The Village Network's Implementation Journey

How do Collaborative Problem Solving (CPS) and the Neurosequential Model of Therapeutics (NMT) work together?

We see NMT as the theoretical underpinning of our work. The neurosciences obviously, and obviously the neurosciences informs Collaborative Problem Solving, but Collaborative Problem Solving, as the neurosciences, NMT in action and the Collaborative Problem Solving along with NMT. But Collaborative Problem Solving certainly speaks to the idea that it's all about relationships and actually sitting down in a respectful way and actually asking the child their opinion of what they think is going on and how can we help them solve with them the struggles that they're having. It has led to a much level, a much deeper level of engagement with the youth.

What has been the impact of Collaborative Problem Solving on the youth in your program?

I think what's really interesting, I think Collaborative Problem Solving it helps right away for one to establish that relationship. But it gives you a good gauge, a good read of where that child's relational skills are at and to what level do they trust the staff. And I know myself working with youth and doing Plan B conversations the same Plan B conversation can go on for several sessions, but you stick with it, and you start talking about what's the struggle about the trust and relationships.

I think that Collaborative Problem Solving really engages the youth at a deeper level, and it really helps the staff understand the importance of establishing that relationship. In some of our programs, our residential programs who've done particularly well with NMT and CPS, they all have done, but as we've implemented this, they've learned different processes to how to implement it. But one program, in particular, led away in training, actually training the kids in Collaborative Problem Solving. So the kids understood what's going on. Soon as the staff starts talking the Plan B way and they know what's happening and they engage in that. We had one situation where a youth wanted to change roommates, and he went to the staff and said, Hey, this idea about changing roommates, he says, "oh, it's going to work because I Plan B'd him."

And he actually used Plan B to talk to his current roommate to see how he would feel about switching roommates. So it's gotten to that level of engagement in some of the programs. The staff use it as a psychoeducation. And we've formatted some of our groups around the NMT, the sequence of engagement, regulate relate reason. And that reasoning piece is when they do in group; they do the Collaborative Problem Solving where they have a problem they want to solve. And as a group, they do a group Plan B, have a group Plan B conversation. Exactly. I remember one staff talking about how we tell the kids what this is, this is what we do. And he said, just that this isn't some big secret. This is what we do. It's not a secret, and it works.

What was it like to move away from a point-and-level system to Collaborative Problem Solving?

I've been in residential, doing residential work for a long time, and I was actually in Chicago as a childcare worker at a large residential program, and I was trained in a point-and-level system, a very popular point-and-level system. And then I moved to Ohio and started working for The Village Network. At some of our programs, I tried to implement this point-and-level system, and then I already had some point-and-level systems in their programs, but it got to the point where we just weren't getting the impact we wanted as much effort we put into this and as much just the time and energy and the training and the resources, we thought we should have been getting better results than we were. And about that time too, we have a new CEO arrived at the village network, and just coincidentally, he said to me, I think we need to get rid of the point-and-level systems.

And he and his previous job, he had done some research about point-and-level systems. He was on the educational side. So we explored the idea, and then we started introducing it to the staff. And we haven't looked back since. It was rough at first, it was difficult at first, and frankly, we even had some staff quit over it. They didn't quite understand what we were trying to accomplish. And frankly, we were young or new at this too. And in hindsight, we would've done it a little bit differently. But it's been some very hard or very rewarding work. Like any culture change or any implementation. Implementational science will tell you, as we removed the point-and-level systems, we had to make sure that everybody understood that this is what's replacing it, Collaborative Problem Solving.

And we had to be prepared that Collaborative Problem Solving takes practice. You have to practice a Plan B conversation. You have to practice the Plan B or the CPS APT and the TSI, and not everybody's at the same skill level. So I think we would've been a little bit more prepared to implement CPS before moving forward and removing the point-and-level systems.

And frankly, we learned just that idea of point-and-level systems and behavior modification and all about taking responsibility for yourself, pull yourself up by the bootstraps that is so ingrained in everything we do. So when staff heard that we're removing these from our programs, they kind of panicked, and they didn't quite understand what we were trying to accomplish, and it made people really nervous and some got really anxious. But we've changed our focus with NMT and CPS. It isn't about holding kids accountable. It's about helping them build that capacity to self-regulate, helping them build the capacity, create the capacity, build the capacity to self-regulate and to problem solve together.

And we explained to the staff, the child can't take responsibility for themselves until they have the neurological capability to do that. Taking responsibility for yourself, that's a very intangible idea. And that's something that happens up in the cortex. And these dysregulated children, they don't have that ability to always be as regulated to be able to do that. So that explanation really helped the staff understand. And we've taken everything instead of point-and-level systems, everything's on the basis of for what degree can the child keep themselves safe? So if a child, as an example, I always use this as example, the child. One Sunday, the group home goes to the YMCA and goes swimming, and you have a child in your program who has a history of running away, and he's doing okay, and you take him to the YMCA, and guess what he does? He runs away.

So then the next time you're working with them and the group's going to go to the pool, to the YMCA, our staff might have a Plan A conversation and says, you're not going to be able to go, because until you have those skills to be able to not run away, to become less impulsive than can regulate yourself, you're not going to go to the YMCA with us today. Now we'll help you develop those skills, and we'll help you work on that. And so that kind of framework, that explanation to the staff, they had a better understanding of what we were trying to accomplish. Everything's based upon safety, the degree to which a child will keep themselves safe, not a total of points that they've earned for the 24-hour period.

There are options with Collateral Problem Solving. So as the example of going to their YMCA, if they're going to their YMCA, the skills involved in that, if it surpasses the skill level of the youth, we're just setting them up in allowing them to go if they don't have that skill level. So that explanation helps the staff understand that, and it helps the youth as well, that we're just not saying no because we're saying no, we're saying no for a reason. We explain we want you to be successful. So, until you can develop that skill, we're not going to let you go to the why. We always though say, we will help you; we will help you build those skills. So it gives them some hope that it isn't just us saying no and see you later.