Patient was brought to the Emergency Dept. after having a violent outburst at a residential facility in Fargo, ND. Concern for physical aggression and property damage. Patient reportedly was involved in a verbal altercation with another resident who was calling him by the wrong pronouns. He has now been discharged from the residential facility with no alternative residential facilities available. Otter Tail County (MN) is the guardian. Guardian has exhausted all options. He has been calm and cooperative in the ED with no outbursts. He is medically cleared and he is not meeting criteria for inpatient psychiatric hospitalization.
Recommended Service: Mental Health Residential Treatment
Mental Health Residential Treatment offers specialized care for individuals with severe mental health issues in a residential setting, focusing on mental health treatment and support.
MCR-F12-255
12 year old with trauma history, in-utero cocaine exposure, long history of behavioral outbursts with adoptive parents, participating in CIBS since November and moved to Phase 2 at Gerard in early January, but struggled and was sent to the ED within 48 hours due to severe outburst at Gerard. Appears to have mild autism spectrum disorder (difficulty with transitions, sensory sensitivity, communication struggles), and likely PTSD related to attempted kidnapping and multiple sexual assaults spring 2022. Has started Vyvanse, Prazosin, and Fluoxetine while boarding, and she has had much less extreme behavioral outbursts, has not needed IM or restraint in weeks. Oppositional, but generally can be verbally redirected. Outbursts tend to be tied to her difficulty with flexibility – eg when meals or medications arrive at slightly different times, or one nurse implements different TV rules than another – will start swearing, sometimes escalating to head-banging, but generally is able to calm on her own when given space (intervening/talking/etc once she is starting to dysregulate tends to escalate rather than de-escalate her). Has loving parents and want her in their home, but fear they cannot keep her safe right now. Regarding running – hasn’t tried to elope from peds floor. Sometimes ran from school or home when upset, walks around neighborhood and comes back. Issues at school have been more blowing up and headbanging. Update as of 4/11 still in ED
M8SAS-M16-1130
Recently at inpatient psych X 10 days. D/c to respite care. Recently transitioned home from respite and aggression within 48 hours of d/c from respite. Needs residential. Interview with North Homes on Monday.
MHF-F8-348
Pt has been residing in foster homes since she was a few days old. Pt has lived in approximately 9 residences, some were with biological family members. She has been in her current foster home since October 2022. Pt is under guardianship through Hennepin County ICWA program with a Hennepin County Case Manager. According to her guardian, pt has been subjected to significant trauma from her previous placements, including physical/emotional/sexual abuse and neglect. Pt’s biological parents’ parental rights were terminated before pt was 1 year old. Pt is now enrolled in school through the MPLS public school, attending while boarding in the ED. She has frequent, chronic aggression in the community. Generally no concerns in the hospital.
MHF-F12-635
Patient presented to the ED from CRTC due to increased aggressive behaviors in the facility towards staff and was unable to return to the facility. Patient not safe to return home due to behaviors and case manager is pursuing residential treatment.
C8SM8SP-F14-885
Patient has previous mental health history and does not want to return home to live with her parents. Patient makes efforts to elope from their care and will escalate her behaviors to ensure she does not return home. Patient has grabbed the steering wheel from mom in an effort elope from the car.
C8SM8M-M8-308
Presents with dysregulation, agitation, aggression, threats of SI/SIB. extensive mental health history. Sexual abuse at early age. In and out of residential treatment. He doesn’t meet inpatient requirement. Mom unable to meet his needs at this time. Mom working with county to find residential placement.
MHF-F16-357
AH-F13-470
Diagnosed with Disinhibited Social Engagement Disorder. Has been inpatient and in PHP continuously since October 2022. Was in residential treatment at Prairie Care in December 2022 but discharged early due to ingesting non-food items. She has not engaged in this behavior for several months. Current struggles include suicidal ideation and self-harm. Struggles with peer relationships. Presents as intrusive and has poor boundaries.
PH-M8-352
Admission: 2/24/23
Presenting concern: PTSD, Depression, Anxiety
Ongoing case conferences weekly with Itasca have occurred. Itasca County holds guardianship.
Discharge Plan:> UPDATE 4/20/23:ADMISSION IS 4/24/23> ADMITTED SUCCESSFULLY TO NORTHWOOD on 4/24/23
Patient is medically ready for discharge; will discharge as soon as RTC/living arrangement is identified.
Interim plan:
-PHP while awaiting RTC (foster parents share they are not able to have patient back into their home at this time)
-Itasca County has submitted referral for SMRT; once approved, this will provide access to disability status/waivers and additional placement options
-MNCHOICE assessment (Referral made to Hennepin County on 04/04/2023)
-Continue CMHCM at CMHS/REACH
RTC:
-Northwest Passage (2-3 month waitlist for patient’s age group; guardian declined referral due to waitlist and out of state)
-Gerard Academy (Referral made, Declined for admission on 3/24)
-Northwoods 35-day assessment (Screening meeting completed on 4/12/23, pending acceptance/admission)
-Clinical submitted on 4/5 to treatment placement specialist at Acadia Healthcare for consideration of out-of-state referral options
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