1/2/2023 EnchantaVaughn Approved (AM) Upon arrival, client was observed on task and displaying age appropriate behaviors. Client was seen in his seat and completing his morning work. Client was able to transition to lunch in a cooperative manner, as evidenced by him listening and following directions. Client was involved in an incident with a former group member who he sized up and proceeded to fight. Client displayed aggressive and violent behaviors by being combative and aggressively responding to redirection. Client attempted to resist and pull away from staff when confronted and separated from altercation. Client was disrespectful toward mental health professionals refusing to process his emotions by walking off and exhibiting increased frustration. Client ignored prompts. Client was not listening or trying to resolve conflict. Client continued to display a negative attitude until administrative showed up. Client decided to get himself together and join his group. Incidents of recent anger outbursts by the client were processed and alternative, adaptive ways to express that anger were reviewed. (PM) The client was assisted in identifying how his body language sometimes contradicts his emotional content. Client unfolded his arms and began to do the right thing. Client participated in the group activity and was positively encouraged by his peers. Client contributed to discussion and was reminded to count to ten before lashing out at others. The client has failed to learn and implement calming/relaxation techniques, and additional time was spent reviewing these techniques. The client accepted the negative feedback that was given regarding his lack of use of self-monitoring to improve defiant and disrespectful behaviors. Client was able to return to class in a civil manner and attend to his studies. (EOD) Teacher reported, client has been making better choices staying away from conflict and working as a team. Client was observed taking short breaks and preparing for the end of the day. Client communicated non aggressive behaviors by keeping his hands to himself and being polite to classmates. Client demonstrated good social skills (e.g. sharing and taking turns) and was supported for deescalating episode he displayed earlier. Client dismissed from school without incident, but failed to meet objectives as observed. (AM) QMHP will teach client necessary coping skills to decrease impulses. QMHP will brainstorm strategies with client and encourage self monitoring. QMHP will assist client with self monitoring skills to enable him to participate in fundamental learning. QMHP will provide mediation and relaxation techniques. QMHP inquired about after school activities. QMHP will collaborate with teacher regarding behaviors and performance. (PM) QMHP applauded client for being the bigger person. QMHP will review and give feedback regarding ADHD and its causes and affect toward client well being and academic functioning. QMHP will provide client with support and encouragment. QMHP will monitor, observe, and redirect client behaviors as needed. QMHP will build rapport. QMHP will explore positive self talk, use instruction modeling, and increase social communication skills with positive reinforcement role play activities. (EOD) QMHP will educate client on behavior modification to help client identify what behavior he need to decrease and avoid daily. QMHP will utilize behavior modification system to aid the client with following directions given by authority figures. QMHP will meet with client daily to discuss progress and expectations that are working and not working in school daily. (AM) Client communicated positive affirmations and self talk. Client utilized self monitoring skills in class. 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. (PM) Client was able to reevaluate himself and display a more positive attitude toward peers and authority. 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 reported a decreased stress level due to her modulation of social contact, and the success of this was reviewed. (EOD) As the client developed understanding of academic expectations, she reported increased satisfaction and function. Client responded well to feedback, interacting well with others. Client implemented her plan for restoring relationships, and this was reviewed.