Risk Factor: Aggression (chronic/ongoing)

This term describes a pattern of repeated and persistent aggressive behaviors, such as chronic physical or verbal aggression.

MHF-F15-4901

Came to our ED on 11/25 after altercation at home with Aunt, who is current custodian. Aunt has refused to take her back home and is refusing any involvement in her care currently. CPS is getting involved. Has CMH worker as well. Nexus YCT has been involved ongoing and is trying to work on referrals for residential, but needs ROIs first. Has interview with residential provider who previously accepted today 12/3.

GC8S-M10-4890

Patient was at school when he began having hallucinations, pulled his hood over his face, then ran into a concrete wall. He was admitted to Gillette for medical management of his bleed needing surgery to repair. Initially he was calm and not demonstrating behaviors then once he was fully off all sedation, he began showing his behaviors. He verbalized thinking everything is poison so he wouldn’t eat or drink, hearing and seeing things that are not there, extremely anxious and afraid. He needed physical holding for safety this am due to behaviors that put him at risk for his safety and others in the room. Patient has a history of this behavior prior to this incident. Strong family history of schizophrenia, this is currently in question for patient. Have connected with Children’s, Abbott and Prairie Care for possibly inpatient psych placement and med management.

MHF-M14-4646

Kiddo came into ED on 9/24 from school for aggressive behavior, was in foster care who is not willing to take pt back. Under custody of the County. Has history of both residential txt (Northwoods 2x) and juvenile detention centers, and has a rule 20. Referral has been made to Prairie Lakes, waiting for response.

MHF-F15-4766

This kiddo came to our ED on 10/21 because she did not have any other placement. County currently has custody. She was previously at Niama House where she had physical aggression toward staff on 10/19. They brought her to the ED on 10/21 and discharged her from their program. She previously boarded in our ED from 4/25-6/20, also due to needing placement.

EHS-F16-4792

Patient is a 16-year-old girl with history of mental illness who was brought to the emergency department from port group home where she has been residing for about 5 days. Patient states that she was in juvenile detention immediately prior to going to the group home. Patient has been prescribed psychotropic medicines in the past, but is not currently using any medications. Recommendation from probation officer and county social worker is juvenile detention center or psychiatric inpatient hospitalization pending long term psych placement. However, LE states they can’t bring her to JDC as she has no charges that would make that appropriate at this time without order from probation. Pt has been aggressive, verbally and physically while in the ED. She has eloped on multiple occasions and has attempted to harm herself.

PH-F8-4701

Recommendation is for QRTP or PRTF – either could potentially meet the needs of this patient and limited treatment centers available due to patient’s age. Patient is currently in psychiatric inpatient hospitalization.
Patient is an 8-year-old female. Patient presented to inpatient from the ED due to increase in unsafe and risk-taking behaviors. This is her fourth inpatient hospitalization; one in 2022 and three in 2024. Patient has attended day treatment twice and participated in outpatient psychotherapy and medication management.

Discharge Plan:
PRTF/QRTP: (county funding approved for QRTP)
– Grafton (declined due to not meeting criteria)
– Northwood (referrals submitted 9/9, on waitlist 9/23 – awaiting update on admission timelines)
– Gerard (unable to accept due to age)
– Avanti (unable to accept due to age)
– Bar None Haven (unable to accept due to age)
– North Homes (unable to accept due to age)
– Heartland Girls Ranch (unable to accept due to age

Continue with following outside providers:
– Therapy/Therapist: Solutions Behavioral Healthcare Professionals
– Primary Care Provider: Sanford Health
– Medication Management: Solutions Behavioral Healthcare Professionals
– Case Management: Solutions Behavioral Healthcare Professionals
– Occupational Therapy: Beyond Boundaries Therapy and Wellness

EH8D-M14-4364

This patient was brought to the hospital by police for aggression and dysregulation exhibited at the group home. He was charged with 5th degree assault after injuring staff members at his group home. His behavior has persisted despite medication adjustments and behavioral plans. He struggles in settings where there is too much sensory input and lack of structure. He has been destroying property and presenting with escalating aggressive, dangerous behaviors, homicidal threats and sexualized behaviors. Despite his impulsive behaviors and subsequent harm to staff members, he displays no remorse, though some question of whether he is able to adequately engage in reality testing possibly related to intellectual disability.
He is a ward of the state. He was placed in foster care at age 6 after suffering from neglect by his biological family. Their rights have been terminated.

MHF-F12-4640

Came to our ED 9/22 from home due to aggressive threats. Previously was IP with our hospital 9/3-9/12. Mom does not feel she can take kiddo home at this time. Is in process of obtaining Childrens Mental Health CM and CADI waiver, but has neither as of now (did request these to be expedited.) Mom is also working on referrals to Residentials (has private insurance) but has not been placed on any lists yet.

HCMCH-M17-4606

17 y/o male with MDD with psychotic features, neurodevelopmental disorder, intellectual disability. He recently discharged from CABHS. Waiting for MSCOCS placement hopefully will be admitted on 10/2. There concern of excessive irritability, agitation, disorganized thoughts, delusions, history of auditory or visual hallucinations, history of self injury and impulsive behaviors leaving to being in dangerous situations.

PH-F10-4549

Recommendation for level 5 QRTP or level 6 PRTF. Patient is currently in psychiatric inpatient hospitalization.
Ten-year-old female patient with a history of in utero exposure and early childhood trauma and attachment concerns, with a historical diagnosis of FASD-Alcohol-Related Neurodevelopment Disorder (ARND). Patient presents with emotional dysregulation, violent threats and aggression, as well as passive suicidal ideation. Patient has been hospitalized multiple times and participated in several outpatient services.

Discharge Plan:
RTC (recommendation letter sent to CMHCM who is requesting county screening meeting)
-Nexus Gerard (referral sent, reviewing, will hear back week of 9/2)
-Northwood (referral submitted, next opening end of year, will review for acceptance at that time)
-North Homes (declined due not have staffing to meet needs related to aggression, SW requested reconsideration; declined 8/21)

PRTF (PRTF eligibility form sent to DHS 8/16)
-Nexus East Bethel (referral submitted w/PRTF eligibility approval 9/4)
-Grafton (referral submitted w/PRTF eligibility approval 9/4)
Bridging with Day tx
-Catholic Charities (referral pending although may not consider d/t RTC rec, IEP sent, 8 person WL)

Current Providers:
Med Management- Mayo Clinic
CM- Dakota County
CADI waiver- Dakota County contracted provider
CTSS