2/8/2023 EnchantaVaughn Approved 1. Behavior: Upon arrival, client was in a shallow and drawn back mood, as evidenced by his standoffish demeanor and uptight posture. Client had a disappointed look on his face but switched moods once session started. Client described that he worries about issues related to personal safety, school, and family, among other things. Client communicated that he didn’t feel like having session today. Client said he was tired from school and wanted to take a nap. Client was assured that the activity only required him to listen. 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 admitted that some of his decisions can put him in tough situations and everything is not the way he perceives. Client shared that he is willing to work on the way he responds to his guardian and those around him as long as he can say how he feel without feeling like he’s going to get in trouble. Client expressed feeling let down by his parents, due to the constant changes in home setting. Client communicated that he does not want to be a part of the conflict with his parents and wants to resolve any issues before it escalates. 2. Behavior: Client continues to state that he doesn’t want any additional assistance or support with his behaviors or feelings. Client did not respond when inquired about his distant behavior but shrugged his shoulders up and down to communicate he did not care. Client presents anger and frustration at this time. Client seem to be irritated and needed a second to cool off before processing. Client began to talk back to the authority figure without any remorse or empathy. Mom interrupted and asked client to go to his room until he learns to talk to adults with more respect. Client was receptive to the idea of practicing breathing technique and meditation strategies. Client is willing to keep working on more positive coping techniques so that he can deal with his feelings around his mom. Once client calmed down he was able to come back with a more mindful and positive attitude. Client was obedient and respectful towards the QMHP’s instructions and directives that were provided to him within the session, correcting his behavior and checking himself by apologizing to mom and counselor. As the QMHP examined and assessed client’s personality, it was noticed that he was compassionate and sympathetic towards the thoughts, feelings and needs of the QMHP, ending session with a positive manners. 1. Intervention: QMHP had one on one with client. QMHP provided support and encouragement to ensure goals and objectives are met. 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 modeled pro-social behaviors for client to strengthen his understanding of them. QMHP engaged the client in a role reversal exercise and required the client to think about his goals. QMHP encouraged client to make good choices and to avoid negative thoughts about himself. QMHP processed client disruptive behaviors. QMHP assisted client in developing more social-emotional skills. QMHP inquired about possible triggers client can experience with applying this skill. QMHP utilized role playing to demonstrate the calming effects of predicting the thoughts, feelings and actions of self and others prior to the outbreak of a conflict. QMHP assisted client in exploring other coping strategies to utilize in the home to indicate how this process reduces angry reactions. QMHP prompted client to share anticipated thoughts and feelings. 2. Intervention: QMHP redirected the client and reminded him that the behavior that he was showing was disrespectful. QMHP demonstrated client's reactions to her and discussed with him the proper way to behave when being spoken to by someone who is an authority figure. QMHP reminded client the importance of respecting adult figures, especially his mother. QMHP role played with client and gave him insight on how to better respond to a situation when he is frustrated. QMHP listened to client explain why he reacts in the manners that he does and why he feels as if his behavior is appropriate. QMHP listened to mother after several attempts to get his attention. QMHP encouraged client’s mom to provide frequent positive reinforcement to maintain client's interest and motivation in maintaining positive behaviors in all settings. QMHP modeled appropriate ways for client to get positive attention from his mom. QMHP isolated client from distractions to decrease disruptive behaviors and to reduce episodes. QMHP assisted client in normalizing the changes that are occurring at home, in school, and around the community. 1. Response: Client had one on one with QMHP to reflect and process feelings about his day. Client responded in a poor manner disregarding the positive reinforcement that the QMHP provided. Client was able to speak calmly and demonstrate his improved communication skills while engaging in self-reflection, discussing good and bad parts of his day. Client implemented his plan for restoring relationships, and this was reviewed. Client believes he will get better if he continues to work hard. Client proceeded to reduce the aggression in his voice while calming down. Client accepted suggestions from QMHP as evidenced by the client responding to interventions appropriately. Client was observed avoiding disruptive and impulsive actions demonstrated when client proceeded to utilize deep breathing. As the client developed understanding of academic expectations, he reported increased satisfaction and function and negative responses diminished. Client is observed making better choices and doing the right thing. Client has improved with staying seated without fidgeting behavior and utilized his breaks appropriately without displaying attention-seeking behaviors to get his way. 2. Response: Client understands that sessions are a privilege and he have to show good work ethic and follow along with the interventions. Client was able to reevaluate himself and display a more positive attitude toward peers and authority. Client retained a lot of the information he was taught which motivates him to pay more attention and take his time. Client is observed problem solving on his own and handling his emotions appropriately. did not display any outbursts during the role play exercise. Client learned to look for similarities rather than differences in himself. Client demonstrated expectations and responded well to redirection from mother and in-home staff. Client did not run away from his therapy or get frustrated like he normally does during self-reflection. Client displays coping skills when faced with conflict due to deep meditation exercises. Client demonstrates problem solving by staying calm and using his senses. Client acknowledges expectations and reviews goals and objectives with counselor and mother. Client reported a decrease in symptoms following the relaxation techniques.