Patient was dropped off at a different ER by the parents of her 4th foster home placement where she was placed 3 days prior as the foster parents didn’t feel they could provide care for the patient due to hyperactivity, impulsivity, aggression, elopement, and sexualized behaviors. Her social workers picked her up from the outside ER and while in route to human services center to board until a new foster home was located, the patient was attempting to remove her seatbelt and she was brought to this ER where initially inpatient psychiatric hospitalization was recommended due to a lack of safety awareness, elopement, sexual behaviors, and need for medication assessment. She was trialed on guanfacine, developed hypotension and this was discontinued, and she was started on Concerta where her elopement attempts, impulsivity, and hyperactivity improved. She remains boarding in the ER while the county pursues foster home placement.
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.
MCR-F17-2442
Long history of trauma started ingesting non-edible items, batteries on 3 occasions. Waiting on County to help with disposition. Ward of state. No attempts at self-harm or ingesting since stay in ED. Last ingestion was day of admission. Surgically removed batteries then back to ED for MH care. Local school district working with her, tutoring. Turns 18 in May.
MCR-F14-2438
Ran away from home (resides with grandma) & stole from Scheels and air pods from a stranger Was tracked by air pods owner who confronted the patient at Red Lobster. Pt assaulted the mother of this individual. History of trauma & SA Kicked out of multiple schools brought gun to Willow creek & threatened to pistol whip classmate. Attempted treatment at Fountain Centers. Restraint chair multiple times.
Declined from Heartland Girls Ranch, Family/Foster Home is not an option due to behaviors, SERCC/Vonwald- patient has been to in the past and has either eloped or been kicked out of the program due to fighting. Trisha will follow up with PORT and Hunter’s Place. These are both sheltered care so similar to Vonwald but in a different geographic area. Neither of these are locked facilities which is also a concern.
Parents unwilling to take her home. Care conference with the county occurred after a week in the ED. Just starting the QRTP process.
HCMCH-F13-2414
Came after being found in the street by a passerby who administered Narcan. Was incoherent, EMS brought her in to HCMC ED. Long history of trauma. Sexually abused in preschool by her father, who is incarcerated currently. Has been vulnerable to sexual exploitation. Her engagement with anyone in the community is a pathway to a friendship. Dakota County financial responsibility. Working with DaK. case mgr. Had an incident at school (interaction with the principal and had some sort of physical contact with him, charged with assault), so now has a probation officer. No aggression noted at hospital. Wonderful family support. Had been living with aunt. Will just walk out and engage with strangers who do not have her best interest in mind. When DA is complete will be looking for placement for her. community placement. Has been at CRTC and VOA. Working on getting all the info to understand her full picture. DRug screen was negative. Unsure if chemical abuse is dependent? She will use substances if someone offers it to her, socially.
HCMCH-F13-2406
History of trauma, sexual exploitation, concurring with MH and substance use. Co-managed by psychology and addiction medicine in the hospital. Community PCP has been established who can also monitor suboxone. Patient in need of short-term placement. Has been referred to Heartland Girl’s Ranch.
SBMC-F16-2371
Substance use history, family signed out from treatment program and has been on the run for the past 6 months after mom signed her out of facility in Brainerd. History of abuse from grandfather whom she was staying with. Leech Lake custody. Drinking since age 9. MH primary dx.
RH-F15-2367
1 week prior to ED pt was found tied up in her home by her parents. She was taken to Children’s and placed into foster care. Mother didn’t believe in Western Medicine and was using THC and tying her up to treat pt’s agitation in the home. Pt presented to Regions ED from the foster home due to increase agitation and needing more staff support, pt has severe ASD, DD. Hx of violence towards self and others. She can’t eat without someone holding her hands because she hits everything away. She is mostly nonverbal, only knows a few words.
Has been in the ED for over 165 hours, she has been started on medications and we have seen a decrease in her level of agitation. She has been more cooperative with ADLs, takes medications, and eating meals w/ assist and staff have been able to redirect her before a code needs to be called. Pt has been declined by all inpatient facilities at this time. CPS in Anoka is current guardian. Has DD waiver. Regions providing sensory support, weighted blankets, stuffed animals, music. Needs 24/7 support.
Mom currently in custody.
AH-M14-2363
Came from Bar None. Sig family trauma, sex trafficked by parents who are incarcerated. Some drug use, but sober now (benzos and opiates). been behaving ok so far. Responding well to limit setting in ED. At Omegon was doing ok aside from relationship issues. Grandmother had custody but has been terminated.
Several referrals – denied due to chemical use/abuse. Shelters denied d/t aggression. High risk for placement. Check into returning to Bar None Omegon? Youth Villages in TN – they can take more aggressive behaviors. ***Discharged to Hotel Care with crisis staffing. The Hennepin County CM/guardian arranged for the placement after 30 days in the ED.
AH-F15-2351
history of running, trauma, generational trauma, emotional dysregulation. Rec CRTC level 6 – barrier to placement. Waiting on County for review and to change to another county agent.
C8SM8M-F11-2346
History of trauma, sexually exploited youth, aggression, ODD, multiple placements, adjustment disorder. Had an Intake with FV PHP program, was accepted, but nowhere to place her to do the program. Meeting today with county to discuss the case. Looking at intensive therapy services, shelters.
Patient been accepted to Fairview’s PHP, pt has a foster mom who is only willing to take pt home after completing PHP, county seeking residential. 3/23 update: transferring 3/24 @ 10:15 am to DIVINE.