15 year old male with a history of ASD, ADHD, trauma, and multiple prior psychiatric hospitalizations and residential placements. He was admitted to the hospital after becoming aggressive and self-injurious while at crisis stabilization home. Patient has a history of making significant threats of violence and has been repeatedly sexually inappropriate. He was removed from his home after having molested a younger cousin. Patient will, at times, express remorse for his behaviors while at other times appearing grandiose and narcissistic, with violence perpetrated in response to narcissistic injury.
Race/Ethnicity: White
MHF-M11-1283
Pt is presented to the ED via EMS by his adoptive mother/aunt for aggressive behavior. Pt got angry after his family arrived home, after a parade, without any candy for him. Pt began to punch holes in the wall, beat his adoptive mother with shoes, throw things at family members, and threaten to kill them. Pt currently lives with his aunt and uncle who are also his adoptive parents. There are five other children in the home. Pt’s birth mother’s parental rights were terminated in 2020 due to child neglect. Pt carries current diagnoses of ADHD, other specified trauma and stressor related disorder, and other specified neurodevelopmental disorder. There is a strong suspicion of fetal alcohol spectrum disorder, although a diagnosis has not been given due to inability to confirm maternal alcohol use during pregnancy. There is genetic loading for mood disorders and substance use. Pt was most recently in a residential treatment facility for six months, and discharged home about a week ago. Pt has a history of inpatient hospitalizations for his aggression with his last hospitalization taking place from 10/26-11/09/2022.
PH-F13-458
Pt has had 4 psychiatric hospitalizations, PHP twice, and outpatient services. Needing RTC and bridging plan. >Discharge from PC Inpatient is 5/11 at 1400, will discharge home until RTC.
Discharge Plan:
RTC-
Avanti (Referral made, declined for admission due to history of aggression)
North Homes (Referral made, 6-8 week waitlist)
Village Ranch (Referral made, pending acceptance)
Gerard (referral made; pending acceptance)
Northwood (referral not made; waitlist over 6 months)
Newport Academy (referral not made; insurance not accepted)
Grafton (CMHCM making referral; though likely doesn’t meet criteria due to no ASD/ID/DD diagnosis)
CRTC (referral placed)
Interim Plan:
Consider PCR (referral not made; insurance not accepted though possibility for a county contract- connecting county worker and PCR)
Continue Psychiatry at Nystrom and Associates
Continue Probation services at Goodhue County
Continue CMHCM at Fernbrook
Establish Family therapy at Nystrom and Associates.
Establish CADI worker at Goodhue County
update as of 6.22.23 – Denied acceptance at CRTC due to aggression and lack of buy in
MHF-M15-1275
Pt is presented to the ED via EMS for erratic behavior. Pt has twice presented to the ED recently after altercations at his group home and his crisis respite program. Pt has been discharged from both of these programs due to aggressive behavior. Pt was returned home after being discharged recently and collateral reports that pt’s behaviors have increased. This ED visit was due to pt beginning to escalate, and was about to throw rocks at his friend’s windows. Pt’s mother’s boyfriend ran out and stopped him from doing so and told him “no” which is a trigger for pt. Pt then began to start banging on doors after he was stopped from throwing rocks. Pt has an injured elbow which was in jeopardy of being re-injured. Pt wouldn’t stop so mom called the police, and they brought EMS who brought him to the hospital. Pt has a diagnosis of Autism Spectrum D/O needing substantial support, Level 3, Unspecified type and suspected intellectual disability. Pt has a hx of agitation, aggressive behaviors with frequent visits to the ED. Pt’s mother and staff deny any suicidal ideation and attempts. Pt currently has a PCP, psychiatrist, case manager, and social worker. Pt has very limited verbal skills, and responds to questions with one- or two-word answers, and a thumbs up/thumbs down.
MCR-F16-279
History of PTSD, RAD, ODD, mood issues, adopted at age 6, multiple foster placements prior. Struggling for many years, 4 suicide attempts fall 2021, placed in a shelter in St Paul and targeted by a sex trafficker and eloped for 2 weeks, repeatedly assaulted, given drugs. Admitted to SEY program at Heartland Girls Ranch March 2022, unsuccessfully discharged October 2022 after assaulting a peer. Receiving school-based CD services through ALC, but no mental health services. Case manager working on residential but no success. Admitted to hospital 1/23/23 after massive OD triggered by breakup. Medically cleared 1/27, declined by all inpatient psych because of assault history. Suicidality has resolved, no behavioral issues. She eloped from the peds floor on 3/16/23 and had to be brought back to the ED by law enforcement. Hospitalization not recommended; county looking at outside placement options.
MHF-M16-1239
Pt is presented to the ED via EMS due to possible ingestion of cold medications. Pt’s father had called 911, reporting patient’s presentation as being confused and “high” on drugs. Pt admitted to taking pills (unclear about the number of pills) in order to get high. He denies that this was a suicide attempt, and currently denies any suicidal ideation. Pt denies recent self-harm, but has a hx of self-harm over one year ago. Pt lives with his father during the week, and mother on the weekends. Medical records indicate the following history: He has a history of major depressive disorder, generalized anxiety disorder, and substance use disorder. He had been evaluated in the ED for close monitoring in the setting of altered mental status secondary to presumed toxic ingestion of unknown substances, and has a history of multiple inpatient psychiatric admissions. Most recently admitted in March 2023 due to “ingestion/inhalation of multiple substances, including dextromethorphan and benadryl”. Pt has a history of residential treatment, and has a hx of substance abuse for several years and participating in both inpatient and outpatient treatment.
MHF-M16-350
Patient presented from group home with aggression, breaking things. He has chronic aggressive behaviors. He was admitted to Hawthorn Center state hospital in 6/21-7/22. During his admission, patient’s mom passed away and he was placed in Beacon Crisis Residence. Patient had a prolonged stay in UMMC ED September 2022-October 2022 and was discharged to RTC in TN. Patient was discharged from the facility in TN due to concerns with the facility and was returned MN. He was brought from the airport to Children’s Hospital on 1/11/23-1/13/23 and was discharged and immediately brought to UMMC ED by parent and county worker. He was in UMMC ED 1/13/23-2/7/23 and was started on Zyprexa ODT due to cheeking medications. He was eventually discharged to crisis home. Patient then returned for further concerns of medication non adherance and exacerbation of psychotic symptoms. He had inpatient admission on Inpatient mental health at UMMC from 2/15/23-3/12/23. Patient was discharged to respite house with additional wrap around services. Patient has had 4 ED encounters since that time. Patient discharged to his group home on 5/1/23 and returned to ED on 5/2/23 due to aggressive behaviors. Patient is unable to return to group home.
MHF-M9-1185
Pt is presented to the ED via EMS due to aggressive behavior in his foster mother’s home. Pt became escalated when his foster mother asked him to take a bath, and began throwing chairs and kicking his mother. Pt has an intellectual disability and lacks insight into behaviors and mental health concerns. Pt has hx of autism and ADHD combined type, and hx of agitation/aggression.
MHF-F18-995
Patient is presented to the ED by EMS from an RTC facility. Patient assaulted another resident and staff members, and attempted to elope from the facility. Patient is under guardianship of Martin County, and is considered a vulnerable adult. Patient has a significant history of abuse, and suicidal ideation. Patient is supposed to follow a low sugar and fat diet due to pancreatitis.
SHSI-M15-922
Suicidal- Increased depression