About Incest & the Missouri Government Response to It - #Fulton State Hospital (FSH) - #Michael Ayele (a.k.a) W

2. MICHAEL L. PARSON, GOVERNOR • ROBERT J. KNODELL, ACTING DIRECTOR SHARIE L. HAHN, DIRECTOR DIVISION OF LEGAL SERVICES P.O.BOX 1527•BROADWAY STATE OFFICE BUILDING•JEFFERSON CITY,MO65102-1527 WWW.DSS.MO.GOV • 573-751-3229 • 573-522-6092 FAX October 28, 2022 Sent via email: Mr. Michael A. Ayele Waac113@gmail.com RE: Sunshine Law Request – 10/25/2022 Dear Mr. Ayele: I am responding on behalf of the Custodian of Records for the Department of Social Services (DSS) to your information request, which DSS received on October 25, 2022. This response is being submitted within the three-day period required by the Sunshine Law, Section 610.023.3, RSMo. Your request was for: [R]esponsive records detailing [1] the formal/informal ties between the MODMH and the Missouri Department of Social Services (MODSS); [2] the definition in use by MODMH and the MODSS for what constitutes “incest;” [3] the position of the MODMH and the MODSS on incest; [4] whether the MODMH and the MODSS play a leading role in the State of Missouri to prevent incest in the population; [5] whether the MODMH and the MODSS are of the position that it’s fine for siblings in Missouri to “make love” (as Dennis Prager says); [6] whether the MODMH and the MODSS are of the position that the children of incestuous relations face no risk whatsoever to their mental health; [7] the mental health services offered by the MODMH and the MODSS to children of incestuous relations; [8] the mental health services offered by the MODMH to individuals promoting incestuous relations on the internet (such as Dennis Prager); [9] your discussions about the decision of Chris Rock to use the term AUXILIARY AIDS AND SERVICES ARE AVAILABLE UPON REQUEST TO INDIVIDUALS WITH DISABILITIES TDD / TTY: 800-735-2966 RELAY MISSOURI: 711 Missouri Department of Social Services is an Equal Opportunity Employer/Program.

3. Ayele, Michael 10/28/2022 Page 2 “crazy” in his 1999 highly rated stand-up comedy routine; [10] the formal/informal opinions of the MODMH about the word “crazy”. The Missouri Department of Social Services has identified no records maintained by our agency responsive to your request. Without further specificity, DSS is unable to locate or otherwise determine whether it maintains records responsive to your request. A Sunshine Law request must be written in such a manner that the custodian of records can identify the records with “reasonable specificity in order to be able to provide access to them”. Anderson v. Village of Jacksonville, 103 S.W. 3d 109, 196 (Mo.App. W.D. 2003). Please let us know if you have additional specificity to add to your request. I hope you find this information helpful. Sincerely, Sharie Hahn General Counsel Department of Social Services Division of Legal Services (573) 751-3229

4. Missouri Department of Mental Health Fulton State Hospital Hospital Policy Policy SORTS clients will have access to a computer consistent with facility resource availability, community safety needs and treatment needs. Purpose To establish procedures for client access to limited computer and Web based law library resources to meet requirements for client access to legal resource documents while ensuring community safety. Definitions  Ward computers: Facility-owned ward-based computers provided to clients for word processing tasks.  Privilege Room computer: Facility-owned computer located in the Privilege Room.  Web Based Law Library computers: Facility-owned computers designated and configured for access to web-based, law library resources for clients located in the Privilege Room or Game Room  Web Based Law Library: Web-based, Law Library resources provided by subscription through dedicated computers firewalled from access to the facility and department LAN and State of Missouri network. Procedures I. General Computer Procedure A. Clients will sign up for computer time and schedule their use in a manner that will provide equitable time for other clients to access the computer. Client access to the ward computer, Privilege Room computer, and the Web based Law Library computer shall comply with the scheduling protocol established for the use of the computers in the areas where each of these computers are located. B. Clients are not permitted to schedule any computer time during the client’s scheduled class/group time. C. Treatment Team approvals for the use of the ward computers and/or Privilege Room computer to compose, complete or view legal forms or documents shall be limited to the following criteria: 1. When the facility receives documentation from the Court stipulating that a particular document must be typed. 2. When the client includes in the justification section of their Team Request a reference to the court ruling or stipulation document that has been provided to the facility requiring specific documents to be typed. 3. Clients are notrequired to have Treatment Team approval to access the Web Based Law Library computers, except when access to these computers has been previously denied due to clinical reasons or abuse/misuse of these computers. D. Clients are notpermitted to store any data/files to any of the computer hard drives. Clients will have access to facility approved storage disks for storage of data/files. Devices will be purchased by the client through the facility and will be labeled with the client’s name and stored in the appropriate designated area. Clients may only have access to this storage device when HOSPITAL POLICY: RI.01.28.05 Chapter RIGHTS AND RESPONSIBILITIES OF THE INDIVIDUAL Title COMPUTER ACCESS AND USE (SORTS-Fulton) Subchapter Patient Rights Effective Date November 1, 2010 Responsible Party Program Director Review Date September 2022 _________________________________________________________________________________________________________________________ APPROVAL: December 09, 2020

