July 28, 2025 • 24 mins
Our guest for this episode is Dr Yvonne Maxwell, a forensic psychologist who specialises in working with individuals with a disability who come into contact with the criminal justice system.
Get Real spoke with Yvonne at the Complex Needs Conference 2025 where she presented on the use of Neurosequential Model of Therapeutics assessment (NMT) to understand the interplay between factors like disability, trauma, and the current circumstances of a person with complex needs.
if you are not a clinician or familiar with this, like me, listen on because Yvonne, who is the Portfolio Manager, Forensic Practice for SAL Consulting explains what it is and broadly about the impact of trauma on brain development, especially in early childhood.
ermha365 provides mental health and disability support for people in Victoria and the Northern Territory. Find out more about our services at our website.
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ermha365 acknowledges that our work in the community takes place on the Traditional Lands of many Aboriginal and Torres Strait Islander Peoples and therefore respectfully recognise their Elders, past and present, and the ongoing Custodianship of the Land and Water by all Members of these Communities.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Get Real is recorded on the unceded lands of the Boon
, Wurrung and Wurundjeri peoplesof the Kulin Nation.
We acknowledge and pay ourrespects to their elders, past
and present.
We also acknowledge that theFirst Peoples of Australia are
the first storytellers, thefirst artists and the first
creators of culture and wecelebrate their enduring
(00:21):
connections to country knowledgeand stories.
Celebrate their enduringconnections to country knowledge
and stories.
Speaker 2 (00:28):
Welcome to Get Real talking.
Mental health and disabilitybrought to you by the team at
Burma 365.
Speaker 1 (00:34):
Join our hosts, Emily Webb and Carenza Louis-Smith,
as we have frank and fearlessconversations with special
guests about all things mentalhealth and complexity with
special guests about all thingsmental health and complexity.
Speaker 3 (00:49):
We recognise people with lived experience of mental
ill health and disability, aswell as their families and
carers.
We recognise their strength,courage and unique perspective
as a vital contribution to thispodcast so we can learn, grow
and achieve better outcomestogether.
Speaker 4 (01:10):
Our guest for this episode is Dr Yvonne Maxwell, a
forensic psychologist whospecialises in working with
individuals with a disability,often intellectual or
developmental, who come intocontact with the criminal
justice system.
I spoke with Yvonne at theComplex Needs Conference earlier
this year, where she presentedon the use of Neurosequential
(01:34):
Model of Therapeutics Assessment, known as NMT, to understand
the interplay between factorslike disability, trauma and the
current circumstances of aperson with complex needs.
If you are not a clinician orfamiliar with this, like me,
listen on, because Yvonne, whoworks with Cell Consulting in
Melbourne, explains what it isand broadly about the impact of
(01:58):
trauma on brain development,especially in early childhood.
I learnt a lot during thisconversation.
Well, dr Yvonne Maxwell, thankyou so much for your time.
Today we're live at the ComplexNeeds Conference, day 1.
So, yvonne, you are presentingtomorrow, but tell us what do
(02:18):
you think so far about theconference?
Speaker 5 (02:20):
So far.
I think it's been reallyinteresting.
I really enjoyed the keynotepresentation this morning.
I was kind of reallyinteresting to see the
similarities between Canada, NewZealand and Australia for the
incarceration for women.
Speaker 4 (02:33):
Yeah, and that was one of the keynotes is Dr Tonya
Nichols, I believe she works alot in the space with yeah in
the criminal justice system inCanada.
So, yvonne, tell us about thework you do and your background.
Speaker 5 (02:47):
So I am a forensic psychologist and I specialise in
forensic disability, which issomething that I am really
passionate about.
I've always been passionateabout working with people with a
disability and started indisability support work and then
I've also had that interest inpsychology and forensic
psychology and decided that Icould mould them together, and
(03:08):
that's what I've been doing overthe last 10, 12 years
specialising in that forensicdisability space to have better
outcomes for people with adisability who are involved in
the criminal justice system.
Speaker 4 (03:19):
So did you start out your career in disability
support, then went on to dopsychology?
What did you do after you leftschool?
Speaker 5 (03:26):
Once I left school, I was studying a psychology
degree, and whilst I wasstudying the psychology degree I
was also working as adisability support worker and I
am technically still employed asa disability support worker and
do some disability supportoccasionally, because I think it
is a really valuable life skillto have.
And then, once I progressedthrough the psychology degrees,
(03:48):
I wanted to specialise inforensic.
So I applied for the Doctorateof Forensic Psychology and was
lucky enough to be one of thepeople that got one of those
places.
And where did you do that?
Deakin University.
Speaker 4 (04:00):
And so did your interest in forensic disability
in that space.
Did that evolve from when youstarted doing disability support
work and studying psychology,or do you have lived experience
or had you encountered thatbefore?
Speaker 5 (04:16):
So both my parents were police officers when I was
very young.
As well as then my mother movedinto being a parole officer
while I was in my teenage years.
So I guess I was exposed toboth sides, growing up around
people, working with people whowere offended and then also
having police in my earlychildhood.
(04:38):
And I guess I do have familymembers who have been
incarcerated as well and I sawand I've seen the struggles that
they've experienced as well.
Speaker 4 (04:46):
Yeah, so it's actually a good broad overview
to have, having that, you knowlens with police officers in the
family, but also the other side, so I can imagine that is very
good for the work you do.
You'll be presenting at theComplex Needs Conference about
the use of neuro-sequentialmodel of therapeutics assessment
with complex clientpresentations.
(05:07):
Now can you explain what thatmeans in simple terms?
I guess because we have peoplewho listen, who are not in the
space.
I mean, I myself am not aprofessional, but I love
learning about the kind of workthat's done.
