1/28/2024 EnchantaVaughn Approved Behavior: Upon arrival to the home setting, QMHP-C met with Josiah for in-home services and to check on how he was doing since the last visit. Josiah was present in the home during session. Josiah was mildly talkative during session which behaviors last about 2 minutes in duration. Behavior: Josiah communicated he was in a good mood. Josiah was witnessed adhering to the rules and regulations in the home and giving mom assistance with anything he needed done around the house; however, mother reports having to redirect him several times in an effort for him to comply with simple rules within the home with behaviors lasting up to 3-5 minutes in duration. Intervention: QMHP-C went to the home to meet with Josiah individually. QMHP-C engaged in conversation with Josiah about his day. QMHP-C actively listened to Josiah verbalize that he was agitated today and the reasons to his agitation. Instruction, modeling and role-playing techniques were used to help Josiah’s general communication skills. QMHP-C taught Josiah effective problem-solving skills (i.e. identifying the problem, brainstorm alternate solutions, select an option, implement a course of action, and evaluate). QMHP-C informed Josiah that when he is agitated to refrain from taking it out on people and communicate how he is feeling to others, so they know exactly how he is feeling. QMHP-C encouraged Josiah to have a better day tomorrow. Intervention: QMHP-C listened to mother verbalize how Josiah became agitated when he didn’t get what he wanted. QMHP-C encouraged mother to allow Josiah to express himself in an age appropriate manner and to redirect when needed. QMHP-C modeled pro-social behaviors for Josiah to strengthen his understanding of them. QMHP-C engaged Josiah in a role reversal exercise and required Josiah to think about his goals for the future. QMHP-C commended Josiah on utilizing coping strategies to increase his understanding of feelings and emotions. QMHP-C intervened to prevent the negative behaviors from escalating. QMHP-C physically redirected Josiah to an alternative activity. QMHP-C provided guidance on alternative behaviors and clear instruction on the alternative behavior. QMHP-C provided positive feedback when Josiah engaged in the more appropriate behavior. QMHP-C will collaborate with mother regarding behaviors and performance. Response: Josiah was a little rude when his mom asked him to stop what he was doing to come to session. Josiah started talking after he became a little receptive as QMHP-C talked to him and coached him on ways to communicate without being hostile or agitated. Josiah reported to QMHP-C that he doesn’t like the way that people talk to him in the house and that he was not happy to stop what he was doing. Josiah expressed frustration and hopes of his attention span and focus improving. Josiah blames his mental illness for his attitude, mood, and behaviors. Josiah 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. Josiah displayed management of individualized behaviors. Josiah has not overreacted with anger to minor frustrations or irritants. Response: Josiah responded in a pleasant manner acknowledging the positive reinforcement that QMHP-C provided. Josiah discussed mental illness and its causes as a family. Josiah displayed interest in learning about ADHD. Josiah was able to reevaluate himself and display a more positive attitude toward peers and authority. Josiah has become more involved in age appropriate social activities and was given positive reinforcement for these choices. Josiah demonstrated expectations and responded well to feedback. Josiah reported a decreased stress level due to his modulation of social contact, and the success of this was reviewed.