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THERAPEUTIC CRISIS
INTERVENTION

Residential Child Care
Project

Cornell University

Family Life Development Center,
New York State College of Human Ecology

 

A child in crisis needs help!

What kind of help and how it is given make a crucial difference
between the child’s learning from the experience or being set
back.

This train-the-trainer program for child and youth care staff
present a crisis prevention and intervention model designed to help
staff assist children to learn constructive ways to handle
crisis.

ACTIONS SPEAK LOUDER THAN
WORDS……

By their example, child and youth care staff shape the behavior
and influence the growth of the young people in their care.

At no time is this issue more important than during periods of
crisis and upset. The skills, knowledge and professional judgment of
staff in reacting to crises are critical in helping children learn
constructive and adaptive ways to deal with frustration, failure,
anger rejection, hurt and depression. The ability of the entire
organization to respond effectively to staff and children in crisis
situations is critical in establishing not only a safe environment
but one that promotes growth and development. The purpose of this
project is to provide a crisis prevention
and management system for residential child care facilites

which will assist the organization in:

  • PREVENTING CRISES FROM OCCURRING
  • DE-ESCALATING CONFLICTS
  • MANAGING ACUTE CRISIS PHASES
  • REDUCING POTENTIAL AND ACTUAL INJURY TO CHILDREN AND
    STAFF

 

What is Therapeutic Crisis
Intervention?

TCI is a model for crisis prevention and intervention that gives
child and youth care staff:

  • The skills, knowledge, and attitudes to help children and
    youth when they are at their most destructive
  • An appreciation of the influence adults have while they are
    responsible for the care and treatment of troubled children and
    youth in crisis stuations
  • The sensitivity to respond to both the feelings and behavior
    of an upset youth in crisis

 

To Establish TCI at Your Organization

THE TCI PROGRAM IS AVAILABLE IN TWO
FORMATS

TCI ASSESSSMENT AND IMPLEMENTAION PACKAGE: A COMPREHENSIVE
APPROACH

TCI TRAIN-THE-TRAINER PROGRAM

 

TCI Assessment and Implementation
Package: A Comprehensive Approach to
Implementing the TCI Model for Residential Child Care Organizations,
Agencies, and Local Districts

CONTENTS

This comprehensive TCI ASSESSMENT AND IMPLEMENTATION
PACKAGE
will include:

  • An assessment of the current crisis prevention and management
    system
  • A critical incident information management system
  • Complete instruction to prepare in-house personnel to become
    TCI trainers
  • On-site technical assistance
  • A final evaluation

 

OUTCOMES OF ESTABLISHING
TCI

  • Increased ability on the part of staff to manage and prevent
    crisis situations with children
  • Fewer physical restraint episodes
  • Fewer injuries to children and staff
  • Increased knowledge and skill on the part of all staff to
    handle crisis episodes effectively
  • A change in the organizational culture

 

INTENDED AUDIENCE

State agencies, child care associations, local districts,
residential child care agencies

 

HOW THE PROGRAM WORKS

Over a two-year period, staff from Cornell University’s
Residential Child Care Project (RCCP) will work closely with the
residential facility to implement the TCI model of crisis management.
This includes:

  • Developing an on-site advisory group
  • Assessing current operations
  • Implementing an evaluation methodology
  • Providing on-site technical assistance
  • Conducting on-site training programs
  • Establishing a critical incident information management
    system

 

Using a train-the-trainer approach, RCCP staff will instruct
selected supervisory and training staff in the TCI Program to deliver
TCI in-service training to all levels of residential child care
staff. Pre/post-testing, interviews and surveys will be conducted to
analyze the effectiveness of this program. Throughout the life of the
project, critical incidents will be compiled in a data collection set
in order to track types and numbers of incidents. An advisory group
will meet with RCCP staff throughout the project to help facilitate
the process and to tailor the model to meet the organization’s
specific needs. Technical assistance will be on-going and available
throughout the life of the project. Implementation occurs in three
phases:

