Trust-Based Relational Intervention (TBRI) - Caregiver Training

About This Program

Target Population: Caregivers (including birth parents, resource parents, and residential direct care staff) of children, youth, and young adults (0-25) who are at risk for/have histories of relational trauma, including maltreatment, abuse, neglect, violence, absence of a consistent caregiver, and involvement in child welfare and/or juvenile justice settings

For parents/caregivers of children ages: 0 – 17

Program Overview

Trust-Based Relational Intervention (TBRI) is a trauma-informed, whole-child approach to caring for vulnerable children and youth. Grounded in attachment theory and developmental neuroscience, TBRI Caregiver Training is designed to help caregivers to see the needs and meet the needs of children and youth in their care. The TBRI caregiving model is based on three sets of interacting principles: Connecting, Empowering, and Correcting. Consistent with the three pillars of trauma-informed care, the three sets of principles focus on building trust and felt-safety in the context of healthy relationships (Connecting), developing self-regulation skills (Empowering), and fostering behavioral and social competence (Correcting). TBRI Caregiver Training is designed to move from theory into practical applications by giving participants a knowledge base, then providing them with real-life strategies and tools they can use with children and youth.

Program Goals

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

  • Improve capacity to support the mental health of children and youth in their care.
  • Promote healthy interactions with children and youth in their care.
  • Help caregivers structure experiences to enhance emotional and behavioral self-regulation.
  • Learn how to prevent or reduce symptoms of trauma in children and youth in their care.
  • Learn how to prevent or reduce behavioral challenges in children and youth in their care.
  • Learn how to create an environment of physical, social, and psychological safety for children and youth in their care.
  • Build capacity to foster emotional and behavioral self-regulation skills in children and youth in their care.
  • Promote mindful awareness, including awareness of their caregiving strategies, triggers, and the impact of their own childhood experiences, and enhance awareness of the needs of children and youth in their care.
  • Build capacity to foster appropriate social and behavioral skills in children and youth in their care.

Logic Model

The program representative did not provide information about a Logic Model for Trust-Based Relational Intervention (TBRI) - Caregiver Training.

Essential Components

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

  • Treatment model/curriculum components:
    • TBRI Connecting Principles
      • Connecting Principles help caregivers and children/youth build trust and meaningful relationships. Strategies include:
        • Engagement Strategies: nonverbal strategies for building connection, such as through:
          • Valuing eye contact
          • Healthy touch
          • Behavioral matching
          • Playful engagement
          • Appropriate voice
        • Mindfulness Strategies: strategies to help caregivers build awareness of what they bring to interactions with their children including:
          • Awareness of self (their own relationship histories, triggers)
          • Awareness of the child’s needs
          • Awareness of situational factors
    • TBRI Empowering Principles
      • Empowering Principles help caregivers effectively attend to children’s internal needs and external environmental in order to promote feelings of safety and improve self-regulation skills. Strategies include:
        • Physiological Strategies: strategies that focus on the internal needs of the child such as addressing:
          • Hydration
          • Blood sugar
          • Sensory needs
        • Ecological Strategies: strategies that focus on the child’s external environment such as:
          • Preparing for transitions
          • Scaffolding learning
          • Creating daily rituals
    • TBRI Correcting Principles
      • Correcting Principles help caregivers effectively address child/youth behavior and teach behavioral and social competence. Strategies include:
        • Proactive Strategies: strategies designed to teach children/youth social skills during calm times.
        • Responsive Strategies: strategies that provide caregivers with tools for responding to challenging behavior.
  • Service Delivery Components:
    • TBRI Caregiver Training is a group training for caregivers.
    • Training sessions typically take place at TBRI Practitioner’s organization or at venue arranged by the organization.
    • Group size varies based on the number of TBRI Practitioners 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 3-4, as the quality of discussions and activities begins 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.
      • 12-20 participants are the ideal number for discussions and activities.
    • TBRI Practitioners are provided with the following materials to guide each of the four sessions (Overview, Connecting, Empowering, and Correcting):
      • Instructor manuals
      • Participant workbooks
      • Presentation slides
      • Videos
    • During Caregiver Training sessions, trainers model TBRI principles and strategies for participants. Trainers provide:
      • Water, snacks, nutritious food, and physical activity at regular intervals (Physiological Strategies)
      • Structured transitions and a predictable schedule (Ecological Strategies)
      • Relationships with participants that are purposefully developed through discussions, activities, breaks, and lunches (Engagement and Mindfulness strategies)
      • Modeling of key TBRI practices such as creating an environment of felt-safety and giving voice which allow for participants to experience a parallel process between the training and the TBRI Principles and Strategies.

