Oppositional Defiant Disorder – Page 4 – Mental Health Collaboration Hub

PH-F12-3437

Update 5/14/24: Patient discharged home to the care of her guardian with outpatient supports to bridge Day Treatment.

Update 5/10/24: Patient tentatively scheduled to discharge home on 5/14/24, with outpatient supports to bridge PHP at Amberwing.

Update 5/6/24: Douglas County CPS is navigating PHP and Day Treatment with the guardian for aftercare. PHP waitlist is approximately 3 weeks and guardian still needs to obtain insurance coverage. Douglas County CPS will be closing out their case on 5/10/24 due to a lack of immediate safety concerns as evidenced by the guardian willing to take the patient home.

Update 4/30/24: Guardian is making statements of wanting the patient to return home. Patient was declined from foster placements in Wisconsin, and family placement is not an option either. Douglas County, WI, CPS, working with the guardian on a transition plan home, including Day Treatment and Outpatient Therapy. Patient remains at the hospital.

Update 4/24/24: Parent still not willing/able to take pt home. County involved and navigating alternative living arrangement/placement. DC rec is PHP.

Update 4/17/24: Parent still not willing/able to take pt home. County involved and navigating alternative living arrangement/placement. DC rec is PHP.

Update 4/3/24: Parent still not willing/able to take pt home. County involved. DC rec is PHP, openings available at PC PHP when patient is able.

Patient was admitted from Essentia Health in Duluth after attempting to run away from home. Pt has conflict w/ dad & has made HI statements toward him (burning him, switching meds out so he will OD). Pt also has a Hx of inappropriate sexual behavior with older men & on the internet.

Historically, patient lived with extended relatives for the first 11 years of her life due to mitigating circumstances that did not allow biological parents to meet her needs. Patient then went to live with her biological mom and was then sent to live with her dad, as mom was unable to meet patient needs. Patient has been with dad for about 1 month now, and he has indicated that he cannot meet her needs either, and declines for the patient to return home.

Discharge Plan:
PrairieCare Recommends:
Establish PHP; county coordinating with Amberwing, estimated 3-week waitlist

Establish Individual and Family Therapy:
-Insight Counseling in Duluth; referral made
-SOAR Services in Superior, WI; referral made
-Nystrom and Associates in Duluth; referral made

Establish PCP
Establish CMHCM (Open with Kalley Rustad at Douglas County CPS for long-term supports, closing case 5/10)
Establish CLTS (Referral made to Douglas County, CPS also coordinating)

Estimated length of stay:
Seven to ten treatment days; patient is medically ready for discharge; pending Douglas County, WI, establishing aftercare with the guardian. Guardian is now willing to take the patient home.

MHF-F15-3804

Patient came to ED on 5/1 after altercation at home with parents. Parents are refusing to pick up, they have told hospital they were coming to pick up, but then do not come. Was previously referred for dual diagnosis IOP, but went for one day and refused to go again. Parents are struggling with behaviors at home, refusing to go to school, drug use (marijuana), refusing mental health care, and med refusal. Has SW embedded from PD involved. CPS is currently investigating, waiting for further direction from them regarding if County plans to pursue out of home placement.

MHF-M16-3747

Patient came to our ED after a physical altercation with another resident at Aspen House, is not able to return there. Has been to multiple shelters and RTCs in the past, success with some of these programs. County is looking at other shelters as well as waiting for a previous provider to send recommendation for PRTF. Has been denied by VOA Bar None- all programs, can’t return to Von Wald shelters, discharged previously from Prairie Care, and can’t return to Aspen. 3rd time in the ED in a month.

REH-F17-3586

5/2 Update: Client has been discharged home twice (contracted for safety) and returned within 24 hours due to attempting to run into traffic. Has been approved for PRTF and referrals have been made to Northwoods (2 year waitlist) and Grafton. Inpt behavioral health is not an option due to previous stays. CABHH referral pending and they are attempting to admit pt when they have discharges.

Presented with attempted suicide on 4/4 (superficial laceration on arm). Also attempted to overdose on Lithium on 4/2. Appears to have a developmental delay. Denied at multiple inpt facilities due to previous aggression. Turns 18 in July.

MHF-F15-3741

Came to our ED after physical altercation with another resident at Prairie Care Residential, can not return there. History of multiple inpatient admissions and PHP. Grandma is guardian and pt is unable to return there due to another child living there that pt can’t be placed with. CMH worker has made multiple RTC referrals and patient has been denied by almost all. Currently looking into a RTC out of state in TN, however this provider does not have a contract so would be a long time before this placement was obtained. Also looking at shelter options.

PH-F14-3695

Update 4/23/24: Patient discharged from inpatient on 4/23/24. Patient scheduled to begin PrairieCare PHP on 4/24/24 while continuing to pursue Group Home placement as recommended by the county.

Patient is a 14-year-old female presenting to inpatient on 03/19/2024 from the ED due to running away from shelter placement. Patient has a history of participating in PHP two times, DBT, ongoing outpatient mental health services, and being in shelter placement.

Discharge Plan:
RTC:
-North Homes (on the wait list)

CD-RTC: Referrals submitted/considered for the following facilities:
-Hazelden (Pt’s insurance not accepted in Minnesota)
-Rogers (Declined due to elopement risk)
-M Health Fairview (Declined due to elopement risk)
-Anthony Louis Center (referral sent 03/27/24)

Group Home Placement (as recommended by JST/county):
-Little Sands (Referral submitted by CM; declined d/t LON)
-Village Ranch (Referral submitted by CM; reviewing 4/10; pending additional review on 4/17)
-North Homes (Pt is on the waitlist for RTC; pt is not eligible for their group home due to age)

Existing Outpatient Providers:
CHMCH: Hennepin County
Psychiatry: Nystrom & Associates

MHF-M11-3615

Came to ED 4/5 after some property destruction at family home. Previously in FV’s PHP program. Mom refusing to pick up and refusing family first services in home. County now has temporary custody for out of home placement, has not been in out of home placement previously. Ongoing CPS worker assigned 4/18 and is starting placement search.

MHF-M16-3505

Pt was in residential at Prairie Care and was discharged due to behaviors/property destruction/aggression, not allowed to return. Just switched custody from one CPS worker to another so details of history are not complete, but information is being gathered. Know she was previously in out of state placement in Oklahoma where she was discharged due to physical aggression. County is looking at VOA- Bar None Haven and Nexus East Bethel, and hospital is referring to Nexus YCT.

MHF-M17-3467

Pt came to ED 3/25 after being on the run for a few weeks. Was previously at hotel crisis respite prior to being on the run, damaged property there and can not return. County is current guardian, though patient turns 18 very shortly and will be his own guardian at that time. History of behaviors, verbal and physical aggression and property destruction. Has been denied from shelters due to behaviors and previously denied from RTCs in and out of state, though due to age would no longer be an option. Refuses all mental health services and has not had a DA since 2020. Is on CADI waiver. Recommendation on weekly call to discuss benefits of IRTS program/treatment with him.

RMC-M17-3365

This patient presented to Ridgeview Medical Center via P.D. after running from his home. He was found in the woods nearby his home with a knife (patient has an ankle monitoring device). Patient reportedly desires out-of-home placement and verbalized plans to use the knife to harm kids who bully him at school. Patient has a significant history of running away from home with more than 30 reported incidents. Patient maintains a desire not to return home at this time. Carver Co. holds temporary decision making authority over patient, by court order.