Patient is presenting to the ED for the following concerns: self-harm. Patient has a history of self-harm, through primarily biting his arm, punching other things or scraping himself with a tack. Mom reported that today was the first time he self-harmed with a blade. Mom reporting increased aggression in the home and at school and feels that patient needs inpatient. Mom explained the patient is in a level 4 school setting. He recently did PHP at Prairie Care and was discharged after three days due to concerns about aggression and inappropriate sexual comments. Mom shared the patient has made comments about wanting to strangle others.
Mom explained that patient may already be on the waitlist for the Village Ranch residential treatment in Cokato. They are also exploring North Home in Bemidji. Mom reported that patient has been diagnosed with ADHD, ODD, PTSD and ASD. She also wonders about FASD due to his biological mothers, drug and alcohol use. Patient was adopted at age 7 by his adopted mom and adopted dad. Mom was his PCA in his last foster home for one year before adoption.
Psychiatric Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD)
DMDD is a psychiatric diagnosis that applies to children and adolescents who exhibit severe temper outbursts and persistent irritability. It is often associated with difficulties in regulating emotions.
MCR-M16-1842
Long history of impulsive behavior and emotional dysregulation in the context of in utero substance exposure, prematurity, and repeated disruption of parental caregiver relationships. The current history suggests that he functioned fairly well over the last couple of years with relatively low level mental health services – highly experienced foster parent, individual therapy every 1-2 weeks, and occasional pharmacology. However, he began using cannabis more regularly and was unable to stop use when limits were set, leading to disruption of his foster placement. He has had significant dysregulation in a shelter and then crisis center setting since losing his foster home placement, including threatening peers, brandishing makeshift weapons, destroying property, and then finally physically attacking a peer (we do not have information about what provoked this) leading to his being sent to the ED. He has been consistently calm and polite here, though withdrawn, without evidence of clear active mood, psychotic, or anxiety disorder that would indicate a need for psychiatric hospitalization.
MHF-M14-2026
Patient is presenting to the ED for the following concerns: verbal agitation, physical aggression, and significant behavioral change. Per patient’s mom, patient has been struggling for several years with anger and aggression, but this past month things have been escalating. Patient got upset at home, threw things, and punched his mom in the face. Patient’s mother called the police. Patient was in Riverside’s inpatient unit 3x in 2020. Patient was referred to PHP, and attended a 3-week PHP at Children’s Hospital. At the completion of the 3-week PHP, patient was recommended for additional treatment in a residential/inpatient setting. Patient has previous mental health diagnosis of PTSD, ADHD, DMDD, anxiety, and depression. Patient has a mental health CM and a psychiatrist.
MHF-F11-2021
Patient is presenting to the ED for the following concerns: verbal agitation, physical aggression. Patient was discharged from residential treatment last week. Patient was supposed to discharge to a group home, but her CADI waiver had expired, and she was discharged home without services. Patient became upset after a stressful day, and began arguing with her brother and mother. Patient “destroyed her room”, attempted to kick out her window, and ran a piece of glass under her nails. Patient’s mother called the police.
Patient has a history of ADHD, depression, anxiety, and aggressive behaviors. She had 5 admissions to inpatient psychiatry, with the most recent one on 9/28/22.
HCMCH-F16-1812
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.
MHF-F11-1660
9/28: Youth still awaits placement to RTC.
9/19: Accepted to Nexus FACTS to assist with Placement Coordination.
9/14/23 UPDATE: Nexus YCT program looking into helping with this child.
Patient is presenting to the ED for the following concerns: verbal agitation, physical aggression, significant behavioral change, abuse or neglect, anxiety, worsening psychosocial stress, suicidal ideation, depression. Patient was staying at a crisis residence after discharging from the ED on 9/1/23. Police were called due to patient becoming aggressive/violent, dysregulated and exhibiting SI/HI plans and threats. Staff at the crisis residence do not feel safe keeping patient at the home due to her violent outbursts, and fear for other residents’ safety.
