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.

CH-M14-3045

The patient is a 14 Y year-old male with a history of mild intellectual disability, reactive attachment disorder, disruptive mood dysregulation disorder, ADHD, and anxiety who presented to the ER on 2/1/24 via law enforcement for assessment of aggressive behaviors at his group home. Group home staff report he has caused $10,000 in damage since his admission to the group home on 1/8 which included damaging house property and 3 staff members vehicles. He received a letter of suspension from the group home effective 2/1/24 due to his behaviors.

He has had extensive MH services including foster home placements, temporary placements with his grandmother and biological father, multiple ER assessments for aggressive behavior with suicidal & homicidal statements, residential at Gerard Academy, residential at Northwoods in 2017 for 6 months, partial hospitalizations in 2015, 2016, and 2023, inpatient hospitalizations at Children’s, Miller Dwan, Prairie Care x2, Prairie St. John’s, day treatment, group home placement, level 4 schooling, in home skills, case management, PCA services, psychological testing, speech therapy, OT, and individual therapy. He is currently on a CADI waiver.

He has a long history of behavioral dysregulation including: fire setting (set a blanket on fire at age 7, burned the trim on the bathroom door at age 7), sexualized behaviors (including anally penetrating a younger male step cousin when the patient was 6 along with engaging in oral sex), aggression towards animals (broke dogs hip, hit/kicked/choked, killed family cat & dog), physical aggression (including slamming staff fingers in the door, giving 2 staff concussions, kicked staff in the chest, hitting, kicking, biting, squeezing, grabbing, has thrown his younger sister), property destruction, self injurious behavior (head banging, wrapping shirts around his neck, picking at his skin), elopement from classrooms and his home, stealing, and hoarding food. He was in detention at Lino Lakes a few months ago for assaulting his mom.

It is not felt that inpatient psychiatric hospitalization is indicated at this time due to the chronicity of his behaviors though he is not able to return to his group home at this time.

CH-F15-2882

Patient presented to the ER after 3 other ER visits from outside ER for physical concerns that were determined to be panic symptoms verses a physical abnormality. Patient has a chronic history of mood and behavioral dysregulation, self-harm, multiple suicide attempts, truancy, and parent child relationship difficulties. She has a history of trauma in the form of witnessing domestic abuse, physical abuse, possible sexual abuse, and the death of her dad due to an OD 4-5 years ago. She has had 2 inpatient hospitalizations along with 2 PHP admissions with little benefit and participation. Mom struggles with following through on recommendations and struggles with alcohol/substance use. A child protection report was filed last year and she moved in to her neighbors though this is no longer an option. She denies any passive or active suicide ideation, plan, or intent. Inpatient hospitalization is not recommended. Mom is not willing to bring her back home at this time due to disruption in the home.

PH-F15-2859

Discharge Plan: *Insurance is BCBS MN PMAP
Residential Treatment – Referrals have been sent to the following facilities:
-Avanti (Referral submitted 10/26, DECLINED)
-Gerard Academy (Referral submitted 10/26; Update received 12/14: Unable to admit due to elopement risk but otherwise approved, will leave on list to review level of risk moving forward; currently under re-review)
-North Homes (ACCEPTED; County funding needed; openings in March/April)

PRTF – Referrals to be sent to the following facilities:
-Grafton (Referral submitted 10/23; pt does not meet exclusionary criteria)
-Nexus East Bethel (Referral sent; only accepting pt’s with MA insurance at this time; will refer once County confirms MA insurance)

Outpatient Services:
Establish CMHCM through Ramsey County (Referral submitted 10/23; intake worker confirmed on 1/10 that a long term worker would be assigned next day)

Continue existing outpatient services:
-Therapy/Therapist: Minnesota Mental Health Clinic in Woodbury
-Prescriber/Medication Management: Nystrom & Associates
-MCRC Runaway Intervention Program at Children’s
-PO Ari Tresselt Ramsey County
-Disability Services intake worker: Ramsey County

Case Description
15-year-old female with a history of depression, anxiety, ADHD, PTSD, as well as some behavioral concerns. Pt has had three hospitalizations in the past year, has done PHP, JDC, outpatient.

PH-F15-2853

Discharge Plan: *INSURED BY BCBS MN PMAP*
Residential Treatment – Referrals have been sent to the following facilities:
-Avanti (Referral submitted 10/26, DECLINED)
-Gerard Academy (Referral submitted 10/26; Update received 12/14: Unable to admit due to elopement risk but otherwise approved, will leave on list to review level of risk moving forward; currently under re-review)
-North Homes (ACCEPTED; County funding needed; openings in March/April)

PRTF – Referrals have been sent to the following facilities:
-Grafton (Referral submitted 10/23; pt does not meet exclusionary criteria)
-Nexus East Bethel (Referral sent; only accepting pt’s with MA insurance at this time; will refer once County confirms MA insurance)

Outpatient Services:
Establish CMHCM through Ramsey County (Referral submitted 10/23; 1/10 intake worker states the long term worker will be assigned tomorrow)
Continue existing outpatient services:
-Therapy/Therapist:Minnesota Mental Health Clinic in Woodbury
-Prescriber/Medication Management: Nystrom & Associates
-MCRC Runaway Intervention Program at Children’s
-PO Ramsey County
-Disability Services intake worker Ramsey County

Case Descreption:
15-year-old female with a history of depression, anxiety, ADHD, PTSD, as well as some behavioral concern. Patient has exhausted several outpatient supports including school in a smaller setting, Childrens hospital, as well as Maplewood PHP, DBT, and engagement with MCRC, JDC and two other shelter placements. Third hospitalization this year.