So tell us about it?
Speaker 5 (05:25):
Yes, so the Neurosequential Model of
Therapeutics, or NMT as morecommonly referred to, is an
assessment process that wasdeveloped by Dr Bruce Perry and
it's quite often used withchildren in particularly for
children in out-of-home care,but it also can be used with
adults, adolescents there isactually no age range and it's
(05:45):
something that once I moved toworking with Cell Consulting
that they have had a reallystrong kind of passionate role
in using NMT assessments, andit's something that I then
became interested in knowingwhether that could be
incorporated within the forensicdisability work that I do.
And I guess in the NMTassessment space it's
essentially looking at the rolethat trauma has on the
(06:08):
development of the brain.
So starting from in utero andthen through childhood
development and understanding,where key developmental stages
of the brain could be impactedby trauma and the type of trauma
.
So the assessment aims to mapthat and it creates a brain map
essentially where it looks atwhere there might be impacts of
trauma in key developmentalstages which are then affecting
(06:31):
the behavioural presentation soyou know, because of attachment,
self-regulation and thoseaspects and then it allows us to
look at specifically wherethose areas might have been
impacted and design interventionto target the areas of need.
So how?
Speaker 4 (06:46):
long has this been in use?
Like is it recent or is it, youknow, a few years old?
Speaker 5 (06:50):
now Bruce Perry has been doing this work for quite a
long time and there are, youknow, various organisations.
Like I said, often do it withchildren.
I think that it is varied andprobably in the last few years
that it's been looked at alsofor adults and how that could be
supported to help with therepair of trauma and the
difficulties they've experienced.
Could you tell me who it is youwork for?
(07:13):
So I work for Cell Consulting,which is a private organisation
that focuses on supportingpeople with particularly complex
needs.
They initially had an office inNew South Wales, but now we
have offices in New South Wales.
But now we have offices in NewSouth Wales, Victoria, nt and WA
.
And so what's your day-to-day?
Speaker 4 (07:29):
work with them.
Speaker 5 (07:31):
My day-to-day work will vary.
I am the portfolio manager forforensic practice nationally, so
I oversee all our forensicstaff and provide supervision
and support to those staff, butI also then will engage in like
assessments such as the NMTassessment.
I will do risk assessments.
I do behaviour support forpeople with complex behaviour
(07:52):
needs.
One of the key focuses we haveas an organisation is that
everyone in the organisation,from the directors down, still
do face-to-face work withclients, because we think it's
really important to be able tokeep learning and experiencing
directly from our clients.
Speaker 4 (08:06):
Yeah, it's like I've worked with people who are still
registered nurses, who are inexecutive roles and they still
get on the tools and do you know, shifts on the hospital, just
to keep their registration, butalso because they love it.
So that sounds really good.
Now, when you conduct a riskassessment and treatment
progress reports, what are thekind of factors that you are
considering with that evaluation?
(08:28):
Is it pretty broad or is itdetailed?
Speaker 5 (08:32):
When I'm doing a risk assessment or a treatment
progress report, I often startoff quite broad, trying to
understand the person and theirlife experiences and then
utilising research such as theR&R model and the Good Lives
model from a forensicperspective to look at how the
criminogenic needs might berelevant to the client, also
(08:53):
looking at the trauma, mentalhealth, many of the other areas
as well.
Speaker 4 (08:57):
Yeah, so getting the life story and then kind of
delving into the different partsthat you need to know.
You just mentioned some modelsGood Life Model and R&R.
What are they?
Speaker 5 (09:08):
The Good Life Model and R&R, which is Risk Needs
Responsivity Model.
They are two models that areutilised within the forensic
space to understand what kind ofintervention or support might
be needed for a client.
So the R&R model looks at therisk level and making sure that
the responsivity and the needsof the person model looks at the
risk level and making sure thatthe responsivity and the needs
of the person are matching tothe risk level, for example,
(09:29):
that we don't over-servicepeople who are low risk, as that
might actually increase theirrisk, and that people who are
high risk have the high level ofsupport that they might need.
The good lives model looks atunderstanding the human needs
that are associated withoffending behaviour.
Speaker 4 (09:45):
So your wheelhouse, the people that you were working
with, have lived experience ofprison or forensic institutions.
Is that the cohort you'realways working with?
Speaker 5 (09:55):
The majority of the cohort that I'm working with is
often people who have had prisonexperience are incarcerated.
I do work at times withadolescents who might be at risk
of entering the justice system,and that is another piece of
work.
I guess I'm quite passionateabout having that opportunity to
support someone to have adifferent outcome other than
(10:16):
prison.
Speaker 4 (10:16):
Yeah, and it seems that early intervention is key.
But when you talk about seeingthe kind of impact that trauma
has on the brain, I mean itstarts very early, doesn't it?
Speaker 5 (10:28):
Yes, so people can experience trauma before they're
even born and that can have asignificant impact on the brain
and the brain development andthen how they have attachment in
early childhood.
Speaker 4 (10:38):
I found it really interesting my eldest daughter,
who finished year 12 last year.
She was doing psychology andone day she came home and she
said do you know that trauma canimprint on your DNA in utero
when you're actually not bornyet?
And I was like, wow, I actuallydidn't know that.
And she was just blown away bythat.
Is that, do you think a lot ofpeople don't realise?
Speaker 5 (10:58):
that I think, unless you're in the space or you know
working in the field, that it'snot particularly talked about a
lot on social media or, and it'squite complex, I guess, to
understand the DNA and theimpacts of trauma.
So I think there probably isquite a few people who don't
necessarily understand or haveaccess to that knowledge and so
(11:18):
with neuro-sequential model oftherapeutics assessment.
