Opinion
No. COA16-678
12-20-2016
IN THE MATTER OF: Q.W.
Attorney General Roy Cooper, by Assistant Attorney General Andrew L. Hayes, for the State. Appellate Defender Glenn Gerding, by Assistant Appellate Defender John F. Carella, for respondent-appellant. Smith Moore Leatherwood, LLP, by Ariel H. Harris and Fred M. Wood, Jr., for appellee Strategic Behavioral Health.
An unpublished opinion of the North Carolina Court of Appeals does not constitute controlling legal authority. Citation is disfavored, but may be permitted in accordance with the provisions of Rule 30(e)(3) of the North Carolina Rules of Appellate Procedure. Mecklenburg County, No. 15 SPC 7408 Appeal by respondent from order entered 16 February 2016 by Judge Tyyawdi M. Hands in Mecklenburg County District Court. Heard in the Court of Appeals 1 December 2016. Attorney General Roy Cooper, by Assistant Attorney General Andrew L. Hayes, for the State. Appellate Defender Glenn Gerding, by Assistant Appellate Defender John F. Carella, for respondent-appellant. Smith Moore Leatherwood, LLP, by Ariel H. Harris and Fred M. Wood, Jr., for appellee Strategic Behavioral Health. TYSON, Judge.
Q.W. ("Respondent") appeals from trial court's order continuing his admission for an additional sixty days at the treatment facility. We affirm.
I. Factual Background
On 13 November 2015, Respondent's mother authorized his voluntary admission to an adolescent psychiatric residential treatment facility. Three days post admission, a licensed social worker conducted an admission evaluation and recommended Respondent be admitted for ninety days. The initial evaluation found Respondent was a fourteen-year-old male, with a long history of behavioral issues and two previous hospitalizations. Respondent was diagnosed as suffering from: (1) attention deficit hyperactivity disorder; (2) oppositional defiant disorder; (3) intermittent explosive disorder; (4) cannabis use disorder; (5) alcohol use disorder; (6) unspecified bipolar disorder; and, (7) a provisional diagnosis of disruptive mood dysregulation disorder.
The evaluation noted Respondent had "a history of starting fires outside of the home, substance abuse, oppositional behavior, noncompliant with his medication for a month or so, running away, angry outbursts, mood instability, anxiety, argumentative behavior, and destruction of property." Respondent had a long history of running away from home. While receiving previous treatment at a group home, he ran away and stayed with a twenty-year-old friend, during which time he consumed and abused alcohol and illegal drugs.
Eleven days later, on 24 November 2015, a hearing was held in the district court on Respondent's continued admission. Based on the social worker's evaluation, the trial court authorized his continued admission for ninety days. Respondent consented to this admission.
On 2 February 2016, the same social worker re-evaluated Respondent and determined that her previous diagnoses were persistent and unchanged. The second evaluation included her previous findings, but added a section to explain why she believed and recommended Respondent needed to continue treatment for an additional sixty days. The social worker found, while Respondent had "made considerable progress over the past month and [had] taken treatment more seriously," issues persisted that needed to be addressed.
She noted that under the treatment center's internal grading system, Respondent had "lost" a level in the previous month, but had recently returned to that level. She stated Respondent admitted he continued to have drug cravings, which needed to be further addressed. Based on her observations, she recommended continued treatment at the facility for an additional sixty days "[d]ue to his needing more treatment on using his positive coping skills to deal with his emotions and establishing an appropriate discharge plan, it is not safe at this time to release him."
On 16 February 2016, the district court held another hearing on Respondent's continued admission. At the hearing, both the social worker and the clinical director of the treatment center testified and recommended Respondent's continued admission for an additional sixty days. Respondent contested this recommendation through counsel and testified on his own behalf. The social worker testified the basis for her recommendation was:
For [Respondent] to continue to work in individual and family therapy on issues around impulsivity, family communication, and rebuilding family relationships. So at this time I am trying to apply to group homes to have him step down from here to a Level 3 group home. So part of the recommendation, I'll get that in place, so he can have a safe and secure discharge.
She also testified to being concerned about Respondent's behavior, while on an outing with the treatment facility three days before the hearing. The social worker stated that while outside the facility, Respondent "got online and started communicating to people in New York, and Mom felt that that was . . . a sign that he's trying several plans to elope." The social worker further testified that Respondent told his mom that if "he gets away, he's going to make sure no one can find him." The social worker concluded she did not believe that, at the time of the hearing, Respondent was ready to step down to any lower levels of supervision and care.
The clinical director of the treatment center, who is responsible for tracking and approving any specialized intervention, also testified that Respondent was not "ready to step down to a Level 3 immediately, let alone [go] home" at the time of the hearing. He testified Respondent's behavior while on the outing was "concerning," because Respondent knew he was not allowed to access Facebook, and Respondent's conduct shows how a "little bit of freedom quickly turns to how do I create plans to get back into my old life." The clinical director also testified if Respondent was discharged from the treatment facility at that point, it would jeopardize Respondent's ability to access case management services.
Respondent testified that he felt he had "been doing good" and was "displaying self control." For example, Respondent stated that he and his roommate were about to fight the day prior to the hearing, but he chose not to be physically aggressive. Respondent also indicated his interest in working to regain his mother's trust, not making any attempts to elope in the month preceding his rehearing, and his participation in the activities offered at the treatment facility. Finally, Respondent testified that he had "no reason to run away" if he were released from the treatment facility and went home.
