1/17/2023 EnchantaVaughn Approved 1. Behavior: QMHP met with client for in-home services and to check on how he was doing since the last visit. Client was present in the home during session but appeared to be in a low tempered mood. Client was inquired why he felt this way. Client did not respond. Client displayed poor communication and was given a moment to cool off. Client appeared to be in a downward mood. Dad expressed that client often acts like this when things don’t go his way. Dad reported that client has had a hard time removing distractions which causes him to be unfocused on the assignments/tasks at hand. Dad reported client gets angry, aggressive, and becomes uncooperative almost daily as a result of his ADHD behaviors. Client displayed hyperactive behaviors. Dad expressed being overwhelmed with client’s increase in bad/inappropriate behaviors. Client have had multiple issues within the home from outside resources that have been addressed numerous of times by dad. Client has issues with understanding the effects of his behaviors. Client was unable to focus today. Client expressed that he tries to communicate with his father in the same way that he communicates with his counselor but it’s hard. Client became frustrated and began to be disruptive and purposely annoy others in order to draw attention away from himself. Client failed to utilize appropriate coping strategies and communication skills within the home. Client became upset when he realized dad and QMHP were talking about his negative behaviors. Client had difficulty focusing and paying attention, especially when it wasn’t his turn to talk. Client was reminded to concentrate on the whole purpose of the session. Client took a second to regroup but was able to turn his day around by attempting to complete the interventions provided by QMHP. 2. Behavior: Client was standoffish and distant, ignoring debriefing and refusing to communicate his feelings when inquired about why he wasn’t participating. Client withdrew during the session as he became quiet and began to display restless behaviors. Client continued to demonstrate quiet behaviors during the session. Client had to be told more than once to show authority the proper respect and to look forward when someone is talking to him. Client frowned up his face and looked away from his counselor. Client is unable to identify many significant positive hopeful things in his life and is provided with examples of those. Client shared that he was not in a good mood. Client reframed from engaging in conversation and tried to cover his face and ears, so he wouldn’t have to listen. Client refused to pay attention, as observed. Client continues to avoid mental health counselor prompts and directives and is encouraged to be respectful and polite. Client often displays frequent outbursts when things don’t go his way. Client becomes easily annoyed. Client reacts by shutting down and displaying irritable behaviors, such as falling and flipping over furniture. Client avoids wanting to listen to information being shared, as he began to pout and roll his eyes at the QMHP. After about 20 minutes of reflective thinking, client was given a break and directed to deep breathe, stretch, and regroup. Client have not utilized healthy coping practices and was urged to do so. Client chose not to express his feelings without exhibiting inappropriate behaviors. Client avoids self-reflection exercise when QMHP inquired him to deeply think about his reaction to certain situations. Client communicated with his counselor that he wanted to end the session. Therefore, client did not finish the assignment and ended the session with a bad attitude and getting up without being dismissed or acknowledging QMHP. 1. Intervention: QMHP went to the home to meet with client individually. QMHP engaged in conversation with client about his day. QMHP actively listened to client verbalize that he was agitated today and the reasons to his agitation. Instruction, modeling and role-playing techniques were used to help client’s general communication skills. QMHP taught client effective problem-solving skills (i.e. identifying the problem, brainstorm alternate solutions, select an option, implement a course of action, and evaluate). 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 educated client about using good manners at home and offering alternative methods and suggestions to model appropriate language that client should use to ask for things or to get someone’s attention. QMHP processed client feelings and offered choices of what to do when faced with conflict or challenged in the home setting. QMHP facilitated a family discussion to talk about common mistakes children with ADHD make and how he can make better choices. QMHP discussed anxiety and explained it is a normal part of life. QMHP intervened to prevent the negative behaviors from escalating. QMHP physically redirected client to an alternative activity. QMHP provided guidance on alternative behaviors and clear instruction on the alternative behavior. QMHP will review key concepts of being responsible with his family. QMHP educated client about being respectful, encouraging, mindful, and fair to peers and authority while making good decisions in the home. QMHP will provide mediation and relaxation techniques, as well as, simple praises and encouragement to continue the positive behaviors he was exhibiting. QMHP aided this intervention with client on social skills. QMHP introduced client to psycho social activity regarding hygiene and staying healthy. The QMHP educated client that it is vital to wash your hands and stay inside. 