Patient was dropped off at a different ER by the parents of her 4th foster home placement where she was placed 3 days prior as the foster parents didn’t feel they could provide care for the patient due to hyperactivity, impulsivity, aggression, elopement, and sexualized behaviors. Her social workers picked her up from the outside ER and while in route to human services center to board until a new foster home was located, the patient was attempting to remove her seatbelt and she was brought to this ER where initially inpatient psychiatric hospitalization was recommended due to a lack of safety awareness, elopement, sexual behaviors, and need for medication assessment. She was trialed on guanfacine, developed hypotension and this was discontinued, and she was started on Concerta where her elopement attempts, impulsivity, and hyperactivity improved. She remains boarding in the ER while the county pursues foster home placement.
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.
CH-M11-1984
Patient presents from PHP where he was discharged due to ongoing aggression and attempts to urinate on staff and floor. Patient currently struggling with family dynamics, limit setting, gender identity, disrobing, property destruction, and aggression.
CH-M13-2506
The patient is a 13 Y year-old male with a history of fetal alcohol syndrome, separation anxiety, ADHD, RAD, sensory processing difficulty, DMDD, conduct disorder, and ODD who presents to the ER on 12/2 via law enforcement for assessment of aggression, suicidal, and homicidal ideation after physically assaulting his adoptive mom and brother and threatening to use a knife or gun to hurt the family when they weren’t looking. The patient made threats to kill himself with a colored pencil. The patient has aggressive outbursts several times per day when he is told no.
The patient has a long history of psychiatric services including residential at Northwoods x3, inpatient hospitalization x1, group home placement, PHP and further outpatient services. The county is currently in the process of developing an individual home for him which is thought to be completed in January though still requires licensing.
RMC-M11-2238
Ward of the state-currently under Wright County Guardianship. Parental rights have been terminated. History of aggressive behavior with homicidal and suicidal comments towards multiple people/on multiple occasions. On 11/15/23, patient was sent to a “calming room” at his school due to throwing a ball at another students face. This caused him to miss out on an outdoor activity that he wanted to attend. Patient was upset and punched one of his teachers (mental health support services personnel) in the nose, causing a broken nose. Had been living with bio-grandparents prior to this incident. He has been removed from foster homes in the past due to homicidal threats to the foster parents/others in the home.
HCMCH-M17-2402
attempted strangulation with the dog leash. HX of MDD, PTSD, ADHD & anxiety.
C8SM8M-M9-2342
ADHD, adjustment disorder, anxiety, Developmental delay, ODD, aggression, sexualized behavior. FAmily was living in shelter. Disregulated episode- tried to strangle self, to ED for assessment. Initially rec for inpt, then decided he did’nt need inpt. Family leaving shelter soon, so not able to take him back at this time. Mom says addicted to porn. Became disregulated once but otherwise has been stable, no SI. Henn county won’t get involved- saying it’s not abandonment, doesn’t have a county case mgr. Some services thru Dakota county. Level 4 school setting. Looking into other shelters. Family thinks he needs tx. Referrals to nexus, Prairie Care, Henn County Peace offering made. Gap in services. 7/21 was at Prairie Care. Mom open to foster home, he doesn’t necessarily need residential. Mom isn’t visiting bec she is scared he will be sent home with her.
Previously attended IP MH at PC in July 2021, no current acute SI, safety concerns in hospital, pt and his family are homeless, got kicked out of shelter due to aggression, pt currently does not have any county supports. Patient’s family moved from St. Cloud. Due to pt’s age, history of aggression, and sexualized behavior (watching porn, taking photos of privates, exposing himself to siblings) mom has been unable to find a shelter that will accept them. referral for services was put in with Hennepin county. DC’d to home with mom.
AH-F15-2303
PTSD, Disinhibited Social Engagement Disorder, Conduct Disorder, ADHD, ODD. Just got approval from HC for funding. Case mgr will start making calls. Doest present well on paper. Challenging behaviors – gets escalated and disreg. with peers. Is able to walk away. Threatens to hurt people but hasn’t yet. Remorseful about behavior. Learning about her dx. Fun kid, gets along with certain peers. Doesn’t work well with peers who have made statements about race. Ready to benefit from res. tx. and work with people 1 on 1. A lot of early childhood disruptions. Not sure why removed from bio mom – per aunt and gramma, she didn’t know how to be a parent. Aunt and gramma say that she has tried to kill them, threatens people, hard to know what’s what and what is recent behavior.
MCR-M11-2224
This child is a ward of Steele County with Significant aggression and significant trauma. Mom died in 2019, Dad in group home for TBI. Suicidal/homicidal statements, thoughts. Tried to place with 19 yo sibling which lasted for a month, but brother doesn’t think he can keep him safe any longer. Came from SERCC to Mayo ED when he escalated to a point that they couldn’t care for him. He has been doing OK since he got there but has had a few instances of escalating to the point of needing to be restrained with holds and sedation. Struggles with conspiracy theories, as his mom died of a septic kidney infection, but he believes that her boyfriend poisoned her. He is fearful of being poisoned; he won’t sleep without someone watching over him. Not safe for a group home at this point.
HCMCH-M17-2004
Update: Accepted by PrairieCare but waiting on funding. looking for respite while waiting.
A 17 year old, African American, assigned male at birth. He identifies with “both” genders (boy and girl) equally. Alternates between male and female persona. Medically stable and boarding on Pediatrics while awaiting placement disposition. History of being bullied.
Approaching his cluster of symptoms from the lens of comorbid autism spectrum disorder and mild intellectual developmental disorder is likely to lead to better treatment adherence and response to intervention.
Given his intellectual concerns and history of emotional dysregulation, the patient would benefit from residential treatment. Such a treatment facility should have access to mental health resources, independent living skills training, and regular recreational and social-emotional supports.
MHF-M15-2183
Patient is presenting to the ED for the following concerns: self-harm. Patient has a history of self-harm, through primarily biting his arm, punching other things or scraping himself with a tack. Mom reported that today was the first time he self-harmed with a blade. Mom reporting increased aggression in the home and at school and feels that patient needs inpatient. Mom explained the patient is in a level 4 school setting. He recently did PHP at Prairie Care and was discharged after three days due to concerns about aggression and inappropriate sexual comments. Mom shared the patient has made comments about wanting to strangle others.
Mom explained that patient may already be on the waitlist for the Village Ranch residential treatment in Cokato. They are also exploring North Home in Bemidji. Mom reported that patient has been diagnosed with ADHD, ODD, PTSD and ASD. She also wonders about FASD due to his biological mothers, drug and alcohol use. Patient was adopted at age 7 by his adopted mom and adopted dad. Mom was his PCA in his last foster home for one year before adoption.