Pt came to ED from North Homes, after increase in physical/verbal aggression and 30 day notice was given and lapsed without another placement found. Was boarding in our ED in Nov 2023 prior to admit to North Homes. Planning to connect with parent/County about re-involving Nexus YCT. Some sexual inappropriate behavior making him difficult to place.
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.
PH-M13-3281
Recommendation is for level 6 PRTF – seeking interim plan for Respite, Shelter Plus, etc.; patient is currently inpatient.
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:
Psychiatry
PCP
CMHCM
CTSS
Day tx (not yet started)
PH-M15-4148
Recommendation is for level 5 residential treatment.
Patient arrived at inpatient from ED due to an increase in suicidal ideation with plan. Patient’s legal guardian is Goodhue County. He currently lives with a foster family. This is his 5th psychiatric inpatient hospitalization. He has done PC PHP 3 times, receives outpatient mental health services, and did CIBS program.
Discharge Plan:
RTC: (will need county funding)
-Gerard (Referral sent)
-North Homes (Referral sent)
-Nexus Mille Lacs (Referral sent)
Referred for Trauma informed therapy and CTSS.
Continue with established outpatient providers:
CMHCM: Fernbrook Family Center
PCP/Medication Management: Allina Health
Guardian Ad Litem: Goodhue County
County Guardian: Goodhue County
MHF-M9-4282
Came to Grand Itasca ED 7/8 after altercation at home where he damaged his room. Has also made threats to family members and gotten in altercations with siblings. Was also in ED 7/5 and 7/3 for altercations taking place at home/in the community. Has history of being abused. Just had a CMH CM assigned a few weeks ago. Hospital has made referral for MNchoices. CMH is looking at placements, options are limited due to age.
AH-F16-4271
Adopted at birth with in utero meth exposure. Several inpatient, residential and outpatient avenues explored both instate and out of state. Patient is declined or asked to leave to due aggression to peers. Juvenile system has discharged back to mental health. Engages in self harm, significant aggression, stealing and fraud, fire setting, etc.
PH-M14-4228
Recommendation is level 5 QRTP, patient is currently inpatient.
Patient is a 14 y/o male w/ hx of depression, anxiety, ADHD, conduct disorder, ptsd , FSIQ 77, currently presenting due to ongoing mood/behavioral dysregulation resulting in hospitalization after aggression w/ mother and boyfriend. Biologically, there is a genetic predisposition for depression, anxiety, substance use. Patient w/ a long hx of impulsive/aggressive behaviors (runs away frequently, physically/verbally aggressive w/ authority figures, ect). Patient is a poor historian per outpatient psychiatrist and parents which impacts ability to know how he is actually doing. At this time, outpatient psychiatrist recommended RTC, and patient is on the wait list.
Patient has previously engaged in PHP, IT, CMHCM, and Intensive outpatient services
RTC
– Northwoods (referral submitted by CMHCM, year long waitlist 6/27)
– Gerard (referral submitted by CMHCM, under review 6/27)
PRTF
– Grafton (referral submitted 6.26)
PH-F15-4188
Recommendation is for level 6 RTC/PRTF – patient is currently inpatient.
15-year-old Female from RTC level 5. Patient admitted to inpatient after struggling with self-regulation after recent inpatient discharge. Patient has had 5 inpatient hopsitalizations since March 2024 with attempts at individual therapy, PHP, RTC (elopment), and In alignment with CMHCM, seeking RTC level of care. Referrals have been sent to Nexus East Bethel, Bar None Haven
Patient insured by Medicaid.
Pt has the following outpatient supports:
CMHCM
MHF-F14-3744
Discharging today 6/20 to group home
Came to our ED solely due to not having another placement. Has boarded in our ED in the past. Was previously at Bar None Shelter plus where she assaulted others and was taken to JDC. Was in JDC for a week when a judge ordered her to be removed, so CPS brought her to the ED as they had no other place to go. CPS is searching for group home placement as that is what the County’s juvenile screening team deemed the appropriate level of care.
MHF-M17-4109
Update: Discharging today 6/20 to hotel crisis respite
Came to the ED this time on 6/9, after refusing to do chores and punching a wall and tree. Dad is refusing to pick up. Was previously in our ED 5/4-5/18 and 5/25-5/28, returned home with Dad both of those times. Case Manager is looking for waiver paid placement, and has been for over a month. Had interview with potential provider 6/12- they are potentially going to do a variance for him to live in adult home if accepted (he’s 3 months from 18). At baseline has some auditory hallucinations, ongoing aggression- primarily verbal, occasionally property, along with some suicidal ideation.
PH-F16-4145
Recommendation is for dual diagnosis residential programming (ASAM 3.5)
Patient arrived at Inpatient from ED due to increased suicidal ideation. This is his 5th psychiatric inpatient hospitalization in the past few years. He has done RTC through Northwest Passages, PC PHP, and began programming at Options day tx before it closed. He does have a history of aggression towards school peers although aggression has not been a concern while in programming or hospitalized.
Discharge Plan:
Dual Diagnosis RTC:
Dual Diagnosis RTC:
-Newport (patient declined due to impulsivity and aggression concerns)
-MHealth Fairview, Maplewood (declined due to acuity of MH and aggression)
-Hazelden (in network benefits approved – initial phone screen complete, awaiting decision for setting up next assessment)
-Wings (pt declined due to physical aggression in previous six months)
-Rogers BH (Referral sent – guardian to complete phone screening and then pt screening will be scheduled)
-Lakeside Academy (Christian based program – patient declines referral due to this)
-Bar None Omegon (unable to refer – only accepts biological males)
-Anthony Louis Center (unable to refer – will not accept those needing dimension 3 ratings or above)