TCI Training

Two overarching goals of TCI

Support: Provide immediate emotional support

Teach: Teach the child how to self-regulate and cope in future stressful situations

Stress Model of Crisis

Baseline

Triggering Event

Escalation

Outburst

Recovery

Pain-based behavior (examples)

- Inability to regulate emotions

- Overreaction to situations

- Impulsive outbursts

- Trauma re-enactment

- Defiance

- Inflexibility

- Running away through anger or fear

- Self injury

- Withdrawal

Four Questions

1) How am I feeling?

2) What does the child feel, need or want?

3) How can I manage the environment?

4) How do I respond?

Spaces within the therapeutic milieu

S.P.I.C.E. (social, physical, ideological, cultural, emotional)

Triune Brain

Thinking brain

Emotional brain

Survival brain

Behavior Support Techniques

Manage the environment

Prompting

Caring Gestures

Hurdle Help

Redirection/Distraction

Proximity

Directive statements

Time away

How to avoid/end a power struggle

Listen and validate feelings

Manage the environment

Give choices and time to decide

Drop the expectation

Nonverbal messaging

Eye contact

Body language

Personal space

Height and gender

Sensitivity to cultural issues

Goals of LSI

Provide a sense of emotional safety

Clarify events for child and adult

Repair and restore the relationship

Help the child learn to regulate emotions

Re-enter the child into the program

Steps of LSI (IESCAPE)

Identify a time and place to talk

Explore the child’s POV and feelings

Summarize feelings and content

Connect trigger to feeling to behavior

Alternative responses to feelings

Plan for future situations and practice

Enter child back into program

Options to handle physical violence

Eliminate an element of a violent situation

Release- maintain a safe distance with a protective stance

Restrain (if okay to do so based on ICSP)

Leave and get assistance

3 criteria to use physical restraint

1. Agency policies and state regulations allow it

2. Our own internal risk assessment indicates it is needed

3. The child can be restrained as indicated by their ICSP

Restraint should be avoided/discontinued when

• Adult cannot control the child safely

• Adult is too angry

• The child has sexual trauma/is sexually motivated

• In a public place

• Child has a weapon

• Child has a medical condition

• Risk of re-traumatization

• Child is on medication that affects their system

Predisposing Risk Factors

• Obesity

• Influence of drugs or alcohol

• Prolonged violent physical agitation

• Underlying medical condition

• Hot/humid environment

• Certain medications

• Toxic stress from severe trauma history

Warning signs of asphyxia

• Going limp

• Cessation of breathing spontaneously

• Saying “I can’t breathe”

• Labored breathing

• Grunting noises

• Gagging/vomiting

• Changes in skin color

• Sudden change in breathing/struggle

• Bobbing of head/fatigue

• Excessive sweating

• Urination

Things to monitor during restraints

• Skin color

• Respiration

• Level of consciousness

• Level of agitation

• Range of motion in extremities

In signs of distress, get medical help immediately!