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Updated July 2014
Affilliated Service Sites using Reflective Network Therapy
 
Seattle, WA   <> St. Louis, MO  <> Cambridge, MA  <>  Piedmont, CA   <> Buenos Aires  <> Walnut Lake Preschool
 
  Summary and Perspective

The University City Children's Center of St. Louis, MO received funding (summer, 2009) from The Lutheran Foundation to staff and be trained in Reflective Network Therapy. Wellspring Family Services of Seattle (formerly Family Services) received Kresge Foundation funds which will cover adiditional RNT classrooms in Wellspring's new facility. Gilbert Kliman, MD, Medical Director of The Children's Psychological Health Center and Steven Zwolak, M.Ed. of the University Child Care Center will be leading their respective teams in the St. Louis collaboration. Keith Myers, LICSW, VP of Clinical and Training Services for Wellspring  and Dr. Kliman are collaborating and coordinating efforts to develop new teacher-therapist teams to treat more children. Their hope is that this expanding model of combining education and therapy will become an in-classroom Reflective Network Therapy training center for for the Northwest. Similarly, it is hoped that the University Child Care Center in St. Louis will provide a center for in-classroom training in the nation's mid-region. Ann Martin Center will continue modeling mental health agency based Reflective Network Therapy services in California. Alicia Mallo, MD continues training of therapists in Buenos Aires. Alexandra Harrison, MD continues her innovative use of Reflective Network Therapy, in Cambridge, MA.

The multiplicity of Reflective Network Therapy service sites is now a basis for further design of data collection and outcome studies. The number of children served also brings new opportunities for more control and comparison data to be organized. We seek advice and help in obtaining funding for such studies. There is  a world-wide recognized need for cost effective ways to help preschoolers with serious psychiatric and developmental disorders such as autism, and Reflective Network Therapy is ready for widespread application. We think our agency is at the leading edge of delivering an evidence-based, replicable, manualized and cost efficient method for helping autistic preschoolers as well as preschoolers who have been psychologically traumatized. 

Wellspring Family Services

-A community-based agency treating homeless and recently homeless traumatized children in transitional housing

In its new facility, in addition to continuing Reflective Network Therapy for homeless preschoolers, Wellspring Family Services will be treating other seriously developmentally and emotionally disturbed children in King County - to some extent regardless of family circumstances or income. 
 
We are finding that the Wellspring Family Services (formerly Family Services of King County) site provides a successful collaborative model for replication by other community-based agencies. Based on our experience with Wellspring Family Services, we can offer demonstrations of Reflective Network Therapy to potential new  affiliated service sites using their own child patient populations.
 
Wellspring Family Services began its collaborative affiliation with The Children's Psychological Health Center in 2007 when 14 therapists and teachers received 4 days of intensive initial training in Reflective Network Therapy. Gilbert Kliman, MD, CPHC's Medical Director enjoyed applying the method to children in a shelter classroom demonstrating Cornerstone techniques to 7 therapists and 7 teachers. Teachers were amazed when they saw how quickly their three year old pupils opened up and began to talk meaningfully and movingly about their traumas, and to show behavioral improvements and cognitive leaps during their very first in-classroom treatment sessions. Videos are available of this event, upon receipt of a confidentiality agreement.
 
When Reflective Network Therapy was first introduced  to the Seattle service site in 2007, it was the first time that CPHC demonstrated Reflective Network Therapy techniques to new teacher-therapist teams by practicing the method with child clients already being served at the host site.  Videotapes of the demonstration treatment sessions show the children responding so well that results were recognized and understood immediately by teachers and mental health professionals alike. Wellspring Family Services administrators, teachers and therapists continue to be enthusiastic about how quickly and how well well their children respond to Reflective Network Therapy.

Wellspring Family Services serves 90 homeless and transitional residence preschoolers and their families each year. Highly traumatized, homeless and recently homeless children are treated using Reflective Network Therapy and a shorter derivative, The Personal Life History Book Method, as a comparison method. Both methods are manualized.

Parent Orientation

After the initial intensive staff training in Seattle, key staff members of the agency helped create a successful orientation for parents of child patients newly afforded the opportunity to receive in-classroom Reflective Network Therapy or Personal Life History Book therapy. Gilbert Kliman, MD met with parents in two separate 90-minute sessions to present RNT treatment options. Parents learned how the two methods help children with emotional and cognitive disturbances. Getting their personal concerns addressed by the CPHC Medical Director was helpful to parents of children additionally traumatized by homelessness. Parents learned how reduction of symptoms of post-traumatic stress disorder is a common benefit with both methods. Phyllis Fullmer (long time member of the CPHC Board of Directors) accompanied Dr. Kliman to the first parent orientation at Family Services in Seattle. She shared first hand knowledge based on her own two daughters who successfully graduated from RNT treatment several years ago with significant cognitive and mental health gains.

