2/10/2023 EnchantaVaughn Approved 1. Behavior: Client conducted session with QMHP on losing control and building positive family relationships. Client displayed sadness due to missing his mom as soon as the conversation began. Client struggled to compromise with dad regarding his failed relationships with his mom and continued to blame his dad for everything he was feeling. Dad appeared to be extremely tired. Dad explained that he was okay with having session today and wanted client to get the most out of in-home services. Client expressed that he wanted to give his dad a break so that he could rest. Client was very concerned about dad and asked if it was something he did, so he could fix it right away. Client’s dad encouraged him to talk to his counselor about his concerns and come up with solutions. 2. Behavior: Client was very impatient with QMHP and dad throughout the session. Client spoke in an aggressive tone, “I don’t want to do this” (referring to the session). 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, requiring one on one to reflect on his poor decisions. Dad expressed that client often acts like this when things don’t go his way. Client made inappropriate comments under his breathe that sounded like he was making threats toward his family. Client continues to avoid answering any of the questions and have a hard time following along in the session. 1. Intervention: QMHP actively listened and provided support as father explained that the client exhibited difficulty in all environments since being in quarantine. QMHP assisted client with recognizing and exploring triggers of his impatience. QMHP encouraged client to continue documenting people and situations that evoke anger or aggressive behaviors. QMHP utilized active listening skills while probing client about situations that provokes his anger. QMHP inquired if client was prescribed any medications for his diagnosis. QMHP inquired if moving was the reason behind client’s inappropriate behaviors as a way to gain more attention. QMHP encouraged dad to talk to client about the new changes in a less therapeutic setting to prepare him for transition and dealing with his thoughts and feelings. QMHP went through program overview with family to reiterate key points and program objectives that would pertain to their specific situation and helping to build a new therapeutic relationship with the family and client without making them feel overwhelmed with questions or being put on the spot. QMHP encouraged client to continue displaying appropriate behaviors in the home. QMHP supported client involvement in selected therapeutic activities. QMHP processed with client about what he learned after the review. QMHP praised client for his cooperation and involvement in the session, despite his circumstances. QMHP praised and recognized client for his hard work, efforts, participation, and working towards improvement by changing daily habits and implementing a positive and consistent routine. 2. Intervention: QMHP conducted second half of session on helping father and family reduce the stressors in the home and community setting. QMHP facilitated family session to encourage open communication with client and dad to process on various ways to express feelings and thoughts in a controlled manner. QMHP discussed with client and father on assertiveness and modeled effective ways to communicate by exploring more constructive ways to discuss problematic behaviors in the home. QMHP informed dad that client can benefit from other services, thus probing them to utilize resources in the community that will help client reduce his aggressive behaviors. QMHP reviewed with father the ability to limit the stress in the home and to utilize the reward system. QMHP utilized active listening skills while probing father on the affect ways that he attempts to reduce client's negative behaviors. Father was praised for his efforts to better himself and his living situation by making sure he provides client with everything he needs to move forward and keep client away from negative influences, such as peers or siblings. QMHP will provide client with support and encouragement as long as he abides by the rules. QMHP will monitor, observe, and redirect client behaviors as much as needed. QMHP will continue to build a rapport with client. QMHP will explore positive self-talk, use instruction modeling, and increase social communication skills with positive reinforcement role play activities. QMHP will educate client on behavior modification to help client identify what behavior he needs to decrease and avoid daily. QMHP will utilize behavior modification system to aid the client with following directions given by authority figures 1. Response: The family began the session with demonstrating negative behaviors. The family was receptive to the redirection provided. The family shared that they will try to go back to having more positive moments instead of arguing and bickering, but the client makes it difficult for them. The family reported that they will continue to work on building with one another. The family shared the things that they were thankful for which assisted in creating a more positive environment. Father verbalized that he will work on not blaming client’s misbehaviors on his surroundings. Father verbalized that he will work on focusing on client’s behaviors, the good and the bad. Client’s grandmother verbalized that she will increase the level of communication with client to find out what is bothering him, in order to inquire with client what is causing him to act out so often and be disrespectful to his dad. As the client developed understanding of therapeutic expectations, he reported increased satisfaction and function. Client stated that talking and sharing things in his life helped him to evaluate his poor choices and correct his mistakes. Client went on to report that he will practice therapeutic techniques with his family when he feels that it is the right time and place to do so. Client has attempted to utilize what he acquired from today’s and previous sessions to reduce symptoms of ADHD. Client responds well to praise and support. Client is striving for a good report so that he can earn his Christmas presents back. Client wants to make his parents proud by doing a good job with all activities in the home. Client is observed problem solving on his own and handling his emotions appropriately once he was able to get out of his own way. Client said he was going to practice coping strategies and relaxation techniques in all aspects of his daily living routine. 2. Response: Client appeared to be unresponsive to QMHP’s interventions and services that were provided to him during the session. Client reported that him and his dad have a better relationship but have difficulty with communicating when he is upset or has a different opinion about his mom supporting him. It was communicated by parent that client needs to realize that he has a lot going for himself, but he allows others to get him off track. Client goes backwards when transitioning to a healthier mindset, due to switching back into his old toxic ways. Client was able to deescalate once given a new discussion topic, but only minimally participated as he continued to be guarded. Client is aware that he can be a hand full. Client admitted that he can’t control his temper sometimes. Client reported that he is looking forward to receiving help and wants to learn how to deal with his anger and depression more effectively. Client understands that his treatment plan is a behavior contract that will reflect his improvements in the home, but he has to learn to trust it. Client stated that he is open to new ideas. Client was acceptive of prompts given by dad and grandmother. Client agreed to listen to the adult and follow all rules no matter if he sees someone else breaking them. Client is reminded to tell an adult if someone is interrupting his learning no matter who it is. Client admitted that some of his tension come from not receiving the love and attention he desires by his parents. Client stated that he wished his Mom and Dad were still living together so he wouldn’t have to choose who to stay with. Client informed QMHP that he has been learning a lot in each session and wants to try and show his dad and grandmother he is capable of being good for the entire week.