WEBVTT 1 00:00:01.740 --> 00:00:02.700 Amy Ingles: Deficit 2 00:00:04.670 --> 00:00:12.930 Amy Ingles: attention, deficit, disorder and antisocial personality. Disorder. So he had a lot going on 3 00:00:13.940 --> 00:00:16.570 Amy Ingles: next slide. 4 00:00:19.220 --> 00:00:38.899 Amy Ingles: So after he was admitted. He started engaging in maladaptive behaviors about 3 days after admission. The first month we had 12 instances, verbal aggression, 14 instances, physical aggression, mostly against staff and housemates 5 00:00:39.470 --> 00:00:47.420 Amy Ingles: 15 instances of sexually inappropriate speech and 3 episodes of threat to self harm 6 00:00:47.460 --> 00:00:55.099 Amy Ingles: and per policy. We always have individuals evaluated if they're threatening self harm 7 00:00:55.220 --> 00:00:59.000 Amy Ingles: with a plan. We we usually take him to 8 00:00:59.260 --> 00:01:06.200 Amy Ingles: St. Mary's for evaluation. So he a lot going on that first month 9 00:01:07.610 --> 00:01:18.930 Amy Ingles: his behavioral difficulties increased in severity and frequency. And then in July of 2,019 a new behavior emerged 10 00:01:19.320 --> 00:01:24.360 Amy Ingles: so he could. Some. He had a highal hernia 11 00:01:24.460 --> 00:01:29.949 Amy Ingles: and could basically vomit on command and was using. 12 00:01:31.410 --> 00:01:37.350 Amy Ingles: That is a way to control staff he would vomit. And then, if the staff 13 00:01:37.510 --> 00:01:39.480 Amy Ingles: attempted to clean it up. 14 00:01:39.530 --> 00:01:50.789 Amy Ingles: he'd physically assault them and then throw, throw vomit on them and collected urine, so could you can imagine we had a lot of staff turnover, 15 00:01:51.460 --> 00:01:55.229 Amy Ingles: due to, you know the nature of his 16 00:01:55.460 --> 00:02:04.190 Amy Ingles: behaviors. So property, destruction, a lot of property, destruction, verbal aggression to people in the community. 17 00:02:04.510 --> 00:02:11.179 Amy Ingles: and you know the the aforementioned issues or multiple multiple evictions 18 00:02:11.570 --> 00:02:12.770 Amy Ingles: next slide. 19 00:02:17.220 --> 00:02:28.040 Amy Ingles: So our goal was for him to live in a community setting and to engage in community activities, the barriers that we 20 00:02:28.450 --> 00:02:38.769 Amy Ingles: that we were dealing with were, you know. public knowledge of criminal history. It was very difficult for us to find housing for this young man? 21 00:02:38.930 --> 00:02:44.460 Amy Ingles: Because if you googled his name it was the first, or if you even Googled. 22 00:02:44.540 --> 00:02:46.709 Amy Ingles: you know, assaulting. 23 00:02:47.150 --> 00:02:57.009 Amy Ingles: you know whatever. And first thing that popped up everywhere was this article, if you googled his name, this lots of stuff came up. 24 00:02:57.280 --> 00:03:04.039 Amy Ingles: so like I said, severe property destruction led to multiple evictions. He was. 25 00:03:04.240 --> 00:03:15.929 Amy Ingles: I think, he had 4 evictions within the first couple of years. verbal and physical aggression against staff. Other residents, people in the community. 26 00:03:16.180 --> 00:03:24.649 Amy Ingles: Definitely made staffing a challenge. He attempted to elope. He would run away from staff. 27 00:03:24.700 --> 00:03:33.730 Amy Ingles: he would jump from moving vehicles so obviously staff were hesitant to take him into the community. because it was a 28 00:03:33.810 --> 00:03:36.440 Amy Ingles: very different, very difficult. 29 00:03:38.380 --> 00:03:39.640 Amy Ingles: so 30 00:03:40.640 --> 00:03:53.980 Amy Ingles: well, medication, refusals, and and the vomiting of medication contributed to his. you know, mood, lobbility. He wasn't. His medications were most definitely not at a therapeutic level. 31 00:03:54.060 --> 00:04:05.590 Amy Ingles: Because of these things, which made. you know, medication management was super difficult. He didn't want to be in the program was a large issue. 32 00:04:05.760 --> 00:04:09.909 Amy Ingles: He wanted to be back home and with his family. 33 00:04:10.310 --> 00:04:14.999 Amy Ingles: They live, you know, nearby. So he still had contact with them. 34 00:04:15.350 --> 00:04:21.790 Amy Ingles: but it wasn't approved by the court or by Dhr because of the 35 00:04:21.930 --> 00:04:30.970 Amy Ingles: sex offender status of other people that were living in the home with the family. So it was kind of a generational issue. 36 00:04:31.010 --> 00:04:33.990 Amy Ingles: And sometimes in these cases. 37 00:04:34.240 --> 00:04:43.109 Amy Ingles: you know. They wanted him home, you know. They wanted him to be there. He was their son. Brother. But 38 00:04:43.260 --> 00:04:53.689 Amy Ingles: it was just. I think there was just a bit overarching concern about what would occur if he returned to that type of a setting 39 00:04:54.690 --> 00:04:58.940 Amy Ingles: next slide. 40 00:05:03.620 --> 00:05:08.490 Amy Ingles: Basically, he was in a constant 41 00:05:09.230 --> 00:05:18.070 Amy Ingles: constant state of crisis. He wasn't ever stable enough to establish any kind of routine. 