8/24/2023 EnchantaVaughn Approved Behavior: When QMHP arrived, client was upset but was able to recollect and focus on her therapy. Client agreed to practice listening skills at home and be more open with her emotions instead of shutting down and avoiding her family. Client continues to struggle with working independently, relying heavily on support from QMHP and mom. Client presented outbursts and attempted to shut down, refusing to process or debrief in the session. Behavior: Client withdrew during the session as she became quiet and began to display restless behaviors. Client continued to demonstrate quiet behaviors during the session. Client stated that sometimes she has a hard time accepting constructive criticism and takes her frustration out on others. Client talked through her problems and discussed that she felt a lot better knowing that she didn’t have to do it alone. Client was able to calm down and channel her energy by helping QMHP with the final psycho social activity. Intervention: QMHP monitored, observed, and redirected client behaviors as needed. QMHP reflected with client on her choices, reviewing both good and bad experiences in the home. QMHP intervened to prevent the negative behaviors from escalating and to promote good energy. QMHP physically redirected client to an alternative activity to keep her mind in a productive state so that she wouldn’t become stagnant or complacent in her own space. QMHP provided guidance on alternative behaviors and clear instruction on the alternative behavior. Intervention: QMHP encouraged client to resist negative behaviors in efforts to refrain from requiring to be redirected by her mom so many times. QMHP utilized empathetic listening skills as client expressed her understanding of her mental illness. QMHP reassured client that she is there to help resolve any issues she has, including her having difficulty completing simple tasks in the home, school, and community. QMHP informed client that refusing to do her work is not acceptable. QMHP encouraged client to be mindful of others personal space and knowing when to set boundaries and walk away. Response: Client complied and went over ISP objectives with QMHP with no resistance. Client was receptive of QMHP interventions, as seen implementing them right away following negative conduct. Client was observed intervening and regulating her emotions without displaying irritable, distant feelings which helped her come out of her comfort zone. Client knows what she needs to do to improve socially and academically. Client is making progress with expressing her feelings and showing others respect and courtesy by talking with appropriate tone, initiating conversation with parent, and waiting for her turn to talk. Response: In the second half of the session, client acknowledged QMHP's redirection after 3-4 prompts. Client stated okay and began to perform in a more enlightened and friendly way. Client proceeded to reduce the aggression in her voice while communicating her thoughts with her counselor. Client accepted suggestions from QMHP as evidenced by the client smiling and saying thank you. Client expressed to QMHP that she understood the importance intensive in-home and promised to contribute to each session.