Aggression (verbal) – Mental Health Collaboration Hub

RMC-M15-4330

On 7/8/24, patient was told he would be spending time with his mother, to which patient had a negative response, causing patient to assault his father and run away. Police located patient at a local middle school just before patient ran across a highway and had to be sedated by EMS due to safety concerns.

Pt has dx that include: reactive attachment d.o., disruptive mood dysregulation disorder, PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections), ADHD, ODD, OCD, pervasive social communication d.o., with low non-verbal skills, high verbal skills, low memory skills, and average IQ.

MHF-F17-4287

Came to ED on 7/8 after parent-child conflict, verbal altercation and mother reports she was scratched. She had been attending Fairview’s PHP program but has been minimally engaged there, reports that she prefers individual therapy over PHP. She has not had any behaviors since being in the ED. Goal is for patient to return to family with services, but Mom has not been agreeable to pick up yet, continuing to work on services to support the family and see if pt can return home.

C8SM8M-F9-4255

Patient presents from former foster placement and is unable to return. History of frequent relocations and caregiver changes.

MHF-F13-4168

Pt came into our ED on 6/13 after a verbal altercation at home with mom, where she left the house and walked to the police station who called crisis and brought pt to ED. Mom is refusing to pick up. Its reported pt was in residential treatment until April 2024, and prior to that was in PHP through Fairview. Mom reports that Case Manager is looking into residential treatment again however we have been unable to reach the CM and their offices are closed the rest of this week. Unsure if there is a recommendation for residential or county approval for that LOC.

RMC-F16-4041

16 year old female who was brought in by EMS in 4-point restraints after being restrained by PD trying to enter river to “drown herself”. Patient argued with her mother just before she threatened to “drown herself in the river;” destruction of house/property per mother’s report. Patient admits to past similar behaviors and has multiple MH hospitalizations on record.

PH-F11-3982

The patient presented after expressing homicidal thoughts (threats of aggression) toward her grandmother with whom she lives. Patient was on her way home from school when she pulled her school lvan driver’s arm to the back of the van as she did not want to return home. Patient was then returned to her school where her grandmother picked her up and eventually brought her to the Emergency Department. Since her presentation to the Emergency Department, the patient has not displayed any aggressive behavior. Patient has irritability and emotional outbursts with grandparent(s) and has displayed these behaviors at school as well. Has mostly been pleasant and cooperative in the Emergency Department. Has some attention seeking behaviors when the Emergency Department is busy.

PH-F17-3791

5/20/24: Patient discharged from inpatient and admitted to PCR.

5/8 update: Patient scheduled for admission to PrairieCare Residential on 5/20/24 at 10:00am.
5/6 update: Patient is currently awaiting an RTC bed through PrairieCare Residential in Maple Grove. Patient has been approved for 3rd pathway funding through Hennepin County. Due to patient behaviors seeming to increase, other options are being explored for aftercare as denials are a possibility. Parents do not feel safe with the patient coming home.

Discharge Plan:
Residential Treatment:
-PrairieCare Residential; intake 5/20/24 at 1000

Other RTC Referrals:
-Nexus Gerard; referral made
-North Homes; referral made, declined due to FAS and IQ
-Avanti Center for Girls; referral made, declined due to aggression and peer conflict

Outpatient Providers:
Establish CMHCM; opened with Soreya Jama through Hennepin County, 3rd pathway funding approved

Establish/Continue CTSS with Samira through Nexus FACTS
Continue Therapy with Mary Midler at Great Lakes Neurobehavioral Center in Edina (weekly)
Continue PCP with Dr. Megan Reilly at Partners in Pediatrics in Plymouth
Continue Psychiatry with Gerard Balan at Plymouth Psych Group
Continue IEP Case Management with Yvette Zeese at Wayzata High School
Continue Neurological Services with Dr. Catalfamo at Noral Neurological Clinic in Bloomington

ADMISSION NOTE: Patient was admitted due to acute safety concern and was unable to contract for safety at home. Pt was in PHP in the past and family was monitoring her 24/7 at home as instructed. Pt became irritated that she is constantly being watched and ended up having altercation with her mother because she was instructed by her mother to change outside of her bedroom because the mother was unable to see her. Pt ended up leaving and went to her grandmother’s house which is next door while mom followed her, pt went straight to the kitchen grabbed a knife and start threatening to stab herself. Mother was able to wrestle the knife out of her hands and called EMS. Pt has a history of depression, anxiety, epilepsy, and fetal alcohol syndrome.

PH-F12-3437

Update 5/14/24: Patient discharged home to the care of her guardian with outpatient supports to bridge Day Treatment.