2. Intervention: QMHP gave client the opportunity to express and explore his perceptions of how his symptoms of ADHD can affect him relationships with family and friends. QMHP encouraged client to present healthier habits and routine by challenging himself to make better choices and try new things. QMHP utilized age appropriate mood regulation skills and techniques, as a way to help control client’s destructive and critical demeanor. QMHP reeducated client on conflict-resolution skills through role-playing, instructions, modeling and behavioral rehearsal to help him be more aware of his negative and inappropriate conduct. QMHP assisted client in developing specific ways and methods that he could utilize to help him regain and regulate his overactive and restless behaviors. QMHP probed client about his ability to not get involved with a negative crowd. QMHP discussed with client the importance of conducting himself appropriately at all times. QMHP probed client about his schedule in efforts to understand his daily routine. QMHP probed client to not be afraid and ask questions if he doesn’t understand any of the in-home assignments. QMHP informed client that when he is agitated to refrain from taking it out on people and communicate how he is feeling to others, so they know exactly how he is feeling. QMHP listened to father verbalize how client became agitated when he didn’t get what he wanted. QMHP encouraged father to allow client to express himself in an age appropriate manner and to redirect when needed. QMHP modeled pro-social behaviors for client to strengthen his understanding of them. QMHP engaged the client in a role reversal exercise and required the client to think about his goals for the future. 1. Response: Client expressed sadness and disappointment when talking about his past and present reactions to going through family disfunction and being torn apart from his mom, due to the abuse and custody. Client continues to make smart remarks and turn away from authority. Client fails to exhibit age appropriate behaviors in the home, due to hyperactive and impulsive decision making. Client showed low level of participation, putting his head down and covering his face not wanting to be bothered. Client is easily frustrated when confronted about not listening to authority figures and begins to move out of his seat. Client is working on walking away and telling an adult before responding to anger provoking situations. Client understands that problem solving starts with thinking before acting. Client displayed an unresponsive and nonchalant attitude toward QMHP when reviewing strategies from previous session. Client displayed an unemotional and flat facial expression on his face, as he appeared disinterested in the instructions, role playing techniques and modeling techniques that were implemented with teaching him effective communication and assertiveness skills to express his anger more appropriately. Client promised he would try his best to correct himself when faced with conflict. Client struggled with expressing or identifying stimulus that triggered his angry emotions. The storytelling techniques were ineffective to modeling appropriate ways to manage stress. Client admitted to counselor that he does sometimes find difficulty in adapting to the rules and regulations in the home. Client displayed body language associated with anger, demonstrated by clenching his fists and face. Client had to be redirected in regard to the relaxation and calming imageries. Client did not offer verbal communication. Therapy activity was viewed as ineffective and unproductive. Client displayed a disinterest in the interventions that were applied to him. Client expressed anger and frustration when he had to communicate directly with his dad without looking at QMHP. Client exhibits low self-esteem during family setting. 2. Response: The interventions were unsuccessful, as client was unable to relax and regain self-control when being instructed in the use of calming imageries, as he continued to display defiant, disrespectful, and stubborn behaviors. Client was resistant and unruly, as he did not display any forms of empathy or concern in response to the talk therapy. Client acknowledged that he tends to engage in disruptive behavior when he begins to become frustrated with school related work and chores. Client exhibits a non-responsive attitude when reflecting on his day. Client failed to identify his triggers and stressors. Client reframed from answering QMHP questions. Client was not in a good mood. Client is easily distracted by external stimuli. Client communicates a lot of sad feelings throughout today’s visit. Client was not focused during the session. Client displayed an unemotional and flat facial expression on his face the entire time. Client appeared disinterested in the instructions, role-playing techniques and modeling techniques that were implemented with teaching him effective communication and assertiveness skills to express his anger more appropriately. Client stated his difficulties in certain situations but displayed a negative tone. Client required assistance as he was unable to lower his voice. Client showed lack of concern and empathy in response to positive cognitions. Client failed to communicate, problem-solve, or resolve conflicts, therefore displaying a negative attitude. Client stated that he and his father often display argumentative and negative behaviors towards each other. Client however mentioned that he is willing to make attempts to improve his actions/behaviors if father actively participate with the services as well.