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.


Pt came to ED after ongoing behavioral concerns at home with guardian/grandmother, physical and verbal aggression, and threats. Previously discharged from CADI GH for physical aggression, went to JDC for that but was released after a rule 20. Declined by North Homes, Northwoods, and CABHH. A CADI home in Duluth that may be an option.


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. CPS recently became involved and CMH and hospital waiting for direction from them on what potential placements can be pursued. Has not been in OOHP previously.


Update 4/10/25: declined at Leo Hoffman, East Bethel, Bar None Haven, does not meet criteria for Grafton, Northwood wait list 2 years. Discharged from Mille Lacs RTC.
Update 4/3/24- declined Leo Hoffman, East Bethel, Waiting to hear back from Grafton, Bar None Haven. Discharged from Mille Lacs. Northwood waitlist 2 years.
Update 4/1/24: Nexus East Bethel PRTF declined pt due to not having a male unit at this time.

15-year-old female identifying patient with a history of depression, anxiety, RAD, PTSD, ADHD, and ODD. Patient has been in and out of treatment settings for 3+ years and has not been at home since. Patient was at an unknown treatment facility and was discharged due to its closing, Northwood Children’s Services PRTF (discharged due to not needing level 6 care) and most recently has been at Nexus Mille Lacs RTC since October 2022. Patient has a history of four inpatient hospitalizations. Patient has been discharged from Nexus Mille Lacs RTC as of 3/20/24 due to them recommending a higher level of care.

Current provider:
CMHCM: Kanabec County

PRTF: (MN DHS eligibility submitted by county and approved)
-Leo Hoffman (declined due to pt acuity)
-Northwood (added to wait list, about 2 years)
-Grafton (pt does not meet acceptance criteria)
-Nexus East Bethel (declined due to not having a male unit)

-Nexus Mille Lacs (pt discharged from program as of 3/20 due to lack of engagement)
-Bar None Haven (declined due to aggression and behaviors)

MN DHS Complex Transitions Team (in process of scheduling care conference)


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.


The patient is a 13 Y year-old male with a history of autism spectrum disorder, disruptive mood dysregulation disorder, ADHD, and depression who presented to the ER on 4/5/24 via EMS from his residential facility for assessment of aggression and suicidal ideation. He has a long history of aggressive behaviors that per chart review worsened around October, 2023 and he has not been able to be safely maintained in his home since that time. He has had several extended hospitalizations and since he was admitted to residential on 2/5 has had 41 incident reports related to attempts to harm himself and aggression when staff attempt to intervene. He has had increasing dysregulation resulting in an increase in restraints, length of time in restraints, and the amount of staff it requires to calm him resulting in the inability to return to residential. Home is not an option at this time.


Update 4/4/24- PRTF funding approved. Pending admission to Nexus East Bethel.
Update 4/3/24- Can admit to Nexus East Bethel, waiting PRTF funding approval- lots of back and forth.
Update 3/21/24- -Northwoods (referral made, waitlist 2+ years) -Grafton (received referral, waiting for confirmation if on waitlist, earliest availability May) -Nexus East Bethel (will complete review next week, if approved pt could likely admit soon)

13 year old female from ED. Pt was at school and was angry and ran from the school. Patient has history numerous psychiatric hospitalizations as well as ten months of treatment at Gerard residential treatment. In alignment with CMHCM, seeking PRTF level of care. At this time parents do not feel they can have the child return home. County looking at respite care, so far unsuccessful. On waitlist (2+ years) at Northwoods, Grafton referral sent, Nexus East Bethel pending acceptance/wiatlist)
Pt insured by Medicaid (had a commercial plan UBH that ended on 3/1/24).
Pt has the following outpatient supports:
Day tx (not yet started)


Update 4/3/24- funding in place, waiting available RTC- accepted at Gerard and North Homes. Waiting to hear back from Avanti and East Bethel.

Case Description: Patient is a 16 y/o individual w/ hx MDD, GAD, ADHD, multiple previous hospitalizations, currently presenting due to SI. Patient went to foster care after discharge in previous hospitalization at PC ( october 2023) and returned to mothers home end of Dec after 1 month. Patient was hospitalized at Prairie St Johns for 1 week ( discharged 3/8) due to intrusive SI . Patient feels she was discharged earlier than she should have been because she was still struggling w/ “feeling safe”. Patient indicated that depression /anxiety and intrusive SI improved significantly in foster care. Patient indicated during the time in foster care, patient worked on her relationship w/ mother and feels it was “helpful. Patient transitioned to mothers home and feels that overall relationship has improved and does not know why depression/SI has escalated again.

Discharge Plan: RTC (county funding approved for RTC)
-Avanti (Referral done, waiting to hear back)
-Gerard (Referral done, Accepted)
-North Homes (Referral done, Accepted, currently on waitlist, openings anticipated in June)

-Nexus East Bethel (Referral in progress)

Existing outpatient providers:
-CMHCM at Sherburne County
-Individual therapy Main Street Family Services-Elk River (Appt scheduled 3/27)
-Family therapy at Main Street Family Services-Elk River
-Primary care at Stellis Health-Monticello
-Psychiatry s at Nystrom & Associates
-In-home skills


Pt was in residential at Prairie Care and was discharged due to behaviors/property destruction/aggression, not allowed to return. Just switched custody from one CPS worker to another so details of history are not complete, but information is being gathered. Know she was previously in out of state placement in Oklahoma where she was discharged due to physical aggression. County is looking at VOA- Bar None Haven and Nexus East Bethel, and hospital is referring to Nexus YCT.


Update 4/4/24: Updated inpatient clinical has been sent to Nexus East Bethel PRTF for review. Nexus East Bethel PRTF did not get to pt’s review on 3/26/24 and is requesting inpatient psychiatrist and PRTF psychiatrist consult directly.

Update 3/21/24 Nexus East Bethel PRTF reviewing for acceptance on 3/26/24.

12-year-old female presenting to inpatient from the ED. This is her second psychiatric inpatient hospitalization.
Recommendation is PRTF. Patient has been approved for funding through MN AFMC PRTF team.
Referral has been sent to Nexus East Bethel PRTF and is under review.