PSYCHIATRIC – CERTIFICATE OF NEED
Dewayne Lowe (DOB: 06/08/2010) is a 12-year-old African American right-handed male
who was admitted to Spring Grove Hospital Center (SGHC) on May 2022. He was
transferred from Charles H. Hickey, Jr. School (CHHJS), where he was admitted on May
2022, to SGHC pursuant to the court order from the Circuit Court for Baltimore County
Sitting as a Juvenile Court in May 2022 for a competency evaluation and in May 2022 for
emergency evaluation including psychiatric evaluation and medication reconciliation. The
court order stated: “The Respondent should return before the Circuit Court for Baltimore
County on June 2022.”
Dewayne has 12 counts of pending charges including Robbery with Dangerous Weapon;
Robbery; Assault-First Degree (x2); Assault-Second Degree (x2); Att-Dangerous Weapon-
Int/Injure; Dangerous Weapon: Conceal; Threat of Mass Violence; Theft: $100 To
Under $1,500; Malicious Destruction Of Property/Value Less Than $1,000; and Animal
Cruel Fail: Provide from an alleged incident that occurred in May 2022.
SOURCES OF INFORMATION
– SGHC records of Dewayne Lowe at SGHC, dated between May 2022 and June 2022.
– Phone interview with Dewayne Lowe's maternal aunt, Dianna Moore, on multiple occasions since Dewayne's admission to SGHC in May 2022. Partially reliable.
– Records from Charles H. Hickey, Jr. School including emails, dated in May 2022.
– Court orders from the Circuit Court for Baltimore County Sitting as a Juvenile Court, in May 2022. Reliable.
– State of Maryland Department of Health and Mental Hygiene Division of Vital Records, Certificate of Live Birth, Date issued was in 2010. Reliable.
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– Psychiatric Evaluation from Catholic Charities Baltimore by OMHC Baltimore City BARDS DSS team, dated in April 2022. Reliable.
– Psychiatric Evaluation completed in November 2017. Reliable.
– Baltimore City Public School records, dated between 2014 and 2019. Reliable.
HISTORY OF PRESENT ILLNESS
Dewayne was upset when he arrived at SGHC. He expressed frustration about the length of
time he spent in a van while transported from CHHJS to SGHC. When he entered SGHC
after completing a COVID-19 rapid test, he continued to express his frustration. He became
upset when he was given a mask to wear. He also did not want to comply with admission
photography and covered his face with his hands. When he was redirected to wear a mask before
entering the unit, Day B, he started cursing at staff members and threw a mask on the floor. It
was picked up by a staff member and when he was offered a mask again, he started becoming
agitated. Dewayne cursed at staff members, clenched his fists and made verbal threats to hurt
staff members. Due to ongoing agitation, more security officers came on the scene.
Dewayne then opted to don a facemask, but he remained upset.
Upon arrival to the unit, Dewayne continued to show agitation, using profanity and making
threats that he would hurt others. Because of ongoing agitation, he was offered as-needed
(PRN) medications (lorazepam-anxiolytic and chlorpromazine-antipsychotic) which he initially
refused but eventually accepted encouragement. Within couple of minutes of taking the
medications, he displayed a change in his behavior. He was more calm and pleasant. In
addition, he stopped using profanity and making threats to others. Instead, he was saying “thank
you” when a security officer brought him some snacks after Dewayne reported feeling
hungry. The admission assessment continued until he started feeling sedated from the
medications and went to nap.
Dewayne reported “I worry about her (mother) a lot” after he heard from her that she
was diagnosed with breast cancer while he was at CHHJS. Later, I found out, his mother
was not diagnosed with breast cancer by his guardian, Dianna Moore, who told me: “He
(Dewayne) is lying.” Ms. Moore reported Dewayne has difficulty telling being truthful. For
example, Dewayne stated his date of birth is June 8, 2008 on his birth certificate, when his actual
birth date is June 8, 2010. Dewayne also said his cousin died two years ago, which Ms. Moore
said was untrue. She clarified that the last time any family member was shot was in 2011
when Dewayne was a year old. Dewayne also reported he was living with his brother, who is
four years younger than him, in the community, but Ms. Moore stated his younger brother
never lived with Dewayne. She described Dewayne's behavior as “he always lies… real bad
liar and manipulator.” Ms. Moore shared with me in November 2021, Dewayne reported her
boyfriend was trying to kill him with a gun, which she said, “none of that is true.”
