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.

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.

AH-M15-2038

UPATE: 1/18/24: Still inpatient. May be going to crisis programming in the near future, but no date yet.
UPDATE 11-15-2023: Still inpatient 1:1 staffing, strict behavior plan.
Patient is a 15 yo M with a past psychiatric history of RAD, PTSD, and ADHD as well as unspecified mood disorder (MDD vs DMDD), spells of trembling, and unspecified anxiety disorder, mostly documented as GAD. Multiple previous inpatient admissions, most recently Feb 2023. Has had numerous ED visits since 02/2023 for aggression. He has a psychosocial history of early parental loss, institutional care, neglect, and profound physical and sexual abuse while living in an orphanage in Ghana following the death of his biological mother in child birth. He was adopted when he was seven years old. Since that time, he has struggled with physically aggressive behavior, typically triggered by losing control of situations by not getting what he wants, being challenged, etc., assaulting both parents and endangering siblings. He can also become agitated and engage in aggression and property damage at the school. When he is not aggressive, however, he presents as extremely polite, pleasant, playful, and affectionate, and he does not struggle with chronic irritability or agitation. His family has worked to keep him in the home and community by maintaining two residences, with father caring for him in a rental and his mother caring for his sibling in their family home for safety over the past three years. He has had numerous inpatient stays, crisis placement, shelter, and residential stays as well as outpatient psychiatric and counseling services in clinic and in the home. Still, his behaviors remain persistently dangerous, culminating in the sexual assault of his father on 10/21/23.
Reach out to Heather Hanson, Social Worker at Abbott with questions or possible matches. She can be reached at 612-863-8569 and/or heather.hanson2@allina.com

MHF-M14-2604

1/18/24. No placement at this time. Waiting for a waiver to open up more funding sources. Denied at respite/shelter due to behaviors

Patient presented from Aspen House shelter due to aggressive behavior and property destruction. Patient is unable to return to shelter. Mother refusing to discharge home. County looking into shelter options and foster care placement

CH-F15-2882

Patient presented to the ER after 3 other ER visits from outside ER for physical concerns that were determined to be panic symptoms verses a physical abnormality. Patient has a chronic history of mood and behavioral dysregulation, self-harm, multiple suicide attempts, truancy, and parent child relationship difficulties. She has a history of trauma in the form of witnessing domestic abuse, physical abuse, possible sexual abuse, and the death of her dad due to an OD 4-5 years ago. She has had 2 inpatient hospitalizations along with 2 PHP admissions with little benefit and participation. Mom struggles with following through on recommendations and struggles with alcohol/substance use. A child protection report was filed last year and she moved in to her neighbors though this is no longer an option. She denies any passive or active suicide ideation, plan, or intent. Inpatient hospitalization is not recommended. Mom is not willing to bring her back home at this time due to disruption in the home.