Mental Health Collaboration Hub
Patient presented to the ER 1/21. Patient is familiar to us. Patient has a complex psychosocial history with prior CPS involvement and a chaotic home environment. Patient typically does well in the ER & hospital setting but struggles at home with severe aggression and behavioral dysregulation in relation to conflict with parents. Patient does not appear to comprehend the severity of his actions and feels like his actions are justified (which appears to be related to his level of functioning). Patient likely needs a crisis respite placement/group home placement, but his CADI waiver and insurance are on hold while transferring to Benton County.
Risk Factor: Developmental Delay
Developmental Delay indicates that a child is not reaching developmental milestones within the expected time frames, potentially signaling underlying developmental issues.
SMCF-M12-6505
Patient has had an increase in ED visits due to an increase in behavioral outbursts including aggression. Patient was transferred to an inpatient psychiatric facility, however, report they cannot meet his medical needs including his incontinence. He was transferred back to the ED. Parents continue to express safety concerns for patient and family members (mom, dad, and 9yr sister). Family report they cannot bring him home at this time. Patient has been denied for hospitalization. He continues to be physically and verbally aggressive towards hospital staff.
MHF-M14-6458
Youth came in to our ED 1/8 after altercation at his Group Home where he has 3:1 staff. Initial recommendation was IP but he was denied by several units. He stabilized while waiting in the ED and the recommendation changed to discharge. Struggling due to sensory needs and the environment of an ED. GH is likely going to take him back once they can figure out staffing and some modifications. Looking for potential ideas to further support this youth in the community. Referral being made for youth ACT team but unsure if he will be accepted due to DD diagnoses. Has DD waiver and CM.
PH-M16-6335
Recommending level 5 RTC
16-year-old male who presented to PrairieCare Inpatient Hospital as a step up from PHP. When home for the weekend, he had increased emotional and behavioral dysregulation with symptoms of psychosis and was brought to the ED by his mother.
He has a psychiatric history of disruptive mood dysregulation disorder, autism spectrum disorder with accompanying intellectual impairment, intellectual developmental disorder, mild, fetal alcohol syndrome, and ADHD.
This is his second psychiatric inpatient hospitalization; he was attending PHP prior to this hospitalization and has a history of psychiatric outpatient services.
PH-M15-6144
Recommedning PRTF/RTC
15 year old male who presents to PrairieCare Inpatient Hospital due to suicide attempt with increased SI and SIB.
He has a history of several inpatient stays, has engaged in PHP, individual therapy, family therapy, and RTC at Gerard
Funding is in place for RTC with Polk County
Discharge plan as of 9/29:
PRTF/Level 6 (referrals placed by CMHCM, Approved by AFMC for PRTF)
– Northwood (reviewing, waitlist 3-4 months)
– Nexus East Bethel (referral submitted, reviewing possible opening early Oct.)
– Grafton (referral submitted, under review, declined due to inability to support level of care)
– Leo Hoffman Center (CMHCM to resubmit referral, declined due to safety concerns and inability to provided 1:1 staffing, able to re-refer upon further stabilization)
QRTP/ Level 5:
– Return to Nexus Gerard (under review, declined to return. Discharge effective 9/12)
– Bar None Haven (referral submitted)
PH-F10-5904
Pt is a 10 year-old female with historic diagnoses of anxiety, depression, ODD, specified neurodevelopmental disorder who presents today to address running away from home. Upon interview pt was observed to be easily distracted and appears to be guarded. Pt was resistant to the interview stating, “I don’t want to answer any questions.” After roughly 5 minutes pt refused the interview process leaving the room and forcefully pushing the door close with writer still in the room. Writer could hear pt yelling and laughing from the hallway “she’s locked in there” and “I locked her in there”.
Mother reports pt has been running away from home and putting herself in dangerous situation. Mother reports pt was sexually assaulted during one of her runaways. Mother reports pt’s motive for running away this time was to get on an airplane. Mother stated due to pt’s behaviors, pt has been hospitalized 3 times within one and a half weeks. Mother reports pt’s mental health is worsening. Mother reports pt struggles with authority figures and being held accountable. Mother states they use to have structure and routine in the home and is trying to incorporate it into the home again but when pt is held accountable, pt will threaten mother and think mother is “being mean.”
MCR-M9-5609
He has been in foster care since he was removed from home in 10/2022 due to physical abuse. He was in foster care with a family and was relatively stable until the past few months, when the foster father died and since then there has been an increase in behaviors. He is unable to return to that foster home. He has very low cognitive functioning, reported to be around a 3 year old, and he was attending school only a few hours per day. He was on a lot of medications and psychiatry has optimized them during his time here.
NMH8R0MGH-M25-5508
Presents to the ER with Guardian, passive suicidal ideation, feels misunderstood with regard to gender and cultural identity, adopted as a child. Adoptive parents not an option for living. Borderline Intellectual Functioning/Possible Fetal Alcohol Syndrome. Per DD Case Manager, they have tried At Home Living, no openings, Genesis homes has not openings and not able to put patient on a wait list. Patient needs a placement that can accommodate transgender, and she has had inappropriate contact with others in prior GH settings. VOA is assessing.
MCHSRW-M12-5457
Patients mother shared that the patient has an extensive treatment history, but has continued to struggle with challenging behaviors and emotion dysregulation. Mom described that “over the last few days he’s just been a terror, despite our best efforts. He freaks out when we try to redirect him. Mom reported that the patient has “aggressive towards people, getting physical and violent, he’s been assaulting his younger brothers.” Mom described that on the day of admission the patient had been going into his brother’s bedroom “trying to annoy them,” and hitting them. Mom called her husband, the patient’s step-father, who is currently out of state for work. The patient’s step-father spoke to the patient over the phone and told him that he needs to change his behavior and reminded him that he has been through so many different programs and should be able to “put on the breaks” with his behavior. The patient began talking back and got confrontational with his step-father, asking “what are you going to do about it?” The patient’s step-father indicated that their would be consequences when he returned and urged the patient not to put his job at-risk by making him return home early to deal with his behaviors. The patient challenged his step-father further making statements such as “fuck you, why don’t you say that to my face?” and “bet, come home then and see what happens.” The patient further stated “I’ll shoot you in the fucking face, right through the eyes.” Mom reported that their is a gun in the home, however it is locked in a gun safe and the patient does not have access to this. Mom then asked the patient where he would get a gun from and the patient indicated that his friends at school have guns. Mom expressed “this has escalated so far beyond me. We are walking on eggshells from the time he gets home from school until he goes back the next day.” Mom reported that she did not feel safe bringing the patient back home. She reported that she had attempted to press charges on the patient today, however police had declined and brought him to the emergency department instead. The patient is uninsured, county is working on his application, but he does not have a county social worker. Has a contracted mental health case manager through Fernbrook.
CH-F11-5026
Pt presented from home, adopted parents, for aggressive behaviors. Third ER visit this month, unable to take pt back home due to frequency and intensity of behaviors as well as 4 other children in the home. Pt initially recommended IP hospitalization, however unable to find placement due to acuity, no beds, or declined due to IQ (56) and inability to participate in programming. Medications adjusted in ER. No violence since medication increase. Family/CADI worker have been looking for more support for several years and pt seems to fall through the cracks due to IQ and aggression.