Speaker 4 (11:23):
What are some of the positive outcomes that can come
from using that on children, butalso adults, Because I imagine
that the impact on adults isprobably obviously a lot longer
because they're older.
But like, what are the goodthings you're seeing?
Speaker 5 (11:37):
with it.
So I've had a few clients wherewe've been working with them for
a number of years and we'veutilised the neuro-sequential
model of therapeutics assessmentand because you can also track
the experiences of persons,we've been able to utilise that
assessment to identify whatintervention should be
implemented first, because oftenwe, particularly with adults,
(11:57):
will seek to go to talk therapyor other interventions and if
that person and their experienceof trauma has impacted on the
brain quite early, they mightstill need some work in the
attachment phase.
So one of the clients I wasworking with for a year we spent
a heavy focus on just buildinga relationship with staff and
that was the therapeuticintervention at that point.
(12:18):
And after that point, once wewere then able to redo the
assessment and look at theincreases or the positive
outcomes from that building ofrelationship, we were able to
actually start then looking atwhether play therapy or art
therapy would be something thatcould be useful for that client.
And I've done that with anumber of clients over the last
few years where we've been ableto target the intervention and
(12:40):
also justify why we might not bedoing intervention that would
be more traditional in a sense,and in those examples we have
seen better outcomes withreduced behaviours of concern,
reduction in contact with thejustice system.
Speaker 4 (12:55):
So I'm quite passionate about incorporating
the NMT into forensic disabilitybecause I have seen the
outcomes, have worked to seewhat the outcomes could look
like, and so it sounds like withthat model of assessment, then
you can essentially tailor, makethe treatment, the therapy, to
that person, instead of, I guess, as you said, going down the
(13:15):
traditional route of trying X, yand Z and it's not going to
work.
Is that true to?
Speaker 5 (13:19):
say, I think, tailor make and also know the order and
the timing, because oftenpeople have really good
opportunities or ideas aboutwhat might be needed.
Particularly when we're workingin that complex space, there'll
be a lot of people trying tosupport that person and
sometimes it's not that thetherapy or the intervention is
not good or not working, butit's not the right timing for it
(13:40):
.
So being able to order it andunderstand that we can't expect
someone to understand respectand self-respect if they haven't
developed an attachment toother people, because how do you
understand that people shouldbe respected or you should have
self-respect if you don'tactually have attachment to
others is something that beingable to explain that to staff,
(14:00):
being able to explain that tocare teams and then work with
that person to build attachmentI've seen that as being a
positive outcome for the clients, but also for the staff to
understand why we're not justthrowing psychology, speech,
therapy, ot at the clients aswell.
Speaker 4 (14:14):
I'm finding this really fascinating and you've
mentioned a few times theimportance of attachment and
that lack of or, you know, notunderstanding what that is is
quite significant.
Can you just explain about therole of attachment and I guess,
if someone's got trauma, I'veheard the term attachment
disorder.
I don't know what the properterm is, but can you just
(14:36):
explain a bit more about thatand why attachment is so
important?
Speaker 5 (14:41):
yep.
So when we think aboutattachment and child development
, that is one of the firstthings that happen in a
traditional or ideal space, oncethe baby is born, there would
be an attachment that's formedto the carer so often mum, but
if it is in other situations itmight be dad or, you know, a
family member or somebody elseand in the first few weeks to
(15:04):
months to years the baby willdevelop an attachment.
And ideally we want a secureattachment where baby knows that
the main carer will be aroundbut is has the opportunity to
start exploring, growing theworld, but knowing that the main
carer is the safe person.
When people experience traumatheir main carer may not have
the capacity for some reason tobe able to be that safe person.
(15:27):
So then the world becomesdangerous and scary because it's
not predictable in that spaceand we might then see that child
have, you know, kind ofdisconnected, avoidant
attachment, where they're justnot really, they don't really
see people as helpful becausepeople have been unsafe.
Or they might become overattached in their attachment to
others, where they then areparticularly like needy or
(15:49):
clingy to adults because againthey're not really sure what's
safe or what's okay.
Speaker 4 (15:54):
So they're often will go one way or the other and I'm
guessing that obviously carriesthrough to adulthood and you
will see the impact of that inthe people that you support and
have supported.
Speaker 5 (16:11):
Yes.
So it imprints, I guess, ontopeople's beliefs and values
about the world.
If you've not had safeattachments in early childhood,
when you're then an adolescentor a young adult trying to see
the world, it's really difficultto trust what other people are
saying so when they might befalling into the wrong crowd or
trying to start relationshipsand work out their friendships
and who they are in the world.
If they don't have those keysupports or have that key
experience that people can betrusted, people are safe and
(16:33):
okay, then it makes it reallydifficult for them to trust the
people around them and they maymake decisions that aren't as
helpful for them.
Speaker 4 (16:42):
And I guess that just then compounds the barriers and
the issues and things thatthey're experiencing.
Yes and so, if you are needingto work on attachment first,
what are some of the things thatmay happen?
Like, what may you do withsomeone?
I guess it depends on theindividual.
Speaker 5 (17:01):
It does depend on the individual, but some of the
things that we might look at ispredictability, particularly so
we know that repetitiveengagement and predictable
engagement is really important,and that doesn't necessarily
mean having the same peopleevery time, because we know in
the disability world, theforensic world, that sometimes
there can be quite a lot ofchanges between staff.
(17:22):
But having a predictableengagement in how staff are
engaging so that might be whatthey say when they come on shift
, that might be what kind ofactivities are available and
making sure that the staff can,while still being individualised
and being a person, bepredictable in how they're going
to reach out to that person,whether it's a child or an adult
(17:43):
.
And then look at other things,such as making sure that not all
activities are instruction orauthority based.
