The

NEATS: A Child & Family Assessment Checklists for Assessment

Jane F. Gilgun

Summary This document contains two checklists: a short form and a long form to use while doing a NEATS assessment. The NEATS guides service providers attention to five areas of human development that research has identified as fundamental. They are Neurobiology, executive function, attachment, trauma, and self-regulation. The NEATS is an acronym for these five areas. The NEATS is also ecosystemic and development, while it also recognizes that human interactions with various persons and environmental events are central to human development. About the Author Jane F. Gilgun, Ph.D., LICSW, is a professor, School of Social Work, University of Minnesota, Twin Cities, USA. She does research on the development of violent behaviors, the meanings of violence to perpetrators, and how persons overcome adversities. See Professor Gilguns other articles, books, & childrens stories on Kindle, iBooks, & scribd.com.

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University of Minnesota, Twin Cities, USA School of Social Work Jane F. Gilgun, Ph.D., LICSW jgilgun@umn.edu January 2009/November 2011 The NEATS: Short Form The use of this short form requires thorough knowledge of Neurobiology, Executive Function, Attachment, Trauma, and Self-Regulation

Neurobiology
What neurobiological issues are present in this family? If there are neurobiological issues, what is being done about them?

Executive Function
What executive function issues are present in this family? If there are executive function issues, what is being done about them?

Attachment
What attachment issues are present in this family? If there are attachment issues, what is being done about them?

Trauma
What trauma issues are present in this family? If there are trauma issues, what is being done about them?

Self-Regulation
What self-regulation issues are present in this family? If there are self-regulation issues, what is being done about them?

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University of Minnesota, Twin Cities, USA School of Social Work Jane F. Gilgun, Ph.D., LICSW jgilgun@umn.edu January 2009/November 2011 The NEATS: A Child and Family Assessment The use of this checklist requires thorough knowledge of Neurobiology, Executive Function, Attachment, Trauma, and Self-Regulation

Neurobiology

Definition: a branch of biology that studies the anatomy and physiology of the nervous system under various conditions of health, stress, and pathology. Prenatal History ____mother had regular prenatal check-ups ____mother was chemical-free ____mother had adequate nutrition during pregnancy ____mother had low-stress family and personal life Birth History ____uncomplicated labor and delivery ____newborn alert and healthy Family History ____father chemical-free ____mother chemical-free ____chemical abuse/addiction in other family members ____ presence of mental illness in family _____if yes, what kind? _____presence of other neurologically-based conditions such as ADHD, autism, bipolar disorder, mental retardation, schizophrenia, obsessive-compulsive issues, sensory issues or depression ____ parents/siblings can read, write, do arithmetic, follow directions Infant Temperament ____ easy ____ slow to warm up _____ difficult Infant Characteristics ____ good eye contact ____ strong cry ____ animated affect; responsive to interactions with others ____ responds warmly to touch and holding ____ easily soothed when stressed ____ developmental milestones on time Parent Characteristics in Relating to Infant ____sensitive and responsive to infant bids for attention and care

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Behavior Characteristics: Children (Toddlers Through Teens) ____impulsivity ____distractibility ____hyperactivity ____ even temperament ____attends to tasks/attention-span developmentally appropriate ____ respects rules/follows directions

____ stays attuned to infants desire for interaction and desire not to interact ____ has others who help with child care and household management

Behavior Characteristics: Parents and Siblings

____impulsivity ____distractibility ____hyperactivity ____even temperament ____attends to tasks/attention-span developmentally appropriate ____ respects rules/follows directions

Case Plan ____ need for neuropsychological exam ____children ____ parents ____ childrens mental health referral ____ chemical dependency evaluation for parents ____ respite care ____occupational therapy ____ special education for child ____psychoeducation ____ other

Executive Function
Definition: a set of inter-related processes responsible for purposeful, goal-directed behaviors. Neural pathways are in the neocortex with connections to many other areas of the brain Parents Behaviors ____parents show good executive skills or == ____predictable ____consistent ____empathic ____flexible, planful, anticipates consequences ____sets clear rules and expectations ____explains reasons for rules and expectations ____ recognizes and praises positive child behaviors ____flexible but clear schedule for meals, playtime, sleep, etc ____ plays with child ____shows teamwork: has others to help with child care and household management

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Child Behaviors ____follows rules ____age-appropriate impulse control ____ responds well to praise ____ anticipates consequences ____age-appropriate consideration of alternatives ____ asks for help with difficult tasks ____ appropriate attention span ____ aware of consequences of behaviors for self and others ____responds to feedback about own behaviors ____age appropriate mental flexibility, planning, and problem-solving Case Plans When Executive Function Issues Exist ____ neuropsychological exams ____ for parents ____ for children ____encourage teamwork: support and education to parents ____help parents to create ____structured environments ____relatively low stimulus environments ____clear expectations ____ clear explanations ____ engage child in problem-solving tasks such as ___consideration of consequences ___ consideration of alternatives ____ simple directions ____ tasks that encourage children to try something that is a bit more complex than other tasks they have performed successfully ____play and leisure time with other children who may have some positive capacities that other children want to emulate _____one-on-one time with adults both in play and in more didactic settings ____Inquire about issues in schools and other settings ____ support parents to work cooperatively with school personnel ____ educate others about how to deal with children with executive function issues ____ advocate for accommodation for children with executive function issues ____ Secure resources that may result in increase in parental executive skills

