5/12/2023 EnchantaVaughn Approved (AM) Upon arrival, client displayed inappropriate conduct when coming into class. Client have been a little off this week, due to personal distractions. Client have not practiced self control or utilized appropriate voice volume during school activities. Client brought a cellphone to school today and continued to take it out of his pocket. When prompted to put i away client got upset and started having episode. Client fell out of his seat, crawled under the table, and started kicking the student’s seat next to him. Teacher reported client was having difficulty maintaining appropriate behavior in class and needed to take a break. Client look extremely frustrated. Client expressed he wanted to attend the program. Client sat with his counselor during the program to ensure he would not act up. Client was not doing a good job sitting quietly and paying attention. Client was directed to focus on the speaker or the phone would be taken away. Client continued being disruptive and loud. Client was prompted a few more times before getting administrative involved. QMHP collaborated with the school’s principal to see how we could handle the situation without interrupting the program. Client was given redirection and positive encouragement that no one is going to take his phone unless he gives adult staff a reason to take it. Client rolled his eyes and smacked his lips. Client was having trouble accepting redirection and consequences went into effect. The principal put the phone in a safe place until the end of the day. Client was encouraged to listen to the adult and behave and he could earn his phone back during free time. Client was educated that reading and writing is fundamental to his education and he needs to take it more seriously. Client shook his head and yelled “No, I don’t want to read”. Client only wants to color and draw or he displays outbursts and temper tantrums when instructed to do other work. Client was given a chance to make better choices and was monitored and supported for changing his day around. (PM) Client behaved hinself at lunch. Client was observed interacting well with peers and being respectful to staff. Client displayed little to no hyperactive behaviors while eating his lunch. Client was assisted by mental health professional and given a coloring activity to encourage him to make good choices. (EOD) During class, client decided to grab his snack early when it was not snack time. Client was not in compliance with teacher’s instruction when prompted several times to put it away. Client ran out of class and displayed episodes down the hallway. When escorted to mental health professional client was resistance and ran back down the hallway. Client was seen in class horse playing on the carpet. Client was directed to put the snack away or he would keep losing privileges. Client was upset and starting kicking objects around the class and banging on the table. Client walked out a few times then returned to the back of the class. Client was seen standing by his cubby hole and hiding. Client was given one more chance to make better choices or his parents would be called. Client went to his seat in a frustrated manner, pouting and sitting in another student’s seat. Client was told to get up and go to the correct seat. Client hesitated and then went to his seat expressing negative attitude and refusing to do his work. Client was given a moment to himself to cope and distress. Client calmed down and began working on his assignment. Client was back on track and doing a much better job. Although, client got himself together by the end of the day he did not achieve his objectives, as observed. (AM) QMHP monitored client individualized behavior modifications in collaboration with his classmates and teachers. QMHP motivated client to respond to exercise and express his feelings. QMHP offered active listening skills. QMHP provided client with encouragement to demonstrate the positive behaviors and expectations they had been talking about. QMHP encouraged client to communicate to his teacher when he needs help. QMHP praised client for staying on task. QMHP complimented client for utilizing acquired skills, paying attention, and focusing on the importance of the assignment. QMHP supported client displaying positive social interaction with peers and authority. QMHP provided redirection when needed and processed with client on what he needs to do to achieve ISP objectives. (PM) QMHP led the group through each therapeutic day treatment exercise. QMHP inquired about client’s day in class and what things are he doing to make it a good day. QMHP educated client about what he can do to make school fun and interesting, such as reading his favorite book, drawing in a journal, or putting his head down close his eyes and practice the mindful behaviors learned in session. QMHP modeled pro-social behaviors for client to strengthen his understanding of what to do in school, at home, and in the community. QMHP prompted client to refrain from impulsive, hyperactive, defiant, and aggressive behaviors especially running, refusing authority instruction, and interrupting others who are trying to learn. QMHP utilized behavior modification strategies including removing client from the stimulant environment in efforts for him to reduce inappropriate behaviors. QMHP will monitor effects of meditation and coping practices daily and report progress to all parents, teachers, and administrative staff. QMHP will assist with reducing anger-provoking situations through self talk and role play scenarios in order to prevent escalation and dealing with anger assertively. (EOD) QMHP will continue to assist client with managing anger and frustration by reviewing and role-playing effective coping skills. QMHP helped client problem solve when he began displaying negativity towards himself and others. QMHP modeled proper positive behavioral expectations for the client to encourage additional layers of support and understanding of rules and expectations. Although client needs improvement, QMHP commended client on his efforts to maintain his ISP objectives throughout the day. QMHP observed client dismissing without incident and preparing for after school activities in a positive manner, as witnessed and reported. (AM) Client displays normal behavior in classroom setting. Client exhibited a positive attitude toward teachers and classmates. Client said it’s boring and he is having challenges with certain activities and needs help. Client said he was being good in class but got in trouble for talking out of turn. Client knows what is expected of him and is trying to make better choices. Client verbalizes positive feelings about himself but recognizes areas he needs to work on. Client smiled and hugged QMHP. Client was observed in his seat and raising his hand. Client interacted well with peers and demonstrates good team building skills. Client displays good attitude by saying “thank you”. Client did an excellent job by showing interest in the session by asking appropriate questions. Client admits when he was wrong and apologizes. Client is learning to calm down, think first, and respond without anger and frustration. Client continues to make progress with ISP objectives. (PM) Client transitions smoothly and safely to session area, displaying appropriate behaviors. Client greets his group members and waits for instruction. Client expresses good statements about his day saying he was doing his work, using his manners, and being fair to others. Client is more confident at school, as evidenced by assertive and proud tone. Client have been doing a better job controlling impulsive and hyperactive behaviors, due to keeping his hands to himself and staying in designated area. Client reduces sadness and finds more excitement in learning about mindful smelling. Client displays good participation in session. Client walks appropriately down the hallway. Client understands that breaks are a privilege and he has to earn it. Client displays coping skills when faced with conflict due to deep meditation exercises. Client anger is moderate to intense, 2-3x per week. (EOD) Client is working on walking away and telling an adult before responding to anger provoking situations. Client understands that problem solving starts with thinking before acting. Client demonstrates problem solving by staying calm and using his senses. Client acknowledges expectations and reviews goals and objectives with counselor and parent daily. Client displays good social behavior in school, as observed and supported by mental health professionals. Client is reported building healthy relationships with after school program and performing a lot better on tests and practice tests given on his grade level.