Update 1/24- County funding for RTC denied on 12/26, now following alternate recommendations as determined by the county. DC was scheduled for 1/4, due to parent request, rescheduled for 1/5.
DISCHARGE PLANS:
Hospital Recommendation is RTC-
Avanti -referral made, accepted, intake 12/28/23
North Homes- referral made, reviewing, no immediate openings
Gerard- referral made, accepted, intake 1/9/24
Alternate Plan:
Mobile Crisis Team (Referral sent by CMHCM)
Day Treatment- Christian Family Solutions (Referral sent by CMHCM, waitlist to about 1/19/24)
Intensive family therapy (Referral to be sent by CMHCM)
PCP- Marlene Jilek, APRN (Mankato Clinic)
Therapy- Claire Alexander, MS, LPCC at PrairieCare Mankato (Availability as soon as next week, requests patient guardian call to schedule appointments)
CMHCM- Nicole Wigern (Blue Earth County)
Presenting Problems: Major Depressive Disorder, PTSD, SI/SIB, Inpatient for the third time this year, has done PHP twice this year
Patient is presenting to the ED for the following concerns: suicidal ideation, depression. Patient reports he tried to kill himself last night by stabbing himself with a dull pencil. Patient reports suicidal and homicidal thoughts that have increased in last two weeks. He has been at North Homes for three months. He was discharged to North Homes after a hospital stay at UMMC in September for SI. At North Homes, the patient escalated and told staff he was suicidal. He took the batteries out of a remote and tried to swallow them. He also tried to stab self with dull pencil. He became combative and needed to be restrained and then kicked staff in chest and tried to kick another staff. Patient then stated he would find each clients personal info and then take pictures of other clients after he killed them and send to parents. Patient told staff he would kill other clients and himself.
Patient reports long history of MH including PTSD, MDD and GAD. Patient has been hospitalized 2 x in past 6 months. Patient reports history of trauma. Patient states he has history of SIB.
This child was previously on the HUB as MCR-F13-2165.
Returned 3/21/23 to Mayo ED after discharging to home on 1/9/23. Was at SERCC, brought to ED for ingestion of metallic items there. Had been in ED > 24hrs now admitted to inpatient unit to monitor his GI. Was in Fernbrook Day treatment. Transitioning to male. ED more related to PICA ingesting nonfood items regularly – batteries, tacks, chargers, etc. 1:1 support for keeping from self-harm. is at home with mom when not in day treatment program. Needs more than day tx support, needs 24 hr. Concern for medication mgt. Absence of psychiatric support. Has been in Prairie Care twice summer 2022 – dc’d for noncompliance. He describes a strong compulsion for ingesting things. He doesn’t claim it to be self harm. when he goes to Mayo, he claims that its a suicidal attempt. Was at Gerard in May and struggled, then inpatient at Children’s in summer. Then came back to Fernbrook. over 30 presentations to ED at Mayo and Metro for self-harm and ingestion. Some are SI. Ingested batteries, screws, chargers, needing med tx/attn. Spent 12 days at Gerard in May, 3 ingestions and elopements while there, they had to dc him as couldnt meet his needs. Just gotten a CADII waiver to help mom supervise at home. Case conf. yesterday – the hope would be that he could be in a residential settings with the understanding that he will ingest things. Licensure issues. He has been declined as he fits everyone’s exclusion criteria. When he is out of crisis, he’s lovely. bright, intelligent.
Seeking ideas for other options for keeping him safe. Consider Gerard? Prairie Care? (have both turned him down). Jennifer Butler working on this case. suggestions to mitigating risk? clear all things from units, reintroducing slowly when able. Mayo has been able to mitigate risk with using paper crafts, crayons, etc. Haven’t had an ingestion for a few months – has a sitter a Mayo though as he’s on a medical unit. Functional behavior analysis? Hasn’t had one, due to instability. Hopefully he will have one soon. *** Discharged to home on 4/3/23 with 24/7 PCS care.
1 week prior to ED pt was found tied up in her home by her parents. She was taken to Children’s and placed into foster care. Mother didn’t believe in Western Medicine and was using THC and tying her up to treat pt’s agitation in the home. Pt presented to Regions ED from the foster home due to increase agitation and needing more staff support, pt has severe ASD, DD. Hx of violence towards self and others. She can’t eat without someone holding her hands because she hits everything away. She is mostly nonverbal, only knows a few words.
