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.
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.
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.
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
12.21.23 This week the case worker came and discharged the child. Created safely plan, and child went home with gramma.
12/13/2023-History of Present Illness: This is a 10-year-old female patient was assessed by the crisis team crisis team recommended the patient go to a higher level care. Patient brought to ED for placement. The patient currently lives with grandmother but is Custody Of Indian child welfare. The patient has a history of PTSD, ADHD, anxiety, The patient has been hospitalized previously at primary care in Brooklyn Center Minnesota for 9 days, on October 23, 2023. The patient has a history of a mental health team including a home counselor at school counselor and outpatient services. Patient was transported here by law enforcement services. On examination the patient denies any pain Or complaints. There are 2 workers from Indian child welfare present with the patient here.Patient evidence of UTI Macrobid 100 mg orally was given Patient will need prescription Patient is transferred or discharge.
Impression: #1 Behavioral issue #2 UTI
Writer met with pt, sleeping and did not wake, and pt’s social worker Vanessa 218-850-9918 to discuss prior services. Pt has several services in place to assist with managing her behaviors. She has a therapist she sees regularly, medication management, is on an IEP, is able to take breaks at school, has in home services, engages in skills work, and does family therapy. Pt is in foster care with her grandma and has been since a young age. Pt does see her mom and gets violent with the siblings. Pt is violent both at school and will destroy property. Pt has aggression towards grandmother and will hit her, law enforcement has been called, however, grandmother does not file charges. Pt was in Prairie Care in October for roughly 9 days with no issues. At this time ICW social worker and grandmother feel inpatient treatment is the next option. Residential treatment was discussed briefly, however, without any legal charges or any recommendations, as well as pt’s young age as a barrier, residential placement is not an option at this time.
Staff will continue to look for inpatient treatment at this time.
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.
Patient presented to the ED from Prairie Care residential due to aggressive behaviors. Patient is at baseline and not recommended for IP MH admission. Prairie Care will not accept back, CPS has custody and reports patient needs RTC. County working on referrals, has been declined from most shelters and RTC in MN.
Patient is presenting to the ED for the following concerns: suicidal ideation, depression. Patient reports he tried to kill himself last night by stabbing himself with a dull pencil. Patient reports suicidal and homicidal thoughts that have increased in last two weeks. He has been at North Homes for three months. He was discharged to North Homes after a hospital stay at UMMC in September for SI. At North Homes, the patient escalated and told staff he was suicidal. He took the batteries out of a remote and tried to swallow them. He also tried to stab self with dull pencil. He became combative and needed to be restrained and then kicked staff in chest and tried to kick another staff. Patient then stated he would find each clients personal info and then take pictures of other clients after he killed them and send to parents. Patient told staff he would kill other clients and himself.
Patient reports long history of MH including PTSD, MDD and GAD. Patient has been hospitalized 2 x in past 6 months. Patient reports history of trauma. Patient states he has history of SIB.
Discharge Plan:
-Gerard (PT denied d/t documented IQ, requested reconsideration as new testing shows IQ as 78, pending)
-Northwoods (Waitlist is 1+ years long)
-North Homes (Pt denied d/t age)
-Acadia Out of State RTC network (Referral sent, pending)
-CABHH (Referral sent, pending)
10 yr old female admitting from Windom Area Health emergency department for suicidal ideation and homicidal ideation. Pt eloped from school and attempted to run into traffic and was brought to the ED via the police. Nobles County is Legal Guardian.
Existing services:
-Psychiatry through Southwest Mental Health Center
-New therapist starting in December through Healing Path in Levurne
-Previous therapist through Greater MN Family Services
-Neuropsych done with Surdy Psychological Mankato
-Nobles County guardian and CMHCM
-Nobles County guardian and CPS
Patient was adopted 2 years prior from Bulgaria. Initially, patient had very odd behaviors. For example, he would like his adoptive dad to be present in the bathroom when he went to the bathroom and showered. Parents state his behaviors have escalated. He has tried to masturbate the dog. He draws pictures of men with erections. He has exposed his genitals to his siblings. Purposefully incontinent of stool at tines. He has killed a Chinchilla and possibly several cats. He has tried to strangle the dog. They found sharp objects including a razor and sharp screwdriver under the bed. He did cut the top of his left hand but states this was an accident. Adoptive mom states they have a special needs child and patient has tried to harm this child. Parents are worried about safety within the home and are unable to bring him home at this time.
