12/12/2023 EnchantaVaughn Approved (AM) Upon arrival, client was observed sitting in his seat eating his breakfast quietly. Client appeared to be in a calm mood, as evidenced by his collective spirit and positive interaction with his peers. Client displayed non aggressive behaviors and was seen following all directions and listening to his teachers, indicating that he was already having a good start to his day. Client displayed good social behaviors and seemed to be on track with his goals and objectives. (PM) Client was involved in a physical altercation with a student in his class. Cafeteria monitors witnessed client chocking/pushing the student and the male student retaliated by fighting him and stomping him to the ground. Client and the student were pulled off the ground and from underneath the table to a safe level and separated and escorted to the office by cafeteria monitor and QMHP. Client was very calm and stable, at this time. Client displayed inappropriate and negative behaviors following the incident (i.e. making loud noises and being disrespectful toward QMHP). Parent was called and informed of the incident. Mom was disappointed that her child is always pointed out for his behaviors but no one takes the time to find out both sides of the story. QMHP communicated to mom that there were several witnesses around who prompted both students to keep their hands to themselves. Client was told more than once and still ended up in a fight. QMHP reassured mom we are not taking up for the other student because they were both wrong but her son has to tell an adult and learn how to walk away before hand to prevent any conflict especially bullying. Client had a chance to talk to mom and calm down. Client explained to his mom that he hit the boy first because he had been picking with him all day. Client seemed a little frustrated by all the attention and wanted to get his things and prepare for early release. Client walked quietly behind his counselor to go get his belongings and to sit and wait for mom. Client was inquired to why he continues to get into fights with the same peers. Client responded with non verbal cues, shrugging his shoulders and shaking his head indicating he doesn’t know why. Client was educated that fighting in school is a big no no and can land him in a lot of trouble. Client was reminded of goals and objectives and what is expected of him at school. Client was acceptive of feedback and promised to make better choices. (EOD) Client walked quietly in the hallways being respectful of peers testing and learning around him while transitioning into individual session to discuss previous behaviors. Client expressed positive feelings as he headed on the stage and showed he could sit and keep his hands to himself. After about 15 minutes client started displaying hyperactive behaviors, such as putting paper in his mouth, falling on the floor, and frowning up his face. Client was extremely fidgety and had a hard time sitting still in the chair, eventually falling asleep. When mom showed up, client was well behaved and content leaving school in a happy mood and waving goodbye to his counselor. Client failed to meet objectives in school today. (AM) QMHP observed client while in the classroom in efforts to determine the need for intervention. QMHP provided a positive hand gesture such as a thumbs up in efforts to show approval of clients current actions. QMHP did not have to redirect client. QMHP was informed of the clients behaviors. QMHP reviewed the reported behaviors with client in efforts to allow him to express his point of view. QMHP encouraged client to list alternative behaviors he could have participated in besides the negative ones that caused him to redirected. (PM) QMHP observed client in his classroom in efforts to assist with any negative behaviors towards his classmates or his teachers. QMHP did not have to intervene with clients behaviors as he demonstrated adherance to classroom rules and expectations. QMHP provided a simple hand gesture to encourage client to continue with the positve classroom behaviors. QMHP observed client as he walked through the hallways with his classroom being led by his teachers. QMHP stated simple praises to client as he walked past. QMHP will continue to offer postive reinforcement when observing client adhering to his ISP objectives. (EOD) QMHP will continue to assist client with managing anger and frustration by reviewing and modeling effective coping skills. QMHP encouraged the client to respect his teacher. QMHP reviewed school rules and expectations with client before walking him into his classroom, ensuring that he was safe and comfortable. QMHP provided strategies such as positive reframing. QMHP assisted client with practicing reframing negative thoughts with more positive thoughts in efforts to reduce impulsive reactions throughout the day. QMHP informed client that he successfully met his ISP objectives for the day in efforts to support his accomplishment. QMHP was informed that client dismissed without incident by his teachers. (AM) Client looked up and saw QMHP observing his classroom behaviors. Client smiled when he saw the positive hand gesture given by QMHP. Client continued to participate in the classroom activities without prompting from QMHP or his teachers. Client remained focused on the classroom lesson as QMHP observed him. Client smiled at QMHP. Client continued to complete his classwork. Client did not require to be redirected by his teachers or QMHP. (PM) Client remained focused while in the hallway. Client waved at QMHP as he passed by. Client was smiling. Client displayed a few disruptive behaviors in the classroom setting, due to stressful environment and wanting to take a break. Client did not utilize any of the conflict resolution skills he has learned. Client continued to be defiant. Client would not express what triggered his negative behaviors. Client did not process that he could have handled the situation differently. Client took a strong stance on why his actions were correct and the teacher was wrong for yelling at him. Client calmed down after counting to 10 and deep breathing exercise. Client was able to respond in a more appropriate way. (EOD) Client apologized for his actions. Client stated the classroom rules and expectations along with QMHP. Client was able to reduce negative behaviors and focus on the lesson. Client anger and frustration was reduced. Client reported that he was happy to have been successful in reaching his ISP objectives throughout the day. Client stated that he could reach them everyday. Client utilized positive body language as he interacted with QMHP. Client was reported to have dismissed without incident.