Case Presentation for the Neurorelational Framework (NRF) Neuro-Relational Framework (NRF) Dyadic Mapping for Reflective Practice: Self, Parent, and Child Name: Cathy Pope and Joshlynn Norquist with Community Team Katie Crask, Shannon Dicks, & Jim Pryce Date: Nov 18, 2016 Connie Lillas, PhD, MFT, RN infantmentalhealth@earthlink.net 1 www.the-nrf.com
Case Presentation for the Neurorelational Framework (NRF) The Neurorelational Fram ework (NRF) is a knowledge translation fram ework that translates brain science into practice : Assess & Intervene: Three Core Concepts: • Step 1: Adaptive vs. toxic stress • Stress Resilience versus Toxic Stress (roots to a tree) • “Serve & return” levels of • Step 2: Age appropriate vs. low levels high quality engagement of relational engagement (trunk of a tree) • Development of brain • Step 3: Age appropriate networks developmental capacities vs. delays or disorders in brain networks (branches of a tree) C. Lillas, adapted from Lillas & Turnbull, 2009 Reflective Practice NRF’s use of RP Five Core Concepts of concepts: RP: In cultural context: In context with cultural similarities/ differences; parallel process & power differentials • Professional use of • Our colors; our HHH; our ourselves four stories • Parallel process • Our colors; our HHH; our four stories • Working alliance • Use of our Hearts • Understanding the story • Holding the family system • Holding the baby in mind in mind – the parents, the child, the relationships Connie Lillas, PhD, MFT, RN infantmentalhealth@earthlink.net 2 www.the-nrf.com
Case Presentation for the Neurorelational Framework (NRF) Body, HHH, & Culture in Bronfenbrenner Circles Society ‐ Institution Community ‐ Team Family ‐ Interpersonal Personality ‐ Personal Head C U L T U R E C U L T U R E Heart Hand Systems Systems Systems Dobbs & Lillas, 2016 Systems Brief Family History Family Structure Primary client was 19 months old Referral through Primary Physician due to failing the MCHAT at 18 months Parents married Older sibling, 4 years old with Expressive Language delay, not connected to services Cultural background: Latino family Mother’s mother and sibling connected, provide fiscal and custodial resources Father’s parents less connected – twice a year visits Both parents have a history of intergenerational abuse and domestic violence Connie Lillas, PhD, MFT, RN infantmentalhealth@earthlink.net 3 www.the-nrf.com
Case Presentation for the Neurorelational Framework (NRF) Cultural Similarities & Differences w/ Power Differentials Differences Sim ilarities with Fam ily • Education gaps Shared family values • Mom cares about structure and predictability – Parents High School Grads • Healthy snacks – Treatment, MA level • Crafts for Holidays • A feeling that even though there are racial • Age differences differences there is a feeling of being similar in – Parents in 30’s family values • Family and practitioners honoring faith based – Provider’s 40-50’s communities, even though different, there is a bridge there • Racial differences • Both parents and practitioners come from being – Latina/ Latino poor and having to work hard to change SES – Caucasian Providers Parallel Processes from the home to the practitioner team Parent Practitioners • Mom was anxious underneath the red zone; • J felt combo zoned with concern; she was hiding following parent’s lead and never knew when mom was going to go red • The holder of power keeps you safe; people – it would come as a quick surprise will keep you safe. • J felt she accommodating to parents’ • Mom was going to get her needs met on her lead but not certain that was the “real” own; by being assertive or aggressive, she need of the family; could feel more was going to get her needs met was needed but not sure what! • Mom was control it by going back into “fake green” • Both practitioners are feeling some “faking green” as well. Concerned about safety and hearing the trauma • Father felt genuine in sharing his trauma history story Case History Timeline • Jan, 2015 – initial IFSP; parents • Sept/ Oct, 2015 – inconsistent main concerns are child is not attendance, ABA services are walking; failed MCHAT; Joshlynn