Patient admitted to inpatient hospital following attempted overdose. Prior to hospitalization pt had resided at home with parents since February 2024. Prior to this pt had 18 month stay at Gerard RTC. Pt also had previous stay at North Homes RTC.
Discharge Plan:
RTC
-PCR (referral sent)
-Gerard (referral sent)
-North Homes (referral sent)
-Village Ranch (declined in February due to behaviors, flight risk, animal cruelty)
-Mille Lacs (referral sent)
-Bar None Shelter Plus (need county referral/funding, CMHCM not supporting)
-Leo Hoffman (referral in progress)
Group Home
-CMCHCM assisting with referrals although pt would need to pursue CADI funding prior to county funding
-MnChoices Assessment through Hennepin County for CADI Waiver (request made, scheduling 6 months out, can expedite if placement is found)
Continue with established outpatient providers:
Individual Therapist: Scott Nielson with Melissa Anderson and Associates
Primary Care Provider: Riverwood in MacGregor
Prescriber/Medication Management: Janet Larson with Riverwood Clinic
CMHCM: Alissa Boser with Aitken County (218-838-2405)
Probation Officer: Jacob Leondhardt with Aitkin County (218-927-7231)
Patient presented via law enforcement to the St. Cloud ETC after eloping from mother’s home and found wandering on Highway 10. Initially aggressive/combative with law enforcement. Patient was cleared for discharge but refused to go with mom, because combative and required PRN to calm down. Was kept overnight. Patient’s mom refused to pick patient up once cleared for discharge due to his ongoing aggressive behaviors. CPS is involved and a new report was filed.
Police hold initiated 7/9/24 and CHIPs petition is being pursued. County CPS worker is seeking foster care placement.
Update (7/18)- Court hearing for CHIPs petition. County CPS case worker is continuing to look for foster care placement. Patient will have twice weekly phone calls with his mother.
Patient came to ED on 7/19 from Nexus East Bethel PRTF after swallowing a foreign object. Was in our inpatient unit from 7/15-7/19 and discharged for only hours before returning. Reports that repeat behavior was pt seeking to be removed from program. Nexus PRTF is not accepting pt back at this time and Mom is unable to have pt return home. Sending referral to Nexus YCT to assist with placement.
Patient came to our ED on 7/22 after an altercation with mother and mother is refusing to pick pt up. Was previously in ED on 7/12 for same reason. Was reportedly discharged from Nexus East Bethel 7/12. Has been denied by Northwoods, Gerard. Was somewhat successful in the past with day treatment, CM is exploring day treatment options.
Brought to ER after assaultive behavior towards group home staff. Since being in the ER, patient has denied SI/HI and been behaviorally regulated with the exception of one incident after being here for 6 days, and was asked to go to his room to avoid potential problems with other patient’s in the ER and he was upset and got restrained. He’s been up for discharge back to his group home since the day he presented to the ER. The county worker has been main contact with group home and are trying to problem solve ways to support patient at the group home. Ombudsmen involved.
Update 7/10 – patient remains boarded, now on EmPATH unit (observation unit/extension of ER) without aggression or behaviors. County guardian making referrals for placement options including respite, crisis, group home, shelter
On 7/8/24, patient was told he would be spending time with his mother, to which patient had a negative response, causing patient to assault his father and run away. Police located patient at a local middle school just before patient ran across a highway and had to be sedated by EMS due to safety concerns.
Pt has dx that include: reactive attachment d.o., disruptive mood dysregulation disorder, PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections), ADHD, ODD, OCD, pervasive social communication d.o., with low non-verbal skills, high verbal skills, low memory skills, and average IQ.
Patient endorses homicidal ideation towards his sibling. Increasing behaviors at home. PHP (Clara’s House) attempted and will be discharged with recommendation of high level of care (residential). Patient has significant trauma after extensive physical abuse from biological mother and likely operates at a much younger age. Patient was removed from his mother’s custody by Ramsey County CPS in May 2024. Aunt is foster care provider.
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.
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
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.
