1/31/2023 EnchantaVaughn Approved 1. Behavior: Upon arrival, client was witnessed in the home attending to her chores and helping her mom clean up an area in the kitchen to prepare for the session. Client was well dressed for session, as she has picked up good hygiene habits. Client greeted her counselor in a respectable way, saying “hello, how are you doing today”. Client seemed to be coping well with her anxiety. Client expressed that she was a little upset when she woke up this morning but has since calmed down. Client admitted some days she is not well behaved, but she had good reasons for her outbursts. Client is so used to not asking for permission and doing things her way, she felt she couldn’t be herself at times. Client said she wanted to have one on one with her counselor and figure out some things that she has been having trouble with in the home. Client expressed that she didn’t want to talk about in front of her mom because she didn’t want to be judged for her mistakes and the way she was acting. Client was granted permission to have one on one outside the home in order to have a little privacy with her and her counselor. Client is still adjusting to the changes in the home and giving her mom space for self-care. 2. Behavior: Client was mildly talkative during the second half of session. Client shared negative thoughts concerning her expectations and responsibilities as the oldest sibling and how she feels overwhelmed at times. Client explained her frustrations and why she has been more stressed than normal lately. Client seem to switch moods a lot depending on what is being asked. Client expressed negative “I statements” (e.g. "I hate staying in that boring house"). Client admits to taking her frustration out on others and not giving her mom the respect, she deserves. Although client was outside, she displayed a negative attitude with flat facial expressions when communicating her feelings to QMHP about her day. Client was not in the mood to talk about her feelings, as evidenced by her dialogue with QMHP but she insisted on using non-verbal cues to express herself. Client was inquired about her mood. Client assured she was okay, just frustrated that everything that allows her to feel normal is virtual when she is her best when she’s socially involved with people, places, and things. Client assures that he is learning and will prove it by improving her conduct in the home. 1. Intervention: QMHP conducted session today on decreasing disrespect for authority figures and taking ownership for her own actions. QMHP probed client about her behaviors. QMHP probed client about her ability to not get involved with a negative person, even if it’s a family member. QMHP discussed with client the importance of conducting herself appropriately at all times. QMHP utilized positive self-talk strategies to help client think positively at all times and to talk about her actions and how they will make people feel. QMHP utilized active listening skills while client was verbalizing information about her day. QMHP encouraged client to remain positive and more positive things will happen. 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 her to reduce inappropriate behaviors. QMHP will monitor effects of meditation and coping practices daily and report progress to all parents, teachers, and other health professionals. 2. Intervention: QMHP explored the client’s capability to cope with her stressors and to get back on track. QMHP assisted client with finding and utilizing necessary resources at home. QMHP prepared client for transition. QMHP probed client about her schedule in efforts to understand her daily routine. QMHP utilized role-play to help client understand the importance of following all directions and limiting outburst of anger in a therapeutic or non-therapeutic setting. QMHP utilized active listening skills while client excitedly discussed her feelings and problems. QMHP educated client about using good manners at home 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 home. 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. QMHP will continue to assist client with managing anger and frustration by reviewing and role-playing effective coping skills. 1. Response: During today’s visit, client was having a hard time in the home and required one on one attention. Client was aggravated as counselor tried to deescalate the situation that was occurring. Client reiterated that she wished she had her own space to explore more things she like to do instead of sharing a room with her 4-year old sister who never cleans up behind herself. Client stated that her ability to exhibit positive behaviors within the home is almost non-existence. Client was provided with redirection for displaying emotional distress to minor irritants. Client was able to share her feelings. Client expressed that she’s trying her best to do the right thing. Client and guardian understood the contract for safety and implemented appropriate behaviors, at this time. Client reduces sadness and finds more excitement in learning about different ways to control her reaction to certain situations and be more receptive and open in therapeutic setting. Client practiced some of the examples of alternate behaviors (e.g. putting her head down, coloring or drawing, thinking about happy moments, and repeating positive “I-statements”). 2. Response: Client was not receptive to counselor’s prompts and redirections and after a period of time resulted to behaving very erratically and becoming physically violent as well. Client has a history of displaying aggressive, non-compliant behaviors towards authoritative figures in the home and/or community setting. The interventions were viewed as ineffective. Client participated in reviewing key concepts of mental skill building to help decrease poor behavior patterns in the home. Client was able to utilize coping skills to eliminate stressors and unwanted feelings. Client displayed self-determination to stay focused and pay attention in her therapy. Client utilized meditation and relaxation techniques to stay on task. Client was seen decreasing anger and frustration from 3x to 1x. Client reported a decrease in symptoms following the relaxation techniques. Client shared that she loves her family even though she does not love to listen all the time. Client communicated that she is working to change her behavior but will need help in order for her to do so. Client communicated her understanding of following directions and being respectful to authority figures and how she plans to make sure she does it more often.