At Stein Forensic Hospital (Stein), the fellow will become skilled in the practice of writing reports for the court and working in a forensic setting. Stein is one of the two forensic facilities in Nevada and is part of the Southern Nevada Adult Mental Health Services (SNAMHS) system.

At Stein, the fellow will carry a caseload of patients and learn how treating patients for competency restoration differs from treating patients in a civil setting. The fellow will be responsible for diagnosis, medication management, assessing the progress of individual patients receiving competency restoration instruction, and documentation. The fellow will also lead a treatment team consisting of a psychologist, social worker, and other professionals.

The fellow will assess patients for competency to continue with adjudication and prepare and submit reports to the court. As part of this process, the fellow will learn the legal and philosophical components defining competency, learn to complete an effective interview, and learn the art of writing clear and concise reports.

The fellow will also write or assist with writing the annual risk assessment on patients committed to the facility under Nevada Revised Statute (NRS) 178.461. Such clients are committed long-term and require a yearly assessment for dangerousness to determine the need for continued treatment in a locked forensic setting. The exercise will introduce the fellow to the concept of risk assessments and assessing for dangerousness.

When indicated, the fellow will testify in court and learn how to present information in a clear format within the scope of practice.

Assisted Outpatient Treatment (AOT) is a court-ordered outpatient civil commitment program for severely mentally ill individuals with a history of frequent psychiatric hospitalizations and arrests. The AOT program rotation is part of the Southern Nevada Adult Mental Health Services (SNAMHS) system.

The fellow will carry a patient caseload and assume responsibility for the diagnosis, medication management, and communication with social workers, caseworkers, and occupational therapists for purposes of monitoring patient progress toward treatment goals. Additionally, the fellow will have frequent contact with probation officers and courtroom personnel, including judges, attorneys, court coordinators, court clerks, and others. The fellow will also have interactions with non-clinical providers, such as community caretakers.

The fellow will frequently encounter ethical and legal issues related to probation revocation, program dismissal, eviction from housing, and allocation of limited resources. They are expected to review written records (clinical and legal), document, and provide testimony when appropriate.

Clark County Detention Center (CCDC) is the county jail serving the metropolitan area of Las Vegas, Nevada. CCDC houses up to 5,000 pre-trial detainees and misdemeanor convictions from 150 to 300 new admissions daily.

At CCDC, mental health care is provided through Wellpath, a healthcare services company. A multidisciplinary team of mental health professionals, including correctional officers, nurses, social workers, nurse practitioners, and psychiatrists deliver mental health services to the detainees.

At CCDC, the fellow will evaluate patient-inmates throughout the facility to understand the various levels of psychopathology resulting in incarceration. Acutely ill patient-inmates with signs of dangerousness may require involuntary medication declarations under Washington vs. Harper. The fellow will have the responsibility to draft and submit to the court. Testimony may be required in this regard.

The fellow will also attend weekly restrictive housing meetings, including stakeholders from across the Las Vegas Metropolitan Police Department (LVMPD). This will provide a front-row opportunity to witness the progressive nature of the LVMPD attempting to bridge the gap in treatment needs for high-risk and high-utilizer patient-inmates from arrest through release.

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The fellow will be included in private practice cases taken on by faculty members on an ad-hoc basis throughout the year. This experience will increase exposure to communication with attorneys, various forensic psychiatric assessments, and report writing.