{"Multiple_Choice__291":"Brittany Lochner","Short_Answer__292":"JoLynn Sundstrom and Fintan Moore","Date__293":"08\/24\/2016","Multiple_Choice__294":"Fatality","Yes_or_No__295":"No","Multiple_Choice__300":"4","Multiple_Choice__301":"Pine","Short_Answer__303":"Allen","Short_Answer__304":"Audette","Date__305":"10\/26\/1999","Date__306":"05\/18\/2016","Multiple_Choice__308":"16 Years","Multiple_Choice__309":"1","Short_Answer__310":"Mother","Multiple_Choice__316":"2","Short_Answer__317":"Residential treatment placement was not provided to the subject child subsequent the mother's request for placement.","Free_Text__318":"During the debriefing, the caseworker indicated that the agency's expectation is that a family must try a number of interventions prior to considering out-of-home placement.  Additionally, there is a process within the agency that is typically followed when out-of-home placement is requested.  Specifically, when a family calls and requests out-of-home placement for a child, the agency wants to know the reason for the placement request (what happened) and what other interventions the family has tried.  After the agency has learned what interventions have or have not been tried, the worker will then work with the family to engage them in least restrictive interventions.  Once the family has exhausted all least restrictive interventions, the agency then utilizes a preplacement screening team to request approval for out-of-home placement.  Once approval for the out-of-home placement is granted, the caseworker can move forward with coordinating the placement.  In the event a child is hospitalized and\/or a hospital is recommending out-of-home placement, and the agency can immediately consider placement.  \r\n\r\nThe agency expectation for a family to exhaust least restrictive interventions and the process the agency typically follows when an out-of-home placement is requested by a family supported the caseworkers decision to not place the subject child in residential treatment and talk with the mother about other options prior to moving towards placement. This decision was further influenced by the fact that the child was not currently hospitalized and a hospital was not recommending out-of-home placement for the child.","Free_Text__319":"The decision for placement not being provided, per the mother's request, was influenced by the agency's threshold for placement not being met.  The development of this threshold was shaped by local and state policy and guidance that supports and encourages least restrictive interventions prior to placement.  The agency's threshold for placement was also affected by the shortage of residential beds and lack of funding for placement services.  In addition, there has been an increase in parents calling to request placement opposed to exhausting least restrictive interventions first.  Contributing factors that further supported the agency's threshold for placement not being met in this case included the fact that the child was not actively suicidal and a hospital was not recommending placement at the time of the request.  Furthermore, the agency believed the child's needs were being met through his engagement with other service providers.","Short_Answer__320":"Safety plan was not documented when mom indicated escalating behaviors.","Free_Text__321":"During the debriefing, it was learned that typically, the agency does not complete a safety plan when a Children's Mental Health case is in assessment, which was the status of this case when the incident occurred.  This standard of practice influenced the caseworker's decision to not complete a safety plan. Additionally, this decision was supported by the fact that the subject child was not suicidal at the time the report was received and there was no indication the subject child was suicidal at the initial meeting with the mother. The caseworker also noted that the subject child had been seeing a therapist for approximately one year prior to the incident and believed that the therapist probably completed a safety plan with the subject child.  Lastly, the therapist did not indicate any concerns of suicidal ideation for the subject child to the agency.   \r\nOn April 28, 2016, the mother requested Children's Mental Health Services for the subject child; specifically, placement in a residential treatment facility.  The mother had previously contacted a residential treatment facility and was told she needed a county referral.  The case was assigned to the children's mental health caseworker on May 2, 2016 and a CMH intro letter was sent to the family that same day. The caseworker had a phone call with the mother on May 6, 2016 and a face-to-face visit took place on May 10, 2016.  The subject child was not present during the initial face-to-face visit as the caseworker let the family decide if the subject child should be present or not.  