2/18/2024 EnchantaVaughn Approved Behavior: Upon arriving at the place of residence, client did not appear in a welcoming mood. Client was very impatient with QMHP and mom throughout the session. Client displayed poor communication and was given a moment to cool at which mother reports behaviors 30-40 minutes in duration. Behavior: Client was inquired to be fair and follow his mom rules out of respect and to try to understand her reasons for not allowing him to go outside by himself. Client returned to not speaking or contributing to the conversation and being disrespectful toward VACCD staff. Client was left alone to think about his responses and the way he viewed things. Guardian reported that client has had a hard time removing distractions which causes him to be unfocused on simple tasks at which his behaviors last for 20-30 minutes in duration. Intervention: QMHP went through program overview with family to reiterate key points and program objectives that would pertain to their specific situation and helping to build a new therapeutic relationship with the family and client without making them feel overwhelmed with questions or being put on the spot. QMHP actively listened and provided support as mother explained that the client exhibited difficulty in all environments. QMHP encouraged mom to talk to client about the new changes in a less therapeutic setting to prepare him for transition and dealing with his thoughts and feelings. QMHP reviewed with mother the ability to limit the stress in the home and to utilize the reward system. QMHP assisted client with recognizing and exploring triggers of his impatience. QMHP encouraged client to continue documenting people and situations that evoke anger or aggressive behaviors. QMHP utilized active listening skills while client explained the things he is dealing with at home. Intervention: QMHP conducted second half of session on helping client reduce the stressors in the home and community setting. QMHP facilitated session to encourage open communication with client and mom to process on various ways to express feelings and thoughts in a controlled manner. QMHP supported client involvement in selected therapeutic activities. QMHP processed with client about what he learned after the review of activities. QMHP discussed with client and mother on assertiveness and modeled effective ways to communicate by exploring more constructive ways to discuss problematic behaviors in the home. QMHP informed mom that client can benefit from other services, thus probing them to utilize resources in the community that will help client reduce his aggressive behaviors. QMHP praised client for his cooperation and involvement in the session, despite his circumstances. QMHP encouraged client to continue displaying appropriate behaviors in the home. Response: Client began the session with demonstrating negative behaviors. Client then proceeded to avoid processing his emotions in front of mom and QMHP. The family was receptive to the interventions provided. The family shared that they will try to go back to having more positive moments instead of arguing and going back and forth, although client makes it difficult for them. The family reported that they will continue to work on building with one another. Mother verbalized that she will work on not blaming client’s misbehaviors on his surroundings. Mother verbalized that she will work on focusing on client’s behaviors, the good and the bad. She also verbalized that she will increase the level of communication with client to find out what is bothering him, in order to inquire with client what is causing him to act out so often and be disrespectful to her. Both realized each other’s feelings and seemed to want to show more effort with understanding one another. Response: The family shared the things that they were thankful for which assisted in creating a more positive environment. As the client developed understanding of therapeutic expectations, he reported increased satisfaction and function. Client stated that talking and sharing things in his life helped him to evaluate his poor choices and correct his mistakes. Client went on to report that he will practice therapeutic techniques with his family when he feels that it is the right time and place to do so. Client has attempted to utilize what he acquired from today’s and previous sessions to reduce symptoms of ADHD. Client responds well to praise and support. Client is striving to be a better son, brother, friend, and client by learning to express himself fully and support others with their feelings as well. Client wants to make his parents proud by doing a good job with all activities in the home. Client said he was going to practice coping strategies and relaxation techniques in all aspects of his daily routine.