1/30/2023 EnchantaVaughn Approved 1. Behavior: Client was present in the home when QMHP entered but appeared to be in a low and sullen mood. Client was inquired why he felt this way. Client did not respond. Client displayed poor communication and was given a moment to cool off. Client appeared to be in a downward mood. Mom expressed that client often acts like this when things don’t go his way. Mom reported that client has had a hard time removing distractions which causes him to be unfocused on the assignments/tasks at hand. Mom reported client gets angry, aggressive, and becomes uncooperative almost daily as a result of his ADHD behaviors. Client avoids wanting to listen to information being shared, as he began to pout and roll his eyes at the QMHP. Client have not utilized healthy coping practices and was urged to do so. Client chose not to express his feelings without exhibiting inappropriate behaviors. Mom expressed being overwhelmed with client’s increase in bad/inappropriate behaviors. Client have had multiple issues within the home that have been addressed numerous of times by mom. 2. Behavior: Client became frustrated and began to be disruptive and purposely annoy others in order to draw attention away from himself. Client failed to utilize appropriate coping strategies and communication skills within the home. Client became upset when he realized mom and QMHP were talking about his past behaviors. Client continued to demonstrate quiet behaviors during the session. Client had to be told more than once to show authority the proper respect and to look forward when someone is talking to him. Client frowned up his face and looked away from his counselor. Client is unable to identify many significant positive hopeful things in his life and is provided with examples of those. Client had difficulty focusing and paying attention, especially when it wasn’t his turn to talk. Client continues to avoid mental health counselor prompts and directives. Client was reminded to concentrate on the whole purpose of the session. After about 20 minutes of reflective thinking, client was given a break and directed to deep breathe, stretch, and regroup. Client took a second to regroup but was able to turn his day around by attempting to complete the interventions provided by QMHP. 1. Intervention: QMHP engaged in conversation with client about his day. QMHP actively listened to client verbalize that he was agitated today and the reasons to his agitation. Instruction, modeling and role-playing techniques were used to help client’s general communication skills. QMHP taught client effective problem-solving skills (i.e. identifying the problem, brainstorm alternate solutions, select an option, implement a course of action, and evaluate). QMHP probed about any angry feelings or the inclination of safe and unsafe behaviors. QMHP utilized active listening as information was conveyed. 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 educated client about using good manners at home and offering alternative methods and suggestions to model appropriate language that client should use to ask for things or to get someone’s attention. QMHP processed client feelings and offered choices of what to do when faced with conflict or challenged in the home setting. 2. Intervention: QMHP aided this intervention with client on personal skills. QMHP introduced client to psycho social activity regarding hygiene and staying healthy. The QMHP educated client that it is vital to wash your hands and stay 6 feet away from others. QMHP facilitated a discussion to talk about common mistakes children with ADHD make and how he can make better choices. QMHP discussed anxiety and explained it is a normal part of life. QMHP gave client the opportunity to express and explore his perceptions of how his symptoms of ADHD can affect him relationships with family and friends. QMHP encouraged client to present healthier habits and routine by challenging himself to make better choices and try new things. QMHP intervened to prevent the negative behaviors from escalating. QMHP redirected client to an alternative activity. QMHP provided guidance on alternative behaviors and clear instruction on the alternative behavior. QMHP will review key concepts of being responsible with his family. QMHP will provide mediation and relaxation techniques, as well as, simple praises and encouragement to continue the positive behaviors he was exhibiting. 1. Response: Client fails to exhibit age appropriate behaviors in the home, due to hyperactive and impulsive decision making. Client showed low level of participation, walking away and avoiding QMHP; not wanting to be bothered. Client is easily frustrated when confronted about not listening to authority figures and begins to increase his anger from 2x to 4x. Client is working on walking away and telling an adult before responding to anger provoking situations. Client understands that problem solving starts with thinking before acting. Client displayed an unresponsive and nonchalant attitude toward QMHP when reviewing strategies from previous session. Client displayed an unemotional and flat facial expression on his face, as he appeared disinterested in the instructions, role playing techniques and modeling techniques that were implemented with teaching him effective communication and assertiveness skills to express his anger more appropriately. Client promised he would try his best to correct himself when faced with conflict. Client struggled with expressing or identifying stimulus that triggered his angry emotions. 2. Response: The storytelling techniques were ineffective to modeling appropriate ways to manage stress. Client admitted to counselor that he does sometimes find difficulty in adapting to the rules and regulations in the home. Client displayed body language associated with anger, demonstrated by clenching his fists and face. Client had to be redirected in regard to the relaxation and calming imageries. Client did not offer verbal communication. Therapy activity was viewed as ineffective and unproductive. Client displayed a disinterest in the interventions that were applied to him. Client expressed anger and frustration when he had to communicate directly with his mom without looking at QMHP. Client exhibits low self-esteem throughout the session. Client was resistant and unruly, as he did not display any forms of empathy or concern in response to the talk therapy. Client acknowledged that he tends to engage in disruptive behavior when he begins to become frustrated with school related work and chores. Client however mentioned that he is willing to make attempts to improve his actions/behaviors if mother actively participate with the services as well.