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Trust-Based Relational Intervention® (TBRI®) Therapeutic Camp

Topic Areas
Scientific Rating
Child Welfare Relevance
Attachment Interventions (Child & Adolescent)
NR  — Not able to be Rated
High

About This Program

Target Population: Children and adolescents from 1 to 18 years of age who experience attachment disturbances due to maltreatment, abuse, neglect, multiple home placements, and violence

For children/adolescents ages: 1 – 18

For parents/caregivers of children ages: 1 – 18

Program Overview

TBRI® is a holistic approach that is multidisciplinary, flexible, attachment-centered, and challenging. It is a trauma-informed intervention that is specifically designed for children who come from "hard places," such as maltreatment, abuse, neglect, multiple home placements, and violence. TBRI® consists of three sets of harmonious principles: Connecting, Empowering, and Correcting. These principles have been used in homes, schools, orphanages, residential treatment centers and other environments. They are designed for use with children and youth of all ages and risk levels. By helping caregivers understand what should have happened in early development, TBRI® principles guide children and youth back to their natural developmental trajectory.

Program Goals

The overall goals of Trust-Based Relational Intervention® (TBRI®) Therapeutic Camp are:

  • Create an environment of physical, social, and psychological safety
  • Recognize and meet children's physiological needs (e.g., hydration)
  • 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)

Logic Model

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

Essential Components

The essential components of Trust-Based Relational Intervention® (TBRI®) Therapeutic Camp include:

  • TBRI® 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 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 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.
  • In the therapeutic camp setting, TBRI® principles and strategies are used with both parents and children in the following ways:
    • In the beginning of camp or prior to the start of camp, parents (caregivers) meet with a professional facilitator (e.g., licensed social worker or counselor) as a group. During these 6-hour groups, parents are provided training (including four TBRI® presentations with workbooks, role-plays, DVD clips, and activities) and a supportive environment where they feel safe to explore their personal attachment histories and strengths/challenges of caregiving. Each group covers one of the topics below:
      • TBRI Introduction and Overview
      • TBRI: Connecting Principles
      • TBRI: Empowering Principles
      • TBRI: Correcting Principles
    • During camp, children are immersed in a sensory and attachment rich environment. They participate in physical activities at least every two hours, have a nutritious snack or meal every two hours, and are offered water throughout the day. Children attend Nurture groups, Movement groups, Life Skills groups, Therapeutic Art groups, Speech & Language groups, and Sensory groups every day. Throughout all of the therapeutic groups, children practice the skills needed to develop meaningful relationships (such as giving and receiving nurture, negotiating personal needs, and being autonomous within relationships). They also practice emotional and behavioral self-regulation skills (such as purposely becoming highly dysregulated and then practicing self-regulation techniques like deep breathing or chair push-ups).
    • Near the end of camp, parents (caregivers) attend camp with their children. First, parents observe camp and discuss what they have observed. Then parents begin to participate in the therapeutic groups during camp with their children. This allows for the scaffolding and support of new skills and strategies and offers a smoother transition from camp to home.
    • In addition to the materials used for the parent groups listed above, materials used for therapeutic summer camps include Leading a Therapeutic Summer Camp: The Hope Connection® Camp Manual and Leading Nurture Groups manual and DVD.
  • Caregivers not attending the camp and other people who provide care for the child are strongly encouraged to attend a TBRI® 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.
  • TBRI® Principles can also be used with families in a variety of ways depending upon the setting and the needs of the family, though the Scientific Rating is based on the Therapeutic Camp model described above. Information on other uses can found on the TCU's Institute of Child Development website.

Program Delivery

Child/Adolescent Services

Trust-Based Relational Intervention® (TBRI®) Therapeutic Camp directly provides services to children/adolescents and addresses the following:

  • Inability to give and receive nurturing care
  • Hypervigilance and lack of felt safety
  • Inability to regulate 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)

Parent/Caregiver Services

Trust-Based Relational Intervention® (TBRI®) Therapeutic Camp 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:
    • Hypervigilance 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)

Recommended Intensity:

Approximately 6-8 hours a day

Recommended Duration:

The recommended intensity is from 2 to 5 weeks (either 4 or 5 days/per week). Follow-up sessions continue as needed.

Delivery Setting

This program is typically conducted in a(n):

  • Group or Residential Care

Homework

Trust-Based Relational Intervention® (TBRI®) Therapeutic Camp includes a homework component:

In a therapeutic summer camp, parents may be assigned homework prior to attending camp (e.g., read The Connected Child book, keep a log of children's behaviors, watch The Healing Families DVD series). During camp, parents are given a summary sheet of the camp day, which includes ideas for reinforcing TBRI® principles and strategies at home through games, books, or activities.

Languages

Trust-Based Relational Intervention® (TBRI®) Therapeutic Camp has materials available in languages other than English:

Romanian, Spanish

For information on which materials are available in these languages, 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:

For a therapeutic summer camp, a large room is usually sufficient for conducting groups. A separate room for sensory activities is desirable, such as a gym. Other outside facilities are also beneficial (e.g., playground, swimming pool, basketball goals, hiking trails). A separate room for parent training/groups is also helpful.

