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TCI Revision
Introduction to TCI
| Question | Answer |
|---|---|
| Effective TCI implementation (the red rose) includes: | Young person and family inclusion Clinical participation Supervision and post-crisis response Training and competency standards Documentation, incident monitoring, and feedback Leadership and program support |
| Therapeutic Milieu Spaces (SPICE) - setting conditions | Social Physical Ideological Cultural Emotional SEE PAGES S112 & S113 |
| Foundations for the Intentional Use of Self | Self-Awareness Self-Regulation Relationship Skills and Attunement Self-Care SEE PAGE S116 |
| Developmental Relationships are Characterised by: | Attachment Balance of Power Progressive Complexity Reciprocity SEE PAGE S109 |
| The Triune Brain | The Thinking Brain The Emotional Brain The Survival Brain SEE PAGE S120 |
| The Basic Aims of TCI | SUPPORT: provide immediate emotional & environmental support to reduce stress and risk and increase young person's sense of safety TEACH: help young people learn and practise ways to regulate their emotions and behaviours SEE PAGE S123 |
| The Stress Model of Crisis - (i) the four phases | Baseline (varies with individual) Trigger/Escalation (characterised by agitation) Escalation (characterised by aggression) Outburst (characterised by violence) Recovery SEE PAGES124 |
| The Stress Model of Crisis - (ii) aims at phases | Baseline: Develop trusting relationships, provide a sense of safety & practice new skills Trigger/Escalation: Reduce stress & anxiety Outburst: keep everyone safe Recovery: Learn from what happened SEE PAGE S124 |
| The Stress Model of Crisis - (iii) strategies at phases | Baseline: change setting cond, avoid triggers, give support Triggers/Escalation: active listening, behaviour support techniques, emotional 1st aid, avoid power struggles Outburst: Non verbal comm, crisis co-reg Recovery: post crisis multilevel response |
| Four questions to ask ourselves in a crisis situation (what...what...how...how...) | 1. What am I feeling now? 2. What does this young person feel, need, expect, or want? 3. How is the environment affecting the situation? 4. How do I best respond? |
| Behaviour Support Techniques | Managing the environment Prompting Caring gesture Hurdle help Redirection & distractions Proximity Directive statements Time away |
| Crisis Communication - nonverbal techniques | Silence Facial expression Eye contact Tone of voice |
| Crisis Communication - Encouraging and eliciting techniques | Minimal encouragements: "uh-huh", "go on", "I see" Door openers: "i'd like to hear more", "tell me about that" Closed questions: "do you like your teacher" Open questions: "how did you respond", "what happened next" |
| Crisis Communication - Reflective responses | CONNECT WITH YOUNG PERSON'S FEELINGS "you look upset" "you seem fed up about something" "you sound angry" |
| Crisis Communication - Empathic Responses | CONNECT WITH YOUNG PERSON'S EXPERIENCE "this is really hard for you isn't it?" "it must be awful to feel like that" "you are having a tough time at the moment aren't you" |
| Crisis Communication - Summarisation | SUM UP THE FEELINGS & CONTENT "You are new at the school and anxious about making friends. You miss your friends from your old school and you are afraid you are going to have to eat lunch alone this year. Right now it doesn't feel worth even trying". |
| Crisis Communication - Active Listening | Helps YP express their thoughts & feelings Reduces defensiveness & opposition Promotes change Communicates we understand & desire to help Help YP to learn to self-soothe as we model through co-reg Help YP to talk out rather than act out |
| Emotional First Aid Strategies | 1. Co-regulate EMOTIONS and be a CALM presence 2. Maintain the RELATIONSHIP and lines of COMMUNICATION 3. PLAN and ANTICIPATE, be a coach |
| Goals of Emotional First Aid | 1. Provide immediate support to reduce emotional intensity 2. Identify & resolve the underlying concerns causing distress 3. Keep the young person in the activity |
| Crisis Co-Regulation Process | 1. What to think (self talk) - the 4 ques 2. What to do (nonverbal strategies) 3. What to say (little, use silence, be calm, assertive, respectful, affirm & validate YP feelings, summarise before making a request, remember tone of voice. 4 schedule LSI |
| Four Ways to Avoid the Power Struggle (Drop the Rope) | 1. Listen and validate the YP feelings 2.Manage the environment 3. Give choices & the time to decide what to do next 4. Drop or change the expectation |
| Life Space Interview in Full - I ESCAPE | Isolate the conversation (time & place) Explore the YP point of view Summarise feelings & content Connect the trigger to feelings & behaviour Alternative responses to feelings discussed Plan developed & practised Enter YP back into the routine |
| What is a Life Space Interview (LSI)? | A verbal process that helps turn crisis events into learning experiences |
| The Goals of the Life Space Interview (LSI) | 1. Provide a sense of emotional safety 2. Helps clarify the event for YP & adult 3. Repairs & restores relationship with YP & adult 4. Helps the YP learn to regulate emotions 5. Re-enter the YP back into the routine |
| Four elements of a Potentially Violent Situation | 1. The spark 2. The target 3. The weapon 4. The level of stress & motivation |
| What are 3 options to manage physical violence without using physical restraint? | 1. Remove one of the four elements 2. Use protective releases, maintain safe distance with a protective stance 3. Leave the situation and get assistance |
| Criteria that needs to be met to perform a restraint | 1. Agency policies and govt regulations allow it 2. The YP ICSP prescribes it 3. Our professional dynamic risk assessment indicates it |
| Some warning signs that a YP is in danger during a restraint | 1. Changes in skin colour 2. Laboured breathing 3. Going limp or not moving 4. Sudden changes in the struggle |
| Examples of pain based behaviour | overreaction to situations impulsive outbursts defiance running away through anxiety self injury withdrawal inability to regulate emotions |
| Setting conditions | Anything that makes challenging behaviour or traumatic stress responses more or less likely |
| Active listening strategies (ensure use in LSI) Focus on feelings & behaviour | Use: silence facial expressions of concern lots of eye contact Appropriate tone of voice |
| Active listening strategies (ensure use in LSI) - phrases, focus on feelings and behaviour | " go on..." "tell me about that" "do you like..." (closed Questions) "what happened next?" (open questions) "you look upset" (connect to feeling) "this must be really hard for you" (connect with experience) |
| Active listening strategies (ensure use in LSI) - summary, focus on feelings & behaviour | " let me go through that again to make sure I understand" "is that correct" |
| LSI Practical mini guide 1. Keep focus on the event 2. use active listening to help YP sequence events 3. Share own POV as witness 4. Explain why,if intervention was necessary 5. Summarise - feelings & content | 6. Make feelings statement - this feeling led to... 7. Encourage YP to offer an alternative behaviour - what could you do? 8. Encourage YP to articulate a plan 9. Agree to plan, YP to restate plan then practise it 10. Prepare YP to re-enter routine |
Created by:
steve t