Mental Health Collaboration Hub
Presents from home. Patient is known to our facility having previously boarded. Patient lives with aunt and uncle. There are issues with their relationship, and it has been increasingly difficult for aunt and uncle to manage, and they do not want patient to return home.
Ancillary Support Service: CADI Case Manager
A CADI case manager is a professional who works with people with disabilities to help them live as independently as possible in community settings. They are responsible for assessing patient needs, evaluating treatment options, creating treatment plans, coordinating care, and gauging progress. They often work with physicians, social workers, families, and human services providers1. The Community Access for Disability Inclusion (CADI) Waiver is a program that provides home and community-based services to children and adults with disabilities who require the level of care provided in a nursing facility. These services are an alternative to institutionalization and promote optimal health, independence, safety, and community integration.
CH-M13-5196
Patient presented to the ER after an unprovoked stabbing of a sibling in the middle of the night requiring emergency surgery and then proceeded outside in the cold without weather appropriate clothing. Patient has chronic aggressive behaviors towards caretakers and other children.
CH-F11-5026
Pt presented from home, adopted parents, for aggressive behaviors. Third ER visit this month, unable to take pt back home due to frequency and intensity of behaviors as well as 4 other children in the home. Pt initially recommended IP hospitalization, however unable to find placement due to acuity, no beds, or declined due to IQ (56) and inability to participate in programming. Medications adjusted in ER. No violence since medication increase. Family/CADI worker have been looking for more support for several years and pt seems to fall through the cracks due to IQ and aggression.
MHF-F14-5169
Kiddo boarded in our ED from 11/18/24-12/18/24 after being discharged from JEC Miller GH. JEC Miller took her into a temporary placement in an apartment setting while County worked toward another permanent placement. On 1/19/25 she returned to our ED after ingesting glass and was sent to our medical floor, where she is currently boarding. County team is looking into placement options- primarily crisis respite. On CADI. Working on Nexus YCT referral to assist with placement coordination.
HCMCED-M11-4844
On 11/14/24 the patient’s foster parents brought him to HCMC APS after he was discharged from Children’s Hospital St Paul because of his aggressive behavior. When in APS the patient began hitting his foster mom and becoming increasingly agitated. Security had to assist in transporting the patient to an emergency department bed, where he was then put into restraints for his and others safety. He was given sedative medications, IM.
The patient has been in foster care since he was 7 years old. He was physically and emotionally abused by his biological mother. He has been hospitalized at Fariview inpatient pediatric psych for a year, where he was then transferred to a residential treatment center. He has been with his current foster parents since August 7th, 2024.
EH8D-M14-4364
This patient was brought to the hospital by police for aggression and dysregulation exhibited at the group home. He was charged with 5th degree assault after injuring staff members at his group home. His behavior has persisted despite medication adjustments and behavioral plans. He struggles in settings where there is too much sensory input and lack of structure. He has been destroying property and presenting with escalating aggressive, dangerous behaviors, homicidal threats and sexualized behaviors. Despite his impulsive behaviors and subsequent harm to staff members, he displays no remorse, though some question of whether he is able to adequately engage in reality testing possibly related to intellectual disability.
He is a ward of the state. He was placed in foster care at age 6 after suffering from neglect by his biological family. Their rights have been terminated.
NMH8R0MGH-M18-4738
Patient with autism and agitation sent from his new group home awaiting placement options. pt’s DD CM Deqa (612-472-2572) to gather more information regarding the Exception Bed Referral. Deqa shared that she was told that she can either refer for the Exception Bed or MFOC but not both. She is moving forward with the MFOC referral, as it would be a long term placement which would be better for the pt in the long run. She has made it known that the referral to MFOC is urgent. If the MFOC referral is denied, Deqa plans to either push on DHS as they have had an opening for 1 year and have not filled it, and/or pursue the Exception Bed. Deqa said she submitted for the Minnesota State- Operated Community Services (MSOCS) referral on 10/15. DHS Complex Transitions Team referral made on 10/15/24.
HCMCH-M12-4692
12 year old male with ADHD, unspecified mood disorder with recent suicide attempt, T1DM, hypothyroidism, asthma who is in the ED after intentionally setting fire and burning house down. Has an IEP for speech therapy.
PH-F10-4549
Recommendation for level 5 QRTP or level 6 PRTF. Patient is currently in psychiatric inpatient hospitalization.
Ten-year-old female patient with a history of in utero exposure and early childhood trauma and attachment concerns, with a historical diagnosis of FASD-Alcohol-Related Neurodevelopment Disorder (ARND). Patient presents with emotional dysregulation, violent threats and aggression, as well as passive suicidal ideation. Patient has been hospitalized multiple times and participated in several outpatient services.
Discharge Plan:
RTC (recommendation letter sent to CMHCM who is requesting county screening meeting)
-Nexus Gerard (referral sent, reviewing, will hear back week of 9/2)
-Northwood (referral submitted, next opening end of year, will review for acceptance at that time)
-North Homes (declined due not have staffing to meet needs related to aggression, SW requested reconsideration; declined 8/21)
PRTF (PRTF eligibility form sent to DHS 8/16)
-Nexus East Bethel (referral submitted w/PRTF eligibility approval 9/4)
-Grafton (referral submitted w/PRTF eligibility approval 9/4)
Bridging with Day tx
-Catholic Charities (referral pending although may not consider d/t RTC rec, IEP sent, 8 person WL)
Current Providers:
Med Management- Mayo Clinic
CM- Dakota County
CADI waiver- Dakota County contracted provider
CTSS
EHS-M16-4154
Patient was brought to ED after making suicidal and homicidal statements during his psychiatric medication appointment. He was evaluated and inpatient psychiatric stabilization was recommended. While in the ED he has been calm and cooperative. Denying suicidal ideation or Homicidal ideation at this time. He does recognize that he has been dysregulated and struggling to find effective coping skills. Recent increase in conflict at home. Has been engaging in self-harm. Mom does not feel safe having him in the home at this time.