The trial court authorized Respondent's continued admission for sixty days, but added it would review the matter in thirty days. The trial court incorporated into its order the findings made in the social worker's evaluation, and made the following additional findings:
Continuing to work on impulsivity, family communication and family relationships. Applying to group homes for a safe [discharge] plan. He shuts down in family sessions and has walked out of one. Most recently he went on an outing and talked to folks in NY. He has said if he gets away no one will find him. Resp. [sic] has a long history of elopement. Resp. reports that he still has drug cravings as of last week. Need to develop a safety plan for substance
abuse upon release and to identify triggers and what to do when he is triggered which includes being alone and conflict. Family work and communication are the work he is doing. Also trying to find a group home that is close to home. He has run away from lower levels of care. Resp. is working hard. Therapist believes discharge now would be dangerous given his history of elopement and current behavior. The primary concern is a successful discharge. Resp. is on level W.Respondent appeals.
II. Jurisdiction
Jurisdiction lies in this Court pursuant to N.C. Gen. Stat. § 122C-224.3(h), which allows any party on the record to appeal a district court's decision at a hearing for review of a minor's admission to a treatment facility.
III. Issues
Respondent argues the trial court erred by ordering his continued admission. He asserts the evidence introduced at the hearing failed to support (1) the trial court's finding that discharge would be dangerous; and, (2) the trial court's conclusions that Respondent needed to remain at the treatment facility because lesser measures were insufficient.
IV. Standard of Review
In reviewing voluntary commitment orders, this Court must "determine whether there was any competent evidence to support the facts recorded in the commitment order and whether the trial court's ultimate findings . . . were supported by the facts recorded in the order." In re M.B., ___ N.C. App. ___, ___, 771 S.E.2d 615, 625 (2011) (emphasis supplied) (quoting In re Allison, 216 N.C. App. 297, 299, 715 S.E.2d 912, 914).
V. Analysis
Minors may be admitted to 24-hour facilities by a parent or any other "legally responsible person" in order to receive treatment. N.C. Gen. Stat. § 122C-221(a) (2015). Once admitted, the minor's continued stay is subject to a hearing before the district court. N.C. Gen. Stat. § 122C-224(a) (2015). N.C. Gen. Stat. § 122C-224.3(f) provides that "[f]or an admission to be authorized beyond the hearing, the minor must be (1) mentally ill or a substance abuser and (2) in need of further treatment at the 24-hour facility to which he has been admitted." N.C. Gen. Stat. § 122C-224.3(f) (2015). The court must find these factors by clear, cogent, and convincing evidence. In re M.B., ___ N.C. App. at ___, 771 S.E.2d at 625 .
The statute also holds that "[f]urther treatment at the admitting facility should be undertaken only when lesser measures will be insufficient. It is not necessary that the judge make a finding of dangerousness in order to support a concurrence in the admission." N.C. Gen. Stat. § 122C-224.3(f).
First, Respondent contends the evidence failed to support the trial court's finding that discharge would be dangerous. We agree with the State that this argument is not relevant, as this case is governed by N.C. Gen. §§ 122C-221 to -224.7, regarding voluntary admissions and discharges. The statute clearly states the trial court does not have to make a finding of dangerousness under this statute. N.C. Gen. Stat. § 122C-224.3(f).
Second, Respondent argues the evidence does not support the trial court's conclusion that he needed continued admission at his current treatment facility, and no lesser means were available. We disagree.
Clear, cogent, and convincing evidence in the record supports the trial court's conclusion that Respondent was in need of further treatment at his current facility. The social worker outlined several reasons in both her evaluation and testimony to justify Respondent's continued admission.
For example, she testified that Respondent needed "to continue to work in individual and family therapy on issues around impulsivity, family communication, and rebuilding family relationships." Her evaluation also noted that Respondent's anger in family sessions still emerged impulsively. She testified that Respondent had a long history of elopement and acting impulsively, and that both she and Respondent's mother were concerned he would try to elope upon being released. Respondent had stated, if "he gets away, he's going to make sure no one can find him," and had made unauthorized contact with acquaintances in New York. Regarding Respondent's continued drug cravings, the social worker testified "we need to develop a safety plan so that he does not return to doing that when he is released."
Although both the social worker and clinical director at the facility testified the goal was for Respondent to eventually step down to a Level 3 group home, they both specifically testified, based on their interactions with Respondent, that he was not ready for immediate transition to a Level 3 group home. In fact, the clinical director testified that immediate discharge would jeopardize Respondent's access to services and continued progress.
The clear, cogent, and convincing evidence presented supports the trial court's findings. Those findings ultimately support the trial court's conclusion and ordering Respondent's continued admission at his current treatment facility.
VI. Conclusion
Clear, cogent, and convincing evidence supported the trial court's conclusion that Respondent was "in need of further treatment at the 24-hour facility to which he [had] been admitted." N.C. Gen. Stat. § 122C-224.3(f). The trial court's order is affirmed. It is so ordered.
AFFIRMED.
Judges McCULLOUGH and DILLON concur.
Report per Rule 30(e).