For the parent training part, Internet connection, a computer, projector, and screen would be needed. Trainers with excellent interpersonal skills and the ability to give informed answers to content-related questions are also needed. In addition, the following TBRI DVDs would be used:

  • Healing Families Series
    • Attachment: Why it Matters (2012)
    • Trust-Based Parenting (2011)
    • A Sensory World: Making Sense of Sensory Disorders (2010)
    • Playful Interaction (2009)
    • Healthy Touch (2008)

Manuals and Training

Prerequisite/Minimum Provider Qualifications

In order to implement a TBRI® Therapeutic Camp, providers have to attend a TBRI® Practitioner Training. There are no minimum educational requirements for attending the TBRI® Practitioner Training.

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:

TBRI® Practitioner Training is provided by the Karyn Purvis Institute of Child Development at Texas Christian University several times a year in various locations.

Number of days/hours:

The TBRI® Professional Workshop consists of approximately 80 hours of training:

  • Phase I (online) = 5 modules for 3-4 hours each
  • Phase II (in person) = 5 days for 8 hours a day

Relevant Published, Peer-Reviewed Research

Purvis, K. B., & Cross, D. R. (2006). Improvements in salivary cortisol, depression, and representations of family relationships in at-risk adopted children utilizing a short-term therapeutic intervention. Adoption Quarterly, 10(1), 25-43.

Type of Study: One-group pretest–posttest study
Number of Participants: 12

Population:

  • Age — 4-12 years
  • Race/Ethnicity — Not specified
  • Gender — 10 Male and 2 Female
  • Status — Participants were adopted children with histories of early maltreatment and neglect.

Location/Institution: Texas Christian University

Summary: (To include basic study design, measures, results, and notable limitations)
The goal in this study was to examine whether the Hope Connection therapeutic summer camp (a TBRI Therapeutic Camp) would lead to reduction in children's cortisol levels and that the reduction would be associated with positive changes in depression and representations of family relationships (i.e., attachment). Measures included the Child Depression Inventory (CDI), the Family Drawings test, and collection of salivary cortisol. Analyses showed reduced levels of salivary cortisol, reductions in child depression, and healthier attachment representations after treatment. Limitations include the lack of a control group, the small sample size, and difficulties collecting the saliva samples for the cortisol tests.

Length of controlled postintervention follow-up: None.

Purvis, K. B., Cross, D. R., Federici, R., Johnson, D., & McKenzie, L. B. (2007). The Hope Connection: A therapeutic summer camp for adopted and at-risk children with special socio-emotional needs. Adoption & Fostering, 31(4), 38-48.

Type of Study: One-group pretest-posttest study
Number of Participants: 19

Population:

  • Age — 3-14 years
  • Race/Ethnicity — Not specified
  • Gender — 10 Female and 9 Male
  • Status — Participants were camp participants with histories of early deprivation and/or maltreatment.

Location/Institution: Texas Christian University

Summary: (To include basic study design, measures, results, and notable limitations)
This study reports on outcomes of the Hope Connection, a therapeutic summer camp (a TBRI Therapeutic Camp). Subjects were recruited through local parent support groups and by referral from child and family therapists. Measures included the TCU Survey of the International Adoption Experience, Child Behavior Checklist (CBCL), Beech Brook Attachment Disorder Checklist (Beech Brook) and Randolph Attachment Disorder Questionnaire (RADQ). Results indicate that the Hope Connection had a significant impact on the children's behavior, with more pronounced gains for children in the younger group. Limitations include the lack of control group or randomization, small sample size, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Purvis, K. B., McKenzie, L. B., & Cross, D. R. (2013). A spontaneous emergence of attachment behavior in at-risk children and a correlation with sensory deficits. Journal of Child & Adolescent Psychiatric Nursing, 26(3), 165-172.

Type of Study: One-group pretest-posttest study
Number of Participants: 18

Population:

  • Age — 3-14 years
  • Race/Ethnicity — Not specified
  • Gender — 9 Male and 9 Female
  • Status — Participants were adopted children who have histories of early deprivation and/or abuse.

Location/Institution: Fort Worth, Texas

Summary: (To include basic study design, measures, results, and notable limitations)
This study reports findings regarding research conducted at therapeutic day camps (based on TBRI Therapeutic Camp) for at-risk children to determine whether multimodal therapies could ameliorate the effects of complex developmental trauma. Adopted children with histories of early deprivation and/or abuse attended 3-week camps; children were grouped by age (ages 3-9 and ages 10-14). Measures utilized include the Beech Brook Attachment Disorder Checklist (BB), Child Behavior Checklist (CBCL), Randolph Attachment Disorder Questionnaire (RADQ), and the Sensorimotor History Questionnaire for Parents (SQP). At baseline, many of the children had sensory deficits; the greater the sensory deficit, the more negative attachment behaviors reported. Increased pro-attachment behaviors were found to have a significant relationship with pre-camp deficits in sensory processing. Limitations include the lack of a control group and the small sample size.

Length of controlled postintervention follow-up: None.

Additional References

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., 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., 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

Casey Call, PhD
Agency/Affiliation: Karyn Purvis Institute of Child Development, TCU
Website: child.tcu.edu/professionals/tbri-training
Email:
Phone: (817) 257-7415
Fax: (817) 257-2383

Date Research Evidence Last Reviewed by CEBC: June 2014

Date Program Content Last Reviewed by Program Staff: April 2019

Date Program Originally Loaded onto CEBC: June 2014