordingtotheClarkCountyChildren’sMentalHealthConsortiumAnnualPlan,allschoolchildrenneedaccesstoscreeninganduniversalbehavioralhealthpromotionactivities.Thefindingsfromtheassessmentsineachsystempointtotheneedtodevelopasystemthatsupportschildrenandfamiliesinawaytoavoidentranceintopublicservicesystems,suchaschildwelfare,juvenilejusticeandspecialeducation.128Byprovidingpubliceducationenvironmentsthatsupportwellnessthroughbehavioralhealthpromotionactivities,manychildrencouldavoiddeeperinvolvementinthepublicservicesystems.Allchildrenhavetherighttolivehealthylivesanddeserveaccesstoappropriateandeffectivementalhealthcare.Itisimportanttoaddressthetremendousamountofunmetneedandimprovethestateofchildren’smentalhealthcareinNevada.Mentalhealthpromotionwithincommunitiesandschoolsaswellasscreeningforearlydetectionofyouthwhoareatriskforsuicideareworkingandareimperativetopreventingyouthfromattemptingandtakingtheirownlives.RECOMMENDATIONSFORIMPROVEMENT:

• Accelerateeffortstopromoteawarenessandhelp-seekingbehaviorsamongyouthintheeducationsystem,aswellasscreeningandearlyinterventiontoidentifybehavioralhealthdisordersbeforethereisacrisis.

124NationalInstituteofDrugAbuseResearchReportSeries.Comorbidity:AddictionandOtherMentalIllnesses.NIHPublicationNumber10-5771RevisedSeptember2010125NevadaOfficeofSuicidePrevention126“Web-basedInjuryStatisticsQueryandReportingSystem,2014Data,”http://www.cdc.gov/injury/wisqars/(2014)1272015NevadaHighSchoolYouthRiskBehaviorSurveyReporthttp://dhs.unr.edu/Documents/dhs/chs/yrbs/2015-YRBS-Reports/2015-Nevada-HS-YRBS-Final.pdf128ClarkCountyChildren’sMentalHealthConsortium,“10YearStrategicPlan.”(2010)http://dcfs.nv.gov/uploadedFiles/dcfsnvgov/content/Meetings/CCCMHC%20Status%20Report%202015%20EXPANDED-FINAL-2-23-15.pdf


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o Identificationandtreatmentofsubstanceabusemustbeincludedinanyefforttoimprovementalandbehavioralhealthissues.

o Universalscreeningforsuicideriskandsubstanceabuseshouldalsoberoutineinallprimarycare,hospitalcare(especiallyemergencydepartmentcare),behavioralhealthcare,andcrisisresponsesettings(e.g.,helplines,mobileteams,firstresponders,crisischatservices).Anypersonwhoscreenspositiveforpossiblesuicideriskshouldbeformallyassessedforsuicidalideation,plans,availabilityofmeans,presenceofacuteriskfactors(includinghistoryofsuicideattempts),andlevelofrisk.

• Publichealthandbehavioralhealthorganizationsshouldassurestaffworkingwithpersonsatriskofsuicidehavebeenappropriatelytrainedandpossessrequisiteskills.

o Allpersonsidentifiedasatriskofsuicidebyprimarycarepracticesandclinics,hospitals(especiallyemergencydepartments),behavioralhealthorganizationsandcrisisservicesshouldhaveacollaborativelydesignedsafetyplanpriortoreleasefromcare.Personswithsuicidalriskleavinginterventionandcaresettingsshouldreceivefollow-upcontactfromtheproviderorcaregiver.

• Continuetoincreasementalhealthpromotioninschools,suchassocialandemotionallearningalongwithsuicidepreventionstrategiesthatneedtobeimplementedforelementary,middle,andhighschoolstudents.Strategiesintheeducationsystemneedtobetailoredtotargetaudiencesbygender,race,disability,andsexualorientation.

• Suicidepreventiontrainingisneededinthefostercare,juvenilejusticeandchildwelfaresystemstoaddressthelargenumbersofyouthwithdepressionandsuicidalideation.

• Mobilecrisisassessmentneedsexpansiontoensurecrisisresponse,familystabilization,andcontinuityofcareforyouthwhoareidentifiedasat-riskorwhohavepreviouslyattemptedsuicide.

• BuilduptheworkforceinallpartsofNevada,especiallyinruralregions,sothereislocalabilitytoprovideappropriatementalhealthresources.

o Addressmentalhealthlicensurebyrequiringreasonableandtransparentlicensurereciprocityformentalhealthprovidersinordertoexpandtheavailableworkforce.

o Supportgreateruseoftechnologytoenhanceaccesstomentalhealthservices,especiallyinareaswheretransportationisproblematic,suchastheruralregionsofourstate.

• Supportyouthtosucceedasadults.Develop,fundandimplementsystem-levelpoliciescoupledwithsuccessfulstrategiestohelpyouthwithmentalhealthneedstransitiontopostsecondaryeducation,employment,andindependentlives.ContributionsforthisentrywereprovidedbytheNevadaOfficeofSuicidePreventionandChildren’sMentalHealthConsortiainNevada.

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7. SexualHealthNevadaChildren’sReportCardGrade:D+

Thesexualhealthgradeencompassesmanyfactorssuchasteenbirthrate,sexualactivity,condomuse,anybirthcontroluse,andsexuallytransmitteddisease(STD)rates.With12.4%ofNevada’shighschoolstudentsnotusinganytypeofbirthcontrol,Nevadaranks14thoutofthe33statesreportingthisinformation.Thisdirectlyaffectstheteenbirthrateof29birthsper1,000femalesages15to19andranksNevada38thinthenation–anaverageoffivebirthshigherthanthenationalaverage.Nevadaranks28thoutof38statesreportinginformationforcondomuse.WithregardtoSTDrates,Nevadarankstowardthemiddleforchlamydia(22nd)andgonorrhea(26th),buthasseenasharpincreaseinsyphilisfrom9.7(per100,00015to24yearolds)in2011to25.1in2014,rankingNevada50thinthenation.129

EveryschooldistrictinNevadaiscurrentlyrequiredtoteachsomesexeducation(NRS389.065),butstandardsvaryacrossthestate.130AsofJanuary2012,nationalstandardsexistforsexualityeducation,astheydoformathandreading.Includingsexeducationstandardsinourhealthstandardsandcurriculumensuresouryouthreceiveconsistent,medically-accurate,factualinformationtomakeinformeddecisions.

• TeenchildbearingcostNevadataxpayersatleast$68millioninfederal,state,andlocaldollarsin2010.Between1991and2010therewere73,470teenbirthsinNevada,costingtaxpayersatotalof$1.5billionoverthatperiod.131

• NevadahasmadesomeprogressandtheteenbirthrateinNevadadeclined62%between1991and2014savingtaxpayersmillionsofdollars.132

• Youngpeople(ages15-24)areparticularlyaffected,accountingforhalf(50percent)ofallnewSTIs.133

• Nevada’sHIVinfectionrateranks24thintheUnitedStates,witharateof16.4casesper100,000individualscomparedtothenationalrateof13.9casesper100,000.134

• STIsplaceasignificanteconomicstrainontheU.S.healthcaresystem.CDCconservativelyestimatesthatthelifetimecostoftreatingeightofthemostcommonSTIscontractedinjustoneyearis$15.6billion.135

129PleaseseeAppendix:ReportCardSources130ClarkCountySchoolDistrict“SexEducationCurriculumInformation,”http://www.ccsd.net/students/sex-ed-info.php(November2014)131“NevadaData”TheNationalCampaigntopreventTeenandUnplannedPregnancyhttp://thenationalcampaign.org/data/state/nevada132Ibid.133“Incidence,Prevalence,andCostofSexuallyTransmittedInfectionsintheUnitedStates.CDCFactSheet.http://www.cdc.gov/std/stats/sti-estimates-fact-sheet-feb-2013.pdf134“SurveillanceReport:DiagnosisofHIVInfectionintheUnitedSatesandDependentAreas,2014.”CentersforDiseaseControlandPrevention.http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf135“Incidence,Prevalence,andCostofSexuallyTransmittedInfectionsintheUnitedStates.CDCFactSheet.http://www.cdc.gov/std/stats/sti-estimates-fact-sheet-feb-2013.pdf

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7. SexualHealthNevadaChildren’sReportCardGrade:D+

Thesexualhealthgradeencompassesmanyfactorssuchasteenbirthrate,sexualactivity,condomuse,anybirthcontroluse,andsexuallytransmitteddisease(STD)rates.With12.4%ofNevada’shighschoolstudentsnotusinganytypeofbirthcontrol,Nevadaranks14thoutofthe33statesreportingthisinformation.Thisdirectlyaffectstheteenbirthrateof29birthsper1,000femalesages15to19andranksNevada38thinthenation–anaverageoffivebirthshigherthanthenationalaverage.Nevadaranks28thoutof38statesreportinginformationforcondomuse.WithregardtoSTDrates,Nevadarankstowardthemiddleforchlamydia(22nd)andgonorrhea(26th),buthasseenasharpincreaseinsyphilisfrom9.7(per100,00015to24yearolds)in2011to25.1in2014,rankingNevada50thinthenation.129

EveryschooldistrictinNevadaiscurrentlyrequiredtoteachsomesexeducation(NRS389.065),butstandardsvaryacrossthestate.130AsofJanuary2012,nationalstandardsexistforsexualityeducation,astheydoformathandreading.Includingsexeducationstandardsinourhealthstandardsandcurriculumensuresouryouthreceiveconsistent,medically-accurate,factualinformationtomakeinformeddecisions.

• TeenchildbearingcostNevadataxpayersatleast$68millioninfederal,state,andlocaldollarsin2010.Between1991and2010therewere73,470teenbirthsinNevada,costingtaxpayersatotalof$1.5billionoverthatperiod.131

• NevadahasmadesomeprogressandtheteenbirthrateinNevadadeclined62%between1991and2014savingtaxpayersmillionsofdollars.132

• Youngpeople(ages15-24)areparticularlyaffected,accountingforhalf(50percent)ofallnewSTIs.133

• Nevada’sHIVinfectionrateranks24thintheUnitedStates,witharateof16.4casesper100,000individualscomparedtothenationalrateof13.9casesper100,000.134

• STIsplaceasignificanteconomicstrainontheU.S.healthcaresystem.CDCconservativelyestimatesthatthelifetimecostoftreatingeightofthemostcommonSTIscontractedinjustoneyearis$15.6billion.135

129PleaseseeAppendix:ReportCardSources130ClarkCountySchoolDistrict“SexEducationCurriculumInformation,”http://www.ccsd.net/students/sex-ed-info.php(November2014)131“NevadaData”TheNationalCampaigntopreventTeenandUnplannedPregnancyhttp://thenationalcampaign.org/data/state/nevada132Ibid.133“Incidence,Prevalence,andCostofSexuallyTransmittedInfectionsintheUnitedStates.CDCFactSheet.http://www.cdc.gov/std/stats/sti-estimates-fact-sheet-feb-2013.pdf134“SurveillanceReport:DiagnosisofHIVInfectionintheUnitedSatesandDependentAreas,2014.”CentersforDiseaseControlandPrevention.http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf135“Incidence,Prevalence,andCostofSexuallyTransmittedInfectionsintheUnitedStates.CDCFactSheet.http://www.cdc.gov/std/stats/sti-estimates-fact-sheet-feb-2013.pdf


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• Ina2008study,youngpeoplewhoreceivedevidence-based,age-appropriateandmedicallyaccuratesexualityeducationusedsignificantlyfeweractsofviolencetowardadatingpartnerbytheendofGrade11.136

• Amongsexuallyactiveboys,thosewhoreceivedevidence-based,age-appropriateandmedicallyaccuratesexualityeducationweremorelikelytopracticesafesex2.5yearslater(i.e.,alwaysuseacondom).137

• Teenswhoreceivedevidence-based,age-appropriateandmedicallyaccuratesexualityeducationwere50%lesslikelytoexperiencepregnancythanthosewhoreceivedabstinence-onlyeducation.138

Widespreadsupportexistsforbalanced,evidence-basedsexeducationinNevada.AJanuary2013pollconductedinthestateshowedthat67%ofNevadansagreewiththepolicyof“teachingsexeducationinschools,includingage-appropriatediscussionsofbirthcontroloptions.”139

RECOMMENDATIONSFORIMPROVEMENT:

SomelevelofsexeducationiscurrentlyrequiredinNevadaschools,butthecurriculumisnotconsistentacrossthestate.Policiesshouldbeimplementedsothatallschooldistrictsoffer*consistentevidence-based,age-appropriateandmedicallyaccuratesexualityeducationcurriculumthatwillinclude:• Reproductiveandsexualanatomyandphysiology,includingbiological,psychosocialand

emotionalchangesthatnaturallyoccur.• AccurateinformationonAIDS/HIVandSTIprevention,testingandtreatmentaswellas

contraception,withanemphasisonrefrainingfromsexasthemosteffectivewaytopreventpregnancyandsexuallytransmittedinfections.

• Developmentofinterpersonalandlifeskillstohelpstudentsdevelophealthyrelationshipsandmakeresponsibledecisionsaboutsexualityandsexualbehavior.

• Inclusionandacceptanceofindividualsregardlessofrace,gender,genderidentity,religion,sexualorientation,ethnicorculturalbackgroundordisability.

• Identificationandpreventionofdomesticanddatingviolence,sexualabuseandlegal,medicalandcounselingresourcesavailable.

• Awarenessandunderstandingtopreventparticipationorexploitationofsexuallyexplicitmaterialovertheinternetandothermediaplatforms.

*Thisrecommendationstillmaintainsthatparentswouldbeabletomakedecisionsabouttheirchildren’sparticipationinthiscoursework,withoutpenalty.

136CAMHCentreforPreventionScience.TheFourthR:RelationshipBasedViolencePrevention.2008.http://youthrelationships.org137CAMHCentreforPreventionScience.TheFourthR:RelationshipBasedViolencePrevention.2008.http://youthrelationships.org138“Abstinence-OnlyEducationandTeenPregnancyRates:WhyWeNeedComprehensiveSexEducationintheU.S.”http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194801/139ThirdEyeStrategies(2012).NevadaVoterOpinionsJulythroughDecember2012.ProducedanddistributedbytheStateCapacity&InnovationFoundation.

Safety “Safety and security don’t just happen, they are the result

of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of

violence and fear.”

