4/17/2023 EnchantaVaughn Approved (AM) Upon arrival, client was observed coming into the school in a calm and peaceful mood, as evidenced by his facial expressions and waving to peers and authority as he passed by them in the hallway. QMHP gave client a thumbs up for expressing optimism and displaying appropriate manners on the way to class. Client grabbed breakfast and was quiet during announcements, making sure to say the pledge of allegiance and remain silent. Client was motivated to go to class and have a good day. Client was seen joining his class and settling into his morning assignments. Client seemed to be enjoying his morning, communicating positive social behaviors (e.g. keeping his hands to himself and giving his peers personal space). Client displayed good active listening skills. Client was encouraged to express himself and be confident about his answers. Client exhibited a positive attitude, and this was monitored during non-stressful and stressful moments in all settings. Client displayed calm and peaceful expressions, lining up with his class to go to lunch. (PM) Client appeared to be a positive mood heading to lunch, as evidenced by his cooperative behaviors in line and displaying appropriate manners. Client interacted well with his peers, initiating meaningful conversations and playing safely. Client was observed cleaning up his trash and preparing for psycho social. Client was observed following directions and ignoring distractions on stage. Client participated in group exercise and was observant to his surroundings (e.g. recognizing when to walk away or mind his business). Client displayed a good attitude towards peers and authority and needed little to no redirection, at this time. Client was able to complete activity, return to class, and transition into the next activity without incident. Teacher reports giving client support and encouragement to enhance his self-esteem. Client was educated with mental health skill building and given the resources he needs to practice the appropriate behaviors. (EOD) Client exhibited cooperative and desirable social skills after lunch and recess. Teacher reported that client has been excelling in his academics and stated he has improved and developed the classroom expectations. Client was seen at his desk working quietly. Client appeared to be in a good mood as evidence by him participating in group activity without conflict. Client remained on task and in cooperation with class rules. Client was not involved with any incidents today and was supported by his teachers and staff. Client continues to build new interpersonal relationships with his peers, sharing and taking turns in a civilized manner. As the client, displays more positive than negative behaviors in school he is doing a much better job maintaining the appropriate conduct in school and staying out of trouble, therefore meeting objectives 1, 2, and 3. (AM) QMHP observed client in the classroom in efforts to determine whether he required assistance. QMHP determined client was on task and did not require assistance. QMHP provided positive gestures to encourage client on his positive classroom behaviors. QMHP reminded client of ISP objectives and what he needs to do in order to achieve them. QMHP reviewed examples of alternative appropriate behaviors he could engage in to stay on task without causing disruption. QMHP encouraged client to resist negative classroom behaviors in efforts to refrain from requiring to be redirected by his teachers so many times throughout the day. QMHP praised client for listening and following directions and interacting well with his peers. QMHP observed client complying with classroom rules and expectations. (PM) QMHP explored the 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 engaged client in a conversation regarding his recent behaviors, progressions and setbacks. QMHP explored client’s responses and responded accordingly. QMHP talked with client about the importance of adhering to rules and expectations in school, at home and in the community. QMHP provided age appropriate understanding of his mental illness and encouraged him to utilize his coping strategies during social and non-social environments. QMHP offered to help client with his work and to give him one on one. QMHP administered psycho educational activity with client and assisted when needed. QMHP provided new skills and strategies to help reduce impulsive and hyperactive decisions. (EOD) QMHP informed client that misbehaving in school carries consequences and that making good choices results in good reward. QMHP encouraged client to refrain from displaying negative behaviors towards his teacher, to talk calmly, and express himself without aggression. QMHP introduced the concept of a behavior contract to client. QMHP reviewed the purpose and expectations of a behavior contract with client in efforts to get him familiar with the concept. QMHP held consultations with client and teacher about effective intervention strategies that build on the client's strengths and compensate for his negative behaviors. QMHP encouraged client’s teacher to provide frequent positive reinforcement to maintain client's interest and motivation in maintaining positive classroom behaviors and completing his school assignments. QMHP assisted client to behave in more positive ways by addressing the conflict he was facing with his teachers. QMHP informed client of replacement behaviors in efforts to decrease attention seeking behaviors the client often is involved in. QMHP modeled appropriate ways for client to get positive attention from his teacher. QMHP inquired of clients’ current mood. QMHP utilized active listening skills as client spoke of his current mood. QMHP assisted client in exploring other coping strategies that he had previously used to solve other problems. QMHP utilized behavior modification strategies including removing Client from the stimulant environment in efforts for him to reduce impulsive behaviors. QMHP modeled proper positive behavioral expectations for the client to administer additional layers of support and display an understanding of expectations. (AM) Client smiled as he saw QMHP's positive gestures. Client was able to process making good choices with QMHP and his teacher. Client listed 3-4 classroom behaviors that he was going to utilize in efforts to remain positive behaviors. Client appeared to be receptive to receiving 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 continued to work on the classroom activity. (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 teacher’s lesson. Client reduced impulsive behaviors after 3-4 prompts from his teachers and QMHP. Client began to show greater control of his anger. Client appeared to decrease the intensity of his anger and frustration. Client was pleasant and cooperative and demonstrated a willingness to discuss the factors contributing to his undesirable mood. 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 aware of the behavior contract and accepted the agreement, communicating he was going to be good and make wiser choices. 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. Teacher praised client for being on his best behavior and correcting his mistakes. Client displayed good behaviors, raising his hand when he asked a question, waiting for his turn to speak, using his words instead of hand signals, saying please and thank you, and giving his teacher good eye contact. Client said he felt great and wanted to color a picture. Client utilized deep breathing techniques to relax and stay calm during stressful environment, especially when kids are running and making noise around him. Client was happy to go to a quieter space to finish the educational assignment, verbalizing appropriate understanding by asking and answering appropriate questions. Client administered positive behavioral expectations, reducing ADHD and meeting objectives.