Archives: Cases

Post Type Description

MHF-M11-1283

Pt is presented to the ED via EMS by his adoptive mother/aunt for aggressive behavior. Pt got angry after his family arrived home, after a parade, without any candy for him. Pt began to punch holes in the wall, beat his adoptive mother with shoes, throw things at family members, and threaten to kill them. Pt currently lives with his aunt and uncle who are also his adoptive parents. There are five other children in the home. Pt’s birth mother’s parental rights were terminated in 2020 due to child neglect. Pt carries current diagnoses of ADHD, other specified trauma and stressor related disorder, and other specified neurodevelopmental disorder. There is a strong suspicion of fetal alcohol spectrum disorder, although a diagnosis has not been given due to inability to confirm maternal alcohol use during pregnancy. There is genetic loading for mood disorders and substance use. Pt was most recently in a residential treatment facility for six months, and discharged home about a week ago. Pt has a history of inpatient hospitalizations for his aggression with his last hospitalization taking place from 10/26-11/09/2022.

PH-F13-458

Pt has had 4 psychiatric hospitalizations, PHP twice, and outpatient services. Needing RTC and bridging plan. >Discharge from PC Inpatient is 5/11 at 1400, will discharge home until RTC.

Discharge Plan:
RTC-
Avanti (Referral made, declined for admission due to history of aggression)
North Homes (Referral made, 6-8 week waitlist)
Village Ranch (Referral made, pending acceptance)
Gerard (referral made; pending acceptance)
Northwood (referral not made; waitlist over 6 months)
Newport Academy (referral not made; insurance not accepted)
Grafton (CMHCM making referral; though likely doesn’t meet criteria due to no ASD/ID/DD diagnosis)
CRTC (referral placed)

Interim Plan:
Consider PCR (referral not made; insurance not accepted though possibility for a county contract- connecting county worker and PCR)
Continue Psychiatry at Nystrom and Associates
Continue Probation services at Goodhue County
Continue CMHCM at Fernbrook
Establish Family therapy at Nystrom and Associates.
Establish CADI worker at Goodhue County

update as of 6.22.23 – Denied acceptance at CRTC due to aggression and lack of buy in

MCR-M14-1090

14 year old with significant trauma history, ward of Olmsted, previously residing in kinship foster placement but repeatedly eloped. Refuses to participate in therapy as an outpatient. Verbally defiant at times but no significant aggression toward caregivers; can have reactive physical fights with peers at school but not unprovoked. County has guardianship since November 2022, but he does have actively involved aunt/uncle who will be the targets for permanency planning.

MCR-F16-279

History of PTSD, RAD, ODD, mood issues, adopted at age 6, multiple foster placements prior. Struggling for many years, 4 suicide attempts fall 2021, placed in a shelter in St Paul and targeted by a sex trafficker and eloped for 2 weeks, repeatedly assaulted, given drugs. Admitted to SEY program at Heartland Girls Ranch March 2022, unsuccessfully discharged October 2022 after assaulting a peer. Receiving school-based CD services through ALC, but no mental health services. Case manager working on residential but no success. Admitted to hospital 1/23/23 after massive OD triggered by breakup. Medically cleared 1/27, declined by all inpatient psych because of assault history. Suicidality has resolved, no behavioral issues. She eloped from the peds floor on 3/16/23 and had to be brought back to the ED by law enforcement. Hospitalization not recommended; county looking at outside placement options.

MHF-M16-1239

Pt is presented to the ED via EMS due to possible ingestion of cold medications. Pt’s father had called 911, reporting patient’s presentation as being confused and “high” on drugs. Pt admitted to taking pills (unclear about the number of pills) in order to get high. He denies that this was a suicide attempt, and currently denies any suicidal ideation. Pt denies recent self-harm, but has a hx of self-harm over one year ago. Pt lives with his father during the week, and mother on the weekends. Medical records indicate the following history: He has a history of major depressive disorder, generalized anxiety disorder, and substance use disorder. He had been evaluated in the ED for close monitoring in the setting of altered mental status secondary to presumed toxic ingestion of unknown substances, and has a history of multiple inpatient psychiatric admissions. Most recently admitted in March 2023 due to “ingestion/inhalation of multiple substances, including dextromethorphan and benadryl”. Pt has a history of residential treatment, and has a hx of substance abuse for several years and participating in both inpatient and outpatient treatment.