So what can we do so that theclient that we're working with
knows that the staff membershave a level of interest in them
as a person?
The interplay between alsostaff and how they engage with
(18:04):
each other is really important,so that they can see that, I
guess what's an appropriatemodelling of engagement as well.
So fascinating.
Speaker 4 (18:13):
I forgot to actually ask you as well when we talk
about forensic disability.
Actually ask you as well whenwe talk about forensic
disability.
Speaker 5 (18:20):
What are we talking about?
Forensic disability isessentially, it's a very well.
It can be broad in terms oflooking at people who have a
disability, have come intocontact with the justice system.
So it does both talk to, Iguess, perpetrators of violence
or other types of offending, butalso it could be victim
survivors as well.
I primarily work withperpetrators of who have engaged
in offending, but also it couldbe victim survivors as well.
I primarily work withperpetrators of, who have
(18:41):
engaged in offending or who mayengage in offending behaviour
and, in looking at it, I guess,all types of offending behaviour
that someone might engage withor have come into contact with
the justice system for.
Speaker 4 (18:53):
And the work you're doing.
I get very much the sense thatit's about prevention, it's
about improving the lives ofthese people so that I guess the
risk of recidivism,re-offending is low, but it's
also, I'm guessing, abouthelping them to live in the
community like safely forthemselves and others yes, so
(19:13):
many of the clients that I'veworked with.
Speaker 5 (19:15):
they have trauma, trauma histories.
They have mental healthdifficulties, drug and alcohol
issues.
They've had, you know, notnecessarily the easiest life,
and providing that person withthe support to live the best
life that they can, I think isreally important because then
that allows to make sure thatthey can live in the community
safely and ultimately that meansthat there's less victims as
well of crime in that space,victims as well of crime in that
(19:38):
space.
Speaker 4 (19:38):
So we know that the people that you know
professionals like yourself andall the people here at the
conference work with you knowthe general community.
Look, they don't have a lot ofsympathy for them.
There's often things thatmisconstrue the experiences of
(19:58):
these people, but also they havedone things that are dangerous
of these people, but also theyhave done things that are
dangerous.
But I mean, what do you wantpeople to understand who don't
work in this space and see whatyou see every day?
What do you want people tounderstand about why it's so
important that we don't give upon people who have these complex
needs?
Have had experience of prisonand you know difficulties and
things like that.
(20:19):
What would you like them toknow?
Speaker 5 (20:20):
I think in my experience of working in this
space, I've never done anassessment.
I've done thousands ofassessments at this point.
I've never done an assessmentwhere I've walked away saying I
don't think that person's worthhelping or they've just done it,
because there's always factorsand reasons that have come into
play and some people might thinkthat they that helps understand
(20:42):
why, or people other peoplemight say that doesn't matter.
Not everyone with thoseexperiences would do an offence.
But what I guess I'veunderstood is that offending and
people's experience of life isnot not as simple as good or bad
.
And you know, there is, I think, people who are in the system,
who are stuck in the system, andthey've had really hard life
(21:04):
experiences, and I guess my viewis that my job is to, like I
said, make sure that if I canhelp these people and support
them to have better lives, thenthat also has a positive impact
on the community because itmeans that there's less likely
to be an offence from thatperson.
I think that is not worthgiving up on.
Speaker 4 (21:22):
What keeps you doing this work?
It's not easy work.
You're working in a space thatnot everyone can do this what
keeps you motivated?
What keeps you just going?
Yeah, this is it.
I guess you enjoy it and it'simportant work.
But what keeps you going?
Speaker 5 (21:39):
because you know you can burn out, and it can, I
guess, sometimes feel not alwayspositive and I think it can be
hard when, when things go wrongor we have outcomes that we
don't desire, it can be reallyhard and there is that risk of
burnout.
I guess those small wins for meare really important in that we
might have seen some success or,you know, a client might have
(22:03):
that was really difficult toengage has started engaging.
Those are along the like longertrajectory.
I have some clients who I'vebeen working with for like five,
six years at this point andbeing able to look at the data
that we collect and see thedifference and see the outcomes.
I have one client where overthe last year they've halved
their behaviours of concern andthat's going from I think it was
(22:26):
200 and something to 86.
So you know, those thingsthey're the things that keep me
going, because I can see thatwhat we are doing is working in
some way and I really just wantto keep on doing that and being
able to support, like I said,the better outcomes.
Speaker 4 (22:41):
So you're presenting at the Complex Needs Conference?
What do you want people in theroom when you're presenting to
know?
What are you hoping that theyget from your presentation?
Speaker 5 (22:50):
I think from the presentation I am really keen
for people to understand thatthere is another way of
including the neuro sequentialmodel of therapeutics,
particularly of adults, and thatit can be effective, not
necessarily in changing theintervention that might be doing
, but the timing and looking atthe order that we do things so
that we can have the bestoutcomes and what is dr yvonne
(23:13):
maxwell's magic wand solution?
Speaker 4 (23:16):
if there was something that you could wave
the magic wand and you think,wow, this would make such a
difference.
You know, we know that it's notas easy as that, but what's?
Speaker 5 (23:26):
what's something you think, gosh, I wish, I wish we
could do that I think I wouldwish that we had enough
resources to be able to supportthose people in early
intervention.
So, as I said before, my myrole is to work with people with
particularly complex needs, butI would love there to be a
space where my role wasn'tneeded anymore, because we could
catch everyone at the earlystages.
Speaker 4 (23:46):
And do you have any final thoughts before we wrap up
that I haven't covered or thatyou want to share with listeners
?
Speaker 5 (23:52):
Just that it is important to look at and
understand the why, because ifwe don't understand the why then
it's really hard to make achange to those behaviours.
