2/5/2023 EnchantaVaughn Approved 1. Behavior: At the beginning of the session client struggled to talk about important issues within his community and family structure that heavily impacts his mental health, education, and lifestyle. Client remained silent while QMHP asked about his day and what things he was doing to make it a good day. However, client chose to distance herself when reflecting on her experiences. Client uses a lot of non-verbal cues to express how she feels. At this time, client behaviors were viewed as impatient, disrespectful, and agitated. Client has issues with understanding the effects of her behaviors. Client was unable to focus today. Client expressed that she tries to communicate with her mother in the same way that she communicates with her counselor but it’s hard. Client became frustrated and began to be disruptive and purposely annoy others in order to draw attention away from herself. Client failed to utilize appropriate coping strategies and communication skills within the home. Client chose not to express her feelings without exhibiting inappropriate behaviors. Client avoids self-reflection exercise when QMHP inquired her to deeply think about her reaction to certain situations. 2. Behavior: Client was verbally aggressive toward VACCD staff when being redirected for her behaviors during the second half of the session. Client did not show interest in today’s session, as evidenced by her closed off expressions and low contact. Client appeared to be frustrated and irritated, as demonstrated by her temper and attitude. Mom said she needed client to stop acting like it’s the end of the world. Client continues to express and elaborate on the negative relationship between her and her family. Client shared her reasons for not following through with instruction, which caused more drama in the house. Client continues to display nonchalant behaviors and lack compassion for her therapist. Client has failed to decrease behaviors associated with ADHD. Mom reported client has had anger issues but recently noticed her anger has developed into insecurity and low confidence traits. Client exhibits poor listening skills, talking over the adult instructing her. It is evidenced that client has not utilized appropriate skills, techniques, or strategies taught by QMHP. Client’s ADHD behaviors have not decreased. Client continues to be defiant, disrespectful, and impulsive. Client had difficulty focusing in the session, due to these behaviors. 1. Intervention: QMHP initiated conversation to confront client about her negative reports. QMHP collaborated with mother regarding behaviors and performance in the home. QMHP actively listened to client verbalize that she was agitated today and the reasons to her agitation. QMHP utilized Instruction, modeling and role-playing techniques to help client with general communication skills. QMHP informed client that when she is agitated to refrain from taking it out on people and communicate how she is feeling to others, so they know exactly how she is feeling about them. QMHP encouraged client to have a better day so she can learn how to calm down on her own when she’s upset. QMHP encouraged mother to allow client to express herself in an age appropriate manner and to redirect when needed. QMHP modeled pro-social behaviors for client to strengthen her understanding of them. QMHP engaged the client in a role reversal exercise and required the client to think about her goals. QMHP provided guidance on alternative behaviors and clear instruction on the alternative behavior. QMHP provided positive feedback when client engaged in the more appropriate behavior. 2. Intervention: QMHP conducted session on losing control and learning to go back to normal behavior without negative episodes. The counselor introduced a handout entitled, "How Does It Make People Feel?" QMHP educated the client that most people try to learn ways to control certain behaviors, but sometimes it can be difficult for them. QMHP informed client that when you have self-control (e.g. avoiding hitting, pushing, screaming, crying, etc.) you not only help yourself, but you also positively affect others (physically or emotionally). The QMHP advised client that when people see you lose control they might feel scared of you, upset or angry, disappointed in you, frustrated with you, confused at why you lost control, and concerned for you. This QMHP enlightened the client that people don’t like to see you lose control, especially if they don’t know why. QMHP challenged client to maintain appropriate behaviors if she expects to be rewarded. QMHP taught client effective problem-solving skills (i.e. identifying the problem, brainstorm alternate solutions, select an option, implement a course of action, and evaluate). QMHP processed with client, "what would you do different tomorrow”. 1. Response: Client became very annoyed when her mom asked her to stop what she was doing to participate in her therapy. Client refused to talk to the mental health professional once she joined the session. Client became a little receptive as QMHP talked to her and coached her on ways to communicate without being hostile or agitated all the time. Client reported to QMHP that she doesn’t like the way that people talk to her like she’s dumb or can’t defend herself. Client expressed frustration and hopes of her attention span and focus would improve. Client blames her mental illness on her mom. Client’s attitude, mood, and behaviors differ depending on what type of day she’s having. Client verbalized that she was feeling some type of way because she always gets in trouble for things her little sister started first. Client did not realize that she doesn’t ask for permission and fails to communicate well when she wants to be open with her mom. Client stated that she doesn’t intend on being negative and agrees she need to work on controlling and channeling her anger, as well as, listening and communicating her feelings better. 2. During the session at the home, mother expressed client’s behaviors have improved but she still has to remind client about remaining consistent with reacting positively when being reprimanded or redirected. Mother and client displayed good communication. Although mom is more stressed with the end of her pregnancy, she has cut back on work to spend more time with her daughter. Client responds well to praise and encouragemeResponse: Client discussed mental illness and its causes as a family. Client displayed interest in learning about ADHD. Client verbalized that she was agitated all day but did not give any specific reasons as to why she remained agitated even after her counselor inquired about it. Client appeared to grasp a clear understanding of the manic behaviors” she often displays in the home especially the behaviors that have affected her the most. Client was assisted in practicing general communications skills. Client understood effective problem-solving skills to help solve or overcome a problem or stressor the she is currently facing. Client understood that when she becomes agitated she needs to refrain from taking it out on people she loves and to communicate how she is feeling with a more positive tone. Client was able to reevaluate herself and display a more positive attitude toward peers and authority. Client communicated positive affirmations and self-talk once she was able to let go of negative, agitated feelings. Client showed good understanding of what it means to be respectful, encouraging, mindful, and fair to others. Client is observed correcting her mistakes and making good choices in the home.