Dewayne denied feeling depressed or having issues with sleep or appetite. Ms. Moore, however,
feels he has been showing some signs of sadness after his maternal grandmother, who lived with
Dewayne since age seven months, passed away when Dewayne was three years old. She pointed
out Dewayne has difficulty regulating his mood as he gets quickly angry and acts
aggressively. He previously reported to an evaluator at Catholic Charities Baltimore that he
struggles with anger.
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While Dewayne was at CHHJS, there were four restraints documented. In May 11, 2022,
Dewayne reported he felt “lied [to] and said COVID was over and it wasn’t” and he was
“becoming an imminent threat while in Douglas Hall.” He was subsequently placed in
restraint. On May 14, 2022, Dewayne “took their (staff) keys” and was restrained “due to
becoming an imminent threat to self and or others.” On May 17, 2022, Dewayne was restrained
“due to an imminent threat.” On May 18, 2022, Dewayne made an allegation toward DJS
staff and also was restrained “for becoming an imminent threat to self and/ or [sic] others.”
On May 21, 2022, Dewayne was not restrained but he “broke the Television on Douglas Hall
while youths [sic] were having leisure time.”
Psychiatric evaluation completed April 2022 noted “A certificate of need was provided in Feb
2022; however, DSS was unable to find the recommended placement.” Dewayne “eloped from a treatment foster care placement as well as from his aunt’s home. There have
been countless incidents where he has been AWOL in the past few months.” When he is out of
home, he tends to engage in risky behavior such as “sexual activity, smoke cannabis, and
has attempted robbery. He has two active charges in Baltimore County for first degree
assault and armed robbery for an incident in which patient went into a grocery store with a
bebe gun with intent to rob them.” It was noted that Dewayne incurred several more theft charges
since the grocery store incident. In March 2022 he ran away from home and was not located until
April 2022 when Dewayne asked his DSS worker to pick him up in Hagerstown. He was placed
back with his aunt but ran away again a few days later. It was noted Dewayne “was placed on
punishment and smashed her car window with bricks. Following this event, he was caught on
camera stealing [a] package off of a friend’s porch.” In April 2022, he injured his shoulder while
he was trying to forcefully enter his aunt’s home by running into a door and self-presented to an
Dewayne's aunt, Ms. Moore, reported he frequently ran away overnight from home and at times
went missing for days to weeks since age 10. Ms. Moore told me when Dewayne does not have a
place to go, he goes to a hospital emergency room, police station or “any type of
building.” There are about 20 to 30 police reports filed due to him running away from home.
One time, Dewayne went to Johns Hopkins Hospital emergency room and told a staff member
there that his aunt was parking a car and he had back pain. He was given Motrin and got
treated for it. Then, child protective service (CPS) was contacted as his aunt was not showing
up, as she was not there and she did not know about this. Ms. Moore stated Dewayne was
also asking “random people to see if he could stay” with them.
PAST PSYCHIATRIC HISTORY
Previous diagnoses: Dewayne was previously diagnosed with Attention-Deficit/
Hyperactivity disorder, Predominantly inattentive presentation; Unspecified Trauma- and
Stressor-Related Disorder; Oppositional Defiant Disorder.
Previous admission: Available record indicated in March 2022, Dewayne was hospitalized
at Johns Hopkins Hospital Bayview for 10 days after endorsing suicidal ideation. Dewayne's aunt stated, “I don’t exactly know what happened.”
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Previous suicide attempt: Dewayne never attempted suicide in the past.
