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.

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.

MCHAHS-M17-5128

Pt has a long term 245 D home here in Little Falls, they have been wonderful to work with this youth. Pt symptoms are increasing such as hallucinations and this can cause him to be aggressive. Pt med provider would like a safe place to adjust his medication, and we have been unable to find any assistance with this as denied by Prairie Care and all PRTF’s. Pt is on the waitlist at CABHH. Told this is long and do not know if he will be accepted or when. Currently Pt is on another 72 hour hold at the local hospital. He bounces back and forth from ER to his 245D home as the medication adjustment or consistent use of current meds is a challenge due to hallucinations and the risk of elopement and aggression that come with the hallucinations.

PH-M15-4994

Psychiatric history of autism spectrum disorder, anxiety, and ADHD, with no prior psychiatric hospitalizations, with no prior reported self-harm, with no prior reported suicide attempts, who presents to PrairieCare due to safety concerns after patient jumped out of his window to run away(he hurt his leg, and was found semi-hypothermic in water) due to anxiety about an upcoming court case regarding him lighting his house on fire with his family inside last month.

HCMCED-M11-4844

On 11/14/24 the patient’s foster parents brought him to HCMC APS after he was discharged from Children’s Hospital St Paul because of his aggressive behavior. When in APS the patient began hitting his foster mom and becoming increasingly agitated. Security had to assist in transporting the patient to an emergency department bed, where he was then put into restraints for his and others safety. He was given sedative medications, IM.
The patient has been in foster care since he was 7 years old. He was physically and emotionally abused by his biological mother. He has been hospitalized at Fariview inpatient pediatric psych for a year, where he was then transferred to a residential treatment center. He has been with his current foster parents since August 7th, 2024.

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

CH-F13-4577

Pt presents from school after high level of aggression, homicidal threats, and property destruction resulting in multiple hours of restraints. Patient has longstanding history of aggression and impulsivity with recent increase and daily occurrence consistent with starting new school. Pt newly to a group home from home placement as of May 2024. Now discharged from level 4 school due to behavior leading to presentation. Looking for IP for medication adjustments, though making changes in the ER in the interim. Difficult placement given neurological functioning, level of aggression, and acuity.