3/20/2023 EnchantaVaughn Approved Behavior: Upon arrival, Client observation was viewed as lazy, inactive, and careless, as she displayed tired and immature reactions. Client had a hard time following direction and struggled with listening to QMHP-C while expressing different mood swings. Client showed a lack of empathy and consideration for QMHP-C and the session. Behavior: During the second portion of the session, Client displayed a poor attitude toward mental health professional due to personal conflicts and external distractions. Intervention: QMHP-C examined and evaluated Client responses to feedback. QMHP-C focused on Client’s ISP objectives and what she needs to do in order to achieve them. QMHP-C offered new ways to heighten Client awareness of her ill-mannered behaviors, as well as helping her with functioning more constructively within her daily life. QMHP-C encouraged Client to present healthier habits and routine by challenging herself to make better choices and try new things. QMHP-C questioned Client on the statements she made about having difficulty expressing her feelings. QMHP-C facilitated an activity on emotions to assist Client to be able to identify and positively express them. QMHP-C reviewed strategies targeted at helping Client to work through her difficulties expressing her anger. Intervention: QMHP-C educated Client with relaxation strategies such as deep breathing and counting to 10 to decrease Client’s aggressive behavior. Client was encouraged to use good judgement, and respect authority figures. QMHP-C provided Client with a release of energy by walking to get a drink of water to help her relax and decrease her hyperactive behavior. QMHP-C used appropriate behavior modeling by pointing out a peer that is demonstrating positive behavior to decrease Client’s impulsive behavior and encourage her to use self-control. QMHP-C assisted Client in exploring other coping strategies that she had previously used to solve other problems. QMHP-C utilized behavior modification strategies including removing Client from the stimulant environment in efforts for her to reduce impulsive behaviors. QMHP-C modeled proper positive behavioral expectations for Client to administer additional layers of support and display an understanding of expectations. Response: Client was reluctant and hesitant to talk about her challenges in the home. Client verbalized low feedback with responding to QMHP-C evaluation of her. Client did not offer any forms of social or friendly rapport back to QMHP-C, remaining unemotional displaying an unresponsive and nonchalant attitude throughout the session. Client took over 30 minutes to reduce hyperactive behaviors. Client became more impulsive and started to cause more disruptions. Client explored numerous ways to express her anger and negative behaviors during the role play with QMHP-C. Client stated her difficulties in certain situations but displayed a negative tone. Client required assistance as she was unable to lower her voice. Client showed lack of concern and empathy in response to positive cognitions. Response: Client did not express verbal communication when she was prompted to apologize. Client displayed difficulty remaining in her seat going into the next intervention. Client listed 2-3 social behaviors that she was going to utilize in efforts to remain positive behaviors. Client appeared to be receptive to receiving positive reinforcement from her teacher as demonstrated by her smiling and inviting body language. The frequency and intensity of Client's defiant affect decreased. Client continued to work on the psycho educational activity. Client required additional redirection from QMHP-C to get her to focus on the assignment. Client was able to settle down and return to activity in a calmer manner. Client was responsive to lesson. Client reduced impulsive behaviors after 2-3 prompts from her mother and QMHP-C. Client began to show greater control of her anger heading into the second half of session.