2/7/2023 EnchantaVaughn Approved 1. Behavior: Client appeared to be in his feelings when QMHP arrived. Mom mentioned client was caught taking stuff that didn’t belong to him and he was upset because he tried to lie about it when he didn’t realize someone was watching him the whole time. Client continues to be defiant, disrespectful, and impulsive in the home. Client had difficulty focusing in the session, due to these behaviors. Client had difficulty concentrating on the therapeutic activity as he continued to fidget in his seat and make unnecessary noise. Client was told to stop and was reminded that he was not setting a good example for his younger brother and sister. Client did not demonstrate a cooperative attitude during the family activity. Client was provided with feedback about how his behavior and verbal messages have a huge impact on the people who love and care for him. Client expressed negative “I statements” (e.g. "I hate staying in this boring house"). Client continued to exhibit negative actions that were perceived as dangerous toward his family. Although, client was fully aware of his actions, he did not make any changes as he continued to complain about simple tasks. Client was encouraged to think positive and reminded to relax when he feels overwhelmed. After about 2-3 prompts, client returned to normal behavior going into the second half of the session to participate in a therapeutic activity. 2. Behavior: Client’s actions suddenly altered. Client was a little more verbal when talking about things he likes. Client seem to switch moods a lot depending on what is being asked. Client chose to distance himself from the QMHP when reflecting on his bad experiences. Client uses a lot of non-verbal cues to express how he feels. At this time, client behaviors were viewed as impatient, disrespectful, and agitated. Client was annoyed with mom correcting him every time he did something wrong. Client demonstrates a physical aggressive personality that makes it hard for client to fully participate in the session without redirection. Client is dealing with his insecurity by being physically abusive to others, which have been confronted. Mom takes on full responsibilities of client’s actions. Client displays hyperactive and impulsive behaviors, 2-3x throughout today’s session, as observed by client unable to stay in one area of the house while QMHP processed his behaviors with mom. Client didn’t quite understand why he was off today and how it affected other people. Client was given suggestions on how to cope with his trauma and treat others like he would want to be treated. Client has a hard time communicating his feelings when he’s put on the spot. Client remained in session in a silent, dull mood and closed his eyes to process his emotions. Client was inquired to explain himself in front of his family before session ended. 1. Intervention: 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 school activities or things he does during his breaks to stay on track with his goals and objectives. QMHP will collaborate with mother regarding behaviors and performance in the morning times during school. QMHP applauded client for being open to receiving the help he requires. 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 trained client in taking steps to prevent problems including displaying positive classroom 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. 2. Intervention: QMHP informed client of more acceptable and expected responses to in home and life situations that would normally lead client to be triggered and display inappropriate, negative behaviors while in the home or community. 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 probed client about his home duties and responsibilities. QMHP empathized with client, giving him space to relax and cool down. QMHP monitored client individualized behaviors in collaboration with family friends, and other staff. QMHP will continue to assist client with increasing self-esteem and confidence by reviewing personal strengths. QMHP reminded client of calming and relaxation techniques. QMHP praised client for opening up to his peers. QMHP monitored client's communication skills in family setting. QMHP monitored for acquisition of objectives. QMHP intervened to assist in explaining objectives to client. QMHP reflected with client on his day, the good and the bad experiences. QMHP encouraged client that tomorrow is a new day. QMHP encouraged client to review goals and objectives. 1. Response: Client joined session to utilize and learn new interventions and strategies. Client has difficulty staying focused when distracted by his siblings who are off task, engaging in aggressive acts. Client has to be reminded to get back on track and lead by example. Client is very independent but can be anti-social as well. Client followed interventions, which motivates him to pay more attention and take his time. and lashing out when upset or frustrated. Client responds well to feedback. Client said he was going to practice coping strategies and relaxation techniques in all aspects of his daily living routine in hopes that he will be a better person. Client is acceptive of redirection. Client understands that his actions have consequences. Client is striving for a good report. Client expressed appreciation to QMHP by smiling and giving good eye contact. 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 with peers by walking away and telling an adult first. Client demonstrated more acceptable responses, avoiding anger provoking situations in the home and community. 2. Response: Client utilized coping skills and impulses started decreasing. Client was observed strategizing a plan to better himself by expressing his thoughts and feelings and exploring his creative side. Client uses making beats as an emotional outlet. Client was taught to deep breathe until he is ready to process his feelings without lashing out or displaying episodes. Client demonstrated responsibility and leadership. Client was acceptive of redirection. Client was able to complete the activity with less than 3 prompts to redirect his focus. Client showed an improvement from previous experiences in the home with his family. Client showed interest in building interpersonal relationships with authority to increase support system. Client expressed positive self-talk, modeled positive behavior, and good communication skills during role play activity. Client thanked QMHP for the support and assistance and helping him stay on track with his goals and objectives. Client was able to be redirected successfully. Client was able to contain impulsive actions. Client was observed having positive interactions with mental health professional. Client learned to avoid negative and defiant behavior and comply to rules.