5. Hospital Policy RI.01.28.05 Computer Access and Use- Client Page 2 they are using it on the computer on the ward. Clients cannot take the storage device off the ward. E. With an approved Team Request, clients may purchase a replacement device for any devices that have become damaged or corrupted. The damaged device will need to be turned in to staff before the client is issued a new one. F. The clients must sign the Disclaimer for Client Electronic Disks form when they receive the device they purchase from the facility. G. Clients are not permitted to change any of the computer settings. H. All homework or legal work a client is working on, must pertain to the client doing the work. Clients are not permitted to work on any homework or legal work for other clients. I. Computer use is restricted to stand alone programs. No web/internet based use will be permitted with the exception of the Web Based Law Library resources. J. Clients will be required to follow all guidelines, rules and protocols that may be unique to the location and designated function of the computer being used. K. No food or beverages may be consumed or placed in vicinity of the computer by anyone using the computer. L. SORTS staff will routinely monitor client use of the computers to ensure the proper use of the equipment. Client storage devices may also be viewed for content by staff for safety and security. This monitoring will be conducted randomly and at times when there is an indicated need. M. Any client use or attempted use of the computer and flash drive outside the parameters listed in this policy, or any damage caused to the computer by a client, may result in loss of computer access and privileges for a period of time as determined by the Treatment Team. N. If misuse of the flash drive occurs, these can be confiscated and may not be returned. Additionally, the client may not be able to purchase further flash drives until team approves. O. Clients requesting printed copies of computer data/files are subject to the following protocol: 1. Clients are required to submit a Team Request explaining what is to be printed and the justification. 2. The Treatment Team will review the request for approval or disapproval. 3. Approved requests will be forwarded to the Administrative Support Clerk (Ward Clerk) for assistance with printing. 4. With an approved Team Request, clients may receive, without charge, up to twelve (12) pages per month of printed copies of completed SORTS treatment related homework assignments. 5. A charge will be imposed for all printed copies of documents (other than the twelve (12) pages per month of completed treatment related homework assignments). The client must have sufficient funds to pay for the print copies, and must approve the payment prior to the copies being printed. P. Printed legal documents are included in the permitted quantity of documents the client is permitted to possess on the ward, as outlined in the Basic Items List, unless approved in advance by the Treatment Team. II. Ward Computer A. Clients must sign up on the schedule sheet. Clients are permitted to sign up for computer time between the hours of 6:00 a.m. and 10:00 p.m. on weekdays, or 6:00 a.m. to 12:00 a.m. on weekends and holidays to work on games, approved skills/educational development programs and SORTS treatment related homework. B. Clients are able to sign up for Computer/Privilege Room time as allowed by their privilege level. Please see the SORTS Program Manual for PV-4 and PV-5.

6. Hospital Policy RI.01.28.05 Computer Access and Use- Client Page 3 C. The use of ward computers is limited to games, approved skills/educational development programs and SORTS treatment related homework. III. Privilege Room computer (Other than Web Based Law Library computer) A. Clients are limited to using the Privilege Room computer during scheduled indoor recreation time. B. The use of the Privilege Room computer is limited to games, approved skills/educational development programs and SORTS treatment related homework. C. The client’s flash drive will be stored in a designated area and on sharps count when not in use. IV. Web Based Law Library Computers A. The Web Based Law Library computer is located in the SORTS Privilege Room and is labeled as a Law Library computer. This computer is designated for legal research by clients. B. Access to the Law Library computer does not require prior Treatment Team approval except in circumstances when there is a compelling clinical reason to limit access or the Treatment Team has limited access subsequent to a client’s abuse or misuse of the Law Library computer. C. The Law Library computer is limited to legal research purposes. D. Downloading a copy of information from the Web Based Law Library computer to a storage disk is not permitted. Therefore, a storage device is not available for use with these computers. E. To print information from the law library computer, the client needs to submit a team request to the Paralegal that includes the citation number and number of pages to be printed. F. A charge will be imposed for all printed copies of documents. The client must have sufficient funds to pay for the print copies, and must approve the payment prior to the copies being printed. G. Clients will sign up for computer time to allow for equitable time among users, and clients need to sign up for using these computers on the Law Library Computer Sign-up Sheet. H. A list of clients interested in using the Law Library computer will be maintained. Clients who have had an opportunity to use the Law Library computer will be rotated to the bottom of list each time they use the computer and clients at the top of the list each week will have the first opportunity to sign up for the computers. I. Clients are permitted to sign up for only one time slot at a time. However, clients will be allowed to sign up for an additional time slot, if a vacant time slot remains on the sign-up sheet at the end of the time period the client originally signed up for. Required Documentation Computer Use Sign-Up Sheets (Ward based) Team Request Disclaimer for Client Electronic Disks Open Recreation Sign-Up Sheet VII. References: DOR 8.300 Hospital Policy RI.01.39 Section 191.227 RSMo Basic Items List

7. Missouri Department of Mental Health Fulton State Hospital Hospital Policy Policy Clients may not possess, view, create pornography, sexually suggestive material, depiction of gratuitous violence or clinically inappropriate items that may negatively impact a client’s treatment due to their history of sexual offending/paraphilic disorder. Employees may not bring pornography, suggestive material, or clinically inappropriate items into the facility that negatively impact a client’s treatment. Purpose To set policy and procedures regarding finding and disposition of pornography, suggestive material, or clinically inappropriate items that may negatively impact a client’s treatment. Definitions  Pornography: Anything that depicts or describes humans or animals in an erotic, objectified, degrading, sexually explicit, or fragmented way. This includes but is not limited to:  Full or partial nudity of adults.  Full or partial nudity of children/juveniles.  Sexually explicit material  Sexual material relating to children/juveniles  Sexually violent material  Sexually Suggestive Material: Books, magazines, audio recordings, drawings, writings, movies, TV shows or other media that may be reasonably considered to promote deviant sexual arousal.  Depiction of Gratuitous Violence – Anything that depicts or describes unnecessary or excessive violence, harm, fear, terror or damage; Violence that does not play an integral role in developing the plot, character or theme of the material as a whole; Violence for the sake of being violent or for the enjoyment of observing violence.  Sexually Inappropriate Material: Any items, publications, recordings, drawings, writings and materials used in deviant sexual fantasies and/or for sexual purposes; Or promoting, supporting, justifying, or excusing sexual, emotional or physical abuse of others. Procedures I. All photographs, publications, audio and visual recordings, and property are subject to consideration as pornography, sexually suggestive material, depiction of gratuitous violence or as clinically inappropriate items. A. Possession of obvious pornography, obvious depictions of graphic violence and obvious clinically inappropriate material by clients results in action per facility clinical procedures. All items shall be confiscated and placed in evidence per Hospital Policy EC.02.23., Chain of Evidence. 1. Per security procedures, all property brought by a client or sent to the client is subject to search. (See Hospital Policy RI.01.14 - Client Mail and Packages; SORTS Policy EC.02.38.05- Security Checks) HOSPITAL POLICY: EC.02.24.05 Chapter ENVIRONMENT OF CARE Title PORNOGRAPHY (SORTS-Fulton) Subchapter Safety and Security Access Effective Date November 1, 2010 Responsible Party Program Director Review Date August 2021 APPROVAL: August 12, 2020

