Patient presented to the ER with concerns for SI. The patient has had multiple residential and inpatient hospitalizations and reports they will not be safe if they return home. The patient was discharged from a 13 month stay in residential in January and was discharged from a 2 week inpatient stay in February.
Psychiatric Diagnosis: PTSD
PTSD is a psychiatric diagnosis that results from exposure to a traumatic event or series of events. It is characterized by symptoms such as flashbacks, nightmares, and severe anxiety, often resulting in impaired daily functioning.
MCMC-F8-1957
Patient is an 8 yr old that has a history of disruptive behaviors at school and at home. She has a history of PTSD ADHD reactive attachment disorder and is on quite a few meds for behavioral health. Apparently she did not sleep well last night and woke up this morning threatening to kill her family members and herself. She continued to escalate at home to the point where mom called psychiatry and they recommended that she come to the ED. She arrives in ED out of control hitting, biting, kicking, and screaming. Mom states that this type of behavior for her has happened frequently in the past but has not had an episode like this for a year or two. She apparently is doing quite well in school and has not had any recent issues. Mom states that when she has these outbursts or crisis that this is typical where she has just a sudden change in her behavior and becomes violent at home. She has not missed any of her medications. Mom denies fever, no recent cough no abdominal pain no nausea vomiting or other recent infections. Mom states that in the remote past she has had a UTI with high fever but typically infections have not caused behavior issues. Patient has an established psychiatrist and has had numerous hopitalizations regarding same issues. Started having visual hallucination yesterday, medication adjustment decreased (risperdal) decreased a couple of months ago with the thoughts that this may be contributing. Biological mother has history of bipolar disorder and grandmother and cousin has history affective schizoid disorder. For the past week her behaviors have been escalating and has been getting harder and harder to negotiate with child. She has threatened to kill her 3 yr old brother and mom concerned for safety of other children in the home.
ADYC-M14-1768
Update: 1/19/24 Pt. still looking for placement.
15-year-old male looking for a group home and residential program. Children’s Mental Health Case Manager has tried everything, and doors are being shut. Client has a physical aggression, verbal aggression, history of PTSD and sexual abuse. Client has experienced abuse from biological father who is in still in the home, and sexual assault that happened possibility of more than one with an older cousin sister. Client mother is giving up on hope on trying to help her child. Client is struggling at home, school, and community. Children’s Mental Health Case Manager has been trying everything to find a placement for him. He’s been going in and out of the ER like every two months now. Children’s Mental Health Case Manager still trying to offer support the way she can by being there every hospital stay, seeing client like twice a month, and having mom keep her on speed dial to talk to client.
Because of experiences, client is chemical dependent on marijuana, perks, and opioids.
PH-M15-3171
Updated 2/22/24: DC Fri 2/23 to Nexus Mille Lacs RTC (County and Nexus recommending PRTF for long term tx). DC pending communication with guardians, have not had a response from them the whole hospitalization.
Update 2/16/24: Nexus Mille Lacs RTC is recommending PRTF level of care for patient. Kanabec County is in support of recommendation and plans to being the referral process.
Case Description:
15-year-old female identifying patient with a history of depression, anxiety, RAD, PTSD, ADHD, and ODD. Patient has been in out of home treatment settings for 3 years. Patient was at an unknown treatment facility and was discharged due to its closing, Northwood Children’s Services PRTF and most recently has been at Nexus Mille Lacs RTC since October 2022. Patient has a history of three inpatient hospitalizations.
Current services:
CMHCM: Kanabec County
RTC: Nexus Mille Lacs
CH-M9-2986
2/15/24/ update. Adjusted meds, doing better. Referring him to CABS, Grafton
Patient admitted to unit after ER boarding within the ER for an extended period as mom didn’t feel safe with him returning home. He has a chronic history of extreme emotional dysregulation with acute worsening since moving to the unit & significant head banging and aggression towards himself and others. He has a history of trauma that is likely impacting his presentation.
PH-F13-2494
Primary Recommendation – RTC
-Nexus Gerard, accepted, admission 2/9 at 1000
Other RTC referrals:
-Avanti, declined
-North Homes, declined
-PrairieCare Residential, declined due to aggression
-Northwoods, referral made, declined for RTC
Out-of-State:
-Northwest Passages (Prairieview), county made referral, waitlist 2-4 months
-Lad Lake in Wisconsin, county made referral
-Youth Villages in Memphis; county made referral, reviewing
-Lava Heights in Utah; county made referral
-Falcon Ridge in Utah; county made referral
-Newport News in Virginia; county made referral
-Summit Oaks in South Dakota, county made referral, declined
-Provo Canyon in Utah; county made referral, declined
-Rogers, Hennepin County does not contract/won’t provide funding
Due to declines from QRTP, exploring PRTF options:
-Nexus East Bethel; referral made, not covered by insurance, potential to switch insurance, reviewing
-Northwoods; referral made, waitlist 2+ years
Bridge to RTC/PRTF; if warranted:
Establish CMHCM (Assigned to Kimberly Trembley through Hennepin County, 612-743-1549, waiting for QI approval for funding)
Establish PHP (SW to reschedule if/when appropriate)
Other Referrals Made:
Acadia Treatment Placement Specialists; referral made
Outpatient Recommendations:
Establish Individual Therapy
Establish Family Therapy
Continue PCP at Indian Health Board in Minneapolis
INSURED BY PRIME WEST MA
Presenting Problems: Experiencing school stressors, family dynamic changes, depression, mood lability, SI via ingestion.
HCMCH-F14-2910
Presented after a sexual assault. She has a known history of depression and PTSD, polysubstance use and prior sexual assaults, trafficking and pelvic inflammatory disease.
MHF-F16-2940
Patient presents after being found on the run by police, ongoing substance use concerns. Patient has been discharged from several CD facilities related to behaviors and/or eloping. Patient continues to need CD treatment, guardian does not feel safe with patient coming home.
MHF-F16-2943
Patient presents from a family friend’s home where she was living however due to ongoing dysregulation and threats to harm the family, patient can no longer stay there. Mother does not feel safe with patient at home due to homicidal threats to family. Patient has no current options and needs long term placement.
MHF-F12-2934
Patient presented from home due to aggression and dysregulated behaviors, which are baseline for patient. Guardian will not allow her to return home, citing safety concerns for himself as patient often becomes aggressive with him. Patient has been to Gerard RTC in fall, 2023 but discharged without completing.