8/8/2023 EnchantaVaughn Approved Behavior: Laylah has a difficult time transitioning from group setting to independent setting. Laylah struggled with following directions and listening during session. Laylah withdrew during the session as she became quiet and began to display restless and out of normal behaviors. Laylah continued to demonstrate quiet and unfavorable behaviors during the session. Behavior: Laylah showed low level of participation, putting her head down and covering her face not wanting to be bothered. Laylah is easily frustrated disengaging in activity presented wanting to do what she liked instead of what was being told to do. Laylah denied that she felt anger, despite the obvious signs (i.e. body language, tone, appearance, etc.). Mom directed Laylah to get up and suggested that QMHP end the session to show Laylah that she will not get her way by acting out and informed Laylah that people are here to help her not treat her like a baby. Intervention: QMHP will implement a routine that will encourage Laylah to be responsible and promote self confidence in academic and social settings. QMHP will educate Laylah on behavior modification to help Laylah identify what behavior she needs to decrease and avoid daily. QMHP assisted Laylah in monitoring her own behaviors in efforts to promote exercising self-control in focused areas such as respecting boundaries with others. QMHP modeled proper positive behavioral expectations for Laylah to implement in her daily activities. QMHP educated and practiced with Laylah on using breathing techniques and other anger management skills to assist her with maintaining a calm spirit. QMHP taught Laylah relaxation, calming, and guided imageries, to help her reduce and regulate her overactive and angry behaviors during the session. Intervention: QMHP reviewed several strategies for conflict resolution skills with Laylah in efforts to increase Laylah’s awareness. Laylah was encouraged to use good judgement, and respect authority figures. QMHP provided Laylah with a release of energy by walking in her space, stretching, and deep breathing exercises. QMHP reiterated with mom the importance of maintaining a healthy relationship with her daughter by allowing her to make new friends other than her little brother that are girls her age in order to venture out and be her own person and be involved in things appropriate for her mental health. QMHP discussed with the family one goal they believe they need to work on individually and as a family to help Laylah maintain daily goals. Prior to the end of session, QMHP asked Laylah, "what would you do different tomorrow” to motivate her to want more for herself. Response: Laylah displayed an unresponsive and nonchalant attitude toward QMHP when reviewing strategies from previous session. Laylah anger is moderate to intense, 3-4x per week. Laylah displayed an unemotional and flat facial expression on her face, as she appeared disinterested in the instructions, role playing techniques and modeling techniques that were implemented with teaching her effective communication and assertiveness skills to express her anger more appropriately. Laylah demonstrated a willingness to discuss the factors contributing to her stress and anxiety. Laylah was able to detect and acknowledge both positive and negative responses modeled by QMHP. Laylah knows what she needs to do to improve socially and academically. Laylah expressed to QMHP that she understood the importance intensive in-home and promised to do a better job in each session. Response: Laylah acknowledged QMHP and explored her options. Laylah proceeded to reduce the aggression in her voice while calming down. Laylah accepted suggestions from QMHP as evidenced by Laylah smiling and saying thank you. Laylah promised she would try her best to correct herself when faced with conflict. Laylah participated in reviewing key concepts on her mental illness and how to manage the symptoms. Laylah was able to speak calmly and demonstrate her improved verbalization skills while conversing with her mom. Laylah was able to utilize coping skills to eliminate stressors and unwanted feelings. Laylah enjoys therapy, as shown with her positive expressions and smile. Laylah interacts well with QMHP and seems to be warming up to therapy sessions the more she involves herself mentally and physically.