3/4/2023 EnchantaVaughn Approved Behavior: QMHP-C met with Anthony and guardian to identify needs that still have not been met or what new changes have transpired since the last report. Anthony did not communicate his feelings at the beginning of session and remained silent while QMHP-C asked about his day and what things he likes and dislikes. Anthony chose to distance himself from the QMHP-C when reflecting on his bad experiences. Anthony uses a lot of non-verbal cues to express how he feels. At this time, Anthony behaviors were viewed as impatient, disrespectful, and agitated. Anthony has issues with understanding the effects of his behaviors. Behavior: Anthony avoids self-reflection exercise when QMHP-C inquired him to deeply think about his reaction to certain situations. Anthony shared his reasons for not following through with instruction, which caused more drama in the house. Intervention: QMHP-C assisted the parent on how to specifically define and identify problem behaviors, identify their reactions to the behavior, determine whether the reaction encourages or discourages the behaviors, and generate alternatives to the problem behavior. QMHP-C assisted the parent on how to implement key parenting practices consistently, including establishing realistic age appropriate rules for acceptable and unacceptable behavior, prompting of positive reinforcement to encourage more positive behavior. QMHP-C encouraged Anthony to utilize positive self-talk as a means of decreasing anxiety and managing frustration when encountering difficult or challenging circumstances. QMHP-C encouraged Anthony not to follow others but to be his own person. QMHP-C will provide strategies for coping and self-control when faced with conflict. QMHP-C will review and give feedback regarding ADHD and its causes and effect to well-being and social performance. Intervention: Instruction, modeling and role-playing techniques were used to help Anthony’s general communication skills. QMHP-C reflected with Anthony on his day, reviewing both good and bad experiences. QMHP-C actively listened to Anthony verbalize that he was agitated today and the reasons to his agitation. QMHP-C informed Anthony that when he is agitated to refrain from taking it out on people and communicate how he is feeling to others, so they know exactly how he is feeling. QMHP-C informed Anthony that when you have self-control, you not only help yourself, but you also positively affect others (physically or emotionally). Response: Anthony appeared to be unresponsive to QMHP-C’s interventions and services that were provided to him during the session. Anthony reported that him and his mom have a closer relationship but have difficulty with communicating with each other when he is upset or has a different opinion than she does. It was communicated by parent that Anthony needs to realize that he has a lot going for himself, but he allows himself to get sidetracked. Anthony increases symptoms associated with his ADHD when transitioning to a healthier lifestyle, due to going back into unhealthy ways. Response: Anthony was able to deescalate once given a new discussion topic, but only minimally participated as he continued to be guarded. Anthony understands that his treatment plan is a behavior contract that will reflect his improvements in the home, but he has to learn to trust it. Anthony stated that he is open to new ideas. Anthony was acceptive of prompts given by his mother and counselor. Anthony agreed to listen to the adult and follow all rules no matter if he sees someone else breaking them. Anthony is reminded to tell an adult if anyone is trying to prevent him from following the rules or pressure him to do bad things.