CH-F16-2451

Update- 1/11/24- The patient has been accepted to MNCCS respite home with a planned admission date of 1/17/24!!!!! Thank you to this facility!!

The patient presented to the ER for the second time on 8/22 via law enforcement for aggressive behavior after she assaulted a staff member at the group home and attempted to bite, throw things, and hit staff upon arrival to the ER resulting in restraints and IM Zyprexa. She had been in the ER earlier in the day after intentionally swallowing a rock in an attempt to get out of her group home and was subsequently discharged back to her group home following psychiatric assessment. Of note, she presented to the ER 3 additional times over the week prior to admission for similar presentations and is well known to the ER due to multiple presentations of pseudoseizures, aggression, and suicide ideation.

She was admitted to the unit after her group home provided a suspension of services notice with the requirement of medication adjustment to be completed in order to return to the group home. Medication adjustments were made, and she has been psychiatrically and physically stable since at least October though she is not able to return to her group home until additional staff are hired and trained.

PH-F15-2511

Update 1/24- County funding for RTC denied on 12/26, now following alternate recommendations as determined by the county. DC was scheduled for 1/4, due to parent request, rescheduled for 1/5.

DISCHARGE PLANS:
Hospital Recommendation is RTC-
Avanti -referral made, accepted, intake 12/28/23
North Homes- referral made, reviewing, no immediate openings
Gerard- referral made, accepted, intake 1/9/24

Alternate Plan:
Mobile Crisis Team (Referral sent by CMHCM)
Day Treatment- Christian Family Solutions (Referral sent by CMHCM, waitlist to about 1/19/24)
Intensive family therapy (Referral to be sent by CMHCM)
PCP- Marlene Jilek, APRN (Mankato Clinic)
Therapy- Claire Alexander, MS, LPCC at PrairieCare Mankato (Availability as soon as next week, requests patient guardian call to schedule appointments)
CMHCM- Nicole Wigern (Blue Earth County)

Presenting Problems: Major Depressive Disorder, PTSD, SI/SIB, Inpatient for the third time this year, has done PHP twice this year

EHSM8S-F10-2635

12.21.23 This week the case worker came and discharged the child. Created safely plan, and child went home with gramma.

12/13/2023-History of Present Illness: This is a 10-year-old female patient was assessed by the crisis team crisis team recommended the patient go to a higher level care. Patient brought to ED for placement. The patient currently lives with grandmother but is Custody Of Indian child welfare. The patient has a history of PTSD, ADHD, anxiety, The patient has been hospitalized previously at primary care in Brooklyn Center Minnesota for 9 days, on October 23, 2023. The patient has a history of a mental health team including a home counselor at school counselor and outpatient services. Patient was transported here by law enforcement services. On examination the patient denies any pain Or complaints. There are 2 workers from Indian child welfare present with the patient here.Patient evidence of UTI Macrobid 100 mg orally was given Patient will need prescription Patient is transferred or discharge. 
Impression: #1 Behavioral issue #2 UTI

Writer met with pt, sleeping and did not wake, and pt’s social worker Vanessa 218-850-9918 to discuss prior services. Pt has several services in place to assist with managing her behaviors. She has a therapist she sees regularly, medication management, is on an IEP, is able to take breaks at school, has in home services, engages in skills work, and does family therapy. Pt is in foster care with her grandma and has been since a young age. Pt does see her mom and gets violent with the siblings. Pt is violent both at school and will destroy property. Pt has aggression towards grandmother and will hit her, law enforcement has been called, however, grandmother does not file charges. Pt was in Prairie Care in October for roughly 9 days with no issues. At this time ICW social worker and grandmother feel inpatient treatment is the next option. Residential treatment was discussed briefly, however, without any legal charges or any recommendations, as well as pt’s young age as a barrier, residential placement is not an option at this time.
 
Staff will continue to look for inpatient treatment at this time.

SMCF-F16-2210

Patients a 16yr female with a history of albinism, anxiety and depression, ADHD, unspecified intellectual disability and borderline personality disorder presenting to the ED with complaints of suicidal ideation with plan. Was discharged from PSJ on 11/08/23. Started PHP at PSJ on 10/9/23, became aggressive and had a episode with SI statements and brought to the ED. Extensive inpatient psychiatric hospitalizations over the past year with >4 at Prairie St Johns, and 4 months at Prairie Care Medical Center from 4/18/23 -8/25/23.

MHF-F14-2598

Patient presented to the ED from Prairie Care residential due to aggressive behaviors. Patient is at baseline and not recommended for IP MH admission. Prairie Care will not accept back, CPS has custody and reports patient needs RTC. County working on referrals, has been declined from most shelters and RTC in MN.

MHF-F15-2472

Patient is presenting to the ED for the following concerns: verbal agitation, suicidal ideation, threats to harm others, property destruction. Patient became upset at school, threw items, and ripped things off of the wall. Patient left school grounds, and police/ambulance were called. Patient has been living with her aunt for the past few months. Patient’s biological mother died when she was an infant, and was abused by a family member who obtained guardianship. Patient makes suicidal and homicidal threats often.
Patient was in the Fairview PHP program earlier this year. She was in the ED in May ’23. Patient no longer has a medication management provider. She has a county CPS worker and a newer case manager. Patient is currently in Equine Therapy 1x/week at Hold Your Horses.