4/20/2023 EnchantaVaughn Approved (AM) Upon arrival, client walked into school with a grumpy look on his face. Client displayed non verbal communication when confronted about his facial expressions. Client was challenged with recouping and deescalating negative behaviors before going into class so that he would not interrupt others who were trying to learn. Client shrugged his shoulders and lowered his head into his coat, demonstrating he was not ready to go to class. Client stated that his teacher always gives him a hard time and singles him out of the all the students and he heates being in her class. Client was encouraged to be respectful and figure out how to deal with his feelings without letting it mess up his day. Client was observed giving teacher a hard time even after having one on one. Client displayed frustration and attempted to walk out of class. Client presented defiance toward authority when confronted about his poor attitude. Client was sent to reflect and cool off. Client appeared guarded and offensive due to encountering other challenges in academic setting. Client was reported to have struggled to maintain expectations and could utilize a break. Client displayed attention seeking behaviors trying to pressure other peers into wrong doing. Client was prompted to focus on himself and stop being a trouble starter. Client required to be monitored and assisted with getting back on task. (PM) Client was able to deescalate aggressive and unpleasant behaviors. Client was observed making appropriate choices, due to listening and following directions. Client did not require to be redirected back into class. Client expressed negative feelings when having to finish his work from earlier. Client was very disruptive in class, making loud noises and talking back to his teacher. Client was reprimanded and pulled to the side to correct his behaviors. Client was observed telling his teacher “NO” and refusing to do his work. Client was instructed to see counselor to be redirected. (EOD) Client informed QMHP people keep messing with him and touching his stuff. Client was educated about sharing and social communication. Client was confident he could go back to class and follow directions without getting into an argument. Client walked back quietly without hyperactive behaviors. Client was reported on task and following directions. Client made it to the end of the day but was reminded to reflect on what he can do better tomorrow, due to not meeting any objectives. Client dismissed promptly and safely from school. (AM) QMHP observed client in the classroom in efforts to determine whether he required assistance. QMHP determined client was on task and did not require assistance. QMHP provided positive gestures to encourage client on his positive classroom behaviors. QMHP reminded client of ISP objectives and what he needs to do in order to achieve them. QMHP reviewed examples of alternative appropriate behaviors he could engage in to stay on task without causing disruption. QMHP encouraged client to resist negative classroom behaviors in efforts to refrain from requiring to be redirected by his teachers so many times throughout the day. QMHP praised client for listening and following directions and interacting well with his peers. (PM) QMHP explored the positive behavior options he was exhibiting with client to support his willingness to continue to make good decisions and have positive behaviors in school. QMHP engaged client in a conversation regarding his recent behaviors, progressions and setbacks. QMHP explored client’s responses and responded accordingly. QMHP talked with client about the importance of adhering to rules and expectations in school, at home and in the community. QMHP provided age appropriate understanding of his mental illness and encouraged him to utilize his coping strategies during social and non-social environments. (EOD) QMHP encouraged client’s teacher to provide frequent positive reinforcement to maintain client's interest and motivation in maintaining positive classroom behaviors and completing his school assignments. QMHP assisted client to behave in more positive ways by addressing the conflict he was facing with his teachers. QMHP informed client of replacement behaviors in efforts to decrease attention seeking behaviors the client often is involved in. QMHP modeled appropriate ways for client to get positive attention from his teacher. QMHP assisted client in exploring other coping strategies that he had previously used to solve other problems. QMHP utilized behavior modification strategies including removing Client from the stimulant environment in efforts for him to reduce impulsive behaviors. QMHP modeled proper positive behavioral expectations for the client to administer additional layers of support and display an understanding of expectations. (AM) Client smiled as he saw QMHP's positive gestures. Client was able to process making good choices with QMHP and his teacher. Client listed 3-4 classroom behaviors that he was going to utilize in efforts to remain positive behaviors. Client appeared to be receptive to receiving positive reinforcement from his teacher as demonstrated by his smiling and inviting body language. The frequency and intensity of the client's defiant affect decreased. Client continued to work on the classroom activity. (PM) Client required additional redirection from QMHP to get him to focus on the classroom assignment. Client was able to settle down and return to classroom activity. Client was responsive to teacher’s lesson. Client reduced impulsive behaviors after 3-4 prompts from his teachers and QMHP. Client began to show greater control of his anger. Client appeared to decrease the intensity of his anger and frustration. Client was pleasant and cooperative and demonstrated a willingness to discuss the factors contributing to his undesirable mood. Client acknowledged that he tends to engage in disruptive behavior when he begins to become frustrated with schoolwork. Client accepted responsibility for his angry outbursts and aggressive behaviors. Client stated he will display anger control and not threaten or intimidate others. (EOD) Client was observed and reported to have been pleasant and cooperative during classroom activities and demonstrated a willingness to adhere to school and classroom rules and expectations. Teacher praised client for being on his best behavior and correcting his mistakes. Client displayed good behaviors, raising his hand when he asked a question, waiting for his turn to speak, using his words instead of hand signals, saying please and thank you, and giving his teacher good eye contact. Client utilized deep breathing techniques to relax and stay calm during stressful moments. Client administered positive behavioral expectations, reducing all symptoms related to ADHD.