Therapeutic Crisis Intervention (TCI)

About This Program

Target Population: Staff working in residential child care organizations

For organizations that serve children ages: 10 – 17

Program Overview

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 and understand the therapeutic use of self.
  • Use trauma-informed noncoercive, nonaggressive environmental and behavioral strategies and interventions that are designed to both de-escalate the crisis and lead to the child’s own emotional self-regulation and growth.
  • Use a dynamic risk assessment that is designed to assess risk and use physical interventions only as a safety intervention that contains a child’s acute aggression and violence; and reduces risk when a child’s behavior is a danger to themselves or others.

Program Goals

The goal of Therapeutic Crisis Intervention (TCI) is:

  • Provide a trauma-informed 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 adaptive coping skills
    • Developing a learning organization

Logic Model

The program representative did not provide information about a Logic Model for Therapeutic Crisis Intervention (TCI).

Essential Components

The essential components of Therapeutic Crisis Intervention (TCI) include:

  • Child and Family Inclusion
    • Include the child and family as active and meaningful participants in making decisions regarding the child’s care and treatment
    • Recruit and involve children and families in all activities
    • Involve children and families in reviewing and evaluating organizational policies and practices
    • Inform families of procedures, strategies, and interventions to prevent, de-escalate, and manage aggressive, self-destructive, and violent behaviors
  • 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
      • Provide policies, procedures, and guidelines that are clearly written and communicated to assist staff members in knowing the effects of complex trauma and how to respond when confronted with potential crises
      • Promote positive programming and an organizational culture to sustain the therapeutic milieu 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
  • Clinical Participation
    • Conduct 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 at intake
      • Address these key questions:
        • How can high-risk behaviors be prevented?
        • Is there a need for an Individual Crisis Support Plan (ICSP)?
        • What intervention strategies should be used if an ICSP is necessary?
          • Include strategies for preventing, de-escalating, and managing potential high-risk behavior specific to the child
          • Include specific physical interventions, if appropriate, or alternative strategies if physical intervention is not an option
    • 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
      • Note any medications that the young person may be taking that would affect the respiratory or cardiovascular system
    • Document any history of physical or sexual abuse that could contribute to the young person experiencing emotional trauma during a physical restraint
    • Review the young person’s ICSP regularly and revise as the child’s condition changes to help staff develop more effective ways to prevent and intervene with the child’s high-risk behaviors
  • Supervision and Postcrisis Response
    • Include reflective and supportive supervision in the implementation and ongoing monitoring of the TCI crisis management system
    • Include a postcrisis 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
    • Deconstruct the incident with all staff members involved in the restraint once things are back to normal so that strategies for intervening in the future can be developed
    • Notify families when their child has been involved in a physical intervention
    • Build a discussion of crisis incidents into team/unit meetings since this helps staff learn from these situations and provides accountability and support at the highest level
  • Training and Competency Standards
    • Provide TCI training as one part of a comprehensive staff development program that provides core training, as well as specialized training based on the population served
    • Provide staff with support, guidance, and training in trauma-informed strategies to prevent, de-escalate, and manage a crisis situation
    • Develop and maintain Cornell University certified TCI trainers to deliver direct training and refresher training
    • Evaluate and monitor staff’s level of competence and knowledge of the TCI strategies and interventions to assure an acceptable standard of performance
  • Documentation, Incident Monitoring, and Feedback
    • Document staff supervision and training and the document and monitor of incidents throughout the facility as part of data management
    • Help monitor the effectiveness of the TCI system by having leadership appoint an agencywide committee 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
    • Review incidents and make decisions about individual and organizational practice and recommend corrective actions using the documentation and monitoring system
    • Make changes to help reduce high-risk situations through clinical reviews of incidents and team or unit reviews that focus on different aspects of the incident and provide feedback on any information or suggestions to the team, clinician, or administration
    • Instill some type of benchmarking or red flagging that calls attention to any situation that exceeds the norm and requires a special review

Program Delivery

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.

Delivery Setting

This program is typically conducted in a(n):

  • Group or Residential Care

Homework

This program does not include a homework component.

Languages

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).

Resources Needed to Run Program

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.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

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

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

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 hours. If the training is less than 28 hours, the physical restraints techniques should not be taught.

Relevant Published, Peer-Reviewed Research

Nunno, M. A., Holden, M. J., & Leidy, B. (2003). Evaluating and monitoring the impact of a crisis intervention system on a residential child care facility. Children and Youth Services Review, 25(4), 295–315. https://doi.org/10.1016/S0190-7409(03)00013-6

Type of Study: One-group pretest–posttest study
Number of Participants: 120

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — 52% Male and 48% Female
  • Status — Participants were staff in a residential child care facility for children ages 5-18 with serious emotional disturbances and/or alcohol or substance abuse, and who had been generally referred by county child welfare agencies or the court system.

Location/Institution: Four-unit residential child care facility in northeastern US

Summary: (To include basic study design, measures, results, and notable limitations)
The study examined the impact of Therapeutic Crisis Intervention (TCI) on documented critical incidents and physical restraint episodes on staff knowledge, confidence and skills, and staff consistency throughout the facility over an 18-month period. Data was collected through measures developed for this project as well as the facility’s critical incident report forms. Results indicated an increase in correct answers from staff knowledge pretest to posttest scores. Increases in confidence levels were statistically significant post-intervention in four areas: staff ability to manage crisis, confidence in coworkers managing crisis, knowledge of agency policy and procedure in crisis management, and staff ability in helping children learn to cope. Limitations included the generalizability of these results to other facilities, as this facility volunteered to participate and thus self-selected, and the lack of a control or comparison group.

Length of postintervention follow-up: 9 months.

Additional References

Holden, M. J., Turnbull, A. J., Holden, J. C., Heresniak, R., Ruberti, M., & Saville, E. (2020). Therapeutic Crisis Intervention: A reference guide (7th ed.). Cornell University. http://rccp.cornell.edu/downloads/TCI_7_SYSTEM%20BULLETIN.pdf

Nunno, M., Holden, M. & Tollar, A.  (2006)  Learning from tragedy: A survey of child and adolescent restraint fatalities.  Child Abuse & Neglect: The International Journal, 30(12), 1333–1342. https://doi.org/10.1016/j.chiabu.2006.02.015

Contact Information

Martha J. Holden, MS
Agency/Affiliation: Cornell University
Website: rccp.cornell.edu/tci/tci-1_system.html
Email:
Phone: (607) 254-5337

Date Research Evidence Last Reviewed by CEBC: September 2013

Date Program Content Last Reviewed by Program Staff: April 2020

Date Program Originally Loaded onto CEBC: August 2011