CPAN Case of the Month – April 2023

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April's case of the month

Each month, PCPs call CPAN with a wide variety of mental health questions. Find out how CPAN helped a doctor

Patient: 30-month-old male with unspecified developmental and behavioral issues.

Reason for CPAN Consultation: PCP requested assistance with next steps to help get patient connected with appropriate assessment and intervention.

Assessment, referrals and resources were requested for a 2-year-old with severe self-injurious behavior including head-banging to the point of losing teeth, scratching and biting self. Provider sent referrals to ECI, developmental pediatrics, occupational and speech therapy and requested a soft helmet—but the patient was still waiting after months. With many social barriers to follow up, the pediatrician had recently sent the family to the ER where little assistance was provided and CPS was called. Provider, a new attending, reached out to CPAN for direction. The CPAN psychiatrist recommended labs, EEG and a follow up with the CPAN BHS.

BHS suggested the following: Ask parent if the patient has any staring spells. If so, add this information along with description of the severity of self-injury and MCHAT (high positive) score in second referral marked “urgent”. Send the same description to Genetics. Follow-up after assessment with CPAN BHS for additional referrals.

Outcome: The patient was seen by Neurology within a few days, diagnosed with Autism, provided a helmet and given a prescription of ABA therapy. Neurology connected the patient with a department social worker to assist with other needs.