Mental Health Collaboration Hub
Patient is presenting to the ED for the following concerns: self-harm. Patient has a history of self-harm, through primarily biting his arm, punching other things or scraping himself with a tack. Mom reported that today was the first time he self-harmed with a blade. Mom reporting increased aggression in the home and at school and feels that patient needs inpatient. Mom explained the patient is in a level 4 school setting. He recently did PHP at Prairie Care and was discharged after three days due to concerns about aggression and inappropriate sexual comments. Mom shared the patient has made comments about wanting to strangle others.
Mom explained that patient may already be on the waitlist for the Village Ranch residential treatment in Cokato. They are also exploring North Home in Bemidji. Mom reported that patient has been diagnosed with ADHD, ODD, PTSD and ASD. She also wonders about FASD due to his biological mothers, drug and alcohol use. Patient was adopted at age 7 by his adopted mom and adopted dad. Mom was his PCA in his last foster home for one year before adoption.
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-F11-2021
Patient is presenting to the ED for the following concerns: verbal agitation, physical aggression. Patient was discharged from residential treatment last week. Patient was supposed to discharge to a group home, but her CADI waiver had expired, and she was discharged home without services. Patient became upset after a stressful day, and began arguing with her brother and mother. Patient “destroyed her room”, attempted to kick out her window, and ran a piece of glass under her nails. Patient’s mother called the police.
Patient has a history of ADHD, depression, anxiety, and aggressive behaviors. She had 5 admissions to inpatient psychiatry, with the most recent one on 9/28/22.
AH-F16-1908
Brought to ED after altercation with mom (family adopted patient after years of fostering). Patient went after mom with a knife, patient reports conflicting stories about incident and what she remembers happened. Had been in residential over a year ago. Was recently suspended from school for 10 days after getting into a fight with another student. Unclear if there have been any other incidents of this nature with mom or family, however, mom is not feeling safe if patient were to return home. CPS is involved, Nexus is now involved, but no placement options on horizon at this time.
MCR-14-1888
a history of diagnoses of PTSD, reactive attachment disorder, Oppositional Defiant Disorder, ADHD and substance use disorder. Her social and developmental history is notable for significant early life trauma related to parental substance use, including at least one episode of Lily herself ingesting methamphetamine as an infant. She was removed from mother’s care at age 10 months and father’s care at age 5 years, and was adopted by maternal grandparents at age 7. She has had essentially lifelong difficulties with dysregulated behavior. She has been at Mayo Clinic since 9/6/2023 following an altercation at the home where she was staying. She was previously residing with a family friend, but is unable to return due to safety concerns by all adults involved, including Olmsted County who assessed this not to be a safe discharge location. Her legal decision maker is her maternal grandmother who has previously adopted her.
RMC-M12-1802
2nd visit to RMC in one week for running away (from school and from home). Verbally abusive towards authority (Sheriff’s Dept. and his grandparents). Recent theft (stole a sweatshirt from the mall) and violation of school policy (vape found in locker). Patient is refusing to return home with grandparents (legal guardians since 10 months old), now claiming they physically and emotionally abuse him. Hennepin Co. CPS has no concerns with safety at home. Patient is now making threats to grandparents, expressing that he wants them to “be murdered.” Grandparents are concerned for their safety after threats made by patient.
MHF-M18-1739
UPDATE 9/21/23 – placement difficult due to the arson incident.
Patient presents to ED for aggressive behaviors. Today, patient lit a fire in the bathroom of his group home because he was “tired of living” and “tired of his group home staff”, after they turned off the wifi in the house. After lighting the fire, police and fire department arrived. Patient was still escalated and refusing to leave the group home while the fire was burning in the bathroom. Patient was brought outside by a police officer, and patient attempted to grab the officer’s handgun. Patient states he did this with intent of using on himself or his group home manager. Patient was quickly handcuffed and restrained into an ambulance.