Program Delivery

Parent/Caregiver Services

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

  • Caregiver’s lack of mindfulness and associated difficulties (e.g., difficulty recognizing and responding appropriately to children’s needs)
  • Caregiver’s lack of awareness about their own caregiving history and its impact on their ability to provide care
  • Caregivers caring for children and youth who experience the following:
    • Inability to give and/or receive nurturing care
    • Hypervigilance and lack of felt-safety
    • Inability to regulate their own emotions and/or behavior
    • Problem behaviors, including both internalizing and externalizing behaviors
    • Sensory-related deficits, (e.g., hypersensitivity and/or hyposensitivity to touch)
    • Poor social skills (e.g., difficulty expressing/getting their own needs met appropriately)
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: TBRI involves all individuals who have a role in providing care for children and youth, including biological parents, resource parents, caseworkers, teachers, coaches, therapists, counselors, social workers, child advocates, and direct care staff in residential settings. Caregivers not attending the training sessions and other adults who provide care for the child are strongly encouraged to familiarize themselves with TBRI (e.g., by viewing a DVD from The Healing Families series or reading The Connected Child book) in order to provide consistency and felt-safety across caregiving environments.

Recommended Intensity:

6-hour sessions which could be every day or once a week

Recommended Duration:

Four sessions that take place daily or weekly depending on the agency

Delivery Settings

This program is typically conducted in a(n):

  • Foster / Kinship Care
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care
  • Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
  • Public Child Welfare Agency (Dept. of Social Services, etc.)
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)
  • Virtual (Online, Telephone, Video, Zoom, etc.)

Homework

This program does not include a homework component.

Languages

Trust-Based Relational Intervention (TBRI) - Caregiver Training has materials available in a language other than English:

Spanish

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:

Computer, projector, and Internet access

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Trainers must complete TBRI Practitioner Training (train-the-trainer) in order to train others in the intervention. There is no minimum educational requirement to attend the trainings to become a TBRI Practitioner.

Manual Information

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

Program Manual(s)

Access to TBRI Caregiver Training manuals and other training materials is provided to individuals who have successfully completed TBRI Practitioner Training (train-the-trainer).

  • Purvis, K., Cross, D. R., & Hurst, J. R. (2013). Trust-Based Relational Intervention® Caregiver Training: TBRI introduction and overview (TBRI practitioner instructor workbook). Karyn Purvis Institute of Child Development.
  • Purvis, K., Cross, D. R., & Hurst, J. R. (2013). Trust-Based Relational Intervention® Caregiver Training: TBRI connecting principles (TBRI practitioner instructor workbook). Karyn Purvis Institute of Child Development.
  • Purvis, K., Cross, D. R., & Hurst, J. R. (2013). Trust-Based Relational Intervention® Caregiver Training: TBRI empowering principles (TBRI practitioner instructor workbook). Karyn Purvis Institute of Child Development.
  • Purvis, K., Cross, D. R., & Hurst, J. R. (2013). Trust-Based Relational Intervention® Caregiver Training: TBRI correcting principles (TBRI practitioner instructor workbook). Karyn Purvis Institute of Child Development.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

TBRI Caregiver Training is available to professionals who successfully complete TBRI Practitioner Training. TBRI Practitioner Training can only be obtained through the Karyn Purvis Institute of Child Development at TCU. Typically, 6 - 9 TBRI Practitioner Trainings are held annually at sites around the world. 

Number of days/hours:

TBRI Practitioner Training consists of two phases:

  • Phase 1- Nine units of online coursework completed over 10 weeks (3-4 hours per unit) and completion of an interpersonal interview (1-2 hours).
  • Phase 2- Five days (40 hours) of on-site, intensive training that focuses on application and implementation of TBRI.

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:

The Karyn Purvis Institute of Child Development offers optional, ongoing implementation support to TBRI Practitioners and organizations implementing TBRI. Formal support is available from KPICD Training Specialists via site visits, teleconferencing, email, or a combination. Training specialists utilize a coaching model with organizational leadership and/or change agents to encourage successful implementation and monitor fidelity to the model.

In addition, the KPICD Research & Evaluation Team conducts evaluations before and after Practitioner Training and at a six-month follow-up to assess training effectiveness, learn about the extended reach of the TBRI model following training, and examine the impact of Practitioner Training on participants.

