The patient is a 13 year-old female with a history of ADHD, inattentive type, anxiety, depression, sexual abuse, suicidal ideation, and self-injurious behaviors that presented to the ER following an intentional overdose in an attempt to end her life. She has had 2 previous inpatient hospitalizations. Patient has a complicated home life with several CPS reports and basically does the caretaking for her younger siblings. Patient has several tattoos given to her by her mother and sister and mother is unwell as well and frequently struggles with suicide attempts and self-harm. Sounds like a significant sexual abuse history within the entire family that may still be occurring. The patient is at risk for sexual exploitation given increased sexuality.
Psychiatric Diagnosis: Trauma and Stressor Related Disorders
Trauma and Stressor Related Disorders are a group of psychiatric diagnoses that result from exposure to traumatic or stressful events, such as acute stress disorder and adjustment disorders.
PH-M15-4658
Pursuing QRTP – patient is currently in psychiatric inpatient hospitalization.
Patient is a 15-year-old male. He presented to inpatient via ED due to increased SI and SIB. He has three historical inpatient hospitalizations, has done DBT and outpatient psychotherapy services, and most recently was at Newport RTC – although was discharged early due to aggression and property destruction.
From an acute psychiatric standpoint, youth is safe to discharge form inpatient care and receive services in the community prior to admission to QRTP. He has made significant progress on treatment goals during hospitalization.
Discharge Plan:
Referrals sent to the following residentials:
– Omegon Ascend (Reviewing, no current waitlist)
– Nexus Gerard (Reviewing, waitlist about a week)
– Nexus Mille Lacs (Reviewing, Current waitlist 2 months)
– North Homes (Declined d/t hx of aggression towards others)
– Northwood (Received, 6-9 month waitlist)
– PrairieCare Residential (Reviewing, 2-3 week waitlist)
Alternative Placement through Wright County:
-Wright County unable to identify alternative placement as of 9/24/24
Plan to bridge until residential:
PrairieCare PHP at MOB (unable to pursue establishing care at this time due to pt continuing to be hospitalized)
Continue with established outpatient providers:
Individual Therapist- Bridging Hope Buffalo
Medication Management- LifeSpan Mental Health Monticello
PCP- HealthPartners Elk River
CMHCM- Wright County
Neuropsych Testing- Clary Clinic St. Cloud
HCMCH-M17-4606
17 y/o male with MDD with psychotic features, neurodevelopmental disorder, intellectual disability. He recently discharged from CABHS. Waiting for MSCOCS placement hopefully will be admitted on 10/2. There concern of excessive irritability, agitation, disorganized thoughts, delusions, history of auditory or visual hallucinations, history of self injury and impulsive behaviors leaving to being in dangerous situations.
MHF-F12-4571
Pt came to our ED on 9/6 following a verbal altercation with foster parent. Foster parent is refusing to let kiddo return. County has custody, limited parental involvement. Was supposed to begin Fairview’s PHP program 9/10 however is unable to being in the ED, should be able to begin that program once placement is found. County is currently searching for shelter/other foster care options and screening for MH group home placements.
CH-M11-4380
Patient endorses homicidal ideation towards his sibling. Increasing behaviors at home. PHP (Clara’s House) attempted and will be discharged with recommendation of high level of care (residential). Patient has significant trauma after extensive physical abuse from biological mother and likely operates at a much younger age. Patient was removed from his mother’s custody by Ramsey County CPS in May 2024. Aunt is foster care provider.
MHF-M17-4109
Update: Discharging today 6/20 to hotel crisis respite
Came to the ED this time on 6/9, after refusing to do chores and punching a wall and tree. Dad is refusing to pick up. Was previously in our ED 5/4-5/18 and 5/25-5/28, returned home with Dad both of those times. Case Manager is looking for waiver paid placement, and has been for over a month. Had interview with potential provider 6/12- they are potentially going to do a variance for him to live in adult home if accepted (he’s 3 months from 18). At baseline has some auditory hallucinations, ongoing aggression- primarily verbal, occasionally property, along with some suicidal ideation.
PH-F15-3876
Recommendation is for Level 5 Residential Treatment; patient is currently inpatient.
Patient presented to inpatient from the ED due to an increase in SI and risky behaviors. Patient has had two previous psychiatric inpatient hospitalization, has attempted PHP, and engaged in outpatient mental health services.
