Kiddo came to our ED 12/23, came from North Memorial ED after incident with Grandma at home, brought to us from County Case Manager. Grandma has custody. Has history of physical aggression, primarily directed at family. Has been calm and cooperative in our ED. CM is currently exploring parent referred shelter programs but all thus far have denied due to age/behavior. OP therapist is recommending RTC for long term plan but needing interim plan as well, Grandma reports it’s not safe to return to her.
Psychiatric Diagnosis: Autism Spectrum/PDD
Autism Spectrum/PDD encompasses a range of neurodevelopmental disorders characterized by difficulties in social interaction and communication, as well as restricted and repetitive behaviors. Autism is considered a spectrum because it can vary in severity and presentation.
MHF-M13-4922
Pt is adopted, Pts parents signed a voluntary out of home agreement with Rice County, Pt has not been home in approximately 3yrs. Numerous failed placements due to aggression. There has been zero movement in regard to placement options. Patient is very aggressive and has been so on the psychiatric unit. Pt presents with all the symptoms of RAD
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.
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.
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.
NMH8R0MGH-M18-4738
Patient with autism and agitation sent from his new group home awaiting placement options. pt’s DD CM Deqa (612-472-2572) to gather more information regarding the Exception Bed Referral. Deqa shared that she was told that she can either refer for the Exception Bed or MFOC but not both. She is moving forward with the MFOC referral, as it would be a long term placement which would be better for the pt in the long run. She has made it known that the referral to MFOC is urgent. If the MFOC referral is denied, Deqa plans to either push on DHS as they have had an opening for 1 year and have not filled it, and/or pursue the Exception Bed. Deqa said she submitted for the Minnesota State- Operated Community Services (MSOCS) referral on 10/15. DHS Complex Transitions Team referral made on 10/15/24.
HCMCH-M17-4606
17 y/o male with MDD with psychotic features, neurodevelopmental disorder, intellectual disability. He recently discharged from CABHS. Waiting for MSCOCS placement hopefully will be admitted on 10/2. There concern of excessive irritability, agitation, disorganized thoughts, delusions, history of auditory or visual hallucinations, history of self injury and impulsive behaviors leaving to being in dangerous situations.
CH-F13-4577
Pt presents from school after high level of aggression, homicidal threats, and property destruction resulting in multiple hours of restraints. Patient has longstanding history of aggression and impulsivity with recent increase and daily occurrence consistent with starting new school. Pt newly to a group home from home placement as of May 2024. Now discharged from level 4 school due to behavior leading to presentation. Looking for IP for medication adjustments, though making changes in the ER in the interim. Difficult placement given neurological functioning, level of aggression, and acuity.
MHF-M7-4555
Came to the ED on 8/27 after behaviors at home of head banging and screaming. Mom has refused to pick pt up thus far, wanting medications prescribed before she is willing to do so. Our psychiatrist has been trying to work with Mom on potential medication changes, but there has not been an agreement thus far. CPS has opened a case and is investigating, and Nexus YCT intake was yesterday. Patient is primarily non-verbal. Mom is reporting he needs residential treatment, but there is no professional recommendation for that at this time and due to age and autism diagnosis, options would be very limited. Mom has connected with Chelida in WI. Pt has DD waiver with in-home services, as well as Washburn ready to come out at discharge.