A 16-year-old female with a history of mood disorder, borderline personality disorder, PTSD who presented to ED with suicidal ideation, threatening behaviors towards her family, and altered mental status. She also struggles with low frustration tolerance, severe emotional dysregulation, and a lack of coping skills. She is currently awaiting inpatient placement.
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-F15-1621
Updated 10/23/23: DC home to in home therapy through CIBS. Still no county funding for QRTP
Updated 10/19/23: Still no county funding for QRTP. Discharge home 10/23 or 10/24 with in home therapy through CIBS.
Update 10/12/23: Still no county funding. Likely moving forward with CIBS at Gerard, will likely discharge next week home.
Update 10/5/23: Gerard admission pending 10/11 now. County funding remains pending. Pt declined from CD RTC noting Mental Health long term RTC.
Update: 9/7/2/3 Gerard admission tentative 9/20, pending county funding.
Update: 8/31/23 Approved for Gerard admission week of 9/18, pending county funding. Also accepted at NorthHomes, 3-6 month waitlist.
SI since the 4th grade, history of trauma, living in cars/shelters, history of CD use.
Discharge Plan:
Primary DC recommendation is RTC*:
Gerard (accepted; pt is next on list for placement; openings week of September 18th)
North Homes (accepted; 3-6m waitlist)
CRTC (referral placed; admissions paused due to staffing)
Avanti (referral not placed; facility not accepting referrals)
*QRTP/RTC County Funding needed as pt has a UCARE PMAP Plan:
Dakota County CMHCM: Referral Placed
-Mother lives in Dakota County and father lives in Rice County (pt will reside with mother following hospitalization, mother provided consents)
-Le Suer County and Scott County CMHCM previously referred to: Cancelled Referral due to Family Moving
MHF-F13-1289
Update 9/28/23: Has potential placement. Awaiting.
Patient was brought in by medics after she was physically aggressive with a staff member at The Aspen House, where she has been living for two months.
Patient has adoptive parents and adoptive siblings. She was adopted when she was two years old, and has recently reconnected with bio-dad.
Patient had prior diagnoses of depression, ADHD combined type, anxiety, neurocognitive disorder related to maternal meth abuse while patient was in utero, and learning disability. She’s been in M Health FV IOP, since she’s been there. She does not participate in groups or other activities much. She’s been in an inpatient mental health unit, mostly at M Health FV, at least four times. The last admit was 4/21-4/27/2022 at FV. She’s had the following RTC placements: Eau Claire Academy, 4-8/2022, CRTC 8/2022-1/2023, and Avanti 1-4/2023. She receives Psychiatry and Therapy services through the group home.
She has had two prior suicide attempts by choking herself.
MHF-M13-1809
Patient presents to the emergency department for the 4th time in 12 days. Patient was discharged from the hospital, went home with his mother, and got into a verbal argument in the car. Patient reports his mother kicked him out of the house, so he went to school. Patient arrived at school and was told that he was not allowed to be there due to historical violent threats against other students, so school staff called police. Patient has recently engaged in property damage at his home and made homicidal threats towards his step-father.
Patient’s father is incarcerated for murder. Patient’s mother has history of childhood sexual trafficking. Patient has ongoing parent-child conflict. Patient has no history of inpatient mental health admission or intensive outpatient treatment. Patient is involved in a youth runaway program. Patient has a school social worker. Patient has established medication management.
Patient’s mother is refusing to pick patient up due to homicidal threats towards family.
SMCW-F15-1775
Pt is brought to the ED by law enforcement due suicidal ideations. Pt has a long standing mental health history. She Has been hospitalized innumerable amounts of times for suicidal ideations. In August alone, she was hospitalized for mental health twice. She has a case worker with social services who is supposedly working on long term placement for her. She is living at home again. In the past, it has been shown that this living situation is not ideal and she has innumerable mental health hospitalizations as she reports self harm and suicidal ideation and plans. 2 days ago, she was walking in the road hoping to get hit by a car. The sheriff was called and pt removed herself from the road and went back home with her mother. Crisis team was called again last night. Pt was outside walking and threatening self harm for 12 hours. Her CSS worker was there during this time. She threatened to hang herself with the clothes line. She finally agreed to go home and watched TV until she fell asleep. She slept until 1:30 pm today. Tonight she was at the church and took a cord and wrapped it around her neck threatening self harm. Law enforcement was contacted as she was refusing to leave the church. She was brought to the ED for evaluation.
Pt reports she doesn’t feel safe to return to home. She reports she wants to die and threatens to cut herself or overdose on medication.
Mother reports pt has a PCA that she stays with. This PCA is her cousin. The cousins father died and pt has not been able to go to stay with her for the last week. Pt has been staying at home with her mother, father and siblings.
Mother reports that this is overwhelming to her and her other children. Supposedly social services is working on long term placement for this patient.
HCMCH-F15-1627
15 y.o. female with history of childhood sexual abuse and more recent sexual exploitation in 2023 with concern for victim of sex trafficking. Presents with suicidal ideation, self-harm behaviors including substance abuse. During this admission drug screen positive for fentanyl and methamphetamine. Patient transferred from HCMC to Sacred Hearth Inpatient Behavioral Health Unit 8/23/23; long term recommendation is residential care. Substance use and placing self in high risk social situations occurs in the context of her trauma history.
