Cases – Page 41 – Mental Health Collaboration Hub

MHF-F14-3262

Patient brought in to ED by case manager after her group home discharged her due to ongoing behaviors and aggression. Case manager did not have alternate placement and therefore patient now boarding in ED until new placement can be found. Patient in need of shelter or crisis respite placement while longer term placement is found. Awaiting funding.

M8SAS-14-3322

Elopement from family home. HI towards mom, could be safely planned. Child has insight, and doesn’t want to harm mom. CPS notified, meeting with the family. Family ok with group home but county isn’t.

PH-F16-2714

Updated 3/7/224: Admission scheduled for 3/12, discharge from hospital will occur same day
Updated 3/1/24: SW was informed the admission date was moved to March 12th. Scheduled admission to Nexus East bethel for March 12th
Updated 2/28/24: East Bethel Accepted- Admission scheduled for March 7th time TBD, pt remains on the inpatient unit.
Updated 2/15/24- East Bethel Accepted- Opening now first week of March, pt remains on the inpatient unit.
Updated 2/1/24: East Bethel Accepted- Opening mid February
Updated 1/25/24: East Bethel tentatively accepted- opening mid February
Updated 1/11/24: East Bethel will review, if accepted- admission in a few weeks.
Update 1/9/24: Patient has been declined to Grafton PRTF due to her behaviors not being appropriate for current milieu and identified as it would not be therapeutic.

Discharge Plans: PRTF is medically recommended by inpatient treatment team
PRTF: Nexus East Bethel (Referral sent & under review, will likely hear about acceptance decision in January 2024)
PRTF: Grafton (declined on 1/9 due to behaviors not appropriate fit for current milieu)
-(DHS eligibility form for PRTF sent and approved)

Referrals to RTC’s made previously by the county:
-LSS, Sioux Falls: Couldn’t meet pt’s needs, low cognitive function, and FAS diagnosis
-Gerard: Couldn’t meet pt’s needs and FAS diagnosis
-North Homes: CMHCM referred for 35 day evaluation, still working on an acceptance
-Avanti: Pt’s legal guardian did not consent due to distance away from home
-Boys Town, Nebraska: Declined due to FAS diagnosis

Continue with established outpatient providers:
-CMHCM: Des Moines Valley Health and Human Services
-Medication Management: Windom Hospital
-Individual Therapist: Greater MN

This is patient’s 5th psychiatric inpatient hospitalization. Patient’s current admission is due to increased suicidal ideation, behavioral dysregulation, and homicidal threats towards staff and peers at school. Patient has utilized outpatient mental health supports such as psychotherapy, medication management, children’s mental health case management, children’s therapeutic support services, vocational rehabilitation skills, as well as group home and respite care. Patient has engaged in partial hospitalization program twice.

CH-F16-3295

Patient presented to the ER with concerns for SI. The patient has had multiple residential and inpatient hospitalizations and reports they will not be safe if they return home. The patient was discharged from a 13 month stay in residential in January and was discharged from a 2 week inpatient stay in February.

MCMC-F8-1957

Patient is an 8 yr old that has a history of disruptive behaviors at school and at home. She has a history of PTSD ADHD reactive attachment disorder and is on quite a few meds for behavioral health. Apparently she did not sleep well last night and woke up this morning threatening to kill her family members and herself. She continued to escalate at home to the point where mom called psychiatry and they recommended that she come to the ED. She arrives in ED out of control hitting, biting, kicking, and screaming. Mom states that this type of behavior for her has happened frequently in the past but has not had an episode like this for a year or two. She apparently is doing quite well in school and has not had any recent issues. Mom states that when she has these outbursts or crisis that this is typical where she has just a sudden change in her behavior and becomes violent at home. She has not missed any of her medications. Mom denies fever, no recent cough no abdominal pain no nausea vomiting or other recent infections. Mom states that in the remote past she has had a UTI with high fever but typically infections have not caused behavior issues. Patient has an established psychiatrist and has had numerous hopitalizations regarding same issues. Started having visual hallucination yesterday, medication adjustment decreased (risperdal) decreased a couple of months ago with the thoughts that this may be contributing. Biological mother has history of bipolar disorder and grandmother and cousin has history affective schizoid disorder. For the past week her behaviors have been escalating and has been getting harder and harder to negotiate with child. She has threatened to kill her 3 yr old brother and mom concerned for safety of other children in the home.

