A 16-year-old female presented to the ED after being away from her group home placement for about 2 weeks. She is a ward of the state and is currently boarding in the ED due to her complex social and mental health history, increased risk of elopement, and the care team’s challenges in developing a safe discharge plan. Referrals are pending.
Psychiatric Diagnosis: Depression
Depression is a psychiatric diagnosis characterized by persistent feelings of sadness, hopelessness, and a loss of interest or pleasure in activities.
PH-M17-4298
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)
MHF-F12-4412
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.
MHF-F17-4377
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.
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.
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-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.
MHF-F13-4168
Pt came into our ED on 6/13 after a verbal altercation at home with mom, where she left the house and walked to the police station who called crisis and brought pt to ED. Mom is refusing to pick up. Its reported pt was in residential treatment until April 2024, and prior to that was in PHP through Fairview. Mom reports that Case Manager is looking into residential treatment again however we have been unable to reach the CM and their offices are closed the rest of this week. Unsure if there is a recommendation for residential or county approval for that LOC.
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)