8. Hospital Policy EC.02.24.05 Pornography Page 2 2. Random searches and searches for cause of client personal property items may occur at any time. 3. Client items that are questionable as to whether they are pornographic, sexually suggestive, depict gratuitous violence or clinically inappropriate may be referred to the Treatment Team for review and recommendation. 4. The case manager will be notified to address the Problem Behavior Worksheet in a treatment setting with a committed client receiving a Problem Behavior Worksheet. B. Employee items are subject to review upon observation by supervisory staff. 1. Employees intentionally presenting obvious pornography, obvious depictions of graphic violence or obvious clinically inappropriate material to clients, other than in a clinically approved setting, will be subject for review for abuse and neglect under DOR 2.205. Confiscation of the items will occur pending investigation of abuse and neglect. 2. Employees possessing in the facility, but not showing to clients, obvious or possible pornography, obvious depictions of graphic violence or possibly clinically inappropriate material, other than for a clinically appropriate activity, will remove the items from the facility. Repeated incidents will be subject to disciplinary action. 3. Employee items that are questionable as to whether they are pornographic, sexually suggestive, depict gratuitous violence or clinically inappropriate shall be removed from the facility at the discretion of the supervisor, Program Director, or Designee. Obvious pornography, obvious depictions of graphic violence reviewed, or sexually suggestive materials justified, and approved by Program Director or designee for use in a specific client or client group intervention is clinically appropriate. A. Stimulus materials for penile plethysmograph assessment are clinically appropriate. II. References DOR 2.205 DOR 6.010

9. Missouri Department of Mental Health Fulton State Hospital Hospital Policy PURPOSE: To guide staff in the use and monitoring of client electronics and accessories. This includes entertainment and storage devices, e.g., music players, CDs, DVDs, VHS, gaming systems, flash drives, etc. This policy also establishes procedures for clients to access these devices that ensure respectful and appropriate use of the devices and system. Respectful use includes the safety and security of the living area and also takes into account the treatment objectives of individual clients. DEFINITIONS  Single Game Devices: single game devices with a closed system such as electronic solitaire, Yahtzee, etc.  Memory Cards: storage devices used for gaming systems.  Multi-game Devices/Systems: hospital owned game systems based in the ward privilege room (Wii, PlayStation, etc.).  Handheld game devices: small gaming devices designed for individual use and easier ability to carry and store  Games: game discs/cartridges used for play on either handheld game devices or multi-game devices/systems  Flash drives: these are removable data storage devices  MP3s: these are portable music devices that allow the person to record and listen to music  iPods: these are a brand of a portable music device (MP3) that was designed by Apple. PROCEDURES HOSPITAL POLICY: RI.01.39 Chapter RIGHTS AND RESPONSIBILITIES OF THE INDIVIDUAL Subchapter Patient Rights Effective Date May 4, 2017 Title ELECTRONICS AND ACCESSORIES Responsible Party Director of Treatment Services Review Date June 1, 2021 1.The appendix in this policy includes items that are allowed specifically in each center. Additionally, more specific requirements such as brands, privilege levels, etc., can be located on the Approved Technology List located on our internet under Staff Resources, Client Centered Electronics. 2.For new items that are allowed to be owned by the client, a request can be made using the Security Assessment for Use of Electronics form. 3.The Case Managers/designee shall have the client sign a user agreement prior to taking possession or using any entertainment or storage devices. The Personal and Hospital Owned Electronics, Accessories, and Storage Agreement is located on the site mentioned above. It only needs to be completed one time per client. Once signed, the form shall be placed in the medical record. 4.During discharge planning, the case manager may want to access the Electronic Review Other Facilities document if the client is being discharged to one of the minimum security settings. This document provides information on what those facilities allow the client to keep and can be used in helping the client determine disposition of these items during the discharge planning process. 5.Charging devices and cords for all devices are located and should stay in the nursing station/designated area. 6.During shift change, devices with batteries in the client’s possession will be inspected to ensure batteries are in place. Movies/TV _________________________________________________________________________________________________________________________ ET APPROVAL: January 16, 2020

