Psychiatric Diagnosis: Reactive Attachment Disorder (RAD)

RAD is a psychiatric diagnosis involving severe difficulties in forming emotional bonds with caregivers, often seen in children who have experienced neglect or trauma.

AH-F16-7617

Previous psychiatric diagnoses: PTSD, depression, anxiety, eating disorder, ADHD, complex trauma, suicide attempts, self-harm

Patient presented to the ED after reporting SI to their guardian. Patient reports a near daily experience of SI and AH/VH of his brother who abused him. Therefore, this is not a new symptom. Patient reports that yesterday there was no particular trigger for his SI and AH/VH, that he took a PRN medication, which usually works for him, and then called his guardian who told him to go to the ED.

While in the ED (and as is common in the community), patient will attempt to use clothing to strangle themselves when dysregulated, often revolving around trauma.

Guardian is Dakota County (Tori Thompson). No contact order for anyone in the biological family.

Hospitalized in ND for a full year and a recent over month stay at Children’s for placement from which they were placed in Mn Care Counseling Crisis home.

Crisis home has given an immediate termination notice and state as they are a crisis home they do not require a 30 day notice, due to inability to keep pt safe. They report running into traffic as a particular concern.

Recommendation is discharge with ongoing outpatient support coping skills, distress tolerance, emotional regulation and behavioral support. Pt presentation appears to be baseline and unlikely to mitigated by an admission which may conversely increase risk of maladaptive coping skills and hospital seeking behavior.

Referrals:

· Wingspan is future development of home for patient; not ready until January

referrals made to all PRTFs
Grafton
Leo Hoffman
North Woods
Nexus East Bethel
No update on possible openings

CABHHS – pt has been declined multiple times due to various reasons including high acuity, Diabetic, Eating disorder – A new referral is in process
Bridgeview—-Dakota county crisis placement; on list but currently full (2 bed facility for Dakota County youth)
Kid Link – referral to all 50 of the facilities they work with, no update on potential openings.
Out of state (Rogers and Acadia)—active referrals, no timeline

C8SM8SP-F12-7384

Child came to the emergency department after getting into an altercation with grandmother at home. Child had gotten physical with grandmother due to phone usage. Child’s legal guardian is grandmother and does not have contact with bio parents. Child has a long history of trauma. Child’s aggression is only toward grandmother; they have also presented to the ED on 5/7, 6/29, 7/8, and 7/28 for similar situation (physically aggressive towards grandmother). Grandmother is refusing to discharge child back into her care.

CH8SCH-F15-6993

Patient is well known to our ER/Hospital. She previously boarded in the ER 3/12/25-5/9/25 when she was transitioned to the Adolescent inpatient unit and boarded until 10/2/25. Patient moved into a group home built for her.

Patient returned to our ER on 6/28/26 and the group home suspended services effective 6/29/26 due to the level of aggression patient has displayed and injuries to staff. Sherburne County and patient’s guardian (adoptive mom) are not appealing.

PH-F16-7247

Recommending outpatient wraparound services.
16-year-old female who presented to PrairieCare after being brought to the emergency department from their group home after an increase in suicidal ideation after intervening twice with a peer’s suicide attempt in the group home.
Patient has a history of 5+ inpatient hospitalizations, group home and PRTF placement.
Children’s mental health case manager is pursuing RTC and group homes as an alternative to home. Referrals were sent to:
– Northwoods (PT has been on waitlist, anticipated timeline at least 1 year as of 07/29)
– Community Living Options
– Little Sands
– Nexus Gerard RTC
– Avanti
– PORT
– Acadia Healthcare
– South East Regional Crisis Center (SERCC)
– Boys Town RTC in Nebraska
– North Homes RTC
– Village Ranch

MHF-F13-7240

This youth presented to the hospital after eloping from her foster residence. She had been on the run for over a month and was brought in by EMS after attempting to enter a youth shelter. She was admitted to the hospital for medical needs and determined to be appropriate for discharge. The foster residence is unable to take her back at this time due to needed home repairs and working on increasing staffing from 1:1 to 2:1.

