12/29/2023 EnchantaVaughn Approved (AM) Upon arrival to the Winter Program, client was observed engaging in impulsive actions with several peers. Client was defiant of QMHPs prompts 4-5 times. Client blamed others for his negative behaviors and appeared unapologetic for participating in disruptive actions. Client did not meet ISP objectives as evidenced by the client being loud and disruptive towards the staff. (PM) Client displayed hyperactive behaviors and was required to be redirected over 5 times as reported by his instructor. Client appeared guarded and defensive as observed by QMHP. Client was observed talking back to his staff in a disrespectful manner as he was being reprimanded. Client did not meet his ISP objectives. Client was disruptive and defiant while in the hallways, as reported by adult staff. Client was required to be redirected 5-6 times prior to QMHP coming to the classroom to intervene. Client stated the instructor was yelling at him for no reason. (EOD) Client became more impulsive and started to cause disruptions. Client was eventually separated from his peers and was stated that his consequence would consist of solitude and excludence from the community outing for 15 minutes. Client stated he never wrote down his feelings and emotions as he keeps them bottled up. The client agreed that journaling his feelings can assist with alleviating anger and frustrations based on his recent experience with the vision board. Client dismissed without incident. Client did not meet objs 2 and 3.(AM) QMHP welcomed client to camp and assessed his behaviors and mood. QMHP inquired about client’s day and provided affirmations. QMHP probed about any angry feelings or the inclination of safe and unsafe behaviors. QMHP utilized active listening as information was conveyed. QMHP communicated with client on displaying appropriate control. QMHP probed client about certain behaviors and how he sometimes feels like the only way to respond is in a negative manner. QMHP continued to engage with client and provided positive reinforcement as he participated in the psycho educational activity and group session. (PM) QMHP utilized behavior modification by verbally instructing client to use his inside voice and play fair. QMHP verbally identified the client's impulsiveness to the client and encouraged the client to use self control and decrease hyperactive behaviors. QMHP utilized age appropriate mood regulation skills and techniques, as a way to help control client’s destructive and critical demeanor, as well as to assist him with regaining and regulating his uncontrollable conduct. (EOD) QMHP informed client of more acceptable and expected responses to negative situations that would normally lead client to be triggered and display inappropriate behaviors while in the social environment. QMHP helped client to get back on track when he was pulled out for misbehavior. QMHP processed with client about his behaviors and offered alternative ways to conduct himself in social setting without getting in trouble or being aggressive.(AM) Client acknowledged QMHP's redirection after 2-3 prompts. Client stated “okay" and then began to calm down his actions. Client proceeded to lower his voice while calming down. Client took over 15 minutes to reduce hyperactive behaviors. Client became more impulsive and started to cause more disruptions. Client was eventually seperated from his peers and endured his concequences of solitude and excludence from the community outing. (PM) Client appeared to be frustrated by the incident, as evidenced by his reluctance to participate in the alternative activity provided by QMHP. Client displayed body language associated with anger, demonstrated by clenching his fists and face. Client continued impulsive behaviors and started running and jumping in circles, as he was prompted to remain seated over 3 times by QMHP and staff. Client left from assigned area without permission and was escorted back by a mental health professional. Client continued aggressive behaviors throughout the day. Client was witnessed by several staff hitting peers and horseplaying while transitioning from one setting to the next. Client failed to utilize mood regulating skills and presented destructive manners, feedback was given in this area. (EOD) Client expressed defensive behaviors as he claimed that he and the other campers are usually playing around when they are displaying inappropriate social skills. Client required to be re-focused by QMHP as he waited for others to explain what they were doing. Client stated he would try better self management skills and promised to be good for the rest of the day. The client was able to select topics that were directly related to reduction of stress and emotional negativity.