Pt is a 15 year old female with a history of unstable placements after having been removed from family care due to physical abuse. She has a history of irritability, impulsivity and mood instability which have led to outbursts, self-harm, aggression and property destruction. She was admitted to the hospital after being discharged from her residential treatment facility due to these behaviors. Patient is requesting medication management for the above listed symptoms while we work with her Hennepin County case manager on placement. She has not had any significant behavioral issues over the past 2 weeks while in the hospital.
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.
RMC-M15-3979
Suspended (5/17) for bringing a knife to school. Went to school on 5/20 with uncle to search locker (items were missing from home-guns, knives, etc.). Pt became agitated and began banging his head on the wall. He also punched his uncle.
MHF-M10-3883
Update 5/23/24: Needs psycho-sexual eval, but there is no place to send him to have it done as it can’t be done in the hospital.
Pt was brought into ED on 5/11 by mother due to allegations of abuse. Mother resides in DV shelter and shelter is not allowing pt to return there due to pt behaviors (bangs his head, kicks walls, makes threats, aggression toward mother.) Mother is trying to find new housing so that pt can return to her. County referrals made to Northwoods, North Homes, Village Ranch and Mille Lacs Academy- programs thus far are months out. Barrier to many programs is pt age. County JST is meeting today at 10:30am to discuss further options. Planning to refer for Nexus YCT once discussed with all team members and ROI is received.
EH8D-F10-3962
Pt has been living in the Residential Services-Jewel Group home for over a year. They gave a 60 day termination of service due to their inability to manage her escalating behaviors (last day of services 6/25/24). They have 2:1 staffing for her. These behaviors include harm to self, or others, striking out, choking herself, throwing things and threatening to kill herself and others. She had been attending TSA day treatment until March after an altercation with a peer. She is currently at a 4th grade level and has an IEP. She was brought to the Welia Mora ED on 5/9 and 5/10 as well as Children’s ED on 5/14 looking for “other placement” and was discharged due to not meeting criteria for inpatient hospitalization.
PH-F14-3891
Update 5/23/24: Patient accepted to Heartland Girls Ranch with scheduled admission Wednesday 5/29 – county funding was approved.
Patient presents to inpatient from the ED due to an increase in SI. This is her third psychiatric inpatient hospitalization. She has done PHP twice and engaged in outpatient mental health services.
Discharge Plans –
RTC: (JST funding meeting on 5/17)
-Avanti Center for Girls (referral under review)
-Nexus Gerard (referral under secondary review)
-North Homes (pt is on waitlist – 4-6 weeks out)
-Village Ranch- Annandale (pt is on waitlist – end of June)
-Heartland Girls Ranch (referral under review)
Continue with established outpatient providers:
– Therapist: Mayo Clinic Health Systems Austin
– Family Therapist: Albert Lea
– Medication Management: Mayo Clinic Austin
– Case Management: Freeborn County
– Occupational Therapist: Mayo Clinic Rochester
HCMCH-F14-3794
Update 5/15: Referral madeEmbark (out of state PRTF) and other 2 PRTF out-of-state referrals, as well as Bar None Haven.
The patient is 14 y/o female with a PMH dx to include DMDD,, ADHD, PTSD, and FASD. The patient has presented to ED for SI, attempts elopement and aggression. The patient has significant hx of MH IP hospital admissions. She was recently d/c Dungarvan after 2.5 years.
Hx of sexual abuse and neglect. She ward of the state. Her extensive trauma history and attachment issues, which hinder her ability to form relationships.
MHF-F14-3886
Came to ED on 5/09/24 via police after increase in suicidal ideation. Pt reports being bullied at her group home, was at Divine. Divine is not allowing pt to return. No physical aggression, continues to have suicidal ideation without attempts. County is working on Group Home placements- wait listed at North Crow, has explored shelters, foster cares- denied by those. Referral was made for MCCP crisis bed and working on hotel crisis respite referrals, as well as CRS homes.
MHF-F11-3813
Patient came to the ED on 5/4 after running away from her foster care. Patient reports she does not want to return to that foster care. County is guardian and CPS/ICWA worker is exploring shelters, denied from Dignity House and Passageways, still waiting to hear from Brittney’s Place. Elopement is main behavioral concern currently, pt did not like the foster care she was in. Not suicidal or violent according to foster parent.
MHF-M17-3807
Pt came into ED on 5/4 via ambulance after property destruction at home. Parent is refusing to pick up. Was previously at Gerard for 45 day eval- discharged on 3/22 to parent. Has a DD waiver CM through the County and they report that he has been approved for out of home placement, making referrals for waiver paid crisis beds and group homes. He has a mild intellectual disability and has some auditory hallucinations that are baseline for pt, Gerard assessment suspected schizophreniform disorder, provisionally.
MHF-M14-3589
Pt came to ED after ongoing behavioral concerns at home with guardian/grandmother, physical and verbal aggression, and threats. Previously discharged from CADI GH for physical aggression, went to JDC for that but was released after a rule 20. Declined by North Homes, Northwoods, and CABHH. A CADI home in Duluth that may be an option.