2/15/2023 EnchantaVaughn Approved 1. Behavior: During the in-home visit, client was seen in the back of the house kicking and knocking over stuff. During this time, client was not in the mood to apologize or pick up what he had knocked over. Client exhibited poor impulse control, as evidenced by him pacing back and forth and being out of control. Client was not on task. Client was reported to have required 3-4 prompts from his mom prior to being sent to QMHP for further assistance. Client was confronted by QMHP and asked why he made such a big fuss when he was in the wrong to begin with. Client was able to process and explain why he was destroying things in the home. Client was acceptive of redirection from his counselor. Client was educated that no one is going to allow him to break stuff without consequences. Client missed both opportunities to apologize and had a meltdown when things didn’t go his way. Client was pulled to the side and confronted about his current and displeasing behaviors. Client would not own up to anything and continued to look clueless in the face. Client finally opened up about what happened and was honest and upfront. Client apologized to his mom and returned to therapy session in a more constructive mood. 2. Behavior: Client have struggled to ignore distractions and finds himself off task and unfocused. Client is learning to respect authority figures by paying attention and listening to direction. After reviewing ISP, client shows difficulty in following home rules often choosing to act out on purpose. Mom have reported several times that client refuses to listen to her. Client displays outbursts when confronted about negative behaviors he displayed throughout the day. Reinforcement was provided to client during psycho educational. Client promised to be more respectful and comply to home rules. Client failed to complete therapeutic activity, as he was observed horse playing in his seat. Client lacked respect for QMHP. Client struggled to refrain from using verbal aggression, as his family appeared to be using profanity around him. Client appeared to be irritable as he was seen pacing the floor. Once client appeared to be calm, he began explaining how he felt disrespected due to his mom yelling at him. Client appeared to be calm after the intervention. Client continues to need help with achieving ISP objectives, due to his inability identifying anger triggers. 1. Intervention: QMHP began the session by inquiring about client’s current thoughts, feelings, and emotions. QMHP facilitated family session to encourage open communication with client and mom to process on various ways to express feelings and thoughts in a controlled manner. QMHP discussed with client and mother on assertiveness and respectful behaviors towards each other. QMHP modeled effective ways to communicate by exploring more constructive ways to discuss problematic behaviors. QMHP educated the client that most people try to learn ways to control certain behaviors, but sometimes it can be difficult. QMHP informed client that when you have self-control (e.g. avoiding hitting, pushing, screaming, crying, etc.) you not only help yourself, but you also positively affect others (physically or emotionally). The QMHP advised client that when people see you lose control they might feel scared of you, upset or angry, disappointed in you, frustrated with you, confused at why you lost control, and concerned for you. Then QMHP enlightened the client that people don’t like to see you lose control, especially if they don’t know why and that can affect how they treat you or deal with you. QMHP reiterated to client the benefits of following the rules and of the privileges he can receive when he does so. 2. Intervention: QMHP focused the next part of the session on limiting sibling rivalry in the home. QMHP assisted client with recognizing and exploring triggers of his impatience. QMHP encouraged client to continue documenting people and situations that evoke anger or aggressive behaviors. QMHP utilized active listening skills while probing client about situations that provokes his anger. After processing client’s feelings, he was redirected to continue exploring feelings and ways to conduct himself appropriately when he becomes upset. QMHP encouraged client to listen to his mother. QMHP encouraged client to be the example for his little sister and brother. QMHP encouraged client not to follow others but to be his own person. QMHP will provide strategies for coping and self-control when faced with conflict. QMHP will review and give feedback regarding ADHD and its causes and effect to well-being and social performance. QMHP assessed and monitored client’s mood and behavior at the end of the session to see if any the interventions were successful. QMHP reflected with client on his day, reviewing both good and bad experiences. QMHP processed with client, "what would you do different tomorrow”. QMHP encouraged client to have a good evening. QMHP encouraged client that tomorrow is a new day. 1. Response: Client joined session to utilize and learn new interventions and strategies. Client engaged in self-reflection, discussing good and bad parts of his day. Client was able to identify the role he plays in each situation. Client communicated his understanding of following directives and being respectful to authority figures and how he plans to make sure he does it more. The family was receptive to the redirection provided. The client began the session with demonstrating negative behaviors but became more respectful toward one another as the session continued. The family shared that they will try to go back to having more positive moments as they did in the past few weeks instead of arguing and bickering, but the client makes it difficult for them. The family reported that they will continue to work on building with one another. Client expressed that he tries to think highly of himself. Client showed good understanding of what it means to be respectful, encouraging, mindful, and fair to others. Client is observed correcting his mistakes and making good choices. Client remembered to apply himself and utilize his strengths to focus on meeting his goals and objectives. 2. Response: Client was able to be redirected successfully. Client stated he would try better self-management as the day pursues. Client was able to contain impulsive actions. Client was observed having positive interactions with his family once he was able to calm down. Client was acceptive of redirection. Client was able to complete his therapeutic activity with less than 3 prompts to redirect his focus in the home. Client showed an improvement from previous defiant experiences in the home with mom. Client learned to avoid negative and defiant behavior and comply to rules. Client was able to maintain his composure when he was confronted with the potential for conflict. Client was observed engaging in several conflict resolution skills by walking away and telling an adult first. Client verbalized that he’s able to focus better when it is quieter and more peaceful. Client took his mind from thinking and doing to a place of concentration, which allowed him to focus on one thing at a time instead of being all over the place and getting easily distracted. Client demonstrated more acceptable responses, avoiding anger provoking situations in the home and community.