2/4/2023 EnchantaVaughn Approved 1. Behavior: When QMHP walked in the home, client and his mother were having a disagreement. Mother became very upset and expressed that she is tired of the client behavior and will no longer tolerate it. Client exclaimed that he does not care and began to talk back and kick furniture in the house. The client did not wish to speak to anyone for 15 minutes and ignored anyone who tried to speak to him, including his counselor. Client’s mother shared that the client had been standoffish with her ever since his relationship fell out with his dad. Client is still getting used to being back with his mom. Client was prompted to refocus 2-3 times by QMHP. Client was reluctant and hesitant to follow home rules and stay in therapy today, due to being in his feelings. Client kept getting off task and involving himself in miscellaneous acts. When client was confronted about his impulsive conduct, his demeanor became rebellious, disobedient and noncompliant, as his personality became more and more defiant. Client expressed feelings of panic and distress throughout the day. Client was reprimanded and lectured on his hyperactive conduct. Client agreed to walk away, count to 10, and think about positive affirmations when having meltdowns at home. 2. Behavior: Client started to exhibit restless, hyperactive, fidgety and uncontrollable manners, as it was complicated and difficult for client to remain in his seat throughout the second half of the session. Client was prompted to try his best to get through the session and to relax and pay attention. Client continued to show guarded behaviors. Client communicated with QMHP that he cannot talk to his mother in the same way he can talk to his counselor and doesn’t want to talk to her about his problems. Client is afraid mom will judge him or yell at him. Client expressed resentment for not being able to be open with his mom during his difficult moments and was sad about it. Client explained that he always to be close to his mom and as he got older he realized he liked different things. Client was supported for being honest. Client was given a 10-minute break to process his thoughts while mom and counselor discussed important information regarding his treatment plan. As the client has been allowed to have greater choice regarding his services and providers, he has been more motivated in treatment. Client exhibited appropriate social skills and team work during psycho educational activity. Client appeared to be obtaining the information and showing more positive feelings as the session came to an end. 1. Intervention: QMHP inquired about evening and morning and how client was feeling today. QMHP initiated a rapport building conversation with client in efforts to learn more of his likes and dislikes as well as triggers to negative behaviors listed on his ISP. QMHP reviewed key concepts of being a responsible child in the home. QMHP educated client about being respectful, encouraging, mindful, and fair to peers and authority while making good decisions in the home. QMHP encouraged client to list alternative behaviors he could have participated in besides the negative ones that caused him to receive redirection. QMHP observed client in the home to assist with any negative behaviors towards mom. as he vented the overwhelming events that had occurred in school. QMHP redirected the client's negative attitude by reminding him that he should not expect immediate gratification upon her request. QMHP educated client that there are different ways to handle conflicts. QMHP reminded client not to take everything personal. QMHP explored the client’s capability to cope with his stressors and to get back on track. 2. Intervention: 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 school, at home and in the community. QMHP held consultations with client and mother about effective intervention strategies that build on the client's strengths and compensate for his negative behaviors. QMHP used the basic listening sequence to clearly draw out the point of view that the client was feeling and get beyond his aggressive language and behaviors. QMHP implemented individualized behavior management techniques with client. QMHP processed with client about psychoeducational activity while assisting with directions. QMHP explained the importance of the activity. QMHP provided feedback to client in regard to questions asked. QMHP explored client’s responses. QMHP helped client develop healthy self-esteem by reducing level of anxiety and emotional reactions related to independent functioning which have been noticed to be affecting client at home and in the community. 1. Response: Client displayed hyperactive behaviors such as yelling out responses out of turn and talking over his mom when confronted about his attitude and poor conduct at home today. Client required to be re-focused 3-4 times by QMHP as others spoke. Client was observed chastising mom about the responses that was shared with his counselor. Client became more impulsive and started to cause more disruptions. Client was eventually separated from therapy session and endured his consequences of solitude and exudence from the individualized treatment and mental health skill building for 15 minutes. Client took over 15 minutes to display fully deescalated behaviors. Client stated he would try better self-management, as the day pursues. The client was able to select topics that were directly related to reduction of stress and emotional negativity, which made him less agitated and more relaxed. Client expressed that he hates being in the house all day. Client wanted to have a better attitude but continued verbalized negative comments and expressing an angry tone throughout the first hour of session. 2. Response: Client displayed partial participation during psycho-educational activity as evidenced by his frequent need to be refocused and minimal interaction during the processing conversational portion of the activity. Client has difficulty staying focused when distracted by others who are doing something else. Client understands that his actions have consequences. Client demonstrated that he was able to process productive expressions of anger. Client chose to get back on task, as observed by him listening and following directions. Client appeared to be learning from his mistakes and correcting them throughout the day. Client was acceptive of encouragement and decided to listen to his mom and do the right thing. Client realized his mom was trying to help him by pushing him to try first and then get more help. Client focused on things he is good at and loves to do at home in order to stay motivated in the therapeutic setting and make something out of himself. Client recognized his triggers and was able to identify common interests and similarities he and other ADHD recipients shared.