dropped (STARS – KC Kids) and CVRC case worker begin case • Nov, 2015 – transition IFSP to show • Feb, 2015 – Cathy joins case as co- that client has not made treater; begin the use of 4 Colors; developmental progress; CVRC case OT/ PT/ SLP begin consultative brought back into services through services supervisor • May, 2015 – ABA services begin due • CVRC supervisor advocates for to failed MCHAT family and intensive ABA is reinstated for both parents’ in their • June, 2015 – Parents separate, homes plus day care Majorie Mason becomes involved with legal services • Jan, 2016 – CYS connects and provides services to mom with older • Aug, 2015 – ABA services dropped; son move from intensive to non- intensive • All of these services continue until his 3 rd birthday; no longer ASD eligible at this time Connie Lillas, PhD, MFT, RN infantmentalhealth@earthlink.net 4 www.the-nrf.com
Case Presentation for the Neurorelational Framework (NRF) Macro Level Overview Early Care & Education THINKING •Motor delays – gross & fine motor, PT consultation •Day care setting after parents separate •KC Kids – Joshlynn • Torticollis • Failed • MRSA MCHAT with BODY Functional FEELING • Allergies ABA Dx of • Hypermobile Mental • PTSD Basic Needs/ Possible ASD joints Health • Constricted Medical • Regulatory play •CVRC lead agency delays – • Cathy & •Speech delays with feeding CYS SLP consultation delays •Sensory – over & under-reactive with OT consultation SENSING Developmental Disabilities Lillas & Turnbull, 2009 Strengths & Vulnerabilities in the 4 Brain Systems The higher the number of risk factors, the higher the vulnerability, thus for case planning, areas where Grandma is less vulnerable and child is more vulnerable, Grandma likely has capacity to support child. If mom is vulnerable in a system, services should be directed to support her in that system. Information gathered from the History Worksheet for the 4 Brain Systems. ACES for Mom and Child ACE for Mom - 4 ACE for Child - 4 • Physical abuse • Physical abuse • Emotional abuse • Exposure to Domestic Violence • Exposure to Domestic Violence • Emotional Neglect • Separation of loss of a • Separation or loss of a parent parent Connie Lillas, PhD, MFT, RN infantmentalhealth@earthlink.net 5 www.the-nrf.com
Case Presentation for the Neurorelational Framework (NRF) Sleep Sleep Cycles: No one is sleeping well. The family uses the TV to help fall asleep. Someone waking up every one to two hours. The Colors Tell Us The Story! • The discussion of the colors allowed for Father’s courage to share his trauma story • The colors are a way to say “We can hold this part of your story, I’m not just your child’s teacher.” • Without the colors we wouldn’t have gotten to their story • Colors neutralize the shame associated with one’s trauma story • Journey of the Colors: – help them understand their story so they can make sense of their story – the story of the colors moves along – – from being shared to being able to think about it and – then to find what they can or want to do about their stress colors Family Pie at Baseline Spikes of red with retreat to Green = 0% blue (parent gives in) Red= 20% Blue= 20% Hypervigilance Blue feels green from all family to the family, the Combo = 60% members safest place Connie Lillas, PhD, MFT, RN infantmentalhealth@earthlink.net 6 www.the-nrf.com
Case Presentation for the Neurorelational Framework (NRF) Mom Pie at Baseline Sit & Moving back Engage Burst of & forth verbal aggression Green = 10% Tight, clenched jaw Red= 10% Dissociation Blue= 10% Limited eye contact Combo = 70% Verbal paucity Dad Pie at Baseline Tense Engaging Green = 50% Quick Reactivity Red= 15% Bright eyes with Blue= 5% Tight expectancy Combo = 30% Physically tried to Leaning in control with immediacy to action and response Child Pie with Mom Baseline Movement with rhythmic high pitched intense Green = 0% sound Red= 10% Drinks milk from Blue= 30% sippie/TV uses Mom is attuned blue to calm Combo = 60% to his cues but himself by her anxiety feeds himself his anxiety Connie Lillas, PhD, MFT, RN infantmentalhealth@earthlink.net 7 www.the-nrf.com
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