1/27/2023 EnchantaVaughn Approved 1. Behavior: Client was mostly quiet during the session and often zoned out, making it hard for him to stay focused. Client exhibited poor listening skills and avoiding coping strategies, therefore stress and anxiety increased. Client displayed an unpleasant attitude and encouragement was given. Client displayed disrespectful behaviors toward his mom, as evidenced by him yelling when she attempted to interact with him to make him feel better. Client lacked respect for both mom and QMHP, as evidenced by client's aggressive behaviors when confronted about his attitude. Client often displays frequent outbursts when things don’t go his way. Client shared that he was not in a good mood. Client reframed from engaging in conversation and tried to cover his face and ears, so he wouldn’t have to listen. Client denied that he felt anger, despite the obvious signs (i.e. body language, tone, appearance, etc.). It is evident that part of client’s mood stems from lack of support and affection from family and friends, based on previous conversations and past reports. Client demonstrated a persistent failure to comply to the rules and regulations that were being processed with him throughout the session. 2. Behavior: Client was extremely withdrawn from the interventions, ignoring debriefing and refusing to communicate his feelings when inquired about why he wasn’t participating. Client refused to pay attention in session, as observed. Client continues to avoid mental health counselor prompts and directives and is encouraged to be respectful and polite. Client displayed a negative attitude with flat facial expressions when communicating his feelings to QMHP about his day. Client was not in the mood to talk about his feelings, as evidenced by his dialogue with QMHP. Client expressed positive comments but had trouble staying focused throughout the session. Client did not respond with an appropriate attitude and needed a cool off break. Client understands that everyone is there to help and support him and that it is okay to ask for help. Client continued to demonstrate negative behaviors during the session. Client shared that he is learning to develop the skills needed to achieve his goals on a daily basis and is proud at how far he has come. Client seem to be heavily impacted by good role models and one on one support. 1. Intervention: QMHP reviewed and gave feedback regarding ADHD and its causes and affect toward client well-being and academic functioning. QMHP utilized active listening skills and was empathetic with the client as he vented the overwhelming events that had occurred. QMHP will provide client with support and encouragement. QMHP will monitor, observe, and redirect client behaviors as needed. QMHP will build rapport. QMHP will explore positive self-talk, use instruction modeling, and increase social communication skills with positive reinforcement role play activities. QMHP will educate client on behavior modification to help client identify what behavior he needs to decrease and avoid daily. QMHP taught client relaxation, calming, and guided imageries, to help him reduce and regulate his overactive and angry behaviors during the session. QMHP provided and demonstrated positive empathy. QMHP implemented active listening skills, as he processed with client. QMHP reviewed ISP objectives with client in efforts to reinforce them as well as provide client with a reference of expected behaviors throughout the session. QMHP worked with client to reduce or eliminate harmful and hostile manner, within his daily functioning life. 2. Intervention: QMHP retrained client on anger management techniques, as a way to help him regulate and regain his emotions and feelings. QMHP utilized a reflective thinking exercise to help the client better understand and identify his triggers and stressors. QMHP intervened aggressive behavior and motivated client to act in a civilized way. QMHP redirected client negative behaviors. QMHP revisited with client about respecting others and discussed applying polite words when asking for help. QMHP gave client the opportunity to open up and share his feelings. QMHP communicated active listening skills. QMHP educated client about sharpening his senses and utilizing problem solving techniques daily. QMHP encouraged client to be respectful to authority and peers. QMHP reminded client to build healthy relationships with his family and use them for support. QMHP utilized cognitive skills to give the client a chance to openly and honestly discuss his feelings about his current state. QMHP will assist with reducing anger-provoking situations through self-talk and role play scenarios in order to prevent escalation and dealing with anger assertively. QMHP will continue to assist client with managing anger and frustration by reviewing and role-playing effective coping skills. 1. Response: It was difficult for client to relax and remain stable when being instructed by the calming techniques during the session. Client was reluctant and hesitant. Client did not offer any forms of social or friendly rapport back to the QMHP, remaining unemotional displaying an unresponsive and nonchalant attitude throughout the session. Client showed lack of concern and empathy in response to positive cognitions. Client did not express verbal communication after positive reinforcement was provided. Client implemented his plan for restoring relationships, and this was reviewed. Client engaged in self-reflection, discussing good and bad parts of his day. Client acknowledged that he tends to engage in disruptive behavior when he begins to become frustrated. Client acknowledges he needs to work on his temper and controlling his anger when he doesn’t get his way. Client understands that his treatment plan is a behavior contract that will reflect his improvements and setbacks in the home and school settings. Client was seen decreasing anger and frustration. Client reported a decrease in symptoms following the relaxation techniques. 2. Response: Client accepted responsibility for his angry outbursts and aggressive behaviors. Client stated he will display anger control and not threaten or intimidate others, especially the people closest to him. Client was aware of the behavior contract and accepted the agreement, communicating he was going to be good and make wiser choices. The interventions were unsuccessful, due to client unable to relax when being instructed by the use of the calming techniques that were utilized during the session. Client was reluctant and hesitant in extending a friendly rapport back to the QMHP. Client displayed an unemotional facial expression on his face. Client showed an unconcern and nonchalant attitude towards the QMHP, in regard to decreasing his impulsive and thoughtless actions towards his dangerous and unsafe behaviors. Client wasn’t interested in the activity provided by QMHP. Client was unable to express his feelings or moods, as he struggled with identifying situations, people, and thoughts that have triggered his anger outbursts. Client appeared to be learning from his mistakes and correcting them throughout the day. Client was able to speak calmly and demonstrate his improved communication skills while engaging in self-reflection.