4/12/2023 EnchantaVaughn Approved (AM) Upon arrival, client was observed following normal routine and grabbing his breakfast. Client was observed in class participating in a group assignment and working hard. Client appeared to be in studious mood, as evidenced by his focus and concentration in class. Client displayed a positive attitude while waiting for teacher to start the next activity. Client was acknowledged for his patience. Client was observed helping others and displaying good sportsmanship. Client was praised for being a responsible student and for initiating his assistance. Client was reminded of goals and objectives. Client was educated with conflict resolution skills and taught about social awareness in order to learn ways to compromise and avoid inappropriate behaviors. Client appeared to be enjoying himself around others and listening to teacher instructions. Client was attentive and well behaved. Client was observed doing the right thing and did not have to be given additional prompts. (PM) Client was seen transitioning into lunch with excellent manners, holding the door for others and using proper voice control. Client was observed exhibiting good table manners, cleaning up his trash and holding meaningful conversations with his peers. Client was praised for making age appropriate choices, such as walking in a single file line, listening to authority, and helping others. Client shared personal stories that he has experienced dealing with today’s topic on “taking action mindfully” and performing acts of kindness around his community. Client verbalizes positive self-talk and affirmations around his peers. Client expresses gratitude and compassion toward his counselor for helping him in school and being there for him. Client exhibits high self-esteem and is observed encouraging his peers to make good choices. Client says he feels good and is having a good day. Client is educated that showing gratitude reduces negativity and keeps the body calm. Client appears to be calm and relaxed after today’s intervention. Client responds by saying “thank you for teaching me the importance of school and helping me become a better student”. QMHP hugged client and escorted him back to class to prepare for tutoring and specials. (EOD) Client showed excellent teamwork, helping his group member complete activity. Client displays appropriate social skills in group setting. Client was thankful that his teacher provides one on one help when he needs it and expresses happy thoughts about being in class. Client enjoys receiving good grades and rewards for his hard work. Client remains on task and is observed following directions promptly. Client is reminded to think before he acts and mindfully consider all solutions before reacting to conflict or problem. Client responds well to feedback. Client understands that everyone is there to help and support him and that it is okay to ask for help. Client was mindful of his classmates who were still testing and utilized appropriate voice volume. Client continued to work on his classwork until it was time to pack up. Client was observed preparing for dismissal. Client waved to his classmates, teachers, and mental health professional as he walked by. Client left school in an upbeat and respectful manner, remaining on track with goals and objectives. (AM) QMHP observed client in the classroom in efforts to determine whether he required assistance. QMHP determined client was on task and did not require assistance. QMHP provided positive gestures to encourage client on his positive classroom behaviors. QMHP reminded client of ISP objectives and what he needs to do in order to achieve them. QMHP reviewed examples of alternative appropriate behaviors he could engage in to stay on task without causing disruption. QMHP encouraged client to resist negative classroom behaviors in efforts to refrain from requiring to be redirected by his teachers so many times throughout the day. QMHP praised client for listening and following directions and interacting well with his peers. QMHP observed client complying with classroom rules and expectations. (PM) QMHP explored the positive behavior options he was exhibiting with client to support his willingness to continue to make good decisions and have positive behaviors in school. QMHP engaged client in a conversation regarding his recent behaviors, progressions and setbacks. QMHP explored client’s responses and responded accordingly. QMHP talked with client about the importance of adhering to rules and expectations in school, at home and in the community. QMHP provided age appropriate understanding of his mental illness and encouraged him to utilize his coping strategies during social and non-social environments. QMHP offered to help client with his work and to give him one on one. QMHP administered psycho educational activity with client and assisted when needed. QMHP provided new skills and strategies to help reduce impulsive and hyperactive decisions. (EOD) QMHP informed client that misbehaving in school carries consequences and that making good choices results in good reward. QMHP encouraged client to refrain from displaying negative behaviors towards his teacher, to talk calmly, and express himself without aggression. QMHP introduced the concept of a behavior contract to client. QMHP reviewed the purpose and expectations of a behavior contract with client in efforts to get him familiar with the concept. QMHP held consultations with client and teacher about effective intervention strategies that build on the client's strengths and compensate for his negative behaviors. QMHP encouraged client’s teacher to provide frequent positive reinforcement to maintain client's interest and motivation in maintaining positive classroom behaviors and completing his school assignments. QMHP assisted client to behave in more positive ways by addressing the conflict he was facing with his teachers. QMHP informed client of replacement behaviors in efforts to decrease attention seeking behaviors the client often is involved in. QMHP modeled appropriate ways for client to get positive attention from his teacher. QMHP inquired of clients’ current mood. QMHP utilized active listening skills as client spoke of his current mood. QMHP assisted client in exploring other coping strategies that he had previously used to solve other problems. QMHP utilized behavior modification strategies including removing Client from the stimulant environment in efforts for him to reduce impulsive behaviors. QMHP modeled proper positive behavioral expectations for the client to administer additional layers of support and display an understanding of expectations. (AM) Client smiled as he saw QMHP's positive gestures. Client was able to process making good choices with QMHP and his teacher. Client listed 3-4 classroom behaviors that he was going to utilize in efforts to remain positive behaviors. Client appeared to be receptive to receiving positive reinforcement from his teacher as demonstrated by his smiling and inviting body language. The frequency and intensity of the client's defiant affect decreased. Client continued to work on the classroom activity. (PM) Client required additional redirection from QMHP to get him to focus on the classroom assignment. Client was able to settle down and return to classroom activity. Client was responsive to teacher’s lesson. Client reduced impulsive behaviors after 3-4 prompts from his teachers and QMHP. Client began to show greater control of his anger. Client appeared to decrease the intensity of his anger and frustration. Client was pleasant and cooperative and demonstrated a willingness to discuss the factors contributing to his undesirable mood. Client acknowledged that he tends to engage in disruptive behavior when he begins to become frustrated with schoolwork. Client accepted responsibility for his angry outbursts and aggressive behaviors. Client stated he will display anger control and not threaten or intimidate others. (EOD) Client was aware of the behavior contract and accepted the agreement, communicating he was going to be good and make wiser choices. Client was observed and reported to have been pleasant and cooperative during classroom activities and demonstrated a willingness to adhere to school and classroom rules and expectations. Teacher praised client for being on his best behavior and correcting his mistakes. Client displayed good behaviors, raising his hand when he asked a question, waiting for his turn to speak, using his words instead of hand signals, saying please and thank you, and giving his teacher good eye contact. Client said he felt great and wanted to color a picture. Client utilized deep breathing techniques to relax and stay calm during stressful environment, especially when kids are running and making noise around him. Client was happy to go to a quieter space to finish the educational assignment, verbalizing appropriate understanding by asking and answering appropriate questions. Client administered positive behavioral expectations, reducing ADHD and meeting objectives.