Previous non-suicidal self-injurious behavior: Dewayne denied previous self-injurious
behavior and his aunt reported “I never seeing that myself.” Available records indicated in
March 2022, Dewayne was hospitalized at Johns Hopkins Hospital Bayview for 10 days after
endorsing suicidal ideation. Dewayne's aunt stated, “I don’t exactly know what happened.”
Previous medication trials: Methylphenidate (Ritalin), Methylphenidate extended-release
Previous outpatient treatment: Dewayne started receiving mental health services from
Baltimore Child & Adolescent Response System (BCARS) then moved to Villa Maria
school-based service. After the COVID-19 pandemic hit, he could no longer get
medications; thus, his pediatrician started prescribing methylphenidate extended-release
(Concerta, stimulant) 36 milligrams in the morning. Available records indicated Dewayne was in BCARS three times in 2021. He was last admitted to BCARS in February 2022 and
received in-school therapy in fifth grade. When Dewayne was six years old, the school
recommended he see a mental health professional as he did “basically everything that [a]
child with ADHD did.” He was diagnosed with Attention-Deficit/Hyperactivity Disorder
(ADHD) and prescribed methylphenidate (stimulant). He initially had no behavioral issues
at home but at age 10 he started running away from home and “missing for weeks.” Ms. Moore reported Dewayne never told her where he was staying.
Previous community placement: Dewayne was placed in the home of family members and
an unlocked residential treatment center (RTC). He has a history of eloping from the RTC
and leaving his family’s home without permission.
Previous physical, sexual, emotional abuse or neglect: Dewayne reported he does not like
people. He said his 16-year-old cousin was killed in 2020 after a gang member shot him
when “I was around a corner” from the incident. He noted feeling guilty as he feels “I wish I
was there.” He also noted witnessing a “shoot out” about four years ago when he was on his way
Symptoms of trauma: Dewayne reported feeling hypervigilant and negative alteration of his
mood and cognition along with difficulty controlling his anger.
When I asked his aunt, Ms. Moore, about those incidents, she stated “never heard that before,
more than likely [a] lie.” She told me Dewayne struggles with telling the truth to others.
SUBSTANCE ABUSE HISTORY
Dewayne reported using marijuana and tobacco products since age eight. He reported
marijuana products make him feel “happy.” He also reported drinking hard liquors.
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Current medical concerns: None. Available records indicated Dewayne has a history of
eczema, dry skin and increased blood lead level. Dewayne was circumcised at age four.
History of traumatic brain injury: Dewayne does not have a history of traumatic brain
injury according to his legal guardian, Ms. Moore.
History of seizure: none.
Medication allergies: none.
Other allergies: none.
Medication or food intolerances: none.
Medications at the time of admission: none.
SOCIAL & DEVELOPMENTAL HISTORY
Birth and early development: Certificate of live birth indicated Dewayne was born with the
full name, Dewayne Allen Lowe Jr., on June 8, 2010 at 11:30pm from Jessica Olivia Rand (mother) and Dewayne Allen Lowe (father). Mother’s age was 13 and father’s age was 19
when they gave birth to Dewayne.
Family dynamics: Dewayne was born and raised in Baltimore City. His aunt, Dianna Moore, voiced concern that there is community violence and Dewayne is a follower and he
is easily influenced by others. Ms. Moore works as a manager at McDonald’s and she is
looking into transferring her job to North Carolina as this would be a better environment to raise
Education: Dewayne was attending Commodore John Rodgers as a sixth grader. He has 504
for “behavior” issues but no individualized education program (IEP). He has been having more
days missing school than attending recently as he has been frequently running away from
home. When he was attending school consistently, he was getting average grades (Bs and Cs).
Records indicated he was suspended “’a lot’ for fighting peers, accidentally hit a teacher once.”
He also was suspended for threatening school staff and telling administrator he wished he
were dead. Dewayne reported he threw a boot at a school staff member’s head and was
Social: Dewayne was living with his maternal aunt (mother’s maternal half-sister) in
the community. Dewayne stated he can obtain firearms in the community. Dewayne has two
FAMILY HISTORY OF SOMATIC AND MENTAL ILLNESS
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Dewayne's mother (bipolar disorder, ADHD, schizophrenia) and maternal
grandmother (depression, substance use) have mental health issues. Ms. Moore informed
that Dewayne's maternal grandmother had “a lot of mental issues.” Available record indicated
there is a family history of cancer and high blood pressure.
