4/17/2023 EnchantaVaughn Approved (AM) Upon arrival, client was observed displaying normal behavior and activity at the beginning of the school day. Client was reported to have been seated in class, doing work causing no disruptions. Client was focused and on task. Client appeared happy as evidenced by him smiling and laughing. Client presented himself with a good attitude. Client was reminded of goals and objectives and what he needs to do in order to achieve them by the end of the school day. Client exhibits excellent voice volume in the hallways, to and from class. Client is witnessed keeping his hands to himself and being polite to his classmates while heading into morning specials. Client did a wonderful job paying attention and following directions. Client appeared to be learning and enjoying his day, as evidenced by his energetic spirit and happy facial expressions. Client was supported by teachers and TDT staff. Client exhibited excellent classroom management by sitting quietly and giving his undivided attention. Client maintains an uplifted spirit despite the distractions in his class. Client is very attentive to his work and is encouraged to keep up the good work. (PM) Client demonstrated good transition into the cafeteria, holding the door open for the person behind him and waiting for his turn to pick up food. Client was observed at his lunch table displaying appropriate interaction with peers. Client was having appropriate conversation. Client was seen playing a game and building new rapport with some of the other kids outside of his class. Client was respectful of staff and peers. Client was helpful to his peers, as evidenced by him picking up trash that wasn’t his. Client was courteous to authority requests and demands when asked to lower his voice and remain seated until the teacher returns. Client was praised for his cooperation and for following rules. As the client headed to psycho-educational and group session he displayed good social behaviors and walking quietly to the stage. Client impulsive behaviors were reduced at this time, due to displaying self-control and following behind peers who were on task. Client seems to be heavily influenced by his environment. Client displayed patience while QMHP organized the activity. Client asked to help QMHP pass out things needed to get started and begin psycho educational assignment. Client was excited to learn something new. Client continues to display gratitude in the school setting. Client did a great job working as a team and sharing supplies. Client earned himself a treat for completing his work and following directions. Client returned to class safely and smoothly. (EOD) Client was observed in his seat and being a good listener. Client exhibits a good attitude while participating fully in all assigned activities. As the client was provided with a calm environment and reassurance that he would be cared for, his level of agitation has decreased. As the client prepared for dismissal, he was observed uplifting his peers and thanking his teacher for their support in class and helping him deal with difficult tasks. Client remained in his seat and was able to refocus his attention to the announcements that were on and his teacher who was reviewing important information regarding upcoming tests and field trips. Client was respectful, giving his full undivided attention to all speakers and waiting to be dismissed from class. Client had a good day and needed no further redirection, meeting school expectations and achieving his 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.