Archives: Cases

Post Type Description

MHF-M16-3091

Patient presented from Aspen House due to suicidal ideation and aggression. He has stabilized and is at baseline level of functioning. Patient unable to return to Aspen House and does not have an alternative placement he can go to. CPS looking into long term placement options. Presents with aggression and suicidal ideation, elopement.

MHF-M17-3101

Patient presented to the ED from school reporting suicidal ideation. Is able to safety plan for discharge however mother not answering calls and unable to discharge related to this. Historically has been in crisis respite placement after mother refused home last fall from a hospital stay.

PH-F15-2886

Update 2/15/24: DC 2/18 to Gerard on 2/19
Discharge Plan: *Insurance is UCARE MN PMAP * County funding approved 1/30/24*

Residential Treatment – Referrals have been sent to the following facilities- pt is accepted at two- waiting county funding and then admission.
-Avanti (Referral submitted 10/26, DECLINED)
-Gerard Academy (Referral submitted 10/26; Accepted, estimated admission around 2/11)
-North Homes (ACCEPTED; openings in March/April)
-PrairieCare Residential could consider pt in interim should county approve funding

PRTF – Referrals to be sent to the following facilities:
-Grafton (Referral submitted 10/23; pt does not meet exclusionary criteria)
-Nexus East Bethel (Referral sent; only accepting pt’s with MA insurance at this time; will refer once County confirms MA insurance)

Outpatient Services:
Establish CMHCM through Ramsey County (Referral submitted 10/23; intake worker confirmed on 1/10 that a long term worker would be assigned next day, now assigned to Clues- they are completing a full intake for CMHCM now, and working on setting up JST meeting with Ramsey County)

Continue existing outpatient services:
-Therapy/Therapist: Minnesota Mental Health Clinic in Woodbury
-Prescriber/Medication Management: Nystrom & Associates
-MCRC Runaway Intervention Program at Children’s
-PO Ari Tresselt Ramsey County
-Disability Services intake worker: Ramsey County

Case Description
15-year-old female with a history of depression, anxiety, ADHD, PTSD, as well as some behavioral concerns. Pt has had three hospitalizations in the past year, has done PHP, JDC, outpatient.

PH-F13-2494

Primary Recommendation – RTC
-Nexus Gerard, accepted, admission 2/9 at 1000

Other RTC referrals:
-Avanti, declined
-North Homes, declined
-PrairieCare Residential, declined due to aggression
-Northwoods, referral made, declined for RTC

Out-of-State:
-Northwest Passages (Prairieview), county made referral, waitlist 2-4 months
-Lad Lake in Wisconsin, county made referral
-Youth Villages in Memphis; county made referral, reviewing
-Lava Heights in Utah; county made referral
-Falcon Ridge in Utah; county made referral
-Newport News in Virginia; county made referral
-Summit Oaks in South Dakota, county made referral, declined
-Provo Canyon in Utah; county made referral, declined
-Rogers, Hennepin County does not contract/won’t provide funding

Due to declines from QRTP, exploring PRTF options:
-Nexus East Bethel; referral made, not covered by insurance, potential to switch insurance, reviewing
-Northwoods; referral made, waitlist 2+ years

Bridge to RTC/PRTF; if warranted:
Establish CMHCM (Assigned to Kimberly Trembley through Hennepin County, 612-743-1549, waiting for QI approval for funding)
Establish PHP (SW to reschedule if/when appropriate)

Other Referrals Made:
Acadia Treatment Placement Specialists; referral made

Outpatient Recommendations:
Establish Individual Therapy
Establish Family Therapy
Continue PCP at Indian Health Board in Minneapolis

INSURED BY PRIME WEST MA

Presenting Problems: Experiencing school stressors, family dynamic changes, depression, mood lability, SI via ingestion.

MHF-M14-3054

Patient presenting from home due to dysregulation and aggressive behaviors towards family. Parents state they do not feel safe taking patient home until he is in RTC and refuse to discharge from the ED. Has case management, unclear where family is at in process of RTC referrals.

AH-F15-2953

Presented to the ED for suicidal ideation. Boarded in the ED and attempts were made to safety plan with family but family refused to take patient home. Pt has an extensive history of running away, threatening others, suicidal ideation and there have been concerns (not proven) about patient taking advantage of vulnerable peers and children. Patient was admitted to ANW in early 2023 for 68 days. RTC was recommended but patient was declined from programs in MN and nationwide. Family was resistant to taking patient home but eventually patient discharged home.

