3/21/2024 EnchantaVaughn Approved Behavior: When QMHP came to the resident, Laylah’s behaviors were viewed as angry, hostile, and irritable, as it was reported by the mother that Laylah was not having a good day. Laylah displayed angry outbursts and lashed out at QMHP when inquired about why she was having a bad day. Mother reports when she tells Laylah she cannot have certain things she will get upset and lash out on her and others within the home setting with behaviors lasting up to 10 minutes in duration. Behavior: Laylah was not as active as she normally is during role-play activities. Laylah communicated she was not happy with the way her mom made her out to be the bad child. Laylah didn’t like having to stop everything she was doing to attend therapy. Laylah was redirected 4-5x by her mom before given a final warning to get her act together or consequences would follow at which behaviors lasted up to 2-3 minutes in duration. Intervention: QMHP addressed Laylah’s negative behavior. QMHP redirected Laylah’s negative behavior. QMHP ensured Laylah was feeling okay as she appeared to be withdrawn from her family. QMHP removed Laylah from the family setting to engage in one on one. QMHP allowed Laylah to individually process what she was going through. QMHP isolated Laylah from distractions to decrease disruptive behaviors and to enhance confidence. QMHP verbally identified the Laylah's impulsiveness to encourage the Laylah to use self-control in efforts to increase Laylah’s awareness skills. QMHP validated Laylah’s feelings but explained the importance of utilizing her coping skills. QMHP stated “You have to learn to ignore others and not be so easily triggered.” QMHP challenged Laylah to identify any situation she has experienced that makes her feel defeated or misunderstood. QMHP further explained different situations that can cause anxiety. QMHP provided feedback regarding Laylah inquiries. QMHP will review and give feedback regarding ADHD and its causes and affect toward Laylah well-being and functioning. Intervention: QMHP explained the importance of being on task and refraining from talking in order to complete her assigned task. QMHP used appropriate behavior modeling by expressing situations that is demonstrating positive behavior to motivate Laylah to participate in the interventions provided. QMHP utilized role playing to demonstrate the calming effects of predicting the thoughts, feelings and actions of self and others prior to the outbreak of a conflict. QMHP educated the Laylah with relaxation strategies such as deep breathing and counting to 10 to decrease aggressive behavior. QMHP intervened to prevent the negative behaviors from escalating. QMHP physically redirected Laylah to an alternative activity. QMHP provided guidance on alternative behaviors and clear instruction on the alternative behavior. QMHP brainstormed with Laylah a list of conflicts that typically occur in the home in efforts to identify possible conditions or triggers that preceded the actual conflict. QMHP discussed with Laylah how empathy, communication, and awareness of another point of view can prevent or reduce conflicts. QMHP prompted Laylah to indicate how this process helps her adapt to stressful tasks. Response: Laylah reported a high level of stress due to her modulation of social distance, and the effect of this was reviewed with parent. As the Laylah developed understanding of home expectations, she reported increased satisfaction and function but still remained in a dull mood. Laylah has difficulty staying focused when distracted by others who are off task and has to be reminded to get back on track. Laylah understands that her actions have consequences. Laylah was taught to take deep breaths and count to 10. Laylah demonstrated how to verbalize her feelings without mistreating others. Laylah was able to speak calmly and demonstrate her improved verbalization skills while conversing with QMHP. Laylah recognized her triggers and was able to identify common interests and similarities her and other ADHD recipients share. Laylah was receptive as QMHP demonstrated and defined the meaning of empathy. Laylah actively participated with QMHP as they discussed and processed empathy. Laylah demonstrated that she was able to process productive expressions of anger. Laylah displayed active behaviors. Laylah was observed in session utilizing and learning new interventions and coping strategies. Response: Laylah engaged in self-reflection, discussing good and bad parts of her day. Laylah verbalized negative feelings about building relationships in the home. Laylah continued to make poor choices in session as it pertains to verbal skills and communication. Laylah displays challenges in a few areas, including but not limited to her daily goals. Laylah stated that she has a hard time controlling her negative thoughts and words and speaks her mind even if it hurts someone feelings because a lot of her anxieties exist from other people saying mean things to her or picking on her. Laylah was reluctant and hesitant to share her feelings until mom praised her.