Patient is a Hennepin County state ward. She has an extensive history of childhood trauma, including neglect, physical abuse, and suspected sexual abuse. She was also prenatally exposed to cocaine. Patient’s grandmother adopted her, who fled with the patient to a different state. Her grandmother’s rights were terminated, and patient has been living in foster care with her aunt since the end of June 2023. Prior to that, patient was living in a group home for approx. six months in Duluth, after completing residential treatment at Northwoods. She arrived to the ED on 08/09/23 following an episode of significant behavioral dysregulation involving throwing furniture down the stairs. She was subsequently admitted to 7ITC and discharged on 08/28/23, returning to the ED on 8/28, and discharging to crisis residence on 9/1. Has a CPS worker, who is her guardian, but no other services/case managers.
PH-F15-1865
**Update 10/18/23: Patient discharged home with outpatient supports, while awaiting Group Home placement**
Patient came to inpatient hospital from residential treatment, patient cannot return to RTC and is not being recommended to attend RTC at this time. Patient in need of group home placement. Adoptive parents are legal guardians and have verbalized that the patient cannot return to their home.
County currently pursuing:
-Group Home (CMHCM pursuing this)
Current/In Progress Wraparound services:
Continue CADI Waiver Services through Hennepin County
Continue Medication Management with Associated Clinic of Psychology
Continue PCP with Sara Brandt at Southdale Pediatrics
Continue with Jessica at Southdale Pediatrics
Continue CMHCM with Doug Inwards at Hennepin County (612-490-9342)
Continue BCBS Insurance Case Management with Allison (888-815-7461)
MHF-M14-1900
Patient presents to the ED via EMS after his group home called 911 due to patient’s aggression. Patient reports that he threw a stool at staff when they asked him to go to bed. Group home to determine whether they will take him back.
Patient has a previous mental health diagnosis of Mood Disorder, Intellectual Disability, Nocturnal Enuresis, Anxiety, ADHD and Autism Spectrum Disorder. Medical records indicate patient presented with similar behaviors to the ED, including defiance, a history of emotional and behavioral dysregulation, and acting out towards staff.
This is patient’s 6th visit in the ED in 2023 for behavioral and/or mental health.
MHF-M18-1739
UPDATE 9/21/23 – placement difficult due to the arson incident.
Patient presents to ED for aggressive behaviors. Today, patient lit a fire in the bathroom of his group home because he was “tired of living” and “tired of his group home staff”, after they turned off the wifi in the house. After lighting the fire, police and fire department arrived. Patient was still escalated and refusing to leave the group home while the fire was burning in the bathroom. Patient was brought outside by a police officer, and patient attempted to grab the officer’s handgun. Patient states he did this with intent of using on himself or his group home manager. Patient was quickly handcuffed and restrained into an ambulance.
Patient was reportedly hospitalized in Floriday last month while on vacation for aggression, agitation, med non-compliance. Patient has been living in his current group home since 2019. Patient attends an alternative school which he enjoys. Patient has PCP and psychiatry per his report. States he has been in “placements” his entire life since being adopted from Ethiopia at a young age by his current adoptive parents. Previous admissions in 2018 for DMDD, and aggression.
Hx of learning disability, aggressive behavior, agitation, outbursts.
MHF-F11-1552
UPDATE: Accepted to Gerard Pending date next week.
Patient is presenting to the ED for the following concerns: verbal agitation, physical aggression, anxiety, worsening psychosocial stress. Patient was threatening to attack kids in her neighborhood with a knife, and threatened to stab her grandfather when he attempted to intervene. Patient’s grandfather locked her out of the house, so she wasn’t able to get anything else to hurt someone with, and patient kicked the lock off of the door.
Patient recently lived in a youth shelter/transitional home called Dignity House for 1.5 weeks until 8/3/2023. She was then sent to the ED for aggression. She had a warrant for arrest due to an assault and threatening homicide to family members. She was taken to JDC on 8/3/2023, had court, and then she was sent to the Bridge for Youth Shelter. Patient got into a physical altercation at The Bridge and was sent back to the ED on 8/8/2023. While in the ED, patient physically assaulted a nurse and was picked up by her grandfather.
Within this year, the patient has had approximately 13 ED visits due to concerns including runaway, aggression, abuse/neglect, and altercations with family members.