Speaker 4 (24:02):
Yvonne, thank you so much for your time, especially
while you're at the conferenceand you want to go to different
presentations.
Honestly, we're so grateful, sothank you for joining us.
Thank you.
Speaker 2 (24:11):
You've been listening to Get Real talking mental
health and disability, broughtto you by the team at Irma 365.
Get Real is produced andpresented by Emily Webb, with
Corenza Louis-Smith and specialguests.
Thanks for listening and we'llsee you next time.
Get Real is recorded on the unceded lands of the Boon
, Wurrung and Wurundjeri peoplesof the Kulin Nation.
We acknowledge and pay ourrespects to their elders, past
and present.
We also acknowledge that theFirst Peoples of Australia are
the first storytellers, thefirst artists and the first
creators of culture and wecelebrate their enduring
(00:21):
connections to country knowledgeand stories.
Celebrate their enduringconnections to country knowledge
and stories.
Speaker 2 (00:28):
Welcome to Get Real talking.
Mental health and disabilitybrought to you by the team at
Burma 365.
Speaker 1 (00:34):
Join our hosts, Emily Webb and Carenza Louis-Smith,
as we have frank and fearlessconversations with special
guests about all things mentalhealth and complexity with
special guests about all thingsmental health and complexity.
Speaker 3 (00:49):
We recognise people with lived experience of mental
ill health and disability, aswell as their families and
carers.
We recognise their strength,courage and unique perspective
as a vital contribution to thispodcast so we can learn, grow
and achieve better outcomestogether.
Speaker 4 (01:10):
Our guest for this episode is Dr Yvonne Maxwell, a
forensic psychologist whospecialises in working with
individuals with a disability,often intellectual or
developmental, who come intocontact with the criminal
justice system.
I spoke with Yvonne at theComplex Needs Conference earlier
this year, where she presentedon the use of Neurosequential
(01:34):
Model of Therapeutics Assessment, known as NMT, to understand
the interplay between factorslike disability, trauma and the
current circumstances of aperson with complex needs.
If you are not a clinician orfamiliar with this, like me,
listen on, because Yvonne, whoworks with Cell Consulting in
Melbourne, explains what it isand broadly about the impact of
(01:58):
trauma on brain development,especially in early childhood.
I learnt a lot during thisconversation.
Well, dr Yvonne Maxwell, thankyou so much for your time.
Today we're live at the ComplexNeeds Conference, day 1.
So, yvonne, you are presentingtomorrow, but tell us what do
(02:18):
you think so far about theconference?
Speaker 5 (02:20):
So far.
I think it's been reallyinteresting.
I really enjoyed the keynotepresentation this morning.
I was kind of reallyinteresting to see the
similarities between Canada, NewZealand and Australia for the
incarceration for women.
Speaker 4 (02:33):
Yeah, and that was one of the keynotes is Dr Tonya
Nichols, I believe she works alot in the space with yeah in
the criminal justice system inCanada.
So, yvonne, tell us about thework you do and your background.
Speaker 5 (02:47):
So I am a forensic psychologist and I specialise in
forensic disability, which issomething that I am really
passionate about.
I've always been passionateabout working with people with a
disability and started indisability support work and then
I've also had that interest inpsychology and forensic
psychology and decided that Icould mould them together, and
(03:08):
that's what I've been doing overthe last 10, 12 years
specialising in that forensicdisability space to have better
outcomes for people with adisability who are involved in
the criminal justice system.
Speaker 4 (03:19):
So did you start out your career in disability
support, then went on to dopsychology?
What did you do after you leftschool?
Speaker 5 (03:26):
Once I left school, I was studying a psychology
degree, and whilst I wasstudying the psychology degree I
was also working as adisability support worker and I
am technically still employed asa disability support worker and
do some disability supportoccasionally, because I think it
is a really valuable life skillto have.
And then, once I progressedthrough the psychology degrees,
(03:48):
I wanted to specialise inforensic.
So I applied for the Doctorateof Forensic Psychology and was
lucky enough to be one of thepeople that got one of those
places.
And where did you do that?
Deakin University.
Speaker 4 (04:00):
And so did your interest in forensic disability
in that space.
Did that evolve from when youstarted doing disability support
work and studying psychology,or do you have lived experience
or had you encountered thatbefore?
Speaker 5 (04:16):
So both my parents were police officers when I was
very young.
As well as then my mother movedinto being a parole officer
while I was in my teenage years.
So I guess I was exposed toboth sides, growing up around
people, working with people whowere offended and then also
having police in my earlychildhood.
(04:38):
And I guess I do have familymembers who have been
incarcerated as well and I sawand I've seen the struggles that
they've experienced as well.
Speaker 4 (04:46):
Yeah, so it's actually a good broad overview
to have, having that, you knowlens with police officers in the
family, but also the other side, so I can imagine that is very
good for the work you do.
You'll be presenting at theComplex Needs Conference about
the use of neuro-sequentialmodel of therapeutics assessment
with complex clientpresentations.
(05:07):
Now can you explain what thatmeans in simple terms?
I guess because we have peoplewho listen, who are not in the
space.
I mean, I myself am not aprofessional, but I love
learning about the kind of workthat's done.
So tell us about it?
Speaker 5 (05:25):
Yes, so the Neurosequential Model of
Therapeutics, or NMT as morecommonly referred to, is an
assessment process that wasdeveloped by Dr Bruce Perry and
it's quite often used withchildren in particularly for
children in out-of-home care,but it also can be used with
adults, adolescents there isactually no age range and it's
(05:45):
something that once I moved toworking with Cell Consulting
that they have had a reallystrong kind of passionate role
in using NMT assessments, andit's something that I then
became interested in knowingwhether that could be
incorporated within the forensicdisability work that I do.
