4/19/2023 EnchantaVaughn Approved (AM) Upon arrival, client was witnessed entering class in a good mood and preparing for the school day. Client unpacked his belongings and began morning assignment without any interruptions. Teacher reported that client has been coping well although he’s a part of a stressful environment. Teacher believes that utilizing breaks throughout the day especially towards the end of the day have benefited client in class and have noticed improvement with his attendance and grades. Client was recognized by his teacher to be on task and being a good leader to his peers and hopes he can continue behaving in this way. Client was very productive during the first half of the day, as evidenced by him paying attention and listening to instructions. Client have been observed in academic setting adhering to classroom rules and being polite to his teachers and peers. Client prepares for lunch by lining up quietly and waiting to be escorted down the hall. (PM) Client displayed excellent transition to and from class. Client was observed during lunch displaying good behaviors and expressing a positive attitude. Client had appropriate interaction with his peers. Client was having appropriate conversation. Client expressed positive thoughts. Client was respectful of staff and cleaning up his table and trash. Client exhibited full participation in group setting. Client was seen listening and following directions. Client displayed age appropriate behaviors, working well with others and being a team player. Client was observed keeping his hands and feet to himself during group activity, setting a good example to his peers who were more aggressive and assertive. Client was observed asking and answering appropriate questions. Client exhibited excellent communication skills by being polite and patient creating a positive working atmosphere. Client was observed making good choices and avoiding negative behaviors. Client learned to use assertive tone instead of aggressive tone when expressing his feelings and emotions about his day. The client described increased self-esteem as he has been reinforced for taking responsibility for his behavior. Client was observed utilizing the positive reinforcers given by authority figures, transitioning back to class in a great mood. (EOD) Client maintained self-control when going back to academic setting. Client reframed from aggressive behaviors and was able to continue his day without incident. Client was seen listening to teacher and giving his undivided attention during a reading exercise. Client displayed a good attitude in group setting. The client was taught to analyze, attack, and destroy his self-defeating beliefs in order to maintain self-control when faced with new problems. Client is observed staying away from others who are doing wrong. Client was provided with positive feedback as he displayed more attempts to use his independent ability to take care of his personal needs. Client was supported for taking advantage of one on one help. Client appeared to be on task and in a good space. Client was seated properly in his seat and facing forward while presenting the correct posture and demeanor. Client prepared for dismissal and announcements by putting away his classwork, books, and supplies and clearing off his desk. Client exited the school building smoothly and safely, successfully achieving 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.