Attachment
Definition: behaviors that maintain contact with individuals who serve as a secure base from which to explore and to which to return under times of stress, as well as to serve as a source of nurturance, guidance, love, and discipline (limit setting, boundary maintenance, authoritative parenting in parent-child relationships, reciprocity of all kinds) Qualities Associated with Secure Attachment ____ sensitive, responsive caregiving ____ mutual responsiveness: reciprocity ____ mutual joy and satisfaction in the relationship ____mutual regulation of affect and attention; attunement

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____ parents maintain self-regulation when children are slow to warm up or have difficult temperaments ____parents have others to support caregiving and household management ____ parents manage own neurological, executive function, and physical and mental health issues ____ parents uses resources to promote childrens healthy development including when children have neurological, executive function, and physical and mental health issues Styles of Child Attachment to Caregivers ____secure ____insecure ____ambivalent ____avoidant ____disorganized ____disordered (reactive attachment disorder) Styles of Adult Attachment to Children ___secure ___resolved ___preoccupied ___dismissive ___disorganized ___disordered Factors That Interfere with Parental Psychological Availability ___ unresolved childhood traumas and stresses ___unmanaged mental illness ___unmanaged neurological issues ___poor executive functioning ___financial stress ___family violence ___housing instability Inner Working Models Definition: Develop from quality of attachment relationships They are internalized expectations about self, others, and how the world works, how to behave in the world, etc., encoded in brain circuitry and perhaps in other places in the human brain and body; also can be considered cognitive maps that help people interpret and make sense of their experiences; sometimes can be thought of as schemas or inner representations General Types of Inner Working Models ____ prosocial, associated with secure child-parent attachments ____ anti-social, sometimes associated with ambivalent/preoccupied and other insecure attachment styles ____ self-destructive, associated with avoidant/dismissive and other insecure attachment styles ____ inappropriate, associated with neurological issues

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Signs of Secure Attachments in Children, Adolescents, and Adults ____admits mistakes ____takes appropriate responsibility ____can laugh at oneself ____takes the initiative ____has a sense of humor, a sense of fun ____shows a range of emotions ____is emotionally expressive ____is empathic ____capacities for standing up for oneself ____seeks trusted people to process negative life events ____seeks safe havens when stressed ____copes with stress and trauma in prosocial ways ____has capacities for trust ____expects good things and responds appropriately when things go wrong ____sets appropriate boundaries ____follows rules but questions unfairness ____enjoys new experiences Professionals as Secure Bases ___practitioners show up Provide ___ a safe haven where difficult issues can be processed ___a sense of safety and trustworthiness ___information to parents about resources for the meeting of basic needs ___advocate for clients Case Plans assessment for styles of attachment require observation of parents and their children interacting with each other ___do parents and children interact? ___are interactions reciprocal? Tailored to childs capacities? ___does parent serve as a secure base? ___are children glad to see parents? ___are children sad when parents leave? ___do parents set firm, kind limits on childrens behaviors? ___do parents show interest in childrens activities? ___do parents and children take pleasure in each others company? ___do children prefer parents over other adults? ___do parents help children with tasks that are a bit more challenging that children have capacities for mastering ___do parents maintain contact with children when children are in out of home care? When parents are unable to provide a secure base, assess for their capacities to ___engage in mental health treatment: therapy and medication ___engage in chemical health treatment ___ learn how to cope with, adapt to, and overcome own histories of stress, trauma, & loss intervention

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Trauma

out-of-home care is indicated in cases of ____pathogenic care ___ reactive attachment disorder ___ parental incapacity to deal with own issues ___ parent does not want child: extreme dismissiveness ___parent shows great ambivalence toward child ___ to the extent possible and feasible, maintain contact with parent in structure, controlled and supervised settings ___ place children in situations where adults/other children have capacities for fostering secure attachments o homes o schools o recreation and other child activities or child/parent activities

Definition: events that are life-threatening or psychologically devastating to the point where persons capacities to cope are overwhelmed and that result in changes in brain circuitry and structures. Traumatized people relive the trauma and their responses are automatic. Persons with histories of secure attachments are likely to learn how to cope with, adapt to, and overcome trauma, while persons with histories of insecure attachments may have a much more difficult time. Signs of Trauma in Children and Parents o Primary Effects ____reliving the traumatic event ____fragmented memories arise unexpectedly ____startle response ____hypervigalence ____agitation ____rapid pulse, sweating ____avoidance of reminders of trauma ____preoccupation with trauma ____dysregulation when reminded of trauma (sights, sounds, smells, taste, sensations) ____possible complex trauma o Secondary Effects ____ADHD-like symptoms ____depression ____anxiety ____oppositional behaviors ____dependency ____difficulties at home, school, peer relations, and work (for teens and adults) General Observations ____the behavioral and psychological parents and children show are expectable given their trauma histories

