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.
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.
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-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.
MCR-M14-1389
UPDATE: 9/7/23 – discharged to AMAS Inc (CADI group home)
UPDATE: 8/31/23 – Care conf tomorrow. Accepted by Sunset House, having zoom meeting with patient today to get to know him better before transition- waiting on them to get licensing.
UPDATE: 8/17/23 – Still in ED. Not able to go to Mille Lacs due to non-participation. There is a CADI group home willing to take him, working on licensing.
UPDATE 7/27 – had a video interview with Nexus Mille Lacs on 7/26, awaiting updates.
Previously MCR 1086: Discharged 6/15/23 to VonWald, returned ED 6/30. 14 year old with significant trauma history, ward of Hennepin County, recent placement at his request with young adult brother that was disrupted due to conflict. Briefly placed at Von Wald shelter but repeatedly eloped in an effort to reunite with his brother, and was brought to the ED. Calm overall except when relocated to a unit that required observation while in the restroom, then repeatedly escalated with verbal threats, closing himself in the bathroom, and hitting the walls. Had an interview with Nexus Mille Lacs on 7/26/23. He is familiar with Nexus Gerard and would feel comfortable there.
MHF-F17-1669
Patient is presenting to the ED for the following concerns: physical aggression, and suicidal ideation. Patient was brought in by EMS after the police were called due to patient becoming physically aggressive towards her 4 year old cousin. Patient said that that her older cousin started to film her when she was becoming physcially aggressive. Per patient, she called 911 on her cousin. Patient then became aggressive towards police, and EMS was called. Patient was placed in restraints and given medication. Patient reported that she made suicidal statements during the incident, but that she did not mean them. She tends to say she wants to kill herself when she’s mad. Patient reports that she has never attempted to hurt herself, and has no intention on doing so. Patient has been off of her medications since June due to her insurance no longer covering them. Patient has been staying with her cousin, while her mom is on vacation. Patient’s cousin is refusing to let her return due to her aggressive behavior.
Patient has had several therapists in the past, and has been to day treatment.
PH-F14-1603
UPDATE: PT DISCHARGED HOME TO MOM.
Patient is a 14-year-old female with history of depression, anxiety, SI, SIB, trauma and aggressive behaviors. Has participated in PHP, RTC, and inpatient levels of care. Insured by Medicaid.
DISCHARGE PLANNING EFFORTS:
Primary Recommendation-
Establish Day Treatment (Patient currently refuses)
Continue CMHCM- Family Wise Services, contracted by Hennepin County
Establish outpatient individual therapy (CM is scheduling)
Establish med management (CM is scheduling)
Discharge has been attempted. Mother/LG will not accept patient back into the home. Patient was living at Passageways Shelter prior to admission and mother/LG consents for shelter placement at discharge. Patient’s aunt/uncle had agreed to take patient in with consent from LG, but aunt declined to pick patient up on day of scheduled discharge and rescinded the offer to accept patient.
Patient needs shelter placement due to family dynamics, thus the following are pursued-
Consider The Bridge for Youth (Denied d/t reported severity of aggression towards mother)
Consider Passageways (Denied again as of 8/16/23)
Consider Brittany’s Place (Denied d/t parent is still LG and would need to complete VPA)
Consider Hope House (No current availability, call back once per week to check)
Consider Itaskin Center Shelter (Referral sent by SW, additional referral needed by CMHCM)
Consider VOA Bar None Shelter (Referral sent by SW, additional referral needed by CMHCM)
Consider Ain Dah Yung Center (Referral sent by CMHCM, no current availability)
Consider RTC, as previously recommended by CMHCM prior to admission*-
Nexus-Gerard (Referral started by CMHCM, clinical sent by SW, awaiting records from CRTC for determination)
CRTC (Referral started by CMHCM, clinical sent by SW, declined for admission due to IQ)
*QRTP Pre Placement Screening with Hennepin County needed to approve funding for QRTP.
Estimated length of stay:
Patient is medically ready for discharge as of 7/18/23
CH-M8-1340
Patient has a history of ADHD, DMDD, and trauma. He presented to the emergency trauma center with foster provider following an anger outburst where he hit himself. Patient also made comments about killing himself and threatened to kill another child in the home. Patient is unable to return to foster home.