42 00:05:18.570 --> 00:05:24.949 Amy Ingles: By the middle of May of 2020 we were right in the thick of covid 43 00:05:25.300 --> 00:05:30.250 Amy Ingles: and staffing became extremely difficult for him. 44 00:05:30.420 --> 00:05:36.739 Amy Ingles: So we made a statewide referral for placement in a more rural community that he would have less. 45 00:05:37.040 --> 00:05:39.700 Amy Ingles: I guess we want to say 46 00:05:40.710 --> 00:05:52.750 Amy Ingles: distractions. you know, like I said he wanted to get out. Go to go to bars, you know. seek drugs, that kind of thing. 47 00:05:53.180 --> 00:05:58.690 Amy Ingles: And we did have a very difficult time finding people that were even willing to work with them. 48 00:05:59.840 --> 00:06:12.699 Amy Ingles: So statewide referral was made and we could not find anyone to accept him. And by then, like I said, we were in the middle of the pandemic, and no one was accepting new consumers. 49 00:06:13.420 --> 00:06:15.850 Amy Ingles: He was 50 00:06:16.200 --> 00:06:23.209 Amy Ingles: evicted from another apartment on December the ninth and 2020, 51 00:06:23.620 --> 00:06:28.560 Amy Ingles: and subsequently he moved into a hotel. He was evicted 52 00:06:28.630 --> 00:06:31.649 Amy Ingles: from a series of hotels. 53 00:06:31.930 --> 00:06:34.560 Amy Ingles: Due to, you know. 54 00:06:35.290 --> 00:06:38.290 Amy Ingles: inappropriate behaviors, mostly. 55 00:06:38.660 --> 00:06:43.700 Amy Ingles: Verbal issues. He would yell at the 56 00:06:43.800 --> 00:06:55.229 Amy Ingles: the apartment. They're the managers to the hotel, he would get into altercations, verbal altercations with other people staying in the hotels, and was asked to leave repeatedly. 57 00:06:55.480 --> 00:07:06.210 Amy Ingles: He pretty much worked his way through every hotel in the town in Huntington, and by 9 of 2021, still in a hotel. 58 00:07:06.610 --> 00:07:13.389 Amy Ingles: he was living at the Coaches inn. If anybody knows anything about Huntington, the coast coaches in is 59 00:07:13.500 --> 00:07:18.289 Amy Ingles: they're pretty lenient with who they allow to stay there. 60 00:07:19.850 --> 00:07:30.380 Amy Ingles: So when we get to this point. You know. Now, what what do we do? He's been evicted from the last hotel in town that would accept him. 61 00:07:30.950 --> 00:07:34.710 Amy Ingles: He did not have a placement at all next slide. 62 00:07:38.880 --> 00:07:42.500 Amy Ingles: So I guess this is a good time to discuss some things. 63 00:07:42.730 --> 00:07:49.170 Amy Ingles: what does anyone have any 64 00:07:50.140 --> 00:08:03.389 Amy Ingles: ideas that we did not discuss about keeping this person in the community. Like I said he did have a lot of I'm sorry. Go ahead, Leslie. Well, I was just gonna interject that you know 65 00:08:03.810 --> 00:08:06.130 Lesley Cottrell: and and kind of tongue in cheek that 66 00:08:06.610 --> 00:08:15.719 Lesley Cottrell: so Amy has many, many cases that we she could have presented. We obviously chose a complicated one that you all picking up in the chat 67 00:08:15.770 --> 00:08:19.770 Amy Ingles: many things going on, and a challenging one just to hit it off. 68 00:08:19.850 --> 00:08:24.870 Lesley Cottrell: you know, with real real life upfront. So and and 69 00:08:25.140 --> 00:08:27.059 Lesley Cottrell: all to say that in these 70 00:08:27.200 --> 00:08:40.620 Lesley Cottrell: questions that Amy's asking us, we recognize it's gonna be difficult, right? It might be limited, but but we wanna push ourselves to to find some answers and learn from others when when we have situations like this. 71 00:08:41.909 --> 00:08:43.809 Lesley Cottrell: So I see some hands up. 72 00:08:43.900 --> 00:08:48.600 Amy Ingles: Amy. Yeah, colleen. 73 00:08:48.720 --> 00:09:02.089 Colleen Lillard: go ahead and unmute yourself. I see that you mentioned about his trauma history. Yeah. So I actually know this patient. I was an intern at hospital when he was there many, many years ago. 74 00:09:03.000 --> 00:09:07.649 Colleen Lillard: So one thing that I wanted to point out about him in particular was, he has an 75 00:09:07.750 --> 00:09:10.560 Colleen Lillard: extremely awful trauma history. 76 00:09:10.860 --> 00:09:33.100 Colleen Lillard: That, I think, is really relevant because it's one more compounding issue on top of others for him. My question for you about keeping him in the community. Was he seeing psychiatry and or therapy services? Yes, he did. In fact, he he was a patient at Marshall psychiatric or my marshals University psych 77 00:09:33.290 --> 00:09:37.869 Amy Ingles: and they were very involved with his case. 78 00:09:37.990 --> 00:09:39.840 Amy Ingles: like, I said, there were just 79 00:09:40.030 --> 00:09:52.910 Amy Ingles: so many factors that we couldn't resolve. One factor, I mean, obviously, the first thing you try to do is rule out medical, you know. Could this be related to the fact that his medications aren't really 80 00:09:53.070 --> 00:09:56.790 Amy Ingles: are really serving him because he's not. 81 00:09:56.810 --> 00:09:59.079 Amy Ingles: you know, he's vomiting them up 82 00:09:59.210 --> 00:10:08.689 Amy Ingles: we discussed having the hernia repaired but the physicians suggested that we not do that because 83 00:10:08.950 --> 00:10:14.770 Amy Ingles: the hernia was basically the only thing keeping his stomach contents in. He just had a lot of 84 00:10:14.930 --> 00:10:19.509 Amy Ingles: damage in that area. So it wasn't like clinically 85 00:10:19.550 --> 00:10:22.159 Amy Ingles: indicated for him to even get. 86 00:10:22.430 --> 00:10:28.200 Amy Ingles: you know, for us to to medically repair the issue that was causing the vomiting. 