Patient presented to the ER after 3 other ER visits from outside ER for physical concerns that were determined to be panic symptoms verses a physical abnormality. Patient has a chronic history of mood and behavioral dysregulation, self-harm, multiple suicide attempts, truancy, and parent child relationship difficulties. She has a history of trauma in the form of witnessing domestic abuse, physical abuse, possible sexual abuse, and the death of her dad due to an OD 4-5 years ago. She has had 2 inpatient hospitalizations along with 2 PHP admissions with little benefit and participation. Mom struggles with following through on recommendations and struggles with alcohol/substance use. A child protection report was filed last year and she moved in to her neighbors though this is no longer an option. She denies any passive or active suicide ideation, plan, or intent. Inpatient hospitalization is not recommended. Mom is not willing to bring her back home at this time due to disruption in the home.
Psychiatric Diagnosis: ADHD
ADHD is a psychiatric diagnosis characterized by persistent patterns of inattention, hyperactivity, and impulsivity that can significantly affect a person’s daily functioning, especially in academic and occupational settings.
MHF-F12-2873
Patient presented from home due to dysregulated behaviors which are chronic for patient. Is recommended with continued outpatient follow up however mother unwilling to accept home at this time.
PH-F15-2859
Discharge Plan: *Insurance is BCBS MN PMAP
Residential Treatment – Referrals have been sent to the following facilities:
-Avanti (Referral submitted 10/26, DECLINED)
-Gerard Academy (Referral submitted 10/26; Update received 12/14: Unable to admit due to elopement risk but otherwise approved, will leave on list to review level of risk moving forward; currently under re-review)
-North Homes (ACCEPTED; County funding needed; openings in March/April)
PRTF – Referrals to be sent to the following facilities:
-Grafton (Referral submitted 10/23; pt does not meet exclusionary criteria)
-Nexus East Bethel (Referral sent; only accepting pt’s with MA insurance at this time; will refer once County confirms MA insurance)
Outpatient Services:
Establish CMHCM through Ramsey County (Referral submitted 10/23; intake worker confirmed on 1/10 that a long term worker would be assigned next day)
Continue existing outpatient services:
-Therapy/Therapist: Minnesota Mental Health Clinic in Woodbury
-Prescriber/Medication Management: Nystrom & Associates
-MCRC Runaway Intervention Program at Children’s
-PO Ari Tresselt Ramsey County
-Disability Services intake worker: Ramsey County
Case Description
15-year-old female with a history of depression, anxiety, ADHD, PTSD, as well as some behavioral concerns. Pt has had three hospitalizations in the past year, has done PHP, JDC, outpatient.
PH-F15-2853
Discharge Plan: *INSURED BY BCBS MN PMAP*
Residential Treatment – Referrals have been sent to the following facilities:
-Avanti (Referral submitted 10/26, DECLINED)
-Gerard Academy (Referral submitted 10/26; Update received 12/14: Unable to admit due to elopement risk but otherwise approved, will leave on list to review level of risk moving forward; currently under re-review)
-North Homes (ACCEPTED; County funding needed; openings in March/April)
PRTF – Referrals have been sent to the following facilities:
-Grafton (Referral submitted 10/23; pt does not meet exclusionary criteria)
-Nexus East Bethel (Referral sent; only accepting pt’s with MA insurance at this time; will refer once County confirms MA insurance)
Outpatient Services:
Establish CMHCM through Ramsey County (Referral submitted 10/23; 1/10 intake worker states the long term worker will be assigned tomorrow)
Continue existing outpatient services:
-Therapy/Therapist:Minnesota Mental Health Clinic in Woodbury
-Prescriber/Medication Management: Nystrom & Associates
-MCRC Runaway Intervention Program at Children’s
-PO Ramsey County
-Disability Services intake worker Ramsey County
Case Descreption:
15-year-old female with a history of depression, anxiety, ADHD, PTSD, as well as some behavioral concern. Patient has exhausted several outpatient supports including school in a smaller setting, Childrens hospital, as well as Maplewood PHP, DBT, and engagement with MCRC, JDC and two other shelter placements. Third hospitalization this year.
SBHC-M10-2773
Behavioral issues, parent takes him on a leash when taking him out of the home. Physically and verbally aggressive to parent(s) and others (peers and staff). Throws items, pulls fire alarms, attempts to elope. Receives CTSS services and has demonstrated significant behaviors within those services. Had been in homebound school program, attempted re-entry into school setting and on first day back, damaged property and assaulted staff as well as directing violence towards peers, resulting in transfer to ER for placement. Treatment team questioning consistency of receiving medications appropriately in the home setting and are recommending residential treatment or a shelter bed until residential treatment can be secured.
CH-F16-2451
Update- 1/11/24- The patient has been accepted to MNCCS respite home with a planned admission date of 1/17/24!!!!! Thank you to this facility!!
The patient presented to the ER for the second time on 8/22 via law enforcement for aggressive behavior after she assaulted a staff member at the group home and attempted to bite, throw things, and hit staff upon arrival to the ER resulting in restraints and IM Zyprexa. She had been in the ER earlier in the day after intentionally swallowing a rock in an attempt to get out of her group home and was subsequently discharged back to her group home following psychiatric assessment. Of note, she presented to the ER 3 additional times over the week prior to admission for similar presentations and is well known to the ER due to multiple presentations of pseudoseizures, aggression, and suicide ideation.
She was admitted to the unit after her group home provided a suspension of services notice with the requirement of medication adjustment to be completed in order to return to the group home. Medication adjustments were made, and she has been psychiatrically and physically stable since at least October though she is not able to return to her group home until additional staff are hired and trained.
MHF-M14-2692
1.4.24 – Nexus YCT doing an intake next week.
Presented to ED after altercation with Mom resulted in property destruction and pushing her. Behavior concerns specifically aggression in home towards mother, siblings; patient is in a level 4 special-education program due to ongoing challenging behavior at school often leading to multiple suspensions, needing higher level of intervention. The police have been called to the home multiple times due to patient’s increasingly violent and aggressive behavior, poor impulse control, low frustration tolerance, agitation and oppositional behavior.
C8SM8SP-F13-2687
Patient presented to ED due to concerns of sexual abuse. Patient has extensive history of eloping from home to meet up with adult men she met online and have sex with them. Mom does not feel she can keep her safe at home due to her risky behaviors.
SMCTRF-M10-2621
Significant behavioral issues, Parent takes him on a lease when taking him out of the home. Physically and verbally aggressive to parent(s) and others (peers and staff) throws items, pulls fire alarms. Attempts to elope.
SMCF-F16-2210
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.