4/2/2023 EnchantaVaughn Approved 1. Behavior: Client expressed that he needed time and space to calm down. Client continues to show disrespectful manners. Client refused to listen to what anyone had to say. Client shrugged his shoulders, indicating he didnât care. Client was not in a good mood, indicating he wasnât going to enjoy the session today. Client continues to express and elaborate on the negative relationship between him and his mom. Client communicated with QMHP that he does not feel as if he need psychotherapy to cope with his symptoms or conditions. Client communicated that he understands he has anger issues and loses his temper quick when things donât go his way. 2. Behavior: Client continues to struggle with working independently, relying heavily on support from QMHP and mom. Client presented outbursts and attempted to shut down, refusing to process or debrief in the session. Client withdrew during the session as he became quiet and began to display restless behaviors. Client continued to demonstrate quiet behaviors during the session and QMHP ended the session and plans to continue working with client to encourage him to speak up for himself. 1. Intervention: QMHP encouraged client to be nice. QMHP monitored individualized behaviors for acquisition of objectives. QMHP encouraged client to listen to his mom. QMHP encouraged client to be the example for others. QMHP encouraged client not to follow others he sees that are doing wrong. QMHP reminded client of goals and objectives. QMHP intervened to assist in explaining behaviors to client and what he needs to work on if he wants to meet his goals and objectives more consistently. QMHP will provide strategies for coping and self-control when faced with conflict. QMHP reviewed and gave feedback regarding ADHD and its causes and effect to well-being and overall performance in the home. QMHP isolated client from distractions to decrease disruptive behaviors and to reduce episodes. QMHP assisted client in normalizing the changes that are occurring in school and session. QMHP implemented a routine that will encourage client to be responsible and promote self-confidence daily. QMHP monitored, observed, and redirected client behaviors as needed. QMHP reflected with client on his choices, reviewing both good and bad experiences. 2. Intervention: QMHP intervened to prevent the negative behaviors from escalating. QMHP physically redirected client to an alternative activity. QMHP provided guidance on alternative behaviors and clear instruction on the alternative behavior. QMHP encouraged client to resist negative behaviors in efforts to refrain from requiring to be redirected by his mom so many times throughout the day. QMHP utilized empathetic listening skills as client expressed his understanding of stressful situation. QMHP provided age appropriate understanding of the situation and why he is there to help resolve any issues he has, including him having difficulty completing chores or homework. QMHP informed client that refusing to do his work is not acceptable and he should take small breaks involving deep breathing and stretching in his seat without initiating conflict or making loud noises. QMHP encouraged client to be mindful of others personal space and knowing when to set boundaries. QMHP encouraged client to refrain from displaying negative behaviors towards his mom, to talk calmly and express himself without aggression. QMHP taught client necessary coping skills to decrease impulses. 1. Response: The client has overreacted with anger to minor frustrations and irritants but was able to reduce self-defeating thoughts. Client anger is moderate to intense, 2-3x per week. 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 need improvement with expressing himself appropriately in the session. Client stated it was boring and he is having challenges with certain activities and needs help. Client knows what is expected of him and is trying to make better choices moving forward. 2. Response: In the second half of the session, client acknowledged QMHP's redirection after 4-5 prompts. Client stated okay and then began to calm down his actions. Client proceeded to reduce the aggression in his voice while calming down. Client accepted suggestions from QMHP as evidenced by the client smiling and saying thank you. Client complied and went over ISP objectives with QMHP with no resistance. Client was receptive of QMHP interventions, as seen implementing them right away following negative conduct.