87 00:10:28.870 --> 00:10:30.580 Colleen Lillard: But given his. 88 00:10:30.720 --> 00:10:44.440 Colleen Lillard: Given his sexually react, his sexual behavior problems, was he put on a sh, a shot, or anything that wouldn't he was. He was. He was. He was taking the depot shot. 89 00:10:45.730 --> 00:10:47.820 Amy Ingles: We did have 90 00:10:48.540 --> 00:11:04.780 Amy Ingles: most of his issues. Sexual issues were verbal, you know, he would just say inappropriate things. There was a couple of incidents where he, was attempting to gain access to a neighbor's pet. 91 00:11:05.270 --> 00:11:08.179 Amy Ingles: and you know 92 00:11:10.800 --> 00:11:17.890 Amy Ingles: this was right before the Depot river began, and I think that's kind of what prompted us to say, hey? 93 00:11:17.960 --> 00:11:21.890 Amy Ingles: I guess I should probably mention the fact that 94 00:11:23.080 --> 00:11:30.439 Amy Ingles: part of the issue, I think, was that when we accepted this person for placement the history was. 95 00:11:30.780 --> 00:11:34.989 Amy Ingles: there wasn't a lot of available information. 96 00:11:35.070 --> 00:11:44.869 Amy Ingles: We kind of found things out as we went along with this guy. We knew obviously what had occurred that made him 97 00:11:45.090 --> 00:11:48.010 Amy Ingles: that that placed him at the hospital. 98 00:11:48.940 --> 00:11:50.040 Amy Ingles: But 99 00:11:50.160 --> 00:11:56.930 Amy Ingles: I mean, there's apparently a very, very long history of 100 00:11:57.280 --> 00:12:09.300 Amy Ingles: cps involvement Aps involvement. He has. you know, people living in the home. I think, a brother and and another family member. There's multiple people in the home 101 00:12:09.340 --> 00:12:13.370 Amy Ingles: that are have criminal histories to their registered sex offenders. 102 00:12:13.510 --> 00:12:16.610 Amy Ingles: He was offended. 103 00:12:16.730 --> 00:12:23.199 Amy Ingles: He was the victim of of that, but we didn't really even know about that until much later in his care. 104 00:12:23.390 --> 00:12:43.779 Colleen Lillard: So one plug. I know this case happened quite a while ago. But if any community provider now has a former forensic patient or a current forensic patient heading their way, and they want some more of that information cause, I think you know, for continuity of care sake, it's very important. 105 00:12:43.780 --> 00:12:56.109 Colleen Lillard: And just know that we would be more than happy to speak to you. And I'm sure there probably was a lot of information that could have been provided, and I'm sorry that didn't get to you 106 00:12:56.310 --> 00:13:01.189 Amy Ingles: from the point of view of people that have done referrals 107 00:13:01.220 --> 00:13:10.480 Amy Ingles: a lot of times when you're trying to convince a provider to accept somebody. You don't want to show all the warts for fear of running them off. 108 00:13:10.700 --> 00:13:22.770 Amy Ingles: But we say this to everyone. Just tell us. you know we understand that there may be challenges to serve in a person, but it's much easier 109 00:13:22.780 --> 00:13:26.389 Amy Ingles: to deal with them. If you have. 110 00:13:26.790 --> 00:13:37.390 Amy Ingles: you know, if you actually have all the information that you need. Things could have been. you know. completed 111 00:13:38.510 --> 00:13:42.429 Amy Ingles: way before he came to us. We could have been better prepared for sure. 112 00:13:42.830 --> 00:13:54.550 Amy Ingles: Amy, real quick. I wanted to. Gillian had a question, and then we've got a couple of pleat things in the chat related to the trauma, so I don't want to move too far from what 113 00:13:54.620 --> 00:13:55.890 Lesley Cottrell: I wanted to get 114 00:13:56.590 --> 00:13:57.610 gillian mccarty: sorry board. 115 00:13:57.770 --> 00:14:00.010 We have an unpopular opinion. 116 00:14:00.140 --> 00:14:01.399 gillian mccarty: To be honest. 117 00:14:01.540 --> 00:14:06.540 I don't believe that everybody who has an id diagnosis 118 00:14:07.810 --> 00:14:12.440 gillian mccarty: means that they also should be eligible for waiver 119 00:14:12.930 --> 00:14:15.680 gillian mccarty: or I. dB, waiver that 120 00:14:17.550 --> 00:14:22.340 Amy Ingles: the I know what you're saying. I know what you're saying. 121 00:14:22.370 --> 00:14:29.369 gillian mccarty: There could be other programs that might be better suited to him. Well, and it sounds to me like 122 00:14:29.420 --> 00:14:42.570 gillian mccarty: he is a danger to himself and to others on a regular occurrence basis that wouldn't be appropriate to be out of the institutional setting 123 00:14:42.730 --> 00:14:54.990 gillian mccarty: until they could properly get his medications under control in that setting and then slowly integrate him into the community properly. 124 00:14:56.230 --> 00:15:01.030 gillian mccarty: Those institutions into 125 00:15:01.420 --> 00:15:08.430 gillian mccarty: the general population is not appropriate for everybody, just because they have an id diagnosis. 