Brain organisation

Mount Saint Vincent Home

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Mount Saint Vincent Home

In stunning Denver Colorado, surrounded by snow capped mountain ranges, I spent the week of 2nd to 6th June 2014, at Mount Saint Vincent Home. This was my second visit to Mount Saint Vincent in as many years and approaching the gateway on my first day, for the first time in weeks, I felt a sense of familiarity and connection.

Mount Saint Vincent Home is located  just a short bus ride from downtown Denver and is situated on a 16 acre property, offering a running track, football field, multiple playgrounds and a swimming pool.  Founded by the Sisters of Charity Leavenworth Kansas in 1883, Mount Saint Vincent had it’s origins as an orphanage.  With social change and the move away from orphanage based care to out of home foster care and residential treatment, Mount Saint Vincent moved with the times and now prides itself on being a treatment center for children ages 3 – 13 years.

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Mount Saint Vincent specializes in treatment of children who have suffered abuse, neglect, trauma and/or mental illness, offering services with a child-focused but family centered approach acknowledging the importance of the family in a child’s healing and recovery.  Referrals to Mount Saint Vincent Home come largely from the County Human Services Department of Child Protection, School districts and other mental health services.

 Mount Saint Vincent offers a variety of services to clients including:

  • A 36 bed residential treatment program consisting of 3 cottages each housing 12 children
  • Individualised day treatment programs for up to 55 children
  • In home treatment and follow up services
  • K – 8 School program that affords children developmentally matched education rather than chronological determined education.
  • An early learning child care program

All of the services offered by Mount Saint Vincent operate under their treatment philosophy that focuses on the regulation of a child rather than compliance; that care is developmentally appropriate and matched and that they afford a child an environment of safety that allows children to ‘try on’ and develop positive relationships.

Mount Saint Vincent has some very innovative service elements including:

  • Creative Arts Therapy team who provide music therapy, dance/movement therapy and art therapy;
  • An animal assisted therapy program onsite using dogs and guinea pigs and offsite using horses
  • An onsite volunteer tactile therapy program offering clothed massage, yoga, meditation/mindfulness, bach flower remedies and reiki for example.
  • Individual Therapy
  • EMDR
  • Swimming
  • Bike Riding
  • Gym
  • Group Therapy Programs including Lego Group and Psychodrama
  • Sensory tool boxes for each child and program
  • The school program has a dedicated mental health clinician to support the inclusion of developmentally matched regulatory activities for the students so to assist in maintaining a state of regulation, coupled with an intervention team able to take students in the moment and provide co-regulation for children to assist them back into classroom learning activities.msv swimming pool

Like everywhere else I had visited up to this point, the staff at Mount Saint Vincent Home are dedicated, passionate and committed to making a difference in the lives of children.  I watched and listened to staff talk openly about their love of the work, the challenges it brings and most importantly the changes they feel privileged to be part of in the journey of these children.  Like all services operating with the public health system there were clearly challenges that the programs were having to manage and deal with, but that aside the Mount Saint Vincent team not unlike Sandhill, Cal Farley’s, Sumner Mental Health and Alexander Youth Network were thoughtful, authentic and so very respectful in their work with children and families.

In 2013 Mount Saint Vincent Home’s Creative Arts Therapy team published an awesome resource called, “Doodles, Dances and Ditties: A Somatosensory Handbook”.  This book is a collection of creative, sensory and movement based activities you can use to regulate children.   You can get it on their website http://www.msvhome.org or via amazon – where I see it now comes in a Kindle version.

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Greater and Less Than – Lessons in learning Through Movement

Somatosensory activities and education, this is a topic close to my heart.

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For a little over two years now I have been consultant and then project manager of a pilot project in Australia looking at the inclusion of patterned, repetitive somatosensory activities in primary school classes.

So often we hear teachers and educators ask about strategies for managing traumatised children and their resultant behaviours in the classroom.   All too often in my clinical practice teachers have looked at me, perplexed when I suggested they could include somatosensory activities into curriculum.  In fact I had almost got to the point that I believed this maybe wasn’t achievable and that I had to enlist an education champion to help me articulate my meaning more clearly.  The latter may still be the case, but in Charlotte NC I had the professionally heart warming experience of watching a relatively new teacher to the Alexander Youth Network (AYN) Psychiatric Residential Treatment Facility (PRTF) School do exactly what I’ve been talking about for years.