10. Hospital Policy RI.01.39 Electronics and Accessories Page 2 of 6 1.This includes any shows that can be viewed on a device and anything viewed on videos, DVD, VHS, etc. See table in Appendix for what is specifically allowed in each center. a.In NFC, DVDs that are brought to the living areas to be used for groups or activities, etc, must be removed from the living area by the group facilitator immediately following the completion of the group. b.In NFC, DVDs that are to remain on the living area must be added to the sharp count. 2.Movies/TV provided for client viewing should adhere to the following guidelines: a.All movies/TV shown to clients are subject to approval by Program Leadership. This would include individualized decisions that the team determines may have a negative therapeutic value for the client. b.Movies/TV with ratings of G/PG may be shown in all centers. PG-13 may be shown at the discretion of program leadership. R-Rated may be shown at discretion of program leadership in NFC and HFC, but may not be shown in SORTS. c.Any questionable TV show, no matter what the rating, should be taken to Program Leadership for approval. d.No movies/TV depicting excessive violence or explicit sexual scenes shall be shown or used. 3.Movies/TV can be rented using program funds or checked out from the FSH library. 4.Staff are prohibited from bringing in personally-owned/personally-rented videos to show to clients. 5.Clients are allowed to own and store their own movies/TV per program rules. However, these are still subject to the same ratings and criteria as stated above. Additionally, these shows must be commercially produced. Music 1.This includes any musical sounds that can be listened to from any device including radios, tape players, iPods, MP3s, CD players, etc. See table in Appendix for what is specifically allowed in each center. a.In NFC, CDs that are brought to the living areas to be used for groups or activities, etc, must be removed from the living area by the group facilitator immediately following the completion of the group. b.In NFC, CDs that are to remain on the living area must be added to the sharp count. c.In NFC, CDs may be purchased by clients but they must transfer music to an approved media source under the direct supervision of staff and placed in storage or sent outside the facility. 2.Music provided for client listening should adhere to the following guidelines: a.All music the clients listen to are subject to approval by Program Leadership. This would include individualized decisions that the team determines may have a negative therapeutic value for the client. b.Music without parent advisory or explicit warnings may be allowed in all centers. Any music with those warnings may be provided at the discretion of program leadership in NFC and HFC, but is not permitted in SORTS. c.Any questionable music, even without the warning label, should be taken to Program Leadership for approval. d.Music depicting excessive violence or explicit sexual acts shall not be allowed. 3.Hospital-owned devices are kept on inventory in the centers. 4.Storage of personal-owned music devices and accessories is based on program guidelines. 5.Music devices that are permitted on the living area in the Appendix still shall be approved for use by the program and Security. Security may modify the device to meet security guidelines with the client's permission; otherwise, the device will go to storage. 6.Staff may assess the client's current behavior to determine if it is appropriate for him/her to have a music device in their possession. This and any additional restrictions must be included on their ITRP. 7.Purchase of music devices, e.g., MP3 players, can be done through the canteen. If purchase is not from the canteen, the music device needs to be unopened and in original packaging. These will have to be approved by security before the client may have possession of the item.

11. Hospital Policy RI.01.39 Electronics and Accessories Page 3 of 6 8.Clients are required to use their own music to upload to the players, e.g., their own CDs can be uploaded to the MP3 players. In keeping with copyright laws, clients may only transfer music files from their MP3 players from CDs they personally own. Clients may not download MP3 files from the internet. Music files cannot be copied or shared with others. a.Clients may use the computers in the library, groups, case management meetings, etc to upload music as long as staff supervision is available. Client shall be supervised while they transfer music to their personal MP3 player. b.Clients are not permitted to transfer media using the Wed-Based Law Library computers. c.If transferring media to an MP3 player from a CD, the CD shall be sent outside the facility or to storage after transfer is complete. 9.Clients on community or unescorted passes that purchase music devices in the community shall have security and the team approve the purchase prior to keeping possession of the item in their room. 10.All personal-owned music devices must be engraved with the client's name. A Release of Responsibility form must be signed at the time of receipt of the device. Living Area-owned devices should have the hospital name engraved on it. 11.Earphones/speakers must be used except with clock radios per program guidelines. Earphones/speakers should not contain metal. Metal antennas must be removed except in HFC. 12.The volume on the music device must not disturb others. 13.Radios may be taken off the living areas for activities occurring outside the building when allowed by the program. 14.Copies of cassette tapes and CDs are allowed, but must be screened by the team before being given to the client. 15.All devices which record external sounds are not permitted with the exception of clients participating in approved therapy. 16.Music devices with photo capabilities are not permitted on grounds unless special permission is received from the COO/designee. 17.If a client attempts to use the music devices as a weapon or is found dismantling or modifying it, it will be confiscated. The music device will be given to Security and removed from the sharps count as applicable. This shall be recorded in a progress note. Gaming Systems 1.Clients may have access to a game system consistent with facility resource availability, community safety needs, and treatment needs. See table in Appendix for what is specifically allowed in each center. 2.No hospital or personal-owned gaming devices will have recording capabilities. 3.Games provided for client play should adhere to the following guidelines: a.Games are subject to approval by Program Leadership. This would include individualized decisions that the team determines may have a negative therapeutic value for the client. b.Games with ratings of E and Teen G/PG may be used in all centers. Anything above teen is not allowed. c.Any questionable game, no matter what the rating, should be taken to the Team Leader, Program Director, or designated treatment team member for approval. d.No games depicting excessive violence or explicit sexual scenes shall be played. 4.Game time use will be schedules per program. Client access to the game systems shall comply with the scheduling protocol established by the program. 5.Clients are notpermitted to store any data/files to any of the hospital-owned game system hard drives. 6.Memory cards may be used for storage of data/files.