126 00:15:08.670 --> 00:15:21.059 Amy Ingles: Yeah, I don't believe that the Idd diagnosis was the thing that we focused our attention on when he was in our care, and I should also mention that he was forensic 127 00:15:21.070 --> 00:15:26.720 Amy Ingles: when he was at sharp, but his jurisdiction ended, and they didn't have any 128 00:15:26.770 --> 00:15:30.210 Amy Ingles: reason for him to remain there at that time. 129 00:15:30.410 --> 00:15:32.779 gillian mccarty: but just because somebody 130 00:15:32.950 --> 00:15:42.049 gillian mccarty: time is served still doesn't mean that it's appropriate to release them into the general population of the world. 131 00:15:42.090 --> 00:15:45.299 Amy Ingles: Much option 132 00:15:45.580 --> 00:15:54.140 gillian mccarty: But it has always been my. An impression that I did waiver is a 133 00:15:55.060 --> 00:16:05.449 gillian mccarty: is a volunteer program, not an entitlement program. and I understand that he has a D Hr. Guardian, but you still have to have a willing participant. 134 00:16:06.180 --> 00:16:19.440 Amy Ingles: Yeah. well, that's not the first time we've had somebody on the program that didn't necessarily want to be on the program. That does happen. And we usually can get past that a lot of times. It's just a matter of 135 00:16:19.520 --> 00:16:23.730 Amy Ingles: maybe not knowing that they're 136 00:16:23.890 --> 00:16:30.700 Amy Ingles: opinions and their wants and and hopes and dreams and goals are gonna be 137 00:16:31.010 --> 00:16:34.740 Amy Ingles: something that the team respects. 138 00:16:34.950 --> 00:16:40.800 Amy Ingles: But in this case he just simply did not want Staff in his home. 139 00:16:40.920 --> 00:16:45.619 Amy Ingles: He didn't want anybody. He felt like it was intrusive. 140 00:16:45.710 --> 00:16:50.389 Amy Ingles: He wanted to go. Do what he you know it. You gotta remember. This is a young fella. 141 00:16:50.480 --> 00:16:53.039 gillian mccarty: He was in a intrusive. 142 00:16:53.220 --> 00:16:59.150 Amy Ingles: and he wanted to have the freedom to go out and do things that maybe 143 00:16:59.590 --> 00:17:01.309 Amy Ingles: you know. Oh. 144 00:17:01.880 --> 00:17:12.169 Amy Ingles: would you? He would end up back in jail eventually. But so what options? Well, we ended up with this fella in the hospital. Okay? 145 00:17:12.970 --> 00:17:14.660 Amy Ingles: But 146 00:17:15.910 --> 00:17:18.599 he went through all of these placements. 147 00:17:18.990 --> 00:17:20.240 Amy Ingles: and 148 00:17:20.780 --> 00:17:32.169 Amy Ingles: what I guess our question would have been, what could we have possibly done differently as far as placements now, and I should mention to a couple of things that we tried 149 00:17:32.760 --> 00:17:37.059 Amy Ingles: like Bob mentioned, there was not 150 00:17:37.810 --> 00:17:48.679 Amy Ingles: the option of a crisis placement. We. We thought that we were going to be able to place him with one of the 2 crisis units. One wasn't open yet. 151 00:17:48.900 --> 00:17:53.049 Amy Ingles: They had absolutely no staff and nothing on the horizon. 152 00:17:53.170 --> 00:18:01.719 Amy Ingles: and the other, initially considered placing him. But their medical director had very 153 00:18:01.890 --> 00:18:05.530 Amy Ingles: had very 154 00:18:05.830 --> 00:18:16.199 Amy Ingles: serious concerns about placing him in the in that facility with other Idd folks that were maybe not as high functioning 155 00:18:16.950 --> 00:18:28.419 Amy Ingles: you know, unable to protect themselves. Kind of situation. So their medical director, I guess Googled the name like they do, and 156 00:18:28.480 --> 00:18:31.950 Amy Ingles: that was the end of that. You know. They just couldn't place them 157 00:18:32.000 --> 00:18:34.140 Amy Ingles: have that option 158 00:18:34.390 --> 00:18:37.329 gillian mccarty: afforded the the ability. 159 00:18:37.890 --> 00:18:47.099 gillian mccarty: Even with staff like was his staff drivers. Was he able to go into the community and come and go with his staff as he pleased. 160 00:18:47.380 --> 00:18:52.210 Amy Ingles: Sure, sure, he went in the community that wasn't an issue. 161 00:18:52.220 --> 00:18:54.039 Amy Ingles: Now, of course. 162 00:18:54.370 --> 00:19:02.120 Amy Ingles: let's compound the problem here with Covid. There were certain times that we we did not. 163 00:19:02.360 --> 00:19:04.489 Amy Ingles: We didn't have our 164 00:19:04.560 --> 00:19:23.050 Amy Ingles: our consumers out and about as much, you know. We had a Huntington terrible hot spot for Covid, so they weren't going to the grocery store every week. He wasn't going. And of course, at this point he's living in a hotel. So it wasn't, you know. He ate out a lot 165 00:19:23.230 --> 00:19:36.689 Amy Ingles: which is also not good but you know he could make you know sandwiches, or have a salad or cereal, but he wasn't. He wasn't participating in a regular day. 166 00:19:36.830 --> 00:19:47.240 Amy Ingles: like everyone else that lives in the community has the opportunity to do so. Does anybody? Can anybody think of a resource that might be 167 00:19:47.480 --> 00:19:49.910 Amy Ingles: You know 168 00:19:50.670 --> 00:20:02.490 Amy Ingles: out there that we didn't think of? As far as this person we did make a referral. We discuss making referrals to an act program. 