3/16/2023 EnchantaVaughn Approved (AM) Upon arrival, client was observed walking into class in a jovial mood, as evidenced by his happy tone and demeanor. Client was observed in his seat preparing for morning announcements. Client displays appropriate interaction with peers by sharing and taking turns. Client is monitored and supported for being in class and not seeking a morning break. Client was observed walking quietly in line, one behind the other while transitioning to participate in his gym special. Client hugged QMHP and presented happy and cheerful expressions. Client entered the gym in a positive and safe manner. Client was observed listening and following directions. Client seem to be having a good day and needed no redirection, at this time. (PM) Client transitioned smoothly into the cafeteria for his lunch period. Client is observed socializing with peers and having meaningful conversation while waiting in line to get food. Client exhibits self-control due to not pushing or shoving and avoiding conflict. Client is respectful and polite to staff by saying please and thank you. Client is seen conducting himself appropriately and staying in his seat. Client had one on one with male QMHP to encourage him that he can manage his symptoms without relying on others for support. Client has shown improvement with reducing sadness, as evidenced by him smiling and laughing despite stressful environment. Client joins group therapy without running and jumping on stage and presents low hyperactive and impulsive behaviors. Client works well with others and is seen being a team player. (EOD) Client was reported at the end of the day walking to the bus area. At this time, client proceeded to horseplay and run down the hallway. A few teachers tried to stop him and politely asked client to stop running and to walk in line with his peers. Client refused and ignored prompts. Teacher moved client into the line to try and get him to follow directions without causing a scene. Client began fighting two staff members who were trying to assist and intervene in the process and get him safely to the bus. Client told authority to “get off me” “I’m going to beat your ass”. Client was escorted immediately to the principal office for redirection and to be written up for a two day suspension for his violent and inexcusable language. This is the first time anyone has heard client talk like that. Client was upset and poured all the way to the office, stomping his feet and yelling. Client started crying when authorities made him wait until someone came to pick him up. Mom was called. Mom contacted client’s TDT counselor in hopes that she could help figure out what happened at the end of the day. Mom was aware that client cursed at an adult and would not comply with requests. Mom was frustrated because she did not have transportation and would have to get a ride up to the school. (AM) QMHP welcomed client to school and provided support and encouragement to ensure a good start to his day and to be on track with achieving his goals and objectives. QMHP monitored client individualized behaviors in collaboration with his teacher and other mental health professional. QMHP encouraged client to make good choices and to utilize self calming techniques (i.e. counting and deep breathing) and processed with him that this behavior is acceptable and discussed actions and consequences. QMHP challenged client to continue displaying a positive attitude while employing positive reinforcement when client is able to achieve his goals and objectives. (PM) QMHP provided praise when the client continued to display positive behaviors throughout the day, remaining on task and was very respectful to peers and authority. QMHP isolated client from distractions to decrease disruptive behaviors and to reduce excessive talking in class. QMHP explored the client’s capability to cope with his stressors. QMHP brainstormed how to resolve conflict without engaging in aggressive behaviors. 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. (EOD) 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 encouragment. 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. QMHP will educate client on behavior modification to help client identify what behavior he need 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 greeted QMHP by saying good morning. Client verbalized positive feelings about goals and objectives. Client communicated that he wants to work independently. Client displayed good participation in various settings and was responsive to all instructions, interacting well with his peers. Client responded in a positive manner acknowledging the positive reinforcement that the QMHP provided. Client said he was going to have a good day and decided to practice yoga poses with group member before returning to class. 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 nd count to 10. Client said he went to a boys and girls club program after school and enjoys playing basketball with his peers. Client was reported displaying age appropriate behaviors and was productive and studious in class. (PM) Client said thank you and continued to do what he was told. Client demonstrated responsibility and leadership. Client was acceptive of redirection. 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. As the client has made more of his own decisions, he reported increased satisfaction and function. Client responded well to feedback, interacting well with his peers. Client agreed to behave and communicated a positive attitude when reviewing problem solving and self control strategies. Client promised he would try his best to correct himself when faced with conflict. Client met with QMHP to discuss progress, setbacks, and improvements. Client understood what he needed to change and planned to fix his mistakes.