Race/Ethnicity: White

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)

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)

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-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.

CRMC-F9-2761

9 year old female recommended for inpatient care due to verbalizing suicide plan. County involved. Outpatient services minimally utilized. MCO has been in the home several times and offered recommendations to family. Parents active and present, but unusre if able to set boundaries or have skills to meet needs. Other kids in home. MCO eval recommended placement and continue in ED until placement located. Avel consult and suggested could go home with safety plan if parents agreeable, parents not agreeable. Physical acting out example pounding on window, reported destroying things at home.

CH-F16-2451

Update- 1/11/24- The patient has been accepted to MNCCS respite home with a planned admission date of 1/17/24!!!!! Thank you to this facility!!

The patient presented to the ER for the second time on 8/22 via law enforcement for aggressive behavior after she assaulted a staff member at the group home and attempted to bite, throw things, and hit staff upon arrival to the ER resulting in restraints and IM Zyprexa. She had been in the ER earlier in the day after intentionally swallowing a rock in an attempt to get out of her group home and was subsequently discharged back to her group home following psychiatric assessment. Of note, she presented to the ER 3 additional times over the week prior to admission for similar presentations and is well known to the ER due to multiple presentations of pseudoseizures, aggression, and suicide ideation.

She was admitted to the unit after her group home provided a suspension of services notice with the requirement of medication adjustment to be completed in order to return to the group home. Medication adjustments were made, and she has been psychiatrically and physically stable since at least October though she is not able to return to her group home until additional staff are hired and trained.

PH-F15-2511

Update 1/24- County funding for RTC denied on 12/26, now following alternate recommendations as determined by the county. DC was scheduled for 1/4, due to parent request, rescheduled for 1/5.

DISCHARGE PLANS:
Hospital Recommendation is RTC-
Avanti -referral made, accepted, intake 12/28/23
North Homes- referral made, reviewing, no immediate openings
Gerard- referral made, accepted, intake 1/9/24

Alternate Plan:
Mobile Crisis Team (Referral sent by CMHCM)
Day Treatment- Christian Family Solutions (Referral sent by CMHCM, waitlist to about 1/19/24)
Intensive family therapy (Referral to be sent by CMHCM)
PCP- Marlene Jilek, APRN (Mankato Clinic)
Therapy- Claire Alexander, MS, LPCC at PrairieCare Mankato (Availability as soon as next week, requests patient guardian call to schedule appointments)
CMHCM- Nicole Wigern (Blue Earth County)

Presenting Problems: Major Depressive Disorder, PTSD, SI/SIB, Inpatient for the third time this year, has done PHP twice this year

SMCTRF-M10-2621

Significant behavioral issues, Parent takes him on a lease 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.

SMCF-F16-2210

Patients a 16yr female with a history of albinism, anxiety and depression, ADHD, unspecified intellectual disability and borderline personality disorder presenting to the ED with complaints of suicidal ideation with plan. Was discharged from PSJ on 11/08/23. Started PHP at PSJ on 10/9/23, became aggressive and had a episode with SI statements and brought to the ED. Extensive inpatient psychiatric hospitalizations over the past year with >4 at Prairie St Johns, and 4 months at Prairie Care Medical Center from 4/18/23 -8/25/23.