2/2/2023 EnchantaVaughn Approved 1. Behavior: When QMHP came inside the house, client presented a negative attitude toward his mom and counselor due to being upset that he got caught engaging in inappropriate conversations online with some of the kids from different schools. Client has had this problem in the past when living with his dad and continues to sneak around, lie, use profanity, and bring up sexual content. Client do not like to deal with the consequences of his actions and attempts to blame others for his mistakes. The client continues to be very cautious about expressing his emotions and was encouraged to do this at his own pace. Client was standoffish and distant, ignoring debriefing and refusing to communicate his feelings. Client was not acceptive of redirection and responded aggressively by saying “I don’t want to be here anymore”. Mother said client often lashes out when confronted and she needs him to work on positive communication skills so that he won’t cause unnecessary drama in the home. Client took 15 minutes to calm down and correct his behaviors, returning to therapeutic exercise in a more pleasant manner. Client inappropriate behaviors were reduced, and he was seen back on task. 2. Behavior: Although client level of participation increased he had a hard time expressing himself in the session. Client seemed to be going in an out and withdrawing himself from the activity. Client kept looking at his mom for reassurance and seemed to be nervous to talk to his counselor about sensitive topics. Client is aware that his counselor is here to help him in the best way, but he has to do his part as well. Client was able to engage in self-reflection and express his perspective. Client explained to mental health professional that he was aware of his past and present behaviors. Client apologized and communicated he was having a hard time dealing with being in the house every day and was starting to have really dark, disturbing thoughts. Client emphasized that he has not tried to hurt himself but thinks about running away and never coming back. Mom showed sympathy towards client at this time and hugged him for opening up about his feelings instead of completely shutting down. As the client was provided with a calm environment and reassurance that he would be cared for, his level of agitation has decreased, and he continues to work towards his objectives. 1. Intervention: QMHP coordinated family session to prepare client for therapeutic contact. QMHP used appropriate behavior modeling by expressing situations that is demonstrating positive behavior to decrease the client’s impulsive behavior and encourage him to use self-control. QMHP monitored progress in demonstrating individualized pro-social skills (e.g. anger management, education, problem-solving, conflict resolution, appropriate verbalization of feelings, and cognitive-behavioral programming). QMHP provided individual, group, and family counseling based on specific treatment objectives. QMHP supported client with meeting his objectives and coping with stressors without needing additional redirection or prompts. QMHP encouraged client to continue displaying age appropriate behavior, and the benefits of this will be reviewed with parent. QMHP conducted a review of previous week behaviors. QMHP assisted client with problem-solving. QMHP provided client with feedback. QMHP encouraged client to practice relaxation and coping techniques twice daily. QMHP reviewed home expectations and how client should be the example for his brother and sister. 2. Intervention: QMHP collaborated with mother in regard to home rules and regulations, home management, effective teaching practices, following verbal and non-verbal instruction, role playing exercises, and an appropriate incentive system. QMHP educated client about using good manners 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 offered empathy and support to client to ensure his needs are met. QMHP encouraged client not to hesitate to reach out, ask questions, or to request for one on one without parent present. QMHP reflected on client behaviors, both good and bad. QMHP educated client on exhibiting leadership and responsible behaviors to encourage others to display the same respect for him. QMHP monitored client's individualized behaviors and how well he works as a team. QMHP instructed client to reiterate his ISP objections in efforts to trigger a desire to achieve them by improving his current attitude. QMHP reinforced client’s positive behaviors and encouraged client to maintain this behavior in the home. 1. Response: Client expressed frustration and hopes of his attention span and focus improving. Client blames his mental illness for his attitude, mood, and behaviors. Client stated that he doesn’t intend on being negative and agrees he need to work on controlling and channeling his anger, as well as, listening and communicating his feelings better. Client recognized his anger triggers and is working to improve them daily. Client reviewed his expectations with QMHP. Client promised to make good choices and work hard. Client started opening up and being himself around QMHP, engaging in therapy and treatment activities and social exercises. Client shared some of the things he does at home to help him feel at peace. Client communicated positive affirmations and self-talk once he was able to let go of negative, agitated feelings. Client appeared to grasp a clear understanding of the manic behaviors he often displays in the home especially the behaviors that have affected him and his family the most. Client is striving for a good report from home every day. 2. Response: Client displayed independence with completing his work in session. Client contributed to discussion and shared his personal expectations and thoughts about his daily experiences. Client responded well to feedback and seemed to be adapting well in the home environment. Once client became comfortable with his position, he was able to avoid distractions and stay on task with no problem. Client recognized his triggers and was able to identify common interests and similarities him and other ADHD recipients share. Client stated he would help others when he can. Client stated he would treat others fairly even if he feels they aren’t treating him fairly. Client stated he would respect adult figures and do what he is told. Client verbalized positive statements about in-home services. Client displayed self-determination to stay focused and pay attention in session. Client responded well to the support provided by QMHP. Client smiled and thanked QMHP for the extra support and for going above and beyond to help his family during this stressful time.