by: Gene Griffin, J.D., Ph.D.
Senior Fellow for Policy and Practice
ChildTrauma Academy
John Lyons, in his post of December 27, 2016, Complicated versus Complex: Implications for Collaboration, distinguished between a complicated system and a complex system. In a complicated system, all components and the result of their interactions are predictable. In a complex system, the final effect is not completely predictable. A helping system, such as a social service agency attempting to support a child who has been traumatized by abuse or neglect, can be viewed as a complex system. In this system multiple approaches are possible and there is no clear line of authority to determine how all participants must act. TCOM proposes that in such a complex social system the best outcome can be obtained by collaboration. Thus, TCOM would argue for getting service providers, the family, and the child to reach a shared understanding of the child and his or her needs and strengths.
This understanding can be achieved via use of the CANS as well as other tools and perspectives. Recently John and Bruce Perry, M.D., Ph.D., have begun collaborating on an assessment process for children in New Mexico’s child welfare system who may be traumatized. Dr. Perry is the Senior Fellow at the ChildTrauma Academy (CTA, http://childtrauma.org), a not-for-profit organization, working to improve the lives of at-risk children and families through direct service, research and education. CTA works to translate emerging findings from neuroscience, developmental psychology, and other related fields into practical applications for the ways we nurture, protect, educate, heal, and enrich children. The “translational neuroscience” work of the CTA has resulted in a range of innovative programs in therapeutic, child protection and educational systems. The core of the programs is its use of the Neurosequential Model of Therapeutics (NMT).
The Neurosequential Model is not a specific therapeutic technique or intervention; it is a developmentally sensitive and neurobiology-informed approach to clinical problem solving. While it has been implemented in multiple clinical populations across the full developmental spectrum (infants to adults), this approach has been most widely used with maltreated children. It is a way to use a child’s history in understanding that child’s current functioning. The approach structures the assessment of a child, articulates the primary problems, identifies key strengths, and applies interventions in a way that help family, educators, therapists and related professionals best meet the developmental needs of that child.
Both the CANS and the NMT use historical and clinical information to produce a functional assessment of a child. One way they differ is that NMT organizes the assessment based on a model of brain development and the possible impact of trauma. Under normal conditions, the brain evolves from lower to higher regions in a standard sequence. As this neurodevelopment is heavily shaped by a child’s experiences during each developmental phase and no two people share exactly the same experiences, each brain develops in slightly different ways. Therefore, the final result is not completely predictable.
This neurosequential development gets even more complex when trauma is introduced to the system. Adverse experiences, just like positive experiences, shape the brain. But powerful, adverse experiences can have a negative effect, resulting in disrupted neurodevelopment. The disruption will vary depending on where the child is at in his or her neurosequential development when the adverse experience occurs. Also, damage can be prevented or minimized by a child’s resilience and by protective factors, such as family support.
NMT assesses a child’s current neurodevelopmental functioning and compares it to a set of age-based norms. It generates a brain map heuristic, which identifies potential issues as well as available strengths and resources. It provides a way to understand the child’s current functioning and suggests ways to move forward. NMT generates a set of educational, therapeutic, and enrichment recommendations that can be sequenced to further the child’s recovery and neurodevelopment. These interventions engage the child, the family and the community. Applied to child welfare, NMT gets clinical professionals, the child, and the family to reach a shared understanding of the impact of abuse and neglect on the child and to collaborate in their response. As TCOM argues, this collaboration should result in the best outcome for the child.
The CTA community of practice is comprised of over 30 independent but interactive “Fellows” and more than 50 training and project partner organizations in dozens of states and multiple countries. The “translational neuroscience” work of the CTA has resulted in a range of innovative programs being implemented in clinical, child protection and educational systems. In this regard, the CTA has become an international leader in creating and disseminating trauma-informed and developmentally sensitive practices and programs.
Collaborative partners are essential to getting the child-helping systems to work together in meeting the neurodevelopmental needs of children. John and TCOM bring the CANS and all its international resources and expertise to this collaboration with Bruce and the CTA in assessing the needs of traumatized children. This partnership has the potential to produce major gains for children and families in the child welfare system. The initial discussions center on the development of a CANS algorithm that would identify children in the New Mexico child welfare system who would be most likely to benefit from NMT. If successful, this model might transfer to other child-serving systems. Pursuant to TCOM, this collaboration is the best way to address the complex needs of traumatized children.
For more information on this post and the work being done at the ChildTrauma Academy, contact Eugene Griffin at e-griffin@northwestern.edu