The patient presented after expressing homicidal thoughts (threats of aggression) toward her grandmother with whom she lives. Patient was on her way home from school when she pulled her school lvan driver’s arm to the back of the van as she did not want to return home. Patient was then returned to her school where her grandmother picked her up and eventually brought her to the Emergency Department. Since her presentation to the Emergency Department, the patient has not displayed any aggressive behavior. Patient has irritability and emotional outbursts with grandparent(s) and has displayed these behaviors at school as well. Has mostly been pleasant and cooperative in the Emergency Department. Has some attention seeking behaviors when the Emergency Department is busy.
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.
EH8D-F15-4024
Pt is a 15 year old female with a history of unstable placements after having been removed from family care due to physical abuse. She has a history of irritability, impulsivity and mood instability which have led to outbursts, self-harm, aggression and property destruction. She was admitted to the hospital after being discharged from her residential treatment facility due to these behaviors. Patient is requesting medication management for the above listed symptoms while we work with her Hennepin County case manager on placement. She has not had any significant behavioral issues over the past 2 weeks while in the hospital.
RMC-M15-3979
Suspended (5/17) for bringing a knife to school. Went to school on 5/20 with uncle to search locker (items were missing from home-guns, knives, etc.). Pt became agitated and began banging his head on the wall. He also punched his uncle.
EH8D-F10-3962
Pt has been living in the Residential Services-Jewel Group home for over a year. They gave a 60 day termination of service due to their inability to manage her escalating behaviors (last day of services 6/25/24). They have 2:1 staffing for her. These behaviors include harm to self, or others, striking out, choking herself, throwing things and threatening to kill herself and others. She had been attending TSA day treatment until March after an altercation with a peer. She is currently at a 4th grade level and has an IEP. She was brought to the Welia Mora ED on 5/9 and 5/10 as well as Children’s ED on 5/14 looking for “other placement” and was discharged due to not meeting criteria for inpatient hospitalization.
PH-F17-3791
5/20/24: Patient discharged from inpatient and admitted to PCR.
5/8 update: Patient scheduled for admission to PrairieCare Residential on 5/20/24 at 10:00am.
5/6 update: Patient is currently awaiting an RTC bed through PrairieCare Residential in Maple Grove. Patient has been approved for 3rd pathway funding through Hennepin County. Due to patient behaviors seeming to increase, other options are being explored for aftercare as denials are a possibility. Parents do not feel safe with the patient coming home.
Discharge Plan:
Residential Treatment:
-PrairieCare Residential; intake 5/20/24 at 1000
Other RTC Referrals:
-Nexus Gerard; referral made
-North Homes; referral made, declined due to FAS and IQ
-Avanti Center for Girls; referral made, declined due to aggression and peer conflict
Outpatient Providers:
Establish CMHCM; opened with Soreya Jama through Hennepin County, 3rd pathway funding approved
Establish/Continue CTSS with Samira through Nexus FACTS
Continue Therapy with Mary Midler at Great Lakes Neurobehavioral Center in Edina (weekly)
Continue PCP with Dr. Megan Reilly at Partners in Pediatrics in Plymouth
Continue Psychiatry with Gerard Balan at Plymouth Psych Group
Continue IEP Case Management with Yvette Zeese at Wayzata High School
Continue Neurological Services with Dr. Catalfamo at Noral Neurological Clinic in Bloomington
ADMISSION NOTE: Patient was admitted due to acute safety concern and was unable to contract for safety at home. Pt was in PHP in the past and family was monitoring her 24/7 at home as instructed. Pt became irritated that she is constantly being watched and ended up having altercation with her mother because she was instructed by her mother to change outside of her bedroom because the mother was unable to see her. Pt ended up leaving and went to her grandmother’s house which is next door while mom followed her, pt went straight to the kitchen grabbed a knife and start threatening to stab herself. Mother was able to wrestle the knife out of her hands and called EMS. Pt has a history of depression, anxiety, epilepsy, and fetal alcohol syndrome.
PH-F14-3891
Update 5/23/24: Patient accepted to Heartland Girls Ranch with scheduled admission Wednesday 5/29 – county funding was approved.
Patient presents to inpatient from the ED due to an increase in SI. This is her third psychiatric inpatient hospitalization. She has done PHP twice and engaged in outpatient mental health services.
Discharge Plans –
RTC: (JST funding meeting on 5/17)
-Avanti Center for Girls (referral under review)
-Nexus Gerard (referral under secondary review)
-North Homes (pt is on waitlist – 4-6 weeks out)
-Village Ranch- Annandale (pt is on waitlist – end of June)
-Heartland Girls Ranch (referral under review)
Continue with established outpatient providers:
– Therapist: Mayo Clinic Health Systems Austin
– Family Therapist: Albert Lea
– Medication Management: Mayo Clinic Austin
– Case Management: Freeborn County
– Occupational Therapist: Mayo Clinic Rochester
PH-F16-3692
Update 5/09/24: Patient discharged from inpatient to home with outpatient supports in place while awaiting admission to RTC. Admission to Avanti RTC tentative 6/4/24
Update 5/08/24: Patient is accepted to Avanti Center for Girls RTC. Tentative admission date is 6/04/24.
Update 5/01/24: Patient is accepted to Avanti Center for Girls RTC. Estimated opening early-mid May. County funding approved for placement.
Update 4/24/24: Patient is accepted to Avanti Center for Girls RTC. Estimated opening early-mid May.
Patient is a 16-year-old female who presented to inpatient from ED due to increase in SI and suicide attempt. She has had 6+ psychiatric inpatient hospitalizations. She has had two residential 35/45-day evaluations as well as a history of participating in outpatient mental health services.
