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.
Patient was dropped off at a different ER by the parents of her 4th foster home placement where she was placed 3 days prior as the foster parents didn’t feel they could provide care for the patient due to hyperactivity, impulsivity, aggression, elopement, and sexualized behaviors. Her social workers picked her up from the outside ER and while in route to human services center to board until a new foster home was located, the patient was attempting to remove her seatbelt and she was brought to this ER where initially inpatient psychiatric hospitalization was recommended due to a lack of safety awareness, elopement, sexual behaviors, and need for medication assessment. She was trialed on guanfacine, developed hypotension and this was discontinued, and she was started on Concerta where her elopement attempts, impulsivity, and hyperactivity improved. She remains boarding in the ER while the county pursues foster home placement.
Patient presents from PHP where he was discharged due to ongoing aggression and attempts to urinate on staff and floor. Patient currently struggling with family dynamics, limit setting, gender identity, disrobing, property destruction, and aggression.
Ward of the state-currently under Wright County Guardianship. Parental rights have been terminated. History of aggressive behavior with homicidal and suicidal comments towards multiple people/on multiple occasions. On 11/15/23, patient was sent to a “calming room” at his school due to throwing a ball at another students face. This caused him to miss out on an outdoor activity that he wanted to attend. Patient was upset and punched one of his teachers (mental health support services personnel) in the nose, causing a broken nose. Had been living with bio-grandparents prior to this incident. He has been removed from foster homes in the past due to homicidal threats to the foster parents/others in the home.
