Pt came to our ED via ambulance after running away from Avanti, because they planned to discharge her home to family where she did not want to go. Avanti will not take her back. She has been cooperative and has not had any behavioral incidents in the ED. She is at her baseline, which includes non-suicidal self injurious behavior. Has history of therapy, psych, PHP, IPMH, foster care. Going to a different family member for kinship placement is currently being discussed though pt is not agreeable at this time.
Psychiatric Diagnosis: Anxiety
Anxiety disorders are a group of psychiatric diagnoses that involve excessive and persistent worry or fear. These disorders can significantly impact daily life and well-being.
PH-F17-4082
Recommendation is for CD residential treatment. Patient is currently inpatient.
17 year old female admitted from the ED. Pt was having increased panic attacks and engaging in self-injurious behaviors by hitting themselves. Patient has been having suicidal ideations. Patient has been using marijuana as a coping strategy. Patient has a history of numerous psychiatric hospitalizations. At this time mother feels the patient can not return home as the family has been staying at a motel.
Pt insured by BCBS PMAP and Medicaid.
Pt has the following outpatient supports:
Individual therapy
Psychiatry/medication management
Primary care
MHF-F17-4287
Came to ED on 7/8 after parent-child conflict, verbal altercation and mother reports she was scratched. She had been attending Fairview’s PHP program but has been minimally engaged there, reports that she prefers individual therapy over PHP. She has not had any behaviors since being in the ED. Goal is for patient to return to family with services, but Mom has not been agreeable to pick up yet, continuing to work on services to support the family and see if pt can return home.
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
CH-F11-3461
Update 6/26/24: Patient doing well and has made improvement with emotional dysregulation. No longer recommending PRTF level of care. Interview with Divine House occurred last week.
Update-5/30/24- Patient has had severe decompensation in part due to child protection concerns along with prolonged hospitalization and has been in the BICU for aggression, self harm, and seeking/securing items to self harm with. It is now recommended that she be placed in a PRTF.
11 year old presented to the ER after discharging from residential for concerns of running away, recent sexual perpetration to 6 year old brother, and homicidal ideation towards current guardian. Active CPS investigation over the last 1.5 years and is unable to return to her mother’s care or a home with younger children. This patient struggles with low insight, poor boundaries, antagonizing behavior, and justifies her behaviors. We attempted to obtain psychological testing though patient was not cooperative and refused. Medications are stable. She continues to display oppositional behaviors at times.
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)
PH-F16-3212
Update 5/16/24: No new information from 5/8 update. Accepted at Bar None Haven, county funding approved. QI completed with recommendation for secure residential setting that is able to accommodate both chemical dependency and mental health treatment. County is inquiring to see if this can be accommodated at Bar None Haven or if they have to look into additional placement options. Medical recommendation is locked mental health RTC. Comprehensive assessment (rule 25) recommends Mental Health Residential. Accepted at Nexus East Bethel PRTF- opening midsummer.
Update 5/8/24: Accepted at Bar None Haven, county funding approved. QI completed with recommendation for secure residential setting that is able to accommodate both chemical dependency and mental health treatment. County is inquiring to see if this can be accommodated at Bar None Haven or if they have to look into additional placement options.
Update 5/01/24: Accepted at Bar None Haven, county funding approved. Missed admissions on 3/20 and 4/30 due to county wanting to complete QI process and having VPA signed in front of a judge before approving placement.
Update 4/25/24: Accepted at Bar None Haven, second opening is now 4/30 and county approved for placement, they are not approving transition on 4/30 wanting a judge to sign the VPA in court and wait the QI process.
Accepted to Nexus East Bethel PRTF, estimated wait list out until August-September.
Update 4/17/24: County funding approved, awaiting open placement at Bar None Haven, previously missed admission due to no funding. Pending acceptance decision at Nexus East Bethel PRTF.
Update 4/3/24: Pt has MA now. CMHCM in process of being assigned and requesting preplacement screening for funding. Denied from Grafton. On waitlist at Bar None Haven, missed admission due to no funding. Pending East Bethel.
Discharge Plan:
Level 6 RTC/PRTF-
Grafton (Referral submitted; Not in network with Prime west, can contract with MA MCO’s and obtain SCA, Denied 2.8.24, re-reviewed, denied)
Nexus East Bethel (Referral submitted; pt will need straight MA; several month waitlist, now has MA so re-reviewing, accepted, admission waitlist til mid-summer)
Bar None Haven (Referral submitted, Tentative admit 3/20-3/21, dependent on county funding, county declining JST screening, requested again, approved)
CMHCM at Beltrami County (Guardian currently in communication with the county, case manager was not being assigned until pt has CD treatment, requested reconsideration)
Notably, Previous services/interventions attempted: Dual Diagnosis IOP, Outpatient therapy, outpatient psychiatry, PCP, CMHCM, CTSS, CD RTCs, Inpatient x3, JDC, previous foster placements.
CMHCM at Beltrami County (Referral completed, services in intake)
INSURANCE- NOW Straight MN MA (was a PRIME WEST MA)
Description: Patient is a 16-year-old Native American female who has a history of depression, anxiety, ADHD, nicotine use disorder, cannabis use disorder, and unspecified trauma. Patient experiences significant impairment(s) in the area(s) of social, emotional, and academical. Patient identifies current supports as her father, sisters, and grandmother. Patient has a history of inpatient psychiatric hospitalization through PrairieCare and Prairie St. Johns.