- Nelson Mandela, Former President of South Africa

Children’s Safety Overview1. Child Maltreatment

2. Youth Homelessness

3. Juvenile Violence

4. Child Deaths and Injury

5. Substance Abuse

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Children’sSafetyOverviewNevadaChildren’sReportCardGrade:D+

In2015,over669,000childrenundertheageof18yearsoldlivedinNevada.140Eachofthesechildrendeservetobesafeandsecure,butoftenlacktheskillstoprotectandcareforthemselves.Forthisreason,itistheresponsibilityoftheparents,guardians,andthecommunitytoensurethesafetyofallourchildrenandyouth.Factorssuchaspoverty,loweducationalattainment,substanceabuse,anddomesticviolencecanallhaveanimpactonchildren’ssafety–resultinginabuseandneglect,homelessness,juvenileviolence,preventableinjuriesandsometimesfatalities.Ensuringthatchildren,andtheirfamilies,haveappropriateaccesstokeyresourcesisessentialtoimprovingthesafetyofchildrenandyouthinNevada.Children’ssafetycanmeanavarietyofthings,butforthepurposeofthisbriefingbook,theareasofchildsafetyarenarrowedtothefollowingfiveareasthatneedimprovementandcontributetotheOverallChildren’sSafetyGradeofD+,whichthestatereceivedonthe2016Children’sReportCard.Detailsineachoftheseareasareprovidedinthesectionsbelowinadditiontorecommendationsforimprovementinthestate.Thesefactorsinclude:

1. ChildMaltreatment 2. YouthHomelessness 3. JuvenileViolence 4. ChildInjuryandDeath 5. SubstanceAbuse

140“AmericanFactFinder”UnitedStatesCensusBureauhttp://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml

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1. ChildMaltreatmentNevadaChildren’sReportCardGrade:C-

Thechildmaltreatmentgradeisbasedonthenumberofchildrenwhohadsubstantiatedexperiencesofmaltreatmentwhichincludephysicalabuse,sexualabuse,andneglectfulmaltreatment.Nevadaremainedrelativelystableinoverallmaltreatment,goingfrom19thin2012to15thin2014.141Forphysical,sexual,andneglectfulmaltreatment,Nevadaranked45th,17th,and27th,respectively.142ThiscontributedtoNevada’s2016rankingof31stinthenationforfostercareplacement,inwhichanaverageof5childrenwereremovedfromtheirhomesandplacedinfostercareper1,000children.143NevadaStateChildWelfareInformationforJuly2014-June2015

July 2014 - June 2015 Clark

CountyWashoeCounty

RuralCounties

TotalStatewide

TotalNewReferrals 21,068 5,680 3,803 30,551InformationOnly 8,866 3,319 2,294 14,579DifferentialResponseorInvestigationInitiated

768 228 434 1,430

TotalClosedInvestigations 11,434 2,033 1,075 14,542Substantiated 2,258 612 149 3,019Unsubstantiated 8,479 1,187 576 10,242DatahasbeenprovidedbyNevadaDivisionofChildandFamilyServices.InNevadain2014,justover40%ofchildmaltreatmentscaseswerechildrenundertheageof5.Themajorityofchildmaltreatmentcasesincludeneglect(approximately76.9%)andphysicalabuse(approximately35.6%),andasmallerpercentageareduetosexualabuse(approximately4.7%).144However,instancesofsexualabusearemorelikelytogounreportedthereforetheprevalenceislikelymuchlarger.Forinstance,itisestimatedthatoneinfourgirlsandoneinsixboyswillbethevictimofchildsexualabusebythetimetheyare18yearsold,however,87%neverreporttheirabuse.145

141“ChildMaltreatment2014,”http://www.acf.hhs.gov/sites/default/files/cb/cm2014.pdf(2014)142“TheStateofAmerica’sChildren,”http://www.childrensdefense.org/child-research-data-publications/data/2014-soac.pdf(2014)143KidsCount,“Children0to17EnteringFosterCare,”http://datacenter.kidscount.org/data/tables/6268-children-0-to-17-entering-foster-care#ranking/2/any/true/868/any/1562(July2014)144DivisionofChild&FamilyServicesNevada,“NevadaContextData,”http://dcfs.nv.gov/uploadedFiles/dcfsnvgov/content/Tips/Reports/Nevada_Context_Data.pdf145DivisionofChild&FamilyServicesNevada,“TaskForceonthePreventionofSexualAbuseofChildren,”http://dcfs.nv.gov/uploadedFiles/dcfsnvgov/content/Tips/Reports/SB258%20Report.pdf(2014)

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Childabuseandneglectcreatesatremendousburdenonsociety,inbothsocialandeconomicterms.Abusedorneglectedchildrensufferfrommuchhigherlikelihoodsofmentalhealthproblems,perpetuationofabuse,suicide,homelessness,teenpregnancy,addiction,andcrime.146Toreduceinstancesofabuseandneglect,Nevada’schildwelfaresystemworkstoprotectchildrenbyprovidingsupportandservicestothemandtheirfamilies.Throughthissupportandservices,thechildwelfaresystemstrivestopreservethechild’sfamily.Unfortunately,sometimesstayinginthecareoftheirparentsisnotalwaysinthebestinterestofthechild.Asalastresortthechildisremovedfromthefamilyandplacedintofostercare.Overall,Nevadatendstomakethedeterminationforremovalmoreoftenthan30otherstates,ranking31stinthenation,withanaverageof5per1,000children.147InDecemberof2015,justover3,000childrenwereinout-of-homeplacements.InNevadain2016,childrenthatwereremovedfromtheirhomehadanaveragestayinfostercareof13monthsinClarkandWashoeCountiesand19monthsinruralcounties.148Nevada’sChildWelfareSystemneedstocontinuetoworktoidentifymechanismsandpoliciesthatcanbeputinplacetopromotefamilypreservation.Enteringintothefostercaresystemshouldnotbetheanswertopermanentlyescapingabuseandneglect;rather,therootcausesofabuseorneglectshouldbeaddressedandthechildwelfaresystemredesignedtofocusmoreonfamily-centeredchildwelfareserviceandprevention.149

RECOMMENDATIONSFORIMPROVEMENT:• Ensurethatadequateresourcesareinplacetoprovidechildrenandfamilieswiththe

servicesneededtosafelypreventremovalsandensuretimelyreunifications.• Ensurethatfosterfamiliesareappropriatelytrainedtobesensitivetodiverseyouth

(includingthoseofdifferentracesandsexualorientations)anddevelopappropriatescreeningpracticesandcheckpointstoensuretheyouthareresidinginahealthyenvironmentwhileinfostercare.

• Establishnewandexpandexistingin-homepreventionandinterventionservicesforfamiliesatrisk,includingbutnotlimitedtoparent-childinteractiontherapy,nurse-familypartnerships,andcounselingservices.

• Includeparentrepresentativesinthedecisionmakingprocessbyrequiringinclusiononstate-leveladvisoryandoversightgroups,asappropriate.

146Zimmerman,F.,Mercy,J.ABetterStart:ChildMaltreatmentPreventionasaPublicHealthPriority.ZerotoThree(J),v30n5p4-10May2010147SeeAppendix:ReportCardDataSources148DivisionofChild&FamilyServicesNevada,“DataBook,”http://dcfs.nv.gov/uploadedFiles/dcfsnvgov/content/Home/features/Data_Book_April_2016%20(2).pdf149CommunityWeWillBrief:http://nic.unlv.edu/files/CommunityWeWillBusinessCase.pdf

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CHILDMALTREATMENT-SPECIALISSUE

TANFforFictiveKinProvidersWhenachildisremovedfromhis/herhome,thechildwelfareagencymustidentifyandnotifyallotheradultrelativeswithinthefifthdegreeofconsanguinityofthechild.150Whenbloodrelativesarenotwillingorabletotakethechild,thepreferenceforplacementisthengiventofictivekin–thosewhohaveafamily-liketietothechild.Relativesandfictivekincaregiversprovidekinshipcare,whichallowsachildtogrowtoadulthoodinafamilyenvironmentandmaintainconnectionstotheirfamily,communityandidentity151.Kinshipcaregiversdifferfromfosterparentsbecausetheyare“unlicensed”whentheyfirstacceptchildrenintotheirhome,whichmeanstheyarenotentitledtothefinancialsupportthatnon-kinfosterparentsreceive.Formostkinshipcaregivers,havingachildplacedintheircarecanbecomefinanciallyburdensome:manyofthesecaregiversareretiredandlivingonfixedincomes;morethanone-thirdarealreadylivingatthepovertyline152;andsomemaybeinpoorhealth153.InNevada,therearetwomainsourcesoffinancialsupportforqualifiedkinshipfamilies.

1. TitleIV-EoftheSocialSecurityAct–Relativeandfictivekinfamiliesmaybecomelicensedasfosterparentsandreceivethesamefostercarereimbursementthatnon-kinfosterparentsreceive.Theprocessismanagedbythechildwelfareagencyandcantakemonths,leavingmanyfamiliesstrugglingtopaythebillswhiletheyareworkingtobecomelicensedwhilecaringforthenewchildrenintheirhome.

2. TemporaryAssistanceforNeedyFamilies(TANF)–Duringthetimerelativesareworkingtobecomelicensed,manyfamiliesmaybeeligibleforasmallerformoffinancialsupportfromtheTANFgrantofferedthroughtheDivisionofWelfareandSupportiveServices(DWSS).Child-onlyTANF,alsoknownasNon-NeedyRelative

150“FosteringConnectionstoSuccessandIncreasingAdoptionsActof2008”https://www.gpo.gov/fdsys/pkg/PLAW-110publ351/pdf/PLAW-110publ351.pdf151ChildWelfareLeagueofAmerica[CWLA]&GenerationsUnited[GU],2011152Nelsonetal.,2010;AllianceforChildren’sRights,2014.153Sakai,Lin,&Flores,2011;Steinetal,2014

InNevada,theFY2014monthly

averagenumberofchildrenin

FosterCarewas4,955.

• 36%ofchildreninfostercare

inNevadaliveinakinship

placement.

• 68%offosterchildrenliving

inakinshipplacementarein

anunlicensedhome.

• Between20-30%ofkinship

placementsarewithafictive

kincaregiver.

In Nevada, the FY2014 monthly average number of children in Foster Care was 4,955.• 36% of children in foster care

in Nevada live in a kinship placement.

• 68% of foster children living in a kinship placement are in an unlicensed home.

• Between 20-30% of kinship placements are with a fictive kin caregiver.

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CaregiverTANF154,isavailabletoindividualscaringfordependentchildren,155otherthantheirownbiologicalchildren,whomeetspecifiedconditions.Theseinclude:I. Providingproofofrelationtothechild(ren)bybirth,marriageoradoptionwithin

the5thdegreeofconsanguinity156,157.II. Proofthebiologicalparentsdonotresideinthehome158,oriftheyareinthe

home,havebeendeclaredbythecourttobementallyorphysicallyincapableofcaringforchildren159.

III. Thegrosshouseholdincomemustnotexceed275%oftheFederalPovertyGuidelinesforhouseholdsize160.

Duetoalackofcoordinatedinformationforfamilies,anapplicationprocessthatcanbecomplicated,andthestigmafamiliesmayfeelisassociatedwithapplyingforawelfarebenefit;feweligiblehouseholdsreceivethechild-onlyTANFgrants161.Inaddition,therearepoliciesthatpreventsomekinshipfamiliesfromaccessingtheTANFgrantatall.

• Paternalrelativesmayfindtheyareunabletoreceivehelpifthebiologicalfatherisnotlistedonthechild’sbirthcertificate162.

• Ifthecaregiverdoesnotshareabloodrelationshiptoallkinshipchildrenintheirhome,thecasewillbedeniedforthechildrenwithwhomthereisabloodrelationshipbecausethesiblingsetisconsideredanassistanceunit163.

• Relativesmustalsoagreetohavechildsupportenforcementofficerspursuethebiologicalparentsforchildsupporttorepaythestate164,arequirementthatdeterssomefamilies.

• Duetorelationshiprequirements,fictivekinfamiliesarenoteligibleforanyfinancialsupportfromTANF.

• Finally,evenifthefamilymeetsallthecriteriatoapply,somerelativefamiliesaredeniedatthewelfareoffice,potentiallyrelatedtothefactthatchild-onlyapplicationsarerelativelyrare.Relativefamilieswouldoftenhavetorequestanappealtocorrectthedecision.

154NVDWSSManual1010.2.3Non-NeedyRelativeCaregiverANon-NeedyRelativeCaregiver(NNRC)isarelative,otherthanalegalparent,whoisnotrequestingassistanceforthemselfandonlyrequestingassistanceforarelativechild(ren).Onlyonenon-parentcaregivermaybeincludedasaneedycaregiverandtheymustbearelativeofspecifieddegree(seemanualsectionA-300).SeemanualsectionA-2600foreligibilityrequirementsandC-140forpaymentamounts.155NVDWSSManual323DEPENDENTCHILD156NVDWSSManual321CAREGIVER157NVDWSSManualRELATIONSHIP158NVDWSSManual1010.2TANFCashPrograms159NVDWSSManual330WHOISINCLUDED160NVDWSSManualA2620.1.1161Mauldon,Speiglman,Sogar,&Stagner,2012;Nelson,2010;AECF,2012162NVDWSSMANUAL323.3ChildrenLivingWithRelativesoftheBiologicalFather163NVDWSSMANUALA2630.2164NVDWSSMANUAL1600PURPOSE,1610ASSIGNMENTOFSUPPORT,1611GOODCAUSEFORNON-COOPERATIONWITHCSEP

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Recommendations:1. Expandchild-onlyTANFtoallowpaymentstofictivekincaregiversofchildreninfoster

carewhomeetallotherrequirements.Basedonthenumberofchildrenperfictivekinplacement,thefinancialimpactwouldbebetween$127Kand$225Kpermonth.165

2. Ensurechildwelfareworkersareinformedofthechild-onlyTANFprogramsothatrelativefamiliesareencouragedtoapplywhentheyfirstgetplacementofachild.IncreasethenumberofTANFtraininghoursforwelfareeligibilityspecialists,withafocusonchild-onlyTANF.


156Onechildperplacement:(Totalnumberofchildreninfostercare*.36kinshipplacements)*.3fictiveplacements*$417.Twochildrenperplacement:[(Totalnumberofchildreninfostercare*.36kinshipplacements)*.3fictiveplacements]/2*$476

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CHILDMALTREATMENT-SPECIALISSUELGBTQYouthinOut-of-HomeCareAccordingtotheNationalComingOutDay:YouthReport,sevenpercentoflesbian,gay,bisexual,transgenderandquestioning/queer(LGBTQ)youthwhoareouttotheirfamiliesindicatedthattheirfamiliesare“notatallaccepting”oftheirsexualidentity.166Forsomeoftheseyouth,thelackofacceptancetheyfacemayresultinabuseand/orneglectfromtheirparents–resultinginLGBTQyoungpeoplebeingoverrepresentedinfostercare.Thelackofacceptancealsoplacestheseyouthatanincreasedriskofhomelessness–increasingthechancesofinteractionswiththejuvenilejusticesystem.AccordingtoTheCenterforAmericanProgress,homelessgayandtransgenderyoutharemorelikelytoresorttocriminalbehaviors,suchasdrugsales,theft,or“survivalsex,”whichputthematriskofarrestanddetainment.Theseyoutharealsoatanincreasedriskofdetainmentforcommittingcrimesrelatedtohomelessness,suchasviolatingyouthcurfewlawsandsleepinginpublicspaces.”167However,fewstateshavelawsandpoliciesinplacedesignedtoprotectthemfromdiscriminationandensurethatprovidersaretrainedonLGBTQcompetencies.

• Asurveyofyouthinfostercarefoundthatnearly1outof5(19.1%)ofLA-basedfosteryouthareLGBTQandthepercentageofyouthinfostercarewhoareLGBTQisbetween1.5and2timesthatofyouthlivingoutsideoffostercare.168

• LGBTQyouthrepresentjust5%to7%ofthenation’soverallyouthpopulation,yetthey

166“GrowingUpLGBTinAmerica:NCODReport”HumanRightsCampaignhttp://www.hrc.org/youth/download-the-report/#.V6uz4mXMyFJ167“TheUnfairCriminalizationofGayandTransgenderYouth”:CenterforAmericanProgresshttps://www.americanprogress.org/issues/lgbt/report/2012/06/29/11730/the-unfair-criminalization-of-gay-and-transgender-youth/168HumanRightsCampaign:WhitePaperLGBTQYouthintheFosterCareSystemhttp://www.hrc.org/resources/lgbt-youth-in-the-foster-care-system

Source: Human Rights Campaign White Paper LGBTQ Youth in the Foster Care System

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compose13%to15%ofthosecurrentlyinthejuvenilejusticesystem.169

EventhoughLGBTQyouthareoverrepresentedinfostercare,only14stateshavefostercarelawsandpoliciesthatareinclusiveofsexualorientationandgenderidentity,andsevenhavelawsandpoliciesthatincludesexualorientationonly170.Currently,Nevadadoesnothaveanyinclusivenon-discriminatorylawsorpolicies.Totackletheseissues,fostercareandjuvenilejusticeagenciesneedtoensurethatallemployeesareproperlyinformedandtrainedtomeettheneedsofLGBTQyouth.

