UPDATE: Pt discharged home with improvement of some symptoms and wraparound services. CABHH and PRTF referral stand.
16 yo adopted white gender fluid/nonbinary adolescent with Albinism of Otter Tail County. No hx of attachment concerns. Delay with speech. Some historical cognitive and attentional concerns. No substance use. Expressing SI, SIB urges and lability. Hospitalized twice in early 2023 until admission to PrairieCare RTC on 4/11/23, needing a higher level of care, admitting to Inpatient 4/18/23. Patient has severe lip biting when dysregulating causing multiple lip lacerations, requiring suturing.
DISCHARGE PLANNING EFFORTS:
Primary Recommendation is CABHH; Referral made, on waitlist.
Residential Treatment or PRTF consideration:
-Avanti; referral made, declined due to aggression and seclusion history
-Northwoods; referral made, on call back list, 9 month waitlist
-North Homes; referral made, accepted, waitlist out to mid-summer/fall 2023> still would need QRTP funding*
-Gerard; referral made, reviewing, declined due to staffing needs in educational settings
-CRTC; referral made, declined
-Heartland Girls Ranch, county SW to refer
-Village Ranch, county SW to refer
PRTF:
-Grafton, referral made, denied, can reach out in a couple months for re-review due to their staffing
-NorthWoods, waitlist 12 months
-Leo A Hoffman; referral not made, only accepting Male patients
Out-of-state RTC:
Guardian declines referrals for out-of-state placement at this time
*QRTP funding is not in place- Parent does not consent to Relative Search which Otter Tail County uses in the QRTP pre placement screening process.
UPDATE 8/31/23: Discharge to family with wraparound services planned for 8/31/23 at 1300 while waiting next Gerard admission (tentative late September) as QRTP pre placement screening has now approved.
UPDATE 8/24/23: Pt remains accepted to Gerard, next admission now late September. QRTP pre placement screening team approved 60 days RTC as of 8/24/23. We will discharge home with wraparound services while waiting RTC admission.
UPDATE 8/8/23: Pt is accepted to Gerard and can admit tentative 8/21- pending preplacement screening/QRTP approval from Hennepin County.
10- year-old female with a history of anxiety, depression, social difficulties, anger and trauma. Aggressive behaviors and increase in suicidal ideations. Has participated in PHP, individual therapy, and psychiatry. Insured by BCBS PMAP.
DISCHARGE PLANNING EFFORTS:
Primary Recommendation: Residential Treatment.
Patient recommended to return to home/community with wraparound services while waiting for Residential. Discharges have been attempted, patient threatened grandmother. (Patient cannot return to mother or to grandmothers- CPS involved)
Wraparound:
Establish CMHCM (Referral to be made internally from CPS case worker)
Establish CTSS (Referral completed to Summer Counseling, reviewing; Referral completed to MN CarePartner, on waitlist, 2-3 months)
Establish FT (Referral completed to Family Attachment Center and Empower)
Continue Individual Therapy with Rachel at ELEOS Psychology Center
Continue Psychiatry with Catherine McCormick-Deaton, DO at Allina Health-St. Paul
Continue PCP at Allina Health-Maple Grove
Residential, when available due to waitlists*:
Consider Nexus-Gerard RTC (Declined due to aggression, being re-reviewed currently)
Consider Northwood Children’s RTC (Referral sent, waitlist 6-9 months)
*Juvenile Treatment Screening with Hennepin County needed to request funding for QRTP/RTC level of care. CPS worker aware of request.
Estimated length of stay:
Patient is medically ready for discharge as of 6/30/23
UPDATE: as of 8/24/23 she has been accepted to a residential facility in Georgia, and the family is waiting for some pieces from their insurance company. Transportation is ready to go once insurance is approved – hopefully end of this week or early next.
Pt is presented to the ED via EMS for the following concerns: verbal agitation, physical aggression, significant behavioral change, and anxiety. Pt has been in a residential treatment center for approximately 5 weeks, and had been in a “crisis state” all day, on day of admission. Pt was requiring frequent restraints, supervision and redirection for up to 8 hours. She was non-compliant with treatment activities, frequently trying to run away from program activities, and into the street. Pt kept searching for sharp objects to self-harm, and assaulted staff when they tried to take objects from her.
These are chronic behaviors for pt. Pt is currently in a 3rd residential treatment program (secure), with a hx of one prior group home placement. Pt has a hx of several mental health hospitalizations, with most recent in October 2022. Patient has a hx of refusing medications.