169 00:20:02.700 --> 00:20:10.889 Lesley Cottrell: Oh, I'm sorry I'm not scrolling down over here. I'll just let you know when they come in 170 00:20:11.370 --> 00:20:14.710 Lesley Cottrell: Jason. You want to give your resource idea. 171 00:20:15.010 --> 00:20:17.200 Jason Bowlick: Yeah. Can you hear me? All right. 172 00:20:17.990 --> 00:20:22.230 Jason Bowlick: very cool. Did you try the home of your own program? If he was one on one. 173 00:20:23.410 --> 00:20:36.580 Amy Ingles: no, I don't think honestly, that's a good, that's a good point. Cause. Then he could just break all of his own stuff, and then he doesn't have to go to hotels and apartments. Right? Exactly 174 00:20:36.620 --> 00:20:51.460 Jason Bowlick: so. When I was 18 and I was in college, I worked for id waiver Agency that had a one on one person. This person sounds more mental health than they do id like, Julian said. I feel like he was dumped off, maybe 175 00:20:51.460 --> 00:21:16.569 Jason Bowlick: to a provider. And then you find out all this stuff after the fact. And that's exactly what's happening now. But id waiver agencies aren't accepting people as dump offs from the hospitals anymore. So that's the real issue. I feel like is just the all. It's just easier to give it to somebody who's willing to do it. So that part in and of itself is the reason why we're having this conversation right now. 176 00:21:16.810 --> 00:21:23.749 Amy Ingles: Yeah, I mean, and I think that you're right. I don't think that they intentionally are trying to be a 177 00:21:23.760 --> 00:21:40.340 Amy Ingles: there's no like subterfuge going on here where they're like. Let's find somebody that doesn't know. And but a lot of times. you know, like I said, information doesn't get shared with the provider agency because of fear of of somebody backing out 178 00:21:40.450 --> 00:21:55.419 Amy Ingles: and and the the truth is, is, we you know, we really don't care. you know, whatever, if the hospital saying that this person's stable. then I think the issue has been for providers that there's no. 179 00:21:55.600 --> 00:21:57.159 Amy Ingles: there's no out. 180 00:21:57.190 --> 00:22:08.640 Amy Ingles: If it doesn't work out. It used to be that when somebody was discharged from the hospital, you could get this temporary order protection, where, if you know 181 00:22:08.840 --> 00:22:22.900 Amy Ingles: a and like, I said, like Bob said, it's not good to just take somebody out of the hospital, and on day one they suddenly are in the community, right? Cause? I worked with the person that was discharged from Colin Anderson. 182 00:22:22.930 --> 00:22:40.420 Jason Bowlick: They had severe trauma. They actually were married and had a husband and children. Some of the children was with siblings, but this person was one on one they had their own home. They physically assaulted me as a 19 year old. 183 00:22:40.420 --> 00:22:57.129 Jason Bowlick: Supports with supervision was very lacking. Part of the reason why I'm in this program currently. But like there are situations where people were discharged from institutions with mental health issues. And because of those mental health issues. They have low IQ 184 00:22:57.130 --> 00:23:21.899 Jason Bowlick: because of, you know, either task avoidance or potentially. The standardized testing for Iqs was not catered to someone with mental health. So like this guy specifically is gonna have perpetual problems, probably for the rest of his life, because of mental health. But the stigma of society is is that? Oh, we'll take whoever we'll send them to whoever will take care of them, because that's what's easiest and hopefully the cheapest. 185 00:23:22.010 --> 00:23:23.940 Jason Bowlick: So like 186 00:23:23.950 --> 00:23:49.569 Jason Bowlick: I feel like this is more of the same of what we're seeing now. And the people that are currently in the institutions are probably going to continue to have this problem perpetually until crisis is addressed. The rates of pay is addressed like all of these issues, aren't something that new to discuss. No, it's just kind of gotten. It's come to a head. Really, it's come ahead again like this. 187 00:23:49.810 --> 00:23:51.590 Amy Ingles: Yeah, this is this is 188 00:23:51.840 --> 00:24:05.009 Amy Ingles: come. And it's definitely gotten worse. Like Bob said, we have 70 people hospitalized with Idd. There doesn't. There's some definite holes in the continue of care we've got. You know. 189 00:24:05.040 --> 00:24:16.039 Amy Ingles: We don't really have a whole lot of options. As far as crisis placements go, we don't have a step down unit which would be amazing for these people that are in the hospital. 190 00:24:16.190 --> 00:24:28.160 Amy Ingles: That has just a it's still gonna have that Icf level of care that they're getting in the hospital in the community 191 00:24:28.430 --> 00:24:35.870 Amy Ingles: the problem that we have. And and so a lot of this is just inherent problems that you have with 192 00:24:35.910 --> 00:24:47.459 Amy Ingles: Medicaid programs. And I don't know if the answer is not a Medicaid program is what they should be participating in temporarily before they get on waiver like something 193 00:24:47.570 --> 00:24:49.030 Amy Ingles: something else. 194 00:24:49.360 --> 00:25:10.559 Jason Bowlick: The problem is is how you gonna fund something like that 100%. And like, you're my hero at the moment. Cause you took. So like, I am 100% on your side, it's just that it's hard to talk agencies into doing something when they're weighing the liability risk as opposed to what they're gonna get reimbursed for care of service. 