And I guess in the NMTassessment space it's
essentially looking at the rolethat trauma has on the
(06:08):
development of the brain.
So starting from in utero andthen through childhood
development and understanding,where key developmental stages
of the brain could be impactedby trauma and the type of trauma
.
So the assessment aims to mapthat and it creates a brain map
essentially where it looks atwhere there might be impacts of
trauma in key developmentalstages which are then affecting
(06:31):
the behavioural presentation soyou know, because of attachment,
self-regulation and thoseaspects and then it allows us to
look at specifically wherethose areas might have been
impacted and design interventionto target the areas of need.
So how?
Speaker 4 (06:46):
long has this been in use?
Like is it recent or is it, youknow, a few years old?
Speaker 5 (06:50):
now Bruce Perry has been doing this work for quite a
long time and there are, youknow, various organisations.
Like I said, often do it withchildren.
I think that it is varied andprobably in the last few years
that it's been looked at alsofor adults and how that could be
supported to help with therepair of trauma and the
difficulties they've experienced.
Could you tell me who it is youwork for?
(07:13):
So I work for Cell Consulting,which is a private organisation
that focuses on supportingpeople with particularly complex
needs.
They initially had an office inNew South Wales, but now we
have offices in New South Wales.
But now we have offices in NewSouth Wales, Victoria, nt and WA
.
And so what's your day-to-day?
Speaker 4 (07:29):
work with them.
Speaker 5 (07:31):
My day-to-day work will vary.
I am the portfolio manager forforensic practice nationally, so
I oversee all our forensicstaff and provide supervision
and support to those staff, butI also then will engage in like
assessments such as the NMTassessment.
I will do risk assessments.
I do behaviour support forpeople with complex behaviour
(07:52):
needs.
One of the key focuses we haveas an organisation is that
everyone in the organisation,from the directors down, still
do face-to-face work withclients, because we think it's
really important to be able tokeep learning and experiencing
directly from our clients.
Speaker 4 (08:06):
Yeah, it's like I've worked with people who are still
registered nurses, who are inexecutive roles and they still
get on the tools and do you know, shifts on the hospital, just
to keep their registration, butalso because they love it.
So that sounds really good.
Now, when you conduct a riskassessment and treatment
progress reports, what are thekind of factors that you are
considering with that evaluation?
(08:28):
Is it pretty broad or is itdetailed?
Speaker 5 (08:32):
When I'm doing a risk assessment or a treatment
progress report, I often startoff quite broad, trying to
understand the person and theirlife experiences and then
utilising research such as theR&R model and the Good Lives
model from a forensicperspective to look at how the
criminogenic needs might berelevant to the client, also
(08:53):
looking at the trauma, mentalhealth, many of the other areas
as well.
Speaker 4 (08:57):
Yeah, so getting the life story and then kind of
delving into the different partsthat you need to know.
You just mentioned some modelsGood Life Model and R&R.
What are they?
Speaker 5 (09:08):
The Good Life Model and R&R, which is Risk Needs
Responsivity Model.
They are two models that areutilised within the forensic
space to understand what kind ofintervention or support might
be needed for a client.
So the R&R model looks at therisk level and making sure that
the responsivity and the needsof the person model looks at the
risk level and making sure thatthe responsivity and the needs
of the person are matching tothe risk level, for example,
(09:29):
that we don't over-servicepeople who are low risk, as that
might actually increase theirrisk, and that people who are
high risk have the high level ofsupport that they might need.
The good lives model looks atunderstanding the human needs
that are associated withoffending behaviour.
Speaker 4 (09:45):
So your wheelhouse, the people that you were working
with, have lived experience ofprison or forensic institutions.
Is that the cohort you'realways working with?
Speaker 5 (09:55):
The majority of the cohort that I'm working with is
often people who have had prisonexperience are incarcerated.
I do work at times withadolescents who might be at risk
of entering the justice system,and that is another piece of
work.
I guess I'm quite passionateabout having that opportunity to
support someone to have adifferent outcome other than
(10:16):
prison.
Speaker 4 (10:16):
Yeah, and it seems that early intervention is key.
But when you talk about seeingthe kind of impact that trauma
has on the brain, I mean itstarts very early, doesn't it?
Speaker 5 (10:28):
Yes, so people can experience trauma before they're
even born and that can have asignificant impact on the brain
and the brain development andthen how they have attachment in
early childhood.
Speaker 4 (10:38):
I found it really interesting my eldest daughter,
who finished year 12 last year.
She was doing psychology andone day she came home and she
said do you know that trauma canimprint on your DNA in utero
when you're actually not bornyet?
And I was like, wow, I actuallydidn't know that.
And she was just blown away bythat.
Is that, do you think a lot ofpeople don't realise?
Speaker 5 (10:58):
that I think, unless you're in the space or you know
working in the field, that it'snot particularly talked about a
lot on social media or, and it'squite complex, I guess, to
understand the DNA and theimpacts of trauma.
So I think there probably isquite a few people who don't
necessarily understand or haveaccess to that knowledge and so
(11:18):
with neuro-sequential model oftherapeutics assessment.
Speaker 4 (11:23):
What are some of the positive outcomes that can come
from using that on children, butalso adults, Because I imagine
that the impact on adults isprobably obviously a lot longer
because they're older.
But like, what are the goodthings you're seeing?
Speaker 5 (11:37):
with it.
So I've had a few clients wherewe've been working with them for
a number of years and we'veutilised the neuro-sequential
model of therapeutics assessmentand because you can also track
the experiences of persons,we've been able to utilise that
assessment to identify whatintervention should be
implemented first, because oftenwe, particularly with adults,
(11:57):
will seek to go to talk therapyor other interventions and if
that person and their experienceof trauma has impacted on the
brain quite early, they mightstill need some work in the
attachment phase.