12. Hospital Policy RI.01.39 Electronics and Accessories Page 4 of 6 7.Memory cards may be purchased by the client and will be labeled with the client’s name. a.Purchase of these memory cards will be in accordance with all program established purchasing privileges and procedures. b.Memory cards will be stored in the appropriate location according to program rules. In SORTS, these are on the inventory list and checked out to clients for use. 8.Clients are not permitted to change any of the hospital-owned game system settings. 9.The treatment team will review content on the game device/systems and delete as needed. 10.Client memory cards also may be viewed for content by staff for safety and security. This monitoring will be conducted randomly and at times when there is an indicated need. 11.Any client use or attempted use of the game device/system outside the parameters listed in this policy, or any damage caused to the hospital-owned game device/system by a client, may result in loss of access and privileges for a period of time as determined by the Treatment Team. 12.Clients shall be respectful to others in the space such as using earphones that do not contain metal and ensuring that the volume on the system does not disturb others. 13.Hospital-owned gaming equipment will be checked out to the client for use according to the program rules and availability. 14.Clients may purchase single game devices, games, and accessories for personal use that are compatible with the gaming system/devices, are cordless, and are in accordance with program rules. 15.The number of games, devices, and accessories allowed and their storage will be based on program guidelines and the hospital policy RI.01.17, Personal Belongings and Storage. 16.Storage of personal-owned single game and hand-held game devices is based on program guidelines. Flash Drives 1.Clients may use flash drives within the center per program guidelines. a.Clients in SLP, NOP, and HFC are responsible for storage of their own flash drives. The client is responsible for each flash drive purchased. The hospital will not reimburse the client for lost flash drives. b.In SORTS and RSM, the flash drives must be kept in inventory and checked in and out. The clients may choose to have the flash drive placed in their personal storage. c.In CRAFT, flash drives are not allowed or stored on any ward. They may be kept in personal storage except when in the possession of the case manager for viewing or mailing out by the client. 2.All flash drives shall be labeled with the client's name. 3.No flash drive sent to the hospital from an outside source will be allowed. Once a flash drive is sent to a source outside the hospital it will not be allowed back into the hospital for use. A new flash drive must be purchased along with a new request for their medical record when applicable. 4.Individual risk will be the determining factor as to whether a client may have personal access to a flash drive. 5.Flash drives must be purchased from the canteen. 6.Flash drives are subject to all library and internet rules. 7.If misuse occurs, these can be confiscated and may not be returned. Additionally, the client may not be able to purchase further flash drives until team approves. 8.The HIPAA Omnibus Rule allows consumers to request only their medical record documents that are already maintained in an electronic format be provided in electronic form via a flash drive.

13. Hospital Policy RI.01.39 Electronics and Accessories Page 5 of 6 9.The process for requesting records is outlined in DOR 8.030. The following process will be followed when requesting the record on a flash drive: a.All clients may request medical record documents to be made available to them on flash drives. Clients receive a new flash drive even when request is to update medical record documents from a previous request. The cost for each flash drive request containing medical record documents is $6.50. Clients are responsible for each flash drive purchase as per center/program guidelines. The content of each flash drive will be encrypted and password protected. b.The case manager can provide assistance to view the records stored on the flash drive in the library or program community for clients in CRAFT. Clients in the rest of NFC, SORTS, and HFC may use flash drives within designated areas. c.If the team determines there is risk associated with the client having a personal flash drive: i.Paper medical record copies still are an option. ii.The flash drive still can be used but must be placed in the client's storage. iii.If the request is to send records outside the hospital, the flash drive can be used. 10.If the client wants paper copies of what is on any flash drive, copy costs will be followed. Paper copies of medical records cannot be made from the flash drive, but can be made by HIMD staff from the electronic record for the client. 11.Information/Material from flash drives cannot be copied to any computer or electronic device. 12.Client flash drives may be viewed for content by the treatment team and security for safety and security. This monitoring will be conducted randomly and at times when there is an indicated need. References: RI.01.17 - Personal Belongings and Storage Personal and Hospital Owned Electronics, Accessories, and Storage Agreement

14. Hospital Policy RI.01.39 Electronics and Accessories Page 6 of 6 APPENDIX What is allowed in each center: "Y"--without any additional criteria means that the items is allowed to be personally-owned. The client still would follow the storage and use rules as stated above. "N"--this means that the item is not allowed anywhere in the center Hospital-owned--means the item can be used on the center with staff supervision, but cannot be owned by the client. These items are typically used for group activities. Any other program or criteria specific requirements will be listed as well. Item NFC VHS tapes Y VCR Hospital-Owned DVD Hospital -Owned DVD Players Hospital-Owned Portable DVD Players Hospital-Owned Radios Y Cassettes Y; Not allowed in CRAFT Cassette Tape Players MP3s Y iPods Hospital-Owned CD Player N Single Game Devices Y; Not allowed in CRAFT Multi-Game Devices Hospital-Owned; Not allowed in CRAFT Handheld Game Devices Memory Cards Y; Not allowed in CRAFT Games Y, Personally-owned games must be cartridge only CDs N; may purchase to transfer music supervised Game Controllers Y, cordless Flash Drives Y, if purchased in Canteen SORTS Y Hospital-owned Y Hospital-owned Hospital-owned Y Y HFC Y Hospital-owned Y Hospital-owned Y Y Y Y Y Y Hospital-owned Hospital-owned Y Y Y Hospital-owned Y Y Hospital-owned Hospital-owned Y Hospital-owned Y Y Y Y Y, Personally-owned games must be cartridge only Y Y Y Y, if purchased in Canteen Y, cordless Y, if purchased in Canteen

