Recommendation is for QRTP or PRTF – either could potentially meet the needs of this patient and limited treatment centers available due to patient’s age. Patient is currently in psychiatric inpatient hospitalization.
Patient is an 8-year-old female. Patient presented to inpatient from the ED due to increase in unsafe and risk-taking behaviors. This is her fourth inpatient hospitalization; one in 2022 and three in 2024. Patient has attended day treatment twice and participated in outpatient psychotherapy and medication management.
Discharge Plan:
PRTF/QRTP: (county funding approved for QRTP)
– Grafton (declined due to not meeting criteria)
– Northwood (referrals submitted 9/9, on waitlist 9/23 – awaiting update on admission timelines)
– Gerard (unable to accept due to age)
– Avanti (unable to accept due to age)
– Bar None Haven (unable to accept due to age)
– North Homes (unable to accept due to age)
– Heartland Girls Ranch (unable to accept due to age
Continue with following outside providers:
– Therapy/Therapist: Solutions Behavioral Healthcare Professionals
– Primary Care Provider: Sanford Health
– Medication Management: Solutions Behavioral Healthcare Professionals
– Case Management: Solutions Behavioral Healthcare Professionals
– Occupational Therapy: Beyond Boundaries Therapy and Wellness
This kiddo came to our ED on 10/21 because she did not have any other placement. County currently has custody. She was previously at Niama House where she had physical aggression toward staff on 10/19. They brought her to the ED on 10/21 and discharged her from their program. She previously boarded in our ED from 4/25-6/20, also due to needing placement.
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
Kiddo came to the ED 9/19 after aggression at his group home. Boarded at our hospital summer of 2023 for a few months. Team does not want him to return to his group home and is seeking crisis respite while they work on finding a new group home. Has DD waiver.
Pt per chart presented 9/15/2024 d/t sent from JAF facility after agitation episode during which pt expressed self-harm ideation via electric outlets. Of note this is a behavior for which he has been sent to ED multiple times and regulates in ED and has been sent back. However, currently facility is not agreeing to take pt back and apparently for the past 5 days since last visit, there has been a plan to discharge pt if there was 1 more ED visit, which is current visit.
Patient presents to the ER from PRTF twice in the same day after boarding for an extended period of time due to aggression towards staff. She has since been discharged from the PRTF as they felt a higher level of care was indicated. She is currently doing well here with intermittent verbal escalations though does struggle with peer relationships. She does express visual and auditory hallucinations though these do appear to be related to trauma.
Brought to ER after assaultive behavior towards group home staff. Since being in the ER, patient has denied SI/HI and been behaviorally regulated with the exception of one incident after being here for 6 days, and was asked to go to his room to avoid potential problems with other patient’s in the ER and he was upset and got restrained. He’s been up for discharge back to his group home since the day he presented to the ER. The county worker has been main contact with group home and are trying to problem solve ways to support patient at the group home. Ombudsmen involved.
Update 7/10 – patient remains boarded, now on EmPATH unit (observation unit/extension of ER) without aggression or behaviors. County guardian making referrals for placement options including respite, crisis, group home, shelter
On 7/8/24, patient was told he would be spending time with his mother, to which patient had a negative response, causing patient to assault his father and run away. Police located patient at a local middle school just before patient ran across a highway and had to be sedated by EMS due to safety concerns.
Pt has dx that include: reactive attachment d.o., disruptive mood dysregulation disorder, PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections), ADHD, ODD, OCD, pervasive social communication d.o., with low non-verbal skills, high verbal skills, low memory skills, and average IQ.
Pt came to ED from North Homes, after increase in physical/verbal aggression and 30 day notice was given and lapsed without another placement found. Was boarding in our ED in Nov 2023 prior to admit to North Homes. Planning to connect with parent/County about re-involving Nexus YCT. Some sexual inappropriate behavior making him difficult to place.
Adopted at birth with in utero meth exposure. Several inpatient, residential and outpatient avenues explored both instate and out of state. Patient is declined or asked to leave to due aggression to peers. Juvenile system has discharged back to mental health. Engages in self harm, significant aggression, stealing and fraud, fire setting, etc.