Discharge Plans:
RTC:
-Gerard (Referral sent & received, wait list out until September or later)
-North Homes (declined due to previous programming experience)
-Avanti Center for Girls (Accepted, opening early-mid May)
CMHCM: Carlton County
PH-F12-3437
Update 5/14/24: Patient discharged home to the care of her guardian with outpatient supports to bridge Day Treatment.
Update 5/10/24: Patient tentatively scheduled to discharge home on 5/14/24, with outpatient supports to bridge PHP at Amberwing.
Update 5/6/24: Douglas County CPS is navigating PHP and Day Treatment with the guardian for aftercare. PHP waitlist is approximately 3 weeks and guardian still needs to obtain insurance coverage. Douglas County CPS will be closing out their case on 5/10/24 due to a lack of immediate safety concerns as evidenced by the guardian willing to take the patient home.
Update 4/30/24: Guardian is making statements of wanting the patient to return home. Patient was declined from foster placements in Wisconsin, and family placement is not an option either. Douglas County, WI, CPS, working with the guardian on a transition plan home, including Day Treatment and Outpatient Therapy. Patient remains at the hospital.
Update 4/24/24: Parent still not willing/able to take pt home. County involved and navigating alternative living arrangement/placement. DC rec is PHP.
Update 4/17/24: Parent still not willing/able to take pt home. County involved and navigating alternative living arrangement/placement. DC rec is PHP.
Update 4/3/24: Parent still not willing/able to take pt home. County involved. DC rec is PHP, openings available at PC PHP when patient is able.
Patient was admitted from Essentia Health in Duluth after attempting to run away from home. Pt has conflict w/ dad & has made HI statements toward him (burning him, switching meds out so he will OD). Pt also has a Hx of inappropriate sexual behavior with older men & on the internet.
Historically, patient lived with extended relatives for the first 11 years of her life due to mitigating circumstances that did not allow biological parents to meet her needs. Patient then went to live with her biological mom and was then sent to live with her dad, as mom was unable to meet patient needs. Patient has been with dad for about 1 month now, and he has indicated that he cannot meet her needs either, and declines for the patient to return home.
Discharge Plan:
PrairieCare Recommends:
Establish PHP; county coordinating with Amberwing, estimated 3-week waitlist
Establish Individual and Family Therapy:
-Insight Counseling in Duluth; referral made
-SOAR Services in Superior, WI; referral made
-Nystrom and Associates in Duluth; referral made
Establish PCP
Establish CMHCM (Open with Kalley Rustad at Douglas County CPS for long-term supports, closing case 5/10)
Establish CLTS (Referral made to Douglas County, CPS also coordinating)
Estimated length of stay:
Seven to ten treatment days; patient is medically ready for discharge; pending Douglas County, WI, establishing aftercare with the guardian. Guardian is now willing to take the patient home.
PH-F17-3426
Update 4/26/24: Patient discharged from inpatient on 4/26/24 and admitted to VOA Bar None Shelter Plus.
Update 4/24/24: Patient has been accepted to VOA Bar None ShelterPlus Program with admission scheduled for Friday 4/26.
Update 4/17/24: Updated clinical/referral resubmitted to Anthony Lewis Center for acceptance consideration.
Update 4/4/24 – County is working towards referrals to group home settings at North Crow Group Home – Cokato and Annadale – Village Ranch while awaiting appropriate RTC placement. Anthony Lewis Center tentatively reconsidering the referral if patient does not need a medical setting.
16-year-old female presenting to PrairieCare Inpatient Hospital. Patient is diagnosed with RAD, depression, anxiety, ADHD, PTSD, polysubstance use emerging personality traits. Patient has had multiple hospitalizations, utilizes outpatient resources and completed DBT, one RTC placement, been in a group home, and is currently in foster placement. Patient’s current foster placement is unwilling to have patient return. Patient is currently under guardianship of Wright County.
Discharge Plan:
Dual Diagnosis RTC:
– MHealth Fairview-Maplewood (Referrals submitted: Update 3.13.24 – Cannot be approved until housing is confirmed)
– Wings (Referrals submitted Denied 3.15.24 due to mental health needs exceeded current program capabilities)
Current Providers:
– Individual Therapy
– Chemical Dependency Counseling
– Medication Management
– CMHCM with Wright County
PH-F14-3695
Update 4/23/24: Patient discharged from inpatient on 4/23/24. Patient scheduled to begin PrairieCare PHP on 4/24/24 while continuing to pursue Group Home placement as recommended by the county.
Patient is a 14-year-old female presenting to inpatient on 03/19/2024 from the ED due to running away from shelter placement. Patient has a history of participating in PHP two times, DBT, ongoing outpatient mental health services, and being in shelter placement.
Discharge Plan:
RTC:
-North Homes (on the wait list)
CD-RTC: Referrals submitted/considered for the following facilities:
-Hazelden (Pt’s insurance not accepted in Minnesota)
-Rogers (Declined due to elopement risk)
-M Health Fairview (Declined due to elopement risk)
-Anthony Louis Center (referral sent 03/27/24)
Group Home Placement (as recommended by JST/county):
-Little Sands (Referral submitted by CM; declined d/t LON)
-Village Ranch (Referral submitted by CM; reviewing 4/10; pending additional review on 4/17)
-North Homes (Pt is on the waitlist for RTC; pt is not eligible for their group home due to age)
Existing Outpatient Providers:
CHMCH: Hennepin County
Psychiatry: Nystrom & Associates