Withoutthesetypesoflaws,policiesandtrainingsinplace,Nevada’sLGBTQyouthfacetheprospectofneglect,discriminationandabusewithintheverysystemschargedtoprotectthem.InappropriateplacementsandalackofunderstandingoftheneedsofLGBTQyouthalsoendangertheirhealthandsafetyastheyareatincreasedriskofphysicalviolence,substanceabuse,unsafesex,homelessnessandevensuicide.

Recommendations:

1. Requireallproviders,staff,fosterparentsanddirectcarestaff(thosewhoworkdirectlywithyouthinout-of-homesettings,includingchildwelfareandjuvenilejustice)tocompleteatleast8hoursofinitialtrainingregardingworkingwithLGBTQyouthandatleast4hoursannuallythereafter.Thesetrainingsmaybeintegratedwithothertrainings,butmustincludespecificcomponentsaddressingtheneedsofLGBTQyouth.

2. Ensurethat“gender”and“sex”aredefinedasthegenderidentityoftheyouthinout-of-homeplacement(nottheirsexassignedatbirth)inallrelevantsectionsoftheNRSandNAC.

3. RequiretheNevadaDivisionofChildandFamilyServices(DCFS)todevelopplacementprotocolsinbothChildWelfareandJuvenileJusticethataddressappropriateplacementofyouthbasedontheirgenderidentity.Theseprotocolsmustbedevelopedwiththeconsultationandinputofkeystakeholders,including:currentand/orformerLGBTQfosteryouthand/oryouthfromjuvenilejustice;representativesfromchildwelfareandjuvenilejusticeagenciesinNevada;representativesfromtheLGBTQcommunity;legalcounsel,includingchildren’sattorneys;juvenileand/orfamilycourtrepresentatives;childadvocates;andothersdeemedappropriatebyDCFS.

4. EstablishaBillofRightsforyouthinthejuvenilejusticesystem,similartotheNevadaFosterYouthBillofRights(NRS432.500–432.550).Includereferenceforcrossover

169“TheUnfairCriminalizationofGayandTransgenderYouth”:CenterforAmericanProgresshttps://www.americanprogress.org/issues/lgbt/report/2012/06/29/11730/the-unfair-criminalization-of-gay-and-transgender-youth/170HumanRightsCampaign:WhitePaperLGBTQYouthintheFosterCareSystemhttp://www.hrc.org/resources/lgbt-youth-in-the-foster-care-system

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youthwhoarealsointhechildwelfaresystemtoclarifywhichrightsapplywhentheyareplacedwithinthejuvenilejusticesystem.

5. RequiretheNevadaDivisionofChildandFamilyServicestoestablishagrievanceand/orcomplaintprocessforallyouthinout-of-homecarethatallowsthemtofileagrievanceand/oracomplaintrelatedtotheirrights(FosterYouthBillofRightsand/orBillofRightsforyouthinthejuvenilejusticesystem)withanindividualorentitythatisnotdirectlyresponsiblefortheircare,buthastheauthoritytoinvestigateandseekremedies,asappropriate,onbehalfoftheyouth.

6. Requirethatallyouthinout-of-homeplacementsreceiveacopyoftheirrights,includingtheprocessforfilingcomplaintsand/orgrievancesasestablishedbyDCFSpertherecommendationabove.


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ChildWelfareFundingIn2011,Nevadarevisedthechildwelfarefundingstructureforthetwourbancountychildwelfareagencies,ClarkCountyDepartmentofFamilyServices(CCDFS)andWashoeCountyDepartmentofSocialServices(WCDSS).171Thenewstructureprovidesthecountieswithanannualcappedblockgrantwhichde-categorizedtheGeneralFundappropriationforthepurposeofchildwelfareintegration.Thepurposeofthechangewastoprovideflexiblefundingtoallowagenciestoredirectchildwelfarefundingtomeettheneedsofthechildrenandfamiliesintheircommunities.172Theblockgrantisdividedintotwoallocations:

(1) AbaseallocationforthebienniumwhichisbasedonthetotalstateGeneralFundappropriatedforthepreviousbiennium.

(2) Thesecondallocationwouldincludetheestimatedcostattributabletoprojectedcaseloadgrowthfortheadoptionassistanceprogram.

Overall,grantfundingissupportedbyfederal,state,andlocalfunds.Duringthe2015-2017biennium,Nevadaallocatedover$256.9milliontoCCDFSandWCDSS;morethanhalfofwhich–$132.2million–camefromtheNevadaGeneralFund.173

Theintentisforchildwelfareagenciestousethesefundstoprovideacompletesystemofcaretochildrenandfamilies.AccordingtotheChildWelfareInformationGateway,“thisapproachisbasedupontheprinciplesofinteragencycollaboration;individualized,strengths-basedcarepractices;culturalcompetence;community-basedservices;accountability;andfullparticipationoffamiliesandyouthatalllevelsofthesystem.Acentralizedfocusofsystemsofcareisbuildingtheinfrastructureneededtoresultinpositiveoutcomesforchildren,youth,and171“SB447”76thNevadaLegislativeSessionhttp://leg.state.nv.us/Session/76th2011/Reports/history.cfm?ID=1086172“ChildWelfareBudget”StateofNevada:Governor’sFinanceOfficehttp://budget.nv.gov173ChildWelfareforCCDFSandWCDSSforthe2009-2011and2011-2013BienniumonlyincludeIntegrationFunding.IntegrationFundingwasprovidedtoCCDFSandWCDSStosupportchildwelfareservicesinClarkCountyandWashoeCountythatweretransferredtoDFSaspartofthechildwelfareintegration.Thisbudgetsupportschildwelfareservicesthatincludesubstitutecare,fostercare,licensingservices,adoptionservices,InterstateCompactonthePlacementofChildren(ICPC),andIntensiveFamilyServices.

2009-2011 2011-2013 2013-2015 2015-2017CCDFS $163,213,704 $163,897,568 $200,556,153 $194,110,821

WCDSS $61,965,397 $60,401,337 $71,996,717 $62,812,911

NevadaBienniumChildWelfareFunding

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ChildWelfareFundingIn2011,Nevadarevisedthechildwelfarefundingstructureforthetwourbancountychildwelfareagencies,ClarkCountyDepartmentofFamilyServices(CCDFS)andWashoeCountyDepartmentofSocialServices(WCDSS).171Thenewstructureprovidesthecountieswithanannualcappedblockgrantwhichde-categorizedtheGeneralFundappropriationforthepurposeofchildwelfareintegration.Thepurposeofthechangewastoprovideflexiblefundingtoallowagenciestoredirectchildwelfarefundingtomeettheneedsofthechildrenandfamiliesintheircommunities.172Theblockgrantisdividedintotwoallocations:

(1) AbaseallocationforthebienniumwhichisbasedonthetotalstateGeneralFundappropriatedforthepreviousbiennium.

(2) Thesecondallocationwouldincludetheestimatedcostattributabletoprojectedcaseloadgrowthfortheadoptionassistanceprogram.

Overall,grantfundingissupportedbyfederal,state,andlocalfunds.Duringthe2015-2017biennium,Nevadaallocatedover$256.9milliontoCCDFSandWCDSS;morethanhalfofwhich–$132.2million–camefromtheNevadaGeneralFund.173

Theintentisforchildwelfareagenciestousethesefundstoprovideacompletesystemofcaretochildrenandfamilies.AccordingtotheChildWelfareInformationGateway,“thisapproachisbasedupontheprinciplesofinteragencycollaboration;individualized,strengths-basedcarepractices;culturalcompetence;community-basedservices;accountability;andfullparticipationoffamiliesandyouthatalllevelsofthesystem.Acentralizedfocusofsystemsofcareisbuildingtheinfrastructureneededtoresultinpositiveoutcomesforchildren,youth,and171“SB447”76thNevadaLegislativeSessionhttp://leg.state.nv.us/Session/76th2011/Reports/history.cfm?ID=1086172“ChildWelfareBudget”StateofNevada:Governor’sFinanceOfficehttp://budget.nv.gov173ChildWelfareforCCDFSandWCDSSforthe2009-2011and2011-2013BienniumonlyincludeIntegrationFunding.IntegrationFundingwasprovidedtoCCDFSandWCDSStosupportchildwelfareservicesinClarkCountyandWashoeCountythatweretransferredtoDFSaspartofthechildwelfareintegration.Thisbudgetsupportschildwelfareservicesthatincludesubstitutecare,fostercare,licensingservices,adoptionservices,InterstateCompactonthePlacementofChildren(ICPC),andIntensiveFamilyServices.

2009-2011 2011-2013 2013-2015 2015-2017CCDFS $163,213,704 $163,897,568 $200,556,153 $194,110,821

WCDSS $61,965,397 $60,401,337 $71,996,717 $62,812,911

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families.”174Toprovidethistypeofcare,CCDFSandWCDSSneedappropriatefundingtoensureadequateinvestigations,casemanagement,familysupportsandotherrelatedservices.

In2012,justoneyearaftertherevisionofthefundingstructure,Nevadaranked38thinthenationinpercapitaspendingonchildwelfareat$22.09.175Thisoverallspendinghasremainedrelativelyflatsince2012–largelyduetotheblockgrantstructure.Inareviewoffederalblockgrantprograms,theCenteronBudgetandPolicyPrioritiesfoundthat“ablockgrant’sbasicstructuremakesthemespeciallyvulnerabletofundingreductionsovertime…Asaresult,thefundsareusedindiffusewaysandtheirimpactishardtodocument.Often,itisdifficulteventotrackindetailhowthemoneyisused.That,inturn,makesiteasierforpolicymakersseekingresourcesfortheirownprioritiestolooktoblockgrantsforsavings,andhasmadeblockgrantsparticularlyvulnerabletofundingfreezesforyearsonend.”176

Recommendations:ToensurethatNevadaisfundingCCDFSandWCDSSatappropriatelevelstoprovideeffectiveandefficientchildwelfareservices,astudyshouldbeconductedtoprovideananalysisof:

• Thecurrentblockgrantstructuretothelocalchildwelfareagencies.Specifically,askingifthisstructureisappropriate/sufficienttosupporttheneedsofthechildwelfareagenciesandifthereareotherstructuresthatmaybemoreappropriate.

• Potentialfundingsourcestosupportchildwelfare.DeterminingwhatothersourcesoffundingareavailabletosupportchildwelfarethatNVisnotcurrentlyreceiving.

• Allfundingsources(local,state,federal,andpotentiallyprivate)thatsupportthebroadchildwelfaresystem.Besidesfundingspecificallydirectedtowardchildwelfareagencies,thesystemitselfisreliantuponmanyothersocialprogramsandsystemsincludingfundingformedicalcare,mentalhealth,substanceabuse,education,juvenilejustice,childcareandothersocialservice/welfareprograms.Thestudyshouldreviewhowthesesystemsarealignedtoensureappropriatesupportservicesforchildrenandfamilies.


174“SystemsofCare”ChildWelfareInformationGatewayhttps://www.childwelfare.gov/pubPDFs/soc.pdf175Calculatedfromcomparingthe2012CaseyChildWelfareFinancingSurveywith2012Censuspopulationestimates.http://www.childwelfarepolicy.org/maps/single?id=345https://www.census.gov/popest/data/state/totals/2012/176http://www.cbpp.org/sites/default/files/atoms/files/11-19-15bud.pdf

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CHILDMALTREATMENT-SPECIALISSUEChildWelfareDataSystem

“Entitiesandcommunitiesshouldendeavortoprovideaholistic,comprehensive,andintegratedexperienceforchildren,youth,andfamiliesseekingsupportandreceivingservices.”–ChildWelfareLeagueofAmerica177Childrenwhoenterthechildwelfaresystemoftencrossoverintoothersystemsofcare.• Achildwhoisabused/neglectedis55%more

likelytobearrestedasajuvenile;178• Morethan20%ofchildrenwholeavefoster

careexperiencedhousingproblemswithintwoyearsofleaving;179

• Formerfosterchildrenaremorelikelytobecomehomeless,incarcerated,ordependentonstateservices.180

Forexample,inClarkCounty,childrenwhoenterthechildwelfaresystemwouldhavetheirinformationenteredintotheUnifiedNevadaInformationTechnologyforYouth(UNITY)datasystemandtheNationalYouthinTransitionDatabase(NYTD).Ifhe/shethenreceiveswelfareservices,theywouldbeenteredintotheCACTUSSystemandtheNevadaOperationsofMulti-AutomatedDataSystem(NOMADS).IftheygothroughthecourtsystemtheywillgetenteredintoOdyssey,andthroughthejuvenilejusticesystemintotheFamilyTracking,ReportingandAutomatedCaseSupport(FamilyTracs)system.Ifthatchildbecomeshomelessorreceiveshomelessnessservices,theywouldbeenteredintotheHomelessManagementInformationSystem(HMIS)andiftheyreceiveworkforceaidtheywouldbeenteredintotheSouthernNevadaWorkforceConnectionsdatareportingsystem(NVTrac).Additionally,theywouldstillbetrackedbytheSchoolDistrictandbyhealthcareservices.Withoutbeingabletoseewhatservices/resourcesachildhasalreadyreceived,theserviceprovidersoperatewithblinderswhichmayresultinalackofappropriateservices,duplicationofservicesandalackofefficiencyamongallagencies.Additionally,manyofthesesystemsareoldandlackthecapacitytoinput,storeand/orreportdatanecessaryfortheseagenciestomaketimelyandappropriatedecisionsfortheseyouth.

177ChildWelfareLeagueofAmerica,NationalBlueprintforExcellinginChildWelfarep.70178CenterforJuvenileJusticeReformhttp://cjjr.georgetown.edu/pdfs/Fall%2008%20NCJFCJ%20Today%20feature.pdf179“PathwaystoandFromHomelessnessandAssociatedPsychosocialOutcomesAmongAdolescentsLeavingtheFosterCareSystem”AmericanPublicHealthAssociationhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2707485/180Lips,Dan“FosterCareChildrenNeedBetterEducationalOpportunities”HeritageFoundationhttp://www.heritage.org/research/reports/2007/06/foster-care-children-need-better-educational-opportunities#_ftn10

IntegratedData

System

HumanServices

Health

Employment

VItalStatistics

JusticeSystem

Education

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CHILDMALTREATMENT-SPECIALISSUEChildWelfareDataSystem

“Entitiesandcommunitiesshouldendeavortoprovideaholistic,comprehensive,andintegratedexperienceforchildren,youth,andfamiliesseekingsupportandreceivingservices.”–ChildWelfareLeagueofAmerica177Childrenwhoenterthechildwelfaresystemoftencrossoverintoothersystemsofcare.• Achildwhoisabused/neglectedis55%more

likelytobearrestedasajuvenile;178• Morethan20%ofchildrenwholeavefoster

careexperiencedhousingproblemswithintwoyearsofleaving;179

• Formerfosterchildrenaremorelikelytobecomehomeless,incarcerated,ordependentonstateservices.180

Forexample,inClarkCounty,childrenwhoenterthechildwelfaresystemwouldhavetheirinformationenteredintotheUnifiedNevadaInformationTechnologyforYouth(UNITY)datasystemandtheNationalYouthinTransitionDatabase(NYTD).Ifhe/shethenreceiveswelfareservices,theywouldbeenteredintotheCACTUSSystemandtheNevadaOperationsofMulti-AutomatedDataSystem(NOMADS).IftheygothroughthecourtsystemtheywillgetenteredintoOdyssey,andthroughthejuvenilejusticesystemintotheFamilyTracking,ReportingandAutomatedCaseSupport(FamilyTracs)system.Ifthatchildbecomeshomelessorreceiveshomelessnessservices,theywouldbeenteredintotheHomelessManagementInformationSystem(HMIS)andiftheyreceiveworkforceaidtheywouldbeenteredintotheSouthernNevadaWorkforceConnectionsdatareportingsystem(NVTrac).Additionally,theywouldstillbetrackedbytheSchoolDistrictandbyhealthcareservices.Withoutbeingabletoseewhatservices/resourcesachildhasalreadyreceived,theserviceprovidersoperatewithblinderswhichmayresultinalackofappropriateservices,duplicationofservicesandalackofefficiencyamongallagencies.Additionally,manyofthesesystemsareoldandlackthecapacitytoinput,storeand/orreportdatanecessaryfortheseagenciestomaketimelyandappropriatedecisionsfortheseyouth.

