Panic, School Refusal, and a Request for Homebound Instruction

The first priority is risk assessment and scope of practice. Jasmine denies suicidal ideation, but I would ask directly about suicidal thoughts, plan, intent, access to means, self-harm, and past attempts, and I would assess whether the eating restriction has become medically concerning. I would not assume that panic explains the restricted eating; I would ask about body image, weight change, and whether she has seen a doctor, and I would involve the school nurse and parent for a health referral. I would explain confidentiality and its limits at the start. Given the panic symptoms, I would assess triggers, avoidance, frequency, and the function of staying in the restroom or going home. I would also screen for depression, trauma, and social stressors. If she discloses suicidal ideation or medical danger, I would follow the district’s risk protocol, notify the parent, and connect her to emergency or outpatient care. I would not diagnose an eating disorder or panic disorder; I would describe symptoms, recommend a medical evaluation, and coordinate with an outside therapist if one is involved. I would make a safety plan with her, identify a trusted adult and a calm-down location, and clarify that I will not keep serious risk secret.

The plan should be exposure-oriented and gradual, not rest-based. I would use a brief CBT-informed approach within my competence: psychoeducation about panic, identifying bodily sensations and catastrophic thoughts, breathing and grounding skills, and then graduated exposure to the hallway and third-period setting. Because I have only 30 minutes weekly, I would build in teacher and counselor supports: a pass to a designated calm-down space with a time limit, a check-in with a trusted adult before third period, and a step-by-step return plan that increases time in class. I would set measurable goals, such as attending third period for 20 minutes by week four and 40 minutes by week six, with daily attendance data and self-rated anxiety ratings. I would avoid homebound instruction as the default because it would remove exposure and may strengthen avoidance; if homebound is considered, it should be time-limited and paired with a return plan. I would also consider a Section 504 plan for accommodations such as extended time, a quiet testing space, and permission to leave class briefly under a structured plan. I would coordinate with the family, teachers, and outside provider, and I would monitor progress weekly rather than waiting for grades to change.

I would acknowledge the assistant principal’s concern about absences and the mother’s desire to protect Jasmine, then reframe the decision as a least-restrictive-environment and treatment-planning question. Homebound instruction is a restrictive placement; it should not be used simply because attendance is poor, and for anxiety it can become an institutionalized form of avoidance. I would ask the team to consider a time-limited trial of school-based supports with a clear attendance and return-to-class plan before approving homebound. I would explain to the mother that Jasmine says she wants to return and that a gradual plan with safety supports is more likely to help than rest at home. I would convene a team meeting including Jasmine, her mother, the assistant principal, the school counselor, a teacher, and the nurse. The meeting should produce a written plan with roles, timelines, attendance goals, crisis steps, and a review date. If the mother insists on homebound, I would document the discussion and explore a compromise such as partial-day attendance with a therapeutic pass. I would also discuss a 504 or special education referral if the anxiety substantially limits a major life activity or educational performance, and I would ensure that Jasmine’s voice is included in the decision.