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Relationship-Based Care: The Neurosequential Model of Therapeutics

Positive relationships—they are a strong point of pride for the staff at Mount Saint Vincent. They are also something Kirk Ward, clinical director, was looking to capitalize on when he put Mount Saint Vincent on the path toward using the Neurosequential Model of Therapeutics (NMT) eight years ago.

“At a certain point in time, I realized we weren’t taking advantage of the biggest strength of our program, which are the relationships we create with the children. So, we began looking towards a more relationship-based model of care,” said Ward.

The Neurosequential Model of Therapeutics combines formal therapy with rich relationships involving trustworthy peers, teachers, and caregivers. Using a brain map that is created after a thorough assessment, NMT matches therapies to a child’s developmental stage and affected brain region.

Using Neuroscience to Inform Care

As a child grows, their brain cells connect, interact, and organize themselves into a tiered system, with the lower regions developing first. The lower parts of the brain—the brainstem and diencephalon—perform the functions that keep the body alive, like breathing, heart rate, and body temperature. The higher parts of the brain develop over a longer period of time (into early adulthood), and are responsible for more complex functions, such as language and abstract thinking. However, the majority of brain organization takes place in the first four years of life.

Children who have experienced chronic trauma develop brains that exist in a constant state of fear. Their stress responses are oversensitive, which helped them adapt to their trauma-filled environments, but also created a negative starting point for their thoughts, feelings, and actions.

“NMT is very intuitive. It really helps you understand why a child is acting a certain way based on their brain development, and it helps create a road map for the types of therapies that will help them heal,” said Ward.

This “road map” is made by reviewing a child’s history to find out the types of trauma, neglect, or stress they were exposed to and at what point in their development they happened.

Rebuilding the Brain from the Bottom Up

Using the map, recommendations can be made on the types of therapies that will help address developmental deficits. While there may be many, the order in which they are targeted is important. Basically, the idea is to start with the problems that happen in the lowest parts of the brain, and work your way up as improvements are seen.

“For example, if you have a child that has experienced a lot of severe developmental trauma in utero, they’re likely going to have symptoms like a variable heart rate, attention difficulties, autonomic regulation problems—brainstem issues that talk therapy won’t impact. Instead, something like music therapy or movement therapy or animal-assisted therapy will engage with those lower parts of the brain and help strengthen them,” Ward said.

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Creating a Positive Environment

Another reason Ward gravitated toward NMT is the fact that many of the interventions used to help children heal are things that don’t necessarily require a therapist to do. Parents, caregivers, teachers, and Mount Saint Vincent staff can all participate in creating an environment for the children that is full of positive, repetitive interventions. Things like “brain breaks” in class, rubbing a yoga ball on a child’s back, chairs in the classrooms that rock—these are all patterned, repetitive, rhythmic activities that impact lower parts of the brain in a constructive way, and anyone can do them.

“NMT is intuitive and non-judgmental. It might be a scary title, but once you get past that, what you’re telling people makes sense,” Ward said. “You don’t need a Ph.D. in psychology to understand why the interventions work. It’s not about shaming anyone or telling them how bad they are—it’s about looking at the situation you have and figuring out a plan to move forward together.”

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