29 terms

Therapeutic Crisis Intervention

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
Triggering Event
Escalation Phase
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
Running away
Self injury
inability to regulate
trauma re-enactment
Managing the setting
Removing weapons
stimulating lights, noises
Nonverbal techniques
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

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
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