4/18/2023 EnchantaVaughn Approved (AM) Upon arrival, teacher reported client was not having a good start to his day and needed a break. Client appeared to be in a tired and draining mood, as evidenced by his tone of voice and dragging his words. Client tend to act out when he does not take his medication properly and is reminded to be consistent. Client absence of medication intake effects him heavily in school and support was provided in this area. QMHP collaborated with teacher on what things can be done to ensure client meets his objectives. Client completed his classwork during his break and returned to class. Client was monitored in academic setting. No redirection was needed at this time. (PM) As the client prepared for lunch he was seen lining up with his class without pushing or shoving. Client failed to turn in his homework and earned himself “silent lunch”. Client chose to sit with his counselor during lunch and process his behaviors. Client was reminded of his objectives and what he need to do in order to successfully achieve them. QMHP told client to make better choices if he plans to get back into class. QMHP communicated with client that he has to stop giving his teacher a reason to kick him out of class by proving he is capable of doing his work and following directions. Shortly after lunch client was sent back to process with QMHP. Client was sent out of class several times today for being disruptive and loud during testing. Teacher reported client did not take his medication and was a little off today. Client was observed talking out of turn and being disrespectful in his seat. Client got into a verbal altercation with a male student in class. Client explained he started yelling after the the person yelled at him first. Client was prompted to ignore others who are doing wrong to prevent him from getting in more trouble. Client responded negatively to the redirection that was provided by QMHP. Client began displaying inappropriate gestures by putting a pencil in his eye, swimming across school furniture, putting things in his mouth, and tapping objects on the table. Client could not sit in his seat for a long period of time and was seen standing up and walking around without permission. (EOD) Client had a hard time maintaining appropriate classroom management skills and ended up back in time out. As the client utilized these breaks to gather himself and do the right thing, he was witnessed in a unstable mood. Client exhibits hyperactive and impulsive behaviors due to non compliance with medication regimen and contributing to external distractions. Client was unable to focus and take constructive criticism seriously. Client continued to make excuses for himself instead of recognizing what he did wrong. Client engaged in reflective thinking with QMHP and was given an opportunity to correct his mistakes. Client assisted school staff with cleaning up the school, exhibiting responsible behavior. Client was applauded for taking initiative to prove himself and having a better attitude. Client enjoys being a helper and a citizen of the school, and these behaviors were encouraged and supported daily. Client focuses when he can move around at his pleasure and needs to work on showing the same cooperation and effort in class. Client did not meet his objectives, due to poor choices and failing to comply to school/classroom rules and expectations. (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.