This patient presented to Ridgeview Medical Center via P.D. after running from his home. He was found in the woods nearby his home with a knife (patient has an ankle monitoring device). Patient reportedly desires out-of-home placement and verbalized plans to use the knife to harm kids who bully him at school. Patient has a significant history of running away from home with more than 30 reported incidents. Patient maintains a desire not to return home at this time. Carver Co. holds temporary decision making authority over patient, by court order.
Race/Ethnicity: White
PCMC-M14-3346
Pt arrived to ER with law enforcement after Aggressive agitated episode with stated suicidal and homicidal thoughts in a young 14-year-old with serious past psychiatric history. Patient is currently in a moderately agitated state but no need for chemical restraints at this time. Patient did agree to laboratory evaluation per protocol suggest in light of the absence of concern of overdose that we will defer to behavioral health evaluation before doing a blood draw. Will attempt to get a urine for drug screen. Behavioral health consult placed unclear if he will cooperate with evaluation. Patient is on one-to-one observation.14 year old male with oppositional defiant disorder, sensory integration dysfunction and ADHD with hyperactive impulsive type presented to Hosptial after disturbing events at school this morning. We know some sort of electronic gadget was taken away from Ethan. He became agitated and apparently attempted to roam the halls looking for his father who is also a teacher at the school making threats against the stepfather. Statements of suicidal ideation were made. Father is reportedly in support of a behavioral health stay due to to the level of aggression that has not been witnessed for a while. During his period of upset he tore off a piece of trim from the school that had nails in it and was swinging it at staff.
PH-F16-2714
Updated 3/7/224: Admission scheduled for 3/12, discharge from hospital will occur same day
Updated 3/1/24: SW was informed the admission date was moved to March 12th. Scheduled admission to Nexus East bethel for March 12th
Updated 2/28/24: East Bethel Accepted- Admission scheduled for March 7th time TBD, pt remains on the inpatient unit.
Updated 2/15/24- East Bethel Accepted- Opening now first week of March, pt remains on the inpatient unit.
Updated 2/1/24: East Bethel Accepted- Opening mid February
Updated 1/25/24: East Bethel tentatively accepted- opening mid February
Updated 1/11/24: East Bethel will review, if accepted- admission in a few weeks.
Update 1/9/24: Patient has been declined to Grafton PRTF due to her behaviors not being appropriate for current milieu and identified as it would not be therapeutic.
Discharge Plans: PRTF is medically recommended by inpatient treatment team
PRTF: Nexus East Bethel (Referral sent & under review, will likely hear about acceptance decision in January 2024)
PRTF: Grafton (declined on 1/9 due to behaviors not appropriate fit for current milieu)
-(DHS eligibility form for PRTF sent and approved)
Referrals to RTC’s made previously by the county:
-LSS, Sioux Falls: Couldn’t meet pt’s needs, low cognitive function, and FAS diagnosis
-Gerard: Couldn’t meet pt’s needs and FAS diagnosis
-North Homes: CMHCM referred for 35 day evaluation, still working on an acceptance
-Avanti: Pt’s legal guardian did not consent due to distance away from home
-Boys Town, Nebraska: Declined due to FAS diagnosis
Continue with established outpatient providers:
-CMHCM: Des Moines Valley Health and Human Services
-Medication Management: Windom Hospital
-Individual Therapist: Greater MN
This is patient’s 5th psychiatric inpatient hospitalization. Patient’s current admission is due to increased suicidal ideation, behavioral dysregulation, and homicidal threats towards staff and peers at school. Patient has utilized outpatient mental health supports such as psychotherapy, medication management, children’s mental health case management, children’s therapeutic support services, vocational rehabilitation skills, as well as group home and respite care. Patient has engaged in partial hospitalization program twice.
