Update: DIfficult to place, haven’t been successful at contact w family
Patient is presenting to the ED for the following concerns: physical aggression, significant behavioral change. Patient has Autism, is non-verbal, has a developmental delay, speech delay, PICA and behavioral issues at home that have been increasingly difficult for the family to manage. Patient was seen her earlier this month after ingesting a battery. Patient reportedly has been accepted for a residential treatment facility in Missouri – Lake Mary Center, though they currently do not have a funding source and intake is not until the end of December. Family has been working with Aurora Behavioral Services, as well as psychiatry and PCA services.
Patient was previously at a group home, due to running away and SI/SIB, pt was readmitted to Inpatient. Inpatient hospitalizations 7/8/23-7/28-23, 9/29/23-10/13/23, 10/16/23-Present.
Recommending PRTF. Referred to all.
Cannot return to previous Group Home. Per County, no interim plan available as parents and foster parents are reportedly not an option.
Patient has the following outpatient providers:
CPS Worker/Legal Guardian
Insurance: BCBS MN and MN MA
UPDATE 11.16.23 – Dragonfly is a potential placement.
Patient recently moved to Minnesota and was displaying sexualized behaviors at school (disrobing, touching herself, attempting to grope teachers, making sexualized comments) CPS was contacted and they were concerned Patient was being sexually abused at home. They were brought to our hospital in need of out of home placement after MCRC visit while dad is investigated. Carver County has temporary custody. Patient has history of developmental delay. No sexualized behaviors toward other kids, mostly with self, while playing with dolls and adults.
Having DX completed this week. County pursuing a variety of options
Developmental Delay, Abuse and neglect
UPDATE 9/14/23: Discharge date to Companion Homes set for 9.22.23
UPDATE: 9.7.23 working on a group home placement.
Patient is presented to the ED via EMS. Patient was discharged from Chelida Residential Facility after 2 years, for assaulting another client. Patient was then admitted to Winnebago Mental Health Institue in WI. Patient was discharged, and returned home to parents. Patient has since demonstrated emotional and behavioral dysregulation such as following his mother around, threatening to hit and push her. Patient also biked to his neighbors, and pulled his pants down in their driveway. Patient has a history of assaulting neighbors and is not supposed to be there.
Patient has historically received services at St. Davids, Fraser, and the MN Autism Center.
Update 7/27 Genesis Group Homes is pursuing an intake to potentially utilize crisis services.
16 year old adopted from Ecuador at age 8 (with twin brother with similar difficulties, as well as 2 other siblings without similar struggles), with ASD and intellectual disability, associated with a microduplication at chromosome 8p23.1, likely in-utero substance exposure, as well as early life neglect (living in an orphanage for much of his young life). Significant aggression difficulties that are becoming more unmanageable by family as he grows larger; unsuccessfully discharged from Chileda in November 2022. Family have financial resources and have purchased a second home for the boys and hired private caregivers in the evenings, but their income limits eligibility for MA and state-funded services. New behavior analyst started working with the family in March. May be on the MSOCS wait list. Currently on the wait list for inpatient care at Kennedy Krieger near Baltimore (brother previously had a good experience there).
State of MN is trying to find a way to build his own home, timing TBD.
Aggressive, DD, low IQ – 40-50, FAS, ward of state, targeted case mgr. Was provisionally discharged from CABHH, not allowed to return. Perhaps a plan is a state run group home, in development?
ASD, impulse control issues, DD, trauma history, pica, SIB, hits self, headbangs, nonverbal, putting foreign objects in body, smears feces, no family involvement, ward of Stearns County. No family involvement. Communicates w laptop, pictures. OT doing sensory work. Referral across MN, WI, ND, SD. Tennessee declines. Very difficult to place. 2 staff in day and 1 at night. Stearns trying to work on a home in their county. Came from her family care at age 4, to group home until 7, then another group home. She has struggled at her most recent group home. Lots of hands-on care. Willing to re-refer her to Grafton – was declined in July.
History of Autism Spectrum Disorder, prenatal exposure to alcohol, cocaine, and heroin. Pt is cognitively delayed and has limited verbal skills. Recently attempted group home, assaulted staff after 1 day; guardian took patient home. Pt presented to ED after assaulting guardian in the home and guardian does not feel safe with patient returning to home, is planning to relinquish custody. In ED, patient is disrobing, throwing feces, assaulting staff, in seclusion. Behavior is chronic and has been seen at similar level historically. Prescribed Zyprexa, Abilify, Clonidine, Thorazine, Atarax, Trazadone.
4/7/23-4/13-23 – Discharged to home.
5/13/23-5/19/23 – Discharged to home.
5/23/23-5/26/23 – Discharged to home.
5/27/23-6/7/23 – Discharged to home.
These notes are from when this child was at RMC – was admitted there 4/7/2022:
ASD, DD, physical and verbal aggression, agitation, trauma, IQ 51, intermittently toilet trained, was in foster care – didn’t work d/t violent behavior. Has a Waiver. Attending PT/OT/SLP while in ED. Tried a respite stay but came back – difficulty with another child there. Under Sibley County now. Grandmother legal custodian – appropriate and involved. He had a low IQ but hasn’t ever attended school regularly. Has done well at Ridgeview. ST/OT/PT. Language improving. Was behaviorally frequently incontinent, better now. Not as into his technology. Continuing to refer to multiple facilities- all say no for multiple reasons. Case manager looking for foster home. He eats well, limited sugar. Much less violence now since April, but it’s the reason why he’s been declined. He needs someone to take a chance – he’s doing well at Ridgeview. Once he gets established, he will most likely do well. Does not need 1:1 attn. Turns 11 in Feb. He’s 1:2 or 1:4. he is on his own 75% of day. He showers, gets dressed, uses toilet, cleans himself up if he has an accident. Takes meds well. Documentation from hospitals is problematic as they mostly document the problems or issues and not the strengths or improvements. CPS has closed the chip case on him. Gramma is now the custodian.
Update: He is completely stable w/ meds. He’s completely continent now. Participating w/ ST, PT, OT. Language skills have grown tremendously. Looking into foster care, w/ just him or 1 other child. Turns 11 in Feb.
Referrals in all over the country. Grafton reached out 11/17. 10 page list, both sides, of rejections. He is a big kid, and when he becomes aggressive – security comes – 98% of the time he can be redirected. In April – there was some violence toward staff, not now. Sibley county is looking for a congregate setting, more staff instead of family. Has Disability services been involved? yes. Multiple care conferences. Grafton originally declined because the behavior score was too high. Should Grafton receive new updates to reconsider? turns 11 in Feb.
Was sent to Juvenile Detention on 1/28/23. Then (date unknown) to home in custody of grandmother. Now at FV Masonic since 2/2023