195 00:25:11.010 --> 00:25:33.750 Amy Ingles: This is Baba. She's my hero, too, and liability has been mentioned a lot in the chat, and and there's been a lot of discussion in the chat real quick, Jason. Question for you, Melina had mentioned, or ask if home of your own program still exists. You mentioned that 196 00:25:34.310 --> 00:25:36.409 Lesley Cottrell: has it been renamed, can you? 197 00:25:36.830 --> 00:25:53.869 Jason Bowlick: I mean, I haven't looked it up at a long time, but like looking at the person to earn their own house, if they have fixed income with, like any of the incentives for people to live in West Virginia like, that's case management. That's something that people have to do to like, plan and get set up for people. 198 00:25:54.150 --> 00:26:01.690 Jason Bowlick: The the bigger part is just kind of looking at what you like. Looking at what we have in our toolbox is like 199 00:26:01.780 --> 00:26:18.780 Jason Bowlick: getting pretty low. So that's kind of where we're at and like, just for the fact that, like every we had this rate study that came out that said, all the States around us have higher rates of pay, and it not be introduced to the legislature, for the budget talks 200 00:26:18.790 --> 00:26:28.319 Jason Bowlick: absolutely something that come up yesterday that there was a bill that was introduced yesterday afternoon 201 00:26:28.390 --> 00:26:30.349 Amy Ingles: in House health. 202 00:26:30.550 --> 00:26:36.779 Amy Ingles: and it got a lot. There was a lot of really good conversation 203 00:26:36.890 --> 00:26:44.730 Amy Ingles: that came out of that. And and one of the great things that I thought came out of that 204 00:26:44.840 --> 00:26:50.359 Amy Ingles: that committee meeting yesterday was that Mike Folio, who's 205 00:26:50.590 --> 00:27:02.929 Amy Ingles: the attorney for disability rights. He laid it out like what the problem was. And you know what the solutions gonna have to be 206 00:27:03.270 --> 00:27:25.539 Jason Bowlick: right. Cause this isn't new. Amy did a rate study for Dhr. In 2,022, and that was submitted the legislature, with the exact like, not the same results, but the same, general, you gotta. You gotta put more into the programs. And what happened with that last year. So like. 207 00:27:25.550 --> 00:27:33.179 Amy Ingles: yeah, that was. And that was unfortunate. I think we were all riding off of the Covid, the Arpa money that we received. 208 00:27:33.240 --> 00:27:37.580 Amy Ingles: But it it definitely was. 209 00:27:38.320 --> 00:27:49.089 Jason Bowlick: you know, it was like putting a Band-aid on an amputation right? And I got severe, like children with severe disabilities like weighing if they're gonna move out of state or not. 210 00:27:49.260 --> 00:28:04.010 Amy Ingles: Yeah, that's that's unfortunate, Amy, could you share the bill number that Mike was present? Yeah, the bill is Bill 4, 4, 0 8. And that was the initial bill was to discuss the development 211 00:28:04.250 --> 00:28:17.930 Amy Ingles: of a 20 bed up to 20 bed Icf. For folks that have Idd, Dd. Waver or Idd, and and very significant disabilities 212 00:28:18.040 --> 00:28:26.319 Amy Ingles: was supposed to be like a transitional type home, and a good point was brought up. We have currently 70 213 00:28:26.440 --> 00:28:37.140 Amy Ingles: 70 open beds right now in the existing Icf, I system. So you know, obviously, more beds, maybe, isn't. 214 00:28:38.180 --> 00:28:50.549 Amy Ingles: It's a complex problem. and maybe morbid isn't going to be the only solution. Obviously, if you open an Icf with 20 beds, you're gonna have a lot of staff. 215 00:28:50.660 --> 00:28:56.120 Amy Ingles: You're going to be competing against a very small pool of people right now. 216 00:28:57.020 --> 00:29:16.179 Bob Hansen: But if we don't fix and work on workforce issues which salaries and having us a viable crisis service system, creating another facility doesn't improve anything really, just, it's just more open beds. 217 00:29:16.340 --> 00:29:21.689 gillian mccarty: They need to find a way to put funding into what already exists before they 218 00:29:21.710 --> 00:29:29.960 gillian mccarty: release more slots before they release more beds. Let's service the people that we already have on the system. 219 00:29:30.310 --> 00:29:31.730 gillian mccarty: Functionally. 220 00:29:32.310 --> 00:29:33.140 Amy Ingles: Yeah. 221 00:29:33.540 --> 00:29:38.620 Amy Ingles: I mean, you have to understand that not everyone on the program 222 00:29:38.660 --> 00:29:40.519 Amy Ingles: is in this. 223 00:29:41.520 --> 00:29:54.360 Amy Ingles: you know, in this situation we're not, you know, a lot of the people that are on Idd waiver live at home with family and and that's just fine. I think the issue that we're running into are these. 