4/17/2023 EnchantaVaughn Approved (AM) Upon arrival, client was observed in class having a good start to his day. Client appeared to be in good spirits, as evidenced by happy and positive expressions. Client was witnessed working well with others and completing classwork. Client had a little trouble staying in his seat, but teacher allowed him to work at his own pace until he was completely focused. Client displayed extreme hyperactivity while others were trying to learn. (PM) Client was observed displaying poor self-control due to crawling on the floor like an animal down the hallway. Client was not able to recognize personal danger due to hitting his head on the floor. Client was advised to be careful and pay attention. Client nodded and got in line for lunch. Client had to be removed from his seat at lunch for being out of control. Client had one on one with his counselor. Client ignored directives and continued to run around the cafeteria. Client was seen horse playing in the bathroom with a few other students. Client was given redirection to go back to his assigned area. Client had to be held in order for him to stop running and chasing people. (EOD) Client left session in a positive mood. Client deescalated his hyperactive behaviors because he didn’t want his mom and dad to get a bad report. Client expressed understanding and patience in class by raising his hand and waiting to be called before getting up out of his seat. Client was monitored and supported for making better choices and participating in class. Client was observed avoiding minor irritants and displaying a cooperative attitude until dismissal, meeting objectives 2 but need improvement with objectives 1 and 3. (AM) QMHP observed client in the classroom in efforts to determine whether he required assistance. QMHP enhanced knowledge of a consistent daily routine. QMHP provided positive gestures to encourage client to verbalize positivity with peers and authority. QMHP enhanced food management skills by encouraging client to bring healthy snacks from home as an alternative for lunch. QMHP expressed understanding of self care and personal hygiene. QMHP offered praise and positive reinforcement to enhance self esteem and sense of achievement. QMHP probed sense of empowerment by communicating positive self talk. (PM) QMHP taught basic problem-solving skills. QMHP increased discipline for inappropriate behaviors. QMHP engaged client in conversation regarding his recent choices, progressions, and setbacks. QMHP utilized empathetic listening skills as client expressed his feelings. QMHP processed client’s responses and gave appropriate feedback. QMHP helped client discover positive outlets of expression and using creativity to avoid negativity. (EOD) QMHP reminded client of his goals and objectives. QMHP explored 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 encouraged client to reframe from displaying defiance of authority toward teachers, to talk calmly and express himself without anger and frustration. QMHP talked with client about the importance of adhering to rules and expectations in school, at home, and in his community. (AM) Client smiled as he saw QMHP's positive gestures. Client continued to work on the classroom activity. Client continued to interact in a positive manner with his teachers and classmates. Client nodded in agreement. Client demonstrated understanding. Client discussed the reasoning behind his negative behaviors towards others with QMHP. Client agreed that he would refrain from displaying negative behaviors towards his teacher. Client calmed down and went into his classroom. (PM) Client required additional redirection from QMHP to get him to focus on the classroom assignment. Client was able to settle down and return to classroom activity. Client was responsive to teachers lesson. Client acknowledged that he tends to engage in disruptive behavior when he begins to become frustrated with schoolwork. Client accepted responsibility for his angry outbursts and aggressive behaviors. Client stated he will display anger control and not threaten or intimidate others. (EOD) Client was observed and reported to have been pleasant and cooperative during classroom activities and demonstrated a willingness to adhere to school and classroom rules and expectations. Client listed 3-4 classroom behaviors that he was going to utilize in efforts to remain positive behaviors. Client appeared to be receptive to recieving positive reinforcement from his teacher as demonstrated by his smiling and inviting body language. The frequency and intensity of the client's defiant affect decreased. Client dismissed without incident.