1/23/2023 EnchantaVaughn Approved (AM) Upon arrival, client was observed in class displaying a displeasing attitude due to not wanting to be in class or start morning work. Client exhibited poor impulse control, as evidenced by constantly moving out of his seat and being disruptive. Client was reported to have required 2-3 prompts from his teacher prior to being sent to QMHP for further assistance. Client participation in a 15 break. Client was acceptive of redirection with his counselor. (PM) During evening academic hours client was not productive. Client decided to knock down everything in his desk and refused to pick it back up. Client sat at his desk without any work and was not on task. Client was upset and threw a tantrum attempting to get his way or get kicked out on purpose so he wouldn’t have to finish his work. Client was confronted by QMHP and asked why he made such a big fuss when he was in the wrong to begin with. Client was educated that no one is going to allow him to leave when he has not done anything in class. Client was told he could go get water after lunch and recess. Client missed both opportunities and had a meltdown when things didn’t go his way. Client was pulled out of class and confronted about his previous and displeasing behaviors. Client would not own up to anything and continued to look clueless in the face. Client finally opened up about what happened and was honest and upfront. Client apologized to his teacher and returned to class in a more positive mood. (EOD) Client exhibits a poor attitude when transitioning from social setting to academic setting. Client have struggled to ignore distractions and finds himself off task and interrupting others who are trying to learn. Client is learning to respect authority figures by listening to directions the first time they are given. After reviewing ISP, client shows difficulty in following class rules often choosing to act out on purpose. Teacher have reported several times that client refuses to listen. Client displays outbursts when confronted about negative behaviors he displayed during class time. Client was observed throwing objects across the room, making unnecessary noise, and disrupting others. and gets out of his seat, often leaving class without permission, and following behind classmates negative behaviors. Reinforcement was provided to client during psycho educational setting. Client continues to make progress with achieving ISP objectives, due to identifying anger triggers. utilizing coping strategies and managing his symptoms better. Client do not demonstrate necessary skills to meet this objective. (AM) QMHP will teach client necessary coping skills to decrease impulses. QMHP will brainstorm strategies with client and encourage self-monitoring. QMHP will provide mediation and relaxation techniques. QMHP inquired about after school activities. QMHP will collaborate with teacher regarding behaviors and performance. QMHP applauded client for being the bigger person. QMHP modeled language for client to use while in school, home and in the community that will promote pro-social behaviors and effective communication. QMHP reiterated to client the benefits of following the rules and of the privileges he can receive when he does so. QMHP assisted client with identifying privileges that he would like but does not receive due to his negative behaviors; in efforts to stimulate his thinking about cause and effect of his behavior choices. (PM) QMHP provided simple non-verbal praises as client was observed displaying positive classroom behaviors. QMHP trained client in taking steps to prevent problems including displaying positive classroom behaviors. QMHP refocused client as he was observed becoming fidgety and restless. QMHP will review and give feedback regarding ADHD and its causes and affect toward client well-being and academic functioning. QMHP will provide client with support and encouragement. QMHP will monitor, observe, and redirect client behaviors as needed. QMHP will build rapport. QMHP will explore positive self-talk, use instruction modeling, and increase social communication skills with positive reinforcement role play activities. (EOD) QMHP used positive regard as he told the client that he appeared to have positive classroom management in class earlier in the day. QMHP informed client of more acceptable and expected responses to classroom and hallway situations that would normally lead client to be triggered and display inappropriate, negative behaviors while in the classroom or hallway. QMHP will educate client on behavior modification to help client identify what behavior he needs to decrease and avoid daily. QMHP will utilize behavior modification system to aid the client with following directions given by authority figures. QMHP will meet with client daily to discuss progress and expectations that are working and not working in school daily. (AM) Client utilized coping skills and impulses started decreasing. Client was observed strategizing a plan to better himself by writing down his thoughts and feelings and exploring his creative side with arts and crafts. Client was taught to deep breathe until he is ready to process his feelings. Client was reported displaying age appropriate behaviors and was productive and studious throughout the day. Client thanked QMHP for the support and assistance and helping him stay on track with his goals and objectives. Client was able to be redirected successfully. Client stated he would try better self-management as the day pursues. Client was able to contain impulsive actions. Client was observed having positive interactions with peers and mental health professionals. (PM) Client demonstrated responsibility and leadership. Client was acceptive of redirection. Client was able to complete his classwork with less than 3 prompts to redirect his focus to the classwork. Client showed an improvement from previous days experiences in the classroom with client. Client showed interest in building interpersonal relationships with peers and authority to increase support system. Client expressed positive self talk, modeled positive behavior, and good communication skills during role play activity. (EOD) Client learned to avoid negative and defiant behavior and comply to rules. Client was seen following directions. Client joined session to utilize and learn new interventions and strategies. Client expressed appreciation to QMHP by smiling and giving good eye contact. Client expressed that he should receive an incentive for his display of desirable behaviors throughout the day. Client did not engage in any disruptive activities or behaviors. Client was able to maintain his composure when he was confronted with the potential for conflict. Client was observed engaging in several conflict resolution skills with peers by walking away and telling an adult first. Client demonstrated more acceptable responses, avoiding anger provoking situations in the classrooms and hallways.