15. Missouri Department of Mental Health Fulton State Hospital Hospital Policy PURPOSE: To insure space, cleanliness, safety, and prevent increased fire hazard risks, the amount of clothing and other personal items allowed in the client’s bedrooms and other storage areas must be limited. This policy outlines the clothing and accessory allowances consistent with promoting safety and security, while being sensitive to each client’s unique treatment needs and facility space limitations. Coaching and support shall be provided to individual clients throughout this process. All staff must be sensitive to and recognize the importance of personal belongings to each client. HOSPITAL POLICY: RI.01.17 Chapter RIGHTS AND RESPONSIBILITIES OF THE INDIVIDUAL Subchapter Effective Date April 2019 Title Personal Belongings and Storage Responsible Party Director of Treatment Services Review Date April 2022 CLIENT RIGHTS: Clients have the right to wear one’s own clothes and to keep and use personal possessions unless the COO/designee determines that this right is inconsistent with the person’s therapeutic care, treatment, habilitation, rehabilitation (Missouri law (RSMo 630.110)). Public safety is considered in the decision to limit this right. Persons committed under 552.040 RSMo, and 632 (SVP section), shall not be entitled to keep and use personal possessions unless the head of the facility determines that these rights are necessary for the person’s therapeutic care, treatment, habilitation or rehabilitation. Individuals, other than those described, have the right to wear their own clothing unless limited/restricted by the COO or physician order. FSH cannot assume responsibility for theft or damage to any items of value that the client chooses to keep in his/her possession while a client is here. PROCEDURES A.There are three areas where clients may keep or store their belongings depending on the item and space limitations. 1.Each client has bedroom storage 2.Each client has long-term storage 3.Living area lockers are available in SORTS and HFC. 4.Short-term storage is available in NFC. B.Each client is provided a storage tote for hygiene items. All hygiene items should fit within the tote. There also is space available outside the bedroom if necessary due to safety concerns. The specific items allowed and access to the items may vary by the program. C.For areas with living area lockers, staff maintain the keys to the lockers and count them during shift report. 1.Security has a master key available to the lockers if needed. The Master key must be returned immediately after use. D.Personal Belongings and Bedroom storage: 1.Each client can store personal items that are allowed per program requirements including clothing, radio, pictures, etc., in their bedroom. The specific items that are allowed and the limits on those items can be found below in the Appendix, Items Allowed. 2.A personal belongings inventory list is kept and maintained by the storekeeper/designee. The list is maintained on the K Drive, under Clothing Inventory. _________________________________________________________________________________________________________________________ ET APPROVAL: August 19, 2021

16. Hospital Policy RI.01.17 Personal Belongings and Storage Page 2 of 8 3.Each client will be provided a labeled 10 gallon plastic container to store their personal belongings in their room. 4.Except in CRAFT, each client will be provided one art box to store art supplies and any additional storage containers for those supplies. All art/writing supplies need to be able to fit in this container. If client does not want container or cannot have one for safety reasons, art supplies will be provided as necessary and appropriate by program leadership. 5.All personal belongings, excluding clothing and shoes, kept in a client’s room, shall not exceed what can fit in the supplied 10 gallon container. Up to four inches of paper may be stored in the room outside of the 10 gallon container. 6.No food items are allowed in bedrooms. 7.Each client can have one laundry hamper. 8.Radios, watches, calculators, clocks, etc., must have the client’s name engraved on it. 9.When possible, all devices that use batteries need to have a battery compartment that can be secured, e.g., screw used to secure compartment and batteries into device. 10.Batteries (non-rechargeable only): a.May only have number of batteries needed for devices in rooms. b.Additional batteries should be labeled with clients name and stored in lockers or storage in living areas with a maximum number allowed in storage as indicated in the appendix below. c.During shift change, devices with batteries in the client’s possession will be inspected to ensure batteries are in place. d.When it is necessary to replace batteries in the client’s devices, nursing staff shall exchange the batteries and dispose of the used ones in a secure location. e.Batteries purchased in the canteen must be turned into staff on living area to be recorded and stored if not needed immediately. 11.Only furniture that is supplied by the hospital can be in the bedrooms. 12.Only electronics approved by the hospital can be in the bedroom. 13.All charging cords will be kept with the charging stations and are not to be taken to rooms or other areas. 14.SORTS has an additional list in the program manual, the Basic Items List, which further outlines approved belongings. 15.Items that are considered contraband will not be allowed in the living area. Some of the items that are considered contraband may be able to be stored in long-term storage provided they are not included in the list of prohibited items in the long term storage section below. 16.Items not listed in the Appendix below or in excess of the limits listed will need to be approved by the Program Director and Security Supervisor. 17.Items may be removed at any time if it is determined to be a safety or security risk in consultation with the Program Director. E.Each client has a storage area (short or long-term storage) outside of the bedroom for use for any items that exceed the limit allowed in the bedroom or are otherwise not allowed in the living areas. The requirements and limits for this space can be found below in the Appendix, Items Allowed. F.Any requests for additional storage must be sent to the COO/designee. This requires a treatment team request through the Program Director/designee.