Dewayne reported his first legal contact was at age 10 for “credit card fraud, assault, possession
of fire arm.” Available records indicated Dewayne has two active charges in Baltimore
County for first degree assault and armed robbery for an incident in which he went into a grocery
store with a bebe gun with intent to rob them.
Dewayne was admitted to SGHC court ordered with 12 counts of pending charges
including Robbery with Dangerous Weapon; Robbery; Assault-First Degree (x2); Assault-
Second Degree (x2); Att-Dangerous Weapon-Int/Injure; Dangerous Weapon: Conceal; Threat of
Mass Violence; Theft: $100 To Under $1,500; Malicious Destruction Of Property/Value Less
Than $1,000; and Animal Cruel Fail: Provide from an incident that happened on 5/9/2022.
SGHC – HOSPITAL COURSE
Dewayne was admitted to the SGHC Adolescent Unit in May 2022 and he is going through
evaluations from the following disciplines: psychiatry, psychology, somatic medicine, nursing,
social work, recreational therapy, and occupational therapy.
Mental status on admission:
Dewayne was awake and alert during the interview process. He was oriented to place, time,
and person based on his ability to correctly state today’s month, today’s year, the name of
“crazy hospital” and his DOB.
He was wearing detention-issued clothes and shoes. He had fair personal hygiene and grooming.
He appeared younger than his biological age based on his short stature and slim body. His gait
was stable and he did not appear having any abnormal muscle movement (AIMS was
zero). Initially, Dewayne was oppositional by refusing to comply with wearing a mask, using
profanity at security officers and glaring at staff members. However, after receiving as-
needed (PRN) medication for agitation, he started engaging in the interview properly and his
demeanor was calm with intermittent eye contact.
Dewayne's speech was regular rate and rhythm without any difficulties with articulation.
His thought process was goal directed and linear without any disorganization. He
denied experiencing any thoughts to harm self or others (Suicide Behaviors Questionnaire-
Revised Plus 2, SBQR-2 was 3). He denied paranoia or ideas of reference. However, he
exhibited behavior that would indicate hypervigilance based on him constantly assessing any
threats around him and not liking to have anyone where his back is facing. He did not appear
having any perceptual disturbances and denied experiencing any hallucination.
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Dewayne had an intact ability to register for three objects (penny, table, cat), which indicates
his immediate memory was intact. He exhibited deficient short-term memory based on his ability
to only recall one out of three objects (penny) in five minutes. His long-term memory
appeared intact as he was able to recall the names of a couple of past presidents: “Donald
Trump” and “Barack Obama.” He was able to tell me the name of the current president.
Dewayne's judgment was poor based on his answer (“I’m gonna pick it up and see if money
in there”) when I asked him “What would you do if you find a stamped, addressed and
sealed envelope on a sidewalk?” His insight appeared poor as he did not seem to understand
reasons for his admission to SGHC.
Dewayne did not answer when I asked him how he feels (just glaring at me). His affect was
angry and upset, but this improved after he was given with PRN medications. He was not
able to perform serial 7s (subtracting 7 from 100 and keeps subtracting 7 from the previous
answer) as his answer was “ninety something” when he subtracted seven from 100. He was
able to spell ‘WORLD’ forward but not backward (he spelled it DLORW). His abstraction
ability was not able to be tested as he started feeling sedated from PRN medications given to
Upon admission, Dewayne was placed on one-to-one staff observation for COVID-19
admission quarantine and threat to hurt others. The day after he was admitted, SGHC
received an email from his DJS worker that his COVID-19 PCR testing, which was performed
in May 2022, came back positive. Thus, Dewayne was placed on quarantine. Dewayne struggled wearing a mask properly over his nose and maintaining distance from other peers.
