2/12/2023 EnchantaVaughn Approved 1. Behavior: Client exhibits a poor attitude when transitioning from social setting to therapeutic setting. Client displayed hostile and disruptive manners toward others. Client did not start his therapy right away. Mom suggested client sit next to his counselor and tell her why he don’t like to his. Client was confronted and sent to have one on one with his counselor. Client stated he didn't get much sleep the night before and was not in a good mood. Client was encouraged to lose the attitude and get his work done. Client expresses negative statements about his work, stating "it’s too hard". Client displayed lack of patience due to blurting out loud and interrupting his counselor and mom while they were talking. Client was encouraged to be quiet and listen. Client exhibited frustration and anger toward authority and was prompted to be more respectful. Client needed redirection at this time. Client seems to be negatively influenced by his friends. Client continued to get up out of his seat and avoid directives. Client was prompted to get back on task and follow directions. Client had a hard time listening and continued to interrupt everyone, which were addressed by QMHP. Client was reminded that he has to be willing to except help in order to get better so that he can successfully do it on his own. Client displays low self-esteem and inability to grasp understanding of age appropriate activities. Client exhibits difficulty with his work and needs one on one assistance. 2. Behavior: Client was verbally aggressive. Client did not show interest in today’s session. Client lacks the manners needed to meet his objectives. Client continues to express and elaborate on the negative relationship between him and his guardian. Client verbalizes alarming statements when he engages in reflective thinking, stating that he becomes really physical when he’s upset. Client continues to display nonchalant behaviors. Client also exhibits sadness and depression and sometimes cries for no particular reason or cause. Client verbalizes different complaints but utilizes his coping skills properly. The client was supported for demonstrating a decrease in level of paranoia. Client shared his reasons for not following through with instruction, which caused more drama in the house. Client was reminded to utilize relaxation techniques and think before he acts. Client displays an increased ability regarding problem solving and making decisions while interacting well within the home and displaying a respectful attitude toward mental health professional and family. 1. Intervention: QMHP conducted session today on decreasing disrespect for authority figures and taking ownership for his own actions. QMHP probed client about his behaviors. QMHP probed client about his ability to not get involved with violence. QMHP discussed with client the importance of conducting himself appropriately at all times. QMHP utilize positive self-talk strategies to help client think positively at all times and to talk about his actions and how they will determine his future. QMHP utilized active listening skills while client was verbalizing information about his day. QMHP encouraged client to remain positive and more positive things will happen. QMHP prompted client to refrain from impulsive, hyperactive, defiant, and aggressive behaviors especially running, refusing authority instruction, and interrupting others who are trying to learn. QMHP utilized behavior modification strategies including removing client from the stimulant environment in efforts for him to reduce inappropriate behaviors. QMHP monitored effects of meditation and coping practices in the home. QMHP explored the client’s capability to cope with his stressors and to get back on track with his objectives. QMHP assisted client with finding and utilizing necessary resources at home. QMHP prepared client for transition into his evening activities. 2. Intervention: QMHP probed client about his schedule in efforts to understand his daily routine. QMHP probed client to not be afraid and ask questions if he doesn’t understand any of the in-home assignments so that he will not have the same failures in other situations. QMHP utilized role-play to help client understand the importance of following all directions and limiting outburst of anger in a therapeutic or non-therapeutic setting. QMHP utilized active listening skills while client excitedly discussed his feelings of being in services and talking about his problems with someone he is still building a relationship with. QMHP educated client about using good manners at home and offering alternative methods and suggestions to model appropriate language that client should use to ask for things or to get someone’s attention. QMHP processed client feelings and offered choices of what to do when faced with conflict or challenged in the home. QMHP will assist with reducing anger-provoking situations through self-talk and role play scenarios in order to prevent escalation and dealing with anger assertively. QMHP will continue to assist client with managing anger and frustration by reviewing and role-playing effective coping skills. QMHP reminded client of his goals and objectives that he is expected to achieve. 1. Response: Client was aggravated as counselor tried to deescalate the situation that was occurring. Client was highly oppositional during session and displayed argumentative and frustrating behavior. Client still struggles with coping with stressors and one on one. Client reiterated that he wished he had his own space to explore more things he like to so while being home with his mom. Client stated that his ability to exhibit positive behaviors within the home is almost non-existence. Client reduces sadness and finds more excitement in learning about different ways to control his reaction to certain situations and be more receptive and open in therapeutic setting. Client practiced some of the examples of alternate behaviors (e.g. putting his head down, coloring or draw, think about happy moments, and repeat positive “I-statements”). Client and guardian were acceptive of QMHP interventions. Both client and guardian provided feedback, actively participated, and engaged with QMHP. Client was able to share his feelings. Client expressed that he’s trying his best to do the right thing. Client and guardian understood the contract for safety and implemented appropriate behaviors, at this time. 2. Response: This has been the first occasion in which client has displayed this level of behaviors in the presence of counselor. Client was acceptive of extra help and support. Client informed counselor of his behaviors and attitude and how he was working on doing better and helping his mom more around the house. Client understood the rules in the home. Client understood the expectations that were established in the home and in the community, and how to conduct himself in each setting. Client utilized the resources provided and seem to be doing better with managing symptoms of ADHD. Client was observed strategizing a plan to better himself by writing down his thoughts and feelings and exploring his creative side with arts and crafts. Client stated that he would try to listen more so that he is able to understand what he needed to do in order to achieve his goals and objectives on a consistent basis. Client displays moderate participation unless he’s distracted. Client recognized when he’s not paying attention and quickly corrected himself. Mom enjoyed seeing client do the right thing for once. After several strategies and restraint by counselor, client was able to stabilize his negative behaviors by utilizing the techniques learned during today’s session.