17. Hospital Policy RI.01.17 Personal Belongings and Storage Page 3 of 8 G.Property in excess of the bedroom limits or otherwise not allowed may be requested to be placed in storage: 1.FSH will store a limited amount of valuables in the vault in Accounting for those clients who are unable to send excess property outside the facility. 2.Items going to storage must be clearly marked with full name and client number. Items for storage may be dropped off at Security or temporarily stored in a designated area in the living area, if available. 3.All items placed in storage will be listed on an inventory sheet. 4.If the item does not fit in the storage container, a notice will be sent to the appropriate team. 5.The team will have 60 days to work with the client to decide what to do with the item. The Storage Room Supervisor will work with the client and case manager to determine what to do with the property: send items home, donating items, discarding them, etc. 6.If sending outside the facility, the case manager will provide the Storage Room with an address to mail the package and an expenditure slip for funds from their personal account for postage. If no funds are available, program funds may be utilized for postage. 7.If the choice is to mail items or to rent a storage area and no funds are available, the treatment team should develop a time limited plan for the client, not to exceed 6 months, for funds to be saved to allow for postage or storage rental. 8.After 60 days if no decision has been made, the item will be discarded. H.Short-term storage in NFC: 1.Clients may visit short term storage on a regular basis. 2.Blocks of time will be set for the area to be open. If the storage area is not open, a special time to visit may be arranged by the case manager. 3.The inventory list should be checked before allowing items to be taken from the bin. I.Long-term storage: 1.Each client has one storage bin located off the living area a.One 25 gallon bin in NFC b.One 33 gallon bin in SORTS and HFC 2.All items accepted must fit in the bins. 3.Items that are allowed in storage but considered contraband in the living area will be separately bagged in their bin in order to keep it from reaching the living areas. 4.The following items cannot be placed in storage. Any exception to this list must be by approved by the program administration in consultation with the COO. a.Food, open hygiene containers, and/or liquids. b.Liquid containers larger than 25 ounces c.Personal hygiene and makeup products d.Aftershaves and gels e.Aerosol cans f.Eating utensils g.Incense h.Tobacco products/matches/cigarette lighters i.Any material that depicts violence, pornography, or other non-therapeutic content j.Rechargeable or regular batteries k.Drugs or alcohol l.Disposable razors or razor blades m.Weapons of any type n.House plants

18. Hospital Policy RI.01.17 Personal Belongings and Storage Page 4 of 8 J.Accessing/Retrieving items from storage: 1.Clients wanting clothing/items from storage shall request these items through the treatment team using the form “Clients Request for Items for Storage.” a.The Clothing Exchange Record must be completed when items are either placed in or removed from storage bins. b.The staff member accessing the property must ensure that all items are marked with the client’s name and living area before given. 2.Clients can only go through their storage bin with supervision, but will be provided an itemized list of stored items when requested. 3.Access to storage will be available during regular working hours when the storekeeper and/or Case Manager are available. 4.If storing a client’s valuables and/or contraband, the item shall be accounted for and secured in the designated storage area, prior to leaving the area. K.Clients will be informed of the facility’s property/storage requirements at the time of admission and when transferring to a different level of care within the facility. When necessary, visitors also will be informed of this policy. L.At admission, staff with the client will examine the client’s personal belongings and explain the policy. 1.An inventory will be taken. 2.Disposition of belongings will be determined as applicable. For items that are not allowed per the hospital policies on Contraband and Items Allowed, the Disposition of Property form FSH-8057 will be completed. The form will be placed in the chart. 3.Clothing will be labeled with client name/living area then distributed to the living area except in SORTS. 4.A Release of Responsibility Form shall be completed and signed by the client for any jewelry or other personal items that are going to be kept in the living area. M.At discharge, an inventory review of all belongings in bedroom and storage areas will be completed with the client and the case manager/designee. Disposition of the item will need to be determined for any accumulated belongings that are not able to be sent with the client. A jail/prison setting only will accept the items they sent with the client. For items that are not able to be sent with the client, the Disposition of Property form shall be completed. N.Items that come through the mail will be examined by security for potential safety/security risks. Items that are not specifically addressed to the client are not allowed to be delivered to the hospital on behalf of the client. Perishable items cannot be sent or delivered. 1.The client will be notified of any item not approved to be in the living area. a.If the item came from a family member, friend, or was purchased by the client, the client will need to determine what to do with the package within 60 days. The Case Manager will communicate with security if an extension is needed. 1.The package may be placed in storage if allowed and it fits within the allotted amount. 2.The package may be returned to sender at the client’s expense. 3.The package may be discarded. b.If the package came from a company and was not sent/purchased by family, friends, or the client, the package will be immediately returned to the sender. O.When new personal items are approved, the Release of Responsibility Form shall be completed and signed by the client. P.Borrowing, trading, swapping, or selling of personal items is not permitted. Q.Staff may randomly search personal belongings in the living area for contraband. R.When ordering items for clients:

19. Hospital Policy RI.01.17 Personal Belongings and Storage Page 5 of 8 1.If ordering an item that will be stored in the client’s bedroom, case managers shall ensure they have not exceeded the belonging limits for the item in their bedroom before ordering it. 2.If ordering an item that will be stored in the client’s storage, case managers do not need to check storage prior to ordering item. 3.Case Managers/Storekeeper will identify item to order and complete the “Client Request for Purchases by the Canteen” form. The form should be sent to Security either using their drop box or emailing them using the Security Distribution List: DMH.FSH Security. 4.Security will ensure the item is allowed and not considered contraband per policy. a.If the intention is to place the item in storage after receipt, security will check the Storage Capacity file for the client to ensure they have room in their storage for the item. b.If client’s storage is full, the case manager will discuss with client options if they still wish to order the item. 5.If approved, security will send approval with the form to the Canteen. 6.Canteen will order the item. 7.When item arrives, security will check item for any safety/security risks, then have the items sent for labeling or engraving as applicable before sending to canteen. 8.Canteen will contact case manager/Storekeeper when item is ready for pickup for the client. S.There are two Clothing Exchanges/Swap Shops available for all clients: one located in the HOPE center in NFC and the other in the SORTS center. 1.Open hours are posted at the location. If those hours do not meet the needs of the client’s treatment schedule, a special appointment may be made with the Storekeeper. 2.In order to obtain an item at the Swap Shop, an item must be exchanged for it unless approved by the treatment team due to necessity. An exchange slip signed by the case manager/designee shall be provided to the Storekeeper. 3.The Inventory list will be updated with the exchange. T.Items for clients with indigent status: 1.When the treatment team identifies the need for items for clients with indigent status, a purchase requisition will be completed and sent to the Storekeeper. 2.If items are not found in personal storage, the Storekeeper will order item if it cannot be found in the Swap Shop. References: Contraband Items – EC.02.22 Possession of Weapons - EC.02.18 Approved Client Clothing and Accessories – RI.01.18

