3/20/2023 EnchantaVaughn Approved (AM) Upon arrival, client is witnessed out of his seat and causing disruption in the classroom while teacher was reviewing homework and beginning lesson for the day. Client pro social behaviors have declined. Client will not comply to rules or directions during morning instruction. Client had a hard time transitioning between classes and listening to authority. Client screamed outloud in a disrespectful tone wanting to frustrate and annoy everyone on purpose. Client was given several warnings. Client understands that there are consequences for his actions and that repercussions would follow if he continues to act out. Client was directed to correct his behaviors. Client refused and withdrew himself away from all staff. Client sat in his seat with a poor attitude, huffing and puffing and covering up his face. (PM) Client displays impulsive behaviors going to lunch, hopping around, cutting his peers in line, pushing and shoving and being silly. Client was directed to stay in line and walk calmly or consequences would follow. Client looked at QMHP with an aggressive expression and slowly got back in line. Client was monitored at lunch. Client held small conversation with peers. Client could not control his voice volume and began to be disruptive again. Client was escorted out by QMHP for one on one. Client required to be redirected by staff 2-3 times. Client made minimal progress towards ISP objectives. Client was heard using negative and vulgar language towards peers. Client was engaged in negative social interactions with peers and staff. Client was verbally aggressive as he explained his point of view to QMHP and staff about his reasons for acting out in school. Client was told that his behaviors are going to get him in trouble and if he chooses not to listen he will sit out of every activity and be given alternative work to do that’s not going to be fun. Client frowned and regrouped himself. Client returned to his group and prepared for the remaining activties. (EOD) Client was not polite, positive, or productive today. Client was very disruptive and defiant in class, refusing to listen to his teacher or follow instructions when he was asked. Client required 1-2 prompts of redirection during soccer, basketball, and kickball activities in the gym. Client displayed restlessness and was unfocused during leisure activities, especially during class and psycho educational. Client was prompted to refocus 3-4 times by QMHP. Client was reluctant and hesitant to follow rules and stay with his age group. Client kept getting off task and involving himself in miscellaneous acts not directed by staff. Client got in trouble for leaving his assigned area without permission. Client continued to require 2-3 prompts of redirection by QMHP and other adult staff. Client refused to do what he was asked and QMHP pulled him to the side for one on one. Client presents anger and frustration at this time. Client seem to be irritated and needed a second to cool off before processing. Client was reminded that school is about learning together and being able to interact with our peers on our age level so that we learn the fundamental principles and develop a sense of maturity and self-control. Client was not able to reduce attention-seeking behaviors or follow directions. Therefore client did not meet goals or objectives. (AM) QMHP employed positive reinforcement when the client was able to achieve all of his objectives, and encouraged him to maintain his positive behavior by providing him with a review of his objectives. QMHP educated the client with relaxation strategies such as deep breathing and counting to 10 to decrease the client’s aggressive behavior. The client was encouraged to use good judgement, and respect authority figures. QMHP provided client with a release of energy by walking to get a drink of water to help him relax and decrease his hyperactive behavior. QMHP used appropriate behavior modeling by pointing out a peer that is demonstrating positive behavior to decrease the client’s impulsive behavior and encourage him to use self-control. QMHP monitored progress in demonstrating individualized pro-social skills (e.g. anger management, education, problem-solving, conflict resolution, appropriate verbalization of feelings, and cognitive-behavioral programming). (PM) QMHP provided individual, group, and family counseling based on specific treatment objectives. QMHP reminded client of goals and objectives. QMHP collaborated with teacher and administrative staff in regards to school rules and regulations, classroom management, effective teaching practices, following verbal and non-verbal instruction, role playing exercises, and an appropriate incentive system. QMHP educated client about using good manners in school 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 school setting. (EOD) QMHP facilitated a group discussion to talk about common mistakes children with ADHD make and how he can make better choices. QMHP reviewed school expectations and how client should conduct himself around peers and authority. QMHP praised and recognized client for his hard work, efforts, participation, and working towards improvement by changing daily habits and implementing a positive and consistent routine. QMHP supported client with meeting his objectives and coping with stressors without needing additional redirection or prompts. QMHP encouraged client to continue displaying age appropriate behavior, and the benefits of this will be reviewed with parent and teacher. QMHP conducted a review of previous week regarding mindful seeing and mindful listening. 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. (AM) The client responded in a positive manner acknowledging the positive reinforcement that the QMHP provided by saying “thank you” while presenting a smile. Client utilized relaxation strategies The client showed his gratitude for being able to release physical tension stating that he feels relaxed and able to catch his breathe again. The client stated that he can be good also, and told QMHP that he will do his best to follow directions and keep his hands to himself. Client was able to cooperate and comply to rules and regulations due to positive peer influence. Client implemented pro social skills successfully. (PM) Client attends therapeutic day treatment daily and has completed all psycho educational activities. Client has presented himself in a responsible way and is making progress towards goals and objectives. Client maintains classroom etiquette by sitting in his seat during instructed classwork, raising his hand and asking appropriate questions, being respectful at his table/desk, remaining quiet during quiet time and active during activity time, listening to his teacher, modeling appropriate behavior, and earning points for a reward without begging for a treat. Client says please, thank you, and excuse me. Client shows empathy towards others and is caring to his peers, as evidenced by him hugging, playing, smiling, and complimenting others. Client avoids negative language (i.e. cussing and using aggressive words). Client engaged in self reflection and reflected on his day, the good and the bad. Client communicated his likes and dislikes. (EOD) Client recognized his triggers and was able to identify common interests and similarities him and other ADHD recipients share. Client understands that he is expected to act civilized and use his inside voice while in the building and transition safely in between class time, lunch time, specials, and other settings. Client is observed making better choices and doing the right thing. Client has improved with staying in class and utilizing his breaks appropriately without needing to displaying attention seeking behaviors to get his way. Client has difficulty staying focused when distracted by others who are off task and has to be reminded to get back on track. Client responds well to praise and support. Client is acceptive of redirection. Client understands that his actions have consequences. Client is striving for a good report from school everyday. Client wants to make his teacher and parents proud by doing a good job. Client is very independent but can be a team player as well. Client reviewed last week discussion with psycho educational group and retained a lot of the information he was taught which motivates his group to pay more attention and take their time. Client is observed problem solving on his own and handling his emotions appropriately. Client avoids meltdowns and lashing out when upset or frustrated. Client responds well to feedback. Client responds well to the positive reinforcement provided by QMHP and is seen increasing self-esteem and confidence. Client said he was going to practice coping strategies and relaxation techniques in all aspects of his daily living routine in hopes that he will be a better person, student, sibling, and friend.