Patient was reportedly hospitalized in Floriday last month while on vacation for aggression, agitation, med non-compliance. Patient has been living in his current group home since 2019. Patient attends an alternative school which he enjoys. Patient has PCP and psychiatry per his report. States he has been in “placements” his entire life since being adopted from Ethiopia at a young age by his current adoptive parents. Previous admissions in 2018 for DMDD, and aggression.
Hx of learning disability, aggressive behavior, agitation, outbursts.
MHF-F14-1493
UPDATE: as of 8/24/23 she has been accepted to a residential facility in Georgia, and the family is waiting for some pieces from their insurance company. Transportation is ready to go once insurance is approved – hopefully end of this week or early next.
Pt is presented to the ED via EMS for the following concerns: verbal agitation, physical aggression, significant behavioral change, and anxiety. Pt has been in a residential treatment center for approximately 5 weeks, and had been in a “crisis state” all day, on day of admission. Pt was requiring frequent restraints, supervision and redirection for up to 8 hours. She was non-compliant with treatment activities, frequently trying to run away from program activities, and into the street. Pt kept searching for sharp objects to self-harm, and assaulted staff when they tried to take objects from her.
These are chronic behaviors for pt. Pt is currently in a 3rd residential treatment program (secure), with a hx of one prior group home placement. Pt has a hx of several mental health hospitalizations, with most recent in October 2022. Patient has a hx of refusing medications.
Residential facility stating that pt has been discharged, however there is no discharge paperwork available. From North Dakota. No case mgr or services in place. Her parents were able to get her into the residential treatment center she was at. Able to DC but nowhere to go at this point.
MHF-M9-808
Patient is presented to the ED by EMS for aggressive behavior towards staff and another resident in his group home. At the group home staff brought the patient out to his school transportation but the patient became dysregulated when he saw the driver was different from prior trips. Patient then eloped to a neighbor’s house where he entered. Staff followed and called the police. Patient was brought back to the group home, but later got into a physical fight with another resident and staff member. Police were called a second time, and patient was transported to the hospital using restraints. The patient has a history of ED visits and has had approximately 6 previous hospital admissions (5/21; 7/21; 10/21; 11/21; 12/21; 9/22). The patient has a diagnosis history of DMDD, ODD, ADHD, GAD, depression, and RAD
MHF-F16-1057
Patient is under the guardianship of Swift County, and presented to the ED from his group home in Hennepin County. Patient got upset after being denied an outing, and went out to the road (not a busy road) and threatened suicide by getting hit by a car. Police were called, and patient was taken back to his group home where he made homicidal threats towards a neighbor. Group home staff then requested patient be seen by the emergency department. Patient has had multiple psychiatric hospitalizations. Patient reports frequent suicide attempts with methods unlikely to harm him, such as tying shoestrings around neck. Patient has a history of self-harm.
PH-F13-458
Pt has had 4 psychiatric hospitalizations, PHP twice, and outpatient services. Needing RTC and bridging plan. >Discharge from PC Inpatient is 5/11 at 1400, will discharge home until RTC.
Discharge Plan:
RTC-
Avanti (Referral made, declined for admission due to history of aggression)
North Homes (Referral made, 6-8 week waitlist)
Village Ranch (Referral made, pending acceptance)
Gerard (referral made; pending acceptance)
Northwood (referral not made; waitlist over 6 months)
Newport Academy (referral not made; insurance not accepted)
Grafton (CMHCM making referral; though likely doesn’t meet criteria due to no ASD/ID/DD diagnosis)
CRTC (referral placed)
Interim Plan:
Consider PCR (referral not made; insurance not accepted though possibility for a county contract- connecting county worker and PCR)
Continue Psychiatry at Nystrom and Associates
Continue Probation services at Goodhue County
Continue CMHCM at Fernbrook
Establish Family therapy at Nystrom and Associates.
Establish CADI worker at Goodhue County
update as of 6.22.23 – Denied acceptance at CRTC due to aggression and lack of buy in
