14 year old with significant trauma history, ward of Olmsted, previously residing in kinship foster placement but repeatedly eloped. Refuses to participate in therapy as an outpatient. Verbally defiant at times but no significant aggression toward caregivers; can have reactive physical fights with peers at school but not unprovoked. County has guardianship since November 2022, but he does have actively involved aunt/uncle who will be the targets for permanency planning.
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-M16-350
Patient presented from group home with aggression, breaking things. He has chronic aggressive behaviors. He was admitted to Hawthorn Center state hospital in 6/21-7/22. During his admission, patient’s mom passed away and he was placed in Beacon Crisis Residence. Patient had a prolonged stay in UMMC ED September 2022-October 2022 and was discharged to RTC in TN. Patient was discharged from the facility in TN due to concerns with the facility and was returned MN. He was brought from the airport to Children’s Hospital on 1/11/23-1/13/23 and was discharged and immediately brought to UMMC ED by parent and county worker. He was in UMMC ED 1/13/23-2/7/23 and was started on Zyprexa ODT due to cheeking medications. He was eventually discharged to crisis home. Patient then returned for further concerns of medication non adherance and exacerbation of psychotic symptoms. He had inpatient admission on Inpatient mental health at UMMC from 2/15/23-3/12/23. Patient was discharged to respite house with additional wrap around services. Patient has had 4 ED encounters since that time. Patient discharged to his group home on 5/1/23 and returned to ED on 5/2/23 due to aggressive behaviors. Patient is unable to return to group home.
SD8SC-M8-1067
Client in process of completing DA through our Assessment Team so not all information is complete at this time. The system has not been helpful to this family for a long time and they are struggling to maintain his adoption. He has low IQ, largely non-verbal with few receptive language skills (communicates by pulling people to things), approved for residential treatment over 3 years ago – not accepted to any placement so far, has a DD case manager and “unlimited” waiver. Historical diagnosis include: ASD, PTSD, GDD, and ADHD. He has significant behaviors including hitting, pushing, stomping and fecal smearing when told “no” or denied access to something even with a body suit. Behaviors of some kind occur multiple times daily. He is aggressive toward all family members but the fecal smearing happens more in response to mother. He has been declined services at over 20 PCA agencies, is not successful attending outpatient therapy services or medical appointments (aggressive to providers and engages in behaviors), no respite providers will accept him, and he has been declined admission to psychiatric hospitalization and most outpatient providers declined him for services as his needs are “too great”. The family includes 4 other children many with special needs, and 2 are medically fragile. The family is to the point where parents are considering having one parent live with this child and the other 4 with the other parent for safety reasons.
6-23-23 client is now linked to Fraser and LSS for possible additional in-home wavier paid supports/services to decrease the likelihood of a boarding or out of home placement
GC8S-F14-863
14-year-old adolescent female with a history of ADHD, witnessed verbal and physical abuse, multi-substance use with significant behavioral issues at school. Pt was admitted to Gillette Children’s on 4-30-2023 with an acute hypoxic ischemic brain injury secondary to hanging herself in a suicide attempt. Pt has made significant improvements in her cognitive and motor functioning since her initial presentation. Pt does not have a previous history of suicide attempts but does have a history of non-lethal cutting behaviors. She has been involved with various mental health providers on an outpatient basis over the past several years. She has never been hospitalized for mental health issues. Pt is currently not suicidal. Pt currently presents with a flat affect and difficulty comprehending the gravity of her suicide attempt. Pt will be ready for discharge from a medical standpoint mid-next week and is expected to be independent in mobility and self-cares, although she will require supervision in the home setting. Pt has the endurance to complete a full day of activity. Please consider Pt for intensive mental health services and parental support as she transitions back to her home setting.
Update 5/18/23 from Mallory at PrairieCare: Amy and I messaged, this pt will DC from RU 5/24/23 and has not had any SI or SIB plans, means, or intent. Likely initially declined for Inpatient due to medical condition. Once medically cleared, discussed referral for PHP due to needing intensive therapeutic intervention, but not imminent danger to self. Amy plans to refer for PHP.
