Patients mother shared that the patient has an extensive treatment history, but has continued to struggle with challenging behaviors and emotion dysregulation. Mom described that “over the last few days he’s just been a terror, despite our best efforts. He freaks out when we try to redirect him. Mom reported that the patient has “aggressive towards people, getting physical and violent, he’s been assaulting his younger brothers.” Mom described that on the day of admission the patient had been going into his brother’s bedroom “trying to annoy them,” and hitting them. Mom called her husband, the patient’s step-father, who is currently out of state for work. The patient’s step-father spoke to the patient over the phone and told him that he needs to change his behavior and reminded him that he has been through so many different programs and should be able to “put on the breaks” with his behavior. The patient began talking back and got confrontational with his step-father, asking “what are you going to do about it?” The patient’s step-father indicated that their would be consequences when he returned and urged the patient not to put his job at-risk by making him return home early to deal with his behaviors. The patient challenged his step-father further making statements such as “fuck you, why don’t you say that to my face?” and “bet, come home then and see what happens.” The patient further stated “I’ll shoot you in the fucking face, right through the eyes.” Mom reported that their is a gun in the home, however it is locked in a gun safe and the patient does not have access to this. Mom then asked the patient where he would get a gun from and the patient indicated that his friends at school have guns. Mom expressed “this has escalated so far beyond me. We are walking on eggshells from the time he gets home from school until he goes back the next day.” Mom reported that she did not feel safe bringing the patient back home. She reported that she had attempted to press charges on the patient today, however police had declined and brought him to the emergency department instead. The patient is uninsured, county is working on his application, but he does not have a county social worker. Has a contracted mental health case manager through Fernbrook.