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.

MHF-M13-3518

Presented from foster care home after making threats to shoot foster parents and himself. History of PTSD, RAD, IQ of 62. Ongoing aggressive behaviors and impulsivity in the home. Foster parents do not feel safe with patient returning home and is in need of new long term placement. CM has explored Dragonfly, Newport academy, RSI, Genesis, Meridian, Beacon, Twin Ports, Pine City crisis, Northstar community respite. CM/guardian allowed our team to make Nexus YCT referral so intake with them for placement coordination is 4/17.

CH-M8-3464

Update 4.18.24 – on wait list for Northwoods, admission wouldn’t be until summer. Looking for a foster family until residential.
update 4/15/24: The patient is medically stable and has been doing very well here on the unit. Has not shown aggression towards others. One minor episode of head banging when frustrated. Medications are providing therapeutic benefit.

Patient with a past history of RAD, PTSD, ODD and questionable FASD that presented to the ER with foster parents of 4.5 months for concerns of aggression, suicidal ideation, and sexually inappropriate behaviors towards others and pets. He has been in several foster/kinship homes since age 5 with significant trauma prior to this including witnessing mom overdosing on several occasions, witnessing the overdose and death of housemate, sexual abuse by bio father, homelessness, sister attempting to suffocate and strangle him on multiple occasions, and physical abuse by caretakers. He was recently found on video touching the house dog sexually and physically inappropriate and has been threatening and pushing his foster mom. Foster providers are unable to accept him back in their home.

PH-F12-3422

Update 4/15/24: Patient discharged from inpatient on 4/15/24 to home with outpatient services while awaiting level 6 RTC/PRTF placement.

Update 4/3/24: Bar None Haven (Referral submitted, Denied 3.22.24), Northwood Children’s (Referral submitted, On waitlist), Grafton (Referral submitted), Nexus East Bethel (Referral submitted). County also working on referral for MITH program (MN Intensive Therapeutic Homes). MN Choice Assessment done.

12-year-old female with DMDD and RAD presenting to PrairieCare Inpatient Hospital. Patient has had multiple psychiatric hospitalizations, 2 RTC placements and 2 JDC placements.

Discharge Plan:
Locked Level 6 RTC – Bar None Haven (Referral submitted)

Current Providers:
CMCHM at Beltrami County
Individual Therapy
Medication Management
Wavier Case Management Services through Beltrami County (In process)

CH-F16-3629

Patient presented to the ER via law enforcement for aggressive behaviors at shelter care resulting in property destruction. Patient is not able to return to the shelter and does not have any safe disposition options.

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-F12-3097

Patient presented from Prairie Care PHP due to aggression and dysregulated behaviors. PHP unwilling to accept patient back, mother unwilling to take home at this time and cites need for RTC. No RTC referrals made currently. Patient needs support in short term placement while outpatient team supports long term plan and placement. Has been in the ED 4 other times. Back and forth from ED to home. No letter of rec. for residential at the moment. Working on it. There is a case mgr, working on a care conference currently.

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