3/22/2023 EnchantaVaughn Approved (AM) Upon arrival, client was having a tough morning as soon as he entered the building. QMHP was asked to speak with him per request of his homeroom teacher Ms. G. Teacher reported client was off when he walked in the class and stormed to his seat. Client did not participate in the morning assignment nor listen attentively to the announcements. Client had an attitude until counselor arrived. Client was inquired why he was upset. Client shrugged his shoulders and continued inappropriate behaviors by smacking his lips and rolling his eyes at QMHP. Client was given quiet time to get his thoughts together and reflect on his behaviors. Client finally calmed down and explained why he was mad. Client stated that people was teasing him and saying mean things. Client was reminded to tell his teacher and stop allowing people to mess his day up. Client promised to turn his day around. (PM) When client wasn't given the attention he desired, impulsive and defiant behaviors increased. QMHP was called again to get client for a brief break. Client was being defiant and disrespectful to authority and began crawling over chairs and running into desks and walls. When counselor suggested calling mom client immediately tightens up, indicating he knew what he was doing and was aware of the consequences. Client was encouraged to sit down, pay more attention, and show his teacher respect by putting away his anything not related to the topic of discussion and participating with his classmates. Client was held back in class before going to lunch to be redirection by his teacher for getting behind on his work. Client was encouraged to pick up his slack and engage fully in his exercises. Client was reminded that he has been improving a lot and need to make better choices moving forward. (EOD) Client was witnessed displaying undesirable behaviors (e.g. not listening to his teacher and not completing his work). Client was reported being noncompliant to instruction and not following directions, resulting in him losing dojo points for not being productive or polite. Client was prompted several times to do his work and client chose to sit at his desk and turn his back away from the board. Client began to get off task more and more. Client was witnessed being distracted by outside stimuli (e.g. other students making loud noises and being rude at nearby table). Client started to pick up the undesirable behaviors by getting out of his seat, jumping over the tables, climbing and running around the desks when he thought his teacher wasn't looking. Client did not have a good day, as reported. Client did not obtain objectives or meet requirements for TDT. (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.