So one of the clients I wasworking with for a year we spent
a heavy focus on just buildinga relationship with staff and
that was the therapeuticintervention at that point.
(12:18):
And after that point, once wewere then able to redo the
assessment and look at theincreases or the positive
outcomes from that building ofrelationship, we were able to
actually start then looking atwhether play therapy or art
therapy would be something thatcould be useful for that client.
And I've done that with anumber of clients over the last
few years where we've been ableto target the intervention and
(12:40):
also justify why we might not bedoing intervention that would
be more traditional in a sense,and in those examples we have
seen better outcomes withreduced behaviours of concern,
reduction in contact with thejustice system.
Speaker 4 (12:55):
So I'm quite passionate about incorporating
the NMT into forensic disabilitybecause I have seen the
outcomes, have worked to seewhat the outcomes could look
like, and so it sounds like withthat model of assessment, then
you can essentially tailor, makethe treatment, the therapy, to
that person, instead of, I guess, as you said, going down the
(13:15):
traditional route of trying X, yand Z and it's not going to
work.
Is that true to?
Speaker 5 (13:19):
say, I think, tailor make and also know the order and
the timing, because oftenpeople have really good
opportunities or ideas aboutwhat might be needed.
Particularly when we're workingin that complex space, there'll
be a lot of people trying tosupport that person and
sometimes it's not that thetherapy or the intervention is
not good or not working, butit's not the right timing for it
(13:40):
.
So being able to order it andunderstand that we can't expect
someone to understand respectand self-respect if they haven't
developed an attachment toother people, because how do you
understand that people shouldbe respected or you should have
self-respect if you don'tactually have attachment to
others is something that beingable to explain that to staff,
(14:00):
being able to explain that tocare teams and then work with
that person to build attachmentI've seen that as being a
positive outcome for the clients, but also for the staff to
understand why we're not justthrowing psychology, speech,
therapy, ot at the clients aswell.
Speaker 4 (14:14):
I'm finding this really fascinating and you've
mentioned a few times theimportance of attachment and
that lack of or, you know, notunderstanding what that is is
quite significant.
Can you just explain about therole of attachment and I guess,
if someone's got trauma, I'veheard the term attachment
disorder.
I don't know what the properterm is, but can you just
(14:36):
explain a bit more about thatand why attachment is so
important?
Speaker 5 (14:41):
yep.
So when we think aboutattachment and child development
, that is one of the firstthings that happen in a
traditional or ideal space, oncethe baby is born, there would
be an attachment that's formedto the carer so often mum, but
if it is in other situations itmight be dad or, you know, a
family member or somebody elseand in the first few weeks to
(15:04):
months to years the baby willdevelop an attachment.
And ideally we want a secureattachment where baby knows that
the main carer will be aroundbut is has the opportunity to
start exploring, growing theworld, but knowing that the main
carer is the safe person.
When people experience traumatheir main carer may not have
the capacity for some reason tobe able to be that safe person.
(15:27):
So then the world becomesdangerous and scary because it's
not predictable in that spaceand we might then see that child
have, you know, kind ofdisconnected, avoidant
attachment, where they're justnot really, they don't really
see people as helpful becausepeople have been unsafe.
Or they might become overattached in their attachment to
others, where they then areparticularly like needy or
(15:49):
clingy to adults because againthey're not really sure what's
safe or what's okay.
Speaker 4 (15:54):
So they're often will go one way or the other and I'm
guessing that obviously carriesthrough to adulthood and you
will see the impact of that inthe people that you support and
have supported.
Speaker 5 (16:11):
Yes.
So it imprints, I guess, ontopeople's beliefs and values
about the world.
If you've not had safeattachments in early childhood,
when you're then an adolescentor a young adult trying to see
the world, it's really difficultto trust what other people are
saying so when they might befalling into the wrong crowd or
trying to start relationshipsand work out their friendships
and who they are in the world.
If they don't have those keysupports or have that key
experience that people can betrusted, people are safe and
(16:33):
okay, then it makes it reallydifficult for them to trust the
people around them and they maymake decisions that aren't as
helpful for them.
Speaker 4 (16:42):
And I guess that just then compounds the barriers and
the issues and things thatthey're experiencing.
Yes and so, if you are needingto work on attachment first,
what are some of the things thatmay happen?
Like, what may you do withsomeone?
I guess it depends on theindividual.
Speaker 5 (17:01):
It does depend on the individual, but some of the
things that we might look at ispredictability, particularly so
we know that repetitiveengagement and predictable
engagement is really important,and that doesn't necessarily
mean having the same peopleevery time, because we know in
the disability world, theforensic world, that sometimes
there can be quite a lot ofchanges between staff.
(17:22):
But having a predictableengagement in how staff are
engaging so that might be whatthey say when they come on shift
, that might be what kind ofactivities are available and
making sure that the staff can,while still being individualised
and being a person, bepredictable in how they're going
to reach out to that person,whether it's a child or an adult
(17:43):
.
And then look at other things,such as making sure that not all
activities are instruction orauthority based.
So what can we do so that theclient that we're working with
knows that the staff membershave a level of interest in them
as a person?
The interplay between alsostaff and how they engage with
(18:04):
each other is really important,so that they can see that, I
guess what's an appropriatemodelling of engagement as well.
So fascinating.
Speaker 4 (18:13):
I forgot to actually ask you as well when we talk
about forensic disability.
Actually ask you as well whenwe talk about forensic
disability.
Speaker 5 (18:20):
What are we talking about?
