2/5/2023 EnchantaVaughn Approved Behavior: Client presented with playful behaviors as he ran to greet QMHP. Client struggled to follow the prompts provided by his mother and continued to demonstrate inappropriate behaviors. Client was unable to process his feelings and began to get frustrated. Client was given constructive criticism that there is no right or wrong answer and was advised to use his words. Client continued to look clueless and unsure and needed assistance with answering the questions. Client becomes easily annoyed. Client reacts by shutting down and displaying irritable behaviors, such as falling and flipping over furniture. Client avoids wanting to listen to information being shared, as he began to pout and roll his eyes at the QMHP. After about 15 minutes of reflective thinking, client was given a break and directed to deep breathe, stretch, and regroup. The client described a pattern of consistent misfortunate events that happened over the week. The client expresses feelings of bad luck due to certain things not going his way. Client verbalizes different complaints. Client described that he worries about issues related to personal safety, relationships, and family among other things. Client was observed in the home reviewing his notes and studying on the chrome book while QMHP conversed with mom. Client is supported with appropriately asking for help. Client engaged in self-reflection with mental health professional and explored all of his feelings. Client was able to process his feelings and think more positively. Client have not utilized healthy coping practices and was urged to do so. The client has a difficult time transitioning from relaxation back into his work. Client is unable to identify many significant positive hopeful things in his life and is provided with examples of those. 2. Behavior: Client presented with probing behaviors as he asked different questions about the session. Client shared that he wasn’t having a good day. Client withdrew during the session as he became quiet and began to display restless behaviors. Client continued to demonstrate quiet behaviors during the session. Client had to be told more than once to show authority the proper respect and to look forward when someone is talking to him. Client frowned up his face and looked away from his counselor. Client expressed sadness and disappointment. Client fails to exhibit age appropriate behaviors in the home, due to hyperactive and impulsive decision making. Client showed low level of participation, putting his head down and covering his face not wanting to be bothered. Client is easily frustrated when confronted about not listening to authority figures and begins to move out of his seat and fall out on the floor. Mom directed client to get up and suggested that QMHP end the session to show client that he will not get his way by acting out and informed client that people are here to help him. Client displayed assertive tone and was sent to his room for a few minutes. Client displays an increased ability regarding problem solving and making decisions while interacting well with mental health professionals. The client has become less agitated as he has felt reassured and was encouraged to maintain this stability. Client is encouraged to engage in self-reflection daily and allow himself to release any tension built up and to work on it one day at a time. Client was seen interacting well with family once he was able to calm down. Client seemed to be enjoying his time left in session, as evidenced by his positive social behaviors ending the session on a good note. Mom was compliant with meeting again and finishing the session on another day. 1. Intervention: QMHP greeted client and assessed his behaviors and mood. QMHP inquired about client’s day and provided affirmations. QMHP probed about any angry feelings or the inclination of safe and unsafe behaviors. QMHP modeled different ways client can walk away from a conflict without getting frustrated. QMHP modeled how to separate client from negative situations by bringing his attention to something more positive, such as arts and crafts or educational movies. QMHP demonstrated how to verbalize feelings without yelling or being aggressive. QMHP was able to speak calmly and demonstrate a strong rapport with client. QMHP utilized active listening as information was conveyed. QMHP communicated with client on displaying appropriate control. QMHP probed client about certain behaviors and how he sometimes feels like the only way to respond is in a negative manner. QMHP will educate client about being respectful, encouraging, mindful, and fair to peers and authority while making good decisions in the community and at home. QMHP will teach client necessary coping skills to decrease impulses on his own. QMHP will brainstorm strategies with client and encourage self-monitoring. QMHP will provide mediation and relaxation techniques, as well as, simple praises and encouragement to continue the positive behaviors he was exhibiting. QMHP modeled pro-social behaviors for client to strengthen his understanding of them. QMHP engaged the client in a role reversal exercise and required the client to think about his goals. QMHP continued to engage with client and provided positive reinforcement as he participated in the session. 2. Intervention: QMHP intervened to prevent the negative behaviors from escalating. QMHP physically redirected client to an alternative activity. 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. 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 setting. QMHP facilitated a family discussion to talk about common mistakes children with ADHD make and how he can make better choices. QMHP discussed anxiety and explained it is a normal part of life. QMHP provided examples of anxiety inducing situations. QMHP provided a list of experiences that is common with his mental illness. QMHP challenged client to identify any situation he has experienced. QMHP further explained different situations that can cause anxiety. QMHP provided feedback regarding client inquiries. QMHP continued to elaborate on ways client can cope and manage stressors. QMHP commended client for his participation and honesty. QMHP conducted a review of previous week interventions. QMHP assisted client with problem-solving. QMHP provided client with feedback. QMHP provided client with positive reinforcement. QMHP encouraged client to practice relaxation and coping techniques in social/academic environment, at home, and in the community. QMHP will collaborate with mom regarding behaviors and performance. QMHP will review and give feedback regarding ADHD and its causes and affect toward his well-being and academic functioning. 1. Response: Client utilized meditation and relaxation techniques. Client was seen decreasing anger and frustration. Client reported a decrease in symptoms following the relaxation techniques. Client verbalized positive feelings about building rapport in each session. Client displayed management of individualized behaviors. The client has not overreacted with anger to minor frustrations or irritants. Client responded in a pleasant manner acknowledging the positive reinforcement that the QMHP provided. Client discussed mental illness and its causes as a family. Client displayed interest in learning about ADHD. Client understands that his treatment plan is a behavior contract that will reflect his improvements and setbacks in the home. Client admits that he can be nicer to his family and can follow directions the first time they are given even if that means he has to stop doing something fun for a second. 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 was acceptive of prompts given by mother and counselor. Client demonstrated minimal progress during this session. Client did not demonstrate any unsafe actions by trying to hit or attack others. Mom shared client has made some major improvements but wants him to put some effort into building more friendships, finding a hobby, and being more independent outside of the home. 2. Response: Client initially presented with talkative behaviors as he probed the QMHP and asked different questions. Client reduced impulsive behaviors after 2-3 prompts from his mother and QMHP. Client began to show greater control of his anger. Client appeared to decrease the intensity of his anger and frustration. Client was pleasant and cooperative and demonstrated a willingness to discuss the factors contributing to his undesirable mood. Client acknowledged that he tends to engage in disruptive behavior when he begins to become frustrated with anything challenging. Client accepted responsibility for his angry outbursts and aggressive behaviors. Client stated he will display anger control and not threaten or intimidate others. Client later displayed quiet behaviors as he shrugged his shoulders and did not want to answer QMHP questions. Client did not respond as information was shared on anxiety and stress. Client is acceptive of redirection. Client understands that his actions have consequences. Client is striving for a good report every day. Client wants to make his counselor and parents proud by doing a good job every day and becoming a leader in the house as the oldest brother. Client reviewed last week discussion with psycho educational group and retained a lot of the information he was taught which motivates his family to pay more attention and take their time. Client is observed problem solving on his own and handling his emotions appropriately.