4/26/2023 EnchantaVaughn Approved (AM) Upon arrival, client was in a feisty mood, as evidenced by his tense facial expressions and talking back to authority. Teacher reported client was not displaying the correct behaviors in class and needed a break. Client continues to bother and disrupt his peers while they are trying to do their work. Client refuses to do his work when asked to get back on task. Client has a hard time following directions when he wants to see his counselor as a way to ignore his teachers directives. Client was given a choice to finish his assignments or he would not be allowed to utilize TDT support due to poor attitude and being disrespectful. Client understands that in order to see his counselor he has to fulfill the responsibilities and duties that are set in school. (PM) Client was reported several times not being productive in class. Client’s dojo points have been consistently taken away throughout the day for poor preparation and performance. Client have been having difficulty with listening and following directions. Client was redirected by QMHP. Client understands he is expected to complete his work and stay seated in class. Client was reminded of his objectives and what he needs to do to achieve them. Client continues to display disruptive behaviors in social and academic settings. Client have been extremely defiant toward authority, talking back and giving his sub and teacher assistant a hard time. (EOD) Client is normally observed acting out in class when his primary teacher is absent. Client tries to interrupt other students who are on task, influencing his peers to follow behind him so that he won't be in trouble by himself. Client chooses to have small outbursts when he can’t have his way or when he wants to come to session during class time. Client displays hyperactive and impulsive behaviors, moderate to intense. Client attempts to walk away when he's given one on one and requested to stop and listen or consequences will follow. Client displayed negative emotions and returned to his seat in an uptight mood. Teacher responded by telling client that he need to get it together and think about his actions. Client began sucking his thumb and shaking his body as a way to show he wasn't going to calm down on his own. Client was put in time out for 10 minutes and redirected by teacher to get back on task. Client put his head down on his desk and remained quiet for the rest of the evening until dismissal, walking safely with his sister and mom back home. Client failed to meet objectives today, due to poor behaviors in class and not being polite to others. (AM) QMHP employed positive reinforcement when the client was able to achieve all of his objectives, and encouraged him to maintain his positive behavior by providing him with a review of his objectives. QMHP educated the client with relaxation strategies such as deep breathing and counting to 10 to decrease the client’s aggressive behavior. The client was encouraged to use good judgement, and respect authority figures. QMHP provided client with a release of energy by walking to get a drink of water to help him relax and decrease his hyperactive behavior. QMHP used appropriate behavior modeling by pointing out a peer that is demonstrating positive behavior to decrease the client’s impulsive behavior and encourage him to use self-control. QMHP monitored progress in demonstrating individualized pro-social skills (e.g. anger management, education, problem-solving, conflict resolution, appropriate verbalization of feelings, and cognitive-behavioral programming). (PM) QMHP provided individual, group, and family counseling based on specific treatment objectives. QMHP reminded client of goals and objectives. QMHP collaborated with teacher and administrative staff in regards to school rules and regulations, classroom management, effective teaching practices, following verbal and non-verbal instruction, role playing exercises, and an appropriate incentive system. QMHP educated client about using good manners in school and offering alternative methods and suggestions to model appropriate language that client should use to ask for things or to get someone’s attention. QMHP processed client feelings and offered choices of what to do when faced with conflict or challenged in the school setting. (EOD) QMHP facilitated a group discussion to talk about common mistakes children with ADHD make and how he can make better choices. QMHP reviewed school expectations and how client should conduct himself around peers and authority. QMHP praised and recognized client for his hard work, efforts, participation, and working towards improvement by changing daily habits and implementing a positive and consistent routine. QMHP supported client with meeting his objectives and coping with stressors without needing additional redirection or prompts. QMHP encouraged client to continue displaying age appropriate behavior, and the benefits of this will be reviewed with parent and teacher. QMHP conducted a review of previous week regarding mindful seeing and mindful listening. QMHP assisted client with problem-solving. QMHP provided client with feedback. QMHP provided client with positive reinforcement. QMHP encouraged client to practice relaxation and coping techniques in social/academic environment, at home, and in the community. (AM) The client responded in a positive manner acknowledging the positive reinforcement that the QMHP provided by saying “thank you” while presenting a smile. Client utilized relaxation strategies The client showed his gratitude for being able to release physical tension stating that he feels relaxed and able to catch his breathe again. The client stated that he can be good also, and told QMHP that he will do his best to follow directions and keep his hands to himself. Client was able to cooperate and comply to rules and regulations due to positive peer influence. Client implemented pro social skills successfully. (PM) Client attends therapeutic day treatment daily and has completed all psycho educational activities. Client has presented himself in a responsible way and is making progress towards goals and objectives. Client maintains classroom etiquette by sitting in his seat during instructed classwork, raising his hand and asking appropriate questions, being respectful at his table/desk, remaining quiet during quiet time and active during activity time, listening to his teacher, modeling appropriate behavior, and earning points for a reward without begging for a treat. Client says please, thank you, and excuse me. Client shows empathy towards others and is caring to his peers, as evidenced by him hugging, playing, smiling, and complimenting others. Client avoids negative language (i.e. cussing and using aggressive words). Client engaged in self reflection and reflected on his day, the good and the bad. Client communicated his likes and dislikes. (EOD) Client recognized his triggers and was able to identify common interests and similarities him and other ADHD recipients share. Client understands that he is expected to act civilized and use his inside voice while in the building and transition safely in between class time, lunch time, specials, and other settings. Client is observed making better choices and doing the right thing. Client has improved with staying in class and utilizing his breaks appropriately without needing to displaying attention seeking behaviors to get his way. Client has difficulty staying focused when distracted by others who are off task and has to be reminded to get back on track. Client responds well to praise and support. Client is acceptive of redirection. Client understands that his actions have consequences. Client is striving for a good report from school everyday. Client wants to make his teacher and parents proud by doing a good job. Client is very independent but can be a team player as well. Client reviewed last week discussion with psycho educational group and retained a lot of the information he was taught which motivates his group to pay more attention and take their time. Client is observed problem solving on his own and handling his emotions appropriately. Client avoids meltdowns and lashing out when upset or frustrated. Client responds well to feedback. Client responds well to the positive reinforcement provided by QMHP and is seen increasing self-esteem and confidence. Client said he was going to practice coping strategies and relaxation techniques in all aspects of his daily living routine in hopes that he will be a better person, student, sibling, and friend.