Cases – Page 62 – Mental Health Collaboration Hub

EH8D-M15-414

15 year old male with a history of ASD, ADHD, trauma, and multiple prior psychiatric hospitalizations and residential placements. He was admitted to the hospital after becoming aggressive and self-injurious while at crisis stabilization home. Patient has a history of making significant threats of violence and has been repeatedly sexually inappropriate. He was removed from his home after having molested a younger cousin. Patient will, at times, express remorse for his behaviors while at other times appearing grandiose and narcissistic, with violence perpetrated in response to narcissistic injury.

EH8D-F15-277

ASD, impulse control issues, DD, trauma history, pica, SIB, hits self, headbangs, nonverbal, putting foreign objects in body, smears feces, no family involvement, ward of Stearns County. No family involvement. Communicates w laptop, pictures. OT doing sensory work. Referral across MN, WI, ND, SD. Tennessee declines. Very difficult to place. 2 staff in day and 1 at night. Stearns trying to work on a home in their county. Came from her family care at age 4, to group home until 7, then another group home. She has struggled at her most recent group home. Lots of hands-on care. Willing to re-refer her to Grafton – was declined in July.

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.