MCMC-F8-1957
Patient is an 8 yr old that has a history of disruptive behaviors at school and at home. She has a history of PTSD ADHD reactive attachment disorder and is on quite a few meds for behavioral health. Apparently she did not sleep well last night and woke up this morning threatening to kill her family members and herself. She continued to escalate at home to the point where mom called psychiatry and they recommended that she come to the ED. She arrives in ED out of control hitting, biting, kicking, and screaming. Mom states that this type of behavior for her has happened frequently in the past but has not had an episode like this for a year or two. She apparently is doing quite well in school and has not had any recent issues. Mom states that when she has these outbursts or crisis that this is typical where she has just a sudden change in her behavior and becomes violent at home. She has not missed any of her medications. Mom denies fever, no recent cough no abdominal pain no nausea vomiting or other recent infections. Mom states that in the remote past she has had a UTI with high fever but typically infections have not caused behavior issues. Patient has an established psychiatrist and has had numerous hopitalizations regarding same issues. Started having visual hallucination yesterday, medication adjustment decreased (risperdal) decreased a couple of months ago with the thoughts that this may be contributing. Biological mother has history of bipolar disorder and grandmother and cousin has history affective schizoid disorder. For the past week her behaviors have been escalating and has been getting harder and harder to negotiate with child. She has threatened to kill her 3 yr old brother and mom concerned for safety of other children in the home.
MCR-M14-3272
Comes from shelter placement (Von Wald) due to aggression. Has probation with court on 3/14/24. Voluntarily placed with Rice County by family due to safety concerns. The CASII score is 6 with strong recommendation for wilderness residential programming, as he has been through a few ‘traditional’ residential programs, so he has some buy-in for wilderness type residential. Looking for shelter vs group home as waiting for residential programming. Parents hesitant to look at out-of-state programs.
PH-F10-2765
Update 2/22/224- Admission to Grafton tentatively scheduled 2/28/24, can discharge interim pending availability.
Update 2/15/24- waiting admission to Grafton end of Feb- date pending- can discharge home interim, pending availability.
Pt is medically cleared for discharge- parents informed county they need to pursue crisis respite for patient.
Discharge Plan:
Residential treatment referrals-
Grafton PRTF (Accepted, next opening tentative end of February)
Northwood Children’s (Referral not sent d/t insurance)
Nexus-East Bethel (Denied d/t not in 6th grade)
Nexus-Gerard (Denied d/t functioning for programming)
Avanti Center (Referral not sent d/t patient’s age)
VOA-Bar None (Referral not sent d/t patient’s age)
Heartland Girls’ Ranch (Referral not sent d/t patient’s age)
Nexus-Mille Lacs (Referral not sent d/t male only programming)
North Homes (Referral not sent d/t patient’s age)
Newport Academy (Referral not sent d/t patient’s age and insurance)
PrairieCare Residential (Referral not sent d/t insurance)
Village Ranch (Referral not sent d/t patient’s age)
Northwest Passage (Referral not sent d/t patient’s age)
Dakota Boys & Girls Ranch (Referral not sent d/t not ND resident)
Rogers Behavioral Health (Referral not sent d/t insurance)
Plan to bridge until residential availability:
Cradle of Love (Accepted, pending county funding)
Northwood Children’s Shelter (CM placing referral)
Kindred Care (CM placing referral)
MCCP Crisis Respite (CADI CM placing referral)
Trauma focused/attachment therapy (Referrals to be placed by CM)
Continue with established outpatient providers:
Ramsey County CADI- (Shakir Consulting Services)
Ramsey County CMHCM- B
PCP- (Entira Vadnais Heights)
OT- Fairview
CTSS- (Nystrom & Associates)
PCA/companion care 3x/week
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
MCR-M12-3200
Conduct disorder (childhood onset), Parent-child relationship problem, ADHD, Borderline intellectual functioning
Pt has outbursts and behaviors causing family in the home to feel unsafe, he has been utilizing a respite home but recently became dysregulated in this setting additionally and struggles with boundary and limit setting. Home environment appears to reflect chronic chaos.
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.