177ChildWelfareLeagueofAmerica,NationalBlueprintforExcellinginChildWelfarep.70178CenterforJuvenileJusticeReformhttp://cjjr.georgetown.edu/pdfs/Fall%2008%20NCJFCJ%20Today%20feature.pdf179“PathwaystoandFromHomelessnessandAssociatedPsychosocialOutcomesAmongAdolescentsLeavingtheFosterCareSystem”AmericanPublicHealthAssociationhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2707485/180Lips,Dan“FosterCareChildrenNeedBetterEducationalOpportunities”HeritageFoundationhttp://www.heritage.org/research/reports/2007/06/foster-care-children-need-better-educational-opportunities#_ftn10

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Thisproblemcouldbealleviatedwiththecreationofanintegrateddatasystem.Integrateddatasystemsaredatasystemsthat“integrateindividual-leveldatafrommultipleadministrativeagenciesonanongoingbasis.Thesesystemsmayexistforjurisdictionsatvariouslevels,includingstates,counties,andcities.Recordsinthesesystemsmayincludethosefromhumanservices(suchaschildwelfare,incomesupports,andchildcaresubsidies),health,employment,vitalstatistics,justicesystemandeducation.”181Theycouldbeaccessedbyparticipatingentitiesandwouldincludesecurelyexchangedinformationthatprotectsprivacyandconfidentiality.Thiswouldallowtheorganizationstoquicklylookuptheirclient,seetheirpersonalinformation,whichwouldbeautomaticallypopulated,andseewhatservicestheirclientshaveusedorarecurrentlyusing.Havinganintegrateddatasystemwouldleadto“anincreasedknowledgeandcommunicationamongagencies,resourcesharingandreductionofduplicatedefforts,greaterspecialization,andanimprovedimagewithclientsandthecommunity.”182Usinganintegrateddatasystemwouldprovidesubstantialbenefitstotheclientsbyoffering“referralstomoreandawiderrangeofservices,improvedaccess,andimprovedcasemanagement,”183whilealsosavingtimeforclientsandproviders.

Recommendations:

TheNevadaLegislatureshouldconductafeasibilitystudytolookattheviabilityofanintegrateddatasystemwithcommunityinput.CAAalsorecommendstheintegratedsystemincludethefollowingkeydesignelements:1. Collectinformationfrommultipleserviceproviders,whichwillprovidegreater

coordination.2. Thepowerofavailabletechnologyshouldbeleveragedtothefullest.Forexample,back-

endsystemsshouldsupportrobust,bidirectionalinformationexchange,andautomaticallypopulateappropriateinformationintoarecordthatfollowsthechildthroughacontinuumofcareandovertime.

3. Informationmustbeexchangedsecurely,inamannerthatprotectsprivacyandconfidentiality,andthetoolsmustsupportthespecificdesignationofindividualsauthorizedtoseespecificportionsoftherecord(i.e.granulardatasegmentationandrole-basedaccess),amongotherprotections.

4. Electronicrecordsgeneratedmustbeabletoextractandsummarizeimportantinformation,andtoincludehistoricalinformationtoprovideanaccurateandcompleteclientrecord.

5. Electronicrecordsshouldbedesignedwithconsumer-facingfeatures,suchaspatientportalsandpre-visitquestionnaires,aswellaslinkstoavailabletoolsthatcanfeedcriticalinformationintotherecord,suchasremotemonitoringdevices.184

181Hendey,Leah,Coulton,Claudia,Kingsley,G.Thomas“ConnectingPeopleandPlace:ImprovingCommunitiesthroughIntegratedDataSystems.http://neighborhoodindicators.org/sites/default/files/publications/final_concept_paper_nnip_ids.pdf182UrbanInstitute.http://www.urban.org/UploadedPDF/coordination_FR.pdf183Ibid.184“ElectronicInformationExchangeElementsthatMatterforChildreninFosterCare”SPARC:StatePolicyAdvocacy&ReformCenterhttp://childwelfaresparc.org/wp-content/uploads/2014/07/15-Electronic-Information-Exchange-Elements-that-Matter-for-Children-in-Foster-Care.pdf

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2. YOUTHHOMELESSNESS NevadaChildren’sReportCardGrade:DTheyouthhomelessnessgradeisbaseduponaccompaniedyouth(childrenunder18withtheirfamilies),unaccompaniedyouth(youthwhoarenotpartofafamilywithchildrenduringtheirepisodeofhomelessness),andunshelteredyouth(youthwhostayinplacesnotmeantforhumanhabitation,suchasthestreets,abandonedbuildings,vehicles,orparks).185YouthhomelessnessisadevastatingandgrowingprobleminNevada.In2012-2013,23,790childrenexperiencedhomelessnessthroughoutNevada,a15%increaseovertheprioryear.186In2014,theNationalCenteronFamilyHomelessnessrankedNevada44thintheUnitedStatesforoverallchildhomelessnessbasedonacompositescorereflectingNevada’sextentofchildhomelessness,childwell-being,riskforchildhomelessness,andstateplanningandpolicyefforts.Nevada’sstatepolicyandplanningeffortsinparticularwereranked47thinthecountry,pointingtoaseriousneedforfocusedpolicyworkaroundyouthhomelessnessinourstate.Researchshowsthatchildrenwhoexperiencehomelessnesswiththeirfamiliesareoftenhungry,sick,andscared,struggletoattendandsucceedinschool,andarelikelytodevelopmentalhealthproblemsasaresultofbeingexposedtohighlevelsofstress,violence,anduncertainty.Unaccompaniedhomelessyouth–youthwhoexperiencehomelessnessontheirownwithouttheirfamilies–findthemselvesinevenmoredanger.In2015,theStateofNevadahadthefourthhighestnumberofunaccompaniedhomelessyouthunderage25(2,310youth)andthesecondhighestnumberofunaccompaniedhomelesschildrenunderage18(825youth)residinginourstateonanaveragenight.187IllustratingNevada’sseverelackofage-appropriatebedsandservicesforthispopulation,in2015,Nevadahadthehighestrateofunaccompaniedhomelessyouthlivingunshelteredofanystateinthecountry,with87.5%ofidentifiedunaccompaniedhomelessyouthunder25livingonourstreetsunshelteredatthetimeofthecount.188Infact,in2015,though2,310unaccompaniedyouthexperiencedhomelessnessinNevadaonanaveragenight,only231bedsthroughoutNevada’shomelessservicessystemweredevotedtohomelessyouth.Youthoftenbecomehomelessduetointer-relatedfactorsoffamilybreakdown,economicinsecurity,and/orresidentialinstability.189Familybreakdownisthemostcommoncontributingfactortoyouthbecominghomelessontheirown:manyyouthleavehomeafterenduringyearsofsexual,physical,and/oremotionalabuse,neglect,parentalsubstanceabuse,andrejection.Homelessyouthfindthemselvesindifferentsituationsandrequiredistinctresourcesfromhomelessadultsbecauseyoungpeopleenterintohomelessnesswithlittleornoworkexperienceorlifeskills,andareoftenforcedintodroppingoutofschoolasaresultoftheirhomelessness.Theyalsoexperiencehigherlevelsofcriminal

185U.S.DepartmentofHousingandUrbanDevelopment,2015,AnnualHomelessAssessmentReport(AHAR)toCongress,https://www.hudexchange.info/resources/documents/2015-AHAR-Part-1.pdf186NationalCenteronFamilyHomelessnessatAmericanInstitutesforResearch,2014,“America’sYoungestOutcasts:AReportCardonChildHomelessness,”http://www.air.org/sites/default/files/downloads/report/Americas-Youngest-Outcasts-Child-Homelessness-Nov2014.pdf187U.S.DepartmentofHousingandUrbanDevelopment,2015,AnnualHomelessAssessmentReport(AHAR)toCongress,https://www.hudexchange.info/resources/documents/2015-AHAR-Part-1.pdf188U.S.DepartmentofHousingandUrbanDevelopment,2015,AnnualHomelessAssessmentReport(AHAR)toCongress,https://www.hudexchange.info/resources/documents/2015-AHAR-Part-1.pdf189NationalCoalitionfortheHomeless,2008

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victimization,includingsexualexploitationandlabortrafficking.RacialandethnicminoritiesandLGBTQyoutharealsooverrepresentedamongthehomelessyouthpopulation,pointingtoaneedforculturallycompetentanddiverseservices.Youthhomelessnesshasdangerousconsequencesforboththeyouthexperiencinghomelessnessandtheircommunities.AccordingtotheNationalAlliancetoEndHomelessness,oneoutofeverythreeteensonthestreetswillbeluredintoprostitutionwithin48hoursofleavinghome190.Everydayhomelessyouthspendonthestreetsincreasestheirlikelihoodofengaginginsubstanceabuse,developingmentalandphysicalhealthproblems,contractingsexuallytransmittedinfections,experiencingunwantedpregnancies,committingandbecomingvictimsofcrimes,gettinginvolvedingangs,droppingoutofschool,andbecominghomelessadults.Homelessyoutharevulnerabletoformingcomplicatedrelationshipswithoureducation,health,welfare,andcriminaljusticesystems,creatingcostlyandlong-termproblemsforthemselvesandtheircommunities.LimitedfederalresourcesarenotenoughtoprovidehousingandservicestoNevada’shomelessyouthandmanylocalandstate-levelfundersandpolicymakersaresimplyunawareoftheextentandseverityofyouthhomelessnessinourstate.Throughbuildingawareness,collaboration,anddevotingconcentratedresourcestoage-appropriate,evidence-basedserviceofferings,wecannotonlyturnindividuallivesaround,butsavesignificantlong-termcosts.Numerousstudieshaveshownthatprovidingunaccompaniedhomelessyouthwithappropriatehousinginterventionsissignificantlycheaperandmoreeffectivethanservingyouththroughthechildwelfareorjuvenilejusticesystems.191RecommendationsforImprovement:

• Createastatewideplanforrespondingtoandendingyouthhomelessness.• Buildawarenessandcollaborationamongsystemsthatinteractwithhigh-riskandhomeless

youth,includinghomelessservices,publiceducation,juvenilejustice,andchildwelfare.• Developacoordinatedcommunityresponsetoyouthhomelessness.• Increaseresourcesfortheproactivepreventionofyouthhomelessness,includingfamily

counseling.• Devotelargerportionsofgeneralfundingandthecreationofspecificfundingstreamsto

supportculturallycompetentyouth-focusedhomelessserviceofferings,includingdrop-incenters,emergencyshelter,transitionalhousing,rapidre-housing,andpermanentsupportivehousingdevelopedspecificallytorespondtoyouths’uniqueneedsanddevelopmentalstage.

• Increasetargetedoutreachandcrisisinterventiontoat-riskandhomelessyouth.• Devoteresourcestohumantraffickingpreventionandinterventionserviceswithinhomeless

youthprograms.• Requirepublicschooldistrictstocreateformalplansonaddressingyouthhomelessnessin

schools.• Reducebarriersforunaccompaniedhomelessyouthtoaccesshighqualityeducation,including

highereducation.• MitigatebarriersaroundaccesstoqualityhealthcareandMedicaidforunaccompanied

homelessyouth.• Advancedatacollection,analysis,andresearcharoundyouthhomelessness.

190NationalAlliancetoEndHomelessness,http://www.endhomelessness.org/191NationalPartnershiptoEndYouthHomelessness;NationalNetworkforYouth

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victimization,includingsexualexploitationandlabortrafficking.RacialandethnicminoritiesandLGBTQyoutharealsooverrepresentedamongthehomelessyouthpopulation,pointingtoaneedforculturallycompetentanddiverseservices.Youthhomelessnesshasdangerousconsequencesforboththeyouthexperiencinghomelessnessandtheircommunities.AccordingtotheNationalAlliancetoEndHomelessness,oneoutofeverythreeteensonthestreetswillbeluredintoprostitutionwithin48hoursofleavinghome190.Everydayhomelessyouthspendonthestreetsincreasestheirlikelihoodofengaginginsubstanceabuse,developingmentalandphysicalhealthproblems,contractingsexuallytransmittedinfections,experiencingunwantedpregnancies,committingandbecomingvictimsofcrimes,gettinginvolvedingangs,droppingoutofschool,andbecominghomelessadults.Homelessyoutharevulnerabletoformingcomplicatedrelationshipswithoureducation,health,welfare,andcriminaljusticesystems,creatingcostlyandlong-termproblemsforthemselvesandtheircommunities.LimitedfederalresourcesarenotenoughtoprovidehousingandservicestoNevada’shomelessyouthandmanylocalandstate-levelfundersandpolicymakersaresimplyunawareoftheextentandseverityofyouthhomelessnessinourstate.Throughbuildingawareness,collaboration,anddevotingconcentratedresourcestoage-appropriate,evidence-basedserviceofferings,wecannotonlyturnindividuallivesaround,butsavesignificantlong-termcosts.Numerousstudieshaveshownthatprovidingunaccompaniedhomelessyouthwithappropriatehousinginterventionsissignificantlycheaperandmoreeffectivethanservingyouththroughthechildwelfareorjuvenilejusticesystems.191RecommendationsforImprovement:

• Createastatewideplanforrespondingtoandendingyouthhomelessness.• Buildawarenessandcollaborationamongsystemsthatinteractwithhigh-riskandhomeless

youth,includinghomelessservices,publiceducation,juvenilejustice,andchildwelfare.• Developacoordinatedcommunityresponsetoyouthhomelessness.• Increaseresourcesfortheproactivepreventionofyouthhomelessness,includingfamily

counseling.• Devotelargerportionsofgeneralfundingandthecreationofspecificfundingstreamsto

supportculturallycompetentyouth-focusedhomelessserviceofferings,includingdrop-incenters,emergencyshelter,transitionalhousing,rapidre-housing,andpermanentsupportivehousingdevelopedspecificallytorespondtoyouths’uniqueneedsanddevelopmentalstage.

• Increasetargetedoutreachandcrisisinterventiontoat-riskandhomelessyouth.• Devoteresourcestohumantraffickingpreventionandinterventionserviceswithinhomeless

youthprograms.• Requirepublicschooldistrictstocreateformalplansonaddressingyouthhomelessnessin

schools.• Reducebarriersforunaccompaniedhomelessyouthtoaccesshighqualityeducation,including

highereducation.• MitigatebarriersaroundaccesstoqualityhealthcareandMedicaidforunaccompanied

homelessyouth.• Advancedatacollection,analysis,andresearcharoundyouthhomelessness.

