7/19/2023 EnchantaVaughn Approved (AM) Upon arrival, client did not start his day off on a good note. Client refused to attend his morning group session. Client was sent to counselor for redirection. Client was very frustrated, folding his arms and stomping his feet. Client rolled his eyes at QMHP and would not communicate or process his feelings. Client was given 10 minutes to cool off and try to change his day around. Client ignored several prompts given by authority and additional redirection was provided. Client was encouraged to be respectful and listen to his counselors. Client was acceptive of feedback and prepared for his lunch break. (PM) After lunch, client behaviors went from positive to negative in the matter of seconds. Male counselor reported client failed to demonstrate appropriate behaviors during assigned activities. Client was witnessed being defiant of authority and creating unnecessary problems. Client refused to listen to QMHP and had trouble working as a group. Client expressed that he did not want to come group session and pushed away his assignment several times. Client was reminded that school is a team effort and he need to start working together. Client was encouraged to do the right thing and to make the right choices. Client was not in a good mood, as evidenced by him getting upset when he realized his behaviors would not be tolerated and would result in a phone call home. Client tried switching his mood and proceeded to do his work but kept choosing to play and joke around instead. (EOD) Client began to get off task more and more. Client demonstrates poor self-control and coping skills when he feels down or sad and can not calm down on his own without relying on TDT support. Client is becoming more aggressive around peers and authority, as monitored and reported. Client verbalizes negative communication toward QMHP and exhibits frustration when coming to attend his session. Client was witnessed being distracted by outside stimuli (e.g. other students making loud noises and being rude). Client started to pick up the undesirable behaviors by getting out of his seat and talking out of turn. Client continued to ignore redirection and gave QMHP a hard time. Client was directed to go back to his seat and follow directions. Client began being aggressive and loud. Client was prompted to be mindful and to treat others how he wants to be treated. Client took 20 minutes to calm down and return to normal activity.(AM) QMHP monitored client individualized behavior modifications. QMHP motivated client to respond to exercise and express his feelings. QMHP offered active listening skills. QMHP provided client with encouragement to demonstrate the positive behaviors and expectations they had been talking about. QMHP encouraged client to communicate to his teacher when he needs help. QMHP praised client for staying on task. QMHP complimented client for utilizing acquired skills, paying attention, and focusing on the importance of the assignment. QMHP supported client displaying positive social interaction with peers and authority. QMHP provided redirection when needed and processed with client on what he needs to do to achieve ISP objectives. (PM) QMHP led the group through each therapeutic day treatment exercise. QMHP inquired about client’s day in class and what things are he doing to make it a good day. QMHP educated client about what he can do to make the program fun and interesting, such as reading his favorite book, drawing in a journal, or putting his head down close his eyes and practice the mindful behaviors learned in session. QMHP modeled pro-social behaviors for client to strengthen his understanding of what to do in school, at home, and in the community. QMHP prompted client to refrain from impulsive, hyperactive, defiant, and aggressive behaviors especially running, refusing authority instruction, and interrupting others who are trying to learn. QMHP utilized behavior modification strategies including removing client from the stimulant environment in efforts for him to reduce inappropriate behaviors. QMHP will monitor effects of meditation and coping practices daily and report progress to all parents, teachers, and administrative staff. QMHP will assist with reducing anger-provoking situations through self talk and role play scenarios in order to prevent escalation and dealing with anger assertively. (EOD) QMHP will continue to assist client with managing anger and frustration by reviewing and role-playing effective coping skills. QMHP helped client problem solve when he began displaying negativity towards himself and others. QMHP modeled proper positive behavioral expectations for the client to encourage additional layers of support and understanding of rules and expectations. Although client needs improvement, QMHP commended client on his efforts to maintain his ISP objectives throughout the day. QMHP observed client dismissing without incident and preparing to transition back home in a positive manner, as witnessed by all staff.(AM) Client displays normal behavior in office setting. Client exhibited a positive attitude toward mental health professionals and peers. Client said it’s boring and he is having challenges with certain activities and needs help. Client said he was being good in class but got in trouble for talking out of turn. Client knows what is expected of him and is trying to make better choices. Client verbalizes positive feelings about himself but recognizes areas he needs to work on. Client smiled and hugged QMHP. Client was observed in his seat and raising his hand. Client interacted well with peers and demonstrates good team building skills. Client displays good attitude by saying “thank you”. Client did an excellent job by showing interest in the session by asking appropriate questions. Client admits when he was wrong and apologizes. Client is learning to calm down, think first, and respond without anger and frustration. Client continues to make progress with ISP objectives. (PM) Client transitions smoothly and safely to session area, displaying appropriate behaviors. Client greets his group members and waits for instruction. Client expresses good statements about his day saying he was doing his work, using his manners, and being fair to others. Client is more confident at school, as evidenced by assertive and proud tone. Client have been doing a better job controlling impulsive and hyperactive behaviors, due to keeping his hands to himself and staying in designated area. Client reduces sadness and finds more excitement in learning about mindful smelling. Client displays good participation in session. Client walks appropriately down the hallway. Client understands that breaks are a privilege and he has to earn it. Client displays coping skills when faced with conflict due to deep meditation exercises. Client anger is moderate to intense, 2-3x per week. (EOD) 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 demonstrates problem solving by staying calm and using his senses. Client acknowledges expectations and reviews goals and objectives with counselor and parent daily. Client displays good social behavior in the program, as observed and supported by mental health professionals. Client is reported building healthy relationships in TDT program and performing a lot better on academic exercises given on his grade level.