5/10/2023 EnchantaVaughn Approved (AM) During morning academic hours client was observed in a careless mood, as seen knocking over things and not picking them up. Client symptoms of ADHD increased significantly as he interacted with his peers. Client struggled to refrain from displaying disruptive behaviors, as evidenced by client horseplaying with his peers at his table during instructional period. Client exhibited negative behaviors as he failed to comply with instruction. Client continued talking until his teacher informed him he would lose points and time at recess if he continues to talk out of turn. Client quickly got quiet and was able to redirect his negative behavior back to positive behaviors. Client remained on task and was able to earn his points back. (PM) During middle academic hours client failed to remain in his designated area, as evidenced by client arriving to his counselor without a permission. Client looked frustrated and upset. Client began yelling and screaming. As the client was being redirected, client displayed aggressive non verbal communication by crossing his arms and rolling his eyes. Client finally complied and adjusted himself back to normal behavior. Client was given a 15-minute cool down break before being escorted back to class. (EOD) Towards the end of the day client struggled to interact with his peers appropriately as he was observed being seated alone. Client appeared to be distant as he was seated at the end of the table. Client was not social and refused to talk to anyone. Client stated “They keep lying on me so I’m going to just stay to myself.” Client failed to interact in a healthy manner with others during, as he prepared for stations. Client appeared to be playing games at his desk, as he failed to acknowledge anyone. Client was prompted to pay attention and utilize this time to practice his social skills and coping strategies with peers. Client had a difficult time working with others without disruptive behaviors. Client continued to misbehave and ignore redirection. Client attempted to walk out of class before confronted by his counselor. Client had one on one with QMHP and was directed to apologize to his teacher for not listening. Client said sorry. No incident was reported following one on one and client was able to leave school in the appropriate manner, but need improvement with all objectives. (AM) QMHP had one on one with client. QMHP explored positive behavior options he was exhibiting with client to support his willingness to continue to make good decisions and display appropriate behaviors in school. QMHP processed thoughts and feelings. QMHP inquired about morning routine and previous activities. QMHP encouraged client to utilize positive self talk as a means of decreasing anxiety and managing frustration when encountering difficult or challenging circumstances. QMHP talked to client about his confidence levels and how they can affect his day and self esteem. QMHP encouraged client to make good choices. QMHP monitored acquisition of behaviors and managing individualized behavioral modification programs. QMHP provided simple praises to client in efforts to motivate client to have a good rest of the day. (PM) QMHP supported client with building new relationships in lunch and interacting with his age group. QMHP assisted client with breathing and relaxation exercises in efforts to reduce symptoms of ADHD. QMHP utilized behavior modification strategies including removing client from the stimulant and stressful environments in efforts for him to reduce impulsive and defiant behaviors. QMHP assisted client in exploring other coping strategies that he had previously used to solve problems and avoid conflict. QMHP observed client in academic and social settings throughout the day to determine the need for redirection. (EOD) QMHP reminded client of goals and objectives and what things he can improve in order to successfully meet ISP. QMHP held consultations with client and teacher about effective intervention strategies that build on the client’s strengths and compensate for his negative behaviors. QMHP encouraged teachers to provide frequent positive reinforcement to maintain client’s interest and motivation in maintaining positive classroom behaviors and completing his school assignments. QMHP reviewed the reported behaviors with client in efforts to allow him to express his point of view and self reflect. QMHP did not have to prompt or intervene any negative behaviors during dismissal, as he demonstrated adherence to classroom rules and expectations. (AM) Client greeted mental health professional by waving and smiling. Client said good morning upon arrival and grabbed breakfast to prepare for his day. Client demonstrated excellent social skills due to positive interaction with peers and helping others. Client expressed he was feeling good. Client stated he wakes up on time for school but has a hard time going to bed on time due to playing video games and watching tv. Client admitted that losing out on sleep is not good for his health or education. Client communicated good “I statements”, such as, “I will be a leader” “I will show respect” “I will do my work and listen to my teacher”. Client expressed low confidence when talking about things he dislikes and other challenging tasks. Client explained he likes to be rewarded and praised by others. Client promised to do the right thing. Client was observed following directions and participating in class. Client said thank you and returned to his seat. (PM) Client seems to enjoy making new friends in school. Client interacts well with his peers unless he feels bullied. Client often follow behind others who are being disruptive and has to be reminded to get back on task. Client utilized breathing and relaxation techniques during therapy session and free time in class. Client was able to reduce hyperactive behaviors with additional support and redirection. Client is seen dealing with stressors and coping appropriately. Client utilized conflict resolution skills in school by problem solving on his own and compromising with his peers. (EOD) Client reviewed goals and objectives. Client admitted he needs improvement and plans to practice skills and strategies at home in order to stop complaining about doing work in school. Client was able to eliminate unwanted behaviors and implement new strengths. Client benefited from positive reinforcement. Client engaged in self-reflection and role-playing activities to correct his mistakes. Client demonstrates excellent conduct at this time while displaying responsible behavior, ending the day on a good note.