The PRTF School do what most neurodevelopmentally and “trauma” informed education programs do, by providing frequent “brain breaks” for their children.  Essentially this is where they step down from academic learning and engage in some form of somatosensory activity such as playing outside, water play, sand play, play doh, calming corners with sofas, bean bags, blankets and soft toys etc. They do this routinely, repetitively and frequently – in fact given the arousal and dysregulation of the children AYN sees in its PRTF, these breaks seemed to work best when applied every 10 or so minutes.  Having access to a staff member dedicated to leading these breaks and co-regulating the children in between them worked a treat as well.   All of this impressed me, but what really stood out was this one teacher who found a way to incorporate somatosensory activities into curriculum based learning!IMG_7140

You know maths and mathematical concepts is a difficult gig at any school, let alone a classroom of children struggling with emotional, social and behavioural difficulties.  So when this teacher came in to teach the concepts of less than and greater than I thought to myself this will be interesting.

Immediately on entry into the room, she invited the children to the front of the class and had them all stand or sit around her as they preferred. She didn’t get flustered or annoyed when children came and went from her teaching space and in doing so, actually appeared to manage keeping them around her and in the vicinity of learning for the whole exercise.  Each child was given a piece of paper containing a number, each child read their number out aloud.  The greater than symbol was drawn on the board and there was minimal question and answer time to ensure that everyone understood the concept of the greater than symbol.

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Less than & Greater than

Then engaging the students in an activity based process, moving them around she asked them two by two (based on those most engaged in the moment) to identify their number and stand either side of her – as she held the greater than symbol.  The student’s task – to put themselves in the right spot – who’s number was greater than the other.  Each student excitedly took their turn and much celebration was had as each pair got it right.  In addition to the movement which we know provides sensory and motor based regulation to the lower parts of the brain, this teacher relied on her voice to ensure up regulation and down regulation in the moment and what was most impressive was that she made the lesson punchy and brief.  In and out in no more than 15  minutes and a key mathematical concept was taught and grasped by these children.

Can somatosensory activity be incorporated into curriculum?

I think it can.  It might take a bit of creativity and planning, and maybe even a shift in basic education philosophy about how to teach children, but I still think this is very achievable.

Alexander Youth Network

 

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In the last week of May I journeyed to beautiful Charlotte in North Carolina to spend the week with my colleagues at Alexander Youth Network (AYN).  AYN’s main campus or headquarters, and the home of it’s Psychiatric Residential Treatment Facility (PRTF) and one of their Day Treatment Programs, is located on a picturesque 60 acre property with buildings nestled in a woodland area with open grounds and recreation areas for their clients.  This campus also houses facilities including a gym, indoor swimming pool and cafeteria.

AYN is a non profit community based organisation receiving funding from fees for services (medicaid, insurance and the like) as well as contributions from individuals, corporations, foundations and government agencies.  AYN serves children ages 5 to 18, who are referred from hospitals, physicians, parents, schools and from state and county organisations such as department of social services and juvenile justice.  AYN serve over 7000 children each year.

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Surrounding woodlands

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Woodland Trail

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Deep in the woodland trail

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Alexander Youth Network Grounds

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Onsite Playgrounds

AYN provide an array of mental health treatment for serious emotional and behavioural difficulities including: diagnostic and outpatient services, community based programs, multisytemic day therapy, therapeutic foster care and an onsite, 36 bed psychiatric residential treatment facility.  The idea being that children, young people and families accessing their services can move from service to service with established working relationships of trust within the one organisation.  Added to this is the strong grounding the staff have in child development, trauma, attachment and neurodevelopment as a core component of their orientation and ongoing training.

