Reactive Attachment Disorder (RAD) – Page 3 – Mental Health Collaboration Hub

PH-M15-3418

Update 4/10/25: declined at Leo Hoffman, East Bethel, Bar None Haven, does not meet criteria for Grafton, Northwood wait list 2 years. Discharged from Mille Lacs RTC.
Update 4/3/24- declined Leo Hoffman, East Bethel, Waiting to hear back from Grafton, Bar None Haven. Discharged from Mille Lacs. Northwood waitlist 2 years.
Update 4/1/24: Nexus East Bethel PRTF declined pt due to not having a male unit at this time.

15-year-old female identifying patient with a history of depression, anxiety, RAD, PTSD, ADHD, and ODD. Patient has been in and out of treatment settings for 3+ years and has not been at home since. Patient was at an unknown treatment facility and was discharged due to its closing, Northwood Children’s Services PRTF (discharged due to not needing level 6 care) and most recently has been at Nexus Mille Lacs RTC since October 2022. Patient has a history of four inpatient hospitalizations. Patient has been discharged from Nexus Mille Lacs RTC as of 3/20/24 due to them recommending a higher level of care.

Current provider:
CMHCM: Kanabec County

PRTF: (MN DHS eligibility submitted by county and approved)
-Leo Hoffman (declined due to pt acuity)
-Northwood (added to wait list, about 2 years)
-Grafton (pt does not meet acceptance criteria)
-Nexus East Bethel (declined due to not having a male unit)

RTC:
-Nexus Mille Lacs (pt discharged from program as of 3/20 due to lack of engagement)
-Bar None Haven (declined due to aggression and behaviors)

MN DHS Complex Transitions Team (in process of scheduling care conference)

MHF-F13-3515

Patient presented from North Homes due to suicidal ideation and aggressive behaviors. Patient was initially recommended for IPMH however stabilized in ED and no longer required admission. Patient has been discharged from North Homes and is in need of long-term placement as she cannot return to guardian’s home. Case manager will be working on referrals for RTC and out of home placements.

MHF-F14-3262

Patient brought in to ED by case manager after her group home discharged her due to ongoing behaviors and aggression. Case manager did not have alternate placement and therefore patient now boarding in ED until new placement can be found. Patient in need of shelter or crisis respite placement while longer term placement is found. Awaiting funding.

PH-F16-2714

Updated 3/7/224: Admission scheduled for 3/12, discharge from hospital will occur same day
Updated 3/1/24: SW was informed the admission date was moved to March 12th. Scheduled admission to Nexus East bethel for March 12th
Updated 2/28/24: East Bethel Accepted- Admission scheduled for March 7th time TBD, pt remains on the inpatient unit.
Updated 2/15/24- East Bethel Accepted- Opening now first week of March, pt remains on the inpatient unit.
Updated 2/1/24: East Bethel Accepted- Opening mid February
Updated 1/25/24: East Bethel tentatively accepted- opening mid February
Updated 1/11/24: East Bethel will review, if accepted- admission in a few weeks.
Update 1/9/24: Patient has been declined to Grafton PRTF due to her behaviors not being appropriate for current milieu and identified as it would not be therapeutic.

Discharge Plans: PRTF is medically recommended by inpatient treatment team
PRTF: Nexus East Bethel (Referral sent & under review, will likely hear about acceptance decision in January 2024)
PRTF: Grafton (declined on 1/9 due to behaviors not appropriate fit for current milieu)
-(DHS eligibility form for PRTF sent and approved)

Referrals to RTC’s made previously by the county:
-LSS, Sioux Falls: Couldn’t meet pt’s needs, low cognitive function, and FAS diagnosis
-Gerard: Couldn’t meet pt’s needs and FAS diagnosis
-North Homes: CMHCM referred for 35 day evaluation, still working on an acceptance
-Avanti: Pt’s legal guardian did not consent due to distance away from home
-Boys Town, Nebraska: Declined due to FAS diagnosis

Continue with established outpatient providers:
-CMHCM: Des Moines Valley Health and Human Services
-Medication Management: Windom Hospital
-Individual Therapist: Greater MN

This is patient’s 5th psychiatric inpatient hospitalization. Patient’s current admission is due to increased suicidal ideation, behavioral dysregulation, and homicidal threats towards staff and peers at school. Patient has utilized outpatient mental health supports such as psychotherapy, medication management, children’s mental health case management, children’s therapeutic support services, vocational rehabilitation skills, as well as group home and respite care. Patient has engaged in partial hospitalization program twice.

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-M14-3045

The patient is a 14 Y year-old male with a history of mild intellectual disability, reactive attachment disorder, disruptive mood dysregulation disorder, ADHD, and anxiety who presented to the ER on 2/1/24 via law enforcement for assessment of aggressive behaviors at his group home. Group home staff report he has caused $10,000 in damage since his admission to the group home on 1/8 which included damaging house property and 3 staff members vehicles. He received a letter of suspension from the group home effective 2/1/24 due to his behaviors.

He has had extensive MH services including foster home placements, temporary placements with his grandmother and biological father, multiple ER assessments for aggressive behavior with suicidal & homicidal statements, residential at Gerard Academy, residential at Northwoods in 2017 for 6 months, partial hospitalizations in 2015, 2016, and 2023, inpatient hospitalizations at Children’s, Miller Dwan, Prairie Care x2, Prairie St. John’s, day treatment, group home placement, level 4 schooling, in home skills, case management, PCA services, psychological testing, speech therapy, OT, and individual therapy. He is currently on a CADI waiver.

He has a long history of behavioral dysregulation including: fire setting (set a blanket on fire at age 7, burned the trim on the bathroom door at age 7), sexualized behaviors (including anally penetrating a younger male step cousin when the patient was 6 along with engaging in oral sex), aggression towards animals (broke dogs hip, hit/kicked/choked, killed family cat & dog), physical aggression (including slamming staff fingers in the door, giving 2 staff concussions, kicked staff in the chest, hitting, kicking, biting, squeezing, grabbing, has thrown his younger sister), property destruction, self injurious behavior (head banging, wrapping shirts around his neck, picking at his skin), elopement from classrooms and his home, stealing, and hoarding food. He was in detention at Lino Lakes a few months ago for assaulting his mom.

It is not felt that inpatient psychiatric hospitalization is indicated at this time due to the chronicity of his behaviors though he is not able to return to his group home at this time.

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-F12-2873

Patient presented from home due to dysregulated behaviors which are chronic for patient. Is recommended with continued outpatient follow up however mother unwilling to accept home at this time.

AH-M16-2327

Patient was in Prairie Lake JDC and his ‘time was served’. County did not have a place for him and reported a judge ordered for a sheriff to drive him from there to ANW for acute MH care. He does not need IP MH care, Crow Wing County does not have a place for him. They are connected with Solutions, working on group home placement.

Patient placed at Crisis respite hotel.