5/11/2023 EnchantaVaughn Approved (AM) Upon arrival, client displayed inappropriate and defiant behaviors at the start of class, not have a good start to his day. Teacher reported that client was asked nicely to slide his chair over and give student at his table space to work and client flipped over his chair and started lashing out at her. Client was prompted to pick his chair up and correct his attitude. Client was angry and upset and refused to listen to his teacher walking away aggressively. Client was escorted to see mental health professional and explain why he was acting up after simple instruction. Client displayed frustration and pouted all the way down the hallway. Client was given a couple minutes to calm down and regulate his emotions to more positive expressions. Client was inquired about incident and what happened in class and at the end of day yesterday during dismissal. Client would not acknowledge any wrong doing or negative behaviors and continued to look flustered in the face, rolling his eyes, and smacking his lips. Client was given redirection. During processing, client communicated that he threw his chair because he was upset at his teacher. Client expressed that he was taken out of class for no reason and felt like he was being picked on. QMHP collaborated with teacher to find out what happened and how can we come to a compromise and get client back on track. Client promised to be good and sit in his seat and finish morning work. (PM) Teacher reported client was not doing any of his work all day. Client was having trouble listening and following directions throughout the day. Client continues to display inappropriate behaviors, talking back to his teacher and being a class clown. Client was observed at his seat preparing for testing. Client exhibited high impulsive behavior and needed to remain in class until he got himself together. Client did not take a break but was given redirection inside of his class and encouraged to make better choices and treat people with respect. Client agreed to behave and do his best. Client was encouraged to utilize conflict resolution skills and keep his hands and feet to himself. As the client transitions to lunch he is observed conducting himself appropriately. Client displays age appropriate behaviors at the lunch table and showing good mannerisms by chewing with his mouth closed, throwing away his trash, and using appropriate voice volume. Client continues to struggle with managing his emotions when faced with conflict. Client is seen being pulled out of the cafeteria by lunch monitor for getting up out of his seat and horse playing when directed more than once to sit back down. Client refused and starting have an episode (i.e. falling out on the floor, crying, kicking, and screaming). Client was given a few minutes to calm down. Client negative symptoms have stabilized, due to positive reinforcement provided by QMHP. Client was reassured that it is not too late to make good choices. Client was able to straighten up and return to his assigned area to finish his work. (EOD) Client was given a cool off break at the end of the day to make sure he will maintain cooperation until dismissal. Client is seen displaying age appropriate behaviors, at this time. Client no longer presents anger and frustration and has learned to control himself around peers and authority. Client positive gestures indicate he will end the day on a good note. Although, client was able to process his feelings and make corrections he did not meet ISP objectives and is encouraged to practice self-control techniques. Client referral will be processed and updated the next school day. Parent will be contacted once behavioral specialist provides documentation on behavior contract and QMHP will follow steps according to his service plan. (AM) QMHP monitored client individualized behavior modifications in collaboration with his classmates and teachers. QMHP expressed gratitude toward positive interaction with his classmates and teachers. QMHP encouraged client to continue displaying positive behaviors. QMHP supported client involvement in selected activities. QMHP processed with client about what he learned from activity after the review from the teacher. QMHP praised client for his cooperation despite of not wanting to go to class or be in school today. (PM) QMHP discussed with student how empathy, communication and awareness of another point of view can prevent or reduce conflicts. QMHP brainstormed with client a list of conflicts that typically occur in his life in school or at home in efforts to identify possible conditions or triggers that preceded the actual conflict. (EOD) QMHP utilized role playing to demonstrate the calming effects of predicting the thoughts, feelings and actions of self and others prior to the outbreak of a conflict. QMHP prompted client to share anticipated thoughts and feelings and to indicate how this process reduces angry reactions. QMHP asked appropriate questions about group activity. QMHP reminded client of school rules and expectations. QMHP supported and monitored client in social and academic setting to ensure goals and objectives are met. (AM) Client modeled different ways to walk away from a conflict when frustrated. Client modeled how to separate himself from negative situations by counting to 10. Client demonstrated how to verbalize his feelings without yelling and being aggressive. Client was able to speak calmly and demonstrate his improved verbalization skills while conversing with other QMHP. (PM) Client participated in brainstorming exercise and was able to identify possible conditions or triggers that precede a conflict in school or at home. Client did not display any outbursts during the role play exercise. Client had difficulty understanding due to minor distractions. Client appeared to be learning from his mistakes and correcting them throughout the day. Client responded well to praise. (EOD) Client was receptive as QMHP demonstrated and defined the meaning of empathy. Client actively participated with QMHP as they discussed and processed empathy. Client demonstrated that he was able to process productive expressions of anger. Client displayed active behaviors in group settings. Client is making progress with expressing himself. Client made insightful comments which contributed to discussion. Client did not run away from group or get frustrated like he normally does during room changes. Client said he likes coloring activities. Client agreed to follow instructions and finish his work. Client was seen interacting well with his classmates and teachers. Client seemed to be enjoying the day and looked excited when transitioning to dismissal setting.