Recommendation is level 5 QRTP, patient is currently inpatient.
Patient is a 14 y/o male w/ hx of depression, anxiety, ADHD, conduct disorder, ptsd , FSIQ 77, currently presenting due to ongoing mood/behavioral dysregulation resulting in hospitalization after aggression w/ mother and boyfriend. Biologically, there is a genetic predisposition for depression, anxiety, substance use. Patient w/ a long hx of impulsive/aggressive behaviors (runs away frequently, physically/verbally aggressive w/ authority figures, ect). Patient is a poor historian per outpatient psychiatrist and parents which impacts ability to know how he is actually doing. At this time, outpatient psychiatrist recommended RTC, and patient is on the wait list.
Patient has previously engaged in PHP, IT, CMHCM, and Intensive outpatient services
RTC
– Northwoods (referral submitted by CMHCM, year long waitlist 6/27)
– Gerard (referral submitted by CMHCM, under review 6/27)
PRTF
– Grafton (referral submitted 6.26)
6/4/24 admission note: Patient is a 14-year-old female admitted to PrairieCare for suicidal ideation and self-injurious behaviors. Patient was recently discharged from a 45-days residential program. 2 days post discharge patient began threatening to kill her mom and reported SI with plan to jump in front of a car. Pt has a history of recurrent major depression SI, and SIB.
Discharge Plan:
SMRT-Hennepin County (7/8)
PRTF/QRTP – Level 6:
-Grafton (declined due to current milieu at facility)
-Nexus East Bethel (unable to refer due to insurance)
-Leo A Hoffman (unable to refer due to males only)
-Bar None Haven (SW to send referral once consent obtained)
-Northwood (SW to send referral once consent obtained)
-The Youth Village in Tennessee (guardian pursuing)
-Acadia Healthcare (SW to send referral once consent obtained)
Current Providers-
Therapy- Paula Ocampo at Lake Country Associates
EMDR therapy-Tiffany Rundquist, Sanford Health Bemidji
Pediatric Neurology- Dr. Ilgarli, Essentia Health
Psychiatry- Daniel Janiczak, MD and Kayla Scheneit, MD- Sandford Bemidji
CMHCM- Erika Kjellberg, Hubbard County
CTSS- Megan Berg, Hubbard County
EMPATH at Bemidji Sanford 2 times/week
Patient was brought to ED after making suicidal and homicidal statements during his psychiatric medication appointment. He was evaluated and inpatient psychiatric stabilization was recommended. While in the ED he has been calm and cooperative. Denying suicidal ideation or Homicidal ideation at this time. He does recognize that he has been dysregulated and struggling to find effective coping skills. Recent increase in conflict at home. Has been engaging in self-harm. Mom does not feel safe having him in the home at this time.
This patient presented to Ridgeview Medical Center via P.D. after running from his home. He was found in the woods nearby his home with a knife (patient has an ankle monitoring device). Patient reportedly desires out-of-home placement and verbalized plans to use the knife to harm kids who bully him at school. Patient has a significant history of running away from home with more than 30 reported incidents. Patient maintains a desire not to return home at this time. Carver Co. holds temporary decision making authority over patient, by court order.
UDPATES TO Discharge Plan 12/12/23:
-Grafton PRTF (Pt accepted, could admit 12/20, due to staffing moved back to mid-end of January)
-Nexus-East Bethel PRTF (Pt accepted, could admit mid -January)
-CABHH (Pt denied admission)
Recommending PRTF. Referrals completed.
Cannot return to previous Group Home. Per County, no interim plan available as parents and foster parents are reportedly not an option. Still seeking county to arrange interim living arrangement between Inpatient and PRTF – for crisis stabilization or group home.
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.
Patient has the following outpatient providers:
CPS Worker/Legal Guardian
CMHCM
GAL
Medication Management
PCP
School Counselor
Insurance: BCBS MN and MN MA
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.
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).
