Trust-Based Relational Intervention (TBRI) – Caregiver Training

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
High
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Trust-Based Relational Intervention (TBRI) – Caregiver Training has been rated by the CEBC in the area of: Parent Training Programs that Address Behavior Problems in Children and Adolescents.

Target Population: Parents (e.g., birth parents, foster parents, kinship parents, adoptive parents, etc.) and caregivers of children who come from ‘hard places,’ such as maltreatment, abuse, neglect, multiple home placements, and violence

For parents/caregivers of children ages: 0 – 17

Brief Description

TBRI Caregiver Training is a group in-person parent training program. TBRI is a holistic approach that is multidisciplinary, flexible, and attachment-centered. It is a trauma-informed intervention that is specifically designed for parents and caregivers of children who come from ‘hard places,’ such as maltreatment, abuse, neglect, multiple home placements, and violence, but is an approach that can be used by parents and caregivers with all children. TBRI consists of three sets of harmonious principles: Connecting, Empowering, and Correcting. These principles can be used in homes (e.g., birth homes, foster homes, kinship homes, adoptive homes, etc.), schools, orphanages, residential treatment centers, and other environments. They are designed to be used by parents and caregivers with children and youth of all ages and risk levels. TBRI is based upon how optimal development should have occurred. By helping caregivers understand what should have happened in early development (including prenatal development), TBRI principles can be used by parents and caregivers to help guide children and youth back to their natural developmental trajectory.

Program Goals:

The goals of Trust-Based Relational Intervention (TBRI) – Caregiver Training are:

  • Help caregivers create an environment of physical, social, and psychological safety
  • Help caregivers recognize and meet children's physiological needs (e.g., hydration)
  • Help caregivers structure experiences to enhance emotional and behavioral self-regulation
  • Enhance caregivers' mindful awareness and mindful caregiving
  • Build and strengthen secure attachments between caregivers and children
  • Build and strengthen resilience in caregivers and children
  • Help caregivers master the use of proactive strategies for behavioral change
  • Help caregivers master the IDEAL Response (Immediate, Direct, Efficient, Active, Leveled at behavior, not child)
  • Help caregivers master Levels of Response (Playful, Structured, Calming, Protective)

Essential Components

The essential components of Trust-Based Relational Intervention (TBRI) - Caregiver Training include:

  • TBRI® Connecting Principles
    • Connecting Principles help children build trust and meaningful relationships. These include:
      • Engagement Strategies, which connect with children nonverbally, such as with eye contact, behavior matching, and playful engagement.
      • Mindfulness Strategies, which involve parents and caregivers being aware of what they bring to interactions with their children, such as being conscious of their own relationship histories.
  • TBRI® Empowering Principles
    • Empowering Principles help children learn important skills like self-regulation. There are two types of Empowering strategies:
      • Physiological Strategies, which focus on the internal physical needs of the child. These include things like hydration, blood sugar, and sensory needs.
      • Ecological Strategies, which focus on the child’s external environment and guide children toward learning self-regulation skills. Ecological Strategies include things like transitions, scaffolding (guided support appropriate to a child’s level that facilitates learning), and daily rituals.
  • TBRI® Correcting Principles
    • Correcting Principles help children learn behavioral and social competence so that they can better navigate the social world they live in. Correcting Principles include:
      • Proactive Strategies, which are designed to teach social skills to children during calm times.
      • Responsive Strategies, which provide caregivers with tools for responding to challenging behavior from children.
  • During a TBRI Caregiver Training session, TBRI principles and strategies are implemented with participants. Water, snacks, and nutritious food are provided for the parents/caregivers, physical activity occurs at regular intervals (i.e., physiological strategies), and there are structured transitions and a predictable schedule (i.e., ecological strategies). Relationships with participants are purposefully developed through discussions, activities, breaks, and lunches (i.e., engagement and mindfulness strategies). These intentional practices allow for participants to experience a parallel process between the training and the TBRI Principles and Strategies.
  • For a TBRI Caregiver Training session, the number of participants trained is dependent upon the number of TBRI Educators conducting the training. A team training approach with 2 or more training facilitators is recommended for all groups.
  • The minimum number of trainees recommended is 10, the quality of discussions and activities begin to decline with fewer participants. The maximum number is dependent upon the number of trainers and the space. Typically, the recommended maximum is 50 participants; 25-40 participants is an ideal size for discussions and activities.
  • Following the TBRI Caregiver Training sessions, participants are provided with implementation support through having access to TBRI Educators for questions, problem solving, and coaching. Some agencies who host the TBRI Caregiver Training sessions also provide regular support groups and continuing education classes after the training but this is not part of the TBRI training and is therefore optional.

