1/26/2023 EnchantaVaughn Approved (AM) Upon arrival, client was observed entering class in a uptight mood, as evidenced by him cringing up his face and frowning. Client presented a negative attitude toward his teacher and counselor due to being upset that he had to deal with the consequences of his actions. Client was standoffish and distant, ignoring debriefing and refusing to communicate his feelings when inquired about his break and time off from school. Client avoided all contact and returned to his class to begin his morning work. The client became very frustrated and upset, being mean and pushing anyone trying to stop him from enjoying free time. Client was educated that he has to earn a break and that his education comes first. Client started to have a melt down and exhibited a poor attitude. Client took 5 minutes to calm down and correct his behaviors, returning to class in a hyperactive way by running down the hallway and making unnecessary noises. (PM) While transitioning to lunch with his class, client was reported displaying aggressive and violent behaviors by being combative and aggressively responding to redirection. Client attempted to resist and pull away from staff when confronted and separated from altercation. Client was disrespectful toward mental health professionals refusing to process his emotions by walking off and exhibiting increased frustration. Client ignored prompts. Client was not listening or trying to resolve conflict. Client continued to display a negative attitude. Client decided to get himself together and join his psycho-educational group. Incidents of recent anger outbursts by the client were processed and alternative, adaptive ways to express that anger were reviewed. (EOD) Teacher reported, client required 1-2 prompts of redirection before he followed through. Client displayed restlessness and was unfocused during classroom activities. Client was prompted to refocus 3-4 times by teacher. Client was moved to a different seat in hopes he would regroup and refocus. Client was monitored attempting to refrain from being involved in horseplay and drama. Client prepared for dismissal and announcements, packing his belongings and exiting the classroom. Client did not adhere to QMHP objectives and is expected to come back tomorrow with a better attitude. (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.