3/6/2023 EnchantaVaughn Approved (AM) During morning hours client struggled to refrain from using aggression as he was observed horse playing with his peers. Client attempted to justify his negative behavior as he stated “We was just playing.” Client failed to complete his assigned task during morning academic hours, as evidenced by him being off task. Client was observed with his head rested on the desk as he pushed his work to the side. Client was not receptive to any redirections provided by authority, as he ignored his teacher and counselor. (PM) Client struggled to interact with his peers during middle hours as he attempted to join them in playing games. Client appeared to not fit in as the others did not openly invite him to their group. Client displayed low self-esteem at this time. Client was sad and starting acting out in class for attention from other groups in the class. Client was prompted to stay with his assigned group and try to get to know them a little better. Client struggled to be in compliance with the rules and regulations of the structured setting as he was distracted and off task during instructional period. Client failed to increase his respect for others as he attempted to ignore his teacher’s redirection. (EOD) Towards the end of the academic day client failed to refrain from disruptive behavior, as evidenced by client using inappropriate communication skills as he yelled across the classroom. Client appeared to be talkative as he refused to stop talking to his peers during instructional period. Client failed to comply with directives from authority figures as he failed to refrain from talking back while being redirected. Client lacked respect for his instructor and another staff member as he used inappropriate communication skills and tone of voice in the library special. Client was kicked out of the library to talk to his counselor in order to stay on track with objectives and earn points. Client has challenges with being quiet for a long time and staying still. Client becomes bored really fast, as seen when he engaged in restless behaviors. Client did not meet any of his objectives today. (AM) QMHP explored the positive behavior options he was exhibiting with client to support his willingness to continue to make good decisions and have positive behaviors in school. QMHP engaged client in a conversation regarding his recent behaviors, progressions and setbacks. QMHP explored clients responses and responded accordingly. QMHP talked with client about the importance of adhearing to rules and expectations in school, at home and in the community. QMHP held consultations with client and teacher about effective intervention strategies that build on the client's strengths and compensate for his negative behaviors. QMHP encouraged clients teacher to provide frequent positive reinforcement to maintain client's interest and motivation in maintaing positive classroom behaviors and completing his school assignments. QMHP implemented positive reward system for those who are given a good report from their teacher or staff member, regarding their behaviors and choices. (PM) QMHP observed client in lunch in efforts to determine whether he required assistance. QMHP supported client with building new interpersonal relationships with his peers. QMHP monitored client positive and negative behavior so that she can confront him individually during psycho social and not in front of others. QMHP reminded client of ISP objectives. QMHP reviewed examples of alternative appropriate behaviors he could engage in. QMHP demonstrated the correct way to get someone’s attention without blurting out loud or talking over people. QMHP separated client from inappropriate interaction with peers, in efforts to reduce tension and stress-provoking situations. QMHP praised client for his commitment in tying to meet his objectives. (EOD) QMHP encouraged client to resist negative classroom behaviors in efforts to refrain from requiring to be redirected by his teachers so many times throughout the day. QMHP observed client complying with classroom rules and expectations. QMHP utilized empathetic listening skills as client expressed his understanding of stressful situation. QMHP provided age appropriate understanding of the teachers perspective of the situation and why she is there to help resolve any issues he has, including him having difficulty completing simple assignments in class. QMHP informed client that refusing to do his work is not acceptable and he should take small personal breaks in class involving deep breathing stretching in his seat without initiating conflict or causing distractions. QMHP encouraged client to be mindful of other students personal space. QMHP encouraged client to refrain from displaying negative behaviors towards his teacher, to talk calmly and express himself without aggression. QMHP helped client to see the positives and to take advantage of his education so that it would motivate him to be successful and to want more in life. (AM) Client responded well to feedback and discussed some things he can do better when it comes to new challenges. Client acknowledges he needs to work on his temper and controlling his anger when he doesn’t get his way. Client understands that his treatment plan is a behavior contract that will reflect his improvements and setbacks in school. Client admits that he can be nicer to people and can follow directions the first time they are given even if that means he has to stop doing something fun. Client was acceptive of prompts given by teacher and counselor. Client agreed to listen to the adult and follow all rules no matter if he sees someone else breaking them. Client is reminded to tell an adult if someone is interrupting his learning and be mindful that snitching for no reason is not okay and can start drama. Client displayed positive interaction with his peers and was supported with building healthy relationships. Although client has difficulty staying focused in class, he is extremely dedicated to getting his work done on time and getting his answers correct. Client presents a positive attitude when given the opportunity to earn a reward. Client implemented the positive reinforcement provided by his teacher and was able to stay motivated and enjoy his day. (PM) Client reviewed ISP objectives with mental health professional. Client said he was aware of his expectations and what he is expected to do each day. Client practiced some of the examples of alternate behaviors (e.g. putting his head on his desk, color or draw, think about happy moments, repeat positive “I statements” 5-10 times, and ask questions that will help him understand things better) in class when he found himself bored or unproductive. Client understood that raising his hand and positive eye contact prevents disruption and is the most respectful way to wait his turn if he wants to get someone’s attention. Client likes to be treated fairly, as evidenced by his reactions to certain disciplinary actions or consequences. Client was happy to know he was improving and meeting his objectives as best as he could. (EOD) Client was acceptive of encouragement and decided to listen to his teacher and do the right thing. Client was seen following school/class rules and expectations without requiring redirection or additional breaks. Client had one on one with QMHP. Client realized his teacher was trying to help him by pushing him to try on his own first and she would correct his mistakes. Client nodded in agreement and promised to do his work so that he can earn participation points and get a good grade. Client was respectful of others and careful not to cross peers personal boundaries and space. Client focused on things he is good at and loves to do in school in order to stay motivated in the school setting and make something out of himself.