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.


Update 4/25/25: Patient discharged from inpatient to Willow Trails Group Home on 4/25.

Update 4/24/24: Patient is medically ready for discharge from inpatient. Tentative admission to Willow Trails Group Home on 4/25.

Update 4/18/24: Patient is medically ready for discharge from inpatient. County is their guardian. County is working on finding foster care/group home placement. Patient has been denied at Village Ranch, is being reviewed at Port Place, Hunter’s Place, and Anoka County Juvenile Center.

Patient presented to the ED on 03/15/2024 after making suicidal statements while at school. Patient noted they have been being bullied, which contributed to the increased in suicidal ideation. Patient denied having a plan to complete suicide but was experiencing passive suicidal ideation and indicated that they would “probably do something with cutting.” The school contacted law enforcement and patient was transported to the ED for further mental health evaluation. Patient was unable to contrast for safety, resulting in them being transported via non-emergent transportation to PrairieCare for short-term stabilization.

Patient is under guardianship of Ottertail County at this time. Placement is being pursued by the county to either a Group Home or Foster Home.

Discharge Plan:
Continue care with existing outpatient providers:
-Individual therapy, PCP and Psychiatry at Behavioral Health in Badger, MN

Patient is medically ready for discharge and is awaiting placement in an appropriate group home/foster home, as identified by the county.


This patient is a 12 Y year-old male with a self-reported history of depression, anxiety, and ADHD who presented to the ER on 4/8/24 by EMS from his residential facility for assessment of suicidal ideation. He was a direct admit to residential from JDC where he was placed due to allegations of sexual offenses towards his 8 year old step-sister. He reports he has harmed his step-sister on multiple occasions and has been in 3 different JDC’s including Red Wing over the last year and reports he didn’t know doing those things were wrong until now. He also reports a history of defending himself against bullies as well as head butting a female staff in the chin while in juvenile detention. He has had “13 or maybe less” attempts to harm himself or end his life and has been hospitalized psychiatrically x2. He reports he has attempted to wrap a scarf around his neck, tried drowning himself in the toilet while in a juvenile detention facility, and attempted to wrap the vacuum cord around his neck. More recently attempted to jump from a stair well, got out a window, and makes attempts to look for glass to harm himself. Residential is not willing to accept him back at this time.


Patient presented to the ER via law enforcement for aggressive behaviors at shelter care resulting in property destruction. Patient is not able to return to the shelter and does not have any safe disposition options.


Patients a 16yr female with a history of albinism, anxiety and depression, ADHD, unspecified intellectual disability and borderline personality disorder presenting to the ED with complaints of suicidal ideation with plan. Was discharged from PSJ on 11/08/23. Started PHP at PSJ on 10/9/23, became aggressive and had a episode with SI statements and brought to the ED. Extensive inpatient psychiatric hospitalizations over the past year with >4 at Prairie St Johns, and 4 months at Prairie Care Medical Center from 4/18/23 -8/25/23.


sexual behaviors, aggression, mostly stable but his history makes placement challenging.


Update on 8/17/23 – still waiting placement, relocated to peds area, not admitted, still an ED patient.

Patient is ward of state with guardianship by Otter Tail County. On a stay of commitment. Terrible trauma history and aggression – toward inanimate objects, but occ if staff gets close, she will be aggressive toward a person. Multiple hospitalizations/boarding situations, multiple (5-6) PRTF placements and failures, including an out of state facility that was suddenly shut down. Was in Rochester for hotel with respite, but they brought her in after less than a week due to behaviors. Struggles to regulate when frustrated.


14yr old male who presents to Emergency Dept with homicidal ideations with dad from school. He denies making statements of a homicidal nature but per report he threatened to kill his school paraprofessional and “shoot up the school.” Patient has access to means and at the time reported intent. He also make threats to hospital staff when angry and has made several comments about owning a gun. He has a history of acting violently and notes when he is angry he could do something to harm others. He missed several days of his psychiatric medications which may be contributing to this escalating behavior. Medication was restarted two days ago but he needs a safe secure environment to restart medication and to further evaluated his risk of threat to others. Patient is perseverative in this thinking, restless, and with disorganized thinking which may be in part due to not receiving his ADHD prior to this assessment but also deserves further assessment.


UPDATE: Pt discharged home with improvement of some symptoms and wraparound services. CABHH and PRTF referral stand.

16 yo adopted white gender fluid/nonbinary adolescent with Albinism of Otter Tail County. No hx of attachment concerns. Delay with speech. Some historical cognitive and attentional concerns. No substance use. Expressing SI, SIB urges and lability. Hospitalized twice in early 2023 until admission to PrairieCare RTC on 4/11/23, needing a higher level of care, admitting to Inpatient 4/18/23. Patient has severe lip biting when dysregulating causing multiple lip lacerations, requiring suturing.

Primary Recommendation is CABHH; Referral made, on waitlist.

Residential Treatment or PRTF consideration:
-Avanti; referral made, declined due to aggression and seclusion history
-Northwoods; referral made, on call back list, 9 month waitlist
-North Homes; referral made, accepted, waitlist out to mid-summer/fall 2023> still would need QRTP funding*
-Gerard; referral made, reviewing, declined due to staffing needs in educational settings
-CRTC; referral made, declined
-Heartland Girls Ranch, county SW to refer
-Village Ranch, county SW to refer

-Grafton, referral made, denied, can reach out in a couple months for re-review due to their staffing
-NorthWoods, waitlist 12 months
-Leo A Hoffman; referral not made, only accepting Male patients

Out-of-state RTC:
Guardian declines referrals for out-of-state placement at this time

*QRTP funding is not in place- Parent does not consent to Relative Search which Otter Tail County uses in the QRTP pre placement screening process.


Patient was brought to the Emergency Dept. after having a violent outburst at a residential facility in Fargo, ND. Concern for physical aggression and property damage. Patient reportedly was involved in a verbal altercation with another resident who was calling him by the wrong pronouns. He has now been discharged from the residential facility with no alternative residential facilities available. Otter Tail County (MN) is the guardian. Guardian has exhausted all options. He has been calm and cooperative in the ED with no outbursts. He is medically cleared and he is not meeting criteria for inpatient psychiatric hospitalization.