1/29/2023 EnchantaVaughn Approved 1. Behavior: Upon arrival, client was witnessed having an argument with his siblings over who turn it was and why they can never agree. Client was thankful his counselor showed up to take him away for a few so that he wouldn’t have to deal with his brother and sister crying and making him look like the bully. Client shared that he wasn’t have a good day. 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 expressed sadness and disappointment. 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 and be disruptive. Mom directed client to get up and suggested that QMHP close session early to show client that he will not get his way by acting out and informed client that people are here to help him. Client displayed assertive tone and was sent to the back of the room to calm down and learn to be respectful and polite. Client was given constructive criticism that there is no right or wrong answer and was advised to use his words. Client continued to look clueless and unsure and needed assistance with answering the questions. Client becomes easily annoyed. Client reacts by shutting down and displaying irritable behaviors, such as kicking and knocking 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. The client has a difficult time transitioning from relaxation back into his session area to complete therapy. 2. Behavior: During the second half of the session, client struggled to follow the prompts provided by his mother and continued to demonstrate inappropriate behaviors. Client was unable to process his feelings and began to get frustrated. work. Client is unable to identify many significant positive hopeful things in his life and is provided with examples of those. Client showed a lack of empathy and consideration for the QMHP and the session. Client displayed a poor attitude toward mental health professional due to personal conflicts and external distractions. Client refuses to participate or contribute to family discussion. Client constantly complains and make excuses for his behavior. Client was seen preoccupied, as he was involved in his own feelings, thoughts, and activities. Client began to display rebellious and stubborn moods, as he then showed disrespect and negative behaviors towards the QMHP. Client was disrespectful toward mental health professionals refusing to process his emotions by walking off and exhibiting increased frustration. Client ignored prompts. Client was not listening or trying to resolve conflict. Client continued to display a negative attitude. Client was encouraged to relax and focus on the positives. Client was seen calming down after given redirection. Client has a hard time accepting “No” when he wants to play or have free time to himself. Client was observed restless, impulsive and hyperactive during session. Client is observed knocking over things and not picking them back up. Client was noticed noncompliant towards mother’s directions, continuing to exhibit actions that were dangerous and disliked. Client have not obtained ISP objectives today. 1. Intervention: During conversation QMHP communicated with client and mother about client’s progression and possibilities of goals and objectives during continuation of services. QMHP also encouraged mother to point out possible stressors and/or irritations that client may trigger by behaving negatively. QMHP consulted with mother about increasing structure in the home to aid client in acknowledging the importance of operating and cooperating in the home setting. QMHP urged mother and client to participate in role reversal activity to aid mother and client to realize how to respond to and interact with each other. QMHP assisted client with recognizing his own personal strengths and how to apply them daily. QMHP continued to monitor client’s relationship with mother and compliance to duties and expectations for the client in the home and in the community. QMHP encouraged client to use his strategies and skills with peers, family, and other relatives to support him with managing symptoms associated with ADHD. QMHP encouraged client to make good choices and to utilize self-calming techniques (i.e. counting and deep breathing) and processed with him that this behavior is acceptable and discussed actions and consequences. QMHP challenged client to continue displaying a positive attitude while employing positive reinforcement when client is able to achieve his goals and objectives. QMHP provided praise when the client continued to display positive behaviors throughout the session, remaining on task and was very respectful to his mom, sister, and brother. 2. Intervention: QMHP assessed client’s behaviors and mood while reflecting on previous activity. QMHP inquired about client’s day and provided affirmations. QMHP probed about any angry feelings or the inclination of safe and unsafe behaviors. Client modeled different ways to walk away from a conflict when frustrated. Client modeled how to separate himself from negative situations by counting to ten. Client demonstrated how to verbalize his feelings without yelling and being aggressive. Client was able to speak calmly and demonstrate his improved verbalization skills while conversing with his mom. 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 continued to engage with client and provided positive reinforcement as he participated in the session. 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 provided examples of anxiety inducing situations. QMHP provided a list of experiences that is common with his mental illness. QMHP challenged client to identify any situation he has experienced. QMHP further explained different situations that can cause anxiety. QMHP provided feedback regarding client inquiries. QMHP continued to elaborate on ways client can cope and manage stressors. QMHP commended client for his participation and honesty in today’s session. 1. Response: Client was somewhat satisfied with knowing he made enough progress to prove he was doing the right thing without overthinking or belittling his growth. Client understands that his treatment plan is a behavior contract that will reflect his improvements and setbacks in the home. Client admits that he can be nicer to his siblings and can follow directions the first time they are given even if that means he has to stop doing something fun. Client agreed to behave and communicated a positive attitude when reviewing problem solving and self-control strategies. Client promised he would try his best to correct himself when faced with conflict. Client was acceptive of prompts given by mother and counselor. Client demonstrated minimal progress during this session. Client did not demonstrate any unsafe actions by trying to hit or attack others. Mom shared client has made some major improvements but wants him to put some effort into building more friendships, finding a hobby, and being more independent. Client initially presented with talkative behaviors as he probed the QMHP and asked different questions. Client reduced impulsive behaviors after 2-3 prompts from 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 his work. Client accepted responsibility for his angry outbursts and aggressive behaviors. Client stated he will display anger control and not threaten or intimidate others. Client later displayed quiet behaviors as he shrugged his shoulders and did not want to answer QMHP questions. Client did not respond as information was shared on anxiety and stress. 2. Response: Client was beginning to behave in a more sensitive way. Client appeared to be in a better mood once he accepted everything isn’t going to go your way. The client communicated positive affirmations and mother began to show her sympathy. Mother expressed client’s behaviors have improved but she still has to remind client about remaining consistent with reacting positively when being reprimanded or redirected by an adult. Mother and client displayed good communication with each other. Although mom is more stressed with client choices and behaviors in the home, mom explains that she wants to spend more time with her son each day. Client responds well to praise and encouragement and is seen paying attention to the activity and listening to QMHP. Client expressed positive thoughts about his strengths but seem to be struggling with his weaknesses. Mother states to QMHP that she has considered implementing a minor schedule for client to assist him with his completion of chores in the hotel, including but not limited to his side of the bed. Mother mentions that schedule assists her as well and allows her to remain focused on completing individual tasks without negative reactions. Mom continues to motivate client to be more independent in order to prepare for the next day. Client utilized breathing and relaxation techniques to manage symptoms and behaviors associated with ADHD. Client was calm and displayed good eye contact and posture. Client stayed seated, despite having to go to the restroom or get a drink of water when given a small break. Client is very inquisitive asking questions regarding his disorder and plans for the day. Client displayed appropriate manners at this time, by saying thank you. Client was very active and engaged today.