Has been in the ED for over 165 hours, she has been started on medications and we have seen a decrease in her level of agitation. She has been more cooperative with ADLs, takes medications, and eating meals w/ assist and staff have been able to redirect her before a code needs to be called. Pt has been declined by all inpatient facilities at this time. CPS in Anoka is current guardian. Has DD waiver. Regions providing sensory support, weighted blankets, stuffed animals, music. Needs 24/7 support.
Mom currently in custody.
SI, self-harm, history of suicide attempts, past (not current) substance abuse, fetal alcohol syndrome disorder (normal IQ), reactive attachment disorder.
Denied from village ranch due to Mental Health concerns, Heartland due to behaviors, Little Sand denied due to recent suicide attempts, Greater MN denied due to hygiene concerns. Just completed res tx in Oct. Cadii waiver? Has been screened for the waiver. Jen Butler will connect. Hunters Place and Port are reviewing. UPDATE FROM 1/12: Accepted to North Homes Eval Program for 1/18/23
FASD, PTSD. Has lived in group homes. LSS home until last summer when there were allegations against staff and drank bleach for self-harm. Series of Shelter placements, ext. ER placements. Admit to Prairie care 2 mos ago, End of Dec. came to ANW ED. Rec group home funded by DD waiver. 18 in March. Leech Lake will be going for guardianship when she turns 18. Had done well in group home setting, but recently had a younger roommate that transferred, and became very upset after that.
SI, SIB, high risk behaviors (running away, substance use), foster family found burn marks on her sheets. Has been in 7 foster homes over last 2 years. CPS/foster family found notes referencing suicide in her room, SIB. ETOH use, THC use, deceitful, dishonesty. School staff and therapist was shocked, presents as a well-adjusted child. As in school. Struggles to connect with people. Makes poor choices with her sister. Likes to burn candles and leaves them, does she forget or is it intentional. Burn marks on sheets, lighter in room. Admitted because of SIB/SI notes. Struggling to find a foster family – from small area so other foster families hesitant to take her in. Question as to if residential treatment is appropriate? At this point, foster care or shelter care is rec. Was formerly at a partial program at Prairie Care.
This child is a ward of Steele County with Significant aggression and significant trauma. Mom died in 2019, Dad in group home for TBI. Suicidal/homicidal statements, thoughts. Tried to place with 19 yo sibling which lasted for a month, but brother doesn’t think he can keep him safe any longer. Came from SERCC to Mayo ED when he escalated to a point that they couldn’t care for him. He has been doing OK since he got there but has had a few instances of escalating to the point of needing to be restrained with holds and sedation. Struggles with conspiracy theories, as his mom died of a septic kidney infection, but he believes that her boyfriend poisoned her. He is fearful of being poisoned; he won’t sleep without someone watching over him. Not safe for a group home at this point.
Patient is presenting to the ED for the following concerns: self-harm. Patient has a history of self-harm, through primarily biting his arm, punching other things or scraping himself with a tack. Mom reported that today was the first time he self-harmed with a blade. Mom reporting increased aggression in the home and at school and feels that patient needs inpatient. Mom explained the patient is in a level 4 school setting. He recently did PHP at Prairie Care and was discharged after three days due to concerns about aggression and inappropriate sexual comments. Mom shared the patient has made comments about wanting to strangle others.
Mom explained that patient may already be on the waitlist for the Village Ranch residential treatment in Cokato. They are also exploring North Home in Bemidji. Mom reported that patient has been diagnosed with ADHD, ODD, PTSD and ASD. She also wonders about FASD due to his biological mothers, drug and alcohol use. Patient was adopted at age 7 by his adopted mom and adopted dad. Mom was his PCA in his last foster home for one year before adoption.
Patient is presenting to the ED for the following concerns: verbal agitation, physical aggression. Patient currently lives with foster mom and dad, mother will soon be entering IRTS but intends to take son back afterward. Patient has been not been taking his medications and engaging in behavior that puts himself and others around him in danger. Patient has high sensory needs that if not attuned to will begin to hurt self and others. Patient was last admitted on 10/20/23 and was inpatient until stabilization. Patient has been attempting to “scratch out” his eyes and turn off devices of his fellow foster care children. Pt is diagnosed with Autism Spectrum Disorder and significant early childhood trauma. Collateral reports that when pt takes meds, he can calm down. Patient is non-verbal.