  • Assessment Phase: RCCP staff will meet with agency
    staff to administer pre-tests and surveys and to conduct
    interviews (all tests and interviews are confidential and
    anonymous). Selected agency personnel will attend a
    “Training-of-Trainers in TCI” workshop.
  • Implementation Phase: All levels of residential child
    care personnel will attend in-service TCI training conducted by
    agency trainers with assistance from RCCP staff. Following the
    completion of direct training, supervisors will attend the “TCI
    Update: Recovery for Staff”, to assist them in monitoring and
    supporting the model and their staff.
  • Evaluation Phase: RCCP staff will administer post-tests
    and surveys and conduct staff interviews. This data, in
    combination with the critical incident data, will be analyzed and
    reported to the agency in a evaluation summary with
    recommendations to maintain the TCI model of crisis
    management.

 

SPECIAL FEATURES

  • Organizational capacity to monitor critical incidents
  • On-site training and technical assistance
  • Selected agency staff trained as trainers in TCI
  • Training materials to conduct 30 hours of in-service
    training
  • A critical incident data management system

 

SIGNING UP FOR THE
PROGRAM

TO DISCUSS THE IMPLEMENTATION OF TCI AT YOUR ORGANIZATION,
CONTACT:

Michael Nunno or Martha Holden
The Residential Child Care Project
Family Life Development Center, Cornell
University
Martha Van Renssalear Hall
Ithaca, New York 14853 Tel. 607.254.5210 Fax.
607.255.4837

 

The TCI Train-the-Trainer
Program: Establishing an In-House TCI
Program

CONTENTS

The train-the-trainer course will provide your agency
representatives with an in-house training capacity in the TCI
curriculum
. The program:

  • Teaches therapeutic, practical and proven methods for managing
    children in crisis
  • Prepares agency staff to conduct in-house TCI training
  • Provides materials and resources to assist staff in presenting
    a high quality in-service training program
  • Demonstrates ways to maximize agency resources to meet the
    demands of working with increasingly troubled youth and
    families

 

GOALS OF TRAINING

  • To present strategies for dealing with children in crisis
  • To show how a crisis can be an opportunity for the child to
    learn new coping skills
  • To teach intervention strategies for de-escalating and
    preventing crises
  • To teach safe, appropriate physical restraint and
    self-protection techniques
  • To teach specialized, effective training techniques

 

OUTCOMES OF THIS
PROGRAM

Upon successful completion of the program participants will be
able to:

  • Intervene with children in crisis in a therapeutic manner
  • Apply crisis prevention and de-escalation techniques
  • Understand their personal strengths and needs relative to
    working with children in crisis
  • Use intervention approaches appropriate to the child and
    situation at hand
  • Avoid power struggles
  • Conduct “life space interviews”
  • Apply verbal and nonverbal de-escalation techniques
  • Use three physical intervention techniques
  • Use crisis as an opportunities for growth and development
  • Conduct therapeutic crisis intervention training

 

INTENDED AUDIENCE

Personnel interested in implementing an on-going, in-service
training program in TCI techniques, including:

  • Trainers
  • Administrators
  • Supervisors
  • Counselors
  • Child care workers

Note: This program requires participants to be capable of
moderate physical activity.

 

HOW THE PROGRAM WORKS

This intensive five-day program will provide child and
youth care staff with the skills and knowledge they need to become
the catalyst through which children change old habits, destructive
responses, and maladaptive behavior patterns in favor of constructive
ways to handle problems. The curriculum stresses crisis prevention
and how to help children learn from their experiences. The program
will teach:

  • Crisis prevention and de-escalation skills
  • Safe physical intervention techniques that respect the dignity
    of the worker and the child

The program will also prepare participants to conduct their own
TCI training. Participants will learn how to:

  • Teach TCI techniques, including how to supervise safe
    restraint practice sessions
  • Use practice sessions and training aids in their programs
  • Handle resistance to training

Participants will have the chance to practice conducting
activities to gain immediate training experience. Training techniques
such as the use of role plays, small group discussions, guided
fantasies, conducting practice sessions, and the use of audio-visual
aids will be demonstrated.

