Get Real: Talking mental health & disability
Get Real presents frank and fearless conversations about mental health and disability, including people with lived experience, frontline workers in the sector, as well as policymakers and advocates. Get Real is produced and hosted by Emily Webb and co-hosted by Karenza Louis-Smith on behalf of ermha365 Complex Mental Health and Disability Services provider (https://www.ermha.org/).
Get Real: Talking mental health & disability
NMT, trauma and childhood brain development with Dr Yvonne Maxwell
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.
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Speaker 2:Welcome to Get Real talking. Mental health and disability brought to you by the team at Burma 365.
Speaker 1:Join our hosts, Emily Webb and Carenza Louis-Smith, as we have frank and fearless conversations with special guests about all things mental health and complexity with special guests about all things mental health and complexity.
Speaker 3:We recognise people with lived experience of mental ill health and disability, as well as their families and carers. We recognise their strength, courage and unique perspective as a vital contribution to this podcast so we can learn, grow and achieve better outcomes together.
Speaker 4:Our guest for this episode is Dr Yvonne Maxwell, a forensic psychologist who specialises in working with individuals with a disability, often intellectual or developmental, who come into contact with the criminal justice system. I spoke with Yvonne at the Complex Needs Conference earlier this year, where she presented on the use of Neurosequential Model of Therapeutics Assessment, known as 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 works with Cell Consulting in Melbourne, explains what it is and broadly about the impact of trauma on brain development, especially in early childhood. I learnt a lot during this conversation. Well, dr Yvonne Maxwell, thank you so much for your time. Today we're live at the Complex Needs Conference, day 1. So, yvonne, you are presenting tomorrow, but tell us what do you think so far about the conference?
Speaker 5:So far. I think it's been really interesting. I really enjoyed the keynote presentation this morning. I was kind of really interesting to see the similarities between Canada, New Zealand and Australia for the incarceration for women.
Speaker 4:Yeah, and that was one of the keynotes is Dr Tonya Nichols, I believe she works a lot in the space with yeah in the criminal justice system in Canada. So, yvonne, tell us about the work you do and your background.
Speaker 5:So I am a forensic psychologist and I specialise in forensic disability, which is something that I am really passionate about. I've always been passionate about working with people with a disability and started in disability support work and then I've also had that interest in psychology and forensic psychology and decided that I could mould them together, and that's what I've been doing over the last 10, 12 years specialising in that forensic disability space to have better outcomes for people with a disability who are involved in the criminal justice system.
Speaker 4:So did you start out your career in disability support, then went on to do psychology? What did you do after you left school?
Speaker 5:Once I left school, I was studying a psychology degree, and whilst I was studying the psychology degree I was also working as a disability support worker and I am technically still employed as a disability support worker and do some disability support occasionally, because I think it is a really valuable life skill to have. And then, once I progressed through the psychology degrees, I wanted to specialise in forensic. So I applied for the Doctorate of Forensic Psychology and was lucky enough to be one of the people that got one of those places. And where did you do that? Deakin University.
Speaker 4:And so did your interest in forensic disability in that space. Did that evolve from when you started doing disability support work and studying psychology, or do you have lived experience or had you encountered that before?
Speaker 5:So both my parents were police officers when I was very young. As well as then my mother moved into being a parole officer while I was in my teenage years. So I guess I was exposed to both sides, growing up around people, working with people who were offended and then also having police in my early childhood. And I guess I do have family members who have been incarcerated as well and I saw and I've seen the struggles that they've experienced as well.
Speaker 4:Yeah, so it's actually a good broad overview to have, having that, you know lens 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 the Complex Needs Conference about the use of neuro-sequential model of therapeutics assessment with complex client presentations. Now can you explain what that means in simple terms? I guess because we have people who listen, who are not in the space. I mean, I myself am not a professional, but I love learning about the kind of work that's done. So tell us about it?
Speaker 5:Yes, so the Neurosequential Model of Therapeutics, or NMT as more commonly referred to, is an assessment process that was developed by Dr Bruce Perry and it's quite often used with children in particularly for children in out-of-home care, but it also can be used with adults, adolescents there is actually no age range and it's something that once I moved to working with Cell Consulting that they have had a really strong kind of passionate role in using NMT assessments, and it's something that I then became interested in knowing whether that could be incorporated within the forensic disability work that I do.
Speaker 5:And I guess in the NMT assessment space it's essentially looking at the role that trauma has on the development of the brain. So starting from in utero and then through childhood development and understanding, where key developmental stages of the brain could be impacted by trauma and the type of trauma. So the assessment aims to map that and it creates a brain map essentially where it looks at where there might be impacts of trauma in key developmental stages which are then affecting the behavioural presentation so you know, because of attachment, self-regulation and those aspects and then it allows us to look at specifically where those areas might have been impacted and design intervention to target the areas of need. So how?
