White – Page 10 – Mental Health Collaboration Hub

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

CH-M9-2986

2/15/24/ update. Adjusted meds, doing better. Referring him to CABS, Grafton

Patient admitted to unit after ER boarding within the ER for an extended period as mom didn’t feel safe with him returning home. He has a chronic history of extreme emotional dysregulation with acute worsening since moving to the unit & significant head banging and aggression towards himself and others. He has a history of trauma that is likely impacting his presentation.

PH-F15-2886

Update 2/15/24: DC 2/18 to Gerard on 2/19
Discharge Plan: *Insurance is UCARE MN PMAP * County funding approved 1/30/24*

Residential Treatment – Referrals have been sent to the following facilities- pt is accepted at two- waiting county funding and then admission.
-Avanti (Referral submitted 10/26, DECLINED)
-Gerard Academy (Referral submitted 10/26; Accepted, estimated admission around 2/11)
-North Homes (ACCEPTED; openings in March/April)
-PrairieCare Residential could consider pt in interim should county approve funding

PRTF – Referrals to be sent to the following facilities:
-Grafton (Referral submitted 10/23; pt does not meet exclusionary criteria)
-Nexus East Bethel (Referral sent; only accepting pt’s with MA insurance at this time; will refer once County confirms MA insurance)

Outpatient Services:
Establish CMHCM through Ramsey County (Referral submitted 10/23; intake worker confirmed on 1/10 that a long term worker would be assigned next day, now assigned to Clues- they are completing a full intake for CMHCM now, and working on setting up JST meeting with Ramsey County)

Continue existing outpatient services:
-Therapy/Therapist: Minnesota Mental Health Clinic in Woodbury
-Prescriber/Medication Management: Nystrom & Associates
-MCRC Runaway Intervention Program at Children’s
-PO Ari Tresselt Ramsey County
-Disability Services intake worker: Ramsey County

Case Description
15-year-old female with a history of depression, anxiety, ADHD, PTSD, as well as some behavioral concerns. Pt has had three hospitalizations in the past year, has done PHP, JDC, outpatient.

PH-F17-2993

Discharged to a friends house 2/2/24
Seeking safe living placement for youth ASAP
Patient is a 17 year old Caucasian female with a history of depression, anxiety, and PTSD. Admitted for SI/SIB related to school stress.
Ukraine Refugee and has been self sustaining since arriving in America. Patient was residing in Duluth with a roommate and roommate will not have patient live with her anymore. Patient does not have any contact with family. Trauma from war in Ukraine.
She has a therapist and psychiatrist in Duluth- will arrange to where she is living. Has completed PHP twice in the past. Pt wants to live in the Twin Cities Metro for access to more resources .Insured by UBH MA plan.

*Barrier to Discharge is housing:
The Bridge for Youth (Referral made, declined due to recent suicidal ideation)
Aspen House (Referral made, pending response)
Hope House (Contacted, no available bed at this time)
Brittany’s Place (Referral made, call at noon to review patient)
Von Wald Shelter (Referral made, pending response)
Life House (Contacted, waiting response)
Hennepin County Front Door (Contacted, they directed to call Homeless shelter, thus unable to help with housing/shelter resources)
Lutheran Social Services (Contacted, no available bed at this time)
UMD Campus Housing (Contacted campus housing, they don’t have campus housing for PSEO students)

CH-M14-3045

The patient is a 14 Y year-old male with a history of mild intellectual disability, reactive attachment disorder, disruptive mood dysregulation disorder, ADHD, and anxiety who presented to the ER on 2/1/24 via law enforcement for assessment of aggressive behaviors at his group home. Group home staff report he has caused $10,000 in damage since his admission to the group home on 1/8 which included damaging house property and 3 staff members vehicles. He received a letter of suspension from the group home effective 2/1/24 due to his behaviors.

He has had extensive MH services including foster home placements, temporary placements with his grandmother and biological father, multiple ER assessments for aggressive behavior with suicidal & homicidal statements, residential at Gerard Academy, residential at Northwoods in 2017 for 6 months, partial hospitalizations in 2015, 2016, and 2023, inpatient hospitalizations at Children’s, Miller Dwan, Prairie Care x2, Prairie St. John’s, day treatment, group home placement, level 4 schooling, in home skills, case management, PCA services, psychological testing, speech therapy, OT, and individual therapy. He is currently on a CADI waiver.