Residential facility stating that pt has been discharged, however there is no discharge paperwork available. From North Dakota. No case mgr or services in place. Her parents were able to get her into the residential treatment center she was at. Able to DC but nowhere to go at this point.
UPDATE: Mom wouldn’t sign ROI for CRTC to she still awaits placement.
Patient is a 15 year-old with a history of PTSD, MDD, and GAD. She has a history of five previous psychiatric hospitalizations and one premature discharge from residential treatment this past spring after restricting her food and water intake (start of present hospitalization). Nutritional intake has continued to decline to the point of needing tube feeds to meet daily nutritional requirements, with symptoms more closely resembling anorexia nervosa at this time.
Patient is already connected with medication management, county case management, CPS, and psychotherapy.
Pt is presented to the ED via EMS after increased verbal and physical threats towards his family. Patient attempted to burn a locked door down with his mom and sister behind it. Patient’s mother called the police, and patient threatened to jump off of the balcony. Patient has a diagnosis of ASD and ADHD.
Patient was hospitalized and in outpatient program about 4 years ago. Per patient’s mother, the patient had been receiving wrap around treatment until he was discharged 4 months ago, when the patient brought a knife to therapy and threatened his therapist with said knife. The patient has been declined for all services by Prairie Care. Patient was assessed by Fairview recently and planned to start day treatment, but he refused to get in the car to go to therapy.
Patient has shown increasing aggression since about October 2022 when he decided he no longer wanted to have a relationship with his father.
*UPDATE: Admission to Gerard 7/28/23- just pending county funding at this time, 2nd screening today, 7/20
16 YO Female in 10th grade. Two previous psychiatric hospitalizations (2/23/22-3/4/22 and 9/17/23-9/27/23) in addition to the current admission. Has attended Day treatment. No alcohol or Drug use. Increasing SI and history of self harm. Hx of sexual abuse at age 9.
DISCHARGE EFFORTS:
-RTC: Avanti Center for Girls (Referral sent, pt accepted, 6 month wait list)
-RTC: Gerard Academy (Referral sent, pt accepted, admission, 7/28/23, pending county funding)
-RTC: North Homes (Referral Sent, pt approved, opening estimated for August-September)
-RTC: Northwood Children’s Services (Referral Sent)
Interim Plan:
-Day Treatment: TSA (pt able to return if/when it is safe to DC)
-CMHCM: Janet, Isanti County
-DBT: (SW to provide resources upon DC for guardian to use after RTC)
State of MN is trying to find a way to build his own home, timing TBD.
Aggressive, DD, low IQ – 40-50, FAS, ward of state, targeted case mgr. Was provisionally discharged from CABHH, not allowed to return. Perhaps a plan is a state run group home, in development?
Patient is presented to the ED by EMS for aggressive behavior towards staff and another resident in his group home. At the group home staff brought the patient out to his school transportation but the patient became dysregulated when he saw the driver was different from prior trips. Patient then eloped to a neighbor’s house where he entered. Staff followed and called the police. Patient was brought back to the group home, but later got into a physical fight with another resident and staff member. Police were called a second time, and patient was transported to the hospital using restraints. The patient has a history of ED visits and has had approximately 6 previous hospital admissions (5/21; 7/21; 10/21; 11/21; 12/21; 9/22). The patient has a diagnosis history of DMDD, ODD, ADHD, GAD, depression, and RAD
Pt presents to the ED via EMS for the following concerns: aggression. Pt was refusing to take her medication, and became aggressive with her parents when they tried to make her. Parents called 911 due to pt becoming aggressive with them, and punching holes in the walls. Medical records indicate mental health diagnosis of Unspecified disruptive impulse control and conduct disorder, major depressive d/o, unspecified anxiety and binge eating d/o. Pt has a rule out diagnosis of autism spectrum d/ and other neurodevelopmental disorder. Pt has a hx of mental health admissions as follow: 3/12 – 3/17/2023. Pt had frequent visits to the ED due to behavioral and emotional dysregulation at home as follow 3/20 – 3/21/2023, 3/22-3/31/2023, 04/02 – 04/03, 04/07-04/11/2023, 04/18/23, and 4/19- 04/20/2023.
Patient is under the guardianship of Swift County, and presented to the ED from his group home in Hennepin County. Patient got upset after being denied an outing, and went out to the road (not a busy road) and threatened suicide by getting hit by a car. Police were called, and patient was taken back to his group home where he made homicidal threats towards a neighbor. Group home staff then requested patient be seen by the emergency department. Patient has had multiple psychiatric hospitalizations. Patient reports frequent suicide attempts with methods unlikely to harm him, such as tying shoestrings around neck. Patient has a history of self-harm.
