1/3/2024 EnchantaVaughn Approved QMHPA greeted Ms. Cosby upon arrival to the home setting. Upon arrival to the home setting, Ms. Cosby appeared to be in a content mood evident by her facial expressions such as a smile on the face. QMHPA engaged Ms. Cosby in a discussion to determine if there has been any improvement in her behaviors as it relates to her coping skills and depressive symptoms. Ms. Cosby discussed with QMHPA, “It has been a little, but she continues to have trouble with being able to control her feelings and coping skills”. QMHPA informed Ms. Cosby that this session was going to focus on her being able to communicate her feelings to decrease the depression that she encounters on a daily basis. Upon arrival, she did not present any symptoms of S/I. QMHPA began the session by inquiring about Ms. Cosby current thoughts, feelings, and emotions. QMHPA engaged Ms. Cosby in a skills building activity. QMHPA explained to Ms. Cosby that the purpose of this activity was for QMHPA to model appropriate communication skills and guided Ms. Cosby practice in this area. QMHPA discussed with Ms. Cosby that it is important that when communicates with her daughter or her husband or anyone in general that she has to communicate with, she be reminded of her tone due and her verbal and non-gestures. QMHPA assisted Ms. Cosby with being able to gain insight in regards to her responses being as though she tends to get emotional. QMHPA engaged Ms. Cosby in another skills building activity. QMHPA explained to Ms. Cosby that the purpose of this activity was to teach her how to identify her anger triggers. QMHPA taught Ms. Cosby this skills by providing Ms. Cosby with a scenario and role-played with her on being able to recognize the connection between surface behaviors such as irritability and anger. Throughout the session QMHPA continued to teach Ms. Cosby effective communication and assertiveness skills to learn how to express feelings in a controlled fashion and meet her needs through more constructive actions. QMHPA assisted Ms. Cosby appeared to be receptive to QMHPAs’ interventions and services that were provided to her during the session. During the session, QMHPA had to redirect Ms. Cosby several times for the use of profanity. Ms. Cosby continued to discuss with QMHPA, “When I think about all the things that I go through or have been through with my daughter, son, other family members, I see why I need to be on medication and I am surprised that I am not in a crazy house”. Ms. Cosby continued to express to QMHPA during the session that she just cannot seem to control her anger at times and she continues to find herself being depressed on a daily basis. She verbalized to QMHPA, “I cannot wait to see my doctor because I think I need something stronger for my depression”. During the skills building activity, Ms. Cosby struggled with being able to convey the information that was provided to her by QMHPA. She understood the scenarios that were being discussed with her; however, she continues to fail how to implement the techniques that are provided during sessions for she indicated, “I just feel like throwing in the towel at times and just fighting everyone”.