Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2025-05-30 Encounter: Spruce text message followed by video call (Google Meet, 2025-05-31) CC: Escalating behavioral and social difficulties at school with risk of expulsion, declining grades, social withdrawal, and concern for depression and self-harm risk. HPI: Parents contacted Dr. Hobbs urgently reporting that Eamon was at risk of being expelled from Breck school due to a pattern of inappropriate language and failure to read social cues — similar to a prior suspension incident. An internal school investigation had surfaced multiple grievances from classmates over the entire school year. Parents noted a pullback from friends approximately 2 months prior, concurrent decline in grades and homework completion. Parents expressed significant concern about Eamon's mental health if expelled and noted a remote but real risk of self-harm. A video call was conducted with both parents on 2025-05-31. Neuropsychological evaluation had been performed earlier in 2025 and was reviewed. Assessment: Eamon's behavioral pattern — difficulty reading social cues, inappropriate language that goes too far, inability to self-regulate — is consistent with neurodivergent profile. Prior neuropsychological testing showed features suspicious for ASD, which was not formally diagnosed. Risk of self-harm assessed as present given circumstances. Multidisciplinary approach recommended including medication adjustment and therapy referral to Rachelle Hansen at Stepping Stone Clinic. Plan: Medication plan established: increase Guanfacine to 1mg AM + 1mg PM; start Sertraline 25mg every morning with plan to increase to 50mg the following week; evaluate response with possible Atomoxetine if ADHD symptoms persist; consider Aripiprazole (Abilify) 1mg only if aggression escalates dangerously. Sertraline 25mg prescription sent to Walgreens on Vernon. Therapy referral made to Dr. Katie Newton and Rachelle Hansen at Stepping Stone Clinic (contact: Amanda Pearl, bhc@steppingstoneclinicmn.com). Consultation with child psychologist occurred; slight preference expressed for Eamon to remain at Breck to work on existing friendships. Eamon ultimately withdrew from Breck; enrolled in Edina schools. Medications: - Guanfacine ER 1mg AM + 1mg PM (increased from prior once-daily dosing) (adjust) - Sertraline 25mg every morning (with plan to increase to 50mg the following week) (new) - Atomoxetine not specified (new (contingent — if ADHD symptoms persist)) - Aripiprazole (Abilify) 1mg (new (contingent — only if aggression escalates dangerously)) Key clinical quotes: "Child psychologist recommended a lot of what I mentioned about going back to Breck, he'd need a plan that he needs to follow and the school needs to follow." "I called in 50mg for him of the sertraline, but changed my mind and changed it to 25mg with an increase to 50mg the next week. Make sure to pick up the 25mg script" "I msg with her today and she's open to seeing Eamon. She has a lot of experience with neurodivergent kids and adhd." Source: Spruce conversation t_27GA7V0S3U800