Review of Chapter Eight

A.  Reminding ourselves of the shame factor

B.  Sharing our personal journal (rotating through class participants)

  1. Who you are at your Best (green zone – Heart/Hand/Head)
  2. Who you are at your Worst (red-Hand/blue-Head/combo-Head)
  3. Dyadic patterns from your past family (mom/dad)
  4. Patterns from past to present, similarities? Differences?
  5. Individual Toxic Stress Patterns
  6. Relational Toxic Stress Patterns
  7. Professional dyadic stress patterns, Rupture? Repair?

C.  Sharing our families

  1. Early Phase Assessment Form AWAKE Cycles
  2. PIES
  3. Check boxes
  4. Toxic Stress Patterns
  5. Integrating Colors with HHH
  6. Parallel Process
  7. Graphical Displays
  8. PIES
  9. Toxic Stress Patterns
  10. Sleep

Chapter Nine, Phase 1, Step 3: Macro and Micro Approach to the Four Brain Systems, the Four Stories and the Use of the History Worksheet and Needs Assessment

ORIENTATION TO GLOBAL CONCEPTS FOR STEP THREE

Branches to the tree. The metaphor for step three is the branches to the tree. Now, the strengths of the roots and the trunk feed into building healthy branches or there are needs that have been gathered along the way from toxic stress at the root level and poor serve and return relational processes in the trunk. Organically, the branches are a result of both the genetics and the environment – the dynamics (epigenetics) of the two interacting, beginning with the in utero environment.

The links between the three steps. Step One informs you if there is a toxic stress pattern that needs to be addressed. Physiological stability is the foundation to the Levels of Engagement. If there is a toxic stress pattern in an individual, dyad, or family system, there is vulnerability or constrictions in Step Two as well, that also need support. While Step One and Two inform you this family needs help, neither step one nor does step two inform you as to what all the multiple causes are that are contributing to the vulnerabilities. That is for Step Three to do! Step Three is a comprehensive approach to assessment (and intervention) that helps you organize the individual differences in each person in the family system, in a neuro-developmentally sensitive manner. As this information is gathered with the parents, the strengths and needs become a guide for use within the family. This information helps inform the parents what they can do for themselves and their children. The four brain systems also help the practitioner and parents organize all of the services they may already be receiving, as well as highlight any pieces that might be missing, so that these can be discussed collaboratively.

Multiple Uses of the Four Brain Systems. There are many layers to the use of the four brain systems. While each part of the tree has depth and breadth to it, the four brain systems are the most rich and multi-faceted. These layers can be thought of as a way to think about parallel process!

First, on a preliminary level, if you have other practitioners on your team that have been gathering information from the family, and they are free to share it with you, you can use the four brain systems to begin to organize the information you’ve gotten, right from the start. The History Worksheet is something that all practitioners across teams can share.

Second, the four brain systems serve as four stories. These consist of interviews that can be done in a concentrated way with a semi-structured interview or over the course of time. As one already knows, the four stories are ever emerging and ever evolving. One begins, yet, as the NRF is like a spiral staircase, one can cycle back at any time to a piece of history or knowledge that may have been hidden.

Third, the four brain systems are a way to begin to understand the global strengths and vulnerabilities of each brain network via looking at risk and protective factors. As one begins and continues to fill in the History Worksheet, the sheer numbers of risk factors can be counted to see where the strengths and vulnerabilities are weighted. In general, we say that a score of four or more is a weight that one carries within that brain system. As there are many risk factors, including the Adverse Childhood Experiences, one can see things from a Micro perspective. As we stand back and observe the sheer numbers of risk factors within each brain network, and where things are balanced or imbalanced with strengths, we shift back out the Macro level.

Fourth, they can be used to understand the families’ global needs and where in your community the resources are –including where your personal warm hand-offs are and where you need to forge new connections. This begins to look at the Macro level of community systems work. Both the Purple Wheel and the Family and Community Needs Assessment are used for looking at the big picture. What team members might you need for this case/family? Whom do you know in each of these areas of need? Whom might you want to form a connection with for future reference?

Following the global interviews of the four stories and using the History Worksheet to look at the strengths and vulnerabilities, one begins to go deeper into the four brain systems. The NRF has organized functional capacities within each brain network so that individual differences in each brain system can be assessed. The following items reflect the details of this micro level depth analysis.

Fifth, assessing functional capacities within each brain system help you take a closer look at the health or distress within a network, helping you identify and plan for services that may be needed for remediation.

Sixth, the brain systems have intervention principles embedded in them all along the way, and they are integrated into the understanding of the functional capacities.

Seventh, as each brain system’s strengths and vulnerabilities are processed, each brain system can be a guide for the cumulative, yet distributed sources of Triggers that contribute to adaptive and toxic stress response and toolkits for stress recovery. The Toolkits can be discovered on the self-regulatory side and the co-regulatory side. The process and concept of using Triggers and Toolkits can begin early on in the learning process of using the four brain systems. However, the mastery and depth of mining the four brain system for triggers and toolkits comes with the depth of these previous layers of knowledge.

Eighth, one goes back out the larger picture, revisiting looking at a community from a Macro point of view, with its systemic and leadership links – within a local area, across a state, and across state leadership lines.

Ninth, they are ways that we can evaluate on a meta-level, where any promising practice or evidence-based treatment is “weighted” from a neurodevelopmental landscape, so they can more judiciously be used for matching the treatment to the needs of the parents/child/family.

