9/11/2023 EnchantaVaughn Approved Behavior: When QMHP came to the resident, client’s behaviors were viewed as angry, hostile, and irritable, as it was reported by the mother that client was not having a good day. Client displayed angry outbursts and lashed out at QMHP when inquired about why she was having a bad day. Mom explained that client have stayed in the bedroom all day and refused to eat, talk, or interact to anyone. Client looked lost in her own thoughts and feelings, as she demonstrated a persistent failure to comply to the rules and expectations and respect for QMHP within the session. Client ignored the instructions and directives of QMHP while showing a lack of empathy and compassion towards authority figures within her environmental surroundings. Behavior: The client was assisted in identifying activities in which she can now be engaged as her psychotic symptoms have gradually debated. Client showed unwillingness to engage in the daily activities provided to her during the session. Client wasn’t interested in doing any work at this time. Client could not stay focus or express herself appropriately without negative feedback or mocking QMHP in a disrespectful way. Client continues to ignore QMHP directives. Client was not as active as she normally is during role-play activities. Client communicated she was not happy with the way her mom made her out to be this angry person. Client was encouraged to have a better attitude and be more productive for the remainder of the session. Intervention: QMHP addressed client’s negative behavior. QMHP redirected client’s negative behavior. QMHP ensured client was feeling okay as she appeared to be withdrawn from her family. QMHP removed client from the family setting to engage in one on one. QMHP allowed client to individually process what she was going through. QMHP isolated client from distractions to decrease disruptive behaviors and to enhance confidence. QMHP verbally identified the client's impulsiveness to encourage the client to use self-control in efforts to increase client’s awareness skills. QMHP validated client’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.” Intervention: QMHP challenged client 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 client inquiries. QMHP will review and give feedback regarding ADHD and its causes and affect toward client well-being and functioning. QMHP used appropriate behavior modeling by expressing situations that is demonstrating positive behavior to motivate client to participate in the interventions provided. QMHP utilized role playing to demonstrate the calming effects of deep-breathing exercises. QMHP prompted client to indicate how this process helps her adapt to stressful tasks. Response: Client reported a high level of stress due to her modulation of social distance, and the effect of this was reviewed with parent. As the client developed understanding of home expectations, she reported increased satisfaction and function but still remained in a dull mood. Client has difficulty staying focused when distracted by others who are off task and has to be reminded to get back on track. Client understands that her actions have consequences. Client was taught to take deep breaths and count to 10. Client was able to speak calmly and demonstrate her improved verbalization skills. Client recognized her triggers and was able to regroup and reset. Response: Client was observed in session utilizing and learning new interventions and coping strategies. Client engaged in self-reflection, discussing good and bad parts of her day. Client verbalized negative feelings about building relationships in the home. Client understood how communicating effectively and assertively could help her resist negative peer pressures. Client also understood the examples that were provided by counselor. Mother verbalized that she will work on not blaming client’s misbehaviors on her mental condition. Mother verbalized that she will work on focusing on client’s behaviors, both as healthy and unstable.