Speaker 4:long has this been in use? Like is it recent or is it, you know, a few years old?
Speaker 5:now Bruce Perry has been doing this work for quite a long time and there are, you know, various organisations. Like I said, often do it with children. I think that it is varied and probably in the last few years that it's been looked at also for adults and how that could be supported to help with the repair of trauma and the difficulties they've experienced. Could you tell me who it is you work for? So I work for Cell Consulting, which is a private organisation that focuses on supporting people with particularly complex needs. They initially had an office in New South Wales, but now we have offices in New South Wales. But now we have offices in New South Wales, Victoria, nt and WA. And so what's your day-to-day?
Speaker 4:work with them.
Speaker 5:My day-to-day work will vary. I am the portfolio manager for forensic practice nationally, so I oversee all our forensic staff and provide supervision and support to those staff, but I also then will engage in like assessments such as the NMT assessment. I will do risk assessments. I do behaviour support for people with complex behaviour needs. One of the key focuses we have as an organisation is that everyone in the organisation, from the directors down, still do face-to-face work with clients, because we think it's really important to be able to keep learning and experiencing directly from our clients.
Speaker 4:Yeah, it's like I've worked with people who are still registered nurses, who are in executive roles and they still get on the tools and do you know, shifts on the hospital, just to keep their registration, but also because they love it. So that sounds really good. Now, when you conduct a risk assessment and treatment progress reports, what are the kind of factors that you are considering with that evaluation? Is it pretty broad or is it detailed?
Speaker 5:When I'm doing a risk assessment or a treatment progress report, I often start off quite broad, trying to understand the person and their life experiences and then utilising research such as the R&R model and the Good Lives model from a forensic perspective to look at how the criminogenic needs might be relevant to the client, also looking at the trauma, mental health, many of the other areas as well.
Speaker 4:Yeah, so getting the life story and then kind of delving into the different parts that you need to know. You just mentioned some models Good Life Model and R&R. What are they?
Speaker 5:The Good Life Model and R&R, which is Risk Needs Responsivity Model. They are two models that are utilised within the forensic space to understand what kind of intervention or support might be needed for a client. So the R&R model looks at the risk level and making sure that the responsivity and the needs of the person model looks at the risk level and making sure that the responsivity and the needs of the person are matching to the risk level, for example, that we don't over-service people who are low risk, as that might actually increase their risk, and that people who are high risk have the high level of support that they might need. The good lives model looks at understanding the human needs that are associated with offending behaviour.
Speaker 4:So your wheelhouse, the people that you were working with, have lived experience of prison or forensic institutions. Is that the cohort you're always working with?
Speaker 5:The majority of the cohort that I'm working with is often people who have had prison experience are incarcerated. I do work at times with adolescents who might be at risk of entering the justice system, and that is another piece of work. I guess I'm quite passionate about having that opportunity to support someone to have a different outcome other than prison.
Speaker 4:Yeah, and it seems that early intervention is key. But when you talk about seeing the kind of impact that trauma has on the brain, I mean it starts very early, doesn't it?
Speaker 5:Yes, so people can experience trauma before they're even born and that can have a significant impact on the brain and the brain development and then how they have attachment in early childhood.
Speaker 4:I found it really interesting my eldest daughter, who finished year 12 last year. She was doing psychology and one day she came home and she said do you know that trauma can imprint on your DNA in utero when you're actually not born yet? And I was like, wow, I actually didn't know that. And she was just blown away by that. Is that, do you think a lot of people don't realise?
Speaker 5:that I think, unless you're in the space or you know working in the field, that it's not particularly talked about a lot on social media or, and it's quite complex, I guess, to understand the DNA and the impacts of trauma. So I think there probably is quite a few people who don't necessarily understand or have access to that knowledge and so with neuro-sequential model of therapeutics assessment.
Speaker 4:What are some of the positive outcomes that can come from using that on children, but also adults, Because I imagine that the impact on adults is probably obviously a lot longer because they're older. But like, what are the good things you're seeing?
Speaker 5:with it.
Speaker 5:So I've had a few clients where we've been working with them for a number of years and we've utilised the neuro-sequential model of therapeutics assessment and because you can also track the experiences of persons, we've been able to utilise that assessment to identify what intervention should be implemented first, because often we, particularly with adults, will seek to go to talk therapy or other interventions and if that person and their experience of trauma has impacted on the brain quite early, they might still need some work in the attachment phase.
