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.

MHF-F14-1493

UPDATE: as of 8/24/23 she has been accepted to a residential facility in Georgia, and the family is waiting for some pieces from their insurance company. Transportation is ready to go once insurance is approved – hopefully end of this week or early next.

Pt is presented to the ED via EMS for the following concerns: verbal agitation, physical aggression, significant behavioral change, and anxiety. Pt has been in a residential treatment center for approximately 5 weeks, and had been in a “crisis state” all day, on day of admission. Pt was requiring frequent restraints, supervision and redirection for up to 8 hours. She was non-compliant with treatment activities, frequently trying to run away from program activities, and into the street. Pt kept searching for sharp objects to self-harm, and assaulted staff when they tried to take objects from her.
These are chronic behaviors for pt. Pt is currently in a 3rd residential treatment program (secure), with a hx of one prior group home placement. Pt has a hx of several mental health hospitalizations, with most recent in October 2022. Patient has a hx of refusing medications.
Residential facility stating that pt has been discharged, however there is no discharge paperwork available. From North Dakota. No case mgr or services in place. Her parents were able to get her into the residential treatment center she was at. Able to DC but nowhere to go at this point.

PH-F14-1603

UPDATE: PT DISCHARGED HOME TO MOM.

Patient is a 14-year-old female with history of depression, anxiety, SI, SIB, trauma and aggressive behaviors. Has participated in PHP, RTC, and inpatient levels of care. Insured by Medicaid.

DISCHARGE PLANNING EFFORTS:
Primary Recommendation-
Establish Day Treatment (Patient currently refuses)
Continue CMHCM- Family Wise Services, contracted by Hennepin County
Establish outpatient individual therapy (CM is scheduling)
Establish med management (CM is scheduling)

Discharge has been attempted. Mother/LG will not accept patient back into the home. Patient was living at Passageways Shelter prior to admission and mother/LG consents for shelter placement at discharge. Patient’s aunt/uncle had agreed to take patient in with consent from LG, but aunt declined to pick patient up on day of scheduled discharge and rescinded the offer to accept patient.

Patient needs shelter placement due to family dynamics, thus the following are pursued-
Consider The Bridge for Youth (Denied d/t reported severity of aggression towards mother)
Consider Passageways (Denied again as of 8/16/23)
Consider Brittany’s Place (Denied d/t parent is still LG and would need to complete VPA)
Consider Hope House (No current availability, call back once per week to check)
Consider Itaskin Center Shelter (Referral sent by SW, additional referral needed by CMHCM)
Consider VOA Bar None Shelter (Referral sent by SW, additional referral needed by CMHCM)
Consider Ain Dah Yung Center (Referral sent by CMHCM, no current availability)

Consider RTC, as previously recommended by CMHCM prior to admission*-
Nexus-Gerard (Referral started by CMHCM, clinical sent by SW, awaiting records from CRTC for determination)
CRTC (Referral started by CMHCM, clinical sent by SW, declined for admission due to IQ)

*QRTP Pre Placement Screening with Hennepin County needed to approve funding for QRTP.

Estimated length of stay:
Patient is medically ready for discharge as of 7/18/23

PH-F16-1369

*UPDATE: Admission to Gerard 7/28/23- just pending county funding at this time, 2nd screening today, 7/20

16 YO Female in 10th grade. Two previous psychiatric hospitalizations (2/23/22-3/4/22 and 9/17/23-9/27/23) in addition to the current admission. Has attended Day treatment. No alcohol or Drug use. Increasing SI and history of self harm. Hx of sexual abuse at age 9.

