2/20/2023 EnchantaVaughn Approved 1. Behavior: Client withdrew during the session as he became quiet and began to display restless behaviors. Client continued to demonstrate ADHD. 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 expressed sadness and disappointment. Client fails to exhibit age appropriate behaviors in the home, and feedback was provided in this area. Client showed low level of participation, not wanting to be bothered. Client is easily frustrated when confronted about not listening to authority figures and begins to stomp and pout. Client displayed assertive tone with grandmother and dad. Client displays an increased ability regarding problem solving and making decisions while interacting with his family. The client has become less agitated as he has felt reassured and was encouraged to be open with his feelings. Client continued to display a negative attitude toward QMHP. Client was encouraged to relax and focus on the positives. Client gets frustrated when he cannot take a break and displays undesirable outbursts (i.e. frowning his face and stomping). Client is observed displaying impulsive behaviors by running around the house, not attending to his studies and therapeutic assignments. Client avoids participating in age appropriate leisure activities (i.e. reading time and quiet time) during the session and continues to make unnecessary noises interrupting QMHP. Client is constantly talking out of turn, knocking things on the floor, and jumping around in his seat. Client has a hard time accepting the actions to his consequences and thinks his grandmother and dad is being hard on him. 2. Behavior: Client was observed restless, impulsive and hyperactive during session. Client was noticed noncompliant towards father’s directions, continuing to exhibit actions that were dangerous. Client was seen as disrespectful and impolite. Client was given a few minutes to calm down and regroup himself. Client was not interested in psycho educational, as evidence by the low motivation and energy displayed. Client displayed minimal participation during session. It was difficult for client to remain seated, giving the impression to the QMHP that he was not listening to the information that was being processed to him by the QMHP. Client is easily irritated and aggravated. Client was distracted and unfocused. Client had a hard time contributing to his work. Client needed a break. Client was given a cool off break to make sure he will maintain cooperation until the end of session. Client actions suddenly altered. Client was a little more verbal when talking about things he likes. Client seem to switch moods depending on what is being asked. Client uses non-verbal cues to express how he feels. Client chose to distance himself from the QMHP when reflecting on his bad experiences. Client required redirection from mental health professional for inappropriate behavior. Client blamed others for his negative behaviors and appeared unapologetic for participating in disruptive ways. Reflective thinking and one on one with QMHP have benefited client in the home setting and allowed him to reevaluate and make more mindful decisions. Client agreed to pay more attention and to find solutions to his problems by reevaluating the way he usually deals with negative situations and doing something new (e.g. being acceptive to different perspectives and reviewing information more than once) even if he feels like it doesn’t matter. As time progressed, the client has demonstrated a cooperative attitude while being supportive of everyone in the household. Client have not obtained ISP objectives since the previous session. 1. Intervention: QMHP engaged client in a conversation regarding his recent behaviors, progressions and setbacks. QMHP explored client’s responses and responded accordingly. QMHP inquired about client’s overall day. QMHP attentively listened to client’s issues. QMHP reeducated client on the dangers of involving himself with activities that are both negative and harmful. 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 processed with client about his previous behaviors and why he believes he could benefit from service. QMHP reminded client of the rules and regulations and what is to be expected. QMHP supported client with making good decisions and following directions. QMHP interacted with client by playing games and talking about his strengths and attributes so that client is more confident around his peers and feel comfortable communicating with an adult about his thoughts and feelings. QMHP gave positive feedback and encouragement throughout the day especially during challenging or stressful tasks. 2. Intervention: QMHP demonstrated and provided client with positive and empathetic acceptance, by applying talk therapy and active listening skills to help client take account his decisions. QMHP used information from client’s teachers and parent to assist client in a safety plan. QMHP used problem-solving activities to help client understand the reason for decreasing his impulsive actions towards his behaviors. QMHP encouraged client to resist negative behaviors in efforts to refrain from requiring to be redirected by his grandma so many times throughout the day. QMHP helped client problem solve when he began displaying negativity towards himself and his family. QMHP provided support and encouragement to ensure goals and objectives are met. QMHP monitored client individualized behaviors in collaboration with his family since staying away from the community environment. QMHP encouraged client to make good choices and to avoid negative thoughts about himself. QMHP processed client positive behaviors. QMHP assisted client in developing more virtual skills. QMHP inquired about possible challenges client can experience with applying this skill. QMHP provided positive feedback. QMHP reflected with client about his feelings. QMHP isolated client from distractions to decrease disruptive behaviors and to reduce episodes. QMHP assisted client in normalizing the changes that are occurring in the community. QMHP explored the client’s capability to cope with his stressors and to get back on track with his ISP goals. 1. Response: Client exhibits low self-esteem during family setting. Client is prone to stress and negative situations that he responds in the same way to everything, good or bad. Client required additional redirection from QMHP to get him to focus on the assignment. Client acknowledged that he tends to engage in disruptive behavior when he is frustrated with schoolwork or feels mistreated. Client accepted responsibility for his angry outbursts and aggressive behaviors. Client listed 3-4 behaviors that he was going to utilize in efforts to remain positive in the home. Client appeared to be receptive to receiving positive reinforcement from his grandmother, as demonstrated by him switching moods. The frequency and intensity of the client's defiant affect decreased. Client learned a lot from observing others and wanted to prove he can be responsible. Client talked about things he would love to do more at home (i.e. play with his friends and go outside). Client verbalizes positive feelings about himself but recognizes areas he needs to work on. Client acknowledges he needs to work on his temper and controlling his anger when he doesn’t get his way. Client was aware of the behavior contract and accepted the agreement, communicating he was going to be good and make wiser choices. Client expressed positive feelings toward the interventions today. Client understands that in order to do his best, he has to feel his best. 2. Response: The interventions were noted unsuccessful, as it was challenging for client to stay calm when being instructed by the use of relaxation techniques. Client was reluctant and hesitate, indicating she needed assistance in communicating his feelings, 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 agreed to be patient and separate himself from conflict. Client seemed to be coping with his stressors and attempting to correct his mistakes as much as possible. Client have a hard time keeping his hands to himself when playing but promised to respect others personal space and boundaries. Client implemented his plan for restoring relationships, and this was reviewed. Father states to QMHP that he has considered implementing a minor schedule for client to assist him with his completion of chores. Father mentions that schedule assists her as well and allows him to rest and have time to attend his therapy as well. Client informed QMHP that he was coping and utilizing deep breathing techniques to stay calm and not overreact. Client was non-responsive to his antisocial behaviors. Dad was attentive and focused on the information that was provided. Dad agreed to next scheduled session with the QMHP.