Patient sent to Cambridge medical center ED due to aggression and numerous ED visits from Bar None. Bar None discharging the patient.
Ancillary Support Service: Children's Mental Health Targeted Case Management
Children’s Mental Health Targeted Case Management involves coordinating and managing mental health services for children and youth to ensure they receive appropriate care and support.
PH-F12-5010
12 year old, history of trauma with subsequent depression and anxiety ADHD and anxiety. Multiple treatment interventions at PHP. Patient reports that depression has been worsening over the last several months and has becoming more difficult to manage. Patient reports ongoing suicidal ideation and difficulty thinking about anything in the future that would be of benefit. Patient reports ongoing mood disorder low mood low energy reports difficulty with school reports anxiety.
R
PH-F15-5000
Previously diagnosed with depression, anxiety, PTSD . Numerous admissions to psychiatric hospitals and Emergency Departments because of suicidal ideation, suicide attempts and self-injury. History of CPS, county mental health case managers and crisis services. Plan to jump off a bridge. Self injury has included cutting, scratching, burning and head banging.
PH-F8-4701
Recommendation is for QRTP or PRTF – either could potentially meet the needs of this patient and limited treatment centers available due to patient’s age. Patient is currently in psychiatric inpatient hospitalization.
Patient is an 8-year-old female. Patient presented to inpatient from the ED due to increase in unsafe and risk-taking behaviors. This is her fourth inpatient hospitalization; one in 2022 and three in 2024. Patient has attended day treatment twice and participated in outpatient psychotherapy and medication management.
Discharge Plan:
PRTF/QRTP: (county funding approved for QRTP)
– Grafton (declined due to not meeting criteria)
– Northwood (referrals submitted 9/9, on waitlist 9/23 – awaiting update on admission timelines)
– Gerard (unable to accept due to age)
– Avanti (unable to accept due to age)
– Bar None Haven (unable to accept due to age)
– North Homes (unable to accept due to age)
– Heartland Girls Ranch (unable to accept due to age
Continue with following outside providers:
– Therapy/Therapist: Solutions Behavioral Healthcare Professionals
– Primary Care Provider: Sanford Health
– Medication Management: Solutions Behavioral Healthcare Professionals
– Case Management: Solutions Behavioral Healthcare Professionals
– Occupational Therapy: Beyond Boundaries Therapy and Wellness
PH-M15-4658
Pursuing QRTP – patient is currently in psychiatric inpatient hospitalization.
Patient is a 15-year-old male. He presented to inpatient via ED due to increased SI and SIB. He has three historical inpatient hospitalizations, has done DBT and outpatient psychotherapy services, and most recently was at Newport RTC – although was discharged early due to aggression and property destruction.
From an acute psychiatric standpoint, youth is safe to discharge form inpatient care and receive services in the community prior to admission to QRTP. He has made significant progress on treatment goals during hospitalization.
Discharge Plan:
Referrals sent to the following residentials:
– Omegon Ascend (Reviewing, no current waitlist)
– Nexus Gerard (Reviewing, waitlist about a week)
– Nexus Mille Lacs (Reviewing, Current waitlist 2 months)
– North Homes (Declined d/t hx of aggression towards others)
– Northwood (Received, 6-9 month waitlist)
– PrairieCare Residential (Reviewing, 2-3 week waitlist)
Alternative Placement through Wright County:
-Wright County unable to identify alternative placement as of 9/24/24
Plan to bridge until residential:
PrairieCare PHP at MOB (unable to pursue establishing care at this time due to pt continuing to be hospitalized)
Continue with established outpatient providers:
Individual Therapist- Bridging Hope Buffalo
Medication Management- LifeSpan Mental Health Monticello
PCP- HealthPartners Elk River
CMHCM- Wright County
Neuropsych Testing- Clary Clinic St. Cloud
NMH8R0MGH-F12-4627
Presented to the ED in the evening, 9/18/24, with her parents after she ran away from school on Tuesday and made suicidal statements to a friend on Monday stating “I’m going to kill myself” which was relayed back to her parents. She also told another peer on Monday that she plans to run away. When she did run away the following day, Mom reports that she was missing for two hours before they found her and there were no known precipitating factors leading to this. Patient tells writer that she “doesn’t know” where she went on Tuesday and “I was walking towards home apparently.” Writer asked about why she is expressing confusion/poor memory of the event and if she was using any drugs/alcohol. She looked at writer, shrugged, then did not answer further. Throughout evaluation, patient is vague, intermittently evasive, and at times mute with writer. She presents with an incongruent and at times inappropriate affect and vacillates from a younger child-like presentation to a more adolescent presentation. She lacks insight into her parents’ concerns and demonstrates poor insight and poor judgement related to her personal safety. She is not willing or able to participate in reflection about why her parents/other adults are having significant concerns for her overall wellbeing, mental health and safety. When asked if she thinks she can maintain safety in the community/at home and also agree to not run away, she will not answer writer.