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It was a contrast to go from services that have decisively removed themselves from the medicaid system or appear to have more flexibility than is given from the public health system and as a result appear better funded and able to provide longer term intervention for their clients.  At AYN the financial resourcing struggle of service delivery was evident in comparison to the private services I had visited.  While the AYN staff were at times a bit despondent about this, I was nonetheless impressed at what they were offering and able to offer.  There is something about not having resources at your fingertips that can contribute to a creative resourcefulness and the team at AYN do this well.  In fact when it comes to neurodevelopmentally informed and respectful interventions AYN have lots to offer:

  • Individual therapy including EMDR, play therapy, sand tray and an awesome play room furnished largely by donation and financial grants
  • Art Therapy including pottery and their very own kiln
  • A ropes course for adventure therapy
  • A Labyrinth
  • Occupational Therapy with a motor and sensory furnished room including a swing and tunnels.
  • Physical Therapy
  • Reiki
  • Swimming
  • Vegetable and flower bed gardens and gardening program
  • Woodland walking trails
  • Playgrounds
  • Gym
  • Developmentally matched classrooms that afford children regular (every 10 – 15 mins) brain breaks and recreation
  • Classrooms that are highly sensory and provide calming, alerting and regulating activities including rocking chairs, bean bags, chill out areas and such
  • Bike program whereby each PRTF child has their own bike.

 

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Art Therapy room including Kiln

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Play Therapy Room

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Play Therapy equipment

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Play Therapy Room – role play and dress ups

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Play Therapy puppets

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Play Therapy sand tray and figures

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Occupational Therapy room

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Developmentally matched classrooms

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Chill out area in classroom

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Of more concern to me than their financial resourcing issues, were the systemic restrictions being placed on AYN in relation to the length of service delivery they are able to offer their clients.  The public health system funding children coming into the PRTF, those clients with the most serious of emotional and behavioural disturbances, are placing pressure on the service to treat and “repair” these children in 3 months.  The years of clinical practice, much of the theory out there, and my more recent acquisition of neurodevelopment and trauma expertise have taught me that it takes more than 3 months to form a trusting relationship with some of these kids.

 And we know that it is only in the context of such trusting relationships that these children can being to heal.

So with that knowledge I take my hat off to my colleagues at AYN and their ability to work within a public health system that places considerable restraint on their ability to really heal these kids.  The staff I met talked openly of the 30 day review process they have to undertake to retain or regain funding for ongoing work and the associated challenges. Despite this, the passion and commitment for their work and the children and families they serve sees them rise daily to these challenges and provide meaningful connections and healing opportunities for North Carolina’s more vulnerable citizens.

 

Rhythmic Riding

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Mindfulness connection

Rhythmic Riding is an equine based therapeutic approach that is one part of the Trauma Focussed Equine Assisted Psychotherapy (TF-EAP) established by Tim & Bettina Jobe from Natural Lifemanship.  In short “TF-EAP utilizes the rhythmic, patterned, repetitive, bilateral movement inherent in riding a horse to increase and reorganize the connections in the brain, thereby increasing the brain’s ability for emotion and impulse control. The horse is able to provide the rhythm required to effectively heal the traumatized brain until the client is able to independently provide that rhythm. In effect, clients passively learn to self-regulate through the use of the rhythmic, patterned, repetitive movement of the horse.” Spirit Reins Website.

Music is often incorporated into the mounted work allowing the horse and rider to move in time to and with the rhythm of the music, again requiring and providing a medium to scaffold regulation and connection between the rider and horse.

I had the opportunity to watch a Rhythmic Riding session at Cal Farley’s.  The session observed was with a group of adolescent girls who had been engaged in TF-EAP work for the whole school year.  As the session I observed was the last for this group for the school year, the focus of the group was less on riding to the rhythm but rather the creation of a mindful connection between rider and horse.

Each participant had their own horse with whom they had been working the whole year, hence I was observing well established rider/horse relationships.  In the spirit of a mindful connection with the animal, the girls rode bareback and the session commenced with a mounted meditation to regulate and ground participants.   Then cue music and the riders and horses were left to regulate and re-organise neural brain networks via the riding or horseback activity. Participants chose to either ride to the rhythm, lie across, over or back on their horse, or even attempt to stand on the back of the horse.  Clinical and Equine Intervention staff observe, comment and process experiences with participants as regulatory and relational successes and difficulties between horse and rider emerge.

