The information in this program outline is provided by the program representative and edited by the CEBC staff. The Therapeutic Crisis Intervention (TCI) program has been reviewed by the CEBC in the area of: Behavioral Management for Adolescents in Child Welfare, but lacks the necessary research evidence to be given a Scientific Rating.

• Types of Maltreatment: Does not target any specific kind of maltreatment
• Target Population: Staff working in residential child care organizations.

At TCI’s core lies the principle that successful resolution of a child’s crisis depends on the environment’s (the care organization) and the individual’s (the care worker) therapeutic and developmentally appropriate response. The TCI system teaches and supports strategies for care workers at all levels of the organization to:

• Assess children’s aggressive behaviors as expressions of needs.
• Monitor their own levels of arousal.
• Use non-coercive, non-aggressive environmental and behavioral strategies and interventions that de-escalate the crisis and that lead to the child’s own emotional self-regulation and growth.
• Use physical interventions only as a safety intervention that contains a child’s acute aggression and violence.

The primary goal of TCI is to provide a crisis prevention and intervention system for residential care organizations that will assist in:

• Preventing crises from occurring by de-escalating potential crises
• Effectively managing acute crises
• Reducing potential and actual injury to children and staff
• Teaching constructive ways to handle stressful situations
• Developing a learning circle within the organization.

The essential components of TCI include:

Leadership and Program Support

• Leadership must:
• be fully informed about the TCI system.
• understand its principles and foundations.
• support the necessary components that are integral to its implementation and maintenance.
• Policies, procedures, and guidelines that are clearly written and communicated assist staff members in knowing what to do when confronted with potential crises.
• By providing sufficient resources including adequate and qualified staff, support for regular external and internal monitoring, and clear rules and procedures that have safeguards against abusive practices, leadership promotes positive programming and an organizational culture to sustain the therapeutic milieu.

Clinical Participation

• At intake, a risk assessment of the child’s propensity to engage in high-risk behaviors and the conditions that have provoked these behaviors in the past can provide valuable information. Key questions to address are:
• How can high-risk behaviors be prevented?
• Is there a need for an Individual Crisis Management Plan (ICMP)?
• What intervention strategies should be used if an ICMP is necessary?
• Well-developed ICMPs include strategies for preventing, de-escalating, and managing potential high-risk behavior specific to the child.
• Included in the plan are specific physical interventions, if appropriate, or alternative strategies if physical intervention is not an option.
• It is important to screen all young people in care for any pre-existing medical conditions that would be exacerbated if the young person were involved in a physical restraint. Any medications that the young person may be taking that would affect the respiratory or cardiovascular system should also be noted.
• If there is a history of physical or sexual abuse that could contribute to the young person experiencing emotional trauma during a physical restraint, it is equally important to document this in the plan.
• Ongoing reviews of the young person’s crisis plan with revisions as the child’s condition changes will help staff develop more effective ways to prevent and intervene with the child’s high-risk behaviors.

Supervision and Post-crisis Response

• Reflective and supportive supervision is built into the implementation and ongoing monitoring of the TCI crisis management system.
• This supervision process includes a post crisis response system to ensure that all young people and staff receive immediate support and debriefing following a crisis as well as a brief medical assessment.
• Once things are back to normal, all staff members involved in the restraint can deconstruct the incident to develop strategies for intervening in the future.
• It is important to notify families when their child has been involved in a physical intervention.
• Building a discussion of crisis incidents into team/unit meetings helps staff learn from these situations and provides accountability and support at the highest level.

Training and Competency Standards

• TCI training is only one part of a comprehensive staff development program that provides core training, as well as specialized training based on the population served.

Documentation, Incident Monitoring and Feedback

• Data management includes the documentation of staff supervision and training and the documentation and monitoring of incidents throughout the facility.
• An agency-wide committee appointed by leadership with the authority and responsibility to enforce documentation requirements and track the frequency, location, and type of incidents as well as any injuries or medical complaints that occur in the facility helps to monitor the effectiveness of the TCI system.
• This documentation and monitoring system allows the facility to review incidents and make decisions about individual and organizational practice and recommend corrective actions.
• A clinical review of incidents and a team or unit review can assist organizations in making changes to help reduce high-risk situations.
• These reviews focus on different aspects of the incident and provide feedback on any information or suggestions to the team, clinician, or administration.
• Some type of benchmarking or red flagging should call attention to any situation that exceeds the norm and requires a special review.

Therapeutic Crisis Intervention (TCI) was designed with a child component that addresses the following presenting problems and symptoms:

• Emotional regulation problems and aggressive behaviors while residing in residential care and treatment facilities

Age range: 6 – 18

Developmental Delays:

This program was not developed for children with developmental delays, and has not been tested for children with developmental delays.

Treatment Involves Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: The main focus of the program is teaching agency staff crisis prevention and de-escalation strategies as well as crisis management.

Therapeutic Crisis Intervention (TCI) was not designed with a parent/caregiver component.

Therapeutic Crisis Intervention (TCI) was not designed to be conducted in a group setting, and has not been tested for use in a group setting.

Recommended Intensity:

The interventions are intended to be used as needed when individuals display anxiety or disruptive behaviors. As such, no prescriptive contact schedule is described in the program.

Recommended Duration:

The program contains strategies for staff to use on an ongoing basis to prevent or intervene in response to crisis situations.

This program is typically conducted in a(n):

• Residential Care Facility

This program does not include a homework component.

Therapeutic Crisis Intervention (TCI) has materials available in a language other than English:

Hebrew

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

The typical resources for implementing the program are:

Staff must be trained in the techniques; health and fitness of all staff trained in the use of physical interventions should be considered.

Open to all staff. Must be trained by a certified TCI trainer.

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:

• Martha Holden
  mjh19@cornell.edu
  phone: (607) 254-5337

Training is obtained:

TCI Training of Trainers programs are offered throughout the US, Canada, the UK, Ireland and Australia and are open enrollment. Agencies can also contract to have a TCI Training of Trainers program delivered at their agency. TCI trainers are required to attend a Cornell University sponsored TCI Update and pass testing requirements at least every 2 years (1 yr in NY State and in the UK and Ireland).

Number of days/hours:

The training of trainers is 5 days. The training delivered by TCI trainers to agency staff is 4-5 days, with a minimum 28 classroom hrs. If the training is less than 28 hours, the physical restraints techniques should not be taught.

This program has been reviewed and it was determined that this program lacks the type of published, peer-reviewed research that meets the CEBC criteria for a scientific rating of 1 – 5. Therefore, the program has been given the classification of "NR - Not able to be Rated." It was reviewed because it was identified by the topic expert as a program being used in the field, or it is being marketed and/or used in California with children receiving services from child welfare or related systems and their parents/caregivers. Some programs that are not rated may have published, peer-reviewed research that does not meet the above stated criteria or may have eligible studies that have not yet been published in the peer-reviewed literature. For more information on the "NR - Not able to be Rated" classification, please see the Scientific Rating Scale.

Child Welfare Outcomes: Not Specified