190NationalAlliancetoEndHomelessness,http://www.endhomelessness.org/191NationalPartnershiptoEndYouthHomelessness;NationalNetworkforYouth


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3. JUVENILEVIOLENCE NevadaChildren’sReportCardGrade:D+Thejuvenileviolencegradeisbaseduponhighschoolviolence,weaponsonschoolproperty,datingviolence,fearofviolence,andjuvenilejustice.In2015,8.5%ofNevada’shighschoolstudentsfeltunsafeattendingschool,ranking30thinthenation.Furthermore,Nevadaranked7thoutof33stateswithdataforstudentsreportingtohavebroughtaweapontoschool(3.7%),and11thinthenationforthepercentageofstudentswhohavebeeninafightoncampus(6.8%).192Thethreatofviolenceatschooldirectlydisruptstheabilityofstudentstoachievesuccessinschoolandincreasestheneedformedicalcare.Theeffectsofviolenceatschoolarefarreachinghowever,andaffectnotonlyfellowstudents,butalsotheschoolandcommunityasawhole.Toensurechildrenreceivetheeducationtheyneed,schoolsmustbebothsafelearningandteachingenvironments.Inadditiontoviolenceatschool,manyofNevada’syouthexperiencebothphysicalandsexualdatingviolence.In2015,Nevadaranked22ndoutof36reportingstatesforphysicaldatingviolenceand22ndoutof30reportingstatesforsexualdatingviolencewith9.6%ofindividualsexperiencingphysicalviolenceand11.5%experiencingsexualviolence.Youthoftenexperienceviolenceindatingandrelationshipswhenonepersontriestomaintainpowerandcontrolovertheotherthroughverbal,physical,emotional,orsexualabuse.Teenagersmaytendtoacceptandconformtosexualstereotypesingreaternumbersthanadults,andmistakecontrollingbehaviorassignsofcaringorlove.Forthesereasons,youthareapopulationparticularlysusceptibletointimidationandcontrolthroughviolence.193ThechallengesfacedbyNevada’syouthinregardstojuvenileviolencecanbeseenfurtherinthenumberofindividualsinvolvedwiththestate’sjuvenilejusticesystem.In2013.Nevadaranked37thinthenationinthenumberofyouthresidinginjuveniledetention,correctionaland/orresidentialfacilitieswith201childrenper100,000;wellabovethenationalaverageof173per100,000.Theeconomicburdenofjuvenilejusticeinvolvementisgreatandhaslonglastingeffectsonthesocialservicesofthecommunity.194JuvenileviolenceiswidespreadintheUnitedStates,andviolenceagainstyouthisthesecondleadingcauseofdeathforyoungpeoplebetweentheagesof15and24nationwide.Itaffectsnotonlyyouth,buttheoverallhealthofthecommunity.Itcanincreasehealthcarecosts,decreasepropertyvalues,anddisruptsocialservicesinadditiontotheeconomicburdensofjuvenilejusticedetention.Thereexistsagreatneedtoadequatelyaddressandpreventallaspectsofjuvenileviolenceinordertoimprovetheoverallhealthofourchildrenandourcommunityasawhole.192CentersforDiseaseControlandPreventionhttp://www.cdc.gov/mmwr/volumes/65/ss/pdfs/ss6506.pdf(June2016)193SeeAppendix:ReportCardSources.194"YouthResidinginJuvenileDetentionCorrectionaland/orResidentialFacilities."KIDSCOUNTDataCenterfromtheAnnieE.CaseyFoundation.N.p.,n.d.Web.30Aug.2016.<http://datacenter.kidscount.org/>.

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RECOMMENDATIONSFORIMPROVEMENT:• SchooldistrictsinthestateofNevadashouldcreateschoolwidepreventionand

interventionstrategiestoincreaseschoolsafetythatincludeongoingstaffdevelopmentandtraining,fosteringschool-lawenforcementpartnerships,institutingschool-basedlinkswithmentalhealthandsocialserviceagencies,andfosteringschool,family,andcommunityinvolvement.195

• Increasepreventioneffortsrelatedtoreducingteendatingviolencewhichmayincludeincreasingaccesstoevidence-basedprogramsabouthealthyrelationshipsofferedinschoolsandotheryouthservingorganizations.Inaddition,moreinformationisneededtoeducatechildrenontheharmsofrecruitmentintoprostitutionbypimpsassextraffickingisaseriousprobleminNevada.

• Youththatbecomeinvolvedinthejuvenilejusticesystem,duringincarcerationandwhileonprobation,needaccesstoadequateresourcesandtreatmenttoassistinrehabilitationandtopreventrecidivism.

• Courtsneedtousestructureddecisionmakingprocessesandtoolsinordertoreduceracialandethnicdisparitiesinjuvenilejusticeprocessing.

• Alljuvenilejusticedatashouldbegeneratedbygender,raceandethnicityinordertomonitortheimplementationofeffectivedecisionmakingprocessesandtotrackthereductionofdisparitiesinthesystem.

195NationalCriminalJusticeReferenceService,“SchoolPoliciesandLegalIssuesSupportingSafeSchools,”https://www.ncjrs.gov/pdffiles1/ojjdp/book2.pdf(September2002)

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4. CHILDINJURYANDDEATHNevadaChildren’sReportCardGrade:C-

Thechilddeathsandinjurygradeisbasedonnon-naturalchilddeathsorthosethatwerearesultofanunintentionalorintentionalinjury.Unintentionalinjuriesincludethingsthatareoftenreferredtoas“accidents”.Theseincludemotorvehicleortrafficaccidents,drowning,poisoningoroverdose,suffocation,fire,etc.Unintentionalinjuriesaretheleadingcauseofhospitalizationanddeathforchildrenages1-18years,bothnationallyandinNevada.196In2014inNevada,thenumberofdeathsduetoinjuryforchildrenages0-17yearswas17.8per100,000,whichisslightlyoverthenationalaverageof14deathsper100,000.197Itisimportanttonotethattheleadingcausesofdeathforchildrenaredifferentdependingontheagegroup.Forexample,youngerchildrenaremorelikelytobeinjuredinnon-motorvehiclerelatedaccidents,whileolderchildrenaremorelikelytobeinjuredinmotorvehicleaccidents.Infact,infantsunderoneyearofagemostfrequentlydiefrominjuriesrelatedtounsafesleeppositioningthatcausesasphyxia,whilechildrenages1-4yearsarethegroupmostatriskfordrowning.Olderchildren–thosebetween5and17–aremostcommonlythevictimsinmotorvehicleaccidents.Accordingtothe2013ChildDeathReviewReportforNevada198,theleadingcauseofdeathforchildrenisnon-motorvehicleaccidentswhichspecificallyincludesuffocation,drowning,gunshotwounds,andpoisoning/overdosewhichisconsistentwiththenationaldata.Listedbelowarethecountsandpercentagesof2013childdeathsbymannerandcauseinNevada(excludingnaturalandundeterminedcauses):

• Non-motorvehicleaccidents–50.0%(n=52)§ Asphyxia(n=22)§ Drowning(n=9)§ DrugExposedInfant(n=6)§ Fall(n=4)§ Overdose(n=3)§ GunshotWound(n=1)§ Weapon(n=1)§ Poisoning(n=1)

196Children’sSafetyNetwork.“2013NevadaStateFactSheet,”http://www.childrenssafetynetwork.org/sites/childrenssafetynetwork.org/files/Nevada%202013%20State%20Fact%20Sheet.pdf197CenterforDiseaseControlandPrevention,“FatalInjuryData,”http://www.cdc.gov/injury/wisqars/fatal.html(August29,2014)198NevadaDivisionofChildandFamilyServices,“2013ChildDeathReviewReportforNevada”,http://dcfs.nv.gov/uploadedFiles/dcfsnvgov/content/Tips/Reports/2013%20Statewide%20Child%20Death%20Report%20(final).pdf

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§ Fire(n=1)§ Other(n=4)

• Motorvehicleaccidents–16%(n=17)

§ Driver(n=6)§ Passenger(n=6)§ Pedestrian(n=5)

• Homicide–19%(n=20)• Suicide–14%(n=15)

Thecommonthemewithallofthesedeathsisthattheyarepreventable.Manyofthesedeathsmayhavebeenpreventedbyprovidingeducationaboutriskfactorsandimprovingsupervisionforthechildrenandyouthatthetimeoftheincidentthatledtotheirdeath.Recommendationstoimprovepreventioneffortsarelistedinthesectionbelow.RECOMMENDATIONSFORIMPROVEMENT:

• Continuetosupporttheactivitiesofchilddeathreviewteamsandincreasefundingdesignatedforpreventionactivities.

• Supporteffortsrelatedtoimprovingfirearmsafetyandrestrictingaccesstofirearmsfromchildrenandyouth.

• Supportandpromoteexistingeffortstoeliminatechilddrowningincidentsbysupportingconsistentpolicyregardingbarrierstoresidentialswimmingpoolsandsupportingeducationaboutdrowningprevention.

• Supportprogramsthatprovidetrainingforparentsandcaregiversofinfantsonsafesleeppracticesaswellasthosethatensurefamilieshavesafesleepspacesforinfantsbyprovidinglowornocostcribs.

• Supporteffortstoprovidesubstanceabusetreatmenttopregnantwomen.

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§ Fire(n=1)§ Other(n=4)

• Motorvehicleaccidents–16%(n=17)

§ Driver(n=6)§ Passenger(n=6)§ Pedestrian(n=5)

• Homicide–19%(n=20)• Suicide–14%(n=15)

Thecommonthemewithallofthesedeathsisthattheyarepreventable.Manyofthesedeathsmayhavebeenpreventedbyprovidingeducationaboutriskfactorsandimprovingsupervisionforthechildrenandyouthatthetimeoftheincidentthatledtotheirdeath.Recommendationstoimprovepreventioneffortsarelistedinthesectionbelow.RECOMMENDATIONSFORIMPROVEMENT:

• Continuetosupporttheactivitiesofchilddeathreviewteamsandincreasefundingdesignatedforpreventionactivities.

• Supporteffortsrelatedtoimprovingfirearmsafetyandrestrictingaccesstofirearmsfromchildrenandyouth.

• Supportandpromoteexistingeffortstoeliminatechilddrowningincidentsbysupportingconsistentpolicyregardingbarrierstoresidentialswimmingpoolsandsupportingeducationaboutdrowningprevention.

• Supportprogramsthatprovidetrainingforparentsandcaregiversofinfantsonsafesleeppracticesaswellasthosethatensurefamilieshavesafesleepspacesforinfantsbyprovidinglowornocostcribs.

• Supporteffortstoprovidesubstanceabusetreatmenttopregnantwomen.


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CHILDINJURYANDDEATH-SPECIALISSUE

SafeHavenSafeHaven,alsoknownasProtectionofChildrenfromAbuseandNeglect(NRS432B.630),allowsparentstosafelysurrendertheirbabyiftheycannolongercareforhim/her.Thislawprotectsinfantsfrombeinginjuredorotherwiseharmedduetounsafeandillegalabandonmentbyprovidingdistressedparentsasafe,anonymousoptionforsurrenderoftheirinfant.IntheeventthatparentsbringachildtoaSafeHavensiteandwishtoremainanonymous:

• ThelawrequiresthattheSafeHavensitetotakepossessionofthechild,noquestionsasked.

• TheSafeHavensiteshouldthenensurethereceiptofimmediatemedicalcareneeded,reportthechild’ssurrendertolawenforcement(iftheSafeHavensiteisnotalawenforcementagency)andthenreportthesurrendertothelocalchildwelfareagency.

• TheChildWelfareAgencythencompletesitsprotocolforsurrenderedinfantswithnoinformationontheparents.

• OncetheChildWelfareAgencydeterminesthistobeaSafeHavensurrender,theywillproceedwithterminationofparentalrightsinordertopreparetheinfantforadoption.Inaccordancewiththelaw,propernotificationofthehearingfortheterminationofparentalrightsmustbeprovided.Whennamesofthebirthparentsareknown,theyareincludedinthepublicnotice.However,ifparentshavesurrenderedtheirchildanonymously(i.e.doesnotprovideanameoranyotheridentifyinginformationatthetimeofsurrender)thereisnoidentifyinginformationtopublish,thusprotectingtheidentityofthebiologicalparentsthroughouttheprocess.

Recently,parentalanonymityhasbeenanissueformotherswhogivebirthinahospitalandimmediatelysurrenderthechildatthehospitalundertheSafeHavenLaw;asthelanguageofNRS432B.60doesnotexplicitlyprotectamother’sanonymity.Thisisduetotheidentifyinginformationformedicalandbillingpurposesthatiscollectedfromthemotherduringheradmissiontothehospitalfordelivery.CurrentlywhenSafeHavenisinvoked:

• CustodyofthechildistransferredtotheChildWelfareAgencyandasthelegalcustodianofthechild,allmedicalrecordsforthebabyaregiventotheChildWelfareAgency.Theserecordsalsoincludeidentifyinginformationforthemotherbecauseinformationonherpregnancyanddeliveryarepertinenttothehealthcareoftheinfant.

• ThisidentifyinginformationonthemotherisprovidedtotheChildWelfareAgencyregardlessofthemother’sintenttoanonymouslysurrenderthechildundertheSafeHavenLaw.

• OncetheidentityofthemotherisknowntotheChildWelfareAgency,theyarerequiredtocontactandnotifyherandanyothernamedparent(father)regardingallproceedings

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toterminateparentalrights,iftheyhavenotalreadycompletedpaperworktovoluntarilyterminatetheirrights.

ThiscanbeproblematicformotherswhoinvokeSafeHavenwithawishorneedtoremainanonymousinanefforttoprotecttheirownsafetyorthesafetyofthechildfromviolenceorotherrepercussionsiftheiridentityisknown–goingagainstthepurposeofthelaw.SafeHavenisintendedtopreventparentsfrom“dumping”infantsunsafely,sotheycanremainanonymouswhileensuringtheinfantisinasafeplace–noquestionsasked.Thisshouldalsoapplytoparentswhochoosetodeliversafely,inahospital.Recommendations:EnactthefollowingamendmentstotheSafeHavenlawtoensureourchildrenarebeingproperlyprotected:

• Clarifythelanguageofthislawtobetterprotectthemother’sanonymitybyprohibitingthereleaseofanyidentifyinginformationonthemotheracquiredbyahospitalorEMSserviceforthepurposeofmedicalcareorbillingtotheChildWelfareAgencyuponsurrenderunderSafeHaven.

o ThisclarificationinthelawprovidesadditionalprotectionforparentsandwillensurethatparentsincrisisfeelcomfortableusingthislawknowingthatnomatterwhichtypeofSafeHavenlocationtheychoosetosurrenderwith,theiridentitieswillbeprotectediftheysowish.Thischangewilleliminateapotentialbarrierforparentsinusingthislawandwillfurtherprotectbabiesfromunsafeandillegalabandonment.

• ClarifythatababyvoluntarilydeliveredtoaSafeHavenprovider,includingafterthebirthofachildwithinahospital,byaparentofthebabywhodoesnotexpressanintenttoreturnandfulfillsallotherSafeHavencriteria,(lessthan30daysold,freeofobviousabuse,etc.)willalsobeconsideredaSafeHavensurrenderandprocessedassuch.

o Thisproposedchangewillensurethatparentswhoresponsiblyleavetheirbabywiththehospitalundertheassumptionofthebaby’ssafety,withoutinvokingtheSafeHavenLawspecifically,arenotchargedwithillegalabandonment.

• Ensurethatanyotherbiologicalparents,whoarenotpresentordidnotparticipateinthedeliveryofthebabybuttheiridentityisknown,isaffordeddueprocessandispubliclynotifiedofthehearingtoterminateparentalrights.

o ThisaffordsprotectiontobiologicalparentswhomaybeunawareofthedecisionofthemothertosurrenderthebabyundertheSafeHavenLaw.

*AdaptedfromtheSafeHavenWorkGroup:Hospital1-pager.Formoreinformationonthistopic,pleasecontact:Children’sAdvocacyAlliance702-228-18695258SouthEasternAve,Suite151,LasVegas,NV891193500LakesideCt,Suite209,Reno,NV89509 www.caanv.org


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toterminateparentalrights,iftheyhavenotalreadycompletedpaperworktovoluntarilyterminatetheirrights.

