19 year old left his adoptive home for a walk, then stopped at a private home and requested that 911 be called due to having suicidal thoughts. Patient is in high school. 4 visit to the ER in two weeks.


The patient presented after expressing homicidal thoughts (threats of aggression) toward her grandmother with whom she lives. Patient was on her way home from school when she pulled her school lvan driver’s arm to the back of the van as she did not want to return home. Patient was then returned to her school where her grandmother picked her up and eventually brought her to the Emergency Department. Since her presentation to the Emergency Department, the patient has not displayed any aggressive behavior. Patient has irritability and emotional outbursts with grandparent(s) and has displayed these behaviors at school as well. Has mostly been pleasant and cooperative in the Emergency Department. Has some attention seeking behaviors when the Emergency Department is busy.


Update 5/23/24: Needs psycho-sexual eval, but there is no place to send him to have it done as it can’t be done in the hospital.
Pt was brought into ED on 5/11 by mother due to allegations of abuse. Mother resides in DV shelter and shelter is not allowing pt to return there due to pt behaviors (bangs his head, kicks walls, makes threats, aggression toward mother.) Mother is trying to find new housing so that pt can return to her. County referrals made to Northwoods, North Homes, Village Ranch and Mille Lacs Academy- programs thus far are months out. Barrier to many programs is pt age. County JST is meeting today at 10:30am to discuss further options. Planning to refer for Nexus YCT once discussed with all team members and ROI is received.


Pt has been living in the Residential Services-Jewel Group home for over a year. They gave a 60 day termination of service due to their inability to manage her escalating behaviors (last day of services 6/25/24). They have 2:1 staffing for her. These behaviors include harm to self, or others, striking out, choking herself, throwing things and threatening to kill herself and others. She had been attending TSA day treatment until March after an altercation with a peer. She is currently at a 4th grade level and has an IEP. She was brought to the Welia Mora ED on 5/9 and 5/10 as well as Children’s ED on 5/14 looking for “other placement” and was discharged due to not meeting criteria for inpatient hospitalization.


Update 5/22/24: Accepted to Nexus East Bethel, PRTF funding approved, tentative admit now in June. SEEKING INTERIM PLAN for Respite, Shelter Plus, etc.

Update 5/15/24 – Accepted to Nexus East Bethel, PRTF funding approved, tentative admit mid/end of May.
Update 5/8/24 – Accepted to Nexus East Bethel, PRTF funding approved, tentative admit mid/end of May.
Update 4/4/24- PRTF funding approved. Pending admission to Nexus East Bethel, potentially early May for both Nexus EB and Grafton.
Update 4/3/24- Can admit to Nexus East Bethel, waiting PRTF funding approval- lots of back and forth.
Update 3/21/24- -Northwoods (referral made, waitlist 2+ years) -Grafton (received referral, waiting for confirmation if on waitlist, earliest availability May) -Nexus East Bethel (will complete review next week, if approved pt could likely admit soon)

13 year old female from ED. Pt was at school and was angry and ran from the school. Patient has history numerous psychiatric hospitalizations as well as ten months of treatment at Gerard residential treatment. In alignment with CMHCM, seeking PRTF level of care. At this time parents do not feel they can have the child return home. County looking at respite care, so far unsuccessful. On waitlist (2+ years) at Northwoods, Grafton referral sent, Nexus East Bethel pending acceptance/wiatlist)
Pt insured by Medicaid (had a commercial plan UBH that ended on 3/1/24).
Pt has the following outpatient supports:
Day tx (not yet started)


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


Update 5/23/24: Patient has been assigned a CMHCM through Sherburne County, waiting to have JST scheduled for funding approval. Referred to PrairieCare Residential and pt was accepted – county unable to support funding as insurance is OON. Referrals sent to Avanti, Gerard, North Homes, and Grafton – all under review and waiting to hear about acceptance decisions.

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. CMHCM has been referred to through the county, will need to obtain funding for RTC.

Discharge Plans –
Avanti (referral sent & received – under review)
Gerard (referral sent & received – under review, tentative openings August)
North Homes (referral resent & received – reviewed, virtual meeting with pt being scheduled)

Grafton (referral sent)
DHS PRTF eligibility (approved 5/13)

CMHCM: Sherburne County (Referral sent) (need to obtain county funding for RTC)

Interim to bridge RTC if/when pt stabilizes:
PHP: PrairieCare – MOB (Intake canceled due to delay in dc)

Continue with established outpatient providers:
-Individual Therapy: Nystrom & Associates
-Family Therapy: Nystrom & Associates
-Medication Management: Allina Health Clinic Cambridge


Patient admitted directly to CRTC on 6/8/23 directly from PrairieCare Inpatient.

Patient had been hospitalized in the Inpatient setting numerous times, she was at PrairieCare Residential 12/19/22-2/22/23 and stepped up to Inpatient for stabilization. PrairieCare Residential is unable to have her return due to their staffing and current milieu. Please note aggressive behaviors have significantly decreased and have not been present in the past month. UPDATE: Accepted to CRTC, waitlist 5-7 weeks- any available bridging shelters/group homes?

Discharge Plan:
Referred to-
-PrairieCare Residential (Re-admission declined on 4/11 due to milieu/staffing concerns)
-Grafton (Not currently accepting patients over age 14)
-Northwest Passage (Does not accept MN MA; Referral declined due to IQ)
-Avanti (Declined due to aggression 12/22; SW to re-refer)
-Gerard (Referral submitted 4/26)
-North Homes (Declined from RTC 11/22 due to IQ)
-CRTC (Referral submitted on 4/14; additional clinical sent 4/25, accepted for admission 5/9; estimated waitlist 5-7 weeks)
-Bar None, Shelter Plus Program (Preliminary Hub referral made, awaiting return message; SW to re-refer for interim placement while awaiting admission to CRTC)
-Refer to Treatment Placement Specialist at Acadia Healthcare for consideration of out-of-state RTC’s
-Consider referral to CIBS program at Avanti (Anoka County unable to fund – no contract)
-Consider referral to CIBS program at Nexus-FACTS (Anoka County unable to fund – no contract)

Group Home:
-PrairieLakes Haven House Group Home (waitlist 2 months)
-Port Group Home (waitlist 2 months)

Therapeutic/Corporate Foster Care:
-Solutions Behavioral Healthcare (Awaiting return call)

Estimated length of stay:
To be determined pending formulation & confirmation of alternative discharge plan

Was initially accepted by CRTC but couldn’t take due to her Casii level of 5.


She has been in foster care placement for the past 3 years. She has four other siblings whom are also in the foster care system. mother’s rights are in the process of being terminated. She ran away from foster home and was staying with a friend. Friend’s mother called police for fear of being in trouble housing a runaway. She refuses to go back to foster provider and foster provider cannot keep patient safe from running. CPS guardian and seeking shelter placement


Update 5/15: Referral madeEmbark (out of state PRTF) and other 2 PRTF out-of-state referrals, as well as Bar None Haven.
The patient is 14 y/o female with a PMH dx to include DMDD,, ADHD, PTSD, and FASD. The patient has presented to ED for SI, attempts elopement and aggression. The patient has significant hx of MH IP hospital admissions. She was recently d/c Dungarvan after 2.5 years.

Hx of sexual abuse and neglect. She ward of the state. Her extensive trauma history and attachment issues, which hinder her ability to form relationships.