MHF-M9-1185
Pt is presented to the ED via EMS due to aggressive behavior in his foster mother’s home. Pt became escalated when his foster mother asked him to take a bath, and began throwing chairs and kicking his mother. Pt has an intellectual disability and lacks insight into behaviors and mental health concerns. Pt has hx of autism and ADHD combined type, and hx of agitation/aggression.
RMC-M14-304
ADHD, Suicidal ideation, Homicidal ideation on presentation, verbal aggression on presentation, mother in-and-out of jail, inconsistent schooling. No physical aggression toward others. Enjoys school. Recent stay at Hope House. Became suicidal, punched a wall, came to ED for crisis stabilization. Resident of Blue Earth County, mom in jail, no father involved. No consistent housing, schooling or services. He was prescribed a med, for ADHD, but hasn’t been consistently taking it due to moving around so much. Hasn’t stayed anywhere long enough for a complete assessment. Calm sweet and appropriate. Wants to go back to Hope House. Possible connections, Prairie Care, on the list for CRTC. Bar None will review, but no openings right now. Went to Prairie Care in Maple Grove. Was sent home by Carver Co Crisis.
M8SAS-M16-1130
Recently at inpatient psych X 10 days. D/c to respite care. Recently transitioned home from respite and aggression within 48 hours of d/c from respite. Needs residential. Interview with North Homes on Monday.
CH-M8-901
Patient with a history of ADHD, DMDD, and trauma that presents after making verbal suicide threat and gesture of putting his hands around his neck. Has a history of suicide statements and self injury when angry. Does not require inpatient hospitalization though is unable to return to foster home. There is difficulty in finding an accepting foster placement.
D/C to new foster home on 6/2/23
SMCW-F15-1034
DIAGNOSIS
1. Suicidal ideation
2. At risk for intentional self-harm
ASSESSMENT/PLAN/DECISION MAKING:
Patient referred observation for suicidal ideation, patient has had prior ER visit earlier this week, unable to place and patient, mother, decided to trial home with safety plan and close follow-up, unfortunately, patient presents back to ER tonight. Referred observation. Will continue to assess for placement options, consider crisis team evaluation in AM as they had recommended her present to the ER tonight. Patient had labs done on 5/22/23, did not repeat at this time as only home for 24hr otherwise has been under hospital care, will obtain if requested by facilities
15-year-old female who was recently discharged from this ER on 5/24/2023 at 1730, presents back after being home with her mom for 24 hours with actions of intentional harm, statements of hurting herself by throwing herself down a flight of stairs, stating that she will find a way to hurt herself if she is discharged back home. Crisis team had instructed her to come to the ER, not called at this time. Patient will be referred observation while assessing placement options. Patient is difficult to place due to her acuity level and also her need for long-term placement, will be in contact with her case manager tomorrow morning. She is on wait list for multiple behavioral health long-term placement options, however, these wait lists are 3 to 6 months long before her case would be reviewed. Patient is greatly triggered by her home atmosphere. Patient was released from juvenile detention on 5/19/2023, spent the night at her mom’s house but then went to a cousin’s house for 2 days before returning to her mom’s house on 5/22/2023 where she presented to the ER within 8 hours of being back home. Patient had discharge from this facility last evening to her mother’s houses there was not another option for her at that time, a safety plan had been discussed with patient and she did follow that safety plan by calling the crisis team, unfortunately returns to the ER tonight.
Placement options are limited, however, will reach out to behavioral health options for patient this evening and tomorrow, again will discuss with case manager for assistance. Consider contacting crisis team tomorrow once patient has calm down for reevaluation is finding an acute placement for this patient has proven difficult in the past several months and may need to develop a safe plan with the crisis team assistance.
Patient states that her siblings are mean to her and tell her to kill herself, due to the disruption she causes at home.
C8SM8SP-F14-885
Patient has previous mental health history and does not want to return home to live with her parents. Patient makes efforts to elope from their care and will escalate her behaviors to ensure she does not return home. Patient has grabbed the steering wheel from mom in an effort elope from the car.