{"Short_Answer__76":"KP_Maplewood Homes-SLC-2020-10","Date__77":"10\/28\/2020","Multiple_Choice__78":"Kristie Pittman","Short_Answer__80":"Maplewood Homes","Short_Answer__81":"Tabitha Snider","Short_Answer__82":"snider.tabatha@yahoo.com","Short_Answer__83":"218-576-6874","Multiple_Choice__84":"Termination of Services","Multiple_Choice__85":"St. Louis County","Date__86":"08\/13\/2020","Free_Text__87":"Termination of services is necessary for the person's welfare and the facility cannot meet the person's needs.  The safety of the person is endangered and positive support strategies were attempted and have not achieved and effectively maintained safety of the person or others.  The health of the person or others in the program would otherwise be endangered.","Multiple_Choice__96":"1","Short_Answer__91":"Provider terminated services due to challenging behaviors","True_or_False__94":"Yes","Date__97":"11\/30\/2020","Free_Text__98":"October 2020 Case Assignment\r\nMaplewood Homes\r\n\r\nLearning Point:  Person had their services terminated due to challenging behavior \r\n\r\nPerson was being served in a rural Family Foster Home setting from May until August of 2020.  Prior to admission into the family foster home, person had been residing at a crises home following service termination from another provider.  Person had a long history of verbalizing suicidal thoughts, self-harm, verbal and physical aggression.  It was reported that he enjoyed the attention he was given when he would be hospitalized, resulting in numerous attempts to become hospitalized.   It was reported that his team was not being successful in finding placement for him.  The team felt that a family foster care who could provide a one to one setting was something that had not been tried before.  Provider had no other clients at the time of initial placement.  Provider has over 20 years of experience in working with vulnerable populations.\r\nProvider reported a good working relationship with the person\u2019s Guardian\/Grandmother along with county case manager. Provider worked closely with psychologist, psychiatrist and ARMS worker.  Provider felt that the team was very supportive.  Things went well for a period of time and the person enjoyed all the attention they received.\r\nAs time went on, the person started to verbalize suicidal ideation to his Grandmother when talking to her on the phone.  One night he eloped following a series of texts to his Grandmother saying he wanted to kill himself.  Provider followed him and called the Sheriff who stated that they were not a \u201ctaxi\u201d service and would not assist.  He was taken to the Emergency Room and calmed down and was released with in a couple of hours.\r\nAnother client moved into the home shortly have this incident.  Person then stated he was going to burn the house down.  Provider had a volunteer at the home stay up all night to observe person as they were not sleeping.   The was again taken to the house admitted and released.   After he returned, he took a lighter and burned himself, this resulted in police being called to the home.  He calmed down once they arrived.  He started to text his Grandmother reporting that he wanted to kill himself.  Grandmother insisted that he return to the hospital.  Once at the hospital Grandmother insisted that he not return to providers home and he was admitted back to the crises home.","Free_Text__100":"The provider terminating a person\u2019s services due to challenging behaviors was influenced by the behaviors escalating in frequency and intensity since service admission.  This was further supported by the person making multiple suicide threats, acts of self-harm by burning themselves, and threats to burn the house down.  The person did not have a history of fire starting prior to admission which further supports the intensity of his escalating behaviors.  The person seemed motivated by the attention he received from his grandmother\/guardian and the hospital.  Person was hospitalized twice and released quickly on two occasions prior to the threat to burn the house down.  On one occasion, law enforcement responded to the providers 911 call and stated that they were not a taxi services and did not provide any mental health support.  Police in the area were overtaxed with 911 calls related to mental health and COVID calls.  In addition to that, at the time of this call, law enforcement from across the state were reporting to Minneapolis to assist with the George Floyd incident, impacting the providers view that law enforcement may not assist.  \r\n\r\nThe guardian and provider agreed that the safety of the person, others in the home, and staff could not be maintained.  This agreement was influenced by the provider attempting to remove all objects that were deemed dangerous.  Room searches were conducted regularly to remove dangerous objects. After the person returned from the hospital, they were still in possession of a lighter.  This further supported their decision that they could not prevent him from self-harm and fire starting behavior or maintain the safety and protection of all involved. \r\n\r\nProviders have a responsibility to protect the health and wellbeing of all people in the home was another influence to the service termination.  Providers responsibility for safety is directed by MnCHOICES and required by the CSSP of each person and as well as the requirement of 245D.   This was supported by the Guardian who was worried about the provider\u2019s safety and the safety of the other person who had just recently moved into the home, resulting in the guardian refusing to allow the person to return to the home.\r\n\r\nThe person being served had several ER visits for suicidal ideation and behaviors and was not given in-patient psychiatric care. Provider and guardian had exhausted available services and felt that service termination was seen as a way to help person obtain in-patient psychiatric services.   COVID-19 Pandemic influenced hospitals to discharge quickly, due to the demand for mental health resources in the area, resulting in person being released from hospital and not receiving the psychiatric attention the team thought he needed, further impacting providers decision to terminate services","Multiple_Choice__101":"0","Multiple_Choice__103":"0","Multiple_Choice__105":"0","Multiple_Choice__107":"0","Multiple_Choice__109":"3","Free_Text__110":"On one occasion, law enforcement responded to the providers 911 call and stated that they were not a taxi services and did not provide any mental health support.  Police in the area were overtaxed with 911 calls related to mental health and COVID calls\r\n\r\nThe guardian and provider agreed that the safety of the person, others in the home, and staff could not be maintained.  This agreement was influenced by the provider attempting to remove all objects that were deemed dangerous.  Room searches were conducted regularly to remove dangerous objects. After the person returned from the hospital, they were still in possession of a lighter.  This further supported their decision that they could not prevent him from self-harm and fire starting behavior or maintain the safety and protection of all involved.","Multiple_Choice__111":"0","Multiple_Choice__113":"0","Multiple_Choice__115":"3","Free_Text__116":"The guardian and provider agreed that the safety of the person, others in the home, and staff could not be maintained.  This agreement was influenced by the provider attempting to remove all objects that were deemed dangerous.  Room searches were conducted regularly to remove dangerous objects. After the person returned from the hospital, they were still in possession of a lighter\r\n\r\nProviders have a responsibility to protect the health and wellbeing of all people in the home was another influence to the service termination.  Providers responsibility for safety is directed by MnCHOICES and required by the CSSP of each person and as well as the requirement of 245D.   This was supported by the Guardian who was worried about the provider\u2019s safety and the safety of the other person who had just recently moved into the home, resulting in the guardian refusing to allow the person to return to the home.","Multiple_Choice__117":"0","Multiple_Choice__119":"3","Free_Text__120":"On one occasion, law enforcement responded to the providers 911 call and stated that they were not a taxi services and did not provide any mental health support.  Police in the area were overtaxed with 911 calls related to mental health and COVID calls.  \r\n\r\nThe person being served had several ER visits for suicidal ideation and behaviors and was not given in-patient psychiatric care. Provider and guardian had exhausted available services and felt that service termination was seen as a way to help person obtain in-patient psychiatric services.   COVID-19 Pandemic influenced hospitals to discharge quickly, due to the demand for mental health resources in the area, resulting in person being released from hospital and not receiving the psychiatric attention the team thought he needed, further impacting providers decision to terminate services","Multiple_Choice__121":"0","Multiple_Choice__123":"0","Multiple_Choice__125":"0","Yes_or_No__432":"Yes"}