The patient is a 13 year-old female with a history of ADHD, inattentive type, anxiety, depression, sexual abuse, suicidal ideation, and self-injurious behaviors that presented to the ER following an intentional overdose in an attempt to end her life. She has had 2 previous inpatient hospitalizations. Patient has a complicated home life with several CPS reports and basically does the caretaking for her younger siblings. Patient has several tattoos given to her by her mother and sister and mother is unwell as well and frequently struggles with suicide attempts and self-harm. Sounds like a significant sexual abuse history within the entire family that may still be occurring. The patient is at risk for sexual exploitation given increased sexuality.
Risk Factor: Self harm
This term refers to instances of isolated, non-repetitive aggressive behavior, such as a single incident of physical aggression or verbal aggression.
PH-F17-4728
Patient is needing an out-of-home, secure, placement, due to ongoing, chronic, safety concerns, that are unable to be managed at home. Patient is recommended to attend Residential Treatment or enter into a secure living environment.
Patient has a significant psychiatric history including:
Psychiatric hospitalizations
-Mayo Clinic Generose 08/2019
-PrairieCare 10/29-11/11/2022
-PrairieCare 08/30-9/7/2023
-Mayo Clinic Generose 09/2023
-PrairieCare 11/8-11/20/2023
-Mayo Clinic Generose 12/2023
-Mayo Clinic Generose 04/2024
-PrairieCare 06/25-7/11/2024
-PrairieCare 07/25-8/14/2024
Residential Treatment:
-North Homes for a 35-day evaluation
-Gerard 08/2020-06/2021
-Gerard 12/2022-06/2023
Day Treatment:
-Fernbrook Family Center
Partial Hospitalization:
-Mayo Clinic November 2021, June 2022; Prairie St. John’s February 2022 and July 2022
-PrairieCare Rochester 11/16-12/21/2022
-PrairieCare Rochester 09/11-9/15/2023
-PrairieCare Rochester 09/19-10/11/2023
History of self-harm by cutting (recently daily), with one prior reported suicide attempt (by overdose, 6/2024), who re-presents to PrairieCare inpatient due to safety concerns related to self-harm by cutting, with increasing suicidal ideation and intention, with an inability to contract for safety, in the context of stressors related to school re-starting.
PH-F8-4701
Recommendation is for QRTP or PRTF – as both could meet the needs of this patient and limited treatment centers available due to patient’s age. Patient is currently in psychiatric inpatient hospitalization.
Patient is an 8-year-old female. Patient presented to inpatient from the ED due to increase in unsafe and risk-taking behaviors. This is her fourth inpatient hospitalization; one in 2022 and three in 2024. Patient has attended day treatment twice and participated in outpatient psychotherapy and medication management.
Discharge Plan:
PRTF/QRTP: (county funding approved for QRTP)
– Grafton (declined due to not meeting criteria)
– Northwood (referrals submitted 9/9, on waitlist 9/23 – awaiting update on admission timelines)
– Gerard (unable to accept due to age)
– Avanti (unable to accept due to age)
– Bar None Haven (unable to accept due to age)
– North Homes (unable to accept due to age)
– Heartland Girls Ranch (unable to accept due to age)
Out of State RTC:
– Rogers Behavioral Health (declined due to insurance)
Continue with following outside providers:
– Therapy/Therapist: Solutions Behavioral Healthcare Professionals
– Primary Care Provider: Sanford Health
– Medication Management: Solutions Behavioral Healthcare Professionals
– Case Management: Solutions Behavioral Healthcare Professionals
– Occupational Therapy: Beyond Boundaries Therapy and Wellness
PH-F16-4545
Recommendation is now for level 6 PRTF. Patient is currently in psychiatric inpatient hospitalization.
Patient is a 16-year-old who identifies as non-binary using they/them. They presented to inpatient from ED due to increased SI. This is patient’s 14th psychiatric inpatient hospitalization. They have participated in outpatient services and PHP historically.
Patient was initially recommended for level 5 QRTP by inpatient providers although Dakota County recommended level 6 PRTF.
Discharge Plans:
PRTF (county determination/recommendation – DHS approved)
-Nexus East Bethel (referral submitted & under review)
-Grafton (not an option as they do not meet admission criteria)
-Northwood (referral submitted; two year waitlist)
RTC: (county declined funding for level 5 QRTP, recommended Level 6)
-Avanti (declined)
-Gerard (referral sent, unable to move forward due to lack of funding)
-North Homes (referral sent, unable to move forward due to lack of funding)
Established outpatient providers:
Individual Therapist: Your Vision
Psychiatrist: Associated Clinic of Psychology
PCP: Allina Healthcare
CMHCM: Dakota County
PO: Dakota County
AH-M13-4588
Pt per chart presented 9/15/2024 d/t sent from JAF facility after agitation episode during which pt expressed self-harm ideation via electric outlets. Of note this is a behavior for which he has been sent to ED multiple times and regulates in ED and has been sent back. However, currently facility is not agreeing to take pt back and apparently for the past 5 days since last visit, there has been a plan to discharge pt if there was 1 more ED visit, which is current visit.
PCMC-F15-4528
Pt presented with mother to ER after taking 30 tablets of 650mg Tylenol arthritis to end her life. She has multiple superficial cuts to her right thigh. Last inpatient treatment in May 2024. Pt states she had argument with couple friends and one friend told another things and now that friend was mad at her or does not like her. This upset her enough to want to end her life.
CH-M11-4450
Patient presented to the ER via law enforcement for homicidal ideation towards his foster family (maternal aunt) and biological brother and had threatened them with a knife. Was removed from his biological home in June due to neglect, abuse, domestic abuse, substance use in the home. Patient with dissociative episodes and resorting back to small child like behaviors.
CH-F12-4277
Patient presents to the ER from PRTF twice in the same day after boarding for an extended period of time due to aggression towards staff. She has since been discharged from the PRTF as they felt a higher level of care was indicated. She is currently doing well here with intermittent verbal escalations though does struggle with peer relationships. She does express visual and auditory hallucinations though these do appear to be related to trauma.
MHF-F13-4407
Patient came to ED on 7/19 from Nexus East Bethel PRTF after swallowing a foreign object. Was in our inpatient unit from 7/15-7/19 and discharged for only hours before returning. Reports that repeat behavior was pt seeking to be removed from program. Nexus PRTF is not accepting pt back at this time and Mom is unable to have pt return home. Sending referral to Nexus YCT to assist with placement.
MHF-F17-4377
Pt came to our ED via ambulance after running away from Avanti, because they planned to discharge her home to family where she did not want to go. Avanti will not take her back. She has been cooperative and has not had any behavioral incidents in the ED. She is at her baseline, which includes non-suicidal self injurious behavior. Has history of therapy, psych, PHP, IPMH, foster care. Going to a different family member for kinship placement is currently being discussed though pt is not agreeable at this time.