The caseworker had the mother sign releases of information during the initial visit to gather records from previous providers and sent them out on May 11.  The caseworker contacted the subject child's therapist that day, as well, to work on getting an updated diagnostic assessment.  The caseworker continued to gather information the next two days for an updated diagnostic assessment.  \r\n\r\nThe agency did not receive records from the hospital regarding the subject child's previous suicide attempt and did not get an updated diagnostic assessment prior to the subject child committing suicide on May 18, 2016.  Following the subject child's suicide, the caseworker attempted a home visit on May 20, 2016, but the family was not home.  The caseworker connected with the mother on June 15 to offer condolences and talk about services for the 12-year old sibling; however, the mother declined services.  The caseworker stated, \u00e2\u20ac\u0153The case went exactly how they envisioned it to go\u00e2\u20ac\u009d. \r\n\r\nThe subject child was involved with the following services at the time of the incident: individual therapy, physical therapy, occupational therapy, school-linked mental health worker, medication management, and chiropractic services.  \r\n\r\nAgency staff also provided the following information during the on-site meeting:\r\n\u00e2\u20ac\u00a2\tThey see parents requesting placements too often and County partners direct families to contact the county for placement.","Free_Text__322":"The decision to not complete a safety plan was impacted by the staff's workload and need to prioritize the multiple tasks required as a CMH worker as defined by CMH policies and timelines.  Additionally, CMH workloads are affected by the number of tasks required by the agency's responsibility to fulfill both Title IV-E requirements and Child and Family Service Review outcomes.  Due to the multiple tasks required during this case, the worker had discretion to prioritize competing caseload tasks.  As a result, the decision to complete a safety plan was a lower priority task in this case because there was no indication the child was suicidal and that a safety plan was needed. This decision was also influenced by the child being involved with several service providers and none indicating that the child was actively suicidal, including a therapist who likely completed a safety plan with the child and his family.  The staff's mental model was such that the child's needs were being met by the service providers he was engaged with; therefore, justifying the decision to not complete a safety plan.  This decision was further reinforced by safety precautions being implemented in the home following the child's previous suicide attempt.","Multiple_Choice__346":"2","Free_Text__347":"Learning Point 1:  Contributing factors that further supported the agency's threshold for placement not being met in this case included the fact that the child was not actively suicidal and a hospital was not recommending placement at the time of the request.  Furthermore, the agency believed the child's needs were being met through his engagement with other service providers.  \r\n\r\nLearning Point 1:  The child was involved with several service providers and none indicated that the child was actively suicidal, including a therapist who likely completed a safety plan with the child and his family.  The staff's mental model was such that the child's needs were being met by the service providers he was engaged with; therefore, justifying the decision to not complete a safety plan.  Safety precautions were also implemented in the home following the child's previous suicide attempt.","Multiple_Choice__350":"1","Multiple_Choice__352":"0","Multiple_Choice__354":"0","Multiple_Choice__356":"0","Multiple_Choice__368":"0","Multiple_Choice__358":"2","Free_Text__359":"Learning Point 1:  The development of the agency's threshold for placement was shaped by local and state policy and guidance that supports and encourages least restrictive interventions prior to placement.  In addition, the child's needs did not meet the threshold for placement.\r\n\u00e2\u20ac\u00a2\tLeast Restrictive \u00e2\u20ac\u201c Minnesota Statutes Chapter 260C and Minnesota Rules, parts 9560.0223 and 9560.0545; Children's Mental Health Act,  sections 245.467, 245.457 and 245.4876\r\n\u00e2\u20ac\u00a2\t10 Best Interest Factors \u00e2\u20ac\u201c 260C.212, Subdivision 2","Multiple_Choice__360":"2","Free_Text__361":"Learning Point 2:  Due to the multiple tasks required during this case, the worker had discretion to prioritize competing caseload tasks.  As a result, the decision to complete a safety plan was a lower priority task in this case because there was no indication the child was suicidal and that a safety plan was needed.","Multiple_Choice__362":"0","Multiple_Choice__364":"0","Multiple_Choice__366":"0","Yes_or_No__370":"Yes"}