224 00:29:54.600 --> 00:30:03.049 Amy Ingles: you know, iss and group home consumers where you know. Maybe they've got. You know. 225 00:30:03.490 --> 00:30:11.580 Amy Ingles: trauma history, youth services, involvement. A lot of these people come from out of state. We just admitted somebody 226 00:30:11.850 --> 00:30:17.749 Amy Ingles: back in November that had been out of in and out of state placement in Utah. 227 00:30:17.990 --> 00:30:19.700 Amy Ingles: and 228 00:30:19.780 --> 00:30:30.989 Amy Ingles: got is, you know, basically applied for Idd waiver. And you know, we just have an interim setting for him until they can figure out what his long term placement is going to be. 229 00:30:31.330 --> 00:30:32.700 Amy Ingles: But 230 00:30:32.970 --> 00:30:38.300 Amy Ingles: it's it's rough. I mean, we have. We have 231 00:30:38.780 --> 00:30:50.750 gillian mccarty: a lot of members who, you're right do live at home. But their parents? I have probably 50 consumers whose parents are over the age of 70. 232 00:30:50.790 --> 00:30:56.479 gillian mccarty: Yeah. And they cannot get local placement for their loved ones. And 233 00:30:56.550 --> 00:31:01.299 and what's going to happen when the people who are providing their care pass away 234 00:31:02.150 --> 00:31:19.639 Amy Ingles: be involved, or another family member, because we get calls every day. I mean, we tell people all the time you better sign up for services. Get them in a day program. Get them in some kind of services. Now. 235 00:31:19.750 --> 00:31:26.379 Amy Ingles: so we, if and when something the inevitable occurs, you have the opportunity 236 00:31:26.470 --> 00:31:39.170 Amy Ingles: to, you know, expand their services and add residential care later on. But what we see a lot of times for these people, we've actually have referrals from clients that have had nothing. 237 00:31:39.290 --> 00:31:46.090 Amy Ingles: They've had 0 services from a behavioral health provider since they graduated from high school 238 00:31:46.400 --> 00:31:54.660 Amy Ingles: or if they even went, I mean, we had a female years ago who came to us that had never attended school. 239 00:31:54.790 --> 00:32:00.189 Amy Ingles: She lived at home with her parents. The only place she ever went in the community was church 240 00:32:00.460 --> 00:32:21.679 Amy Ingles: and the parents died within a couple of months of each other, and a sister who wasn't equipped to deal with the situation, kind of inherited her, and she ended up in a residential placement. But it was like, this is a microwave. This is a stove. This was a 60 year old woman who'd never stepped foot in a kitchen 241 00:32:21.690 --> 00:32:24.870 Amy Ingles: because there's fear that she was gonna be. 242 00:32:24.940 --> 00:32:31.139 Amy Ingles: you know, she's gonna be injured somehow by you know, being there. So you would be amazed 243 00:32:31.440 --> 00:32:36.670 Amy Ingles: at the the absolute spectrum of 244 00:32:36.880 --> 00:32:43.199 Amy Ingles: of cases that we get. And that's part of the problem. It's like there's very little expertise 245 00:32:43.280 --> 00:32:54.799 Amy Ingles: in dealing with clients that are duly diagnosed, and you have to. Almost. It's like kind of a catch. 22. You want to be in an area where there's resources. 246 00:32:54.920 --> 00:33:06.010 Amy Ingles: You know that there's good psychiatric services, that there's available activities for these folks. But a lot of times these are people that come from very rural settings. 247 00:33:06.060 --> 00:33:15.340 Amy Ingles: and they have a very difficult time adjusting to. I guess I'll call it city life. Huntington's, you know. It's a city. 248 00:33:15.410 --> 00:33:22.700 Amy Ingles: and they're not used to having neighbors. You're not used to seeing police routinely up and down the roads. 249 00:33:22.830 --> 00:33:26.129 Amy Ingles: and it is hard for a lot of people to adjust. 250 00:33:27.330 --> 00:33:43.660 Lesley Cottrell: Sorry. We just kind of got on the weeds in the weeds on that, and that's that's where we need to go. I just chat as things close out, people are putting potential additional resources. I don't know. 251 00:33:44.110 --> 00:33:53.930 Lesley Cottrell: So, Kelly Mark Tucker, would you? All? Wanna I mean, I know you put some things in the chat. But please say more on that end. 252 00:33:57.160 --> 00:33:59.809 Bob Hansen: Thanks, Jason, for putting that up, too. 253 00:34:02.650 --> 00:34:04.009 Tucker Riggleman: Hi, can you hear me? 254 00:34:05.150 --> 00:34:19.890 Tucker Riggleman: Yeah. I was just wondering about if this individuals ever connected with peer recovery. I know. You said they were in Huntington. There's Recovery Point and several other resources there. I know that doesn't directly help with finding them a place, but 255 00:34:19.900 --> 00:34:32.009 Tucker Riggleman: They are connected in that world a lot, and I have been a peer recovery specialist in the State, and worked closely with lots of housing groups and things like that. So just wondering if they were ever connected. 256 00:34:32.340 --> 00:34:34.969 Amy Ingles: No, it actually it wasn't. 257 00:34:35.920 --> 00:34:42.389 I don't think it was definitely one of the primary issues that we were dealing with. I think it was more of like 258 00:34:43.250 --> 00:34:45.360 Amy Ingles: he was very opportunistic. 