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
Came to ED 4/5 after some property destruction at family home. Previously in FV’s PHP program. Mom refusing to pick up and refusing family first services in home. County now has temporary custody for out of home placement, has not been in out of home placement previously. Ongoing CPS worker assigned 4/18 and is starting placement search.
**Contact department: HCMC Acute Psychiatric Services (APS) 612-873-9300
13 y.o. male boarding in ED. Brought in by adoptive mother after running away from home 3 times. Multiple suspensions from school (including currently) for fighting. Mother unwilling to bring patient home. Physically assaulted mother after he was brought back home. Went to Uncle’s house and left via window. Has been making passive comments indicating suicidal ideation and not having any sense of danger- getting into cars with strangers. Significant increase in challenges since he began going through puberty about 6 months back.
Copied from ED note:
“Collateral from mother and family:
Foster mother took in his sister first, took him as well at 16 months old. States that when he first came to live with her he would eat out of the trash, and from bowls on the floor like a dog. Took several months to correct this. Patient was then returned to his paternal grandmother in chicago, but was only there for two months. Foster system asked mother to adopt him and keep him with his sister. Some school issues, briefly on IEP. Mother was kindergarten teacher.
In the past 6 months, since hitting puberty and undergoing a growth spurt, patients behaviors have been worsening. In Nov of 23 patient attempted to start a fire in his bedroom. He has been in a plethora of fights at school. Is currently suspended. Believes that everyone hates him. Since January he has been making comments to family about ending his life. Reportedly had knife in his room at one point. 3x running away from home. 1st time was not far and he came home quickly. 2nd he made his way from north Minneapolis to S St. Paul, and was with a complete stranger for approximately 9 hours. Family reports that patient refuses to speak about this time. Was acting strangely after he returned. 3rd was yesterday after he became angry and physically assaulted mother. Was found by police (allegedly engaging in burglary?) Was brought to uncles house per request of mother, as he had been quite belligerent with her earlier. Patient normally behaves well with uncles, but today he waited until he was unsupervised and climbed out of a ground floor window to run away again.”
Not appropriate for inpatient pediatric medical floor. Boarding in HCMC Emergency Department. HCMC Acute Psychiatric Services do not feel patient needs an inpatient psychiatric admission. Family and NEXXUS advocate not comfortable with discharge unless plan for significantly increased outpatient support. No formal diagnoses. Has been completely compliant and appropriately behaved since presenting to the ED 32+ hours prior.
Per Emergency Protective Care Order, in need of out of home placement. Legal guardian through county, living with father in ND wasn’t successful.
Foster placement is not being recommended. Kinship placement has not been successful and is not a current option.
Patient has gone through Hennepin County QRTP screening – residential placement is recommended and is in alignment with psychology and psychiatry consult recommendations.
Pt came to ED 3/25 after being on the run for a few weeks. Was previously at hotel crisis respite prior to being on the run, damaged property there and can not return. County is current guardian, though patient turns 18 very shortly and will be his own guardian at that time. History of behaviors, verbal and physical aggression and property destruction. Has been denied from shelters due to behaviors and previously denied from RTCs in and out of state, though due to age would no longer be an option. Refuses all mental health services and has not had a DA since 2020. Is on CADI waiver. Recommendation on weekly call to discuss benefits of IRTS program/treatment with him.
2/29/24: Still inpatient. Children’s Mental Health Case Mgr assigned this week.
Update 2/8/24: Still in inpatient. Denied from Northwoods, Gerard, PrairieCare due to aggression and age. Denied from group homes as well. Exploring 2 family member possibilities. Trying to get a Case manager assigned. Anoka non secure 45-day assessment program could include a psycho-sexual assessment (? age requirements?).
Patient presented to the ED by mother’s boyfriend due to concerns of sexual abuse. History of physical and sexual abuse and recently has been perpetrating on his younger siblings and having increased behavioral concerns and aggression. Placed on a welfare hold for placement, court ordered to out of home placement. Has been denied by 7 foster homes, no shelters accepting patients his age. CPS currently has custody.
Pt presents with behavioral escalations from out of home placement. Pt currently in hospital with no d/c plan at this time coordinated by county. Pt has a history of trauma and sexualized behaviors.
Patient brought in to ED by case manager after her group home discharged her due to ongoing behaviors and aggression. Case manager did not have alternate placement and therefore patient now boarding in ED until new placement can be found. Patient in need of shelter or crisis respite placement while longer term placement is found. Awaiting funding.
Presented from home following an episode of aggressive behaviors. History of FAS, parents do not feel safe with patient returning to their home. Seeking crisis respite or shelter placement for patient. Has been calm and cooperative in the ED.
Patient presents to ED for behavior escalation from foster setting. Guardianship lies within county.
