Specifications include, but are not limited to: COMPONENT 1: SYSTEM OVERVIEW AND CONSULTATION Review the Nevada forensic mental health system to understand: Current structure, statutes, and practices Interface of the forensic mental health system with other components of the mental health system Challenges and gaps Existing and potential resources Recent and current Nevada strategies to address challenges Stakeholders and potential collaborators ACTIONS: Review collateral information, interview stakeholders, develop and distribute survey Understanding the Nevada context How do Nevada's challenges and gaps compare and contrast with other states? To what extent are administrative structures adequate for current needs and goals? What existing models (from other states) or emerging research might provide guidance for Nevada? ACTION: Review and present models and best practices from other states and relevant literature. Identifying opportunities for improvement Potential plans for change and improvement Internal DHHS policy Internal DHHS forensic infrastructure (e.g., state office of forensic mental health, tele-health capacity, staffing support). External policies from other stakeholders that may impact DHHS clients Potential statutory changes Potential financial implications ACTION: Create broad recommendations regarding vision and goals for meaningful change to Nevada's forensic mental health system, including a focused feedback session and subsequent prepared written report. Determining additional areas of focus Review findings, gaps, and potential recommendations with DHHS personnel Identify potential areas for more specialized consultation Clarify priorities for subsequent consultation tasks ACTION: Discuss identified gaps, potential follow-up consultation, and subsequent tasks and timeframes with DHHS personnel. COMPONENT 2: COMPETENCY SYSTEM IMPROVEMENTS Review Nevada's competency to stand trial (CST) evaluation system Determine policies and procedures that align evaluators into a more unified workforce with uniform protocols and procedures Determine logistics, workloads, required procedures for conducting evaluations Tele-evaluation training and logistics Qualification and/or certification standards for evaluators Assist as necessary to train evaluators on new procedures ACTION: Collaborate with DHHS to develop policies, protocols, and procedures regarding CST evaluations and evaluators. Reviewing Nevada’s CST restoration system Explore potential options to reduce pressure on the wait list for competency restoration Programmatic decisions: Diversion, outpatient restoration Placement decisions: Jail-based restoration vs inpatient Clinical decisions: Triaging defendants for inpatient care, optimizing inpatient restoration services and staff Statutory decisions: limitations on restoration Additional areas: Involuntary meds, Sell