 
Ongoing Training, Supervision and Consultation

Ongoing training and supervision, in addition to periodic site visits by senior CPHC staff, rely heavily on frequent video conferencing, supported by onsite conferences and seminars. Wellspring Family Services Clinical Director, Keith Myers, LICSW, and CPHC Medical Director Gilbert Kliman,  MD expect that Reflective Network Therapy training and supervisory seminars will have an influence on the entire staff of Wellspring Family Services, providing a model for attunement and engagement of children.

Learning about child development and child psychopathology will be enhanced for staff, trainees, and some attendees from nearby facilities of higher learning.  Mr. Myers and Dr. Kliman are planning for Wellspring Family Services to develop  further as a training center where therapists, teachers and other facilities can learn to use Reflective Network Therapy.

Linda Hirshfeld, PhD (Senior therapist and Certified Reflective Network Therapy Trainer) visited Family Services of King County (now Wellspring Family Services during July and August of 2008 to augment previous follow-up onsite and remote supervision and training in treatment delivery. She worked with therapist Judy Burr-Chellin who provided an overview of program start-up and detail about the unique circumstances of the population she's working with. Dr. Hirshfeld video taped treatment sessions and was able to provide some markers about session set-ups (briefing and de-briefing) as well as offer welcome advice regarding some challenges presented by classroom dynamics. As is typical of ongoing training support, they reviewed taped sessions together and discussed clinical considerations of the work. Dr. Hirshfeld was pleased with how Judy then applied insights gained from their discussion of technical aspects of the method.

Dr. Gilbert Kliman was impressed with the quality of the work going on when he performed follow up consultation and onsite supervision in 2008 and 2009. Additional supervision is provided remotely using high quality video conferencing. As Medical Director, Dr. Kliman directly oversees the development of existing staff as well as the training  of new therapist-teacher teams to use Reflective Network Therapy.

Ann Martin Cornerstone

 

 

 

 

 

 

 

 

 

Linda Hirshfeld, PhD, a very talented and experienced Reflective Network Therapy practitioner, conducts in-classroom treatment sessions at this service site. An early childhood education specialist is part of the reflective network for the children learning and being treated in a play group setting. Dr. Hirshfeld's practice is an important addition to the program offerings at the prestigious Ann Martin Center in Piedmont, California. The Ann Martin Center is known for its emphasis on both emotional and educational support. Dr. Hirshfeld continues to document consistently strong results for both cognitive and clinical improvements among the children she treats, including IQ rises for children treated at Ann Martin Cornerstone. Ann Martin Cornerstone recently moved into a more spacious classroom (across the street from the Ann Martin Center.) The larger venue helps accommodate frequent visitors who wish to learn more about the method. This service site has become a valuable demonstration laboratory for mental health professionals who visit to see Reflective Network Therapy in action.

Dr. Hirshfeld is often tapped by Dr. Kliman to explain Reflective Network Therapy and RNT techniques to others. Dr. Hirshfeld served as co-presenter with Gilbert Kliman at the four-day training intensive conducted last year for teachers and therapists at Family Services in Seattle and continues to help conduct ongoing training at the newer service site. Video of Dr. Hirshfeld's in-classroom treatment sessions at Ann Martin Cornerstone was a particularly valuable training tool to help explain the treatment work going on in the classroom to therapists and teachers new to Reflective Network Therapy. Iher experience using Reflective Network Therapy, Dr. Hirshfeld treated two child patients with selective mutism and serious developmental delays who recovered from their selective mutism very quickly during Reflective Network Therapy sessions. One of these children recovered during the debriefing following a single therapy session. This story is captured on a video of a conversation between Dr. Hirshfeld and Dr. Kliman recorded in 2007. In this DVD, "A Cornerstone Conversation" they discuss Reflective Network Therapy, how it is carried out and which distinctive features of the method seem to help children most. 