Area(s) of Risk: suicidal ideation, elopement, inability to care for self
Level of Risk: High for elopement and safety chronically for past few months which has been demonstrated repeatedly by running away and making unsafe choices such as getting in a stranger’s car and making pornographic videos of herself. Level of risk for SI statements is fluctuating and it is noted that pt does not have hx of suicide attempts.
Intent to Act: No
Referrals made to adolescent child psychiatric hospitals however no openings. Patient calm, cooperative and not having sx or bx thus appropriate to dc back home as of 9/20 however parents declining to have her discharge to home.
Child Protection involved as well as patient’s mental health case manager.
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
PH-M14-4088
Recommendation is for level 5 RTC – patient is currently inpatient.
14-year-old Male from ED. Patient got in a fight with their father and ran away from home. Patient has had several other inpatient hospitalizations and has completed a partial hospitalization program with PrairieCare. In alignment with CMHCM, seeking RTC level of care. At this time parents do not feel they can have the child return home. Referrals have been sent to Gerard Academy and Nexus Mille Lacs.
Patient insured by UCARE MA PMAP.
Pt has the following outpatient supports:
Individual Therapy
Psychiatry
PCP
CMHCM
PH-M17-4298
Patient admitted to inpatient hospital following attempted overdose. Prior to hospitalization pt had resided at home with parents since February 2024. Prior to this pt had 18 month stay at Gerard RTC. Pt also had previous stay at North Homes RTC.
Discharge Plan:
RTC
-PCR (referral sent)
-Gerard (referral sent)
-North Homes (referral sent)
-Village Ranch (declined in February due to behaviors, flight risk, animal cruelty)
-Mille Lacs (referral sent)
-Bar None Shelter Plus (need county referral/funding, CMHCM not supporting)
-Leo Hoffman (referral in progress)
Group Home
-CMCHCM assisting with referrals although pt would need to pursue CADI funding prior to county funding
-MnChoices Assessment through Hennepin County for CADI Waiver (request made, scheduling 6 months out, can expedite if placement is found)
Continue with established outpatient providers:
Individual Therapist: Scott Nielson with Melissa Anderson and Associates
Primary Care Provider: Riverwood in MacGregor
Prescriber/Medication Management: Janet Larson with Riverwood Clinic
CMHCM: Alissa Boser with Aitken County (218-838-2405)
Probation Officer: Jacob Leondhardt with Aitkin County (218-927-7231)
PH-M15-4148
Recommendation is for level 5 residential treatment.
Patient arrived at inpatient from ED due to an increase in suicidal ideation with plan. Patient’s legal guardian is Goodhue County. He currently lives with a foster family. This is his 5th psychiatric inpatient hospitalization. He has done PC PHP 3 times, receives outpatient mental health services, and did CIBS program.
Discharge Plan:
RTC: (will need county funding)
-Gerard (Referral sent)
-North Homes (Referral sent)
-Nexus Mille Lacs (Referral sent)
Referred for Trauma informed therapy and CTSS.
Continue with established outpatient providers:
CMHCM: Fernbrook Family Center
PCP/Medication Management: Allina Health
Guardian Ad Litem: Goodhue County
County Guardian: Goodhue County