After shift rant

[Sassy5d]

Just needed to blow off some frustration to understanding folks.

We have a youngster that used to come in every so often, by police, for psych eval.

Long story short, his parent would tell him to do something at home, stop playing a video game or they would just butt heads, the youngin would respond by screaming, throwing a fit and breaking something. The the police get called and he gets brought in.

The youngster, over 12, does not act out when he comes in, he allows us to do what we need to do, is slightly resistant, as most youngsters are, but no behaviors.

I notice the visits are becoming more and more frequent, it's the same story. If he's told to do something or stop playing his video game, he responds by throwing a fit and breaking something. I've heard the parent multiple times say 'I just can't handle him'

Now I don't know what goes on behind closed doors, or at their house. But like I said, the visits are getting more and more frequent. Are we missing the mark on referrals? He's on medications and takes them. I'm not trying to be judgmental here, I'm looking for honest suggestions. It seems to me like possibly some lack of home structure.. He becomes unruly, you call the police, he comes to the hospital. He hangs out with us, parent shows up and wants to then take him home.

Pt and parent now know everyone at work on first name basis.

I'm just wondering what sort of message is further being taught to this kid. Do whatever you want and the only consequence is a time out in the hospital for a few hours.

[CP2013]

I've heard of this in children before, like an oppositional defiant disorder perhaps.

If he's already on medications, see if that counselor is also investigating if there are a)triggers that still set him off and/or b)if other combinations of medications would be more beneficial (if they are even needed at all).

Some schools will sit children down with a counselor for evaluation if they act out in class. If this is only happening at home, a call to the prescriber/counselor may be needed to explain how frequent the visits are becoming and that perhaps parenting classes are in order. I have seen parenting classes offered by a child's therapist so that the parents are able to more effectively manage the challenges of raising a preteen.

[Altra, BSN, RN]

I'm just wondering what sort of message is further being taught to this kid. Do whatever you want and the only consequence is a time out in the hospital for a few hours.

What sort of message? At the very least, a horribly dependent one. I think you know that.

You mentioned that the patient is on meds - psych meds? If there is psych history and he is brought to the ER for acute out of control behavior/psych eval -- is his psych provider/case manager/crisis manager contacted? I would be very surprised if that kind of "referral" has not been made.

[Anna Flaxis, BSN, RN]

What kind of behavioral health resources are available in your area? It sounds like this family might benefit from seeing a family therapist, and that the youngster might benefit from having his own counselor that he can confide in. I think this would be the first step for me, trying to find community resources for this family. Counseling services are covered by many insurance plans for a reasonable copay. Start digging and find out what's available in your community.