Layers to the Use of the Four Brain Systems & Links to Phases and Worksheets
LEARNING PHASE 1
First level / A way to organize any preliminary data collected and shared with you / Phase 1 / History Worksheet
Second level / Four stories that are interviews in concentrated form or spread out over time / Phase 1 / Four Interviews
Third level / Organizes risk and protective factors, count the number of risk factors / Phase 1 / History Worksheet
Fourth level / Organizes individual needs and warm handoff links practitioners have or do not have in the community / Phase 1 / Purple Wheel
Family and Community Needs Assessment
LEARNING PHASE 2
Fifth level / Assesses functional capacities within each brain system that show strengths, vulnerabilities, or often both / Phase 2 / Current Functional Capacities
Sixth level / Use intervention principles embedded within the four brain systems / Through all phases / In text, references to bottom
-up and top-down processes
Seventh level / Organizes Individualized Triggers and Toolkits for stress responses and stress recovery / Phase 2 / Brain System Triggers and Toolkits
Eighth level / Provides macro level view of cross-sectored links within a community, across systems of care on a state level, or national level / Phase 2 / Purple Wheel
Yellow Circle
Bronfenbrenner’s Layers
LEARNING PHASE 3
Ninth level / Meta-level map for where promising practices and evidence based treatments are “weighted” from a neurodevelopmental perspective for matching treatments with needs / Phase 1 & 2 / Material Introduced in NRF Chapter 9 & 11

GENERAL ORIENTATION TO THE FOUR BRAIN SYSTEMS, MACRO AND MICRO USE

As already mentioned, there are many uses of the four brain systems. In this Phase, I am orienting you to the use of them as a way to begin, right away, to organize individual differences in a comprehensive, yet organized and systematic fashion. This is referred to as the Micro level of using the four brain systems for individual organization. Second, I am orienting you to the four brain systems as a way to organize your family’s use of all of the community systems of care. This shift helps you look at the larger picture and begins your journey as a practitioner who is interested in holding in mind the larger picture, seeing your sector as part of a larger whole. A family in need can enter through any one of the five sectors we hold in mind. Organizing care through the four brain systems, and using a common language and shared approach with the NRF’s three steps, provides an avenue for a more efficient and effective way to service our most at-risk infants and at-risk parents.

Orientation to bottom-up and top-down processes. Our brains are built “bottom-up” and while there is a linear progression to the brain’s development there is also a non-linear aspect to it. So, we usually think of the first couple years of life as particularly “bottom-up” because we are primarily “doing” and not “thinking” yet it is now clear that these dual tiers have a lot of intersections and influences upon each other. So, it’s not as neat and tidy as it sounds. As we develop, many behaviors are a combination of both bottom-up and top-down processes. In order to get clear on the distinctions, though, bottom-up processes are behaviors that are habitual and automatic. We do to have to talk or think about them to do them. In contrast, top-down processes are ones that are deliberate and intentional, often requiring conscious control. These require thinking and sometimes, talking. When the environment is predictable, we benefit from having fixed and automatic habits and routines in place. It would be very time consuming if every time you went to make breakfast you had to read a manual on how to do it. It’s efficient to know how to get ready for school or work through these rather rote routines. At the same time, life is also unpredictable. For these instances, we need to be able to respond to novelty with thought and flexibility. This takes more energy to do! Thus, the balance of the two is optimal. An automatic system and a thinking system are each necessary and complimentary to each other. (Deborah Budding, 2015)

Many ways of learning require bottom-up processes the NRF references as procedural learning and that is why if you are taking an NRF course, there are usually procedural learning exercises embedded in the training programs. BTW, procedural knowledge and memories are akin to “implicit” knowledge and memories. When on the ski slopes learning how to ski, one has to think but one is also doing. This means that one learns how to become “automatic” with the use of the NRF through using it and doing the exercises. When learning the NRF, one has to both do and think, very taxing indeed! However, just as learning any routine or filling out a particular paper trail, it takes practice. Over time, the practice becomes procedural and at that point, will have a lot of automaticity built in. That means you won’t have to think so hard just to get through an intake or an Early Assessment Phase Form! That gives you more energy to deal with more complex cases and curve balls that come your way.

Micro level understanding of the four brain systems. The simplest way of understanding the four brain systems is often a way I might also orient a family to them or a new practitioner to the NRF. Notice that as the meaning of each brain system is told, there is a movement from the inside to the outside, back to the inside, back to the outside. So, we are moving in and out of our connections to our “internal milieu” –known our bodies, with connections to our “external milieu” –known as our outside world.

“Our brains begin “bottom-up” and that means we begin with connecting to our bodies! And in order to be at our best, we have to get calm inside our bodies to feel relaxed and present. Our infants and young children have to do this, too! As we get calm inside our bodies, we can begin to notice what’s going on outside of us. We start to notice the world around us in the form of sensations –everything from smells, tastes, sights, sounds, movement, and touch. Now, what happens next is that we immediately start to cycle back to organize what’s inside of us by noticing a continuum of emotional reactions - whether we feel neutral about something, not really registering it or caring too much about it, whether we feel safe and really like what’s coming at us from the outside world, whether we feel challenged by something and may not like it so much, or whether we feel threatened and really don’t like it. As we organize our inner world to this emotional continuum, then we begin to be able to adapt back out to the outside world and figure out how we want to respond to the outside world! Even infants can turn their head and eyes – which means they have some ability to “motor” towards or away, and they certainly can protest. So in this way, at a very early age and thereafter, we can motor or move towards something we prefer, motor or move away from something unpleasant, and if we cannot motor or move away from something very quickly that we don’t like or feel threatened by, we can protest – loudly. As our brain matures, we can begin to make decisions and plan ahead as to how we are going to adapt to the external world. This is the essence and the priorities of our four brain systems, whether we are very young or very old.”