Recommendation is now for level 6 PRTF. Patient is currently in psychiatric inpatient hospitalization.
Patient is a 16-year-old who identifies as non-binary using they/them. They presented to inpatient from ED due to increased SI. This is patient’s 14th psychiatric inpatient hospitalization. They have participated in outpatient services and PHP historically.
Patient was initially recommended for level 5 QRTP by inpatient providers although Dakota County recommended level 6 PRTF.
Discharge Plans:
PRTF (county determination/recommendation – DHS approved)
-Nexus East Bethel (referral submitted & under review)
-Grafton (not an option as they do not meet admission criteria)
-Northwood (referral submitted; two year waitlist)
RTC: (county declined funding for level 5 QRTP, recommended Level 6)
-Avanti (declined)
-Gerard (referral sent, unable to move forward due to lack of funding)
-North Homes (referral sent, unable to move forward due to lack of funding)
Established outpatient providers:
Individual Therapist: Your Vision
Psychiatrist: Associated Clinic of Psychology
PCP: Allina Healthcare
CMHCM: Dakota County
PO: Dakota County
Came to our ED 9/22 from home due to aggressive threats. Previously was IP with our hospital 9/3-9/12. Mom does not feel she can take kiddo home at this time. Is in process of obtaining Childrens Mental Health CM and CADI waiver, but has neither as of now (did request these to be expedited.) Mom is also working on referrals to Residentials (has private insurance) but has not been placed on any lists yet.
Presented to the ED in the evening, 9/18/24, with her parents after she ran away from school on Tuesday and made suicidal statements to a friend on Monday stating “I’m going to kill myself” which was relayed back to her parents. She also told another peer on Monday that she plans to run away. When she did run away the following day, Mom reports that she was missing for two hours before they found her and there were no known precipitating factors leading to this. Patient tells writer that she “doesn’t know” where she went on Tuesday and “I was walking towards home apparently.” Writer asked about why she is expressing confusion/poor memory of the event and if she was using any drugs/alcohol. She looked at writer, shrugged, then did not answer further. Throughout evaluation, patient is vague, intermittently evasive, and at times mute with writer. She presents with an incongruent and at times inappropriate affect and vacillates from a younger child-like presentation to a more adolescent presentation. She lacks insight into her parents’ concerns and demonstrates poor insight and poor judgement related to her personal safety. She is not willing or able to participate in reflection about why her parents/other adults are having significant concerns for her overall wellbeing, mental health and safety. When asked if she thinks she can maintain safety in the community/at home and also agree to not run away, she will not answer writer.
Area(s) of Risk: suicidal ideation, elopement, inability to care for self
Level of Risk: High for elopement and safety chronically for past few months which has been demonstrated repeatedly by running away and making unsafe choices such as getting in a stranger’s car and making pornographic videos of herself. Level of risk for SI statements is fluctuating and it is noted that pt does not have hx of suicide attempts.
Intent to Act: No
Referrals made to adolescent child psychiatric hospitals however no openings. Patient calm, cooperative and not having sx or bx thus appropriate to dc back home as of 9/20 however parents declining to have her discharge to home.
Child Protection involved as well as patient’s mental health case manager.
Recommendation for level 5 QRTP or level 6 PRTF. Patient is currently in psychiatric inpatient hospitalization.
Ten-year-old female patient with a history of in utero exposure and early childhood trauma and attachment concerns, with a historical diagnosis of FASD-Alcohol-Related Neurodevelopment Disorder (ARND). Patient presents with emotional dysregulation, violent threats and aggression, as well as passive suicidal ideation. Patient has been hospitalized multiple times and participated in several outpatient services.
Discharge Plan:
RTC (recommendation letter sent to CMHCM who is requesting county screening meeting)
-Nexus Gerard (referral sent, reviewing, will hear back week of 9/2)
-Northwood (referral submitted, next opening end of year, will review for acceptance at that time)
-North Homes (declined due not have staffing to meet needs related to aggression, SW requested reconsideration; declined 8/21)
PRTF (PRTF eligibility form sent to DHS 8/16)
-Nexus East Bethel (referral submitted w/PRTF eligibility approval 9/4)
-Grafton (referral submitted w/PRTF eligibility approval 9/4)
Bridging with Day tx
-Catholic Charities (referral pending although may not consider d/t RTC rec, IEP sent, 8 person WL)
Current Providers:
Med Management- Mayo Clinic
CM- Dakota County
CADI waiver- Dakota County contracted provider
CTSS
Pt presents from school after high level of aggression, homicidal threats, and property destruction resulting in multiple hours of restraints. Patient has longstanding history of aggression and impulsivity with recent increase and daily occurrence consistent with starting new school. Pt newly to a group home from home placement as of May 2024. Now discharged from level 4 school due to behavior leading to presentation. Looking for IP for medication adjustments, though making changes in the ER in the interim. Difficult placement given neurological functioning, level of aggression, and acuity.
This pt discharged from our ED on 8/6 after being here since 7/22, went to a Beacon crisis home for approx 24 hours and returned to the ED again on 8/7, after aggressive behavior. Previous number was MHF-M12-4418. Also boarded in our ED in April 2024 for 20 days, and at different hospital in June. Hennepin County has temp custody and he is on DD waiver. Currently looking at a CRS home that requires exception bed approval through DHS, Grafton, remains on the MCCP crisis pool list, and judge is making determination if returning to Mom may be an option. Has been to Zane crisis, Beacon crisis, VOA Bar None, and done PHP with FV.
Pt came to our ED on 8/9 from parents home after an altercation. Parents are refusing to pick pt up. They report pt is involved in some gang activity and verbal and physical aggression toward them at home. Has been to 3 residential programs, and multiple placements Northwoods, Gerard and Bar None. He continues to exhibit behaviors in all settings. County does not feel another residential would be beneficial as the last 3 haven’t improved behaviors. Therapist is currently working on IQ testing but unsure if that can be completed in the hospital. Team is looking at starting MNchoices process to get waiver options.
Came to us 7/22 via EMT after aggression and property destruction at hotel crisis respite, provider wont take pt back. Previously boarding in our ED 4/5 to 4/25, with somewhat frequent ED visits between. Has previously been to VOA Bar None. Hennepin County has custody and our team was struggling with reaching the CPS worker yesterday/this morning- going to continue reaching out for further plan/details.
Pt came to our ED via EMT on 8/5/24 after an altercation at home. He has a history of multiple inpatient stays, done PHP and day treatment, been to Gerard, Newport, and JDC. There have been 2 rule 20 evals that have deemed him incompetent, one just finalized on 8/7. Dad currently has custody and is refusing to pick up, reporting that he wants more help. Pt has history of abuse from both parents. CPS is petitioning for temp custody and placement is at a stand still while we wait for that to go through.
Kiddo came to GICH ED on 7/31 from Little Sand GH after an altercation there. Pt had verbally and physically aggressed toward peer and staff, and had self harm/head banging. According to the team this was her first incident of physical aggression, she has not been violent in the past. Does have history of self harm and verbal aggression. Little Sand is recommending a higher level of care. Team would like PRTF placement and have made referral to Nexus East Bethel. Exploring VOA Bar None for interim plan, has not been accepted anywhere yet.
