Case Study: Kempsville Acute

1.) Describe the method or methods you would use to determine priorities for both existing and potential services that the Lakeview Medical Center might offer.

Presenting Problem: Dejon has a diagnosis of ADHD- CT, Disruptive Mood Dysregulation Disorder, and R/o Learning Disorder. He has presented with being verbally and physically aggressive towards his siblings and mother, and he requires constant adult supervision. He is impulsive and he lacks the skills needed to be trusted in the community. De’jon’s poor judgment leads him to be put in situations where he is either harming others or setting himself up to be injured. He was involved in a shooting of a 7 year old child in the head with bb gun in Marcy 2016. He intentionally obtained the bb gun. He also threatened bodily harm to school staff and was involved with shoving a teacher this past school year. He has poor coping skills and he becomes explosive and dangerous to others when he is in frustrating situations.

Furthermore, stays at a friends house while his mother works from 1:00am to 5:00am. Per documentation the patient presents with mannerism of throwing his head back, laughing at inappropriate times, and throws his hands over eyes to talk. The patient presented with these behaviors during the time of assessment. According to collateral the patient reports to "Ms. Mitchell, principal at Tabernacle Elementary School, that he was going to kill himself and others." Collateral reports that patient cut himself with a broken razor from a pencil sharpener. Further, the patient reports that he is useless and that no one likes him nor does he have anyone to play video games with. The patient expresses these thoughts during the assessment. According to collateral the patient has multiple incidents with his behavior since 2013. As noted, "Some of these behaviors including pulling string out around neck from sweatshirt, smashing milk in cafeteria, kicking others students, swinging a waffle bat at another student, inappropriate language and hitting a student on the bus." The mother expresses that the patient does not see a need to go to school and wishes to stay home.

Pt is a 12 y/o African American female presented at NNBHC with dx of ADHD combine type, ODD, Disruptive Mood Dysregulation D/O, Mood D/O, PTSD and Sexual Abuse (victim/ perpetrator), who have been feeling severely depressed and SI. Pt states that she has had SI with a plan to overdose or cut her wrist. Pt is considered high risk due her unsuccessful attempt to commit suicide on 7/5/2015 by taking a handful (unknown quantity) of Clonidine. She was hospitalized at CHKD until she was medially stable, than transferred to Maryview for mental stabilization. Pt states that she is unable to contract for safety at this time, and unsure of what she may do due to her impulsivity. Pt has also have been currently distributing nude pictures to adult males via cell phone. Virginia Beach Police Department is involved with the solicition of child pornography per report from pt mother. Pt have been using explicit communication of sexual acts via text message with males and females. Since 7/5/15 there have been a change in medication Vyvanse 70mg to 30mg. Pt have a hx of becoming verbally aggressive towards hospital staff when medications change. Pt denies any psychosis or paranoid thinking.

The client has high motivation for treatment within MRFH. The client was diagnosed with Alcohol Use Disorder: Severe and Cocaine Use Disorder (crack): Moderate. The client sought treatment at MRFH when he realized he had lost control of using alcohol and crack cocaine. The client stated he attended the MRFH program in the 1980 's but does not remember the exact date of attendance. The client stated he was diagnosed with Mild Depression by a primary care physician when he was 56-years-old. The client reports he has no history of suicidal or homicidal attempts, and currently denies having any suicidal ideations or homicidal ideations. The client stated one to two times per week he experiences muscle tension and worrying about things that he often realizes have no significance. The client stated prior to the age of 18-years-old, "I would knock over my neighbors mailboxes and destroy their gardens, because they would make my parents aware of my wrong doings and that was way of getting them back." The client stated, there was one time that I started a fire and blamed it on my brother. I would break things as well and blame someone else. The client stated if there was an event taking place that he wanted to participate in, he would rush and complete what he was doing so he could become involved in other events taking place around him. The client stated, "I started using drugs and alcohol without thinking about what the consequences. The client appeared to be oriented to the

T.R. is a 69 year old, Caucasian female with a history of schizophrenia who presented to University Hospital Medical Center Emergency Room under Baker Act for recent suicidal attempt. According to the Baker Act report, she ran out of her retirement facility, trying to be hit by vehicles. She suffered a slight injury to her right ankle, as the slightly slightly hit her in an effort to abruptly stop the vehicle. She verbalized to police officers she wanted to die. She reported that peers in her retirement community learned about her history and had been gossiping about her. She reported increased paranoia due to this. She was hospitalized in the same psychiatric unit two months ago, after she was diagnosed with depression. Patient states the reason she was diagnosed with depression is because her two sons are not willing to talk to her. She states that she is separated and living without her family in an Assisted Living Facility. As per patient and chart review, the patient was born and raised in New Jersey and moved to South Florida. The patient currently lives in a retirement home and had to move several times to the different Assisted Living Facility, due to her paranoia and delusional behavior. She is currently retired and reports that she used to work from home as a home health aide. She has two sons and tries to maintain a good relationship with them, but denies any contact with them. She reports the biggest stressor is basically a relationship with her

