2/13/2023 EnchantaVaughn Approved 1. Behavior: Upon QMHP’s arrival, client conduct was viewed as hyperactive, restless, busy, and fidgety. Client did not communicate his feelings at the beginning of session and remained silent while QMHP asked about his day and what things he likes and dislikes. Client chose to distance himself from the QMHP when reflecting on his bad experiences. Client was observed easily distracted during the session. It was difficult for client to remain still, giving the impression to the QMHP that he was not listening to the information that was being processed to him by the QMHP. Client is easily irritated and aggravated when his grandmother embarrasses him in front of QMHP for not listening during the session. Client is very manipulative and tries to do anything to get kicked out of the session and was encouraged to control his temper and respect his family. 2. Behavior: During the session, the QMHP attempted to help the client regain and regulate his emotions and feelings, as he attempted to calm down with words of comfort. Client was hyper aggressive and continuously shouted inappropriate statements to his dad and mental health professional; symptoms which directly correlate to his current diagnosis of Attention Deficit Hyperactive Disorder. Client struggled with following directions. Client discussed things he would like to do over what the QMHP instructed him to do. Client continued to give his family a hard time after being asked to participate in the assigned activity. 1. Intervention: QMHP assessed and monitored client’s mood and behavior. QMHP probed in order to process and explore causes of client’s increase in possible reasons for setbacks and failures. QMHP redirected client a few times in the session to refocus and pay attention in order to finish the session and get the most out of it. QMHP educated client on ways to prevent distractions from affecting his attention span. QMHP discussed and spoke with dad and client about in-home services and how they liked it so far. QMHP reviewed and discussed objectives and goals that will allow and teach client how to channel his reported behaviors within the home, school, and community environments. QMHP explained the importance of removing distractions when trying to complete an assignment or task. QMHP modeled pro-social behaviors for client to strengthen his understanding of what to do in school, at home, and in the community. 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, as well as, simple praises to help build high self-esteem and challenge client to do good on his own. QMHP prompted client to refrain from impulsive, hyperactive, defiant, and aggressive behaviors especially running, refusing authority instruction, and interrupting another’s person day. 2. Intervention: QMHP examined and evaluated client responses to feedback. QMHP focused on client’s ISP objectives and what he needs to do in order to achieve them. QMHP offered new ways to heighten client awareness of his ill-mannered behaviors, as well as helping him with functioning more constructively within his daily life. QMHP encouraged client to present healthier habits and routine by challenging himself to make better choices and try new things. QMHP questioned client on the statements he made about having difficulty expressing his feelings. QMHP facilitated an activity on emotions to assist client to be able to identify and positively express them. QMHP reviewed strategies targeted at helping client to work through his difficulties expressing his anger. QMHP utilized age appropriate mood regulation skills and techniques, as a way to help client’s destructive and critical demeanor, as well as to assist him with regaining and regulating his uncontrollable conduct. QMHP encouraged client to be mindful of others personal space. QMHP encouraged client to refrain from displaying negative behaviors towards his mom, to talk calmly and express himself without aggression. QMHP demonstrated and provided positive empathetic acceptance while utilizing talk therapy and active listening skills to enhance self-esteem and confidence. QMHP provided redirection when needed and processed with client on what he needs to do to achieve ISP objectives every day. 1. Response: Client did not seem to be interested in having session today and continued to exhibit an unconcern attitude in response to QMHP reeducating the conflict-resolution skills. Dad and grandma were attentive and focused on the information that was provided. Client was reluctant and hesitate, as he remained mistrustful in regard to extending a friendly or respectful rapport back to the QMHP. Client acknowledged QMHP’s redirection after 4-5 prompts. Client stated ok and then began to calm down his actions. Client proceeded to lower his voice while calming down. Client appeared disinterested in regard to the information that was being provided to him by the QMHP in response to how his negativity affects himself and others. Client still struggles with coping with stressors and require services. Client is making progress with expressing his feelings and showing others respect and courtesy by talking with appropriate tone, initiating conversation with peers, and waiting for his turn to talk before blurting out loud. Client said he loves role play activities and utilizes this to stay focused in the home. Client was able to utilize coping skills to eliminate stressors and unwanted feelings. Client utilized meditation and relaxation techniques. Client smiled at QMHP and said thank you. Client reduces sadness and finds more excitement in learning about different ways to control his reaction to certain situations and be more receptive and open in therapeutic setting. 2. Response: Client said he was aware of his expectations and what he is expected to do each day. Client practiced some of the examples of alternate behaviors (e.g. counting, coloring, thinking about happy moments, repeating positive “I-statements” 5-10 times, and asking questions that will help him understand things better) at home when he found himself bored or unproductive. Client understood that raising his hand and positive eye contact prevents disruption and is the most respectful way to wait his turn if he wants to get someone’s attention. Client likes to be treated fairly, as evidenced by his reactions to certain disciplinary actions and consequences. The interventions were unsuccessful, due to client unable to relax when being instructed by the use of calming techniques that were utilized during the session. Client had one on one with QMHP. Client realized his counselor was trying to help him by pushing him to try on his own first. Client proceeded to reduce the aggression in his voice while calming down. Client accepted suggestions from QMHP but was reluctant and hesitant in extending a friendly rapport back to the QMHP. Client displayed an unemotional facial expression on his face. Client showed an unconcern and nonchalant attitude towards QMHP, in regard to decreasing his impulsive and thoughtless actions towards his dangerous and unsafe behaviors.