The patient presented after expressing homicidal thoughts (threats of aggression) toward her grandmother with whom she lives. Patient was on her way home from school when she pulled her school lvan driver’s arm to the back of the van as she did not want to return home. Patient was then returned to her school where her grandmother picked her up and eventually brought her to the Emergency Department. Since her presentation to the Emergency Department, the patient has not displayed any aggressive behavior. Patient has irritability and emotional outbursts with grandparent(s) and has displayed these behaviors at school as well. Has mostly been pleasant and cooperative in the Emergency Department. Has some attention seeking behaviors when the Emergency Department is busy.


Suspended (5/17) for bringing a knife to school. Went to school on 5/20 with uncle to search locker (items were missing from home-guns, knives, etc.). Pt became agitated and began banging his head on the wall. He also punched his uncle.


Update 5/23/24: Needs psycho-sexual eval, but there is no place to send him to have it done as it can’t be done in the hospital.
Pt was brought into ED on 5/11 by mother due to allegations of abuse. Mother resides in DV shelter and shelter is not allowing pt to return there due to pt behaviors (bangs his head, kicks walls, makes threats, aggression toward mother.) Mother is trying to find new housing so that pt can return to her. County referrals made to Northwoods, North Homes, Village Ranch and Mille Lacs Academy- programs thus far are months out. Barrier to many programs is pt age. County JST is meeting today at 10:30am to discuss further options. Planning to refer for Nexus YCT once discussed with all team members and ROI is received.


Bio mom is deceased, bio dad ‘s rights terminated and was recently released from prison. Was placed with grandparents who are in process of terminating rights and want no visitation, mostly due to gender identity preferences. Hennepin county placed kiddo at Bar None shelter, and she was kicked out due to behavior incident involving threats toward peers. Much of this may be related to identity issues. Bar None will not take her back. On MCCP crisis bed list. Shelters have declined. Have tried foster care, but no success. 1 relative in another state that may be willing to take her, but that is a 6-month process with out of state process.
Hennepin CPS assigned worker is Michael Branscum # 612-558-2682.


Update: O5/16, Central Pre-Admission denied the patient’s placement in CABHH, appealing this decision. Comprehensive Home Care (Respite Provider) accepted him moving date TBD.
Update: 5/15 referred to CABHH he previously denied on 3/29 along with residential and respite placement.
16 y/o M with hx of intellectual disability, poor distress tolerance, and maladaptive patterns to get needs met. Presents with chronic behavioral pattern of acting out to get needs met. Pervasive behavioral patterns in the community result in unsafe behaviors, high utilization of ERS, loss of placements, and exacerbating attachment struggles. He was d/c from respite placement through Twin Cities Home Care on 5/14 due to aggression and impulsive behaviors.


5/20/24: Patient discharged from inpatient and admitted to PCR.

5/8 update: Patient scheduled for admission to PrairieCare Residential on 5/20/24 at 10:00am.
5/6 update: Patient is currently awaiting an RTC bed through PrairieCare Residential in Maple Grove. Patient has been approved for 3rd pathway funding through Hennepin County. Due to patient behaviors seeming to increase, other options are being explored for aftercare as denials are a possibility. Parents do not feel safe with the patient coming home.

Discharge Plan:
Residential Treatment:
-PrairieCare Residential; intake 5/20/24 at 1000

Other RTC Referrals:
-Nexus Gerard; referral made
-North Homes; referral made, declined due to FAS and IQ
-Avanti Center for Girls; referral made, declined due to aggression and peer conflict

Outpatient Providers:
Establish CMHCM; opened with Soreya Jama through Hennepin County, 3rd pathway funding approved

Establish/Continue CTSS with Samira through Nexus FACTS
Continue Therapy with Mary Midler at Great Lakes Neurobehavioral Center in Edina (weekly)
Continue PCP with Dr. Megan Reilly at Partners in Pediatrics in Plymouth
Continue Psychiatry with Gerard Balan at Plymouth Psych Group
Continue IEP Case Management with Yvette Zeese at Wayzata High School
Continue Neurological Services with Dr. Catalfamo at Noral Neurological Clinic in Bloomington

ADMISSION NOTE: Patient was admitted due to acute safety concern and was unable to contract for safety at home. Pt was in PHP in the past and family was monitoring her 24/7 at home as instructed. Pt became irritated that she is constantly being watched and ended up having altercation with her mother because she was instructed by her mother to change outside of her bedroom because the mother was unable to see her. Pt ended up leaving and went to her grandmother’s house which is next door while mom followed her, pt went straight to the kitchen grabbed a knife and start threatening to stab herself. Mother was able to wrestle the knife out of her hands and called EMS. Pt has a history of depression, anxiety, epilepsy, and fetal alcohol syndrome.


Update 5/23/24: Patient accepted to Heartland Girls Ranch with scheduled admission Wednesday 5/29 – county funding was approved.