Parent/Caregiver Services

Trust-Based Relational Intervention (TBRI) – Caregiver Training directly provides services to parents/caregivers and addresses the following:

  • Caregivers' lack of mindfulness, and associated deficits (e.g., inability to remain calm and recognize children's needs)
  • Caregivers' lack of awareness about their own caregiving history, and its impact on their own ability to provide care
  • Caregivers who have children that experience the following:
    • Inability to give and/or receive nurturing care
    • Hyper-vigilance and lack of felt safety
    • Inability to regulate their own emotions and/or behavior
    • Problem behavior, including both internalizing and externalizing behaviors
    • Sensory related deficits, including, for example, hypersensitivity and/or hypo-sensitivity to touch
    • Poor social skills (e.g., doesn't know how to appropriately ask for their needs)
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: TBRI involves all individuals involved in providing care for children including biological parents, adoptive parents, foster parents, caseworkers, teachers, coaches, therapists, counselors, social workers, child advocates, and direct care staff. Caregivers not attending the training sessions and other people who provide care for the child are strongly encouraged to attend a TBRI Caregiver Training session (or watch a DVD from The Healing Families series or read The Connected Child book) in order to use the same voice with the child.

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Outpatient Clinic
  • Residential Care Facility
  • School

Homework

This program does not include a homework component.

Languages

Trust-Based Relational Intervention (TBRI) – Caregiver Training does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

Computer, projector, and Internet access

Minimum Provider Qualifications

Trainers must be TBRI Educators in order to train others in the intervention. There is no minimum educational requirement to attend the trainings to be a TBRI Educator.

Education and Training Resources

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

Training Contact:
Training is obtained:

TBRI Educator training is obtained through the TCU Institute of Child Development.

Number of days/hours:

TBRI Educators must complete the TBRI Practitioner Training, as well as the TBRI Educator Training in order to gain access to the TBRI Educator training materials and train parents/caregivers.

  • TBRI Practitioner Training is intended for professionals working with caregivers and children (note: these practitioners do not train parents on TBRI, they learn the TBRI principles to help them work with the children and families they see in their practice). It includes 2 phases:
    • Phase 1: Online pre-training includes an interpersonal interview, reading assignments, watching DVDs, and answering comprehension and application questions. Each module takes approximately 3-4 hours to complete (total 15 – 20 hours).
      • TBRI® Overview
      • Connecting Principles
      • Empowering Principles
      • Correcting Principles
      • Putting It All Together
    • Phase 2: On-site training includes lectures, activities, video scoring, role-plays, case studies, and skills checks (40 hours)
    • After completing both phases successfully, participants are considered TBRI Practitioners, but to lead TBRI Caregiver Training, TBRI Practitioners must also complete TBRI Educator training.
  • TBRI Educator training consists of 5 online units designed to deepen understanding of TBRI, enhance training skills, and allow participants to become familiar with all training materials. Each unit takes approximately 3-4 hours to complete (total 15 – 20 hours). After successful completion, participants are considered TBRI Educators.

TBRI Educators have access to TBRI Educator training materials and are authorized to train clients (e.g., caregivers, biological parents, foster parents, kinship caregivers, biological caregivers) and individuals within their organizations who can then use the TBRI principles in their practices.

Total = Approximately 80 hours

Implementation Information

Since Trust-Based Relational Intervention (TBRI) – Caregiver Training is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Trust-Based Relational Intervention (TBRI) – Caregiver Training.

Formal Support for Implementation

There is formal support available for implementation of Trust-Based Relational Intervention (TBRI) – Caregiver Training as listed below:

Institute of Child Development (ICD) Training Specialists are available through e-mail and telephone to answer questions the TBRI Educators may have regarding the training materials.