20. Hospital Policy RI.01.17 Personal Belongings and Storage Page 6 of 8 Personal Belongings APPENDIX Page 1 of 3 Items allowed in bedroom with allowance limits. If N/A is listed, no specific limits set, only required to fit in allotted storage containers. *Some items may have restrictions due to Safety or Security. Refer to the Contraband and Approved Clothing Policies and program manuals for those restrictions. ITEM ALLOWED Clothing and Accessories Jacket/Coat* NFC SORTS HFC 3 1-coat 1-light jacket 3 1 2 1 3 5 14 2 14 14 14 1 1 1 7 1 2 5 3 Shoes/Footwear* Shower Shoes Night Wear/Pajamas (PJs) Robes* Pullovers/sweaters/cardigans/hoodies/sweatshirts Bras* Underwear Thermal Underwear Socks T-Shirts/Shirts/Tops/blouse/tank tops/undershirts/etc Pants/shorts/skirts/dresses Belts* Suspenders* Neckties* Handkerchiefs/Bandanas Gloves* Hats/Caps Hair Ties Plastic Coated Has to fit in hygiene box or container Eyeglasses* Sunglasses* Jewelry (bedroom/locker)* 3 1 3 1 10 5 14 2 14 20 15 1 1 1 2 2 4 N/A 5 1 4 10 5 14 2 14 28 15 2 1 1 3 2 6 N/A 2 2 N/A 2 1 See Basic Item list 1 N/A 2 2 N/A Wristwatches* Billfolds No metal decorations, clips, or leather lacing 2 N/A 3 N/A

21. Hospital Policy RI.01.17 Personal Belongings and Storage Page 7 of 8 Personal Belongings APPENDIX continued Page 2 of 3 ITEM ALLOWED NFC SORTS HFC Music, Electronics, and Accessories Personal music player (MP3, radio, CD Players, etc) May depend on program guidelines Can keep personal speakers for each device except in CRAFT Alarm Clock Antennas must be removed in NFC and SORTS Portable DVD players Hospital-owned only in NFC and SORTS Cassettes/CD’s/DVDs/VHS tapes In NFC, no CDs/DVDs are allowed In SORTS, limit is dependent on privilege level In HFC, limits are set by privilege/pass level (escorted pass; unescorted pass; and community pass levels) Calculators Must have Technology Services team and treatment team approval Electronic personal organizer/Calendar Must have Technology Services team and treatment team approval Hand held computer games Needs Technology Services team approval In SORTS, only single game devices allowed Refer to Electronics and Accessories policy for more requirements Single Game Devices Refer to Electronics and Accessories policy for more requirements Games: Cartridge only in NFC and HFC Refer to Electronics and Accessories policy for more requirements Flash drives Refer to Electronics and Accessories policy for more requirements Memory cards 16 Gb limit per card Game Controllers Must be cordless except SORTS Headphones: In NFC and SORTS excluding: oAny with metal bands oAny with long, strong unbreakable strings or cords Batteries No rechargeable batteries Extras that do not fit in devices must be labeled and kept in locker or living area storage 2 (one of each) 2 3 (one of each) 1; not allowed in CRAFT 0 1 1 0 1 15 3-30 20/30/40 1; not allowed in CRAFT 1 1 1; not allowed in CRAFT 1 1 1 1 N/A 2 1 N/A N/A N/A N/A N/A N/A N/A 1 per device 2 1 per device 1 1 1 2 2 2 8 8 12

22. Hospital Policy RI.01.17 Personal Belongings and Storage Page 8 of 8 Personal Belongings APPENDIX continued Page 3 of 3 ITEM ALLOWED NFC SORTS HFC Other Personal Belongings Books or magazines (any combination, including religious materials): Has to fit in container In SORTS, limit is dependent on privilege level Art Supplies per program guidelines Has to fit in art box or tote May have additional program limits Writing tablet Has to fit in container Pen/pencil Only flex pens/pencils in NFC; CRAFT must check in/out Has to fit in art box or tote All papers, including personal, legal, religious Not to exceed (approximately 4 inches) outside of their bin Comb/brush/pic Has to fit in hygiene box or tote Stuffed animals and excludes: Approved on an individual basis in SORTS Cannot exceed 12 inches in height Note: Each room is allowed 1 weighted animal that is approved by team and security outside the stuffed animal limits. Pictures, posters, calendars: Cannot have any with spiral edges Cannot be displayed on doors or windows) No more than 20% covering each wall Has to fit in tote if not on wall May have additional limits based on program or privilege level Hygiene items* Has to fit in hygiene tote May have additional program limits Electric razors Kept in locked cabinet In HFC, may keep if on community pass Beard Trimmer Kept in locked cabinet In HFC, may keep if on community pass House Plants Not allowed in NFC and SORTS Blankets Queen size or smaller; should not touch floor when bed is made Pillows Not allowed in CRAFT Towels/Washcloths In SORTS, Gold Privilege level required Not allowed in CRAFT 10 4-10 10 N/A N/A N/A N/A N/A N/A 10 N/A N/A N/A N/A N/A N/A 1 N/A 5 N/A 5 N/A N/A N/A N/A N/A N/A 1 1 1 1 1 1 0 0 N/A 1 1 1 2 2 2 3 sets 3 sets 4 sets

23. APPENDIX A.

36. APPENDIX B.