2/5/2023 EnchantaVaughn Approved 1. Behavior: Client exhibited poor impulse control, as evidenced by constantly moving out of his seat and being disruptive. During this time, client was not productive. Client decided to knock down everything in his way and refused to pick it back up. Client exhibits a poor attitude when transitioning from social setting to academic setting. Client displayed hostile and disruptive manners. Client did not start his work in the session right away. Client was encouraged to lose the attitude and get his work done before he's penalized for his actions. Client have struggled to ignore distractions and finds himself off task and interrupting others who are trying to learn. Client is learning to respect authority figures by listening to directions the first time they are given. After reviewing ISP, client shows difficulty in following home rules often choosing to act out on purpose. Dad have reported several times that client refuses to listen to him and his fiancé. Client displays outbursts when confronted about negative behaviors. Client was reported to have required 3-4 prompts prior to being sent to QMHP for further redirection. Client participated in a 20-minute break to cool and get back to normal affect. 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 was acceptive of redirection with his counselor. Reinforcement was provided to client during psycho educational. Client promised to be more respectful and comply to rules. 2. Behavior: Client was observed throwing objects across the room, making unnecessary noise, and disrupting others, out of his seat, often leaving without permission, and following behind sibling’s negative behaviors. Client failed to complete his assigned task as he was observed talking out of turn. Client lacked respect for authority figure. Client struggled to refrain from using verbal aggression. The client has to be reminded to communicate positive feedback and not to let his pride get in his way of learning and receiving help. Client was sent to his room to regroup. 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 Dad yelling at him. Client appeared to be calm after interventions. Client continues to need help with achieving ISP objectives, due to his inability identifying anger triggers. Client explained to QMHP why he always gets in trouble. Client was mildly talkative during session. Client was unable to focus today. Client expressed that he tries to communicate with his father in the same way that he communicates with his counselor but it’s hard. Dad reported that client was angry and uncooperative since he woke up this morning. Client avoids self-reflection exercise when QMHP inquired him to deeply think about his reaction to certain situations. 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 educated that no one is going to allow him to leave when he has not done anything in the session to improve with mental illness which defeats the purpose of being in service. Client apologized to his dad and returned to therapy session in a more constructive mood. Client found himself feeling down for the remainder of the session, dismissing in an aggressive mood and putting his head down in his lap. Client was left alone to cope with his emotions. Dad thanked QMHP for her assistance. 1. Intervention: QMHP listened to father verbalize how client became agitated when he didn’t get what he wanted. QMHP encouraged father to allow client to express himself in an age appropriate manner and to redirect when needed. QMHP modeled pro-social behaviors for client to strengthen his understanding of them. QMHP intervened to prevent the negative behaviors from escalating. QMHP trained client in taking steps to prevent problems including displaying positive home behaviors. QMHP refocused client as he was observed becoming fidgety and restless. QMHP will review and give feedback regarding ADHD and its causes and affect toward client well-being and academic functioning. QMHP will provide client with support and encouragement. QMHP will monitor, observe, and redirect client behaviors as needed. QMHP will build rapport. QMHP will explore positive self-talk, use instruction modeling, and increase social communication skills with positive reinforcement role play activity. QMHP used positive regard as he told the client that he appeared to have positive home management earlier in the day. QMHP informed client of more acceptable and expected responses to situations that would normally lead client to be triggered and display inappropriate, negative behaviors while in the home. QMHP will review key concepts of being responsible with the family. QMHP will educate client about being respectful, encouraging, mindful, and fair to peers and authority while making good decisions in the home. QMHP will teach client necessary coping skills to decrease impulses. QMHP will brainstorm strategies with client and encourage self-monitoring. QMHP will provide mediation and relaxation techniques, as well as, simple praises and encouragement to continue the positive behaviors he was exhibiting. QMHP aided this intervention with client on social skills. QMHP assisted client to behave in more positive ways by addressing the conflict he was facing with his Dad. 2. Intervention: QMHP reiterated to client the benefits of following the rules and of the privileges he can receive when he does so. QMHP assisted client with identifying privileges that he would like but does not receive due to his negative behaviors; in efforts to stimulate his thinking about cause and effect of his behavior choices QMHP will help client develop healthy self-esteem by reducing level of anxiety and emotional reactions related to home and other independent functioning. QMHP will teach client necessary coping skills to decrease impulses. QMHP will brainstorm strategies with client and encourage self-monitoring. QMHP will provide mediation and relaxation techniques. QMHP inquired about after session activities. QMHP will collaborate with mother regarding behaviors and performance. QMHP utilized active listening skills as client spoke of his current mood. QMHP will educate client on behavior modification to help client identify what behavior he needs to decrease and avoid daily. QMHP will utilize behavior modification system to aid the client with following directions given by authority figures. QMHP will meet with client daily to discuss progress and expectations that are working and not working in the home weekly. QMHP actively listened to client verbalize that he was agitated today and the reasons to his agitation. Instruction, modeling and role-playing techniques were used to help client’s general communication skills. QMHP taught client effective problem-solving skills (i.e. identifying the problem, brainstorm alternate solutions, select an option, implement a course of action, and evaluate). QMHP informed client that when he is agitated to refrain from taking it out on people and communicate how he is feeling to others, so they know exactly how he is feeling. QMHP encouraged client to have a better day tomorrow. 1. Response: Client was a little rude when his dad asked him to stop what he was doing to come to session. Client started talking after he became a little receptive as QMHP talked to him and coached him on ways to communicate without being hostile or agitated. Client reported to QMHP that he doesn’t like the way that people talk to him in the house and that he was not happy to stop what he was doing. Client has difficulty staying focused when distracted by others who are off task and has to be reminded to get back on track. Client was able to be redirected successfully. Client stated he would try better self-management as the day pursues. Client learned a lot from observing others and wanted to prove he can be responsible by participating in all the leisure and fundamental activities and showing good sportsmanship. Client talked about things he loves about being in service and what things he would love to do more now that he’s limited to outside resources. Client communicated that he feels that he will be better behaved, due to consistent support in the home with Dad and seeing QMHP 4x a week. 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. Client is observed making better choices and doing the right thing. Client has improved with staying in and utilizing his breaks appropriately without needing to displaying attention seeking behaviors to get his way. Client responds well to praise and support. Client is acceptive of redirection. Client understands that his actions have consequences. Client reported a decreased stress level due to his modulation of social contact, and the success of this was reviewed. 2. Response: Client informed counselor of his behaviors and attitude and how he was working on doing better and helping his Dad 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 coping skills and impulses started decreasing. Client showed good understanding of what it means to be respectful, encouraging, mindful, and fair to others. in class. Client utilized meditation and relaxation techniques. Client was seen decreasing anger and frustration. Client reported a decrease in symptoms following the relaxation techniques. 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 was taught to deep breathe until he is ready to process his feelings. Client was acceptive of redirection. Client was able to complete psycho social activity with less than 3 prompts to redirect his focus to recognizing triggers and negative reactions to conflict. The client showed his gratitude for being able to release physical tension stating that he feels relaxed and able to catch his breathe again. The client stated that he can be good also and told QMHP that he will do his best to follow directions and keep his hands to himself. Client avoids negative language (i.e. cussing and using aggressive words). Client engaged in self-reflection and reflected on his day, the good and the bad. Client communicated his likes and dislikes in the home. Client admitted he was getting adjusted to the new routine with staying with dad. Client showed an improvement from previous days experiences in the home with dad.