Upon completion of the program, participants will become part of
an international network of TCI trainers. This network serves to help
trainers share experiences, innovations, modifications and
difficulties in implementing training programs in their respective
agencies. Trainers will receive a newsletter and opportunities to
attend TCI Update Training.

 

SPECIAL FEATURES

Five days of intensive participatory training conducted by
two RCCP faculty members

A trainer’s manual which contains course materials for 30
hours
of in-service training and includes the following
training aids for each module:

  • Lectures/presentations
  • Group activities
  • Photographs of physical techniques
  • Training tips
  • Resources
  • Handout materials
  • Flip chart materials
  • Additional child care resources

A two-hour video package which corresponds to the trainer’s
manual

A student workbook which can be used to conduct in-service
training at your agency

A certificate of completion and an opportunity to register with
the Residential Child Care Project as a TCI trainer and become part
of an international network of TCI trainers

 

SIGNING UP FOR THE
PROGRAM

  • Course Locations: Programs are offered on a
    fee-for-service basis throughout the United States, the United
    Kingdom and Australia. Courses are limited to 18
    participants.
  • On-Site Training: The Residential Child Care Project is
    also prepared to bring this training program to your organization.
    Organizations have arranged, on a fee-for-service basis, to offer
    this program to their staff or member organizations. This assists
    organizations with their efforts to implement uniform standards
    for child and youth care staff. Organizations interested in an
    on-site Train the Trainer programs should contact:

    Eugene Saville
    The Residential Child Care Project
    Family Life Development Center, Cornell
    University
    Martha Van Renssalear Hall
    Ithaca, New York 14853 Tel. 607.254.5210 Fax.
    607.255-4837

 

The TCI Curriculum
Outline

The TCI Curriculum includes five
modules:

DAY
ONE

DAY
TWO

DAY
THREE

DAY
FOUR

DAY
FIVE

1
2
3
4
5
CRISIS AS OPPORTUNITY
AWARENESS
EARLY INTERVENTION
THERAPEUTIC PHYSICAL INTERVENTION
RECOVERY

Defines crisis and identifies how adults can intervene in
a crisis situation to help the child learn better ways of
coping with traumatic events.

Teaches how to maintain self control in preventing or
handling a crisis through awareness of personal feelings and
values, the child’s needs and wants, and environmental
effects on behavior.

Presents verbal and non-verbal techniques which, if used
before a situation escalates to crisis stage, can return an
upset child to normal functioning.

Explains the rationale for physical restraint and when it
should and should not be used, and demonstrates the safe use
of various physical intervention techniques.

Explains what to do after the physical restraint in order
to help the child learn that there are better ways of
dealing with difficult situations than losing control.

  • The stress model of crisis
  • Intervention approaches
  • Awareness of self
  • Dealing with anger in a crisis
  • Awareness of the child
  • Awareness of the environment
  • Crisis prevention in the cottage setting
  • Behavior management techniques
  • Active listening
  • Life space interviewing
  • Conflict resolution
  • Rationale for restraint
  • Making the decision to restrain
  • Non-verbal communication
  • Team restraint
  • Single person restraint
  • Baskethold
  • Self-protection
  • Letting go
  • Life space interview during recovery
  • Recovery for staff
  • Life space interview as a supervision tool
  • Recovery for the agency

 

The Residential Child Care
Project

The Residential Child Care Project (RCCP) is an international
outreach and training organization established in 1982 as part of the
Family Life Development Center at Cornell University to disseminate
model techniques in the prevention of institutional child abuse and
neglect.