259 00:34:45.560 --> 00:34:52.159 Amy Ingles: and at that time it wasn't legal anywhere around here to get marijuana. 260 00:34:52.370 --> 00:34:56.030 Amy Ingles: And so he, you know, he 261 00:34:56.380 --> 00:35:05.560 Amy Ingles: so college town, he figured out which of the neighbors in the areas that we were that he was living. Which of those neighbors had 262 00:35:05.630 --> 00:35:10.699 were were users, and like I said, it wasn't like he was 263 00:35:11.000 --> 00:35:16.629 Amy Ingles: you know, out trying to get a fix anywhere. It was just more opportunistic. 264 00:35:16.920 --> 00:35:20.949 I'm gonna go, become friends with these people and 265 00:35:20.970 --> 00:35:37.709 Amy Ingles: try to get them to give me, you know. Give me some some of the weed. and Ps. While I'm over here I like your dog and then, when these people found out what was going on, they, of course, pitched to fit, and he had to be moved. 266 00:35:37.810 --> 00:35:40.570 Amy Ingles: You know, I know that we talk about 267 00:35:40.710 --> 00:35:47.360 Amy Ingles: people that have forensic histories. Housing for them is an extremely difficult 268 00:35:47.430 --> 00:35:48.760 Amy Ingles: undertaking. 269 00:35:49.020 --> 00:35:54.709 Amy Ingles: They don't qualify for a lot of places if they have any kind of a criminal history. 270 00:35:55.400 --> 00:35:59.440 And there is. There's a lot of cherry picking that goes on. 271 00:35:59.730 --> 00:36:09.580 Amy Ingles: If you're an agency that's fortunate to have a good relationship with a community landlord that has a lot of properties which we do. Thank God! 272 00:36:09.760 --> 00:36:17.669 Amy Ingles: that's about the only way you can accept these people is you get a landlord that is super understanding 273 00:36:17.800 --> 00:36:19.710 Amy Ingles: and doesn't care. 274 00:36:20.190 --> 00:36:30.630 Amy Ingles: You know they don't mind, you know, if as long as you fix it, we were like $78,000 into damages and hotel expenses. 275 00:36:30.650 --> 00:36:35.510 Amy Ingles: So it does become an issue of, you know, at what cost. 276 00:36:35.720 --> 00:36:48.020 Amy Ingles: you know, does serving somebody like this takes away from all the other folks that you're providing care to like. It does it? Is it absolutely eats up all your time energy. 277 00:36:48.030 --> 00:36:53.870 Amy Ingles: and it really isn't fair to everybody else and your resources, you know. 278 00:36:55.050 --> 00:37:02.650 Lesley Cottrell: So this has been a wonderful discussion, and, Amy and Bob, you are absolutely fabulous for getting us started. 279 00:37:02.740 --> 00:37:12.050 Lesley Cottrell: the we just the time is is coming in, and we spend time for lunch to talk to one another. I think it goes by pretty fast with these issues? 280 00:37:12.100 --> 00:37:23.289 Lesley Cottrell: So just a few closing opt items, I do. Wanna give a shout out to Kelly. She's put some chats in there. Please take a look before you. Log off on the on the side of 281 00:37:23.360 --> 00:37:34.579 Lesley Cottrell: family supports marks mentioned specialized family care, which is another option. Again, we need more providers on that side, as well as what Kelly mentioned, which is training 282 00:37:34.630 --> 00:37:48.719 Lesley Cottrell: particularly. And then things like this case, people like in this case, where pre, if they're non verbal, if they're aggressive self-interest, the more you add onto it the less training we have to properly 283 00:37:49.320 --> 00:37:53.950 Lesley Cottrell: approach it. So that's definitely one of the items we need to talk about. So 284 00:37:54.070 --> 00:38:01.300 Lesley Cottrell: everyone, I think. has brought up a topic that's coming up in the next 5 sessions. 285 00:38:01.400 --> 00:38:12.179 Lesley Cottrell: So again, the idea is that this is big. And so we're we're taking a sliver of it and digging deeper in the next few sessions. This is one to get us ready and excited about it. 286 00:38:12.340 --> 00:38:21.639 Lesley Cottrell: So if you like this, if you are ready to push and gather resources and kind of have a bigger voice to this. Join us. 287 00:38:21.650 --> 00:38:24.120 Lesley Cottrell: I put the dates. 288 00:38:24.300 --> 00:38:34.629 Lesley Cottrell: and they were also in the re reservation or registration. Excuse me, they'll be out. We're gonna get it out more often more to more places. As well join us. 289 00:38:34.850 --> 00:38:46.300 Lesley Cottrell: Join us. So some of these resources that people have shared and heather just shared a positive behavior support. Thank you, Heather, we're gonna send this out. We're also gonna send some other overviews. 290 00:38:46.320 --> 00:38:53.769 Lesley Cottrell: And again, just thank you all for voicing whatever perspective you have today, cause it's the only way this is gonna work. 291 00:38:54.100 --> 00:38:58.810 Lesley Cottrell: And so with that, we're gonna close out, I have 292 00:38:58.880 --> 00:39:02.449 Lesley Cottrell: thumbs up. Everyone who said they wanted a certificate of attendance. 293 00:39:03.050 --> 00:39:16.000 Lesley Cottrell: They're coming in. So if you forgot to do that, please do that, I'll let it roll for a little bit and thank you for spending your lunch with us. We really appreciate it. Amy and Bob.