Now as I said, this group had been active for a full school year – so the girls, in most cases, had established enough self regulatory capacity that the rhythm provided by the horse merely provided a value add.  This was not the case for all participants however.  Fascinating for me was the experience of being witness to one young woman who arrived to the group clearly dysregulated – slamming the car door, storming past those of us milling about and stomping into the yard to collect her horse.  Naturally the process of getting her horse was complicated by her emotional presentation, her horse on seeing and sensing her turned and moved away from her.

Despite eventually haltering her horse and mounting him bareback, it was obvious the connection between the two was tenuous, the horses ears were often back, his eyes looked a little wild and big and his rider was really struggling to control him.  The mental health clinician in the group reflected to this young woman what she was observing, however this girl’s dysregulation was such that she wasn’t in the thinking and hearing part of her brain – instead she explained the relationship with the horse away as the result of her not liking or being able to ride as well bareback.

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The trusted connection

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Riding with Rhythm

 

 

 

 

 

 

 

The session was a real struggle for this lass, while the other participants were riding in time to the rhythm, clearly demonstrating their self regulation and ability to connect with and trust their horse, she just couldn’t get the connection. In fact watching on I could just tell that the horse was waiting for the right moment to assist her off his back.

That moment came not long after the session commenced.  Instead of focussing on herself and taking care of her own emotions, the participant, watching what others were doing and becoming increasingly frustrated at her inability to manage herself and her ride, decided to try and throw her leg over so as to ride the horse side on.  Sensing the movement in balance, the horse took quick action and dispensed of her from his back.  From there the session quickly took a turn for worse and despite the attempts of very skilled clinical and equine support staff, she was unable to remount the horse or develop insight into her emotional state and it’s impact on the situation at hand.

In hindsight, which is always 20-20, maybe on arrival staff could have suggested that today wasn’t the day to participate, but then who knows, it could have gone the other way, she could have got on the back of that majestic animal and the rhythm and movement of the horse could have been enough to start to regulate her and afford her success in the experience.  It’s a tough call and it just highlighted to me the absolute importance of the attuned relationship that knows and gets the young person so as to be better placed to make that call.  Unfortunately for this young woman that key relationship wasn’t present that day.

While this is a reflection of a challenging Rhythmic Riding session – it was clear to me the value of such activity and from my experience on horseback previously discussed I can see how this activity provides the necessary patterned, repetitive and rhythmic activity for enhanced regulation.

 

 

 

 

Sensory Deprivation and Relaxation: The experience of a Floatation Tank.

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Have you heard of a Floatation Tank or the use of floating for sensory deprivation and/or relaxation?

I’m not going to go into detail about the Floatation Tank and what it is, the rationale for its use and some of the benefits that have been derived from its use.  Instead for all of that information you can follow this link http://en.wikipedia.org/wiki/Isolation_tank and read all about it on Wikepedia.

Suffice to say that I’d not heard much about the floatation tank or the experience of sensory deprivation using this device before.  No I haven’t seen Altered States, although I believe that is now on the must watch list given the number of times I’ve since been asked.  Enough of this chatter, let me tell you about my experience of the Floatation Tank!!

On arrival at Sandhill and during my initial tour, I was presented with the float tank and the offer to go in it.  I was initially quite apprehensive and said no.  However after a wise conversation and keen reminder that there is a difference between theoretically understanding and experientially understanding something, coupled with some self reflection about really learning and understanding neurodevelopmentally informed interventions,  I agreed to give it a go.

Now I get a bit claustrophobic! I do not like enclosed spaces or the sensation that I’m trapped or cornered.  Needless to say my stress response was a somewhat active and my initial heart rate was a little elevated after 1. getting into my bathers and coming out in front of a relative stranger and 2. considering the idea of climbing into the contraption pictured above and knowing the door was going to be closed and there wasn’t going to be much light.  In fact I think from memory my heart rate was somewhere in the high 90s. My blood pressure was also taken, it was pretty normal, if anything a bit on the low side but not clinically low.

