1/31/2023 EnchantaVaughn Approved 1. Behavior: Upon arrival, client presented himself with a passionate approach, expressing he felt ready and excited to see QMHP because he had so much to share. Client expressed positive thoughts about his day. Client stated that he did good with staying clean and keeping his distance of 6ft from everybody and spending less time outside. Client expressed that he finished all of his chores (i.e. cleaning up his room, vacuuming, and washing dishes). Client expressed that he helped his dad put up groceries and set the table. Client stated he got a chance to finally show everyone that he can do the right thing without being told. Client communicated that he loves getting compliments and being rewarded. Client was happy to accomplish his goals before the end of the week. Client began completing his therapy assignment without distractions. Client maintained appropriate behavior throughout the session. As the client has increased his verbalizations of emotions, he focused onto his feelings that were motivating and uplifting. Client was reminded to think positive and continue to utilize coping strategies and relaxation techniques to maintain a positive spirit when he gets down and out. Client shook his head in agreement. Client continued to express positive feelings and demonstrate positive behavior. Client expresses gratitude and compassion toward his counselor for helping him and being there for him. Client exhibits high self-esteem and is observed encouraging himself to make good choices. Client says he feels good and is having a good day. Client is educated that showing gratitude reduces negativity and keeps the body calm. Client appears to be calm and relaxed after today’s intervention. 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. 2. Behavior: Client communicated that he was feeling good about himself since spending more time at home with dad. Client was well dressed in clean clothes, fresh haircut, and appeared to be a confident mood, as evidenced by his positive tone and energetic demeanor. Client was observed in the session on task and displaying excellent pro social behaviors (e.g. helping counselor during group activity, sharing his thoughts when needed, and volunteering to pass documents for review). Client was focused and on task. Client was having appropriate conversation with dad. Client was respectful to dad and QMHP. Client displayed good manners, saying please and excuse me when trying to get someone’s attention or asking for help. Client presented objectives, reducing frequency of anger outbursts in the home daily. Client displayed little to no impulsive behaviors, as observed displaying self-control and keeping his hands to himself. Client exhibited responsible behavior during session and exhibited mature behaviors that were supported and encouraged by the adult. Client appeared to be in a jovial mood, as evidenced by his happy spirit and positive attitude. Client was noticed compliant towards father’s directions but continued to exhibit actions that were related to his ADHD and specified challenges. Client seem to switch moods a lot depending on what is being asked. Client uses a lot of non-verbal cues to express how he feels. 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 displayed good listening skills while counselor reviewed new material for upcoming session. 1. Intervention: QMHP observed client in the living room 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 behaviors in the home. 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 behaviors in efforts to refrain from requiring to be redirected so often. QMHP praised client for listening and following directions and interacting safely during each intervention. QMHP observed client complying with rules and expectations. 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 at home, the program, and in the community. 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 the program, 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 to understand what it is that the assignment is about. QMHP administered psycho educational activity with client and assisted when needed. QMHP provided new skills and strategies to help reduce impulsive and hyperactive decisions. QMHP informed client that misbehaving carries consequences and that making good choices results in good reward. 2. Intervention: 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 father about effective intervention strategies that build on the client's strengths and compensate for his negative behaviors. QMHP reminded client not to take everything personal or to the heart and to try and relax so that he’s less stressed and more interested in building better relationships in the home and decreasing his symptoms associated with his mental health condition. QMHP encouraged client’s father to provide frequent positive reinforcement to maintain client's interest and motivation in maintaining positive behaviors and completing his “at home” school assignments and/or chores. QMHP assisted client to behave in more positive ways by addressing the conflict he was facing with his dad and friends in the community. 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 dad and peers. QMHP inquired of client’s current mood. QMHP utilized active listening skills as client spoke of his current mood regarding not seeing his mom and siblings often anymore. 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 encouraged client to refrain from displaying negative behaviors towards his dad, to talk calmly, and express himself without yelling or getting upset. QMHP modeled proper positive behavioral expectations for the client to administer additional layers of support and display an understanding of expectations. 1. Response: Client smiled as he saw QMHP's positive acts of kindness. Client was able to process making good choices with QMHP and his dad. Client listed 3-4 behaviors that he was going to utilize in efforts to remain positive in the home. Client appeared to be receptive to receiving positive reinforcement from his father, as demonstrated by him smiling and warm inviting body language. The frequency and intensity of the client's defiant affect decreased. Client continued to work on the psycho-educational activity. Client required additional redirection from QMHP to get him to focus on the assignment. Client was able to settle down and return to the activity. Client was responsive to counselor’s lesson. Client reduced impulsive behaviors after 3-4 prompts from his dad 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 is frustrated with his work or feels mistreated. Client accepted responsibility for his angry outbursts and aggressive behaviors. Client stated he will display anger control and not threaten or intimidate others. Client displayed positive self-talk, ability to follow instructions, role play of appropriate way to act, increased communication and exhibiting the positive reinforcers that were provided by QMHP. Client has implemented the correct behaviors, by avoiding disruptive and impulsive actions demonstrated when client proceeded to walk away from negative behaviors. Client acknowledged QMHP's praise by saying thank you. Client was observed intervening and regulating his emotions correctly. Client was able to demonstrate fairness and kindness to peers and authority. Client provided several scenarios for QMHP to model positive prosocial behaviors within. Client was able to detect and acknowledge both positive and negative responses modeled by QMHP. Client is learning to calm down, think first, and respond without anger and frustration. Client continues to make progress with ISP objectives, as noticed. 2. Response: Client verbalizes positive outlooks about himself but recognizes areas he needs to improve with. Client continued to interact in an optimistic way around his father and counselor. Client was seen making the right choices and staying out of trouble. Client responded well to feedback and discussed some things he can do better when it comes to new challenges. Client acknowledges he needs to work on his temper and controlling his anger when he doesn’t get his way. Client smiled and hugged QMHP. 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 throughout the day, demonstrating a willingness to adhere to home rules and expectations. Client demonstrated positivity about being in the home and coming up with new hobbies, such as exercising, drawing, and making music. Client appeared happier and less disruptive in the home. Father 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 him turn to speak, using his words instead of hand signals, saying please and thank you, and giving his counselor good eye contact. Client said he felt great and wanted to stretch. Client utilized deep breathing techniques to relax and stay calm during stressful environment, especially when kids are running and making noise outside of the house. Client was happy to go to a quieter space to finish the educational assignment, verbalizing appropriate understanding by asking and answering appropriate questions. The client responded in a positive manner acknowledging the positive reinforcement that the QMHP provided by saying “thank you” while presenting a smile. Client utilized relaxation strategies promptly. The client showed his gratitude for being able to release physical tension stating that he feels relaxed and calm. Client administered positive behavioral expectations, reducing ADHD and meeting objectives.