MCR-M14-3272

Comes from shelter placement (Von Wald) due to aggression. Has probation with court on 3/14/24. Voluntarily placed with Rice County by family due to safety concerns. The CASII score is 6 with strong recommendation for wilderness residential programming, as he has been through a few ‘traditional’ residential programs, so he has some buy-in for wilderness type residential. Looking for shelter vs group home as waiting for residential programming. Parents hesitant to look at out-of-state programs.

PH-F10-2765

Update 2/22/224- Admission to Grafton tentatively scheduled 2/28/24, can discharge interim pending availability.
Update 2/15/24- waiting admission to Grafton end of Feb- date pending- can discharge home interim, pending availability.
Pt is medically cleared for discharge- parents informed county they need to pursue crisis respite for patient.

Discharge Plan:
Residential treatment referrals-
Grafton PRTF (Accepted, next opening tentative end of February)
Northwood Children’s (Referral not sent d/t insurance)
Nexus-East Bethel (Denied d/t not in 6th grade)
Nexus-Gerard (Denied d/t functioning for programming)
Avanti Center (Referral not sent d/t patient’s age)
VOA-Bar None (Referral not sent d/t patient’s age)
Heartland Girls’ Ranch (Referral not sent d/t patient’s age)
Nexus-Mille Lacs (Referral not sent d/t male only programming)
North Homes (Referral not sent d/t patient’s age)
Newport Academy (Referral not sent d/t patient’s age and insurance)
PrairieCare Residential (Referral not sent d/t insurance)
Village Ranch (Referral not sent d/t patient’s age)
Northwest Passage (Referral not sent d/t patient’s age)
Dakota Boys & Girls Ranch (Referral not sent d/t not ND resident)
Rogers Behavioral Health (Referral not sent d/t insurance)

Plan to bridge until residential availability:
Cradle of Love (Accepted, pending county funding)
Northwood Children’s Shelter (CM placing referral)
Kindred Care (CM placing referral)
MCCP Crisis Respite (CADI CM placing referral)
Trauma focused/attachment therapy (Referrals to be placed by CM)

Continue with established outpatient providers:
Ramsey County CADI- (Shakir Consulting Services)
Ramsey County CMHCM- B
PCP- (Entira Vadnais Heights)
OT- Fairview
CTSS- (Nystrom & Associates)
PCA/companion care 3x/week

ADYC-M14-1768

Update: 1/19/24 Pt. still looking for placement.

15-year-old male looking for a group home and residential program. Children’s Mental Health Case Manager has tried everything, and doors are being shut. Client has a physical aggression, verbal aggression, history of PTSD and sexual abuse. Client has experienced abuse from biological father who is in still in the home, and sexual assault that happened possibility of more than one with an older cousin sister. Client mother is giving up on hope on trying to help her child. Client is struggling at home, school, and community. Children’s Mental Health Case Manager has been trying everything to find a placement for him. He’s been going in and out of the ER like every two months now. Children’s Mental Health Case Manager still trying to offer support the way she can by being there every hospital stay, seeing client like twice a month, and having mom keep her on speed dial to talk to client.

Because of experiences, client is chemical dependent on marijuana, perks, and opioids.

HCMCECC-F16-3230

**For follow up please contact Stacy Stickney-Ferguson, HCMC pediatric social worker at 612-873-2259 or email stacy.stickneyferguson@hcmed.org

Brought in my EMS after being kicked out of the Bridge for Youth shelter- tripped over 4-foot fence and broke right ankle while eloping. Has been staying with friends. Grandmother is guardian and lives in North Carolina. Returned to MN in Foster Care in December of 2023. Has a case manager through Brown County, Denise Kamm (507-276-3411). Denise reports patient has run away from multiple group homes, foster homes, and shelters. Denise the CM saying she has exhausted resources, places, and shelters for this patient. Denise says trying to find a shelter but likely not going to be able.

Currently in the HCMC Emergency Department but is pending admission up to our pediatric floor for boarding until placement can be determined. Please see above contact information for follow up. Has a broken ankle that is splinted and in a stirrup brace, she will have crutches on discharge. No pertinent medical history noted. High elopement risk.