Case Study: Mr. Flowers

D-Met with the patient to address a fax from DCF request of the patient records. The patient immediately said, " Don't send this shit. I cannot stand that worker.....I was in court the other day and I am tired of this and this worker always in my business." The writer explained to the patient that should he continue to refuse to sign an ROI, it may hurt his reunification with his son as the patient detailed to this writer about how DCF got involved in his life ( According to the patient, he was intoxicated when visiting his son and a case was called against him and the child's mother). The patient made it clear to the writer that he has no desires to signed an ROI for DCF and for the clinic to ignore DCF request.

Mental health: Client reported that he is currently waiting for an appointment for MH services from his OTP. The client reported his intention to continue attending a PTSD support group while in the program. Client denied having any S/I and H/I at this time.

Mr. Julian is a 47 year old male who presented to the ED via LEO under petition for a mental health evaluation by his wife for alleged suicidal ideation and substance abuse. TTS assessed Mr. Julian on today's date and reports he does not meet commitment criteria. TACT spoke with Dr. Jody Osborne who recommended to rescind petition. TACT assisted with rescinding petition and delivering paperwork to clerk of court. TACT spoke with wife in regards to a valid phone number for her to be contacted. She reports her cell phone number is (336) 963-7186. Mrs. Julian also proceeded to inform me of the situation which brought Mr. Julian to the ED. She reported her husband "stealing" her key to her lock box, which her handgun is in and taking it out to

Haskey was very upset by this, she was under the impression that Mr. Haskey was going to Arbor Ridge for rehabilitation. Mr. Haskey retorted by saying “Arbor ridge was full so they are putting me here”. Mr. Haskey was very adamant of this and insisted in being put in his own bed. Mrs. Haskey was very distressed by this and stated “I can’t take care of you, I’m not a nurse and I don’t know how to help you and if you fall I cannot possibly lift you up”. While on the way out S/O EMT Perez was very unsure about the situation at hand and stated to Mrs. Haskey that he would immediately report this to his supervisor. After S/O EMT Perez cleared he talked to his supervisor S/S EMT Salamy about the situation and eventually found out after following up with the Arbor Ridge Nursing staff that Mr. Haskey had a room ready for him and that the staff were waiting for his arrival. After receiving this news S/O EMT Perez, S/O EMT Ayesu and S/S Salamy reported back up to CT-403 and S/S Salamy explained the situation to Mrs. Haskey and apologized for the mis-communication error that had happened at some point during the return process. S/O EMT Ayesu and S/S EMT Salamy escorted Mr. Haskey to his room at Oak Grove 3205 and with the help of S/O EMT Perez and the nursing staff placed MR. Haskey in his

RMHU: Evesole, no problems, spoke to him briefly, was waiting for medical to disburse his medication. Evesole also went out to the recreation yard for fresh air for about 10 minutes. Mr. Evesole also is requesting to attend church, I have not given him an answer as of yet, wasn’t sure if he could. I’m adding that Mr. Evesole has been very cooperative today with appropriate behaviors and verbal discussions, with staff and clinical. Alexander, V. wrote order for him to stay on Constant Observation due to masturbating the night before also a code was called. I spoke to him and

Reporting party (RP) stated he arrived at the facility to meet with resident George Dixon (7/11/52) on 3/29/17. Resident was recently placed at the facility after being released from the hospital. Staff did not allow RP to enter the facility so that he could conduct his metal health assessment for the resident. RP presented his business card from his agency but was still denied entry. The resident has been enrolled in RP's program since 02/01/16 and has been visited previously by Social Worker Kathy Kleinman and by staff Denise Ramirez on 3/10/17. Staff told RP that he has to contact the administrator to make an appointment to visit with resident. RP's agency faxed over the consent for treatment to the facility and the DMH contract. Patient's

SC met with Pa, for scheduled RA HV in Pa's home on 03/1/2016. The completed both the LCD and CMI assessment. Pa appeared clean, appropriately dressed in PJ's and sitting on the couch SC in the home. Present in the home were the Pa visiting nurse Scott from Millennium home care. He was on the phone trying to order the Pa medicines. Also Pa’s aide was present from the agency aide. Pa appeared weak and in discomfort. The SC asked Pa if she okay and she reported that she is in a lot of pain. The SC asked if she is taking her medications and she reported that she ran out that’s why the nurse is helping now. The SC asked the Pa how did that happen and she stated that when she saw her PCP in January for her post hospital and rehab discharged he

Erica Yelverton /QDDP submitted, 8/16- 6/16 MARS, 8/16- 6/16 progress report, 8/6/16-8/9/16 Cross bridge nursing progress note, physician progress note & Baptist South inpatient 8/7/16 preliminary note, since her last visit Crossbridge admitted Misty on 8/6/16 due to suicidal threats, had incidents on 8/6/16 ( VA, Elopement) & 7/13/16 (PD, SIB & 1 PRN) and her tegretol level (6.2) was done on 7/18/16, currently she is inpatient at Crossbridge awaiting an commitment hearing on 8/16/16.She does not have a legal guardian.

