5/10/2023 EnchantaVaughn Approved (AM) Upon arrival, client was reported to have been seated in class, doing work causing no disruptions. Client was focused and on task. Client appeared happy as evidenced by him smiling and laughing. Client was reminded of goals and objectives. Client was praised for his cooperation and for being on task. Client engaged in group discussion utilizing team building skills and active listening skills while interacting with his peers during psycho educational activity. Client expressed positive thoughts. Client showed excellent teamwork, helping his group member complete activity. Client displays appropriate social skills in group setting until someone tries to tell on him. Client behaviors went from positive to negative in the matter of seconds. Client began horseplaying going down the hallway. Client became aggressive with peers. Client started spinning and kicking in line. Client was not paying attention to what he was doing and kicked a teacher sending her to immediate care. (PM) Other adult staff witnessed and reported client kicked the teacher in the hallway with his prosthetic leg. Client was angry that he made a mistake and did not handle the consequences to well. Client was sent straight to the principals office. Client had to be escorted out of the back of the building bc he is a threat to the school and staff. Client was able to calm down after reporting to the principals office. Client claimed he was trying to spin and kick the wall and “accidentally” kicked his teacher. Client become angry, irate, and defiant following the incident. Teacher was sent to the hospital for additional support. (EOD) The following consequences persist: phone call home, incident report citation, 3-5 day suspension, and additional services for at home support until client is allowed back in school for a parent/teacher conference and reinstatement. Client was observed sad and down. Client remained quiet and did not respond to the feedback given by QMHP. Client displayed a nonchalant attitude and did not seem empathetic about what he did. Client was educated that this is a major deal and could have landed him in expulsion. Client communicated non verbal affirmations by nodding his head and frowning his face as an indication he knew that he was in big trouble. Client understands that physical assault will not be tolerated and have to be reported to the school board. Mom picked up client early to prevent him from doing anything else that could result in more days out of school. Client dismissed in a positive manner, but failed to meet objectives as reported. (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.