FAQs - Neurosequential Model of Therapeutics© (NMT)
What is the Neurosequential Model of Therapeutics?
The Neurosequential Model of Therapeutics (NMT) is a developmentally-informed, biologically-respectful approach to working with at-risk children. The NMT is not a specific therapeutic technique or intervention; it is a way to organize the child’s history and current functioning to optimally inform the therapeutic process. The NMT integrates several core principles of neurodevelopment and traumatology into a comprehensive approach to the child, family and their broader community. The NMT process helps match the nature and timing of specific therapeutic techniques to the developmental stage of the child, and to the brain region and neural networks that are likely mediating the neuropsychiatric problems. The goal of this approach is to structure assessment of the child, the articulation of the primary problems, identification of key strengths and the application of interventions (educational, enrichment and therapeutic) in a way that will help family, educators, therapists and related professionals best meet the needs of the child. Active participation of caregivers and other adults in the child’s life is important to the success of the NMT; indeed, by weaving various activities throughout the child’s various relationships and environments, the majority of “therapeutic” experiences are provided outside of the actual context of conventional therapy. The model has three key components – assessment, staffing/training and the array of recommended therapeutic, educational and enrichment activities (see Perry, 2006; Perry and Hambrick, 2008; Perry, 2009). A related approach, the Neurosequential Approach to Caregiving (NAC) incorporates the same principles but the practical application informs parenting, early childhood education, education and a range of other settings where focus of the work is not specifically “clinical” in nature. This application of neurodevelopmental principles, the NAC, is a powerful complement to the use of NMT in clinical populations.
How was the Neurosequential Model of Therapeutics created?
Over the last twenty years, the ChildTrauma Academy (CTA) has developed a neurodevelopmentally informed framework for working with traumatized and maltreated children (Perry, 2006). This framework is based on our growing understanding of complex issues facing children in today’s modern world. Using a neurodevelopmental perspective has allowed us the opportunity to generate a common set of concepts and principles based in biology that has helped us better understand the etiology of many problems seen in children with disrupted development; these disruptions can be from any variety of developmental insults ranging from pre-natal drug or alcohol exposure to witnessing violence to intra-familial chaos to outright abuse and neglect. In addition, this perspective has helped us better understand how to intervene and begin to heal the problems we see in these at-risk, maltreated and traumatized children. With regard to specific clinical work, the NMT approach has been used in CTA clinical work with maltreated and traumatized children for over a dozen years. The specific modification of this approach for special populations has been underway for the last ten years. Currently, the NMT is being utilized in a range of clinical and educational settings including residential treatment, therapeutic foster care, therapeutic pre-schools and traditional outpatient mental health settings. The results have been promising and outcomes research is underway.
NMT implementation in the therapeutic preschool setting was spearheaded by
Dr. Rick Gaskill, a CTA Fellow and Clinical Director at Sumner Mental Health Center in Kansas Independent research by Dr. Sharon Barfield at the University of Kansas had documented the efficacy of this approach with high-risk children (Barfield et al., submitted).
Where is the NMT currently being used?
The CTA is currently working to help certify several programs and institutions. Each of these projects is somewhat different but basically involves integrating NMT into clinical practice and program development. Key partners actively obtaining Institutional Certification include Take Two of Berry Street in Melbourne Australia, St. Aemelian-Lakeside in Milwaukee, WI, Cal Farley’s Boys Ranch in Texas and NFI, Vermont in Burlington, Vermont. Sandhill Child Development Center in New Mexico, Mount St. Vincent’s Home in Denver, Alexander Youth Network in Charlotte, NC are in the process of completing training certification. Several other sites will be added in 2010-2011.
In addition, several partnerships are in place to introduce the core concepts of NMT/NAC into existing policy, programs and practice into the child protective (CPS) and other public systems (e.g., mental health, juvenile justice). Projects to help bring these concepts to public systems have taken place in Illinois, Alberta, Wisconsin and soon, Oregon and New Mexico. A very exciting project is underway in partnership with New Mexico Children, Youth and Families Department (CYFD). In 2010, New Mexico will be the first state to bring NMT/NAC to both the mental health and CPS systems (and related systems) in a pilot project in Valencia County.
How is the NMT model brought into a program?
Introducing the NMT or NAC involves a process of capacity building and training for the primary groups of adults working with the target population of children. There is an NMT certification process that involves didactic, self-guided and case-based training elements. While individualized versions of this process are created for each program and community, the primary methods include: an on-sight series of training visits; distance learning opportunities using our online University (www.ChildTraumaAcademy.com), CTA-prepared training curriculum using DVD and prepared supplemental materials, and ongoing case-based and didactic trainings using Web-enhanced audio conferencing. For more information about NMT Certification, see below.
Can individuals and organizations become certified in the NMT approach?
Yes. The CTA offers both options. Apply for either version by completing our NMT Training Certification Application.
Where can I get more information about the NMT?
A broad introduction to the concepts is provided in The Boy Who Was Raised as a Dog, a book by Dr. Perry and Maia Szalavitz published in 2007 (http://childtraumaacademy.org/BoyDog.aspx). The appended references will also provide some useful background.
The best way for an individual or program to learn more about the NMT is to participate in the ongoing CTA NMT Case-based trainings that are offered every quarter. In these 90-minute long web-based conferences, clinicians from across the US, Canada and abroad present children they are struggling with and a clinical teaching conference model is used to help better understand the child and suggest specific interventions based upon the NMT approach.
There are several NMT articles posted on this website. Dr. Perry provides some background to the development of the NMT in his chapter titled Applying Principles of Neurodevelopment to Clinical Work with Maltreated and Traumatized Children.
A special NMT DVD (Introduction to the Neurosequential Model of Therapeutics) is now available to help introduce the NMT and its core principles to clinical and non-clinical settings. View our ORDER FORM
or visit the CTA online store for more information.
Special program project, training and general inquiries regarding the NMT or other CTA projects and activities please contact the CTA at ChildTrauma@ChildTraumaAcademy.org This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; or call 866-943-9779.
Updates will be posted on this site periodically (www.ChildTrauma.org). Subscribing to the free CTA Newsletter may also be a good way to stay up to date on materials and training opportunities.
References
Dobson, C. & Perry, B.D. (2010) The role of healthy relational interactions in buffering the impact of childhood trauma in Working with Children to Heal Interpersonal Trauma: The Power of Play (E. Gil, Ed.) The Guilford Press, New York, NY, pp. 26-43
Perry, B.D. (2006) 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
Perry, B.D. & Dobson, C.D. (2009) Surviving childhood trauma: the role of relationships in prevention of, and recovery from, trauma-related problems. Counselling Children and Young People: Journal of CCYP, a division of British Association for Counseling and Psychotherapy, March, 2009 28-31
Perry, B.D. and Hambrick, E. (2008) The Neurosequential Model of Therapeutics. Reclaiming Children and Youth, 17 (3) 38-43
Perry, B.D. (2009) Examining child maltreatment through a neurodevelopmental lens: clinical application of the Neurosequential Model of Therapeutics. Journal of Loss and Trauma 14: 240-255
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