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.

CH-M16-4938

Patient presented to the ER via EMS on 12/4/24 after an intentional overdose of chlorpheniramine maleate 4 mg / dextromethorphan hydrobromide 30 mg pills in an attempt to get high. He required PICU admission for anticholinergic toxicity and treatment with Precedex related to agitation and history of aggression with anticholinergic toxicity. He has had multiple ER visits for substance use. He was previously admitted here for inpatient psychiatric hospitalization from 11/7-11/15 and was discharged with plans to attend outpatient SUD treatment in Wisconsin. as he was not willing to participate in residential treatment. This is at least his 6th intentional overdose in attempts to get high and his 5th hospital admission requiring PICU admission. He is currently under the emergency guardianship of Mille Lacs County related to a CHIPS petition as he has been abandoned by his mom who moved to Wisconsin. He is also currently on probation with Mille Lacs County. He has not previously been successful with past SUD treatment or inpatient psychiatric hospitalizations. Has very poor insight and follow through- though is able to express his desire for sobriety.

CH-F16-4861

The patient is a 16 year-old female that presented to the ED on 11/11/24 from PHP via EMS after attempting to stab herself in the arm with a pen. This is the same concern which has led patient to having multiple ETC visits and this being her 4th psychiatric hospitalization, all since October 2023 (attempted PHP x2 though was brought to the ER due to stabbing herself with a pen in the arm). Patient was placed on a county emergency protective hold with CHIPS now in place. Patient and parents open to residential treatment.

SL8SHOD-F15-4879

Pt has has multiple psychiatric hospitalizations, is aggressive often, and very unpredictable in her behaviors. She was in an ED for about a month, and was placed at Northwoods residential treatment. She was engaging in self harm. and making threats to jump out of a window. Pt assaulted police who came to remove her from the facility for psychiatric care. Northwoods does not feel that they can keep her or the other patients safe there, so they are not willing to accept her back.

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 supportive 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.

EHS-F16-4792

Patient is a 16-year-old girl with history of mental illness who was brought to the emergency department from port group home where she has been residing for about 5 days. Patient states that she was in juvenile detention immediately prior to going to the group home. Patient has been prescribed psychotropic medicines in the past, but is not currently using any medications. Recommendation from probation officer and county social worker is juvenile detention center or psychiatric inpatient hospitalization pending long term psych placement. However, LE states they can’t bring her to JDC as she has no charges that would make that appropriate at this time without order from probation. Pt has been aggressive, verbally and physically while in the ED. She has eloped on multiple occasions and has attempted to harm herself.

PH-F8-4701

Recommendation is for QRTP or PRTF – either could potentially 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

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

CH-F13-4756

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.

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

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.