Fidelity Measures

There are fidelity measures for Trust-Based Relational Intervention (TBRI) – Caregiver Training as listed below:

Training participants complete a TBRI Rate Your Understanding evaluation at the end of each training day. Participant evaluations are sent to the ICD for review.

Implementation Guides or Manuals

There are implementation guides or manuals for Trust-Based Relational Intervention (TBRI) – Caregiver Training as listed below:

There are Instructor Manuals for the following workbooks:

  • TBRI Introduction and Overview
  • TBRI: Connecting Principles
  • TBRI: Empowering Principles
  • TBRI: Correcting Principles

Access to Instructor Manuals and workbooks are given to TBRI Educators. Presentation slides, including videos and activities which correspond to instructor and participant workbooks, are also provided to TBRI Educators.

Research on How to Implement the Program

Research has not been conducted on how to implement Trust-Based Relational Intervention (TBRI) – Caregiver Training.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcomes: Not Specified

Purvis, K.B., Razuri, E. B., Howard, A.R., Call, C., DeLuna, J., Hall, J.S., & Cross, D. R. (2015). Decrease in behavioral problems and trauma symptoms among at-risk adopted children following trauma-informed parent training intervention. Journal of Child & Adolescent Trauma, 8(3), 201-210. doi:10.1007/s40653-015-0055-y

Type of Study: Randomized pretest-posttest design with a control group
Number of Participants: 96

Population:

  • Age — Children: 5-12 years; Adults: 41-43 years
  • Race/Ethnicity — Children: 37.5% White/Caucasian, 30.2% Black/African American, 5.2% Hispanic/Latino, 21.9% Asian, 2.1% Native American, and 3.1% Other; Adults: 97.9% White/Caucasian, 2.1% Hispanic/Latino
  • Gender — Children: 62.5% Male and 37.5% Female; Adults: 93.8% Female, 6.38% Male
  • Status — Participants were adopted children with histories of early maltreatment and neglect and their parents.

Location/Institution: Texas Christian University

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The current study evaluated the effectiveness of Trust-Based Relational Intervention (TBRI) – Caregiver Training in reducing behavioral problems and trauma symptoms in at-risk adopted children. Participants were randomly assigned to either TBRI Caregiver Training or a control group. Reported here are results for the 48 participants in the TBRI Caregiver Training group and 48 participants in a matched sample control group who had complete data through the final round of data collection. Measures utilized include the Strengths and Difficulties Questionnaire (SDQ) and Trauma Symptoms Checklist for Young Children (TSCYC). Results indicated that children of parents in the TBRI Caregiver Training group demonstrated significant decreases in behavioral problems and trauma symptoms after intervention. Scores for children in the control group did not change. Limitations include lack of full randomization, use of small sample size, reliance on self-reported measures, and lack of follow-up.

Length of postintervention follow-up: None.

References

Purvis, K. B., Cross, D. R., & Pennings, J. S. (2009). Trust-Based Relational Intervention: Interactive principles for adopted children with special social-emotional needs. Journal of Humanistic Counseling, Education, and Development, 48, 3-22.

Purvis, K. B., Cross, D. R., Dansereau, D. F., & Parris, S. R. (2013). Trust-Based Relational Intervention (TBRI): A systematic approach to complex developmental trauma. Child & Youth Services, 34(4), 1-28.

Purvis, K. B., Parris, S. R., & Cross, D. R. (2011). Trust-Based Relational Intervention: Principles and practices. In E. A. Rosman, C. E. Johnson, & N.M. Callahan (Eds.), Adoption Factbook V (pp. 485-489). Alexandria, VA: National Council for Adoption.

Contact Information

Name: Casey Call, PhD
Agency/Affiliation: Karyn Purvis Institute of Child Development,TCU
Website: child.tcu.edu/professionals/tbri-training
Email:
Phone: (817) 257-4283
Fax: (817) 257-0630

Date Research Evidence Last Reviewed by CEBC: June 2017

Date Program Content Last Reviewed by Program Staff: February 2017

Date Program Originally Loaded onto CEBC: June 2016