1/29/2023 EnchantaVaughn Approved 1. Behavior: As the session had begun, the client was noticed distant, distracted, and impulsive as he displayed unconcern and disinterest toward making improvements with his behaviors. During the conversation with QMHP, it was difficult for client to express himself and be honest about the role he plays in his added stress. Client displayed inappropriate conduct as he continued to show a lack of attention and consideration towards the information that was being processed with him, despite methods and techniques used to help him control his overactive and impulsive behaviors. Client displayed angry emotions and had a hard time listening and following directions. Client became frustrated when he could not express his thoughts during family discussion and started having episode, turning his back toward his counselor and covering his face. Client was not acceptive of feedback from peers or authority and displayed a lot of temper tantrums when he didn’t receive the attention that he desired. Client was reprimanded and lectured on his noncompliant behaviors. Client presented defiance toward authority when confronted about his poor attitude. Client was sent to reflect and cool off in his room. 2. Behavior: Client appeared guarded and offensive due to encountering other challenges in the home. Client was inattentive and unfocused as it was challenging and difficult for him to remain in one area of the house. Client would periodically interrupt QMHP. Client became frustrated, beginning to exhibit a temper. During the session, the QMHP attempted to help the client regain and regulate his emotions and feelings, as he attempted to calm down with words of comfort. Client was defiant of QMHPs prompts 2-3 times. Client blamed others for his negative behaviors and appeared unapologetic for participating in disruptive actions. Client’s demeanor then became very reserved and limited in his verbalizations and comments regarding the topic of discussion. Client stated that he feels more connected with his counselor than some of the people he attempted to try to get close too, including but not limited to family members. The client however struggled to maintain self-control during parts of the session when he became distracted or unfocused. Client needed to let go of his doubt and negative energy and was supported with contributing to discussion. 1. Intervention: QMHP will educate client on behavior modification to help client identify what behavior he needs to decrease and avoid daily. QMHP worked with client on methods and techniques to help him reduce, lesson, or eliminate his impulsive conduct and as well as to be more aware of his unpleasant behaviors within his daily functioning life. QMHP reiterated to client the benefits of following the rules and of the privileges he can receive when he does so. QMHP assisted client with identifying privileges that he would like but does not receive due to his negative behaviors; in efforts to stimulate his thinking about cause and effect of his behavior choices. QMHP gave client the opportunity to express and explore his perceptions of how his symptoms of ADHD can affect his relationships with peers and adult figures. QMHP instructed client to reiterate his ISP objections in efforts to trigger a desire to achieve them by improving his current negative attitude. QMHP reviewed methods and tactics to help client positively advocate for himself by the use of assertive communication and conflict resolution skills daily and as well as to assist in reducing negative actions in the home. 2. Intervention: QMHP facilitated an activity on emotions to assist client to be able to identify and positively express them. QMHP completed an activity with client that allowed him to write the words of the thoughts and emotions that he feels when he thinks of his family and close relationships. QMHP discussed client’s responses with him and modeled for him how to approach his family/friends about his feelings, good or bad. QMHP role played with the client to assist him in bettering his social-emotional-mental skills. QMHP offered new ways to heighten client awareness of his ill-mannered behaviors, as well as helping him with functioning more constructively within his daily life. QMHP encouraged client to present healthier habits and routine by challenging himself to make better choices and try new things. QMHP questioned client on the statements he made about having difficulty expressing his feelings. QMHP reviewed strategies targeted at helping client to work through his difficulties expressing his anger. QMHP prompted client to share anticipated thoughts and feelings and to indicate how this process reduces angry reactions. QMHP will continue to assist client with working towards targeted goals and objectives. 1. Response: Client was not in a good mood at this time. Client had difficulty relaxing and following QMHP prompts. Client continued aggressive behaviors. Client did not extend a sociable rapport back to the QMHP. Client required redirecting from QMHP to reduce his voice volume 2-3 times. Client self-esteem and confidence remained low. Client continued to display hyperactive behaviors for 15-20 minutes prior to decreasing them. Client required to be re-focused by QMHP as he waited for his dad to speak. Client communicated understanding by nodding his head. Client is aware that he can be a hand full. Client admitted that he can’t control his temper sometimes. Client reported that he is looking forward to receiving help and wants to learn how to deal with his anger and depression. Client understands that his treatment plan is a behavior contract that will reflect his improvements in the home. Client expressed that when he is involved in a conflict he will take a self-time out. Client was attentive to the role play activity, even implementing strategies he just learned to reduce his negative responses. Client demonstrated his knowledge through his provided examples. 2. Response: Client displayed difficulty remaining in his seat going into the next intervention. Client was resistance to applying what he learned to real life situations. Client explored numerous ways to express his anger and negative behaviors during the role play with QMHP. Client appeared disinterested in regard to the information that was being provided to him by the QMHP in response to how his negativity affects himself and others. The interventions were noted unsuccessful, as it was difficult and challenging for client to relax when being instructed by the use of calming techniques. Client exhibited an unemotional facial expression on his face, indicating he was not in the mood to process or reflect on his day. Client was reluctant and hesitate, as he remained mistrustful in regard to extending a friendly or respectful rapport back to the QMHP. Client acknowledged QMHP’s redirection after 2-3 prompts. Client demonstrated that he was able to process productive expressions of anger. Client understands that mother is trying to aid client with his prioritizing skills and create structure in the home.