ThiscanbeproblematicformotherswhoinvokeSafeHavenwithawishorneedtoremainanonymousinanefforttoprotecttheirownsafetyorthesafetyofthechildfromviolenceorotherrepercussionsiftheiridentityisknown–goingagainstthepurposeofthelaw.SafeHavenisintendedtopreventparentsfrom“dumping”infantsunsafely,sotheycanremainanonymouswhileensuringtheinfantisinasafeplace–noquestionsasked.Thisshouldalsoapplytoparentswhochoosetodeliversafely,inahospital.Recommendations:EnactthefollowingamendmentstotheSafeHavenlawtoensureourchildrenarebeingproperlyprotected:

• Clarifythelanguageofthislawtobetterprotectthemother’sanonymitybyprohibitingthereleaseofanyidentifyinginformationonthemotheracquiredbyahospitalorEMSserviceforthepurposeofmedicalcareorbillingtotheChildWelfareAgencyuponsurrenderunderSafeHaven.

o ThisclarificationinthelawprovidesadditionalprotectionforparentsandwillensurethatparentsincrisisfeelcomfortableusingthislawknowingthatnomatterwhichtypeofSafeHavenlocationtheychoosetosurrenderwith,theiridentitieswillbeprotectediftheysowish.Thischangewilleliminateapotentialbarrierforparentsinusingthislawandwillfurtherprotectbabiesfromunsafeandillegalabandonment.

• ClarifythatababyvoluntarilydeliveredtoaSafeHavenprovider,includingafterthebirthofachildwithinahospital,byaparentofthebabywhodoesnotexpressanintenttoreturnandfulfillsallotherSafeHavencriteria,(lessthan30daysold,freeofobviousabuse,etc.)willalsobeconsideredaSafeHavensurrenderandprocessedassuch.

o Thisproposedchangewillensurethatparentswhoresponsiblyleavetheirbabywiththehospitalundertheassumptionofthebaby’ssafety,withoutinvokingtheSafeHavenLawspecifically,arenotchargedwithillegalabandonment.

• Ensurethatanyotherbiologicalparents,whoarenotpresentordidnotparticipateinthedeliveryofthebabybuttheiridentityisknown,isaffordeddueprocessandispubliclynotifiedofthehearingtoterminateparentalrights.

o ThisaffordsprotectiontobiologicalparentswhomaybeunawareofthedecisionofthemothertosurrenderthebabyundertheSafeHavenLaw.

*AdaptedfromtheSafeHavenWorkGroup:Hospital1-pager.Formoreinformationonthistopic,pleasecontact:Children’sAdvocacyAlliance702-228-18695258SouthEasternAve,Suite151,LasVegas,NV891193500LakesideCt,Suite209,Reno,NV89509 www.caanv.org


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CHILDINJURYANDDEATH-SPECIALISSUE

Health&SafetyRequirementsforRecreationProgramsRecreationprogramsareanimportantindustryforNevada’schildrenandfamilies.Manyparentsenrolltheirchildinasportsteam,summercamp,danceclasses,artlessonsorafter-schoolprograms.Theseprogramsoftenprovideuniqueeducationalandsocialexperiencesforchildren.Formanyparentstheseprogramsprovideanadditionalformofafterschoolcarethatallowsthemtowork.Theyalsohelpparentsfosternewskillsorexpertisefortheirchild.InNevada,therearemultipletypesofrecreationprogramsthatoffersupervisionofchildrenwhichinclude:

• Out-of-school recreation program- arecreationprogramoperatedorsponsoredbyalocalgovernmentinafacilitywhichisowned,operatedorleasedbythelocalgovernmentandwhichprovidesenrichmentactivitiestochildrenofschoolage.199

• Out-of-school-timeprogram-aprogram,otherthananout-of-schoolrecreationprogram,thatoperatesfor10ormorehoursperweek,isofferedonacontinuingbasis,providessupervisionofchildrenwhoareoftheagetoattendschoolfromkindergartenthrough12thgradeandprovidesregularlyscheduled,structuredandsupervisedactivitieswherelearningopportunitiestakeplace.200

• Seasonalortemporaryrecreationprogram-arecreationprogramthatisofferedtochildrenforalimitedtimeordurationandmayinclude,withoutlimitation:

o Aspecialsportsevent,whichmayinclude,withoutlimitation,acamp,clinic,demonstrationorworkshopwhichfocusesonaparticularsport;

o Atherapeuticprogramforchildrenwithdisabilities,whichmayinclude,withoutlimitation,socialactivities,outingsandotherinclusionactivities;

o Anathletictrainingprogram,whichmayinclude,withoutlimitation,abaseballorothersportsleagueandexerciseinstruction;and

o Otherspecialinterestprograms,whichmayinclude,withoutlimitation,anartsandcraftsworkshop,atheatercampanddancecompetition.201

Out-of-schoolrecreationprogramsaregovernedbyNRS423A.600-650–requiringbackgroundchecksofstaffandwellashealthandsafetyrequirementstoensurethewell-beingofchildrenandyouthwhoparticipateintheseprograms.However,neitherout-of-school-timeprogramsnorseasonalortemporaryrecreationprogramshavetomeetthesebasicsafetyrequirements,potentiallyendangeringchildren.ToensurethesafetyofNevada’schildren,out-of-school-timeprogramsandtheseasonalortemporaryrecreationprogramsshouldberequiredtomeetthesamerequirementsasoutof

199NevadaRevisedStatute432A.0277https://www.leg.state.nv.us/nrs/NRS-432A.html200NevadaRevisedStatute432A.0278https://www.leg.state.nv.us/nrs/NRS-432A.html201NevadaRevisedStatute43A.029https://www.leg.state.nv.us/nrs/NRS-432A.html

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schoolrecreationprogramsasstatedinNRS423A.600-650.Theserequirementsinclude,butarenotlimitedto,thefollowing:

• Requirementsforthesitewhereprogramisoperated:o Complieswithapplicablelawandregulationsconcerningsafetystandards;o Complieswithapplicablelawandregulationsconcerninghealthstandards;o Hasacompletefirst-aidkitaccessibleonsite;o Hasanemergencyexitplanpostedon-siteinaconspicuousplace;ando Hasnotlessthantwostaffmemberson-siteandavailableduringthehoursof

operationwhoarecertifiedandreceiveannualtrainingintheuseandadministrationoffirstaid,including,withoutlimitation,cardiopulmonaryresuscitation.

• Requirements for staff of program: o Abackgroundandpersonalhistorycheck;ando AchildabuseandneglectscreeningthroughtheStatewideCentralRegistryforthe

CollectionofInformationConcerningtheAbuseorNeglectofaChildestablishedbyNRS432.100todeterminewhethertherehasbeenasubstantiatedreportofchildabuseorneglectmadeagainstthestaffmember.

• Requirementfornumberofparticipantsintheprogram:o Doesnotexceedaratioofonepersonsupervisingevery20participants;ando Willnotcausethefacilitywheretheprogramisoperatedtoexceedthemaximum

occupancy as determinedby the State FireMarshal or the local governmentalentitythathastheauthoritytodeterminethemaximumoccupancyofthefacility.

• Required components of program: o An inclusioncomponent forparticipantswhoqualifyundertheAmericanswith

DisabilitiesActof1990,42U.S.C.§§12101etseq.;o Regularrestroombreaks;ando Nutritionbreaks.

Inaddition,theseprogramsshouldberequiredtomaintaincertainrecordsforparticipantsandto submit reports of inspections of facilities where programs operate. By adopting therequirements for out-of-school-time programs and the seasonal or temporary recreationprograms,familieswouldknowtheirchildrenareinhealthyandsafeenvironmentswithpositiveadultsupervision.

Recommendations:Requireout-of-school-timeprogramsandtheseasonalortemporaryrecreationprogramstomeetthesamehealthandsafetyrequirementsasoutofschoolrecreationprogramsasstatedinNRS423A.600-650.Additionally,Nevadashouldimposeacivilpenaltyonapersonwhooperatesaprogramandfailstocomplywithsuchrequirements.Formoreinformationonthistopic,pleasecontact:Children’sAdvocacyAlliance702-228-18695258SouthEasternAve,Suite151,LasVegas,NV891193500LakesideCt,Suite209,Reno,NV89509 www.caanv.org


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schoolrecreationprogramsasstatedinNRS423A.600-650.Theserequirementsinclude,butarenotlimitedto,thefollowing:

• Requirementsforthesitewhereprogramisoperated:o Complieswithapplicablelawandregulationsconcerningsafetystandards;o Complieswithapplicablelawandregulationsconcerninghealthstandards;o Hasacompletefirst-aidkitaccessibleonsite;o Hasanemergencyexitplanpostedon-siteinaconspicuousplace;ando Hasnotlessthantwostaffmemberson-siteandavailableduringthehoursof

operationwhoarecertifiedandreceiveannualtrainingintheuseandadministrationoffirstaid,including,withoutlimitation,cardiopulmonaryresuscitation.

• Requirements for staff of program: o Abackgroundandpersonalhistorycheck;ando AchildabuseandneglectscreeningthroughtheStatewideCentralRegistryforthe

CollectionofInformationConcerningtheAbuseorNeglectofaChildestablishedbyNRS432.100todeterminewhethertherehasbeenasubstantiatedreportofchildabuseorneglectmadeagainstthestaffmember.

• Requirementfornumberofparticipantsintheprogram:o Doesnotexceedaratioofonepersonsupervisingevery20participants;ando Willnotcausethefacilitywheretheprogramisoperatedtoexceedthemaximum

occupancy as determinedby the State FireMarshal or the local governmentalentitythathastheauthoritytodeterminethemaximumoccupancyofthefacility.

• Required components of program: o An inclusioncomponent forparticipantswhoqualifyundertheAmericanswith

DisabilitiesActof1990,42U.S.C.§§12101etseq.;o Regularrestroombreaks;ando Nutritionbreaks.

Inaddition,theseprogramsshouldberequiredtomaintaincertainrecordsforparticipantsandto submit reports of inspections of facilities where programs operate. By adopting therequirements for out-of-school-time programs and the seasonal or temporary recreationprograms,familieswouldknowtheirchildrenareinhealthyandsafeenvironmentswithpositiveadultsupervision.

Recommendations:Requireout-of-school-timeprogramsandtheseasonalortemporaryrecreationprogramstomeetthesamehealthandsafetyrequirementsasoutofschoolrecreationprogramsasstatedinNRS423A.600-650.Additionally,Nevadashouldimposeacivilpenaltyonapersonwhooperatesaprogramandfailstocomplywithsuchrequirements.Formoreinformationonthistopic,pleasecontact:Children’sAdvocacyAlliance702-228-18695258SouthEasternAve,Suite151,LasVegas,NV891193500LakesideCt,Suite209,Reno,NV89509 www.caanv.org


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5. SUBSTANCEABUSENevadaChildren’sReportCardGrade:C-

In2015,Nevadaandotherstatehighschoolstudentsweresurveyedandreportedtheirdrugandsubstanceabuse.Comparedtotheotherstates,Nevadafaresverywellinthepercentageofhighschoolstudentswhosmokecigarettes(7.5%)orusesmokelesstobacco(5.1%),ranking2ndand4threspectively.However,thosewhouseanytypeoftobaccohassignificantlyincreasedfrom14.8%to30.4%,droppingourrankingfrom2ndto15th.Thismaybeduetothegrowingpopularityofelectronicvaporproducts,also,knownase-cigarettes.Resultsfromthe2012NationalYouthTobaccoSurvey(NYTS)indicatethatmorethan1.78millionmiddleandhighschoolstudentsnationwidetriede-cigarettes.E-cigarettesdonotjustemit“harmlesswatervapor.”Secondhande-cigaretteaerosol(incorrectlycalledvaporbytheindustry)containsnicotine,ultrafineparticlesandlowlevelsoftoxinsthatareknowntocausecancer.Exposuretofineandultrafineparticlesmayexacerbaterespiratoryailmentslikeasthmaandconstrictarteries.202AccordingtotheCDC,morethanhalf(51.1%)ofthecallstopoisoncentersduetoe-cigarettesinvolvedyoungchildren5yearsandunder.203The2012NYTSfoundthat76.3%ofmiddleandhighschoolstudentswhousede-cigaretteswithinthepast30daysalsosmokedconventionalcigarettes.204,205Thisraisesconcernsthate-cigarettesmaybeanentrypointtoconventionaltobaccoproducts.Withregardstoalcoholconsumption,Nevadaranked26thinthenationwith33.5%ofNevadahighschoolagedyouthreportedcurrentlydrinkingalcoholonaregularbasis.Inaddition,64.8%reportedhavinghadatleastonedrinkintheirlife.206Nevada’srateoftreatmentforalcoholuseamongpersonsaged12orolderwithalcoholdependencewaslowerthanthenationalratefrom2008to2012.Amongpersonsaged12orolderwithalcoholdependence,approximately9,000individualsreceivedtreatmentfrom2008to2012,representingonly4.2%ofthepopulationsreportingalcoholdependence.Nevadaranksamongtheworststatesformostdruguseexceptheroinandmarijuana(whereNevadaranks18thof32and20thof36reportingstates),ranking23rdof27statesforecstasyuse,19thof29statesformethamphetamineuse,30thof32statesforprescriptiondruguse,and15thoutof29forinhalantuse.207Evidencesuggeststhattheyoungertheageofaperson’s202AmericansforNonsmokers’Rights,“ElectronicSmokingDevicesandSecondhandAerosol,”http://no-smoke.org/pdf/ecigarette-secondhand-aerosol.pdf(2014)203CentersforDiseaseControlandPrevention,“NotesfromtheField.CallstoPoisonCentersforExposurestoElectronicCigarettes—UnitedStates,September2010–February2014,”(April4,2014)204CentersforDiseaseControlandPrevention,“ElectronicCigaretteUseAmongMiddleandHighSchoolStudents—UnitedStates,2011–2012,”(September6,2013)205Legacy,“TobaccoFactSheet,ElectronicCigarettes,”http://www.legacyforhealth.org/content/download/582/6926/file/LEG-FactSheet-eCigarettes-JUNE2013.pdf(May2014)206“NevadaHighSchoolYouthRiskBehaviorSurvey2015,”nccd.cdc.gov/youthonline/App/Results.aspx?LID=NV(2015)207CenterforDiseaseControlandPrevention,“YouthRiskBehaviorSurveillance–UnitedStates,2015,”http://www.cdc.gov/mmwr/volumes/65/ss/pdfs/ss6506.pdf(June10,2016)

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onsetofdruguse,thehigherthelikelihoodoftheperson’slaterdevelopmentofaddictionwillbe.208Forthesereasons,itisimportanttoappropriatelyaddresssubstanceabuseissuesinadolescentswithage-appropriateprevention,intervention,andtreatmentmeasures.Inaddition,researchshowsthat“thehighrateofcomorbiditybetweendrugusedisordersandothermentalillnessesarguesforacomprehensiveapproachtointerventionthatidentifiesandevaluateseachdisorderconcurrently,providingtreatmentasneeded.”209RECOMMENDATIONSFORIMPROVEMENT:

• Giventheriseintheuseofe-cigarettesbyyouth,Nevadaneedsstrongerpoliciesthat

prohibitminorsfrompossessingandusinge-cigarettes.• Improve/enhanceandincreasesubstanceabusetreatmentoptionsforyouth,especially

ages14-17.• Accelerateeffortstopromoteawarenessandhelp-seekingbehaviorsamongyouth,as

wellasscreeningandearlyinterventioninschoolstoidentifybothsubstanceabuseandmentalandbehavioralhealthdisordersbeforethereisacrisis.

o Identificationandtreatmentofmentalandbehavioralhealthmustbeincludedinanyefforttoimprovesubstanceuseorabuse.

o Universalscreeningforsubstanceabuseandsuicideriskshouldalsoberoutineinallprimarycare,hospitalcare(especiallyemergencydepartmentcare),behavioralhealthcare,andcrisisresponsesettings(e.g.,helplines,mobileteams,firstresponders,crisischatservices).Anypersonwhoscreenspositiveforpossiblesuicideriskshouldbeformallyassessedforsuicidalideation,plans,availabilityofmeans,presenceofacuteriskfactors(includinghistoryofsuicideattempts),andlevelofrisk.

• Requirepharmaciestoincludeinformationwithprescriptionsaboutthedangersofusingprescriptiondrugsforrecreationalpurposes.

o Inaddition,requirepharmaciestoincludeimportanceofsecuringandtrackingprescriptiondrugsaswellasinformationaboutoptionsforproperdisposalofunusedprescriptionsdrugs.

