2/9/2023 EnchantaVaughn Approved 1. Behavior: Upon arriving to the home, client exhibited appropriate affect and laidback behaviors as he engaged in a positive manner with the QMHP. Client displayed his ability to use positive communication as he expressed his feelings and concerns. Client showed control over any intense angry feelings. Client seem to be heavily impacted by good role models and one on one support. Behaviors were maintained and managed at this time. Client displays the correct manners, saying please and excuse me when he had to ask a question. Client is seen conversing and responding well to feedback. Client was observed following rules and being compliant of the reinforcement provided by mom and mental health counselor. Client demonstrates he is capable of sitting down for the entire session without running and jumping from seat to seat. Client was able to cope and relax in his environment and complete his assignment without any distractions or horse play. Client shared personal stories that he has experienced dealing with today’s topic on “taking action mindfully” and performing acts of kindness around his community and in the home. Client verbalizes positive self-talk and affirmations around his mom, brother, and sister. Client expresses gratitude and compassion toward his counselor for helping him and being there for him during the pandemic. Client exhibits high self-esteem and is observed encouraging himself to make good choices. Client says he feels good and is having a good day. 2. Behavior: The family showed meaningful connections during today’s session. They interacted well with one another and spoke to each other calmly and peacefully. The family laughed and joked with one another and needed no help on their dialogue or interactions. Client was thankful that his counselor provides one on one help when he needs it and expresses blissful thoughts about being in session. Client enjoys receiving compliments and rewards for his hard work. Client remains on task and is observed following directions promptly. Client is reminded to think before he acts and mindfully consider all solutions before reacting to conflict or problem. Client responds well to feedback. Client understands that everyone is there to help and support him and that it is okay to ask for help. Client was showing a positive attitude in all areas today. Client was calm and patient and sitting appropriately in his seat without hyper activeness or impulsive behaviors, which were noticed by mom and QMHP. Client was well-behaved and stayed on task the entire time. Client was observed helping and displaying good sportsmanship. Client was praised for being a responsible person and for initiating his assistance. Client seems to be interested in working on himself, as evidenced by successfully completing the intervention and modeling good self-talk and affirmations. Client asked mom, brother, and sister to join him so that he could feel more confident about sharing his feelings regarding his mental illness. 1. Intervention: During therapy session, QMHP explored the underlying factors contributing to the client’s pattern of blaming others for his disruptive behaviors and negative attitude. QMHP listened to client verbalize his feelings towards making good decisions at home and avoiding conflicts with mom and other adult family members. QMHP encouraged client to have a good day. QMHP monitored individualized behaviors for acquisition of objectives. QMHP encouraged client to listen to his mother. QMHP encouraged client to be the example for his little brother and sister. QMHP firmly and consistently confronted client on how his involvement with negative peer group impacts himself and others. QMHP utilized a role-reversal technique to assist client with alternative ways to avoid negative interaction and to assist him with better decision-making skills. QMHP supported client as he identified how his patterns of blaming others is associated with underlying feeling of inadequacy and insecurity. QMHP challenged client to continue displaying a positive attitude while employing positive reinforcement when client is able to achieve his goals and objectives. QMHP provided praise when the client continued to display positive behaviors throughout the day, remaining on task and was very respectful to siblings, parent/guardian, and mental health professional. QMHP probed in order to process and explore different perspectives related to his treatment plan. QMHP reviewed and discussed the importance of displaying respectful behaviors within the home and community. QMHP went over services, objectives, and goals. QMHP reviewed effective communication skills with client to improve the way he spoke to family members. 2. Intervention: QMHP encouraged client and parent to take notes during the session to instill repetition and understanding of each therapeutic intervention used today. QMHP provided feedback and applied active listening skills throughout the session. QMHP discussed with the client triggers to different emotions that increase the potential for acting out behaviors, as well as, strategies and interventions to assist client in managing strong emotions and avoiding negative thinking. QMHP prompted client to express how he believes parents and children should treat each other. QMHP encouraged client to think twice before reacting negatively or aggressively in situations that may not need that level of reaction to be solved. QMHP used the basic listening sequence to clearly draw out the point of view that the client was feeling and get beyond his aggressive language and behaviors. QMHP implemented individualized behavior management techniques with client. QMHP processed with client about psychoeducational activity while assisting with directions. QMHP explained the importance of the activity. QMHP provided feedback to client in regard to questions asked. QMHP explored client’s responses and provided appropriate feedback. QMHP supported client making good decisions and having positive behaviors at home. QMHP observed client in his own space to determine if he required assistance. QMHP observed client complying with rules and expectations. QMHP talked to client about his confidence levels and how they can affect his thoughts and behaviors. QMHP encouraged client to utilize positive self-talk as a means of decreasing anxiety and managing frustration when encountering difficult or challenging circumstances. QMHP reminded client of his strengths and abilities. QMHP praised client for his efforts and being respectful to his mom. Mom expressed cheerful attitude toward client, as they closed out the session with QMHP. 1. Response: Client admitted the underlying factors contributing to his pattern of blaming others for his behaviors stemmed from being in a toxic environment and seeing other families split apart. Client stated it’s easier to talk about other people than it is to talk about himself but plans to do better with avoiding conflict in the home. Client said he was feeling ecstatic and plans to have a wonderful day. Client shook his head and returned to the activity. Client displayed management of individualized behaviors at this time. The client has not overreacted with anger to minor frustrations or irritants in the home today. Client responded in a pleasant manner acknowledging the positive reinforcement that the QMHP provided. 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 did not display any outbursts during the role play exercise. Client learned to look for similarities rather than differences in others. Client demonstrated expectations and responded well to redirection from mother and QMHP. Client did not run away from his family or get frustrated like he normally does. Client was able to speak calmly and demonstrate his improved communication skills while engaging in self-reflection. During the session at the home, mom expressed to the counselor that though client’s behavior has improved he still has to sometimes remind client about remaining consistent with reacting positively when being reprimanded or redirected. Mom states to counselor that she has implemented a minor schedule for client to assist him with his completion of chores. Mom mentions that schedule assists her as well and allows her to remain focused on completing tasks and chores concerning the other siblings in the home. 2. Response: Client transitions smoothly and safely with the next activity, displaying appropriate behaviors. Mom and client grabbed loose leaf paper to take notes during the session. Client and mom demonstrated they understood the therapeutic interventions provided and plans to utilize them daily. Client was acceptive of the support, feedback, and encouragement. Client was happy Client exhibited good social behaviors. Client was able to reevaluate himself and display a more positive attitude toward siblings, mom, and counselor. Client has become more involved in age appropriate social activities and was given positive reinforcement for these choices. Client demonstrated expectations and responded well to feedback. Client verbalizes positive feelings about himself but recognizes areas he needs to work on. Client smiled and hugged QMHP. Client was observed in his seat and raising his hand. Client interacted well within his home environment. Client reported a decreased stress level due to his modulation of social contact, and the success of this was reviewed. Client implemented the positive reinforcement provided by his counselor and is able to stay motivated and enjoy his day. Client exhibited good manners after earning incentive for his hard work. Client reduces sadness and finds more excitement in learning about his family history and mental health. Client continues to make progress with ISP objectives. 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, as evidenced by him asking questions and maintaining a cheerful mood.