Archives: Cases

Post Type Description

PH-F16-1316

UPDATE: Pt discharged home with improvement of some symptoms and wraparound services. CABHH and PRTF referral stand.

16 yo adopted white gender fluid/nonbinary adolescent with Albinism of Otter Tail County. No hx of attachment concerns. Delay with speech. Some historical cognitive and attentional concerns. No substance use. Expressing SI, SIB urges and lability. Hospitalized twice in early 2023 until admission to PrairieCare RTC on 4/11/23, needing a higher level of care, admitting to Inpatient 4/18/23. Patient has severe lip biting when dysregulating causing multiple lip lacerations, requiring suturing.

DISCHARGE PLANNING EFFORTS:
Primary Recommendation is CABHH; Referral made, on waitlist.

Residential Treatment or PRTF consideration:
-Avanti; referral made, declined due to aggression and seclusion history
-Northwoods; referral made, on call back list, 9 month waitlist
-North Homes; referral made, accepted, waitlist out to mid-summer/fall 2023> still would need QRTP funding*
-Gerard; referral made, reviewing, declined due to staffing needs in educational settings
-CRTC; referral made, declined
-Heartland Girls Ranch, county SW to refer
-Village Ranch, county SW to refer

PRTF:
-Grafton, referral made, denied, can reach out in a couple months for re-review due to their staffing
-NorthWoods, waitlist 12 months
-Leo A Hoffman; referral not made, only accepting Male patients

Out-of-state RTC:
Guardian declines referrals for out-of-state placement at this time

*QRTP funding is not in place- Parent does not consent to Relative Search which Otter Tail County uses in the QRTP pre placement screening process.

PH-F10-1534

UPDATE 8/31/23: Discharge to family with wraparound services planned for 8/31/23 at 1300 while waiting next Gerard admission (tentative late September) as QRTP pre placement screening has now approved.
UPDATE 8/24/23: Pt remains accepted to Gerard, next admission now late September. QRTP pre placement screening team approved 60 days RTC as of 8/24/23. We will discharge home with wraparound services while waiting RTC admission.
UPDATE 8/8/23: Pt is accepted to Gerard and can admit tentative 8/21- pending preplacement screening/QRTP approval from Hennepin County.

10- year-old female with a history of anxiety, depression, social difficulties, anger and trauma. Aggressive behaviors and increase in suicidal ideations. Has participated in PHP, individual therapy, and psychiatry. Insured by BCBS PMAP.

DISCHARGE PLANNING EFFORTS:
Primary Recommendation: Residential Treatment.

Patient recommended to return to home/community with wraparound services while waiting for Residential. Discharges have been attempted, patient threatened grandmother. (Patient cannot return to mother or to grandmothers- CPS involved)

Wraparound:
Establish CMHCM (Referral to be made internally from CPS case worker)
Establish CTSS (Referral completed to Summer Counseling, reviewing; Referral completed to MN CarePartner, on waitlist, 2-3 months)
Establish FT (Referral completed to Family Attachment Center and Empower)
Continue Individual Therapy with Rachel at ELEOS Psychology Center
Continue Psychiatry with Catherine McCormick-Deaton, DO at Allina Health-St. Paul
Continue PCP at Allina Health-Maple Grove

Residential, when available due to waitlists*:
Consider Nexus-Gerard RTC (Declined due to aggression, being re-reviewed currently)
Consider Northwood Children’s RTC (Referral sent, waitlist 6-9 months)

*Juvenile Treatment Screening with Hennepin County needed to request funding for QRTP/RTC level of care. CPS worker aware of request.

Estimated length of stay:
Patient is medically ready for discharge as of 6/30/23

AH-M14-302

UPDATE 8/24/23 – remains at Abbott Northwestern.

ASD, lower functioning, home bound schooling, aggression towards family and staff. On wait list for MCCP crisis bed, out of state referrals being looked at. As of 4/11/23, still waiting on placement. got the waiver for group home, but no providers available.

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

CH-M8-1340

Patient has a history of ADHD, DMDD, and trauma. He presented to the emergency trauma center with foster provider following an anger outburst where he hit himself. Patient also made comments about killing himself and threatened to kill another child in the home. Patient is unable to return to foster home.

MCR-F15-1269

UPDATE: Mom wouldn’t sign ROI for CRTC to she still awaits placement.

Patient is a 15 year-old with a history of PTSD, MDD, and GAD. She has a history of five previous psychiatric hospitalizations and one premature discharge from residential treatment this past spring after restricting her food and water intake (start of present hospitalization). Nutritional intake has continued to decline to the point of needing tube feeds to meet daily nutritional requirements, with symptoms more closely resembling anorexia nervosa at this time.

Patient is already connected with medication management, county case management, CPS, and psychotherapy.