6/18/2023 EnchantaVaughn Approved Behavior: Upon arrival, client behaviors were viewed as distracted and chatty. Client was lectured about her hyperactive conduct. Client was respectful towards the QMHP’s instructions and directives that were provided to her within the session. Client displayed unmanageable behaviors, as she repeatedly laid on the living room floor, rolling around, not taking the session seriously. Client was also seen running back and forth throughout the home without any form of remorse for her negative and nonchalant attitude. Behavior: Client is often observed talking back to authority and showing frequent anger reactions, in which she exhibited oppositional defiance, failing to achieve objective 1. Client was non-compliant for most of the session. It was difficult for client to remain in her seat while talking to the QMHP. Client appeared very moody today for no reason neglecting her duties in the home and in the session. Intervention: The QMHP facilitated an individual psycho educational exercise which consisted of the client identifying 3 positive ways to deal with anger and frustrations. The QMHP explored the client’s responses and responded by reminding the client to refrain from self-alarming and negative statements. QMHP reiterated client safety plan by identifying coping skills she can utilize. QMHP engaged the client in conversation. QMHP practiced calming techniques by modeling examples for the client to follow, such as walking away and cooling off and counting to ten. Intervention: QMHP observed the client’s progression and responded accordingly. QMHP reiterated the directives 2 times to ensure the client understands the exercise. QMHP encouraged the client to try to release her emotions so that she doesn’t bottle them up and explode all at once. QMHP reminded the client that talking about her feelings is healthy. QMHP reviewed client’s goals and objectives with parents. QMHP prompted the client to think about how her negative actions can affect others. QMHP communicated with mom that client need to learn how to calm down on her own. QMHP will continue to assist client with managing anger and frustration by reviewing and role-playing effective coping skills. Response: Client struggled with expressing her feelings in response to the reasons and causes for her negative and impolite behaviors. Client frowned her face up and ignored the exercise. Client failed to identify 3 positive ways to deal with anger and frustration, remaining aggravated. Client continued to express negative statements. Client reduced eye contact with QMHP and showed no interest in following safety plan. Client offered no form of verbal communication and refused to calm down in an appropriate manner. Client rolled her eyes and smacked her lips at QMHP. Mother verbalized that she does not know why client consistently displays these behaviors. Response: The client participation level was low when practicing calming techniques, as evidenced by client flat mood and demeanor. The client looked confused, indicating that she didn’t know the reason for her negative behaviors. Client displayed a disinterest in the therapeutic activities, due to avoiding discussion and prompts. Client was unable to relax when being instructed by the use of the calming and relaxing techniques. Client was resistant and reluctant in regard to the QMHP positive empathetic acceptance. Client was inattentive and unfocused throughout the session.