After he completed with COVID-19 admission quarantine, he continued on one-to-one
staff observation for making threats to hurt others.
Dewayne's behavior was described as “oppositional, defiant, rude and disrespectful to staff for
the most part of the shift. He was rude during rehab group, cursed staff walked back to the unit.”
His interaction with other peers was “negative” as he was “cursing and rude to staff.”
Dewayne gets upset when redirected. He was also making a gun gesture with his hand at a
charge nurse. When he was redirected for such behavior “patient became verbally and
physically aggressive posturing in manner to attack staff.”
Dewayne was restrained six times since his admission to SGHC: May 27, May 28, May 29,
May 31, June 5 and June 8. On May 27, he became very agitated and refused to
follow any redirections along with not complying with mask wearing. On May 28, Dewayne was agitated and not complying with wearing a mask. On May 29, he was not following
redirections and wanted to stay in the hallway and did not comply with mask wearing (he was
COVID-19 positive) and was close to another peer, cursing at staff members and made a
threat to “fuck them (staff members) up.” On May 31, Dewayne became upset when staff
could not locate a movie. He kicked trash, threw a food tray, broke a pay phone and threatened
to hit staff. On June 8, he was restrained after throwing a plastic chair, posturing at a staff
member and making threats to hurt
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staff. He received oral as needed medications including lorazepam 1mg, olanzapine 5mg, and
Dewayne was not prescribed any medications while at the detention center. Upon admission
to SGHC, he was not prescribed any medication to assess his clinical symptoms. When he was
seen in milieu, he was struggling with ADHD symptoms including inattention,
hyperactivity and impulsivity. Verbal consent was obtained from his guardian and
Methylphenidate 5 milligram was initiated. Dewayne has been verbalizing not wanting to
take his medications stating his mother would not want him on any medications. When I
called his guardian, she told me there was no conversation with Dewayne about his
medication and she would like Dewayne to take his medications as she feels medications do
help him with his behaviors. He was observed once to spit out his medication; thus he was
ordered to have a mouth checks with each medication administration.
PRIMARY PSYCHIATRIC DISORDERS
Disruptive Mood Dysregulation Disorder (DMDD)
Attention-Deficit/Hyperactivity Disorder, combined presentation (ADHD)
Posttraumatic Stress Disorder (PTSD)
Conduct Disorder, Childhood onset
Cannabis Use Disorder
Tobacco Use Disorder
Alcohol Use Disorder
OTHER MEDICAL CONDITIONS
History of elevated blood lead level
History of dry skin
History of Eczema
1.Dewayne has primary psychiatric diagnoses of Disruptive Mood Dysregulation Disorder (DMDD); Attention-Deficit/Hyperactivity Disorder, combined presentation (ADHD);
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Conduct Disorder, Childhood onset; Posttraumatic Stress Disorder (PTSD); Cannabis
Use Disorder; Tobacco Use Disorder; and Alcohol Use Disorder.
2. In light of available aftercare options and in considering the least restrictive clinically-
appropriate option, Dewayne should be released to the care of a residential treatment
center (RTC) where he would receive intensive mental health care services
including medication management. The program should emphasize anger management,
treatment of oppositional behaviors, and have a substance abuse treatment component.
Considering his PTSD diagnosis, individual trauma therapy is recommended. Family
therapy would be appropriate to provide Dewayne's guardian with resources and
education to provide structure and discipline at home once he is released into the
3. Dewayne should meet with a psychiatrist on a regular basis. He is currently
prescribed methylphenidate 5 milligrams in the morning and methylphenidate 5
milligrams at 1pm.
4. Dewayne should see a primary care provider for regular monitoring of his
physical wellness and prior history of elevated blood lead level, dry skin and
eczema. While Dewayne was at SGHC, he did not require any medications for somatic
5. Dewayne should return to his grade appropriate education. Dewayne was
attending Commodore John Rodgers as a sixth grader. He has 504 for “behavior” issues.
6. Dewayne would benefit from male mentor who can guide him to healthier ways to
manage his anger and encourage him to engage in prosocial behaviors.