1/23/2024 EnchantaVaughn Approved Behavior: Upon arrival to the home setting, Josiah was slowly receptive to the discussion and intervention provided by counselor, due to not listening. Josiah expressed that he did not feel like having session today and wanted QMHP-C to leave. Josiah remained restless, fidgety, and chatty making it difficult for the Josiah to pay attention or hear QMHP-C when given prompts and tasks. Josiah could not stay focus or express himself appropriately without negative feedback or mocking QMHP-C in a disrespectful way. Josiah continues to ignore QMHP-C directives. Behavior: Josiah often presents frustration when reflecting on his own feelings, due to not wanting the spotlight and not wanting to admit to his mistakes or accept the consequences. Josiah maintained low self-esteem throughout the entire session. Josiah was not happy with losing out on play time and expressed wanting to take charge and be a team player. Intervention: QMHP-C continued to work with Josiah to help him increase respect for others in and out the home. QMHP-C asked Josiah to identify, roleplay, and model appropriate social skills during session. QMHP-C provided positive words of praise and reassurance to encourage and promote confidence and respect for himself. QMHP-C asked Josiah open ended questions to get him to interact and increase participation. QMHP-C modeled pro-social behaviors for Josiah to strengthen his understanding of them. QMHP-C reminded and practiced breathing and relaxation techniques to teach Josiah the importance of the “stop, think before act” method. QMHP-C held consultations with Josiah and mother about effective intervention strategies that build on the Josiah's strengths and compensate for his negative behaviors. QMHP-C encouraged Josiah’s mother to provide frequent positive reinforcement to maintain Josiah's interest and motivation in maintaining positive behaviors and completing his chores around the house, including all therapeutic assignments given by QMHP-C. Intervention: QMHP-C complimented Josiah for utilizing acquired skills, paying attention, and focusing on the importance of the assignment. QMHP-C reminded Josiah not to take everything personal and to relax. QMHP-C assisted Josiah to behave in more positive ways by addressing the conflict he was facing with his mom, siblings, or friends in the community. QMHP-C informed Josiah of replacement behaviors in efforts to decrease attention seeking behaviors the Josiah often is involved in. QMHP-C modeled appropriate ways for Josiah to get positive attention from his mom and peers. QMHP-C inquired of Josiahs’ current mood. QMHP-C utilized active listening skills as Josiah spoke of his current mood. QMHP-C assisted Josiah in exploring other coping strategies that he had previously used to solve other problems. QMHP-C utilized behavior modification strategies including removing Josiah from the stimulant environment in efforts for him to reduce impulsive behaviors. QMHP-C continued to support Josiah in meeting his needs according to his service plan. Response: Josiah was unable to relax and regain self-control when being instructed in the use of calming imageries, as he continued to display defiant, disrespectful, and stubborn behaviors. Josiah was resistant and unruly, as he did not display any forms of empathy or concern in response to the talk therapy. Josiah did not extend a sociable rapport back to QMHP-C. Josiah struggled with expressing or identifying stimulus that triggered his angry emotions. The storytelling techniques were ineffective to modeling appropriate ways to manage stress. Josiah admitted to counselor that he does sometimes find difficulty in adapting to the rules and regulations in the home only because he sometimes has to adjust to the schedule that mother has implemented. Josiah understands that mother is trying to aid him in prioritizing skills and creating structure in the home so that he can depend on himself without waiting for someone to direct him to do the right thing. Josiah did however mention to counselor that he has noticed mother has been making efforts on breaking the communication barrier in the home. Response: Josiah also mentioned that mother has also been consistent with his activeness in communicating with her outpatient services as well. Josiah stated that mother has been praising and encouraging him when he displays positive and respectful behaviors in the home. QMHP-C retrained Josiah on relaxation skills, which included pace breathing, muscle relaxation, and calming imageries as a way for Josiah to regain and control his rebellious and hyperactive conduct. QMHP-C processed with mother about watching what she says and does in front of Josiah so that he doesn’t pick up poor habits. QMHP-C verbalized and reiterated to mother that she needs to define clear rules and implement consequences for all behaviors, good and bad.