Pt came to us 11/18/24 after an altercation at her ongoing GH in which she physically aggressed against another youth. Its reported that youth plans to press charges. She is not allowed to return to that GH, but that provider is working to see if they can set up a new setting for this pt, both temporary and ongoing. Team also has another GH they are looking into for her. This kiddo boarded with us previously, prior to discharge to her last GH, 9/24-11/1 of last year. Dakota County currently has custody. She is also open to CMH and waiver.
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.
GC8S-M10-4890
Patient was at school when he began having hallucinations, pulled his hood over his face, then ran into a concrete wall. He was admitted to Gillette for medical management of his bleed needing surgery to repair. Initially he was calm and not demonstrating behaviors then once he was fully off all sedation, he began showing his behaviors. He verbalized thinking everything is poison so he wouldn’t eat or drink, hearing and seeing things that are not there, extremely anxious and afraid. He needed physical holding for safety this am due to behaviors that put him at risk for his safety and others in the room. Patient has a history of this behavior prior to this incident. Strong family history of schizophrenia, this is currently in question for patient. Have connected with Children’s, Abbott and Prairie Care for possibly inpatient psych placement and med management.
MHF-M14-4646
Kiddo came into ED on 9/24 from school for aggressive behavior, was in foster care who is not willing to take pt back. Under custody of the County. Has history of both residential txt (Northwoods 2x) and juvenile detention centers, and has a rule 20. Referral has been made to Prairie Lakes, waiting for response.
NMH8R0MGH-M13-4848
Patient was placed in residential treatment for one year in 2022-2023 from the ER. Grandmother/legal guardian does not feel safe with patient in her home as he has been physically aggressive with her, she is declining to pick him up from the ER and wants out of home placement. Per Grandma, he was successful in the home following residential treatment, however, this year his aggression has become worse. Community case manager has been unsuccessful in securing placement.
HCMCED-M11-4844
On 11/14/24 the patient’s foster parents brought him to HCMC APS after he was discharged from Children’s Hospital St Paul because of his aggressive behavior. When in APS the patient began hitting his foster mom and becoming increasingly agitated. Security had to assist in transporting the patient to an emergency department bed, where he was then put into restraints for his and others safety. He was given sedative medications, IM.
The patient has been in foster care since he was 7 years old. He was physically and emotionally abused by his biological mother. He has been hospitalized at Fariview inpatient pediatric psych for a year, where he was then transferred to a residential treatment center. He has been with his current foster parents since August 7th, 2024.
MHF-F15-4766
This kiddo came to our ED on 10/21 because she did not have any other placement. County currently has custody. She was previously at Niama House where she had physical aggression toward staff on 10/19. They brought her to the ED on 10/21 and discharged her from their program. She previously boarded in our ED from 4/25-6/20, also due to needing placement.
PH-F17-4728
Patient is needing an out-of-home, secure, placement, due to ongoing, chronic, safety concerns, that are unable to be managed at home. Patient is recommended to attend Residential Treatment or enter into a supportive living environment.
Patient has a significant psychiatric history including:
Psychiatric hospitalizations
-Mayo Clinic Generose 08/2019
-PrairieCare 10/29-11/11/2022
-PrairieCare 08/30-9/7/2023
-Mayo Clinic Generose 09/2023
-PrairieCare 11/8-11/20/2023
-Mayo Clinic Generose 12/2023
-Mayo Clinic Generose 04/2024
-PrairieCare 06/25-7/11/2024
-PrairieCare 07/25-8/14/2024
Residential Treatment:
-North Homes for a 35-day evaluation
-Gerard 08/2020-06/2021
-Gerard 12/2022-06/2023
Day Treatment:
-Fernbrook Family Center
Partial Hospitalization:
-Mayo Clinic November 2021, June 2022; Prairie St. John’s February 2022 and July 2022
-PrairieCare Rochester 11/16-12/21/2022
-PrairieCare Rochester 09/11-9/15/2023
-PrairieCare Rochester 09/19-10/11/2023
History of self-harm by cutting (recently daily), with one prior reported suicide attempt (by overdose, 6/2024), who re-presents to PrairieCare inpatient due to safety concerns related to self-harm by cutting, with increasing suicidal ideation and intention, with an inability to contract for safety, in the context of stressors related to school re-starting.
PH-F8-4701
Recommendation is for QRTP or PRTF – either could potentially meet the needs of this patient and limited treatment centers available due to patient’s age. Patient is currently in psychiatric inpatient hospitalization.
Patient is an 8-year-old female. Patient presented to inpatient from the ED due to increase in unsafe and risk-taking behaviors. This is her fourth inpatient hospitalization; one in 2022 and three in 2024. Patient has attended day treatment twice and participated in outpatient psychotherapy and medication management.
Discharge Plan:
PRTF/QRTP: (county funding approved for QRTP)
– Grafton (declined due to not meeting criteria)
– Northwood (referrals submitted 9/9, on waitlist 9/23 – awaiting update on admission timelines)
– Gerard (unable to accept due to age)
– Avanti (unable to accept due to age)
– Bar None Haven (unable to accept due to age)
– North Homes (unable to accept due to age)
– Heartland Girls Ranch (unable to accept due to age
Continue with following outside providers:
– Therapy/Therapist: Solutions Behavioral Healthcare Professionals
– Primary Care Provider: Sanford Health
– Medication Management: Solutions Behavioral Healthcare Professionals
– Case Management: Solutions Behavioral Healthcare Professionals
– Occupational Therapy: Beyond Boundaries Therapy and Wellness
EH8D-M14-4364
This patient was brought to the hospital by police for aggression and dysregulation exhibited at the group home. He was charged with 5th degree assault after injuring staff members at his group home. His behavior has persisted despite medication adjustments and behavioral plans. He struggles in settings where there is too much sensory input and lack of structure. He has been destroying property and presenting with escalating aggressive, dangerous behaviors, homicidal threats and sexualized behaviors. Despite his impulsive behaviors and subsequent harm to staff members, he displays no remorse, though some question of whether he is able to adequately engage in reality testing possibly related to intellectual disability.
He is a ward of the state. He was placed in foster care at age 6 after suffering from neglect by his biological family. Their rights have been terminated.
CH-F13-4756
The patient is a 13 year-old female with a history of ADHD, inattentive type, anxiety, depression, sexual abuse, suicidal ideation, and self-injurious behaviors that presented to the ER following an intentional overdose in an attempt to end her life. She has had 2 previous inpatient hospitalizations. Patient has a complicated home life with several CPS reports and basically does the caretaking for her younger siblings. Patient has several tattoos given to her by her mother and sister and mother is unwell as well and frequently struggles with suicide attempts and self-harm. Sounds like a significant sexual abuse history within the entire family that may still be occurring. The patient is at risk for sexual exploitation given increased sexuality.