12/14/2023 EnchantaVaughn Approved (AM) Upon arrival, client entered the classroom in a hostile and disruptive manner. Client did not start his work right away. Teacher subtracted points for not being productive or polite. Client was confronted and sent to have one on one with his counselor. Client stated he didn't get much sleep the night before and was not in a good mood. Client was encouraged to lose the attitude and get his work done before he's penalized for his actions. Client promised to be more respectful and comply to classroom rules so that he can earn his dojo points back. Client failed to complete his assigned task as he was observed talking to his peers. Client was off task as he discussed non- related school topics with his peers. Client took toys and snacks out his bag, as he appeared to be showing it off to his peers at his desk. Client lacked respect for authority figure as he stated “My mom gave this to me so you can’t take it.” Client struggled to refrain from using verbal aggression during morning hours as his peers appeared to be using profanity towards him. Client appeared to be irritable as he was seen pacing the floor. Once client appeared to be calm, he began explaining how he felt disrespected due to his peer cursing at him. Client appeared to be calm after interventions. (PM) Client displayed disruptive behaviors in music class. Client was sent to speak with his counselor. Teacher praised client for all of his efforts in the past but was very disappointed at him today. Teacher did not understand what went wrong and why client was acting this way. Client verbalized he did not want to be in the class but instead of asking for a break he took his attitude out on others. Client displayed negative body cues (rolling his eyes, shrugging his shoulders, and shaking his head). Client was in a nonchalant mood. Client was inquired about his feelings. Client was reminded that it isn’t fair to mistreat others because he’s not enjoying himself. Client was educated that it hinders the whole class when the teacher cannot teach. Client looked down and displayed sadness. Client communicated that even if he was in another setting he would react the same. Client had trouble interacting with peers, due to being upset. Client finally broke his silence and opened up to QMHP. Client was able to play games and engage with his peers in a positive manner after conversing with his counselor. Client was ready to go back to class and make better choices. (EOD) During the final period client appeared to have a transition in his demeanor as he was able to complete his assigned task. Client appeared to be energized after his break as he socialized with his psycho educational group as well. Teacher did not report any negative behaviors at this time and client was able to turn his day around completely. Client was observed packing up and waiting to be dismissed, as the school day came to an end. Client needs improvement with all objectives, as seen throughout the day. (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.