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By Barbara Kessler, TJJD Communications

TJJD is expanding its therapeutic program by providing training for selected mental health professionals in an approach known as the Neurosequential Model of Therapeutics.

nmt1NMT, as it’s called, is an internationally known program that carefully considers the brain development of a youth and how that may have been hindered or disrupted by adverse childhood events and traumatic experiences.

Using NMT methods, therapists see a child’s (or adult’s) behaviors in a new light, as having become engraved at different stages of brain development in response to frightening situations, such as abuse, neglect, family chaos and witnessing or suffering violence.

This groundbreaking approach, developed by acclaimed psychiatrist Dr. Bruce D. Perry, helps therapists better analyze a youth’s trauma background and develop a more well-rounded, sensitive and individualized program of care.

NMT “takes trauma informed care to the next level,” said Evan Norton, TJJD’s director of Treatment Programs. “It peels back the onion and gets to the heart of it all, the neurobiology.”

Put another way, NMT helps therapists and those in their care see the full impact of trauma’s toxic legacy, and how it can sustain maladaptive behaviors and short-circuit learning, impulse control and decision making.

“Everyone’s brain develops differently and this enables us to not generalize but really, truly address what these kids’ needs are,” Norton said.

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In early 2020, TJJD selected 20 of its mental health professionals to receive training in the Neurosequential Model of Therapeutics. The participants are stationed across all five of TJJD’s secure facilities. They met for virtual classes led by Perry’s Neurosequential Network and also gathered for follow-up virtual discussions within their discrete TJJD group.

Dr. Perry, the principal of the Neurosequential Network and Senior Fellow of The ChildTrauma Academy, also is a Professor (Adjunct) in the Departments of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine at Northwestern University in Chicago and previously served as Chief of Psychiatry for Texas Children's Hospital in Houston. The author of numerous papers and three books, Dr. Perry’s latest book, What Happened to You? Conversations on Trauma, Resilience, and Healing(2021), is a New York Times bestseller co-authored with Oprah Winfrey. 

The 20 professionals in NMT training at TJJD are set to receive their completion certificates in August for this first phase of what is becoming a highly sought-after training, Norton said. A smaller group of clinicians will continue with a second year of advanced classwork in NMT.

nmt3Already, TJJD clinicians have been putting their new skills into practice and reported to Norton, who’s also taking the training, that they’re gaining deeper insight into the needs of the youth they see.

NMT is helping them better tailor treatment plans to individual needs and assist youth who’ve suffered multiple complex traumas.

“They feel more effective, like they can connect more effectively,” he said. “And they appreciate getting a better biological look at the kids, getting a more holistic picture of the child.”

The therapists use an NMT metric along with a close review of the youth’s developmental and social history and current behaviors. They may call on caseworkers, parents and guardians to get a detailed picture of a youth’s past.

“The metric identifies risk-age ranges and brain development areas for me,” said Kathryn Hallmark, a longtime TJJD therapist taking the NMT course. She records the background information she has gathered into a timeline detailing the “psychoeducation” of the child.

“For example, a kid was removed into a CPS foster home in infancy with multiple changes of homes before he was adopted and suffered peer bullying throughout school, but he doesn’t understand why he became so angry and aggressive. I can break it down for him in terms of care-giver connection drops (losses) at each age of risk and later with his peers.”

Those many caregiver changes, Hallmark said, “led him to struggle with trust and connection, which later impacted his problems with peers.” As the therapist, she can help such a youth unpack these early challenges and see how the lack of connection fueled his frustration and anger.

“I can talk to him about how he avoided his feelings,” she said.

In Hallmark’s example, the youth lacked the “mirroring” or “attunement” experiences that young children need from stable, nurturing caregivers to develop emotional range, cope with angry feelings and make the strong connections that underpin healthy development.

nmt2Research shows that sturdy connections with caring adults are critical to a child’s healthy neurological and social maturation. When those relationships are disrupted, absent, sporadic or harmful, a child’s biological brain development can be impeded. The result can cascade through the years, resulting in behavioral, educational and social difficulties.

The NMT program, like TJJD’s Texas Model set of reforms, emphasizes the power of connections as the key to healing. NMT urges therapists to track a youth’s relationship history as they work together to repair or build new healing connections.

With a deeper understanding of a child’s complete background and neurobiology, the NMT-trained therapists can help kids move past that fight-or-flight response they learned as a traumatized toddler or the paralyzing hypervigilance that took root when they were abused. Those reactions may no longer make sense, but until a youth’s trust in others is restored, and new neural pathways built, these maladaptive behaviors can continue.

Hallmark gives the example of another youth who “lived in a chronically violent neighborhood, witnessed violence, lost a parent in childhood, experienced a head injury, and began a pattern of reactive aggression. He tended to view everyone as a potential threat.”

“After completing his NMT metric, we were able to map out ages of trauma and difficulties with communication and connection, which affected how he looks at others, then and now, from a reactive survivalistic manner that can explode in violence towards others and himself,” she said.

With that understanding, and new positive connections with others, a youth can navigate his way past the negative behaviors holding him back.

The bottomline: NMT training will be an important tool for TJJD therapists and would be for any therapist working with at-risk youth, Norton said.

“It’s great that we can get so many clinicians trained in this program, because this takes us much closer to have a truly trauma informed system.”

Photos: Top, Dr. Evan Norton; Right, Youth talk after a therapeutic seminar at Giddings; Bottom: Tamayo Halfway House youth connect and reflect after a run at a park.