12/13/2023 EnchantaVaughn Approved (AM) Upon arrival, client was seen coming into the school with a positive attitude, very welcoming to others, and in a good mood. Client grabbed breakfast and headed to homeroom. Client was quiet and respectful at his seat while listening to the morning announcements. Client was supported during morning academic hours with contributing to the activity and following directions. Client displayed age appropriate behavior with her peers as she worked in groups. Client appeared to be the spokesman for the group as he allowed his members to tell him their thoughts and he shared them with the class. Client displayed positive behavior throughout the period and did not require any redirection. (PM) Client displayed appropriate behavior with his peers during middle academic hours, as evidenced by client helping his peer with the assigned task. Client was allowed to assist his peer with the assignment as he had completed his assigned task and displayed good behavior when doing so. Client used positive communication skills as he spoke quietly using his inside voice. Client was observed in lunch being cooperative and sitting in his seat without hyperactive or impulsive behaviors. Client symptoms appeared to be stabilized as the client showed excellent control of himself by managing his reactions to stressful and challenging tasks. (EOD) Towards the end of the academic day, client’s teacher reported that client was more attentive and less talkative in class now and appeared to be participating more. Teacher also added that she felt the change in client’s behavior may be due to another student being switched out of the class. During specials client appeared to be in a pleasant mood evident by being on task. Client presented with the necessary tools needed in order to complete assigned task. Client seemed to be interacting with his peers appropriately during specials as he was observed participating in gym. Client used age appropriate behaviors as he did played basketball and other team building activities with his peers. Client returned to class to prepare for dismissal. No incidents were reported at this time. Client met all objectives. (AM) QMHP greeted client and praised his positive interactions at school. QMHP listened as client provided feedback concerning his anxiety. QMHP challenged client to think positive thoughts. QMHP inquired about his morning routine. QMHP actively listened to client express his needs and wants. QMHP commended client for his positive communication modeled in class without displaying aggressive or defiant behavior. QMHP utilized behavior modification by verbally instructing client to relax his voice and calm down when he gets upset. QMHP assisted client in monitoring his own behaviors in efforts to promote exercising self-control in focused areas such as respecting boundaries with others. QMHP modeled proper positive behavioral expectations for the client to apply in social and non-social environments. (PM) QMHP assessed client's behaviors and mood in specials, lunch, and recess. QMHP communicated with client on displaying appropriate control. QMHP probed client about certain behaviors and how he sometimes feels like the only way to respond is in a negative manner. QMHP verbally identified the client's impulsiveness to the client and encouraged the client to use self control and decrease hyperactive behaviors. QMHP introduced concept of nonverbal communication cues in efforts to review the expected behaviors or results to the nonverbal cues. QMHP continued to engage with client and provided positive reinforcement as he participated in the session. (EOD) QMHP discussed anxiety and explained it is normal part of life. QMHP provided examples of anxiety inducing situations. QMHP provided a list of experiences that is common with his mental illness. QMHP challenged client to identify any situation he has experienced. QMHP further explained different situations that can cause anxiety, such as the fear of asking for help. QMHP provided feedback regarding client inquiries with other subjects. QMHP continued to establish a positive supportive relationship with client. QMHP offered simple suggestions to the client for behaving appropriately in the community and encouraged client to practice the positive behaviors at home and at school. QMHP encouraged client to participate in desirable behaviors for the entire day. QMHP informed client that he needed to regulate his anger outbursts in efforts to reduce them and work towards achieving his ISP objectives for the day. QMHP continued to elaborate on ways client can cope and manage stressors at school, home, and in the community. (AM) Client smiled as he was affirmed for his mature and pleasant behaviors. Client informed QMHP that he was coping and utilizing deep breathing techniques to stay calm and not overreact to minor irritants. Client was able to recover and adjust his negative behaviors to a more positive and constructive manner throughout the morning debrief with mental health professional. Client was receptive and open towards the positive reinforcement provided by QMHP. Client struggled to identify his stimulus that triggered his frustrated and angry emotions, indicating that he is unaware of his inappropriate behaviors. Client appeared sincere and apologetic, as he followed the instructions of the QMHP. Client was able to decrease his overactive and angry behaviors within a few minutes of redirection. Client was receptive and approachable during the first half of the day, extending a welcoming rapport back to the QMHP and his teacher. (PM) Client initially presented with talkative behaviors as he probed the QMHP and asked different questions. Client began to display positive thoughts throughout the session. Client was receptive and open to the interventions, as he was attentive and focus on the information and activities that were being processed without any difficulties. Client appeared to have a clear knowledge of the interventions. Client was sociable and friendly in regards to the QMHP’s positive empathy. Client was able to express and explore his perceptions of relationship skill building. Client complied and went over ISP objectives with QMHP with no resistance. Client stated he was going to achieve his goals today. (EOD) Client was able to relax and regain and regulate his overactive behaviors. Client demonstrated moderate progress with asking for help. Client was able to communicate with the QMHP in a respectful and polite manner. Client communicated that he felt safe and comfortable talking to his TDT counselor more than some of his teachers. Client understood that he is responsible for confiding in other adult figures for support and giving them the chance to help him as well. Client was fully engaged in the conversation with his peers and making insightful comments. Client showed initiative with doing a better job with coping and managing stressors without attention-seeking behaviors or acting out of character. Client dismissed from school without incident, reearning points he lost on his dojo and showing commitment with reducing his temper.