Discharge Plan:
RTC: (JST Thursday 5/30 at 1030 to approve funding for RTC)
Avanti (ACCEPTED – opening 6/11, pending county funding support)
Gerard (referral sent & received – under review, tentative openings August)
North Homes (referral resent & received – under review)
PCR (accepted – insurance OON, county unable to support county contract for funding)
PRTF:
Grafton (referral sent & received – under review)
DHS PRTF eligibility (approved 5/13)
CMHCM: Sherburne County
Continue with established outpatient providers:
-Individual Therapy: Nystrom & Associates
-Family Therapy: Nystrom & Associates
-Medication Management: Allina Health Clinic Cambridge
PH-F17-3791
5/20/24: Patient discharged from inpatient and admitted to PCR.
5/8 update: Patient scheduled for admission to PrairieCare Residential on 5/20/24 at 10:00am.
5/6 update: Patient is currently awaiting an RTC bed through PrairieCare Residential in Maple Grove. Patient has been approved for 3rd pathway funding through Hennepin County. Due to patient behaviors seeming to increase, other options are being explored for aftercare as denials are a possibility. Parents do not feel safe with the patient coming home.
Discharge Plan:
Residential Treatment:
-PrairieCare Residential; intake 5/20/24 at 1000
Other RTC Referrals:
-Nexus Gerard; referral made
-North Homes; referral made, declined due to FAS and IQ
-Avanti Center for Girls; referral made, declined due to aggression and peer conflict
Outpatient Providers:
Establish CMHCM; opened with Soreya Jama through Hennepin County, 3rd pathway funding approved
Establish/Continue CTSS with Samira through Nexus FACTS
Continue Therapy with Mary Midler at Great Lakes Neurobehavioral Center in Edina (weekly)
Continue PCP with Dr. Megan Reilly at Partners in Pediatrics in Plymouth
Continue Psychiatry with Gerard Balan at Plymouth Psych Group
Continue IEP Case Management with Yvette Zeese at Wayzata High School
Continue Neurological Services with Dr. Catalfamo at Noral Neurological Clinic in Bloomington
ADMISSION NOTE: Patient was admitted due to acute safety concern and was unable to contract for safety at home. Pt was in PHP in the past and family was monitoring her 24/7 at home as instructed. Pt became irritated that she is constantly being watched and ended up having altercation with her mother because she was instructed by her mother to change outside of her bedroom because the mother was unable to see her. Pt ended up leaving and went to her grandmother’s house which is next door while mom followed her, pt went straight to the kitchen grabbed a knife and start threatening to stab herself. Mother was able to wrestle the knife out of her hands and called EMS. Pt has a history of depression, anxiety, epilepsy, and fetal alcohol syndrome.
PH-F12-3368
Update 5/17/24: Patient discharged home to guardian with PHP in place. Still pursuing PRTF/level 6 RTC.
Update 5/15/24: PRTF funding approved. Patient accepted to Nexus East Bethel PRTF, tentative opening August-September. Referral sent to Bar None Haven level 6 RTC, referral is under review. Scheduled discharge home to PHP interim on 5/17
Update 5/9/254: PRTF funding approved. Patient accepted to Nexus East Bethel PRTF, tentative opening August-September. Referral sent to Bar None Haven level 6 RTC, referral is under review. Tentative discharge home to PHP interim on 5/15
Update 4/24/24: Patient has been accepted to Nexus East Bethel PRTF. Estimated availability for opening is August-September.
Update 4/4/24: Updated inpatient clinical has been sent to Nexus East Bethel PRTF for review. Nexus East Bethel PRTF did not get to pt’s review on 3/26/24 and is requesting inpatient psychiatrist and PRTF psychiatrist consult directly.
Update 3/21/24 Nexus East Bethel PRTF reviewing for acceptance on 3/26/24.
12-year-old female presenting to inpatient from the ED. This is her second psychiatric inpatient hospitalization.
Recommendation is PRTF. Patient has been approved for funding through MN AFMC PRTF team.
Referral has been sent to Nexus East Bethel PRTF and is under review.
PH-F14-3891
Update 5/23/24: Patient accepted to Heartland Girls Ranch with scheduled admission Wednesday 5/29 – county funding was approved.
Patient presents to inpatient from the ED due to an increase in SI. This is her third psychiatric inpatient hospitalization. She has done PHP twice and engaged in outpatient mental health services.
Discharge Plans –
RTC: (JST funding meeting on 5/17)
-Avanti Center for Girls (referral under review)
-Nexus Gerard (referral under secondary review)
-North Homes (pt is on waitlist – 4-6 weeks out)
-Village Ranch- Annandale (pt is on waitlist – end of June)
-Heartland Girls Ranch (referral under review)
Continue with established outpatient providers:
– Therapist: Mayo Clinic Health Systems Austin
– Family Therapist: Albert Lea
– Medication Management: Mayo Clinic Austin
– Case Management: Freeborn County
– Occupational Therapist: Mayo Clinic Rochester