1/24/2023 EnchantaVaughn Approved 1. Behavior: When QMHP arrived at the home, client was in a silent and out-of-the-way, as evidenced by his unfriendly demeanor and tense posture. Client described that he worries about issues between his parents, among other things. Client communicated that he didn’t feel like talking about his day. Client said he was tired and wanted to lay down. Client was prompted to try his best to get through the session and to relax and pay attention. Client was assured that the activity only required him to listen. Client was attentive and followed along with the simple task. Client displayed positive facial expressions and appeared to be retaining the information discussed by QMHP. Client cheered up and decided to do his best and challenge himself so that he could finish the session without complaining or falling asleep. Client communicated positive attitude and engaged in activity without frustration or being distracted by external stimuli. Client gave really good feedback and was responsive to all instructions given to him. Client was given praise and reinforced for participating in the session and developing self-determination skills. Client continues to display appropriate social skills in therapeutic setting. Client demonstrated ability to multi task by working independently and helping his mom when he needed. Client showed he is capable of exhibiting responsible behavior at home by being fair and showing compassion. Client demonstrated that he was aiming to meet his objectives today, as evidenced by his determination and carefree spirit. Although client had a hard time paying attention and sitting still he was careful not to talk over QMHP while she was going over the instructions to the therapeutic activity. 2. Behavior: Client did not communicate his feelings at the beginning of session and remained quiet while QMHP asked about what was on his mind and what part of the directions he needed help understanding. Client’s actions suddenly altered. Client was a little more verbal when talking about himself. Client seem to switch moods a lot depending on what is being asked. Client chose to distance himself from the QMHP when reflecting on his bad experiences in the home. Client uses a lot of non-verbal cues to express how he feels. At this time, client behaviors were viewed as aggravated, impolite, and troubled. Client was annoyed with mom correcting him every time he did something wrong. Client was verbally aggressive. Client did not show interest in today’s session. Client lacks the manners needed to meet his objectives. Client continues to express and elaborate on the negative relationship between him and his guardian. Client shared his reasons for not following through with instruction, which caused more drama in the house. Client continues to display nonchalant behaviors. Client also exhibits sadness and depression and sometimes cries for no particular reason or cause. Client demonstrates a physical aggressive personality that makes it hard for client to fully participate in the session without aggressive behavior. Client displayed hyperactive and impulsive behaviors, 3-4x throughout today’s session, as observed by client constantly pacing back and forth and unable to stay in one area of the house while QMHP processed his behaviors with dad. Client fails to cooperate or contribute to discussion and this behavior put him in a bad mood for the remainder of the session. 1. Intervention: QMHP processed and reiterated with client about the rules and regulations of in-home. QMHP assisted the client with understanding the expectations that have been established in the home and community. QMHP went over social skills activities with client to help him understand the importance of following rules the first time they are given. QMHP activity helped client state, demonstrate, or identify how to communicate his feelings. QMHP processed with client the thinking questions to each social skill activity. QMHP will help client develop healthy self-esteem by reducing level of anxiety and emotional reactions related to home or other independent functioning. QMHP will teach client necessary coping skills to decrease impulses. QMHP will brainstorm strategies with client and encourage self-monitoring. QMHP will provide mediation and relaxation techniques. QMHP inquired about after school activities. QMHP will collaborate with father regarding behaviors and performance. QMHP applauded client for being the bigger person. QMHP modeled language for client to use while in the home that will promote pro-social behaviors and effective communication. QMHP reiterated to client the benefits of following the rules and of the privileges he can receive when he does so. QMHP assisted client with identifying privileges that he would like but does not receive due to his negative behaviors; in efforts to stimulate his thinking about cause and effect of his behavior choices. QMHP provided simple non-verbal reinforcers as client was observed displaying negative home behaviors and ignoring prompts. 2. Intervention: QMHP reviewed and gave feedback regarding ADHD and its causes and affect toward client’s well-being and emotional functioning. QMHP monitored, observed, and redirected client behaviors as needed. QMHP monitored client individualized behaviors in collaboration with parent, himself, his peers, siblings, and environment. QMHP encouraged client to make good choices and to avoid negative thoughts about himself. QMHP processed client positive behaviors. QMHP assisted client in developing more social skills. QMHP inquired about possible challenges client can experience with applying this skill. QMHP provided positive feedback. QMHP reflected on client goals and objectives. QMHP isolated client from distractions to decrease disruptive behaviors and to reduce episodes. QMHP assisted client in normalizing the changes that are occurring outside the home. QMHP explored positive self-talk, use instruction modeling, and increase social communication skills with positive reinforcement role play activities. QMHP educated client on behavior modification to help client identify what behavior he needs to decrease and avoid daily. QMHP utilized behavior modification system to aid the client with following directions given by authority figures. QMHP explored the client’s capability to cope with his stressors and to get back on track. QMHP modeled the correct behaviors and conduct during quiet time. QMHP assisted client with finding and utilizing necessary resources. QMHP verbalized the awareness that all people are unique, learn differently, and have various strengths and weaknesses that can either hold them back or push them forward. 1. Response: Client and guardian implemented QMHP interventions successfully. Both client and guardian provided feedback, actively participated, and engaged with QMHP. Client was fidgety and required one on one attention. Client was provided with redirection for displaying emotional distress to minor irritants. Client was able to share his feelings. Client expressed that he’s trying his best to do the right thing. Client and guardian understood the contract for safety and implemented appropriate behaviors, at this time. Client was aggravated as counselor tried to deescalate the situation that was occurring. Client reiterated that he wished he had more space to practice hobbies that he used to engage in when everyone could go outside, while being home with his dad. Client stated that his ability to exhibit positive behaviors within the home is almost non-existence. Client reduces sadness and finds more excitement in learning about different ways to control his reaction to certain situations and be more receptive and open in therapeutic setting. Client stated that he would try to listen more so that he is able to understand what he needed to do in order to achieve his goals and objectives this week. Client was not receptive to counselor’s prompts and redirections and after a period of time. Client has a history of displaying aggressive, non-compliant behaviors towards authoritative figures in the home setting. Client was highly oppositional during session and displayed argumentative and frustrating behavior. Client still struggles with coping with stressors and requires in-home services. Client was acceptive of extra help and support at this time. 2. Response: Client discussed mental illness and its causes as a family. Client displayed interest in learning about Attention Deficit Hyperactive Disorder. Client believes he will get better if he continues to work hard. Client was acceptive of support and encouragement. Client exhibited good social behaviors. Client was able to reevaluate himself and display a more positive attitude toward peers and authority. Client has become more involved in age appropriate social activities and was given positive reinforcement for these choices. Client demonstrated expectations and responded well to feedback. Client reported a decreased stress level due to his modulation of social contact, and the success of this was reviewed. Client responded well to feedback, interacting well with others. Client implemented his plan for restoring relationships, and this was reviewed. Client acknowledged QMHP and explored his options. Client proceeded to reduce the aggression in his voice while calming down. Client accepted suggestions from QMHP as evidenced by the client smiling and saying thank you. Client displayed positive self-talk, ability to follow instructions, role play of appropriate way to act in the home, increased communication and exhibiting the positive reinforcers that were provided by QMHP. Client has implemented the correct behaviors in session toward in-home staff. Client was observed avoiding disruptive and impulsive actions demonstrated when client proceeded to walk away and utilize deep breathing. Client was observed intervening and regulating his emotions. Client knows what he needs to do to improve socially and academically. Client expressed to QMHP that he understood the importance of intensive in-home and promised to do a better job in each session moving forward. Client dismissed without incident.