So the time had come and in I climbed, laid my body down in the epsom salted water, put my head back and began to float.  The door was closed and the space became dark.  I’d like to tell you that I quickly came to feeling relaxed, but that’d would be a lie.  My first 5 minutes (well it felt like 5 minutes) was spent just trying to calm my heart rate, which upon closing the door had cleared passed the 100 barrier – I could feel it in my chest.  I found myself wondering how the children and young people we see at Take Two, with significant abuse and trauma histories would go in this situation? I’m still not sure I have an answer on this one and I think it could be tricky for some of our kids.

After I’d managed to calm the anxiety about being enclosed, I let myself relax into the water that was holding me afloat and just experience what was going on. Now this is when I started to learn all sorts of things about myself.  Things I probably knew, but because of a world filled with sensory distractions I’d not ever really taken notice of.   You know, every time my body was almost or had just tipped over the edge into a state of relaxation, I found the need to sensory seek.  I’d pull at my togs (bathing suit), scratch an itch (there was a bit of itchiness in the first bit of the float), need to push myself off a wall and move about in the tank and then try and work out where I was positioned or as I do best, have a string of thought processes to keep the mind busy.

This went on for some time, and then out of no where I could hear my heart beating slow and steady, in fact at that moment that was all there was.  I just listened to it and found myself experiencing the beginnings of a deep sense of calm and dare I say it, even relaxation.  I found myself thinking “now if I had one of these at home, I could do 30 mins in one of these and feel relaxed”.  Before I knew it the door was opened and out I climbed, wet and salty but feeling really relaxed (note I’m not someone who relaxes often or really even takes the time to relax). Post heart rate measures saw a 20 beat per minute drop to somewhere in the 70s and a slight (still healthy) increase in blood pressure.  What’s interesting is that my results were consistent with the patterns Sandhill are finding in their children.  I can’t wait for them to do some research on this and get it published.

What blew my mind more however was the fact that I honestly believed I was only in there for 20 minutes, 30 at a push!  I was in the tank a whole hour, 60 minutes and that’s when I realised that I had experienced the state of such relaxation that I’d lost sense of time.

Floating is an interesting experience and I will definitely be doing it again and again.  I highly recommend it, even if you just try it once.  If nothing else, like me you might learn things about yourself you didn’t really know beforehand.

 

 

 

Sandhill Child Development Center: Authenticity in Relationships

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Del Rio House

I spent the week of May 12 -16 with the staff and residents at Sandhill Child Development Center in Los Lunas New Mexico.  “Sandhill Child Development Center is a residential program for children ages 5 to 13 at admission, who are experiencing significant difficulties functioning in their current home, school or community due to an inability to regulate their emotional states. By repairing a child’s trust in care and adult guidance, Sandhill gives the child the tools necessary to proceed with a healthy and bright future. Sandhill Child Development Center emphasizes a relationally-based clinical approach that is grounded in the Neurosequential Model of Therapeutics (NMT) developed by Bruce Perry, M.D., Ph.D. and The ChildTrauma Academy.” www.sandhillcenter.org  Sandhill takes children from all over the United States.

As one of the ChildTrauma Academy’s initial partner certification sites there was no question about visiting Sandhill.  Having been at the implementation of neurodevelopmentally informed interventions in their residential treatment for some time now, I wanted to see for myself where they were up to and what discoveries they had made.

Sandhill have two homes located on two different sites a short drive from each other in Los Lunas, New Mexico.  The home pictured above and it’s surrounding property align the Rio Grande River and both homes look out onto majestic mountain ranges.  Spending time with Sandhill you can’t help but feel relaxed and like you’ve known these people all your life.  The Zimmerman Family who run the service, exemplify nothing short of authenticity in relationships and with that as their template their recruitment of staff seems to follow suit.  It is clear from Management to Direct Child Care staff that relationships are the core of the healing approach at Sandhill.  Wrap that up with all the staff having a thorough grounding in neurodevelopment theory and you have a program applying all sorts of playful, rhythmic, sensory and somatic interventions with the children staying there.