Patient presents to inpatient from the ED due to an increase in SI. This is her third psychiatric inpatient hospitalization. She has done PHP twice and engaged in outpatient mental health services.

Discharge Plans –
RTC: (JST funding meeting on 5/17)
-Avanti Center for Girls (referral under review)
-Nexus Gerard (referral under secondary review)
-North Homes (pt is on waitlist – 4-6 weeks out)
-Village Ranch- Annandale (pt is on waitlist – end of June)
-Heartland Girls Ranch (referral under review)

Continue with established outpatient providers:
– Therapist: Mayo Clinic Health Systems Austin
– Family Therapist: Albert Lea
– Medication Management: Mayo Clinic Austin
– Case Management: Freeborn County
– Occupational Therapist: Mayo Clinic Rochester


Update 5/23/24: Patient has been accepted to Avanti RTC with a scheduled admission for Tuesday 6/4.

Update 5/15/24: Patient was accepted to North Homes RTC, guardian declined. Patient accepted to Avanti RTC with tentative opening 6/10.

Patient is a 17-year-old individual who identifies as non-binary and uses they/them pronouns. They admitted to PrairieCare Inpatient Hosptial via ED due to an increase in suicidal ideation. This is their 3rd psychiatric inpatient hospitalization, they have done PHP, and engaged in outpatient mental health therapy and psychiatry. County funding has been approved for RTC on 4/25/24.

Discharge Plan:
RTC: (county funding approved on 4/25)
-Avanti (ACCEPTED, tentative opening 6/10)
-Gerard (Referral sent & received, awaiting secondary review)
-North Homes (accepted with immediate opening – county and guardian declined placement)

Continue with established outpatient providers:
-Individual therapy: South Central Human Relations-Owatonna
-CMHCM: MN Prairie County Alliance


Update 5/23/24: Patient has been assigned a CMHCM through Sherburne County, waiting to have JST scheduled for funding approval. Referred to PrairieCare Residential and pt was accepted – county unable to support funding as insurance is OON. Referrals sent to Avanti, Gerard, North Homes, and Grafton – all under review and waiting to hear about acceptance decisions.

Patient presented to inpatient from the ED due to an increase in SI and risky behaviors. Patient has had two previous psychiatric inpatient hospitalization, has attempted PHP, and engaged in outpatient mental health services. CMHCM has been referred to through the county, will need to obtain funding for RTC.

Discharge Plans –
Avanti (referral sent & received – under review)
Gerard (referral sent & received – under review, tentative openings August)
North Homes (referral resent & received – reviewed, virtual meeting with pt being scheduled)

Grafton (referral sent)
DHS PRTF eligibility (approved 5/13)

CMHCM: Sherburne County (Referral sent) (need to obtain county funding for RTC)

Interim to bridge RTC if/when pt stabilizes:
PHP: PrairieCare – MOB (Intake canceled due to delay in dc)

Continue with established outpatient providers:
-Individual Therapy: Nystrom & Associates
-Family Therapy: Nystrom & Associates
-Medication Management: Allina Health Clinic Cambridge


Patient admitted directly to CRTC on 6/8/23 directly from PrairieCare Inpatient.

Patient had been hospitalized in the Inpatient setting numerous times, she was at PrairieCare Residential 12/19/22-2/22/23 and stepped up to Inpatient for stabilization. PrairieCare Residential is unable to have her return due to their staffing and current milieu. Please note aggressive behaviors have significantly decreased and have not been present in the past month. UPDATE: Accepted to CRTC, waitlist 5-7 weeks- any available bridging shelters/group homes?

Discharge Plan:
Referred to-
-PrairieCare Residential (Re-admission declined on 4/11 due to milieu/staffing concerns)
-Grafton (Not currently accepting patients over age 14)
-Northwest Passage (Does not accept MN MA; Referral declined due to IQ)
-Avanti (Declined due to aggression 12/22; SW to re-refer)
-Gerard (Referral submitted 4/26)
-North Homes (Declined from RTC 11/22 due to IQ)
-CRTC (Referral submitted on 4/14; additional clinical sent 4/25, accepted for admission 5/9; estimated waitlist 5-7 weeks)
-Bar None, Shelter Plus Program (Preliminary Hub referral made, awaiting return message; SW to re-refer for interim placement while awaiting admission to CRTC)
-Refer to Treatment Placement Specialist at Acadia Healthcare for consideration of out-of-state RTC’s
-Consider referral to CIBS program at Avanti (Anoka County unable to fund – no contract)
-Consider referral to CIBS program at Nexus-FACTS (Anoka County unable to fund – no contract)

Group Home:
-PrairieLakes Haven House Group Home (waitlist 2 months)
-Port Group Home (waitlist 2 months)

Therapeutic/Corporate Foster Care:
-Solutions Behavioral Healthcare (Awaiting return call)

Estimated length of stay:
To be determined pending formulation & confirmation of alternative discharge plan

Was initially accepted by CRTC but couldn’t take due to her Casii level of 5.