This youth came into our ER 9/13 from Grandparents home, who are custodians. He was just in our inpatient unit until 9/11. He came in for suicidal ideation and was cleared for discharge. It’s reported by his team that ongoing he uses suicidal threats to get out of unpreferred activities, and if that doesn’t result in what he wants, he escalates further. He had safety planned with our team for discharge, but when Grandma called him on 9/14 to discuss, he was making suicidal statements to avoid returning home and Grandma then refused to get him. Grandma tried to get him again 9/16 but when she showed up to the ED he escalated and threw an object at her and she left the ED. It’s reported he’s been struggling since the death of his great grandma early last month. Currently there is no recommendation for residential or higher level of care. He’s done PHP in the past and is currently set up with CTSS, DBT, Individual therapy, family therapy and psychiatry at home, but has been in the hospital a lot so hasn’t gotten a lot of these services, and uses suicidal statements to get out of participating in some of them. The County is not exploring any out of home placements at this time. Bereavement counseling and respite were discussed, but those can’t begin until he is discharged. He has endorsed that he enjoys the hospital setting and ambulance rides.