World-wide, there have been over 3000 professionals trained as
TCI trainers
. These trainers are located in 40 states throughout
the United States, Puerto Rico, Canada, the United Kingdom, Ireland,
Australia, Russia and Finland.

 

RESEARCH UNDERLYING THE TCI
PROGRAM

Through a grant from the National Center of Child Abuse and
Neglect (NCCAN) in 1979, a study of child abuse and neglect in New
York State foster care institutions was undertaken to assess the
nature and extent of child abuse and neglect when it occurs in the
institutional setting, and to identify those factors associated with
its incidence. Factors associated with the incidence of abuse and
neglect included the inappropriate use of discipline, isolation and
restraint, and poor management practices. The Family Life Development
Center staff spent many months researching other crisis intervention
curriculums, meeting with child care experts, and visiting child care
agencies in order to develop a comprehensive training program that
addressed the issues outlined in the research. Therapeutic Crisis
Intervention training was developed and pilot-tested at approximately
eight facilities from the study sample of sixteen. Concurrently, the
entire sample was involved in the testing of a model response system
in reporting and investigating child abuse. From 1981 to 1982, child
abuse reports (not instances of abuse) in those facilities which had
pilot-tested the Cornell curriculum
decreased by forty percent. In those
sample facilities which were not exposed to the new training
materials reporting increased by more
than two hundred percent. (Note: By virtue of being in the sample,
all of these agencies were much more sensitive to reporting issues
and, therefore, more likely to make a report.)

 

SURVEY OF TCI
EFFECTIVENESS

Two surveys of TCI trainers and agencies have been completed since
1991 to help determine the effectiveness of the program, and to learn
how the TCI model has been implemented. Over 300 agency
representatives from throughout North American, the United Kingdom,
Ireland and Australia responded to these surveys. The results show
that agencies and trainers perceive TCI training improving their
staff’s ability to respond to crises in safe and therapeutic ways.
More importantly, this training enables staff to avoid the crisis in
many situations using communication, awareness, and management skills
learned in the TCI program. Staff confidence levels rise and their
need to intervene physically decreased.

 

EVALUATION OF TCI
EFFECTIVENESS

From 1994-1997, the RCCP and child caring agencies in Northeastern
United States and the United Kingdom, conducted joint evaluation
projects which introduced TCI into residential treatment settings and
evaluated its effect on the organizations. Throughout the life of
this project, critical incidents were collected and an advisory group
from the agencies met with Cornell staff. Other data collection
methods were pre- and post-tests, and interviews with staff
supervisors and children. All levels of residential child care
personnel attended TCI training (five-day offerings) conducted by the
child caring agencies TCI trainers. Supervisors attended the TCI
update, Recovery for Staff, to assist them in monitoring and
supporting the model.

Results from the projects included a decrease in physical
restraint episodes, fighting incidents, physical assaults, runaways,
and verbal threats. Results also indicated that after attending TCI
training staff felt more confident in their ability to manage any
crisis situation, work effectively with co-workers, and help children
learn to cope more successfully with life crisis. Staff were less
afraid to manage crisis situations and were more child focused. They
also reported an increase in knowledge about agency policy and
procedures for crisis management.

 

OTHER PROGRAMS

Other components of the RCCP include regular TCI Updates on topics
such as:

  • Recovery for Staff
  • TCI for Family Care Providers
  • Implementation, Evaluation, and Skill Development
  • Investigation of Abuse and Neglect in Out of Home Care
    (IOHC)
  • Institutional Self Assessment

 

The Resdiential Child Care Project

Faculty and Consultants

 

Michael Nunno, D.S.W., Principal
Investigator
Dr. Nunno, formerly a Child Protective Services
caseworker and supervisor, is the RCCP’s Principal Investigator. He
provides consultation and technical assistance to state, national and
international organizations and agencies on child protective services
training and on the development of effective preventive approaches
and intervention responses to the abuse of children in out-of-home
care.

