The National Quality Improvement Center for Adoption and Guardianship Support and Preservation (QIC-AG) is a five-year cooperative agreement, funded through the Department of Health and Human Services, Administration for Children and Families, Children’s Bureau, designed to promote permanence when reunification is no longer a goal and improve adoption and guardianship preservation and support. For more information about this project, please click here.
Writer April Dinwoodie has profiled each of the eight projects that are overseen by the center for The Imprint. Today, in our final installment, she explores the work being done with the Neurosequential Model of Therapeutics (NMT) in Tennessee.
If child welfare and related systems are to provide permanency services and supports that meet the varied needs of the diverse population of foster and adoptive families they serve, they should be equipped with the sophisticated tools to determine the very best course of action on their behalf.
This is especially true in response to stabilizing and then strengthening families at risk of a crisis. With this in mind, QIC-AG’s work in Tennessee is focused on implementing the Neurosequential Model of Therapeutics (NMT) for families who have adopted from the public child welfare system as well as families who have adopted through an intercountry or private domestic process.
The NMT was developed by Dr. Bruce Perry, founder of the ChildTrauma Academy. It is not a specific therapeutic technique or intervention – it is a way to organize developmental history and current functioning to inform the clinical decision-making and treatment planning process. The NMT assessment helps the clinical team better understand the nature and timing of adversity and resilience-related factors during the child’s development. This helps the parent, teacher and clinician better understand the child’s current functional strengths and needs.
The NMT is being implemented in connection with Tennessee’s Department of Children’s Services (DCS) and Harmony Family Center’s Adoption Support and Preservation program. The NMT metrics are rooted in three core elements:
- Assessment: Where the child has been
- Functional Review: Where the child is now
- Recommended Interventions: Where the child can grow
The NMT incorporates key principles of neurodevelopment into a capacity-building component for a clinical team. Clinicians, educators, caregivers and, when appropriate, clients learn about the sequential development of the brain.
They learn about how the timing of stress, abuse and neglect, as well as the intensity, duration and pattern (e.g., chaotic, unpredictable versus predictable), influence the developing brain. This basic background in brain organization and neurodevelopment helps provide the rationale for the ‘sequential’ therapeutic approach.
The brain develops from the bottom up – starting with the brainstem, which houses motor and sensory inputs – and is most likely to heal in that way, especially if adversity in the client’s development impaired typical brain organization and functioning. With this in mind, the NMT is rooted in the belief that therapeutic interventions should focus on repairing the brain from the bottom up and provide a structured process to help guide the selection, and track the effectiveness, of interventions. Treatment planning involves selection of the “types” of interventions (e.g., somatosensory dominant versus a cognitive dominant approach), as well as the “dosing” (intensity and duration) and pattern (e.g., daily, weekly).
The NMT assessment process is guided by a set of web-based tools also known as the NMT Metrics that help clinicians organize a child’s history and assess current functioning. Such assessment is especially relevant to children who have experienced early trauma. The information gathered in the metric is used to identify various areas in the brain that may have functional or developmental impairments and ultimately helps guide the selection of the most appropriate, developmentally sensitive interventions for a child.
In order to administer the NMT, Tennessee expanded its comprehensive assessment and added pre/post measures into the intake process. In addition, given the extent of commitment required and the reality that an agency must be prepared to support their staff throughout the certification process, Harmony Family Center dedicated a part-time training director to guide, support and administer the NMT training process.
“Really digging in to the concept of the intimacy barrier has helped me understand some of my children’s more puzzling behaviors,” said one parent who has participated in the Tennessee program. “Dr. Perry’s advice to remain patient, parallel and persistent, has truly changed the way I interact with a child who appears surly, ambivalent, disinterested in being part of the family or unloving. Remembering that these behaviors come from very early relational templates and that my presence, reactions and parental commitment can actually be the catalyst to healing has been so empowering.”
During a two-year period (October 2016 to October 2018), a total of 313 families were served by the ASAP Program. Of those, 170 in the intervention sites received NMT and 143 in the comparison sites received ASAP services as usual. A detailed evaluation report is planned for September 2019.
To learn more about the QIC-AG’s work with Tennessee and the Neurosequential Model of Therapeutics (NMT), check out the full profile online.
April Dinwoodie is a transracially adopted person and a nationally recognized thought leader in foster care and adoption. Dinwoodie’s podcast “Born in June, Raised in April: What Adoption Can Teach the World!” helps to facilitate an open dialogue about adoption, foster care and family today. She is the founder of Adoptment, a mentoring program that matches foster youth with adopted adults, and is retained by clients, including the QIC-AG, to help raise awareness of their work to support children and families.