Forensic disability isessentially, it's a very well.
It can be broad in terms oflooking at people who have a
disability, have come intocontact with the justice system.
So it does both talk to, Iguess, perpetrators of violence
or other types of offending, butalso it could be victim
survivors as well.
I primarily work withperpetrators of who have engaged
in offending, but also it couldbe victim survivors as well.
I primarily work withperpetrators of, who have
(18:41):
engaged in offending or who mayengage in offending behaviour
and, in looking at it, I guess,all types of offending behaviour
that someone might engage withor have come into contact with
the justice system for.
Speaker 4 (18:53):
And the work you're doing.
I get very much the sense thatit's about prevention, it's
about improving the lives ofthese people so that I guess the
risk of recidivism,re-offending is low, but it's
also, I'm guessing, abouthelping them to live in the
community like safely forthemselves and others yes, so
(19:13):
many of the clients that I'veworked with.
Speaker 5 (19:15):
they have trauma, trauma histories.
They have mental healthdifficulties, drug and alcohol
issues.
They've had, you know, notnecessarily the easiest life,
and providing that person withthe support to live the best
life that they can, I think isreally important because then
that allows to make sure thatthey can live in the community
safely and ultimately that meansthat there's less victims as
well of crime in that space,victims as well of crime in that
(19:38):
space.
Speaker 4 (19:38):
So we know that the people that you know
professionals like yourself andall the people here at the
conference work with you knowthe general community.
Look, they don't have a lot ofsympathy for them.
There's often things thatmisconstrue the experiences of
(19:58):
these people, but also they havedone things that are dangerous
of these people, but also theyhave done things that are
dangerous.
But I mean, what do you wantpeople to understand who don't
work in this space and see whatyou see every day?
What do you want people tounderstand about why it's so
important that we don't give upon people who have these complex
needs?
Have had experience of prisonand you know difficulties and
things like that.
(20:19):
What would you like them toknow?
Speaker 5 (20:20):
I think in my experience of working in this
space, I've never done anassessment.
I've done thousands ofassessments at this point.
I've never done an assessmentwhere I've walked away saying I
don't think that person's worthhelping or they've just done it,
because there's always factorsand reasons that have come into
play and some people might thinkthat they that helps understand
(20:42):
why, or people other peoplemight say that doesn't matter.
Not everyone with thoseexperiences would do an offence.
But what I guess I'veunderstood is that offending and
people's experience of life isnot not as simple as good or bad
.
And you know, there is, I think, people who are in the system,
who are stuck in the system, andthey've had really hard life
(21:04):
experiences, and I guess my viewis that my job is to, like I
said, make sure that if I canhelp these people and support
them to have better lives, thenthat also has a positive impact
on the community because itmeans that there's less likely
to be an offence from thatperson.
I think that is not worthgiving up on.
Speaker 4 (21:22):
What keeps you doing this work?
It's not easy work.
You're working in a space thatnot everyone can do this what
keeps you motivated?
What keeps you just going?
Yeah, this is it.
I guess you enjoy it and it'simportant work.
But what keeps you going?
Speaker 5 (21:39):
because you know you can burn out, and it can, I
guess, sometimes feel not alwayspositive and I think it can be
hard when, when things go wrongor we have outcomes that we
don't desire, it can be reallyhard and there is that risk of
burnout.
I guess those small wins for meare really important in that we
might have seen some success or,you know, a client might have
(22:03):
that was really difficult toengage has started engaging.
Those are along the like longertrajectory.
I have some clients who I'vebeen working with for like five,
six years at this point andbeing able to look at the data
that we collect and see thedifference and see the outcomes.
I have one client where overthe last year they've halved
their behaviours of concern andthat's going from I think it was
(22:26):
200 and something to 86.
So you know, those thingsthey're the things that keep me
going, because I can see thatwhat we are doing is working in
some way and I really just wantto keep on doing that and being
able to support, like I said,the better outcomes.
Speaker 4 (22:41):
So you're presenting at the Complex Needs Conference?
What do you want people in theroom when you're presenting to
know?
What are you hoping that theyget from your presentation?
Speaker 5 (22:50):
I think from the presentation I am really keen
for people to understand thatthere is another way of
including the neuro sequentialmodel of therapeutics,
particularly of adults, and thatit can be effective, not
necessarily in changing theintervention that might be doing
, but the timing and looking atthe order that we do things so
that we can have the bestoutcomes and what is dr yvonne
(23:13):
maxwell's magic wand solution?
Speaker 4 (23:16):
if there was something that you could wave
the magic wand and you think,wow, this would make such a
difference.
You know, we know that it's notas easy as that, but what's?
Speaker 5 (23:26):
what's something you think, gosh, I wish, I wish we
could do that I think I wouldwish that we had enough
resources to be able to supportthose people in early
intervention.
So, as I said before, my myrole is to work with people with
particularly complex needs, butI would love there to be a
space where my role wasn'tneeded anymore, because we could
catch everyone at the earlystages.
Speaker 4 (23:46):
And do you have any final thoughts before we wrap up
that I haven't covered or thatyou want to share with listeners
?
Speaker 5 (23:52):
Just that it is important to look at and
understand the why, because ifwe don't understand the why then
it's really hard to make achange to those behaviours.
Speaker 4 (24:02):
Yvonne, thank you so much for your time, especially
while you're at the conferenceand you want to go to different
presentations.
Honestly, we're so grateful, sothank you for joining us.
Thank you.
Speaker 2 (24:11):
You've been listening to Get Real talking mental
health and disability, broughtto you by the team at Irma 365.
Get Real is produced andpresented by Emily Webb, with
Corenza Louis-Smith and specialguests.
Thanks for listening and we'llsee you next time.
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