Pt came to ED after ongoing behavioral concerns at home with guardian/grandmother, physical and verbal aggression, and threats. Previously discharged from CADI GH for physical aggression, went to JDC for that but was released after a rule 20. Declined by North Homes, Northwoods, and CABHH. A CADI home in Duluth that may be an option.
Recommended Service: PRTF
PRTF facilities provide intensive psychiatric care in a residential setting for individuals, often children and adolescents, with severe mental health issues.
PH-F16-3669
Update 4/29/24: Patient discharged from Inpatient on 04/19/24 to wraparound outpatient mental health services while continuing to pursue RTC options.
Patient admitted to PrairieCare Inpatient Hospital 3/19/24 from the ED following increased thoughts of suicide with a plan. Pt has had previous IP stays at PrairieCare, Mayo Clinic, Riverside and Prairie St. John’s. Pt had a previous residential stay at Gerard. RTC has been pursued and funding has been approved through Dakota County although currently pt has been declined by viable in-state options. Level 6/PRTF programming is also being explored.
Referral is currently pending at Bar None Haven. Referral also made to Acadia to explore out of state options. Referral will be made to Nexus East Bethel PRTF as CMHCM is willing to help pt switch to straight MA if Nexus is able to accept. Patient is medically ready for discharge and is pursuing an interim plan of dcing home with wrap around services while awaiting placement.
RTC (CASII LEVEL 5) (funding approved, in QI process):
-Acadia (referral sent to explore out of state options)
-Avanti (declined)
-PCR (declined)
-North Homes (declined)
-Gerard (declined)
-Northwoods (waitlist 2+ years, so not a viable option)
-Newport (Insurance not accepted, so not a viable option)
-Nexus Mille Lacs (only accepts biologically male patients, so not a viable option)
PRTF/CASII LEVEL 6
-Bar None Haven (referral pending)
-Nexus East Bethel (referral to be sent, CMHCM able to help switch to straight MA if accepted)
-Grafton (requires ID dx)
-Leo Hoffman (only accepts biologically male patients)
-Northwoods (2+ year WL)
PH-F12-3422
Update 4/15/24: Patient discharged from inpatient on 4/15/24 to home with outpatient services while awaiting level 6 RTC/PRTF placement.
Update 4/3/24: Bar None Haven (Referral submitted, Denied 3.22.24), Northwood Children’s (Referral submitted, On waitlist), Grafton (Referral submitted), Nexus East Bethel (Referral submitted). County also working on referral for MITH program (MN Intensive Therapeutic Homes). MN Choice Assessment done.
12-year-old female with DMDD and RAD presenting to PrairieCare Inpatient Hospital. Patient has had multiple psychiatric hospitalizations, 2 RTC placements and 2 JDC placements.
Discharge Plan:
Locked Level 6 RTC – Bar None Haven (Referral submitted)
Current Providers:
CMCHM at Beltrami County
Individual Therapy
Medication Management
Wavier Case Management Services through Beltrami County (In process)
PH-M15-3418
Update 4/10/25: declined at Leo Hoffman, East Bethel, Bar None Haven, does not meet criteria for Grafton, Northwood wait list 2 years. Discharged from Mille Lacs RTC.
Update 4/3/24- declined Leo Hoffman, East Bethel, Waiting to hear back from Grafton, Bar None Haven. Discharged from Mille Lacs. Northwood waitlist 2 years.
Update 4/1/24: Nexus East Bethel PRTF declined pt due to not having a male unit at this time.
15-year-old female identifying patient with a history of depression, anxiety, RAD, PTSD, ADHD, and ODD. Patient has been in and out of treatment settings for 3+ years and has not been at home since. Patient was at an unknown treatment facility and was discharged due to its closing, Northwood Children’s Services PRTF (discharged due to not needing level 6 care) and most recently has been at Nexus Mille Lacs RTC since October 2022. Patient has a history of four inpatient hospitalizations. Patient has been discharged from Nexus Mille Lacs RTC as of 3/20/24 due to them recommending a higher level of care.
Current provider:
CMHCM: Kanabec County
PRTF: (MN DHS eligibility submitted by county and approved)
-Leo Hoffman (declined due to pt acuity)
-Northwood (added to wait list, about 2 years)
-Grafton (pt does not meet acceptance criteria)
-Nexus East Bethel (declined due to not having a male unit)
RTC:
-Nexus Mille Lacs (pt discharged from program as of 3/20 due to lack of engagement)
-Bar None Haven (declined due to aggression and behaviors)
MN DHS Complex Transitions Team (in process of scheduling care conference)
CH-M13-3592
The patient is a 13 Y year-old male with a history of autism spectrum disorder, disruptive mood dysregulation disorder, ADHD, and depression who presented to the ER on 4/5/24 via EMS from his residential facility for assessment of aggression and suicidal ideation. He has a long history of aggressive behaviors that per chart review worsened around October, 2023 and he has not been able to be safely maintained in his home since that time. He has had several extended hospitalizations and since he was admitted to residential on 2/5 has had 41 incident reports related to attempts to harm himself and aggression when staff attempt to intervene. He has had increasing dysregulation resulting in an increase in restraints, length of time in restraints, and the amount of staff it requires to calm him resulting in the inability to return to residential. Home is not an option at this time.
PH-F16-3524
Update 4/3/24- funding in place, waiting available RTC- accepted at Gerard and North Homes. Waiting to hear back from Avanti and East Bethel.
Case Description: Patient is a 16 y/o individual w/ hx MDD, GAD, ADHD, multiple previous hospitalizations, currently presenting due to SI. Patient went to foster care after discharge in previous hospitalization at PC ( october 2023) and returned to mothers home end of Dec after 1 month. Patient was hospitalized at Prairie St Johns for 1 week ( discharged 3/8) due to intrusive SI . Patient feels she was discharged earlier than she should have been because she was still struggling w/ “feeling safe”. Patient indicated that depression /anxiety and intrusive SI improved significantly in foster care. Patient indicated during the time in foster care, patient worked on her relationship w/ mother and feels it was “helpful. Patient transitioned to mothers home and feels that overall relationship has improved and does not know why depression/SI has escalated again.
Discharge Plan: RTC (county funding approved for RTC)
-Avanti (Referral done, waiting to hear back)
-Gerard (Referral done, Accepted)
-North Homes (Referral done, Accepted, currently on waitlist, openings anticipated in June)
PRTF:
-Nexus East Bethel (Referral in progress)
Existing outpatient providers:
-CMHCM at Sherburne County
-Individual therapy Main Street Family Services-Elk River (Appt scheduled 3/27)
-Family therapy at Main Street Family Services-Elk River
-Primary care at Stellis Health-Monticello
-Psychiatry s at Nystrom & Associates
-In-home skills
HCMCH-M16-3181
Per Emergency Protective Care Order, in need of out of home placement. Legal guardian through county, living with father in ND wasn’t successful.
Foster placement is not being recommended. Kinship placement has not been successful and is not a current option.
Patient has gone through Hennepin County QRTP screening – residential placement is recommended and is in alignment with psychology and psychiatry consult recommendations.
M8SAS-14-3322
Elopement from family home. HI towards mom, could be safely planned. Child has insight, and doesn’t want to harm mom. CPS notified, meeting with the family. Family ok with group home but county isn’t.
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.
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