Therapeutic Crisis Intervention

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TCI Objective

To provide the skills and knowledge to students to develop new responses to their environment that will enable them to achieve a higher level of social and emotional maturity.

5 Components to make TCI effective

1. Leadership & Program support
2. Clinical participation
3. Supervision & post crisis response
4. Training and Competency standards
5. Documentation and incident monitoring and feedback

Setting Conditions

Setting Conditions (anything that makes challenging behavior more or less likely to occur.
* Organizational Culture
*Environment, e.g. hot, cold
*Program related, e.g. staff, routine, activities
*Personal, e.g. illness, trauma, meds
*Relationship-based, e.g. excessive controls, "us vs them" culture
Positive Organizational Culture
*Supports developmentally appropriate practice
*Provides opportunities for children to participate successfully in activities
*Involves children, families, staff in decision making
*Encourages relationship building activities
*Creates a learning organization
A calming physical environment
Activities, programs, routines
Treat each child as an individual
Encourage positive relationships

A crisis occurs when

A young person's inability to cope results in a change in behavior

The goals of Crisis Intervention

Support & Teach

Degrees of Stress

Baseline
Triggering Event
Escalation Phase
Outburst
Recovery

Recovery Phase

Higher-teach coping skills from incident
No Change-resolve crisis, getting back to baseline
Lower-do more harm than good

Four questions we ask ourselves in a crisis situation

What am I feeling now?
What does young person feel, need, or want?
How is the environment affecting the situation?
How do I best respond?

How do I respond?

Manage the environment to neutralize triggers
Engage the student, give emotional support
Excercise self-control over own feelings

Self Talk-4 feelings

How would I feel in same situation?
This is not about me
We've been thru this before
I can handle this

Meaning of behavior

behavior reflects needs

Pain based behavior

Impulsive outbursts
Agression
Running away
Self injury
defiance
inability to regulate
trauma re-enactment

Managing the setting

Removing weapons
stimulating lights, noises
crowding
chaotic

Nonverbal techniques

silence
nods
soft voice
eye contact

Encouraging and Eliciting Techniques

"How did you respond"
"I'd Like to hear more"

Understanding responses(labels & validates)

" You feel uncomfortable when your friends talk about school."
"Here is what I hear you saying, ..."

Active listening

identifies and validates feelings
reduces defensiveness
promotes change

Goals of emotional first aid

1. Provide immediate help and support to reduce emotional intensity (co-regulation)
2. Resolve the immediate crisis
3. Re-enter the child back into the program/activity

Strategies of emotional first aid

Drain off emotions-getting back to baseline
clarify events-understanding of situation
Maintain the relationship and lines of communication
Remind child of expectations and mediate the situation

Conflict cycle

Stressful incident
Student's feelings
Student's behaviors
Adult's response

How to avoid the conflict cycle

Listening & Validating feelings
Managing the environment
Giving choices and time to decide
redirecting the young person to another positive activity
Appealing to the self-interests of the student
dropping or changing the expectation

Reactive Aggression

Emotional flooding
verbal outburst

Proactive Aggression

Goal oriented-manipulative

Immediate Response Priorities

Reactive

Safety
Understanding and support
Remove or reduce stimulus

Nonverbal Behaviors

Eye contact
body language
personal space
height differences
gender differences
cultural differences

Elements of a potentially violent situation

Potential trigger to violence
A target
weapon
level of stress or motivation

Remove the potential trigger to violence by:

Don't touch angry person
avoid making moves or provocative statements
Avoiding the conflict cycle and counter aggression
Removing others who might trigger the violence

Goals of Life Space Interview

Return student to baseline
Clarify events
Repair and restore relationship
Teach new coping skills
Reintegrate the student back into program

Life space interview steps

Isolate the conversation
Explore students point of view
Summarize the feeling
Connect feelings to behavior
Alternative behaviors discussed
Practice new behavior
Enter back into routine

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