D-Met with the patient as she placed on HOLD due to recent concern of her overall well-being reported by Nurse Frank as he reported to this writer yesterday of his concerns that the patient's boyfriend is refusing her to increase on her methadone due to an agreement and the patient tends to appear emotional. Upon meeting with the patient, the patient immediately knew why she is meeting with her and started to get emotional. Denies feeling SI/HI. According to the patient, she had an agreement with her boyfriend of which she agreed to increase her dose up to 55mgs as her boyfriend will closely monitor her recovery. The patient does not feel unsafe around her boyfriend as she reported. This writer strongly advised the patient that she has rights to her own recovery process because it's her in the recovery and seeking treatment, at which the patient agreed. But says, "I am fine with my current

CM was out on vacation for the period of 5/2/2016 to 5/9/2016. On 5/19/2016, CM met with the client to update Assessment and to complete Other ILP Review. In the meeting client appears to be friendly and cooperative. She appears to have some cognitive impairment. Client reported WECARE/Wellness referred the client to see Dr. Larissa Lempert/Neurology. Next upcoming appointment is scheduled for 5/26/2016. During the meeting session, client was dressed appropriately for the weather and had good hygiene. She ambulates with a cane due to leg problem. Client affect was flat. Client denied suicidal or homicidal ideation.

The patient was placed on HOLD to see the writer to address his non-compliance with treatment. The patient was reminded about his Step 3 of the patient engagement. According to the patient as the writer reviewed the patient case history of his no show for counseling, group attendance, and continuously AWOL, the patient only response was, " I, know." The writer then inquired of the patient efforts to engage in mental health services through ICRC. The patient admits that he haven't done the intake when the deadline was extended for the third time. The writer discussed with the patient about the risk of facing an intent to discharge due to his non-compliance and addressed alternatives such as suboxone and transferring to a clinic in Massachusetts to accommodate the work location. The patient declines the writer's suggestion as he wants to remain with HCRC-Hartford due to the positive treatment and said. " You guys really care....I do not want to be discharge.....I, mean what is the process of the intent of discharge?" The writer explained to the patient about the appeal process as his record will be reviewed by the Practice Manager to determine as to whether or not to forward with the discharge or the discharge to be overturn.

On September 14th a child showed up with her mother for an outpatient procedure. The minor was checked in at registration and then proceeded back to prepare for surgery with the pre-op nurse. At this time the mother further explained that she would be leaving the facility but gave contact information to get a hold of her once the procedure was complete. This information was placed on a note pad and note in the patients file. Once pre-op was complete the child was taken back to the OR were she was cared for by the OR nurse. After the procedure was complete the recovery nurse ensured the patient started to wake and then handed off to the discharge nurse. After waiting for the mother to return for about a half hour the patient started to become upset. Looking in the waiting area and not being able to locate the mother the, once the discharge nurse got a call from security that the father had shown up the nurse gave discharge instructions to the father and allowed the father to take the child.

Mrs. Flowers’ actions are a lifeline to Marguerite because at first Marguerite was silent but Mrs. Flowers said “I had planned to invite you for cookies and lemonade,” and that had made Marguerite feel good that she was thought of and liked. She had read to Marguerite and she had thought “her reading was a wonder in my ears,” she had also trusted Marguerite with a book that was her favorite that was called “A Tale of Two Cities”. Mrs. Flowers had shown Marguerite that she was liked, and she had realized after all that had been done for her that she was liked.

On Saturday 12/12/2015 at 2155 hours, Security Officer Omar Alonso was dispatched to room # 37 for a signal (34) Customer Service Assist. ON arrival he immediately realized that the call was for a Disorderly Patient in ED (51D) and called dispatch for additional officers to respond. While waiting for back up the patient, Armando Montalvo (DOB: 08/15/1986; FIN# 84957381) who was intoxicated, tried to exit the room to leave the unit. Officer Alonso had to use MOAB hands on techniques to restrain the patient and get him back on his stretcher by the time additional Security Officers arrived and assisted in keeping the patient inside the room by using verbal communication.

The therapist met with the client. The client presented as tired and depressed mood aeb reporting that he did not take his medication for 4 days since he AWOLed on last Saturday. The client added that he feels anxious because he does not know what he will do next step as he asked several questions about the consequences of the AWOL and if he will go home soon, or go to another facility, or go to a hospital, and when he will discharge from the facility. The client shared that he AWOL ed with the other client last Saturday and he did not expect that he will be discharged from the facility due to the AWOL especially this is the first time to AWOL. The client stated, “I was at the other facility and I have witnessed several AWOLS and it was for them the second time and they had only tier freeze, but for me they will kick me out of the facility.” The client shared that he feels that it is not fair for him to be punished in this way. The client reported that he does not feel good being alone at the facility and he does not feel okay dealing only with the staff members without peers or other new client at the facility.