208NationalInstituteonDrugAbuse,“PreventingDrugAbuse:ThebestStrategy,”http://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preventing-drug-abuse-best-strategy(July2014)209NationalInstituteofDrugAbuseResearchReportSeries.Comorbidity:AddictionandOtherMentalIllnesses.NIHPublicationNumber10-5771RevisedSeptember2010


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onsetofdruguse,thehigherthelikelihoodoftheperson’slaterdevelopmentofaddictionwillbe.208Forthesereasons,itisimportanttoappropriatelyaddresssubstanceabuseissuesinadolescentswithage-appropriateprevention,intervention,andtreatmentmeasures.Inaddition,researchshowsthat“thehighrateofcomorbiditybetweendrugusedisordersandothermentalillnessesarguesforacomprehensiveapproachtointerventionthatidentifiesandevaluateseachdisorderconcurrently,providingtreatmentasneeded.”209RECOMMENDATIONSFORIMPROVEMENT:

• Giventheriseintheuseofe-cigarettesbyyouth,Nevadaneedsstrongerpoliciesthat

prohibitminorsfrompossessingandusinge-cigarettes.• Improve/enhanceandincreasesubstanceabusetreatmentoptionsforyouth,especially

ages14-17.• Accelerateeffortstopromoteawarenessandhelp-seekingbehaviorsamongyouth,as

wellasscreeningandearlyinterventioninschoolstoidentifybothsubstanceabuseandmentalandbehavioralhealthdisordersbeforethereisacrisis.

o Identificationandtreatmentofmentalandbehavioralhealthmustbeincludedinanyefforttoimprovesubstanceuseorabuse.

o Universalscreeningforsubstanceabuseandsuicideriskshouldalsoberoutineinallprimarycare,hospitalcare(especiallyemergencydepartmentcare),behavioralhealthcare,andcrisisresponsesettings(e.g.,helplines,mobileteams,firstresponders,crisischatservices).Anypersonwhoscreenspositiveforpossiblesuicideriskshouldbeformallyassessedforsuicidalideation,plans,availabilityofmeans,presenceofacuteriskfactors(includinghistoryofsuicideattempts),andlevelofrisk.

• Requirepharmaciestoincludeinformationwithprescriptionsaboutthedangersofusingprescriptiondrugsforrecreationalpurposes.

o Inaddition,requirepharmaciestoincludeimportanceofsecuringandtrackingprescriptiondrugsaswellasinformationaboutoptionsforproperdisposalofunusedprescriptionsdrugs.

208NationalInstituteonDrugAbuse,“PreventingDrugAbuse:ThebestStrategy,”http://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preventing-drug-abuse-best-strategy(July2014)209NationalInstituteofDrugAbuseResearchReportSeries.Comorbidity:AddictionandOtherMentalIllnesses.NIHPublicationNumber10-5771RevisedSeptember2010

Appendix 2017

APPENDIX

84

Indi

cato

r G

rade

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ank

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men

tal h

ealth

tre

atm

ent o

r cou

nsel

ing

in th

e pa

st 1

2 m

onth

s F-

49

49

.3%

20

11/

12

« (0

.0)

Nat

iona

l Sur

vey

of C

hild

ren'

s Hea

lth. N

SCH

201

1/12

. Dat

a qu

ery

from

the

Child

and

A

dole

scen

t Hea

lth M

easu

rem

ent I

nitia

tive,

Dat

a Re

sour

ce C

ente

r for

Chi

ld a

nd

Ado

lesc

ent H

ealth

web

site.

Ret

rieve

d 08

/19/

16 fr

om w

ww

.chi

ldhe

alth

data

.org

Atte

mpt

ed S

uici

de- P

erce

ntag

e of

Nev

ada

high

scho

ol st

uden

ts

who

atte

mpt

ed su

icid

e F+

30

10

.70%

20

15

(+

4.9%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Atte

mpt

ed S

uici

de D

ata

Tabl

es-N

evad

a,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol a

nd

Prev

entio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Suic

ide-

Sui

cide

Rat

e A

ges 0

-18

B-

16

2.29

%

2014

¯

(-1.

59%

) Ce

nter

for d

iseas

e Co

ntro

l and

Pre

vent

ion-

Sui

cide

s Age

s 0-1

8 N

evad

a 20

14 –

W

ISQ

ARS

Fata

l Inj

ury

Repo

rts 1

999-

2014

”. C

ente

r for

dise

ase

Cont

rol a

nd

Prev

entio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

APPENDIX

85

Prev

entiv

e C

are-

Per

cent

age

of h

igh

scho

ol st

uden

ts w

ho d

id

not s

ee a

den

tist.

D29

31

.1%

20

15

¯ (-

0.6%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Ora

l Hea

lth C

are

Dat

a Ta

ble-

Nev

ada,

H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l and

Pr

even

tion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Teen

Bir

th R

ate-

# o

f birt

hs fo

r tee

ns a

ge 1

5 to

19

per 1

000

fem

ales

F+

38

29

.00%

20

14

¯ (-

4%)

Kid

s Cou

nt D

ata

Cent

er-T

otal

Tee

n Bi

rths

” K

ids C

ount

Dat

a Ce

nter

. N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Sexu

al A

ctiv

ity- C

urre

ntly

sexu

ally

act

ive

B-

12

27.0

0%

2015

¯

(-2.

2%)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- S

exua

l Act

ivity

Dat

a Ta

bles

-Nev

ada,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol a

nd P

reve

ntio

n.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Con

dom

Use

- Con

dom

use

dur

ing

last

sexu

al in

terc

ours

e C+

28

46

.30%

20

15

¯ (-

12.7

%)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- C

ondo

m U

se D

ata

Tabl

es-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l and

Pre

vent

ion.

N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

No

birt

h co

ntro

l use

: HS

stud

ents

who

did

not

use

any

met

hod

to p

reve

nt p

regn

ancy

dur

ing

last

sexu

al in

terc

ours

e C+

14

12

.40%

20

15

¯ (-

3.6%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

No

Birt

h C

ontr

ol U

se”

Dat

a Ta

bles

-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l an

d Pr

even

tion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Chl

amyd

ia (S

TD R

ate)

- rat

e 15

-24

year

old

s per

100

,000

C+

22

20

19.6

20

14

(+

53.5

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Chl

amyd

ia (S

TD R

ate)

NC

HH

STP

Atla

s”

Cen

ter f

or D

isea

se C

ontr

ol a

nd P

reve

ntio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Syph

ilis (

STD

Rat

e)- r

ate

15-2

4 ye

ar o

lds p

er 1

00,0

00

F-

50

12.4

0%

2015

(+15

.4)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- S

yphi

lis (S

TD R

ate)

NC

HH

STP

Atla

s”

Cen

ter f

or D

isea

se C

ontr

ol a

nd P

reve

ntio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Gon

orrh

ea (S

TD R

ate)

- ra

te 1

5-24

yea

r old

s per

100

,000

C-

26

36

9.1

2014

(+64

.5)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- G

onor

rhea

(STD

Rat

e) N

CH

HST

P At

las”

C

ente

r for

Dis

ease

Con

trol

and

Pre

vent

ion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Fost

er C

are

Plac

emen

t- #

of c

hild

ren

rem

oved

& p

lace

d in

fo

ster c

are,

per

1,0

00 c

hild

ren

unde

r age

18

in p

opul

atio

n D+

31

5%

20

14

« (0

.0)

Kid

s Cou

nt D

ata

Cent

er- C

hild

ren

Fost

er C

are

Plac

emen

t” K

ids C

ount

Dat

a Ce

nter

. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Mal

trea

tmen

t- To

tal c

hild

mal

treat

men

t vic

tims r

ate

per 1

,000

of

the

popu

latio

n un

der a

ge 1

8 B

15

6.50

%

2014

¯

(-1.

7%)

U.S

. Dep

artm

ent o

f Hea

lth &

Hum

an S

ervi

ces,

Adm

inist

ratio

n fo

r Chi

ldre

n an

d Fa

mili

es, A

dmin

istra

tion

on C

hild

ren,

You

th a

nd F

amili

es, C

hild

ren’

s Bur

eau.

(201

6).

Child

mal

treat

men

t 201

4

Phys

ical

Mal

trea

tmen

t- Pe

rcen

tage

of c

hild

vic

tims

F45

36

.4%

20

13

(+

2.4%

) Ch

ildre

n's B

urea

u- M

altr

eatm

ent:

Mal

trea

tmen

t Typ

es o

f Chi

ld V

ictim

s Chi

ld W

elfa

re

Out

com

es R

epor

t Dat

a “U

.S. D

epar

tmen

t of H

ealth

& H

uman

Ser

vice

s Chi

ldre

n's

Bure

au

Sexu

al M

altr

eatm

ent-

Perc

enta

ge o

f chi

ld v

ictim

s B

17

5.3%

20

13

« (+

0.4%

) Ch

ildre

n's B

urea

u- M

altr

eatm

ent:

Mal

trea

tmen

t Typ

es o

f Chi

ld V

ictim

s Chi

ld W

elfa

re

Out

com

es R

epor

t Dat

a “U

.S. D

epar

tmen

t of H

ealth

& H

uman

Ser

vice

s Chi

ldre

n's

Bure

au

Neg

lect

- Per

cent

age

of c

hild

vic

tims

C27

75

.6%

20

13

« (0

.0)

Child

ren'

s Bur

eau-

Mal

trea

tmen

t: M

altr

eatm

ent T

ypes

of C

hild

Vic

tims C

hild

Wel

fare

O

utco

mes

Rep

ort D

ata

“U.S

. Dep

artm

ent o

f Hea

lth &

Hum

an S

ervi

ces C

hild

ren'

s Bu

reau

Acc

ompa

nied

You

th- S

hare

of H

omel

ess F

amili

es in

the

US

B+

12

0.

00%

2015

« (-

0.4%

)

The

U.S

. Dep

artm

ent o

f Hou

sing

and

Urb

an D

evel

opm

ent O

ffice

of C

omm

unity

Pl

anni

ng a

nd D

evel

opm

ent -

The

2015

Ann

ual H

omel

ess A

sses

smen

t Rep

ort (

AHAR

) to

Con

gres

s" T

he U

.S. D

epar

tmen

t of H

ousin

g an

d U

rban

Dev

elop

men

t Offi

ce o

f Co

mm

unity

Pla

nnin

g an

d D

evel

opm

ent.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Una

ccom

pani

ed Y

outh

- Esti

mat

es o

f Una

ccom

pani

ed

Hom

eles

s Chi

ldre

n an

d Y

outh

F

47

2,

310.

0

2015

(+

388

)

The

U.S

. Dep

artm

ent o

f Hou

sing

and

Urb

an D

evel

opm

ent O

ffice

of C

omm

unity

Pl

anni

ng a

nd D

evel

opm

ent-

The

2015

Ann

ual H

omel

ess A

sses

smen

t Rep

ort (

AHAR

) to

Con

gres

s" T

he U

.S. D

epar

tmen

t of H

ousin

g an

d U

rban

Dev

elop

men

t Offi

ce o

f Co

mm

unity

Pla

nnin

g an

d D

evel

opm

ent.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Uns

helte

red

You

th- %

of U

nacc

ompa

nied

Chi

ldre

n an

d Y

outh

w

ho w

ere

Uns

helte

red

F-

50

87

.5%

2015

(+0.

6%)

The

U.S

. Dep

artm

ent o

f Hou

sing

and

Urb

an D

evel

opm

ent O

ffice

of C

omm

unity

Pl

anni

ng a

nd D

evel

opm

ent-

The

2015

Ann

ual H

omel

ess A

sses

smen

t Rep

ort (

AHAR

) to

Con

gres

s" T

he U

.S. D

epar

tmen

t of H

ousin

g an

d U

rban

Dev

elop

men

t Offi

ce o

f Co

mm

unity

Pla

nnin

g an

d D

evel

opm

ent.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

APPENDIX

86

Hig

h Sc

hool

Vio

lenc

e- N

V H

S st

uden

ts re

porte

d in

volv

emen

t in

figh

ting

on sc

hool

pro

perty

) B

11

6.8%

20

15

« (0

.0)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- P

hysi

cal F

ight

ing

at S

choo

l Dat

a Ta

bles

-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l an

d Pr

even

tion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Wea

pons

on

scho

ol p

rope

rty-

NV

HS

stud

ents

repo

rted

to

have

car

ried

a w

eapo

n on

scho

ol p

rope

rty)

B+

73.

7%

2015

«

(+0.

4)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- W

eapo

n Ca

rryin

g at

Sch

ool D

ata

Tabl

es-

Nev

ada,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol

and

Prev

entio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Datin

gViolen

ce-P

hysic

alV

iole

nce

D+

22

9.6%

20

15

¯ (-

1.3%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Dat

ing

Viol

ence

Dat

a Ta

bles

-Nev

ada,

H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l and

Pr

even

tion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Datin

gViolen

ce:S

exua

lVio

lenc

eF

29

11.5

%

2015

¯

(-0.

7)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- D

atin

g Vi

olen

ce D

ata

Tabl

es-N

evad

a,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol a

nd

Prev

entio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

FearofV

iolence-

NV

HSst

uden

tsw

hofe

ltun

safe

att

endi

ng

scho

olin

the

past

30

days

)F+

30

8.

5%

2015

¯

(-2.

6%)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- F

ear o

f Vio

lenc

e D

ata

Tabl

es-N

evad

a,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol a

nd

Prev

entio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

JuvenileJu

stice-

Per

sons

und

era

ge2

1de

tain

ed,i

ncar

cera

ted,

or

pla

ced

inre

siden

tialf

acili

ties.

D37

20

120

13

¯ (-

45)

Kid

s Cou

nt D

ata

Cent

er- Y

outh

Res

idin

g in

Juv

enile

Det

entio

n, C

orre

ctio

nal a

nd/o

r Re

side

ntia

l Fac

ilitie

s.” K

ids C

ount

Dat

a Ce

nter

. N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Child

Deaths-

All

Inju

ryD

eath

sand

Rat

esp

er1

00,0

00A

ges0

to

5

C 25

17

.78

20

14

« (+

0.09

%)

Cent

er fo

r dise

ase

Cont

rol a

nd P

reve

ntio

n- C

hild

Dea

ths,

All

Inte

nts,

Age

s 0-1

8 N

evad

a 20

14 –

WIS

QAR

S Fa

tal I

njur

y Re

port

s 199

9-20

14”.

Cen

ter f

or d

iseas

e Co

ntro

l and

Pre

vent

ion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Road

Trafficinjurie

sand

Deaths-

Tra

nspo

rtD

eath

sAll

tran

spor

tatio

nre

late

dde

aths

and

rate

sper

100

,000

Age

s0-1

8

B 13

4.3

20

14

(+

0.76

%)

Cent

er fo

r dise

ase

Cont

rol a

nd P

reve

ntio

n- R

oad

Traf

fic In

juri

es A

ges 0

-18

Nev

ada

2014

– W

ISQ

ARS

Fata

l Inj

ury

Repo

rts 1

999-

2014

”. C

ente

r for

dise

ase

Cont

rol a

nd

Prev

entio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Road

Trafficinjurie

sand

Deaths-

Tra

nspo

rtD

eath

sAll

tran

spor

tatio

nre

late

dde

aths

and

rate

sper

100

,000

Age

s0-1

8 B

13

4.3

20

14

(+

0.76

%)

Cent

er fo

r dise

ase

Cont

rol a

nd P

reve

ntio

n- R

oad

Traf

fic In

juri

es A

ges 0

-18

Nev

ada

2014

– W

ISQ

ARS

Fata

l Inj

ury

Repo

rts 1

999-

2014

”. C

ente

r for

dise

ase

Cont

rol a

nd

Prev

entio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Drow

ning

-Dro

wni

ngD

eath

sDro

wni

ngD

eath

sand

Rat

esp

er

100,

000

Ages

0to

18

D-

25

1.44

2013

¯(-

0.14

) Ce

nter

for d

iseas

e Co

ntro

l and

Pre

vent

ion-

Dro

wni

ngs A

ges 0

-18

Nev

ada

2013

–

WIS

QAR

S Fa

tal I

njur

y Re

port

s 199

9-20

14”.