Interventions include:

  • Individual weekly therapy for the child
  • Family therapy – both face to face during visits and via Skype sessions
  • Parent training sessions
  • Modelling sessions/co-parenting on site
  • EMDR
  • Animal Assisted Interventions – Horses, cats, dogs, chickens and peacocks.  Including day to day care of animals, as well as play and working with the animals therapeutically.
  • Nutrition – provision of a “brain friendly” diet which strives to use many organic and whole foods.
  • Exercise and recreation – including sports, team building, martial arts and other exercise based activities.
  • Service Learning via voluntary interaction in the community – litter/trash clean up on roads & volunteering at the local animal shelter.
  • Neurofeedback
  • Floating
  • Wilderness Adventure Therapy.
  • Daily education program through Del Rio Academy whereby the students are closely monitored from skilled and attuned education staff and given “brain breaks” when needed to help re regulate.  This involves taking the children out of the classroom in small groups and having them engage in exercise such as running laps, bilateral stimulation exercises, walking and talking and much more.
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Romero House

All of this provided on site or as part of the one program!

Sandhill has capacity for up to 30 children and adolescents at any given time and their average length of stay is around 18 months.  While the lists of interventions is broad, it is by no means all of what they do and one of the lovely observations I made was in fact the individual consideration given to each child’s sensory or regulatory need in the moment and matching all sorts of movement, sensory, mindful, relaxation and/or exercise based regulatory activity to them.

As I left Sandhill I reflected to their staff, that you know a program is doing a good job when the clients come up and tell you about themselves, why they are there and what they have learnt and how thankful they are for the experience at Sandhill.  Even more so when this happens in a house full of preadolescent and adolescent boys!

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Del Rio Swimming Pool

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Del Rio Academy onsite at Del Rio Property

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The Bath House: Home to the Float Tank and Neurofeedback

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Sports Court @ Romero (note trampolines in background)

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Romero Sports Court

 

 

 

 

Therapeutic Preschool: Building Emotional Regulation

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Dr Rick Gaskill: Clinical Director Sumner Mental Health Services

Sumner Mental Health Services provide therapeutic support to the Futures Unlimited Preschools in Wellington KS. Specifically they provide support via the provision of Mental Health Case Management and a role called Individual Psychosocial Rehabilitation workers (IPR), for children classified with Severe Emotional Disturbance (SED). Provision of these services is made available via the USA Medicaid system, and each of the children receiving these services must have met diagnostic classification to receive services.

I observed the absolute value of the IPR role in the preschool setting as I watched an IPR with a 6 year old child with significant emotional disturbance.  From the outset of allocated time, the IPR provided this child with one to one, undivided attention, co-regulation and supported emotionally and developmentally respectful redirection when necessary.  Enacting her role, the IPR was regularly in physical contact with the child in the classroom.  During circle time the child placed herself in the lap of the IPR, leaning back and cuddling into the worker, while the worker provided gentle touch, stroking and running her fingers through the child’s hair.

The IPR worker scaffolded the child from activity to activity in transitions, keeping distractions to a minimum and providing nothing short of opportunities for success for the child, all of this done through largely relational based interaction and regulation.  At the outset of their time, I watched the IPR prepare the child for her impending departure and watched her regulate the rhythm of the hour for the child, so that in the 10 minutes before the IPR’s departure, they moved to a corner and engaged in a quiet activity, drawing together so that their separation provided drawings that could be swapped as transitional objects.  The IPR giving the girl the drawing she had done and vice versa – the child then able to take and keep a piece of her precious IPR worker.  In the two minutes prior to the IPR leaving – the teacher joined the dyad and a process of “handover” occurred and here again while the IPR made her exit, the teacher provided hugs and relational interaction to enable the child to succeed in the moment emotionally.

What really stood out to me was the fact that this child, in the hour supported by the IPR was able to experience success and a baseline level of emotional regulation, contrary to descriptions that had been given of her.  Her IPR remained attuned to her emotional state and danced the dance of catching early signs of emotional dysregulation, such that the child was able to be redirected, be that via comfort, movement, touch or scaffolding to another activity.

