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.
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
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.
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.
Patient is presented to the ED by EMS after getting into an altercation with his mother. Patient threatened mother, and ran away from home. Police found the patient three hours later and was brought to the hospital. Patient has a history of mental health issues, aggression, and is currently on probation for making terroristic threats at his school.
Admission: 2/24/23
Presenting concern: PTSD, Depression, Anxiety
Ongoing case conferences weekly with Itasca have occurred. Itasca County holds guardianship.
Discharge Plan:> UPDATE 4/20/23:ADMISSION IS 4/24/23> ADMITTED SUCCESSFULLY TO NORTHWOOD on 4/24/23
Patient is medically ready for discharge; will discharge as soon as RTC/living arrangement is identified.
Interim plan:
-PHP while awaiting RTC (foster parents share they are not able to have patient back into their home at this time)
-Itasca County has submitted referral for SMRT; once approved, this will provide access to disability status/waivers and additional placement options
-MNCHOICE assessment (Referral made to Hennepin County on 04/04/2023)
-Continue CMHCM at CMHS/REACH
RTC:
-Northwest Passage (2-3 month waitlist for patient’s age group; guardian declined referral due to waitlist and out of state)
-Gerard Academy (Referral made, Declined for admission on 3/24)
-Northwoods 35-day assessment (Screening meeting completed on 4/12/23, pending acceptance/admission)
-Clinical submitted on 4/5 to treatment placement specialist at Acadia Healthcare for consideration of out-of-state referral options
16 year old, county ward, who has been at Gerard Academy for 1.5 months and had escalating SI in the context of conflict with peers at Gerard and then ultimately learning that father’s parental rights were terminated. Long previous history of neglect and possible abuse, multiple family members with substance use disorders. At Gerard was leaving the facility and finding sharps to potentially harm himself with. Initially was recommended for inpatient psychiatric care, but declined by all facilities due to history of aggression or behavioral issues in those facilities previously. Eventually acute SI resolved while boarding in the ED, but as plans have been made to work on return to Gerard, he has repeatedly stated he does not want to go back there and will hurt himself or others if he does. His case manager reports that similar statements have arisen repeatedly in the past as placement facilties start to challenge him and seem to serve the function of avoiding difficult emotions. Currently trying to work with Gerard staff and case manager to help him safety plan for a return to Gerard.
Child admitted to ED in agitated state with foster parents. Has had history of trauma and abuse. School refusal and elopement from past treatment settings.
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