MHF-M16-1654
UPDATE : Transferred to BAr None shelter 9/13/23
UPDATE 9.7.23 – working with Nexus FACTS for Placement Coordination Services. New Diagnostic Assessment 9/7.
Patient presents to the Emergency Department from a residential treatment facility, following attempted self-harm and suicidal ideation, with a plan to slit his throat with a screw. Staff monitored and stopped the patient from harming himself. The patient experienced intense emotions as he thought about the trauma he experienced at the hands of his father.
Patient was seen in the ED on 8/14/2023 with a similar presentation. Medical records indicate a hx of physical and sexual abuse, conflicts with his father, patient had pulled a knife on this father, and hx of substance abuse. Patient denies current substance use, and has 60 days of sobriety.
8/24- Patient was discharged from residential facility
PH-F13-1646
UPDATE 9/7/23: Pending potential foster/emergency beds.
UPDATE 8/31/23: Possible emergency foster bed open 9/5, emergent SMRT application in process. Still waiting living placement.
13 y/o female with a history of PTSD, depression, ADHD, mild CD concerns. Patient has a history of previous psychiatric hospitalizations related to increase in SI, SIB, and/or suicide attempts. Patient currently has an outpatient therapist and children’s mental health case manager; treatment history includes outpatient therapy and psychiatric hospitalizations as well as one prior placement at Northwoods crisis stabilization program. Patient is in foster care under guardianship of St. Louis County. Patient was in a foster home prior to inpatient hospitalization but is unable to return to that placement after discharge. Patient has Ucare PMAP insurance.
Discharge Recommendations:
Continue individual therapy established provider
Continue CMHCM with established provider
Continue primary care/medication management with established provider
Establish psychiatry (SW to refer/follow up with outpatient team RE: pending referral)
Estimated length of stay:
Until placement is established by the County (Patient is medically ready for discharge as of 08/16/23)
PH-F16-1316
UPDATE: Pt discharged home with improvement of some symptoms and wraparound services. CABHH and PRTF referral stand.
16 yo adopted white gender fluid/nonbinary adolescent with Albinism of Otter Tail County. No hx of attachment concerns. Delay with speech. Some historical cognitive and attentional concerns. No substance use. Expressing SI, SIB urges and lability. Hospitalized twice in early 2023 until admission to PrairieCare RTC on 4/11/23, needing a higher level of care, admitting to Inpatient 4/18/23. Patient has severe lip biting when dysregulating causing multiple lip lacerations, requiring suturing.
DISCHARGE PLANNING EFFORTS:
Primary Recommendation is CABHH; Referral made, on waitlist.
Residential Treatment or PRTF consideration:
-Avanti; referral made, declined due to aggression and seclusion history
-Northwoods; referral made, on call back list, 9 month waitlist
-North Homes; referral made, accepted, waitlist out to mid-summer/fall 2023> still would need QRTP funding*
-Gerard; referral made, reviewing, declined due to staffing needs in educational settings
-CRTC; referral made, declined
-Heartland Girls Ranch, county SW to refer
-Village Ranch, county SW to refer
PRTF:
-Grafton, referral made, denied, can reach out in a couple months for re-review due to their staffing
-NorthWoods, waitlist 12 months
-Leo A Hoffman; referral not made, only accepting Male patients
Out-of-state RTC:
Guardian declines referrals for out-of-state placement at this time
*QRTP funding is not in place- Parent does not consent to Relative Search which Otter Tail County uses in the QRTP pre placement screening process.
PH-F10-1534
UPDATE 8/31/23: Discharge to family with wraparound services planned for 8/31/23 at 1300 while waiting next Gerard admission (tentative late September) as QRTP pre placement screening has now approved.
UPDATE 8/24/23: Pt remains accepted to Gerard, next admission now late September. QRTP pre placement screening team approved 60 days RTC as of 8/24/23. We will discharge home with wraparound services while waiting RTC admission.
UPDATE 8/8/23: Pt is accepted to Gerard and can admit tentative 8/21- pending preplacement screening/QRTP approval from Hennepin County.
10- year-old female with a history of anxiety, depression, social difficulties, anger and trauma. Aggressive behaviors and increase in suicidal ideations. Has participated in PHP, individual therapy, and psychiatry. Insured by BCBS PMAP.
DISCHARGE PLANNING EFFORTS:
Primary Recommendation: Residential Treatment.
Patient recommended to return to home/community with wraparound services while waiting for Residential. Discharges have been attempted, patient threatened grandmother. (Patient cannot return to mother or to grandmothers- CPS involved)
Wraparound:
Establish CMHCM (Referral to be made internally from CPS case worker)
Establish CTSS (Referral completed to Summer Counseling, reviewing; Referral completed to MN CarePartner, on waitlist, 2-3 months)
Establish FT (Referral completed to Family Attachment Center and Empower)
Continue Individual Therapy with Rachel at ELEOS Psychology Center
Continue Psychiatry with Catherine McCormick-Deaton, DO at Allina Health-St. Paul
Continue PCP at Allina Health-Maple Grove
Residential, when available due to waitlists*:
Consider Nexus-Gerard RTC (Declined due to aggression, being re-reviewed currently)
Consider Northwood Children’s RTC (Referral sent, waitlist 6-9 months)
*Juvenile Treatment Screening with Hennepin County needed to request funding for QRTP/RTC level of care. CPS worker aware of request.
Estimated length of stay:
Patient is medically ready for discharge as of 6/30/23