Speaker 5:So one of the clients I was working with for a year we spent a heavy focus on just building a relationship with staff and that was the therapeutic intervention at that point. And after that point, once we were then able to redo the assessment and look at the increases or the positive outcomes from that building of relationship, we were able to actually start then looking at whether play therapy or art therapy would be something that could be useful for that client. And I've done that with a number of clients over the last few years where we've been able to target the intervention and also justify why we might not be doing intervention that would be more traditional in a sense, and in those examples we have seen better outcomes with reduced behaviours of concern, reduction in contact with the justice system.
Speaker 4:So I'm quite passionate about incorporating the NMT into forensic disability because I have seen the outcomes, have worked to see what the outcomes could look like, and so it sounds like with that model of assessment, then you can essentially tailor, make the treatment, the therapy, to that person, instead of, I guess, as you said, going down the traditional route of trying X, y and Z and it's not going to work. Is that true to?
Speaker 5:say, I think, tailor make and also know the order and the timing, because often people have really good opportunities or ideas about what might be needed. Particularly when we're working in that complex space, there'll be a lot of people trying to support that person and sometimes it's not that the therapy or the intervention is not good or not working, but it's not the right timing for it. So being able to order it and understand that we can't expect someone to understand respect and self-respect if they haven't developed an attachment to other people, because how do you understand that people should be respected or you should have self-respect if you don't actually have attachment to others is something that being able to explain that to staff, being able to explain that to care teams and then work with that person to build attachment I've seen that as being a positive outcome for the clients, but also for the staff to understand why we're not just throwing psychology, speech, therapy, ot at the clients as well.
Speaker 4:I'm finding this really fascinating and you've mentioned a few times the importance of attachment and that lack of or, you know, not understanding what that is is quite significant. Can you just explain about the role of attachment and I guess, if someone's got trauma, I've heard the term attachment disorder. I don't know what the proper term is, but can you just explain a bit more about that and why attachment is so important?
Speaker 5:yep.
Speaker 5:So when we think about attachment and child development, that is one of the first things that happen in a traditional or ideal space, once the baby is born, there would be an attachment that's formed to the carer so often mum, but if it is in other situations it might be dad or, you know, a family member or somebody else and in the first few weeks to months to years the baby will develop an attachment.
Speaker 5:And ideally we want a secure attachment where baby knows that the main carer will be around but is has the opportunity to start exploring, growing the world, but knowing that the main carer is the safe person. When people experience trauma their main carer may not have the capacity for some reason to be able to be that safe person. So then the world becomes dangerous and scary because it's not predictable in that space and we might then see that child have, you know, kind of disconnected, avoidant attachment, where they're just not really, they don't really see people as helpful because people have been unsafe. Or they might become over attached in their attachment to others, where they then are particularly like needy or clingy to adults because again they're not really sure what's safe or what's okay.
Speaker 4:So they're often will go one way or the other and I'm guessing that obviously carries through to adulthood and you will see the impact of that in the people that you support and have supported.
Speaker 5:Yes. So it imprints, I guess, onto people's beliefs and values about the world. If you've not had safe attachments in early childhood, when you're then an adolescent or a young adult trying to see the world, it's really difficult to trust what other people are saying so when they might be falling into the wrong crowd or trying to start relationships and work out their friendships and who they are in the world. If they don't have those key supports or have that key experience that people can be trusted, people are safe and okay, then it makes it really difficult for them to trust the people around them and they may make decisions that aren't as helpful for them.
Speaker 4:And I guess that just then compounds the barriers and the issues and things that they're experiencing. Yes and so, if you are needing to work on attachment first, what are some of the things that may happen? Like, what may you do with someone? I guess it depends on the individual.
Speaker 5:It does depend on the individual, but some of the things that we might look at is predictability, particularly so we know that repetitive engagement and predictable engagement is really important, and that doesn't necessarily mean having the same people every time, because we know in the disability world, the forensic world, that sometimes there can be quite a lot of changes between staff.
Speaker 5:But having a predictable engagement in how staff are engaging so that might be what they say when they come on shift, that might be what kind of activities are available and making sure that the staff can, while still being individualised and being a person, be predictable in how they're going to reach out to that person, whether it's a child or an adult. And then look at other things, such as making sure that not all activities are instruction or authority based. So what can we do so that the client that we're working with knows that the staff members have a level of interest in them as a person? The interplay between also staff and how they engage with each other is really important, so that they can see that, I guess what's an appropriate modelling of engagement as well. So fascinating.
Speaker 4:I forgot to actually ask you as well when we talk about forensic disability. Actually ask you as well when we talk about forensic disability.
