5/17/2023 EnchantaVaughn Approved (AM) Upon arrival, client displayed inappropriate and defiant behaviors at the start of class, not have a good start to his day. Teacher reported that client was asked nicely to slide his chair over and give student at his table space to work and client flipped over his chair and started lashing out at her. Client was prompted to pick his chair up and correct his attitude. Client was angry and upset and refused to listen to his teacher walking away aggressively. Client was escorted to see mental health professional and explain why he was acting up after simple instruction. Client displayed frustration and pouted all the way down the hallway. Client was given a couple minutes to calm down and regulate his emotions to more positive expressions. Client was inquired about incident and what happened in class and at the end of day yesterday during dismissal. Client would not acknowledge any wrong doing or negative behaviors and continued to look flustered in the face, rolling his eyes, and smacking his lips. Client was given redirection. During processing, client communicated that he threw his chair because he was upset at his teacher. Client expressed that he was taken out of class for no reason and felt like he was being picked on. QMHP collaborated with teacher to find out what happened and how can we come to a compromise and get client back on track. Client promised to be good and sit in his seat and finish morning work. (PM) Teacher reported client was not doing any of his work all day. Client was having trouble listening and following directions throughout the day. Client continues to display inappropriate behaviors, talking back to his teacher and being a class clown. Client was observed at his seat preparing for testing. Client exhibited high impulsive behavior and needed to remain in class until he got himself together. Client did not take a break but was given redirection inside of his class and encouraged to make better choices and treat people with respect. Client agreed to behave and do his best. Client was encouraged to utilize conflict resolution skills and keep his hands and feet to himself. As the client transitions to lunch he is observed conducting himself appropriately. Client displays age appropriate behaviors at the lunch table and showing good mannerisms by chewing with his mouth closed, throwing away his trash, and using appropriate voice volume. Client continues to struggle with managing his emotions when faced with conflict. Client is seen being pulled out of the cafeteria by lunch monitor for getting up out of his seat and horse playing when directed more than once to sit back down. Client refused and starting have an episode (i.e. falling out on the floor, crying, kicking, and screaming). Client was given a few minutes to calm down. Client negative symptoms have stabilized, due to positive reinforcement provided by QMHP. Client was reassured that it is not too late to make good choices. Client was able to straighten up and return to his assigned area to finish his work. (EOD) Client was given a cool off break at the end of the day to make sure he will maintain cooperation until dismissal. Client is seen displaying age appropriate behaviors, at this time. Client no longer presents anger and frustration and has learned to control himself around peers and authority. Client positive gestures indicate he will end the day on a good note. Although, client was able to process his feelings and make corrections he did not meet ISP objectives and is encouraged to practice self-control techniques. (AM) QMHP welcomed client to school and provided support and encouragement to ensure a good start to his day and to be on track with achieving his goals and objectives. QMHP monitored client individualized behaviors in collaboration with his teacher and other mental health professional. QMHP encouraged client to make good choices and to utilize self calming techniques (i.e. counting and deep breathing) and processed with him that this behavior is acceptable and discussed actions and consequences. QMHP challenged client to continue displaying a positive attitude while employing positive reinforcement when client is able to achieve his goals and objectives. (PM) QMHP provided praise when the client continued to display positive behaviors throughout the day, remaining on task and was very respectful to peers and authority. QMHP isolated client from distractions to decrease disruptive behaviors and to reduce excessive talking in class. QMHP explored the client’s capability to cope with his stressors. QMHP brainstormed how to resolve conflict without engaging in aggressive behaviors. QMHP will teach client necessary coping skills to decrease impulses. QMHP will brainstorm strategies with client and encourage self monitoring. QMHP will provide mediation and relaxation techniques. QMHP inquired about after school activities. QMHP will collaborate with teacher regarding behaviors and performance. QMHP applauded client for being the bigger person. (EOD) QMHP will review and give feedback regarding ADHD and its causes and affect toward client well being and academic functioning. QMHP will provide client with support and encouragment. QMHP will monitor, observe, and redirect client behaviors as needed. QMHP will build rapport. QMHP will explore positive self talk, use instruction modeling, and increase social communication skills with positive reinforcement role play activities. QMHP will educate client on behavior modification to help client identify what behavior he need to decrease and avoid daily. QMHP will utilize behavior modification system to aid the client with following directions given by authority figures. QMHP will meet with client daily to discuss progress and expectations that are working and not working in school daily. . (AM) Client greeted QMHP by saying good morning. Client verbalized positive feelings about goals and objectives. Client communicated that he wants to work independently. Client displayed good participation in various settings and was responsive to all instructions, interacting well with his peers. Client responded in a positive manner acknowledging the positive reinforcement that the QMHP provided. Client said he was going to have a good day and decided to practice yoga poses with group member before returning to class. Client utilized coping skills and impulses started decreasing. Client was observed strategizing a plan to better himself by writing down his thoughts and feelings and exploring his creative side with arts and crafts. Client was taught to deep breathe nd count to 10. Client said he went to a boys and girls club program after school and enjoys playing basketball with his peers. Client was reported displaying age appropriate behaviors and was productive and studious in class. (PM) Client said thank you and continued to do what he was told. Client demonstrated responsibility and leadership. Client was acceptive of redirection. Client showed interest in building interpersonal relationships with peers and authority to increase support system. Client expressed positive self talk, modeled positive behavior, and good communication skills during role play activity. (EOD) Client learned to avoid negative and defiant behavior and comply to rules. Client was seen following directions. Client joined session to utilize and learn new interventions and strategies. As the client has made more of his own decisions, he reported increased satisfaction and function. Client responded well to feedback, interacting well with his peers. Client agreed to behave and communicated a positive attitude when reviewing problem solving and self control strategies. Client promised he would try his best to correct himself when faced with conflict. Client met with QMHP to discuss progress, setbacks, and improvements. Client understood what he needed to change and planned to fix his mistakes.