 

Martha Holden, M.S., Project
Director
Ms. Holden, previously an associate director of a
residential treatment center, is the Project Director of the
Residential Child Care Project. She provides curriculum development,
training and technical assistance in crisis management and violence
prevention in residential child care facilities, foster care and
educational settings internationally.

 

Greg Wise, M.A., Field
Instructor
Mr. Wise, having formerly worked as a residential
child care supervisor and with the developmentally disadvantaged and
mentally ill, is an instructor in the Therapeutic Crisis Intervention
program. He delivers TCI training and TCI Updates and provides
technical assistance to residential facilities throughout New York
State.

 

Eugene Saville, Program Assistant
Mr. Saville provides logistical support to the Residential Child
Care Project. He is responsible for scheduling, registration,
marketing and administrative support.

 

Kristen Carlison, Research Support
Aide, Evaluation Project Analyst
. Ms. Carlison provides
evaluation and research support to the Residential Child Care
Project. She provides programming and data systems development and
management.

 

Marsha Kleine, Administrative
& Conference Assistant.
Ms. Kleine provides administrative
support to the Residential Child Care Project. She provides
conference assistance to the Project Director and Principal
Investigator.

 

Beth Laddin, M.S.W., Instructor
Ms. Laddin, formerly a risk assessment project coordinator and
quality control monitor for residential facilities, is a social
worker in an elementary school in Albany, NY.

 

Andrea Mooney, M.Ed., JD,
Instructor
Ms. Mooney, previously the program manager of the
RCCP, a teacher and trainer, is a co-author of the TCI program and
TCI Updates. Presently, she is the law guardian in Tompkins County,
New York.

 

Jack C. Holden, M.S.,
Instructor
Mr. Holden, formerly a child care worker and
supervisor, is president of Mueller Holden and Associates, a
consultant/training firm. He is a co-author of TCI Update.

 

I. Franklin Kuhn, Jr. Ph.D,
Instructor
Dr. Kuhn is a licensed clinical psychologist
and private consultant and provides training and consultation to
residential centers nationally.

 

Carla Sockwell Morgan, M.Ed.,
Instructor
Ms. Sockwell is the Clinical Director for the Northern
Region of the Lutheran Family Services in North Carolina where she
provides training and consultation to all levels of residential child
care staff.

 

Raymond Taylor, M.S.W.,
Instructor
Mr. Taylor is responsible for the
administration and delivery of training resources to child welfare
and residential workers throughout the Falkirk region in Central
Scotland.

 

Nick Pidgeon, M.S.W.,
Instructor
Mr. Pidgeon is a private consultant in Scotland. Mr.
Pidgeon delivers training programs to child welfare and residential
workers in a variety of topics including crisis management.

 

Doug Bidleman, B.A.,
Instructor
Mr. Bidleman is the coordinator for the Sociotherapy
Training at Hillside Children Center in Rochester, NY. Mr. Bidleman
specializes in crisis intervention and physical restraint training
techniques.

 

Mary Ruberti, M.S.W.,
Instructor
Ms. Ruberti, formerly a residential worker, is
presently providing transitional case management services for the
preventative services department at St. Joseph’s Villa in Rochester,
NY. Ms. Ruberti is also working on her M.S.W.

 

Phil Ishmael, B.A., Instructor
Mr. Ishmael is a private consultant in NY, providing training and
consultation to schools and residential centers

 

Diane Genco, M.A., C.P.C.,
Instructor
. Ms. Genco works with D&G Milieu Consultants in
Mesa, AZ. She specializes in training and crisis intervention
services.

 

Sandy Patterson, M.S.,
Instructor
. Mr. Patterson is principal at High Close School near
London, England where he oversees residential and educational
services for troubled children.

 

Angela Stanton-Greenwood, M.A.,
Instructor
. Ms. Stanton-Greenwood is a trainer and social worker
at a residential center for learning disabled children and adults in
Yorkshire, England.