3/20/2023 EnchantaVaughn Approved (AM) Upon arrival, client was seen entering the school building laughing and playing with his peers. Client greeted counselor and staff and went straight to class. Client was observed giving teacher a hard time. Client displayed frustration and attempted to walk out of class. Client presented defiance toward authority when confronted about his poor attitude. Client was sent to reflect and cool off. Client appeared guarded and offensive due to encountering other challenges in academic setting. Client was reported to have struggled to maintain expectations and could utilize a break. Client displayed attention seeking behaviors trying to pressure other peers into wrong doing. Client was prompted to focus on himself and stop being a trouble starter. Client required to be monitored and assisted with getting back on task. (PM) Client was able to deescalate aggressive and unpleasant behaviors. Client was observed making appropriate choices, due to listening and following directions. Client did not require to be redirected back into class. Client expressed negative feelings when having to finish his work from earlier. Client was very disruptive in class, making loud noises and talking back to his teacher. Client was reprimanded and pulled to the side to correct his behaviors. Client was observed telling his teacher “NO” and refusing to do his work. Client was instructed to see counselor to be redirected. (EOD) Client informed QMHP people keep messing with him and touching his stuff. Client was educated about sharing and social communication. Client was confident he could go back to class and follow directions the first time. Client walked back quietly without hyperactive behaviors. Client was reported on task and following directions. Client made it to the end of the day but was reminded to reflect on what he can do better, due to not meeting any objectives. (AM) QMHP observed client in the classroom in efforts to determine whether he required assistance. QMHP enhanced knowledge of a consistent daily routine. QMHP provided positive gestures to encourage client to verbalize positivity with peers and authority. QMHP inquired about medication regimen to ensure appropriate self functioning. QMHP enhanced food management skills by encouraging client to bring healthy snacks from home as an alternative for lunch. QMHP expressed understanding of self care and personal hygiene. QMHP offered praise and positive reinforcement to enhance self esteem and sense of achievement. QMHP probed sense of empowerment by communicating positive self talk. (PM) QMHP taught basic problem-solving skills. QMHP increased discipline for inappropriate behaviors. QMHP engaged client in conversation regarding his recent choices, progressions, and setbacks. QMHP utilized empathetic listening skills as client expressed his feelings. QMHP processed client’s responses and gave appropriate feedback. QMHP helped client discover positive outlets of expression and using creativity to avoid negativity. (EOD) QMHP reminded client of his goals and objectives. QMHP explored positive behavior options he was exhibiting with client to support his willingness to continue to make good decisions and have positive behaviors in school. QMHP encouraged client to reframe from displaying defiance of authority toward teachers, to talk calmly and express himself without anger and frustration. QMHP talked with client about the importance of adhering to rules and expectations in school, at home, and in his community. (AM) Client smiled as he saw QMHP's positive gestures. Client continued to work on the classroom activity. Client continued to interact in a positive manner with his teachers and classmates. Client nodded in agreement. Client demonstrated understanding. Client discussed the reasoning behind his negative behaviors towards others with QMHP. Client agreed that he would refrain from displaying negative behaviors towards his teacher. Client calmed down and went into his classroom. (PM) Client required additional redirection from QMHP to get him to focus on the classroom assignment. Client was able to settle down and return to classroom activity. Client was responsive to teachers lesson. Client acknowledged that he tends to engage in disruptive behavior when he begins to become frustrated with schoolwork. Client accepted responsibility for his angry outbursts and aggressive behaviors. Client stated he will display anger control and not threaten or intimidate others. (EOD) Client was observed and reported to have been pleasant and cooperative during classroom activities and demonstrated a willingness to adhere to school and classroom rules and expectations. Client listed 3-4 classroom behaviors that he was going to utilize in efforts to remain positive behaviors. Client appeared to be receptive to recieving positive reinforcement from his teacher as demonstrated by his smiling and inviting body language. The frequency and intensity of the client's defiant affect decreased. Client dismissed without incident.