Fidelity Measures

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

TBRI Rate Your Understanding assessments are included in Caregiver Training participant workbooks so that trainers can monitor fidelity.

Implementation Guides or Manuals

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

The TBRI Practitioner Training Notebook and Resource Manual is a comprehensive guide for practitioners implementing TBRI on an organizational level. The manual provides the theoretical groundwork for delivering the treatment model, but also covers important implementation-related topics, such as implementation ‘practice principles,’ the phases of organizational implementation, the role of leadership and change agents, and case studies on organizational change.

Karyn Purvis Institute of Child Development. (2020). TBRI practitioner training notebook and resource manual. Karyn Purvis Institute of Child Development.

Research on How to Implement the Program

Research has been conducted on how to implement Trust-Based Relational Intervention (TBRI) - Caregiver Training as listed below:

  • Crawley, R. D., Razuri, E. B., Lee, C., & Mercado, S. (2021). Lessons from the field: Implementing a Trust-Based Relational Intervention (TBRI) pilot program in a child welfare system. Journal of Public Child Welfare, 15(3), 275–298. https://doi.org/10.1080/15548732.2020.1717714
  • Parris, S. R., Dozier, M., Purvis, K. B., Whitney, C., Grisham, A., & Cross, D. R. (2015). Implementing Trust-Based Relational Intervention in a charter school at a residential facility for at-risk youth. Contemporary School Psychology, 19(3), 157–164. https://doi.org/10.1007/s40688-014-0033-7
  • Purvis, K. B., Cross, D. R., Jones, D. & Buff, G. (2012). Transforming cultures of care: A case study in organizational change. Reclaiming Children and Youth, 21(2), 12–20. https://eric.ed.gov/?id=EJ980569

Relevant Published, Peer-Reviewed Research

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. https://doi.org/10.1007/s40653-015-0055-y

Type of Study: Pretest-posttest study with a nonequivalent control group (Quasi-experimental)
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; Parents: 97.9% White/Caucasian and 2.1% Hispanic/Latino
  • Gender — Children: 62.5% Male and 37.5% Female; Parents: 93.8% Female and 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 basic study design, measures, results, and notable limitations)
The purpose of this study was to evaluate the effectiveness of Trust-Based Relational Intervention (TBRI) – In Person Training [now called 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 or a control group. Reported here are results for the 48 participants in the TBRI 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 group (n=48) demonstrated significant decreases in behavioral problems on the SDQ and significant decreases in trauma symptoms on the TSCYC after intervention. Scores for children in a matched-sample 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.

The following studies were not included in rating Trust-Based Relational Intervention (TBRI) - Caregiver Training on the Scientific Rating Scale...

Howard, A. R., Parris, S. R., Nielsen, L. E., Lusk, R., Bush, K., Purvis, K. B., & Cross, D. R. (2014). Trust-Based Relational Intervention® (TBRI®) for adopted children receiving therapy in an outpatient setting. Child Welfare, 93(5), 47–64. https://www.proquest.com/docview/1804902181

The current investigated the effects of Trust-Based Relational Intervention (TBRI) – In Person Training [now called Trust-Based Relational Intervention (TBRI) – Caregiver Training] with traditional postadoption services. Measures utilized include the Brief Psychiatric Rating Scale for Children (BPRS-C), the Child’s Global Assessment Scale (CGAS) and the Parental Stress Scale (PSS). Results indicated a reduction in children’s psychiatric problems, as well as parents’ own stress levels, when parents demonstrated an investment in the intervention model. Limitations include lack randomization, lack of control group, small sample size, and lack of follow-up. Note: The study in this article was not used for rating TBRI due to it being a one-group pretest–posttest study.

Additional References

Purvis, K. B., Howard, A. H., & Call, C. D. (2018). Trust-Based Relational Intervention. In K. D. Buckwalter & D. Reed (Eds.), Attachment theory in action: Building connections between children and parents (pp. 143-156). Rowman & Littlefield.

Purvis, K. B., Cross, D. R., Dansereau, D. F., Parris, S. R. (2013). Trust-Based Relational Intervention (TBRI): A systemic approach to complex developmental trauma. Child and Youth Services, 34(4), 360-386. https://doi.org/10.1080/0145935X.2013.859906

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(1), 3–22. https://doi.org/10.1002/j.2161-1939.2009.tb00064.x

Contact Information

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: October 2021

Date Program Content Last Reviewed by Program Staff: January 2022

Date Program Originally Loaded onto CEBC: June 2016