PH-F17-2993

Discharged to a friends house 2/2/24
Seeking safe living placement for youth ASAP
Patient is a 17 year old Caucasian female with a history of depression, anxiety, and PTSD. Admitted for SI/SIB related to school stress.
Ukraine Refugee and has been self sustaining since arriving in America. Patient was residing in Duluth with a roommate and roommate will not have patient live with her anymore. Patient does not have any contact with family. Trauma from war in Ukraine.
She has a therapist and psychiatrist in Duluth- will arrange to where she is living. Has completed PHP twice in the past. Pt wants to live in the Twin Cities Metro for access to more resources .Insured by UBH MA plan.

*Barrier to Discharge is housing:
The Bridge for Youth (Referral made, declined due to recent suicidal ideation)
Aspen House (Referral made, pending response)
Hope House (Contacted, no available bed at this time)
Brittany’s Place (Referral made, call at noon to review patient)
Von Wald Shelter (Referral made, pending response)
Life House (Contacted, waiting response)
Hennepin County Front Door (Contacted, they directed to call Homeless shelter, thus unable to help with housing/shelter resources)
Lutheran Social Services (Contacted, no available bed at this time)
UMD Campus Housing (Contacted campus housing, they don’t have campus housing for PSEO students)

CH-M14-3045

The patient is a 14 Y year-old male with a history of mild intellectual disability, reactive attachment disorder, disruptive mood dysregulation disorder, ADHD, and anxiety who presented to the ER on 2/1/24 via law enforcement for assessment of aggressive behaviors at his group home. Group home staff report he has caused $10,000 in damage since his admission to the group home on 1/8 which included damaging house property and 3 staff members vehicles. He received a letter of suspension from the group home effective 2/1/24 due to his behaviors.

He has had extensive MH services including foster home placements, temporary placements with his grandmother and biological father, multiple ER assessments for aggressive behavior with suicidal & homicidal statements, residential at Gerard Academy, residential at Northwoods in 2017 for 6 months, partial hospitalizations in 2015, 2016, and 2023, inpatient hospitalizations at Children’s, Miller Dwan, Prairie Care x2, Prairie St. John’s, day treatment, group home placement, level 4 schooling, in home skills, case management, PCA services, psychological testing, speech therapy, OT, and individual therapy. He is currently on a CADI waiver.

He has a long history of behavioral dysregulation including: fire setting (set a blanket on fire at age 7, burned the trim on the bathroom door at age 7), sexualized behaviors (including anally penetrating a younger male step cousin when the patient was 6 along with engaging in oral sex), aggression towards animals (broke dogs hip, hit/kicked/choked, killed family cat & dog), physical aggression (including slamming staff fingers in the door, giving 2 staff concussions, kicked staff in the chest, hitting, kicking, biting, squeezing, grabbing, has thrown his younger sister), property destruction, self injurious behavior (head banging, wrapping shirts around his neck, picking at his skin), elopement from classrooms and his home, stealing, and hoarding food. He was in detention at Lino Lakes a few months ago for assaulting his mom.

It is not felt that inpatient psychiatric hospitalization is indicated at this time due to the chronicity of his behaviors though he is not able to return to his group home at this time.

AH-M16-2983

This child has a history of chaotic/unstable social/living situation. There is a long history of CPS involvement including being removed from his home living environment. There has historically been concerns for medical neglect (mother refusing to consent to treatment/medications, poor/lack of outpatient follow-up) and physical abuse. In recent months he has spent time between living with his mother in Minnesota and his father in North Dakota (parents are divorced). Parental rights were recently terminated and as of ~1 week ago is now under the legal guardianship of Hennepin/County/Sarah Conway (he was reportedly recently physically assaulted by mother). There is a history of trauma with maladaptive coping including chronic suicidal ideation with significant history of self-injury and/or suicidal threats. There is also a history of endorsing auditory command hallucinations of a male or female voice telling him to harm/kill himself. It has previously been noted that he copes with stress/frustration/emotion by acting out/harming self and running away.

Patient is not recommended for inpatient mental health and needs support in establishing safe placement in the community.