DISCHARGE EFFORTS:
-RTC: Avanti Center for Girls (Referral sent, pt accepted, 6 month wait list)
-RTC: Gerard Academy (Referral sent, pt accepted, admission, 7/28/23, pending county funding)
-RTC: North Homes (Referral Sent, pt approved, opening estimated for August-September)
-RTC: Northwood Children’s Services (Referral Sent)

Interim Plan:
-Day Treatment: TSA (pt able to return if/when it is safe to DC)
-CMHCM: Janet, Isanti County
-DBT: (SW to provide resources upon DC for guardian to use after RTC)

MHF-F16-1057

Patient is under the guardianship of Swift County, and presented to the ED from his group home in Hennepin County. Patient got upset after being denied an outing, and went out to the road (not a busy road) and threatened suicide by getting hit by a car. Police were called, and patient was taken back to his group home where he made homicidal threats towards a neighbor. Group home staff then requested patient be seen by the emergency department. Patient has had multiple psychiatric hospitalizations. Patient reports frequent suicide attempts with methods unlikely to harm him, such as tying shoestrings around neck. Patient has a history of self-harm.

EH8D-F15-277

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.

PH-F13-458

Pt has had 4 psychiatric hospitalizations, PHP twice, and outpatient services. Needing RTC and bridging plan. >Discharge from PC Inpatient is 5/11 at 1400, will discharge home until RTC.

Discharge Plan:
RTC-
Avanti (Referral made, declined for admission due to history of aggression)
North Homes (Referral made, 6-8 week waitlist)
Village Ranch (Referral made, pending acceptance)
Gerard (referral made; pending acceptance)
Northwood (referral not made; waitlist over 6 months)
Newport Academy (referral not made; insurance not accepted)
Grafton (CMHCM making referral; though likely doesn’t meet criteria due to no ASD/ID/DD diagnosis)
CRTC (referral placed)

Interim Plan:
Consider PCR (referral not made; insurance not accepted though possibility for a county contract- connecting county worker and PCR)
Continue Psychiatry at Nystrom and Associates
Continue Probation services at Goodhue County
Continue CMHCM at Fernbrook
Establish Family therapy at Nystrom and Associates.
Establish CADI worker at Goodhue County

update as of 6.22.23 – Denied acceptance at CRTC due to aggression and lack of buy in

MHF-M17-1182

Pt is presented to the ED via EMS. Pt resides at a residential treatment facility, where he has been for the past three months. While at the group home, pt reports he became upset by hallucinations and began banging his head. Pt states that he wanted to harm himself and possibly end his life. Pt has hx of baseline S/I and threats of suicide. Pt reports hx of physical and sexual abuse (does not provide further details.) Pt has hx of Borderline Personality Disorder, DMDD, PTSD, GAD and Unspecified Psychosis.

MHF-F18-995

Patient is presented to the ED by EMS from an RTC facility. Patient assaulted another resident and staff members, and attempted to elope from the facility. Patient is under guardianship of Martin County, and is considered a vulnerable adult. Patient has a significant history of abuse, and suicidal ideation. Patient is supposed to follow a low sugar and fat diet due to pancreatitis.

MCR-F12-255

12 year old with trauma history, in-utero cocaine exposure, long history of behavioral outbursts with adoptive parents, participating in CIBS since November and moved to Phase 2 at Gerard in early January, but struggled and was sent to the ED within 48 hours due to severe outburst at Gerard. Appears to have mild autism spectrum disorder (difficulty with transitions, sensory sensitivity, communication struggles), and likely PTSD related to attempted kidnapping and multiple sexual assaults spring 2022. Has started Vyvanse, Prazosin, and Fluoxetine while boarding, and she has had much less extreme behavioral outbursts, has not needed IM or restraint in weeks. Oppositional, but generally can be verbally redirected. Outbursts tend to be tied to her difficulty with flexibility – eg when meals or medications arrive at slightly different times, or one nurse implements different TV rules than another – will start swearing, sometimes escalating to head-banging, but generally is able to calm on her own when given space (intervening/talking/etc once she is starting to dysregulate tends to escalate rather than de-escalate her). Has loving parents and want her in their home, but fear they cannot keep her safe right now. Regarding running – hasn’t tried to elope from peds floor. Sometimes ran from school or home when upset, walks around neighborhood and comes back. Issues at school have been more blowing up and headbanging. Update as of 4/11 still in ED