This patient is currently in Foster care. He has been moved from Dublin, Ga to Hazlehurst, Ga. He was

Pt is a 12 y/o Caucasian female presenting to NNBHC due to self-harming behaviors. The pt stated that she had an “episode” last night stating she was crying and inconsolable making SI statements and self-harmed. Pt showed assessor about 10 superficial slashes from a razor she used to her left forearm. The pt stated she had it in her room for almost 5 months just in case if she felt she was needed to feel the pain. Mother reports she was there during the episode and the left the pt for less than 2 minutes when she engaged in self-harming behaviors. The pt stated this episode went on for almost a 1.5hr, and there was an unknown trigger. Per mother report there have been some stressors in regards of the mother and father

Presenting Problem: Zachary has required x3 inpatient hospitalization within a 6 month time frame. Zachary struggles with communication in the family dynamics that generally evoke anger, irritability, physical aggression, and suicidal statements. Most recently he was admitted at NNBHC due to SI, HI statements and AWOL behaviors. He is not compliant with medication compliance or participating in outpatient treatment. He states overall mood has been on and off with periods of feeling down. He reports decrease interest in activities.

Gadsden is located in the northeastern corner of Alabama and is the county seat of Etowah County. It is 60 miles

Plans: BHH-HWE will continue to provide health and wellness support to Matt and his family. The next meeting will be scheduled in conjunction with the

Providing quality delivery care is the cornerstone of Kaiser operation and addressing language needs of the diverse communities it serves is receiving attention from the National Diversity and Inclusion Office. Kaiser’s National Diversity and Inclusion was established with the objective to promote, support, and assist the regions in implementing the Kaiser Permanente Board of Directors agenda in providing culturally competent medical care and culturally appropriate services to improve the health and satisfaction of its members.

Michael is a 12 years old boy who is a slim built and he is attending year seven at a local High school for visual Arts and Design. Michael is living with his mother, father, and younger brother. Michael has presented symptoms of severe stress, moderate mood, and normal anxiety during the last week before the assessment. Michael has a history Obsessive Compulsive Disorder and he indicated fears of harming other, resulting in checking and reassurance behaviour as well as he tended to be a perfectionist on some tasks. Michael reported a symptom of liable mood, increased energy and hyperactive behaviour for a month-long period in the last three months. Also, he had a symptom of difficulties with attention and

He walks around with a hard on. Ja’Kevion alleged that Tray who is 4 or 5 years older, messed with him when he was 4 years old. The incident happened one time. Tray stays in Wilkinson County and has MDDD. His mom name is Stacey and the reporter stated Marion would have more information for that family. Mom said Ja’Kevion told her about the incident and she told him not to go around Tray. She did not report the allegation. Reporter stated mom does not leave the children home alone with each other. She makes Ja’Kevion sit by himself and she keeps the younger children with her. She is afraid to leave the children around Ja’Kevion. Reporter feels there is something wrong with Ja’Kevion. He appears depressed. He look like he has a lot on his mind. At school last year the reporter noticed he did not socialize with the other child and he was to himself. He do not have a behavior problem. Mom wanted to tell the reporter is information because she wants to get Ja’Kevion some help. Reporter stated mom is a private person. The family have working utilities and food in the home. Reporter is not aware

The significance of community hospitals such as Community Hospital in Monmouth County, New Jersey, is greater than one may expect for primary and secondary care services provided to the local communities around the United States. Community Hospital’s mission is to provide exceptional primary care. However, with the declination of profitability in primary care, Community Hospital has had to compete with Shore University Medical Center (SUMC) and University Hospital (UH) for revenue restoration. The decline of Medicare and Medicaid reimbursements and the steady progression toward specialty care vs. primary care require a core alteration to the mission statement to adjust to the changes within the current healthcare system. A newly modified mission and vision statement will prove that Community Hospital has the ability to regain its relevance within the healthcare industry as a leading primary care provider in the community and increase its revenue. The implementation of the new mission and vision for Community Hospital is expected to be upheld without compromising the core values of compassion, advancement, reputation, efficiency, and physician integration. A few proposed strategies to help Community Hospital create a new and improved business model, may seem cumbersome and challenging, however could greatly improve the overall direction of Community Hospital.