C8SM8SP-F15-7087

Child presented to Children’s ED due to increased suicidal ideation. Dakota County has had guardianship prior to him presenting to ED. Child was residing at a group home and reported to staff about increase thought of self-harm. Staff at group home called EMS and child was brought to Children’s ED for mental health evaluation. They did not meet inpatient criteria and have been recommended to discharge. The group home denied their return due to unsafe behaviors, such as tying clothing around their neck when dysregulated. Extensive trauma history from bio parents.

MHF-F13-7007

Youth came into the ED 7/2, from home, after being discharged from Fairview’s IPMH program on 7/1. Mom is refusing to allow her to return home. IP unit set pt up with attachment-based therapy to start 7/2, day treatment to start 7/9, psychiatry appt 7/9, and a referral for CTSS when available. Parents are declining to take back with those services. County offered CIBS services again as well, parents refused. Parents state they will only take home with 24/7 in home care which isn’t an option. Parents also state they will only accept RTC or a permanent group home (CRS) There is no current LOC recommendation for RTC, and pt just got onto the wait list for MNchoices assessment yesterday for the 1st time, so neither are options currently. Parents are not allowing referrals to parent referred shelters as those are not permanent solutions. No placements being explored currently because parents aren’t agreeable to current options., and no CPS involvement for County paid shelters.

EH-M16-6874

Report by psychiatrist
This is a 16-year-old male with a prior history of mild intellectual disability with a full-scale IQ in the 50s but apparent better verbal functioning, bipolar disorder, reactive attachment disorder, autism spectrum disorder and ADHD. Patient was brought in the emergency on 4/27/2026 by law enforcement. He had been making threats at school of stabbing others with a pencil had been attempting to elope. On 4/26/2026 he severely assaulted group home staff causing facial fractures requiring facial surgery. He tells myself “I was mad at the group home made up that stuff I never said I was going to go in there and set the other roommates deck “. Mother states that perhaps he was upset that the other client came out and put the his hand on staff and patient may have been jealous of this. It was a fairly severe sleep assault. Group home and previously given a 60-day notice. However when I talk to group home staff they state that they would have taken him back if he was stabilized. Case manager and mother sent an email on 5/5/2026 terminating their stay with that group home with mother telling me that group home said that they would take the client back but did not want the mothers involved any further. Patient does have some insight in this states he wants to avoid juvenile detention and states he knows what he did was wrong. He also describes knowing it was wrong to assault his mother and apparently another client in their foster home when he previously lived at home and went to juvenile detention. He appears very motivated to avoid juvenile detention.

Overall he has done reasonably well in the emergency room. He is slightly unkempt at times and needs redirection and can be somewhat irritable with this but has not had any physical aggression. In regards to his anger he states “I have bipolar disorder “. He is worried about charges being pressed for his recent actions but does not believe that they have been pressed.

Patient’s mother describes what sounds like perhaps manic episodes which can last for up to 5 days. She notes that the first hallmark is decreased need for sleep with excessive energy he seems to fixate on certain things and may have delusions with her state that he gets out of touch with reality. He has grandiose ideas and is overall very pleasant. He also becomes more hypersexual at these times and may attempt to touch staff. She feels that getting on top of the poor sleep with Zyprexa early on has been helpful.

There is been some concerns about depressive lows at times when he is more irritable and can and will risk of acting out. Patient denies this currently states he enjoys fishing, playing games and cooking. His sleep and appetite are fairly good. He apparently is been making comments to his mother about not wanting to live or being shot by law enforcement. When staff of asked him about this he states “I was just mad and saying that “. He denies current suicidal thoughts of myself. Apparently at age 8 he had placed a cord around his neck.

Patient has a long history of being very impulsive and rapidly fluctuating moods. I did not review symptoms of ADHD in detail with him. There is no current clear psychosis and no clear obsessions or compulsions. There were no clear recent stressors which triggered his change in behavior recently. I do wonder if the group home giving the 60-day termination notice in mid April as part of what triggered some these behaviors.

NFH8EB-F15-6850

Youth struggles to maintain appropriate boundaries with peers, engages in instigating behaviors and has a significantly strained relationship with her caregivers, which has continually contributed to disruptive attachments.