Update 5/10/24: Patient tentatively scheduled to discharge home on 5/14/24, with outpatient supports to bridge PHP at Amberwing.

Update 5/6/24: Douglas County CPS is navigating PHP and Day Treatment with the guardian for aftercare. PHP waitlist is approximately 3 weeks and guardian still needs to obtain insurance coverage. Douglas County CPS will be closing out their case on 5/10/24 due to a lack of immediate safety concerns as evidenced by the guardian willing to take the patient home.

Update 4/30/24: Guardian is making statements of wanting the patient to return home. Patient was declined from foster placements in Wisconsin, and family placement is not an option either. Douglas County, WI, CPS, working with the guardian on a transition plan home, including Day Treatment and Outpatient Therapy. Patient remains at the hospital.

Update 4/24/24: Parent still not willing/able to take pt home. County involved and navigating alternative living arrangement/placement. DC rec is PHP.

Update 4/17/24: Parent still not willing/able to take pt home. County involved and navigating alternative living arrangement/placement. DC rec is PHP.

Update 4/3/24: Parent still not willing/able to take pt home. County involved. DC rec is PHP, openings available at PC PHP when patient is able.

Patient was admitted from Essentia Health in Duluth after attempting to run away from home. Pt has conflict w/ dad & has made HI statements toward him (burning him, switching meds out so he will OD). Pt also has a Hx of inappropriate sexual behavior with older men & on the internet.

Historically, patient lived with extended relatives for the first 11 years of her life due to mitigating circumstances that did not allow biological parents to meet her needs. Patient then went to live with her biological mom and was then sent to live with her dad, as mom was unable to meet patient needs. Patient has been with dad for about 1 month now, and he has indicated that he cannot meet her needs either, and declines for the patient to return home.

Discharge Plan:
PrairieCare Recommends:
Establish PHP; county coordinating with Amberwing, estimated 3-week waitlist

Establish Individual and Family Therapy:
-Insight Counseling in Duluth; referral made
-SOAR Services in Superior, WI; referral made
-Nystrom and Associates in Duluth; referral made

Establish PCP
Establish CMHCM (Open with Kalley Rustad at Douglas County CPS for long-term supports, closing case 5/10)
Establish CLTS (Referral made to Douglas County, CPS also coordinating)

Estimated length of stay:
Seven to ten treatment days; patient is medically ready for discharge; pending Douglas County, WI, establishing aftercare with the guardian. Guardian is now willing to take the patient home.

PH-F14-3601

Update 4/25/25: Patient discharged from inpatient to Willow Trails Group Home on 4/25.

Update 4/24/24: Patient is medically ready for discharge from inpatient. Tentative admission to Willow Trails Group Home on 4/25.

Update 4/18/24: Patient is medically ready for discharge from inpatient. County is their guardian. County is working on finding foster care/group home placement. Patient has been denied at Village Ranch, is being reviewed at Port Place, Hunter’s Place, and Anoka County Juvenile Center.

Patient presented to the ED on 03/15/2024 after making suicidal statements while at school. Patient noted they have been being bullied, which contributed to the increased in suicidal ideation. Patient denied having a plan to complete suicide but was experiencing passive suicidal ideation and indicated that they would “probably do something with cutting.” The school contacted law enforcement and patient was transported to the ED for further mental health evaluation. Patient was unable to contrast for safety, resulting in them being transported via non-emergent transportation to PrairieCare for short-term stabilization.

Patient is under guardianship of Ottertail County at this time. Placement is being pursued by the county to either a Group Home or Foster Home.

Discharge Plan:
Continue care with existing outpatient providers:
-Individual therapy, PCP and Psychiatry at Behavioral Health in Badger, MN

Patient is medically ready for discharge and is awaiting placement in an appropriate group home/foster home, as identified by the county.

ADYC-M14-1768

Update: 1/19/24 Pt. still looking for placement.

15-year-old male looking for a group home and residential program. Children’s Mental Health Case Manager has tried everything, and doors are being shut. Client has a physical aggression, verbal aggression, history of PTSD and sexual abuse. Client has experienced abuse from biological father who is in still in the home, and sexual assault that happened possibility of more than one with an older cousin sister. Client mother is giving up on hope on trying to help her child. Client is struggling at home, school, and community. Children’s Mental Health Case Manager has been trying everything to find a placement for him. He’s been going in and out of the ER like every two months now. Children’s Mental Health Case Manager still trying to offer support the way she can by being there every hospital stay, seeing client like twice a month, and having mom keep her on speed dial to talk to client.

Because of experiences, client is chemical dependent on marijuana, perks, and opioids.