He has a long history of behavioral dysregulation including: fire setting (set a blanket on fire at age 7, burned the trim on the bathroom door at age 7), sexualized behaviors (including anally penetrating a younger male step cousin when the patient was 6 along with engaging in oral sex), aggression towards animals (broke dogs hip, hit/kicked/choked, killed family cat & dog), physical aggression (including slamming staff fingers in the door, giving 2 staff concussions, kicked staff in the chest, hitting, kicking, biting, squeezing, grabbing, has thrown his younger sister), property destruction, self injurious behavior (head banging, wrapping shirts around his neck, picking at his skin), elopement from classrooms and his home, stealing, and hoarding food. He was in detention at Lino Lakes a few months ago for assaulting his mom.

It is not felt that inpatient psychiatric hospitalization is indicated at this time due to the chronicity of his behaviors though he is not able to return to his group home at this time.

PH-F15-2859

Discharge Plan: *Insurance is BCBS MN PMAP
Residential Treatment – Referrals have been sent to the following facilities:
-Avanti (Referral submitted 10/26, DECLINED)
-Gerard Academy (Referral submitted 10/26; Update received 12/14: Unable to admit due to elopement risk but otherwise approved, will leave on list to review level of risk moving forward; currently under re-review)
-North Homes (ACCEPTED; County funding needed; openings in March/April)

Outpatient Services:
Establish CMHCM through Ramsey County (Referral submitted 10/23; intake worker confirmed on 1/10 that a long term worker would be assigned next day)

PH-F15-2853

Discharge Plan: *INSURED BY BCBS MN PMAP*
Residential Treatment – Referrals have been sent to the following facilities:
-Avanti (Referral submitted 10/26, DECLINED)
-Gerard Academy (Referral submitted 10/26; Update received 12/14: Unable to admit due to elopement risk but otherwise approved, will leave on list to review level of risk moving forward; currently under re-review)
-North Homes (ACCEPTED; County funding needed; openings in March/April)

PRTF – Referrals have been sent to the following facilities:
-Grafton (Referral submitted 10/23; pt does not meet exclusionary criteria)
-Nexus East Bethel (Referral sent; only accepting pt’s with MA insurance at this time; will refer once County confirms MA insurance)

Outpatient Services:
Establish CMHCM through Ramsey County (Referral submitted 10/23; 1/10 intake worker states the long term worker will be assigned tomorrow)
Continue existing outpatient services:
-Therapy/Therapist:Minnesota Mental Health Clinic in Woodbury
-Prescriber/Medication Management: Nystrom & Associates
-MCRC Runaway Intervention Program at Children’s
-PO Ramsey County
-Disability Services intake worker Ramsey County

Case Descreption:
15-year-old female with a history of depression, anxiety, ADHD, PTSD, as well as some behavioral concern. Patient has exhausted several outpatient supports including school in a smaller setting, Childrens hospital, as well as Maplewood PHP, DBT, and engagement with MCRC, JDC and two other shelter placements. Third hospitalization this year.

SBHC-M10-2773

Behavioral issues, parent takes him on a leash when taking him out of the home. Physically and verbally aggressive to parent(s) and others (peers and staff). Throws items, pulls fire alarms, attempts to elope. Receives CTSS services and has demonstrated significant behaviors within those services. Had been in homebound school program, attempted re-entry into school setting and on first day back, damaged property and assaulted staff as well as directing violence towards peers, resulting in transfer to ER for placement. Treatment team questioning consistency of receiving medications appropriately in the home setting and are recommending residential treatment or a shelter bed until residential treatment can be secured.

CH-F16-2246

Update: 1/15/24- Patient has been accepted by Nexus with an admission date of 1/16/24!!

Patient presented to the ER from out of state due to being kicked out of residential treatment for elopements and aggression towards staff and peers. She was boarded in the ER for a significant amount of time before being admitted to the mental health unit for boarding. Patient has CHIPS case though parents are actively involved in her care. Patient has an extremely high risk of elopement and has a history of being sexually trafficked while on elopement. Patient struggles with conduct, low academic performance, and history of aggression. She has had 2 rule 20 assessments and was found incompetent. Patient has been declined from PRTF’s from over 25 states.