One Agency’s Transformational Journey to Becoming Trauma Informed - PowerPoint Presentation

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Uploaded On 2019-11-23

One Agency’s Transformational Journey to Becoming Trauma Informed - PPT Presentation

One Agencys Transformational Journey to Becoming Trauma Informed George Ghitan Executive Director Steps to Transformation Certification of Clinicians Agency Achieve Status as Flagship for NMT ID: 767091

perry based evidence bruce based perry bruce evidence program nmt rights reserved 2014 relational repetitive regulation models childtrauma programs

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One Agency’s Transformational Journey to Becoming Trauma Informed George Ghitan, Executive Director

Steps to Transformation Certification of Clinicians Agency Achieve Status as Flagship for N.M.T. Training and Education of all Staff 2 Pilot Sites Collaborative Problem Solving Integration with Evidence Based Models

Hull Services Total of 27 Different Programs 3 Secure Programs 5 Residential Programs and 2 Day Programs School and Day Program 2 Group Homes 2 I.L.S. Group Homes I.L.S. Support Program In-home Support Foster Care Kinship Program Wraparound Program

Hull Services Total of 27 Different Programs ( cont’d) Community Parenting Program (COPE) School Based Prevention Program (PATHS) 4 Support Programs to Subsidized Housing Mental Health Prevention Program Coordinator of Home Visitation Indigenous Intergenerational Trauma Program

Hull Services as Flagship Hull began the 2 year certification process in May 2011. In September 2013, Hull became a Flagship Site for the ChildTrauma Academy and NMT. Active involvement in training and research activities with the ChildTrauma Academy and its learning network of other clinicians and programs across the world.

What is NMT? Neurosequential Model of Therapeutics (NMT) is a revolutionary evidence based practice based on the understanding of neuroscience and brain development NMT was developed by Bruce D. Perry, Ph.D., M.D. and the ChildTrauma Academy over the last 20 years

Anthropology Neurobiology Developmental Psychology Developmental Neuroscience Neurosequential Model in Caregiving ( NMC)Neurosequential Model Neurosequential Model in Education ( NME ) Neurosequential Model of Therapeutics (NMT) Clinical Practices/Settings Caregiving Practices & Settings Educational Practices & Settings Neurosociology

Cortex Limbic Diencephalon Cerebellum Brainstem Abstract thought Concrete Thought Affiliation/reward "Attachment" Sexual Behavior Emotional Reactivity "Arousal" Appetite/Satiety Blood Pressure Heart Rate Body Temperature Sleep Motor Regulation NE DA Relational difficulties Depressive & affect symptoms Alcohol – substance abuse Trauma core symptoms Guilt Shame ANS - body SER All rights reserved © 2006-2011 Bruce D. Perry and The ChildTrauma Academy

Impact of P rolonged Trauma Being in a low level fear state for prolonged periods of time may present as: Impulsive Withdrawn Hypervigilant HyperactiveDepressed AnxiousRegressive behaviour Sleep difficultiesAcquire new developmental tasks at a slower rateOften meet criteria for:ADHD, Anxiety Disorder NOS, Major Depressive Disorder, Conduct Disorder/Oppositional Defiant Disorder, Attachment Disorders

Causes of Dysregulation 1 . Disruption of intrauterine development 2. Attachment Problems 3. Extreme Traumatic Stress 11

Stress Unpredictable Vulnerability Predictable Resiliency Severe Moderate Controlled Uncontrolled

Core elements of positive developmental, educational and therapeutic experiences:

Functional Brain Map Key (Part C)

Brain Map Development

Answering the Question: What does an NMT program look like? NMT Training (relevant). Brain mapping (relevant). Creating a Therapeutic Web (Relational, Rewarding). Relationally healthy caregiver characteristics (Relational). Safe, predictable, structured environment (Rhythmic, Repetitive). Sequencing of interventions (Rhythmic, repetitive).

Skills training (for self-regulation) (Rhythmic, Repetitive, Rewarding, Relational). 8. Preventative and responsive dosing of somatosensory activities; patterned, repetitive activities that support self- regulation (prompting use of NMT skills prior to stressful events, and caregiver recognition of distress/dysregulation) (Rhythmic, Repetitive). 9. Activity scheduling (planned dosing) (Rhythmic, Repetitive). 10. Parental assistance with regulation difficulties (Rhythmic, Repetitive, Relational, Relevant). 11. Relational permanence- life span mentor/friend/relative (Relational, Rewarding). What does an NMT program look like? (cont.)

Exercise balls Standing desks Fidget toys Treadmills Drums Wii Theraband Weighted vests and blankets Zuma Rockers Visual timers Various bean bags, balls, etc. Activity cards Wake and Shake Quiet area to calm Emotional first aid kits Resources

Interactive Metronome Equine Assisted Therapy Drama Music and Movement Eye Movement Desensitization Reprocessing Heartmath In Synch Massage Therapy Interns in programsDrumming (training in drumming for staff)

Brain Booster Activity Cards

Self-Regulation between dosing

Collaborative Problem Solving Neurobiologically Grounded Developmental Lags and Delays Skill Deficits Emotion Regulation Skills Cognitive Flexibility Skills Executive Functioning Skills Language Processing Skills

CAFAS scores Reduction in critical incidents Changes in NMT metrics Increase in executive functioning scores Outcomes

CAFAS 2011-2014

PTP Outcomes 2009-10 6 21 0.29 28.57 2009-10 2010-11 4 23 0.27 17.39 2010-11 2011-12 1 22 0.05 4.55 2011-12 Pt > 20 incidents Total points

Restrictive Interventions Reduction at Secure Services 2012 - 2013 2013 - 2014 317 192 33% reduction in Restrictive Interventions

Primary Somatosensory Relational/ Somatosensory Traditional Psychotherapy or Primary Cognitive Activity Primary Neural Impact of Various Therapeutic, Educational or Enrichment Activities

Hull’s Use of Evidence-Based Models Community Parenting Education (COPE) Promoting Alternative Thinking Strategies (Fast Track/PATHS) Attachment Self-Regulation and Competency (ARC) Stop Now And Plan (SNAP) Positive Parenting Program (PPP) High Fidelity Wraparound (HFWA) Dialectical Behaviour Therapy (DBT) Multidimensional Family Therapy (MDFT) Cognitive Behavioural Therapy (CBT) Applied Behaviour Analysis (ABA ) Therapeutic Crisis Intervention (TCI)

Which Evidence Based Treatment Models are Relevant? Which Evidence Based Treatment Models are Relationally Rich ? Which Evidence Based Treatment Models are Rewarding?Which Evidence Based Treatment Models areRespectful? Which Evidence Based Treatment Models areRhythmic?Which Evidence Based Treatment Models are Repetitive?

Review of our Evidence Based Interventions

Challenges Dosage Measurement Integration with Evidence Based Practices Training Expanding Methods and Tools and Interventions