Therapeutic Crisis Intervention Strategies

From KNILT

Introduction

Welcome to my mini-course page. In this professional development training, participants will learn the basics of Therapeutic Crisis Intervention Strategies (TCIS) and be expected to understand the content in an effort to implement de-escalation techniques, perform a Life Space Interview and execute (non-restrained certified) protective stances while a child may be in route or in crisis. Please watching the following video for more information regarding Therapeutic Crisis Intervention Strategies training which was developed by the Residential Child Care Project at Cornell University.

Course Units and Topics

During the first unit: Crisis as an Opportunity, participants will learn:

• The importance of self-awareness when entering a crisis situation

During the second unit: De-Escalating the Crisis, participants will learn:

• The use of crisis communication and active listening while de-escalating a potential crisis
• The types of behavior support techniques while de-escalating a potential crisis
• The goals of emotional first aid and strategies

During the third unit: Managing the Crisis, participants will learn:

• The 2 types of aggression found typically during a crisis situation
• The objective of crisis co-regulation when dealing with a crisis situation
• The way to execute a Life-Space Interview after a crisis

The Goals of TCIS

Many children lack the positive coping skills necessary for handling negative emotions and stressful situations; however, the likelihood of aggressive behaviors increases among this demographic of students. Crisis experiences provide opportunities for adults to teach children the lack these coping skills optional behaviors and responses which, hopefully, support in the short-term as well as help in developing new coping skills in the long-term. The first goal of TCI is to reduce the stress and pain of the situation and the second goal is to teach the student constructive coping skills that are used to replace the negative or unwanted behaviors and responses to stressful situations and negative emotions.

Causes of Stress

I personally believe in the Extinction Induced Variation Theory.
This video clip interviews a mother and explains her reasoning for entering her child into a Residential Program.

What is the Stress Model of Crisis?

The Stress Model of Crisis explains the important role we play in helping students work through the crisis in a way that is a constructive, learning experience.

Stress Model of Crisis Figure Kristen Mennella TCIS Cornell University.jpg

Precrisis State (Baseline): It's fundamental for adults to understand the typical behavior of a child or client they work alongside with. It is critical that the adult takes the first step in identifying a situation that may lead to a potential crisis. To do this, it is critical to know how the students, staff and the classroom operate "normally". It is only by knowing each individual's baseline behavior when not stressed, that we can identify the first phases of the crisis, intervene early, and prevent the situation from escalating through the Stress Model of Crisis.

Triggering Event: Students who are already struggling and experience high levels of stress as they attempt to cope with everyday challenges are more likely to react negatively or emotionally to a frustration or to a challenging situation than those who are not already stressed. The increased stress can be a result of environmental and psychological factors called setting conditions. Setting conditions are situations that are present that may likely escalate a student when there is a triggering event. Because the child was already stressed due to the setting condition, the likelihood that a frustrating event or stressful interaction will result in a behavior outburst if increased. The following are examples of a triggering event:
• The child may have failed a test in a previous class.
• The child may be in a room that is a similar color of a room that he or she was previously abused in.
• The child may have not slept well the night before.

Escalation Phase: During the escalation phase, there are some obvious signs of increased anxiety and failure to cope effectively with the stressful situation. As the behaviors increase in duration, frequency or manifest, the likelihood of the student responding to interventions decreases. During this phase the student may be threatening or behaving in ways that are recognizable signs of escalation. The following are examples of behaviors that may occur in the escalation phase:
• The child may be withdrawn.
• The child may be damaging property.
• The child may be yelling.

Outburst Phase: During this period of the Stress Model of Crisis, the student may act out in an aggressive manner that is dangerous to student and staff. Prior to the outburst phase, we have used request and responded rationally to help regulate their emotions. Now as adults, we must continue to try to de-escalate and provide safety and protection for the student, other students and staff. The following are examples of behaviors that may occur in an outburst phase:
• The child may be causing injury to themselves.
• The child may be physically assaulting students or staff.
• The child may be having an uncontrollable tantrum.

Recovery Phase:

KM TCIS Recovery Phase Figure.jpg

The recovery phase is the last section of the Stress Model of Crisis. During the recovery phase it's up to the adult to provide the child with an opportunity to learn from this crisis experience. After the outburst, the child should be allowed to calm down. The body begins to calm itself naturally by relaxing the mind and muscles. There are 3 possible outcomes in all crisis situations: the lower level outcome, no change/no growth, and the higher level outcome.