4/14/2023 EnchantaVaughn Approved (AM) Upon arrival, client is observed displaying appropriate behaviors when entering his class, going straight to his seat, and taking out a pencil. Client was polite and calm. Client was mindful of the behaviors he was displaying being careful not to invade anyone else's space. Client spoke to his counselor upon arrival. The client was taught about situations he should break from his established routine if he wanted to continue having good mornings. The client was focused on his responsibilities regarding treatment developing good habits to go straight to class when he gets to school. Client was observed quietly working on an assignment along with his peers. 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 demonstrates positive social interactions in his class. Client was seen on task and exhibiting good 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. Client presents positive facial expressions and a good spirit heading into his afternoon specials. (PM) Client walked into the cafeteria displaying appropriate social behaviors. Client was seen interacting and engaging in conversation. Client cleaned up his trash and remained seated until lunch ended, going into his counseling session with a positive attitude. Client was monitored displaying age appropriate behaviors and waiting for instruction. Client was inquired to share something that he has learned today. Client stated he learned how to think of something funny or something that makes him happy whenever he is faced with challenges and defeat to keep him motivated and content around negativity or conflict. Client engaged in reflective thinking with mental health professional. Client displayed active listening skills in individual setting. Client was acceptive to feedback. Client was observed complying to rules and regulations. Client displays positive attitude and low symptoms of ADHD. Client complies to instruction and is seen working as a team. Client communicates well in group setting, expressing positive thoughts about activity. Client expressed positive thoughts and communicated that he understands the importance effective problem solving and know what it means to be fair. Client was able to share examples in her own life as it relates to dealing with conflict at home and in the community. Client showed excellent teamwork, helping his group member complete activity. Client displays appropriate social skills in group setting by taking turns and being mindful of other peers’ personal space. Client returned to class in a positive mood, as evidenced by his smile and hugging QMHP. (EOD) Client works well with others. Client understands his expectations and leads by example. Client is observed being polite and courteous. Client social behaviors were monitored. Client is seen executing safety plan in the hallways while transitioning to new setting. Client was supported for having a good day and being able to remain in class until dismissal. Client packed up his belongings quietly, making sure to put his homework in his bookbag and listening out for the announcements. Client exhibits good interaction with his peers while walking to the bus area, displaying appropriate conduct and behaviors. Client met all objectives, as evidence and observed. (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.