MHF-F6-1228

Pt presented to the ED via EMS after jumping out of her mother’s car into traffic, stating that she wanted to die. Pt lives with her mother and brother, who moved to MN from TX in December of 2022, to escape domestic violence and pervasive sexual trauma. Pt has a history of significant sexual abuse from their father, including sex trafficking. Pt has been screaming, kicking, and running outside, placing the family’s housing at risk.

MHF-M16-350

Patient presented from group home with aggression, breaking things. He has chronic aggressive behaviors. He was admitted to Hawthorn Center state hospital in 6/21-7/22. During his admission, patient’s mom passed away and he was placed in Beacon Crisis Residence. Patient had a prolonged stay in UMMC ED September 2022-October 2022 and was discharged to RTC in TN. Patient was discharged from the facility in TN due to concerns with the facility and was returned MN. He was brought from the airport to Children’s Hospital on 1/11/23-1/13/23 and was discharged and immediately brought to UMMC ED by parent and county worker. He was in UMMC ED 1/13/23-2/7/23 and was started on Zyprexa ODT due to cheeking medications. He was eventually discharged to crisis home. Patient then returned for further concerns of medication non adherance and exacerbation of psychotic symptoms. He had inpatient admission on Inpatient mental health at UMMC from 2/15/23-3/12/23. Patient was discharged to respite house with additional wrap around services. Patient has had 4 ED encounters since that time. Patient discharged to his group home on 5/1/23 and returned to ED on 5/2/23 due to aggressive behaviors. Patient is unable to return to group home.

MHF-M17-1182

Pt is presented to the ED via EMS. Pt resides at a residential treatment facility, where he has been for the past three months. While at the group home, pt reports he became upset by hallucinations and began banging his head. Pt states that he wanted to harm himself and possibly end his life. Pt has hx of baseline S/I and threats of suicide. Pt reports hx of physical and sexual abuse (does not provide further details.) Pt has hx of Borderline Personality Disorder, DMDD, PTSD, GAD and Unspecified Psychosis.

SD8SC-M8-1067

Client in process of completing DA through our Assessment Team so not all information is complete at this time. The system has not been helpful to this family for a long time and they are struggling to maintain his adoption. He has low IQ, largely non-verbal with few receptive language skills (communicates by pulling people to things), approved for residential treatment over 3 years ago – not accepted to any placement so far, has a DD case manager and “unlimited” waiver. Historical diagnosis include: ASD, PTSD, GDD, and ADHD. He has significant behaviors including hitting, pushing, stomping and fecal smearing when told “no” or denied access to something even with a body suit. Behaviors of some kind occur multiple times daily. He is aggressive toward all family members but the fecal smearing happens more in response to mother. He has been declined services at over 20 PCA agencies, is not successful attending outpatient therapy services or medical appointments (aggressive to providers and engages in behaviors), no respite providers will accept him, and he has been declined admission to psychiatric hospitalization and most outpatient providers declined him for services as his needs are “too great”. The family includes 4 other children many with special needs, and 2 are medically fragile. The family is to the point where parents are considering having one parent live with this child and the other 4 with the other parent for safety reasons.

6-23-23 client is now linked to Fraser and LSS for possible additional in-home wavier paid supports/services to decrease the likelihood of a boarding or out of home placement

MHF-F13-251

History of Autism Spectrum Disorder, prenatal exposure to alcohol, cocaine, and heroin. Pt is cognitively delayed and has limited verbal skills. Recently attempted group home, assaulted staff after 1 day; guardian took patient home. Pt presented to ED after assaulting guardian in the home and guardian does not feel safe with patient returning to home, is planning to relinquish custody. In ED, patient is disrobing, throwing feces, assaulting staff, in seclusion. Behavior is chronic and has been seen at similar level historically. Prescribed Zyprexa, Abilify, Clonidine, Thorazine, Atarax, Trazadone.
4/7/23-4/13-23 – Discharged to home.
5/13/23-5/19/23 – Discharged to home.
5/23/23-5/26/23 – Discharged to home.
5/27/23-6/7/23 – Discharged to home.