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_____children and parents do not want to deal with their trauma because when they have attempted to previously, they have been shamed and blamed ____children and parents have complex traumas related to ___having experienced multiple traumas and to ___the insensitive and stigmatizing responses that others have had to them when they have wanted to talk about their trauma or when they show effects of trauma Parents and children deal with the effects of trauma in ways that are ____pro-social ____anti-social ____self-destructive ____inappropriate Other professionals have mistaken the primary and secondary effects of trauma for ___oppositional behaviors ___emotional disturbances ___behaviors that must be punished ___behaviors that merit zero tolerance ___as behaviors to be laughed at Parents Responses to Behaviors Associated with Child Traumas ____recognizes that child is reliving trauma/dysregulating ____recognizes that this is an automatic response ____keeps child safe ____keeps others safe ____ maintains own executive function and self-regulation ____ seeks help of other knowledgeable people ____does not leave child alone ____lets emotions run their course ____when child re-regulations, check in ___asks how child is ___what is going own ___ guides child to use words ___gradually, when child is ready, considers alternatives ____ seeks professional help so that child can deal directly with trauma and learn to cope with, adapt to, and overcome the effects of trauma School Staff/Other Adults Responses to Behaviors Associated with Child Traumas ____recognizes that child is reliving trauma/dysregulating ____recognizes that this is an automatic response ____keeps child safe ____keeps others safe ____ maintains own executive function and self-regulation ____ seeks help of other knowledgeable people ____does not leave child alone ____lets emotions run their course ____when child re-regulations, check in ___asks how child is ___what is going own

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___ guides child to use words ___gradually, when child is ready, considers alternatives ____ seeks professional help so that child can deal directly with trauma and lean to cope with, adapt to, and overcome the effects of trauma Other responses to trauma ____behaviors are similar to disorganized and disordered attachments ____sustained, long-term, prolonged episodes of dysregulation such as needing to scream and cry for long periods of time ____origins of trauma are unknown Parents and Teachers ____ are well educated about the nature of trauma ____have respite from being with children who have experienced trauma ____ have the emotional and instrumental support to deal with children who have experienced trauma ____recognize how difficult it can be to deal with children who have experienced trauma Significant others ____recognize how difficult it can be to deal with children who have experienced trauma ____provide emotional and instrumental support Case Plans ____parents are willing to do whatever it takes to ensure that children develop capacities to cope with, adapt to, and overcome adversities ____referral to therapists who have capacities to create safe havens for children and the skills to guide children to reprocess the trauma and integrate traumatic events into their understanding of themselves, others, and how the world works ____therapists have capacities to work with both parents and children ____parents engage in services that help them to deal with their own traumas _____parents and social service encourage children to engage in activities that ____children are engaged in activities ___they enjoy ___that they are good at ___that give them a sense of mastery ___in settings where other children have good executive skills and good self-regulation ____learn new executive and self-regulation skills ____persons who are sources of trauma ___ take responsibility for their behaviors ___say I am sorry I hurt you. ___tell the children that some children think they did something wrong ___tell the children that the children did nothing wrong ____child safety comes first ____out of home placements are ___safe ___culturally appropriate ___parent figures are

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___sensitive, responsive, and competent ___structure activities ___set clear rules and expectations ___reward appropriate behaviors ____Nothing trumps child safety ___not the sanctity of the family ___not cultural issues ___not keeping the family together ___Not saving the county or state money ___Not because the professionals are burned out

Self-Regulation
Definition: capacities to manage and make sense of ones own thoughts, emotions, and behaviors in times of stress and in the course of everyday life. Some view self-regulation as one of the executive functions Children, Parents, and Professionals ____maintain emotional, cognitive, and behavioral balance during times of stress ____respond prosocially to stress and reminders of trauma ____can be soothed when dysregulated ____respond appropriately when others are dysregulated ____work through situations where there is disagreement and potential for dysregulation ____do not pretend to be dysregulated to get own way Case Plans _____Basic Human Needs are Met _____Safe, Predictable Families _____Safe Neighborhoods and Schools _____Social Histories _____Neurological Exams _____Medical Exams _____Psychological and Educational Evaluations _____Deal Directly with Childrens Trauma _____Structured Childrens Intervention Programs _____Involvement of Children in Activities They Enjoy _____Parental Participation in Helping Systems _____Education and Advocacy About Social Policy _____Involvement in Informal Networks _____Parental Self-Care _____Service Provider Self-Care