3/8/2023 EnchantaVaughn Approved Upon arrival, it was noticed right away client and his mother were having a disagreement. Mother became very upset and expressed that she is tired of the client's defiant behaviors and will no longer tolerate it. Client’s mother shared that the client had been standoffish with her ever since coming back from staying with his Dad. Client is still getting used to being with his mom all day. Client was prompted to refocus 2-3 times by QMHP. Client was reluctant and hesitant to follow home rules and stay in therapy today, due to being in his feelings. QMHP inquired about evening and morning to view how client was feeling throughout the day. QMHP initiated a rapport building conversation with client in efforts to learn more of his likes and dislikes as well as triggers to negative behaviors listed on his ISP. QMHP engaged client in a conversation regarding his recent behaviors, progressions and setbacks. QMHP reviewed key concepts of being a responsible child in the home. QMHP observed client in the home to assist with any negative behaviors towards mom, as he vented the overwhelming events that had occurred earlier in the day. QMHP educated client about being respectful, encouraging, mindful, and fair to peers and authority while making good decisions in the home. QMHP encouraged client to list alternative behaviors he could have participated in besides the negative ones that caused him to receive consistent redirection. QMHP reminded client not to take everything personal. Client displayed hyperactive behaviors such as yelling out of turn and talking over his mom when confronted about his attitude and poor conduct at home today. Client expressed that he hates being in the house all day and has to be around active behaviors in order to stay focused. Client required to be re-focused 3-4 times by QMHP as others spoke. Client was observed chastising mom about the responses that was shared with his counselor. Client became more impulsive and started to cause more disruptions. Client was eventually separated from therapy session and endured his consequences of solitude and exudence from the individualized treatment and mental health skill building for 15 minutes. Client was able to display fully deescalated behaviors as treatment continued. Client stated he would try better self-management, as the day pursues. The client was able to select topics that were directly related to reduction of stress and emotional negativity, which made him less agitated and more relaxed.