Speaker 5:What are we talking about? Forensic disability is essentially, it's a very well. It can be broad in terms of looking at people who have a disability, have come into contact with the justice system. So it does both talk to, I guess, perpetrators of violence or other types of offending, but also it could be victim survivors as well. I primarily work with perpetrators of who have engaged in offending, but also it could be victim survivors as well. I primarily work with perpetrators of, who have engaged in offending or who may engage in offending behaviour and, in looking at it, I guess, all types of offending behaviour that someone might engage with or have come into contact with the justice system for.
Speaker 4:And the work you're doing. I get very much the sense that it's about prevention, it's about improving the lives of these people so that I guess the risk of recidivism, re-offending is low, but it's also, I'm guessing, about helping them to live in the community like safely for themselves and others yes, so many of the clients that I've worked with.
Speaker 5:they have trauma, trauma histories. They have mental health difficulties, drug and alcohol issues. They've had, you know, not necessarily the easiest life, and providing that person with the support to live the best life that they can, I think is really important because then that allows to make sure that they can live in the community safely and ultimately that means that there's less victims as well of crime in that space, victims as well of crime in that space.
Speaker 4:So we know that the people that you know professionals like yourself and all the people here at the conference work with you know the general community. Look, they don't have a lot of sympathy for them. There's often things that misconstrue the experiences of these people, but also they have done things that are dangerous of these people, but also they have done things that are dangerous. But I mean, what do you want people to understand who don't work in this space and see what you see every day? What do you want people to understand about why it's so important that we don't give up on people who have these complex needs? Have had experience of prison and you know difficulties and things like that. What would you like them to know?
Speaker 5:I think in my experience of working in this space, I've never done an assessment. I've done thousands of assessments at this point. I've never done an assessment where I've walked away saying I don't think that person's worth helping or they've just done it, because there's always factors and reasons that have come into play and some people might think that they that helps understand why, or people other people might say that doesn't matter. Not everyone with those experiences would do an offence. But what I guess I've understood is that offending and people's experience of life is not 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, and they've had really hard life experiences, and I guess my view is that my job is to, like I said, make sure that if I can help these people and support them to have better lives, then that also has a positive impact on the community because it means that there's less likely to be an offence from that person. I think that is not worth giving up on.
Speaker 4:What keeps you doing this work? It's not easy work. You're working in a space that not everyone can do this what keeps you motivated? What keeps you just going? Yeah, this is it. I guess you enjoy it and it's important work. But what keeps you going?
Speaker 5:because you know you can burn out, and it can, I guess, sometimes feel not always positive and I think it can be hard when, when things go wrong or we have outcomes that we don't desire, it can be really hard and there is that risk of burnout.
Speaker 5:I guess those small wins for me are really important in that we might have seen some success or, you know, a client might have that was really difficult to engage has started engaging. Those are along the like longer trajectory. I have some clients who I've been working with for like five, six years at this point and being able to look at the data that we collect and see the difference and see the outcomes. I have one client where over the last year they've halved their behaviours of concern and that's going from I think it was 200 and something to 86. So you know, those things they're the things that keep me going, because I can see that what we are doing is working in some way and I really just want to keep on doing that and being able to support, like I said, the better outcomes.
Speaker 4:So you're presenting at the Complex Needs Conference? What do you want people in the room when you're presenting to know? What are you hoping that they get from your presentation?
Speaker 5:I think from the presentation I am really keen for people to understand that there is another way of including the neuro sequential model of therapeutics, particularly of adults, and that it can be effective, not necessarily in changing the intervention that might be doing, but the timing and looking at the order that we do things so that we can have the best outcomes and what is dr yvonne maxwell's magic wand solution?
Speaker 4: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 not as easy as that, but what's?
Speaker 5:what's something you think, gosh, I wish, I wish we could do that I think I would wish that we had enough resources to be able to support those people in early intervention. So, as I said before, my my role is to work with people with particularly complex needs, but I would love there to be a space where my role wasn't needed anymore, because we could catch everyone at the early stages.
Speaker 4:And do you have any final thoughts before we wrap up that I haven't covered or that you want to share with listeners?
Speaker 5:Just that it is important to look at and understand the why, because if we don't understand the why then it's really hard to make a change to those behaviours.
Speaker 4:Yvonne, thank you so much for your time, especially while you're at the conference and you want to go to different presentations. Honestly, we're so grateful, so thank you for joining us. Thank you.
Speaker 2:You've been listening to Get Real talking mental health and disability, brought to you by the team at Irma 365. Get Real is produced and presented by Emily Webb, with Corenza Louis-Smith and special guests. Thanks for listening and we'll see you next time.
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