The New York Institute for Psychotherapy Training in Infancy, Childhood and Adolescence

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The Building Blocks Program at NAC     THE NEW ALTERNATIVES FOR CHILDREN (NAC)   As described in the paper: Dyadic Treatment, Reflective Functioning, and Videofeedback: Fostering Attachment with Families in the Foster Care System (Cohen, P., Journal of Infant, Child and Adolescent Psychotherapy, Vol. 15(2), pp.104–119,  “The New Alternatives for Children (NAC), [is] a child welfare agency providing services to children and families involved with the Administration for Children’s Services in New York City. At least one child in the family must have a medical, emotional, or cognitive challenge, and many of their parents have their own challenges, including traumatic histories with multiple adverse childhood experiences. In addition, many of the families suffer the effects of ongoing exposure to poverty and violence as well as many disrupted connections.” The Building Blocks Program facilitates a dyadic therapeutic intervention with an underserved and often difficult-to-reach group of high-risk parents and children.    THE BEGINNINGS In 2011 Dr. Harvey Mar (then director of Psychological Services at NAC) and Dr. Phyllis Cohen (director of the New York Institute for Psychotherapy Training in Infancy, Childhood and Adolescence, NYIPT) conceptualized the Building Blocks Program, after a discussion about the overwhelming needs of the NAC families with young children involved in the child welfare system. The Building Blocks Program was developed to address the attachment deficits of the parents and children at NAC and to provide training and supervision for NAC therapists to work with those parents who are in danger of losing their parental rights or who have children already placed in foster care. Funding for this program has been received from more than one source.   The Building Blocks therapists were originally selected from a core of NAC licensed social workers and psychologists, interns and externs, mental health counselors, and art therapists. In the Spring of 2012, shortly after beginning the program, Dr. Mar passed away suddenly. Dr. Laura Parsons, a psychologist with experience in early childhood development, then took over as the Building Blocks agency director, overseeing administrative aspects of the program. NYIPT has provided training and clinical supervision and support to the therapists. In the social work department at NAC high-risk families from Foster Care and Prevention Services are identified and referred for various mental health services, including the Building Blocks Program. For many of the Building Blocks families, the risk of permanently losing their parental rights looms large. For some, their infants were removed and placed in foster care at birth. Birth parents whose children are already in foster care placement might participate in a Foster Care Services Program at NAC, or in the Bridges to Health program, a service that provides support to children who have been or are currently in foster care and who have developmental or behavioral challenges. Decisions regarding visitation schedules and custody are made by the larger systems of child protective services, foster care agencies, and, ultimately, family court. Initially, it was anticipated that parents and children would participate in the Building Blocks Program for a period of 6–12 months, however, for a variety of reasons, some cases have terminated within 1–2 months while others have lasted for 6–12 months and even several years. At this time, NYIPT has provided training, case consultation, and on-going Reflective Supervision for multiple therapists who have worked with several hundred families at NAC.  WHAT IS BUILDING BLOCKS?   The Building Blocks Program offers training and supervision to therapists who work dyadically with birth mothers and their young children under 5 who are at risk of being placed, or have already been placed, in foster care. The dyads are seen during their supervised visits in a clinic setting at the New Alternatives for Children. The parents come in with traumatic histories, including adverse childhood experiences, disrupted connections, mental illness, ongoing exposure to poverty and violence, and most have little social support. Many of the children have significant medical, emotional, and/or cognitive challenges.   The Building Blocks Program includes 3 Components: 1. Training for therapists to work with parent-child dyads; 2. Treatment for parents and children in supervised play/visitation sessions; and 3. Reflective Supervision with therapists in group and individual sessions. Our BB model utilizes a paradigm of Nested Mentalization in which a holding environment is provided for the therapists who, in turn, hold the parent, who can then hold the child. (Slade, 2005). Nested Mentalization provides an umbrella for the work while the therapists use video and videofeedback as a tool for positive change while promoting emotional healing and parent-child attachment. Videotaped session excerpts are presented in supervision for the therapists to learn to “see,” and in videofeedback with mothers to help stimulate their curiosity and promote a reflective stance. We aim for the parents to shift from controlling the child’s behavior through action, to thinking about the child’s mind, including their intentions, feelings, and thoughts. Based on their research, Miriam and Howard Steele suggest: “to help children [reach] …their full social and emotional potential, a central aim of intervention and prevention work must be to encourage reflective functioning in parents” (Steele & Steele, 2008, p.155).  And in the Reflective Supervision group, Building Blocks supervisors make every effort to understand the thoughts and feelings of the therapists to complete the Mentalization nest (A.Remez, JICAP, 2016),   The Building Blocks Program is an innovative psychodynamic treatment approach that was designed to work within a social service agency structure. It is based on concepts of attachment, attunement, and Reflective Functioning (Fonagy et al, 2002), and builds on the research of Beatrice Beebe (2003) in mother-infant interaction and non-verbal communication, and Howard and Miriam Steele (2008), and Dan Stern (1985).   Building Blocks was designed to help the most vulnerable disadvantaged high-risk parents and children who have physical and/or mental disabilities to be more emotionally available to their children. Many programs have been designed to help vulnerable parents by improving their capacity for reflection, but they are implemented in different settings. For example, in the GABI Program (Group Attachment Based Intervention) parent-infant dyads are seen in groups at Montefiore Hospital in the Bronx, New York (M. & H. Steele), and in the Minding the Baby Program, mothers and infants are seen in home settings in New Haven, Connecticut (A. Slade). In contrast, separate parent/infant dyads are seen in an agency setting at the New Alternatives for Children in New York City.   CHALLENGES AND GOALS OF THE BUILDING BLOCKS PROGRAM   Many of the Building Blocks parents are in distress, lacking the ability to provide adequate care for their children, foster emotional security, or show interest in their child’s affective experience. Many birth parents are overwhelmed by the challenges of life and may have little understanding of how to manage the specific problems related to their child’s diagnosis or how to recognize or respond to their child’s developmental needs. Because many of the parents are emotionally unstable and/or medically fragile, they may be unable to provide adequate stimulation for their child or cannot identify their nonverbal communication signals.   Thus, with so many impediments, many of the parents do not experience the joys and satisfactions from an emotional bond with their young child. Some may blame their own families or themselves for their untenable situation, some may experience helplessness as parents, and many have feelings of low self-worth. Their experience in the Building Blocks Program helps birth parents feel understood and known so that they can begin to make room to know and understand their vulnerable child.     For selected references on NYIPT and Building Blocks click here .

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