Cornerstone Argentina

 

Since 2005, Alicia Asman Mallo, MD, child psychiatrist and psychoanalyst, has served as the Director of Cornerstone Argentina in Buenos Aires. Her work using Reflective Network Therapy is supported by a Cornerstone Service and Research Fellowship from The International Psychoanalytic Association and funding from The Children’s Psychological Health Center. Currently ten children are being treated five days a week at this service site, in two classes.

Positive mental health gains (evidenced by CGAS testing and Childhood Autism Rating Scales) have been documented for most of the children treated by Dr. Mallo and her team. Many of the children served at Cornerstone Argentina are severely autistic and as a consequence have mental retardation. These children are sometimes so developmentally delayed or regressed that they cannot be IQ tested. We are very encouraged by the results so far. Dr. Mallo has documented significant positive test results, including a rare achievement. There has been an IQ rise for a very severely retarded child.

In-classroom Reflective Network Therapy sessions are captured on video with parental permission (as is true for other Cornerstone service sites). These videos become an important part of CPHC’s video archives for training and independent scientific study. Dr. Mallo’s video of her 2-year follow up with a child patient who has apparently almost completely recovered from Autism and who is transitioning into regular school was presented and discussed at a major Psychoanalytic Conference in Santiago, Chile at the FePAL Congress (Federación Psicoanalítica de América Latina), September 24, 2008. Dr. Mallo is often invited to speak about Reflective Network Therapy. She was a presenter at two major events in 2007: the Annual Symposium of the Buenos Aires Psychoanalytical Association and the Flappia psychotherapy conference in Uruguay.

 

Alicia Mallo, MD reports IQ and mental health gains for very severely autistic and retarded child patients treated with Reflective Network Therapy in Buenos Aires.

Dr. Mallo plans to lead a CPHC certification course for new therapists and teachers in Buenos Aires training in Reflective Network Therapy, with curriculum oversight by Gilbert Kliman, MD. Dr. Mallo recently reported IQ progress for children treated at Cornerstone Argentina who could be tested. She noted that she is now receiving referrals for children who are or who become testable by IQ. A pledge has been received of an additional gift to CPHC for the purpose of continued testing to measure progress at this service site. It will be used for independent diagnoses, Childhood Autism Rating Scale and CGAS rating and an additional series of the same measures at one year follow ups.

Mental Health Gains - Child Patients receiving Reflective Network Therapy at Cornerstone Artentina

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See the Research section of this website for more extensive outcome data regarding cognitive improvements and mental health gains in multiple service sites as well as detailed charts comparing Reflective Network Therapy (RNT) with other methods.

 

Cambridge Cornerstone

In-Classroom Treatment Service directed by Alexandra Harrison, MD, Assistant Clinical Professor in Psychiatry at Harvard Medical School

The Cambridge pilot project took off early in 2008 and is coming along in an innovative way. Alexandra Harrison, MD is consultant to a private nonprofit preschool. After two children from the school were referred to her for evaluation, she decided to follow the Reflective Network Therapy design of treating them with play therapy sessions in the classroom and narrating their experiences before and after the play sessions with the teacher in the presence of the child. She has found that these two interventions, in addition to direct assistance in peer interactions, make it possible for the children to engage in the pool of cultural knowledge held by their classmates.

The classroom teachers have become Dr. Harrison’s close collaborators. The head teacher proved to be a talented and perceptive co-therapist. Dr. Harrison has also worked with the parents of the children to support their individual playtimes, with the goal of developing reciprocal pretend play. Both of these interventions have been very useful to the children in their developmental progress.

Alicia Mallo, MD, Cornerstone Argentina Director’s visit to the school in June was a wonderful opportunity. Not only did she have a chance to tour the school and talk at length with the director, but she and Ms. Demko began discussions about a possible teacher exchange between the Cambridge school and the Buenos Aires school. Ms. Demko, who holds a degree in special education, already has established teacher exchanges with schools in China. Dr. Harrison is eager to continue her work at the school in the Fall.

CPHC is very excited about this project’s potential to further research about several unusual features of Reflective Network Therapy associated with our results. The first is that the therapy takes place in the school, within the classroom group. The second is that the child’s parents, teacher, and therapist are in contact about the child multiple times a week. The third, and perhaps the most remarkable, is that the therapist (and teachers) reflect on the child’s relational experience, out loud in front of the child, both to the child and to all these important people in the child’s life many, many times a day.

The Children's Psychological Health Center established a special fund for the Cambridge Cornerstone Pilot Project to support therapeutic education scholarships and other associated costs.


 

 

 


 

 

 
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