Imagine the long term benefits we could achieve if our kindergarten/preschool children who struggle emotionally, received opportunities like this at the time when their brains are still actively organising neural networks.  Could we start to create early changes in neural templates from over active stress response systems and emotional dysregulation to enable younger children a better platform for self regulation?

Trauma & Brain development – some basics to set the scene!

brain-fullI’ve been working in the child trauma field all my career as a Clinical Psychologist and while my university training provided me a good foundation for assessing and understanding children it’s only in the last 5 – 7 years that I really feel like it’s all coming together and I have a much better understanding of how to more effectively treat children who have experienced trauma.

Developments in neuroscience have shed so much light on how our brains really work and more importantly for child trauma how they organise and develop. As a result of these discoveries we can now better plan treatment for infants, children and adolescents that is more respectful of neural development and in turn be much more efficient and effective in change.

What do I mean by all of this?  Well to really help you understand this lets take a quick and VERY simplified science lesson in relation to brain organisation according to Dr Perry of the ChildTrauma Academy.

  • To simplify things, lets think of the brain as having four main parts: the brainstem, the diencephalon, the limbic and cortex.  Each part of the brain is responsible for different functions.  The brainstem at the bottom of our brain takes care of things like heart rate, temperature regulation and blood pressure.  Neuroscientists often refer to this as the survival part of our brain – its the bit that really concentrates on keeping us alive.  The diencephalon manages things like our sleep/wake cycles, appetite/hunger, motor skills.  Our limbic system can be thought of as the emotional and relational centre of the brain.  Uniquely human and at the top of our brain is our cortex – the home of our things like abstract thinking, problem solving and language skills.  While each part of the brain is responsible for its own set of functions – they all work together and can influence each other.
  • The brain organises from the bottom up (brainstem to the cortex) and healthy organisation of one part is largely dependent on the lower part being organised well.  Like making a wedding cake – you need a good foundation layer on which to place the upper layers, otherwise there will be an unhappy bride!

failed wedding cake

  • Our brain develops as a function of our experience, or organises in a use dependent way.  The more we experience particular events, the stronger the neural connection made will be as a result.   So if you grow up experiencing lots of stress and fear, you will grow up more wired for stress and fear.
  • A large component of the neural organisation happens in the first 4-6 years of life.  This doesn’t mean that your brain is developed by 6 – not at all, our brains continue to develop throughout our lifespan it just means that the experiences we have in those first 4 – 6 years are much more powerful in organising the way our neural connections are formed.
  • And while we now know that our brains are ‘plastic’ and changeable, we also know that the different parts of the brain aren’t equally changeable.  For very good reasons the bottom more simple parts of our brain are harder to change than our cortex which is much more plastic.

So what does all this mean for child trauma?

Infants and children who experience trauma and/or neglect in consistent or chaotic ways while their brains are organising  during those first 4-6 years, will have lasting neurodevelopmental insults as a result. While they will display the behavioural challenges that we so readily see, many of these children will also have difficulties in functions mediated by lower parts of the brain, things like faster resting heart rates, motor and/or sensory difficulties, attention problems, and sleep difficulties.   So back to the wedding cake – if the bottom parts of the brain are disorganised  and dysregulated as a result, then the foundation for the upper parts of the brain is compromised and there will be associated difficulties throughout the brain.  Other elements complicate and further contribute to disruption in brain organisation as a result of trauma – but they are another blog!

So to be more neurodevelopmentally informed in trauma treatment and effective in healing,  it makes sense that we need to reorganise and regulate the lower parts of the brain before we tackle the higher and more cognitive parts of the brain.  We need to sequentially reorganise and regulate the brains of these children so to assist them to be ready to benefit from traditional cognitive and insight oriented treatments.

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 References:

Perry, B.D.  The Neurosequential Model of Therapeutics:  Applying principles of neuroscience to clinical work with traumatized and maltreated children In: Working with Traumatized Youth in Child Welfare (Ed. Nancy Boyd Webb), The Guilford Press, New York, NY, pp. 27-52, 2006