Cen

ter f

or d

iseas

e Co

ntro

l and

Pr

even

tion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Alcoho

l-Nev

ada

high

scho

olst

uden

tsw

hocur

rent

lyd

rank

al

coho

lD

26

33

.50

%

2015

¯

(-1%

)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- C

urre

nt A

lcoh

ol D

ata

Tabl

es-N

evad

a,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol a

nd

Prev

entio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Cigarettes

-Nev

ada

high

scho

olst

uden

tsw

hoh

ave

ever

sm

oked

any

ofa

cig

aret

te

C+

13

33.3

0%

20

15

¯ (-

7.1%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Eve

r Cig

aret

te U

se D

ata

Tabl

es-N

evad

a,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol a

nd

Prev

entio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Cig

aret

tes-

Nev

ada

hig

h sc

hool

stud

ents

who

cur

rent

ly u

se

ciga

rette

s A+

2

7.50

%

2015

¯

(-2.

8%)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- C

urre

nt C

igar

ette

Use

Dat

a Ta

bles

-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l an

d Pr

even

tion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Smok

eles

s Tob

acco

- Cur

rent

smok

eles

s tob

acco

use

A

4 5.

10%

20

15

« (+

0.1%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Cur

rent

Sm

okel

ess T

obac

co U

se D

ata

Tabl

es-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l and

Pre

vent

ion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Any

Tob

acco

- Use

any

form

of t

obac

co

C+

15

30.4

0%

20

15

(+

15.6

%)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- U

se a

ny fo

rm o

f Tob

acco

Dat

a Ta

bles

-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l an

d Pr

even

tion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Dru

gs- N

evad

a hi

gh sc

hool

stud

ents

that

hav

e us

ed

met

ham

phet

amin

es a

t lea

st on

ce in

thei

r liv

es

C-

19

3.80

%

2015

¯

(-30

.2%

Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Met

ham

phet

amin

e U

se D

ata

Tabl

es-

Nev

ada,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol

and

Prev

entio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

D

rugs

- Nev

ada

high

scho

ol st

uden

ts h

ave

used

any

form

of

coca

ine

F+

27

6.60

%

2015

¯

(-1.

1%)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- C

ocai

ne U

se D

ata

Tabl

es-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l and

Pre

vent

ion.

N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Dru

gs- C

urre

nt m

ariju

ana

use

C-

20

19.3

0%

20

15

(+

0.6%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Cur

rent

Mar

ijuan

a U

se D

ata

Tabl

es-

Nev

ada,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol

and

Prev

entio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Dru

gs-E

ver u

sed

inha

lant

s C

+ 15

7.

70%

20

15

¯ (-

2.6%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Inha

lant

Use

Dat

a Ta

bles

-Nev

ada,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol a

nd P

reve

ntio

n.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Dru

gs- E

ver u

sed

ecsta

sy

F+

23

7.30

%

2015

¯

(-3.

9%)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- E

csta

sy U

se D

ata

Tabl

es-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l and

Pre

vent

ion.

N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Dru

gs- E

ver u

sed

hero

in

C-

18

2.70

%

2015

¯

(-0.

6%)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- H

eroi

n U

se D

ata

Tabl

es-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l and

Pre

vent

ion.

N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Dru

gs- E

ver t

ook

pres

crip

tion

drug

s with

out a

doc

tor's

pr

escr

iptio

n F

30

18.5

0%

20

15

¯ (-

0.9%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Pre

scri

ptio

n D

rug

Use

Dat

a Ta

bles

-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l an

d Pr

even

tion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Pre-

K E

nrol

lmen

t- Pe

rcen

tage

of 3

and

4 y

ear o

lds e

nrol

led

in

pres

choo

l F-

50

32

.8%

20

14

(+

1.1%

)

Nat

iona

l Ins

titut

e fo

r Ear

ly E

duca

tion

Rese

arch

(NIE

ER) -

The

Stat

e of

Pre

scho

ol

2015

” N

atio

nal I

nstit

ute

for E

arly

Edu

catio

n Re

sear

ch (N

IEER

). N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Pr

e-K

Ava

ilabi

lity-

Enr

ollm

ent o

f 3- a

nd 4

-yea

r-old

s in

Stat

e Pr

e-K

. Pre

scho

ol S

peci

al E

duca

tion

and

Fede

ral a

nd S

tate

Hea

d St

art

F 47

12

%

2014

-20

15

(+

1.1%

) N

atio

nal I

nstit

ute

for E

arly

Edu

catio

n Re

sear

ch (N

IEER

) -Th

e St

ate

of P

resc

hool

20

15”

Nat

iona

l Ins

titut

e fo

r Ear

ly E

duca

tion

Rese

arch

(NIE

ER).

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Pre-

K S

pend

ing-

Sta

te sp

endi

ng o

n pr

e-k

prog

ram

s per

cap

ita

F42

$4

6.35

20

14-

2015

(+$1

.76)

N

atio

nal I

nstit

ute

for E

arly

Edu

catio

n Re

sear

ch (N

IEER

) -Th

e St

ate

of P

resc

hool

20

15”

Nat

iona

l Ins

titut

e fo

r Ear

ly E

duca

tion

Rese

arch

(NIE

ER).

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

4th

Gra

de R

eadi

ng- P

erce

nt o

f 4th

Gra

der's

Rea

ding

Sco

res

Prof

icie

nt a

nd a

bove

F-

45

29

.0%

20

15

¯(-5%

)Ed

ucat

ion

Wee

k Re

sear

ch C

ente

r- N

evad

a-St

ate

Hig

hlig

hts 2

016

Edu

catio

n W

eek

Qua

lity

Cou

nts 2

016

Cal

led

to A

ccou

nt: N

ew D

irec

tions

in S

choo

l Acc

ount

abili

ty”

Educ

atio

n W

eek

Rese

arch

Cen

ter N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

8th

Gra

de M

ath-

Per

cent

of 8

th G

rade

r's M

ath

Scor

es

Prof

icie

nt a

nd A

bove

F-

42

26

.1%

20

15

¯

(-4

.2)

Educ

atio

n W

eek

Rese

arch

Cen

ter-

Nev

ada-

Stat

e H

ighl

ight

s 201

6 E

duca

tion

Wee

k Q

ualit

y C

ount

s 201

6 C

alle

d to

Acc

ount

: New

Dir

ectio

ns in

Sch

ool A

ccou

ntab

ility

” Ed

ucat

ion

Wee

k Re

sear

ch C

ente

r N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Post

seco

ndar

y Pa

rtic

ipat

ion-

You

ng a

dults

enr

olle

d in

po

stse

cond

ary

educ

atio

n or

with

a d

egre

e F-

50

40

.1%

20

14

¯ (-

0.5)

Ed

ucat

ion

Wee

k Re

sear

ch C

ente

r- N

evad

a-St

ate

Hig

hlig

hts 2

016

Edu

catio

n W

eek

Qua

lity

Cou

nts 2

016

Cal

led

to A

ccou

nt: N

ew D

irec

tions

in S

choo

l Acc

ount

abili

ty”

Educ

atio

n W

eek

Rese

arch

Cen

ter N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

H

igh

Scho

ol D

ropo

ut R

ate-

you

th o

f hig

h sc

hool

age

who

are

no

t atte

ndin

g F+

42

6.

0%

2014

¯

(-1

%)

Kid

s Cou

nt D

ata

Cent

er- T

eens

Age

s 16

to 1

9 N

ot in

Sch

ool a

nd N

ot H

igh

Scho

ol

Gra

duat

es”

Kid

s Cou

nt D

ata

Cent

er. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Hig

h Sc

hool

Gra

duat

ion

Rat

e- G

radu

atio

n Ra

tes

F-

51

60.0

%

2012

¯

(-2.

7)

Educ

atio

n W

eek

Rese

arch

Cen

ter-

Nev

ada-

Stat

e H

ighl

ight

s 201

6 E

duca

tion

Wee

k Q

ualit

y C

ount

s 201

6 C

alle

d to

Acc

ount

: New

Dir

ectio

ns in

Sch

ool A

ccou

ntab

ility

” Ed

ucat

ion

Wee

k Re

sear

ch C

ente

r N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Mon

ey p

er P

upil-

Pre

K to

12t

h pu

blic

act

ual e

xpen

ditu

res)

F

46

$8,4

14

2014

(+ $

191)

Ed

ucat

iona

l Fin

ance

Bra

nch-

Pub

lic E

duca

tion

Fina

nces

: 201

4 Ec

onom

ic

Reim

burs

able

Sur

veys

Div

isio

n Re

port

s" U

.S. D

epar

tmen

t of C

omm

erce

Eco

nom

ics

and

Stat

istic

s Adm

inist

ratio

n” N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Pupi

l to

Teac

her

Rat

io- P

reK

and

12t

h pu

blic

stud

ent-t

each

er

ratio

- stu

dent

s per

teac

her

F47

20

.6

2013

-20

14

« (-

0.2)

G

land

er, M

ark

Nat

iona

l Cen

ter f

or E

duca

tion

Stat

istic

s- S

elec

ted

Stat

istic

s fro

m th

e Pu

blic

Ele

men

tary

and

Sec

onda

ry E

duca

tion

Uni

vers

e: S

choo

l Yea

r 201

3-20

14”

U.S

. D

epar

tmen

t of E

duca

tion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Empl

oym

ent-

Chi

ldre

n w

hose

par

ents

lack

secu

re e

mpl

oym

ent

D33

32

%

2014

¯(-2%)

Kid

s Cou

nt D

ata

Cent

er- C

hild

ren

Who

se P

aren

ts L

ack

Secu

re E

mpl

oym

ent K

ids

Coun

t Dat

a Ce

nter

. N.p

.,n.d

. Web

. 19

Aug

. 201

6.

APPENDIX

87

Dru

gs- N

evad

a hi

gh sc

hool

stud

ents

hav

e us

ed a

ny fo

rm o

f co

cain

e F+

27

6.

60%

20

15

¯ (-

1.1%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Coc

aine

Use

Dat

a Ta

bles

-Nev

ada,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol a

nd P

reve

ntio

n.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Dru

gs- C

urre

nt m

ariju

ana

use

C-

20

19.3

0%

20

15

(+

0.6%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Cur

rent

Mar

ijuan

a U

se D

ata

Tabl

es-

Nev

ada,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol

and

Prev

entio

n. N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Dru

gs-E

ver u

sed

inha

lant

s C

+ 15

7.

70%

20

15

¯ (-

2.6%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Inha

lant

Use

Dat

a Ta

bles

-Nev

ada,

Hig

h Sc

hool

You

th R

isk

Beha

vior

Sur

vey,

201

5” C

ente

r for

Dise

ase

Cont

rol a

nd P

reve

ntio

n.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Dru

gs- E

ver u

sed

ecsta

sy

F+

23

7.30

%

2015

¯

(-3.

9%)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- E

csta

sy U

se D

ata

Tabl

es-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l and

Pre

vent

ion.

N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Dru

gs- E

ver u

sed

hero

in

C-

18

2.70

%

2015

¯

(-0.

6%)

Cent

er fo

r Dise

ase

Cont

rol a

nd P

reve

ntio

n- H

eroi

n U

se D

ata

Tabl

es-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l and

Pre

vent

ion.

N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Dru

gs- E

ver t

ook

pres

crip

tion

drug

s with

out a

doc

tor's

pr

escr

iptio

n F

30

18.5

0%

20

15

¯ (-

0.9%

) Ce

nter

for D

iseas

e Co

ntro

l and

Pre

vent

ion-

Pre

scri

ptio

n D

rug

Use

Dat

a Ta

bles

-N

evad

a, H

igh

Scho

ol Y

outh

Ris

k Be

havi

or S

urve

y, 2

015”

Cen

ter f

or D

iseas

e Co

ntro

l an

d Pr

even

tion.

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Pre-

K E

nrol

lmen

t- Pe

rcen

tage

of 3

and

4 y

ear o

lds e

nrol

led

in

pres

choo

l F-

50

32

.8%

20

14

(+

1.1%

)

Nat

iona

l Ins

titut

e fo

r Ear

ly E

duca

tion

Rese

arch

(NIE

ER) -

The

Stat

e of

Pre

scho

ol

2015

” N

atio

nal I

nstit

ute

for E

arly

Edu

catio

n Re

sear

ch (N

IEER

). N

.p.,n

.d. W

eb. 1

9 A

ug. 2

016.

Pr

e-K

Ava

ilabi

lity-

Enr

ollm

ent o

f 3- a

nd 4

-yea

r-old

s in

Stat

e Pr

e-K

. Pre

scho

ol S

peci

al E

duca

tion

and

Fede

ral a

nd S

tate

Hea

d St

art

F 47

12

%

2014

-20

15

(+

1.1%

) N

atio

nal I

nstit

ute

for E

arly

Edu

catio

n Re

sear

ch (N

IEER

) -Th

e St

ate

of P

resc

hool

20

15”

Nat

iona

l Ins

titut

e fo

r Ear

ly E

duca

tion

Rese

arch

(NIE

ER).

N.p

.,n.d

. Web

. 19

Aug

. 201

6.

Pre-

K S

pend

ing-

Sta

te sp

endi

ng o

n pr

e-k

prog

ram

s per

cap

ita

F42

$4

6.35

20

14-

2015

(+$1

.76)

N

atio

nal I

nstit

ute

for E

arly

Edu

catio

n Re

sear

ch (N

IEER

) -Th

e St

ate

of P

resc

hool

20

15”

Nat

iona

l Ins

titut

e fo

r Ear

ly E

duca

tion

Rese

arch

(NIE

ER).

N.p

.,n.d

. Web

. 19

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. 201

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89

Children’sAdvocacyAllianceTheChildren’sAdvocacyAlliance(CAA)isacommunity-basednonprofitorganizationthatservesasanindependentvoiceforNevada’schildrenandfamiliesbyadvocatingforimprovedpolicies,practicesandlawsrelatedtochildren’shealth,safetyandschoolreadiness.

Staff:DeniseTanata,JD,ExecutiveDirectorShelbyHenderson,MA,PolicyManager–SchoolReadinessJaredBusker,PolicyAnalystKaiaBartling,ProjectManagerAlejandraMartinez,ProjectAssistantChildren’sAdvocacyAlliance5258S.EasternAve.#151LasVegas,NV891193500LakesideCt,Suite209Reno,NV89509(702)228-1869www.caanv.org

NevadaInstituteforChildren'sResearchandPolicyTheNevadaInstituteforChildren'sResearchandPolicy(NICRP),locatedwithintheSchoolofCommunityHealthSciencesattheUniversityofNevadaLasVegas,isanot-for-profit,non-partisanorganizationdedicatedtoimprovingthelivesofchildrenthroughresearch,advocacyandotherspecializedservices.Staff:TaraPhebus,MA,ExecutiveDirectorAmandaHaboush-Deloye,PhD,AssociateDirectorDawnDavidson,PhD,SeniorResearchAssociateM.AmarisKnight,MEd,AssistantResearchAnalystValeriaGurr,MA,ProgramCoordinatorPCANVPatriciaHaddad,ResearchAssistantMirzahTrejo,ResearchAssistant

NevadaInstituteforChildren’sResearchandPolicyHomeofPreventChildAbuseNevadaSchoolofCommunityHealthSciencesUniversityofNevada,LasVegas4505MarylandPkwyLasVegas,NV89154-3030(702)895-1040Fax(702)895-2657nic.unlv.edu

2017


BRIEFING BOOK


2017

Children’sLegislativeBriefing Book

2017


BRIEFING BOOK


2017


BRIEFING BOOK
