Therapeutic Crisis Intervention Strategies Mini-Course

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My name is Kristen Mennella, a 23 year-old, first-year Graduate student at The University of Albany. I was born and raised in the city of Albany and currently work in their school district as a Teaching Assistant in a self-contained, third-, fourth-, and fifth-grade classroom. I was offered the position after working as a Teaching Assistant in a private, self-contained institution for children that have been traumatized or identified with emotional disturbances. I have been working in this specific field for over a year and have decided to use my observations and findings to reform the ways in which inner-city students with disabilities are taught.

Many people have told me I have too much on my plate at once but I am determined and ambitious which has made me smile, sing, and dance through the stress of it all! The small amount of free time I do have once a week I spend on my family, who I still live with, and my closest friends. During breaks from school and work I enjoy reading (historical fiction, fiction and coming of age stories) and writing (raps, poems and memoirs). I'm interested in astrology and meditation, both of which, I practice and use in my daily life. I recently picked up hula-hooping and have been working on tricks in my sanctuary which happens to be my basement.

Topic & Purpose

The intent of this mini-course is to teach educators and paraprofessionals working with elementary-level students identified with emotional/behavioral disturbances (EBD) and/or other health-impairments to use and practice Therapeutic Crisis Intervention Strategies (TCIS) which were developed by Cornell University and is a required certification while working with these children.

The topics that will be covered:

• What are the 2 main goals of TCI? How is this training necessary when working with emotionally disturbed children?

• What is the Crisis Cycle? How does it relate to TCI?

• What is the Stress Model of Crisis? How does it relate to TCI?

• How can you de-escalate a child before the crisis occurs?

• Which techniques are used by adults working with escalated children to protect themselves?

• What is the acronym to follow while conducting a Life-Span Interview (LSI)?

Learning outcomes

Learners will be able to...

• Identify the 2 goals of TCI while working with EBD children.

• Label the parts of The Crisis Cycle and how explain how this cycle can reduce power struggles when used appropriately in a given setting.

• Label the Stress Model of Crisis and define the terms labeled on the diagram.

• Identify multiple ways to de-escalate children before a crisis occurs.

• Identify ways to protect yourself against an escalated child before needing to restrain.

• Follow the steps to complete an LSI based on a given situation.

Needs Assessment & Analysis of Learner & Context

1. Instructional Problem

Under “The Individual’s with Disabilities Education Act” (IDEA) and the addition of the civil rights law “Section 504”, all children regardless of gender, age, ability, cultural/religious background and socio-economic status are expected to attend grade-school for free in the least restrictive environment (p. _). The Department of Education in New York State has identified 13 possible classifications of disabilities which include: Autism, deafness, deaf-blindness, emotional disturbance, hearing impairment, learning disability, developmental delays, multiple disabilities, orthopedic impairment, other health-impairment, speech or language impairment, traumatic brain injury (TBI) and visual impairment (pp. 32 – 34).

Due to the educational laws, all students, regardless of disability must be served. However, very few teachers and professionals working with students identified with having an emotional disturbance or other-health impairment are prepared for the unpredictable challenges that occur on a day-to-day basis for these young learners. Colleges and universities that are supposed to be preparing special education teachers for their career have been failing their graduates because they do not realize the severity and relevance of emotional disturbances and/or other health-impaired students, especially in a specific demographic. The lack of understanding for the child’s disability and how to prevent crisis episodes (i.e.; running out of class, physically fighting with peers or adults, verbally threatening others) from happening forces educators to place these students in “learning” environments that are unsuitable for their health and educational growth. Even worse, parents are placing their children in residential programs to treat their trauma which becomes counteractive.

In order to work with children diagnosed with having an emotional disturbance or other health-impairment, we must prepare teachers, families, communities and professionals how to effectively teach children self-regulation, societal norms and coping skills. Unfortunately, research does not provide many answers as to how or why trauma effects children. However, Cornell University has designed a professional development course that is a required certification when working with children diagnosed with an emotional disturbance, or have endure traumatic events, called “Therapeutic Crisis Intervention Strategies” (TCIS).

2. What's to be Learned?

The participants of the Therapeutic Crisis Intervention Strategies (TCIS) professional development course will learn how the following elements that pertain to the understanding of working alongside children with emotional disturbances and/or other health-impairments, which include: the crisis cycle, the stress model of crisis, and how to conduct a Life Space Interview (LSI). The learners will also learn how to de-escalate children before they enter a crisis and how professionals can protect themselves regardless of the traumatized child’s state.

3. The Participants

The following mini-course is a professional development opportunity designed for any professional working with children identified as being emotionally-disturbed under The Individual's with Disabilities Education Act (IDEA). These professionals may be include, but not limited to: special educational teachers, instructional support, social workers, nurses, child-care workers and TCIS trainers. The learners will become knowledgeable about the importance for using and implementing Therapeutic Crisis Intervention Strategies (TCIS), as well as, how to remain calm, in-control and protected when working with a child during and after a crisis.

4. Context for Instruction

The intended professional development course can only be completed solely online. Therefore, the participants must have access to a computer and the internet, as well as, a voice recorder or webcam. Direct instruction will be used as the course develops and will include: lecture-based readings, research, worksheets, graphics and video. Participants will be assessed dependent upon the information previously learned throughout the lesson and unit. The information will overlap and will force the learners to review and master content before moving forward through the lessons in each unit.

5. Exploring the Instructional Problem & Solution

The participants in this mini-course will be continuously learning the basics of Therapeutic Crisis Intervention Strategies (TCIS) through readings, case studies, diagrams and worksheets. As the learner begins to learn more about TCIS, as a whole, those participating will be able to apply these models and/or strategies in their daily lives.

6. Goals for Mini-Course

The first goal for this mini-course is to ensure that professionals know the key elements of Therapeutic Crisis Intervention Strategies. The second goal for this professional development training is to focus on how to implement TCIS in an effective manner. The last goal of these lessons include an overall generalization of how to use one or more of these elements in their daily lives (i.e.; parenting or de-escalating co-workers).

Performance Objectives

At the conclusion of this course, learner's will be able to:

• Identify the 2 goals of TCIS

• Classify terms for both The Crisis Cycle and Stress Model of Crisis

• Develop a list of de-escalating strategies

• Execute each (non-restrained certified) TCIS protective techniques

• Execute a Life Space Interview (LSI)

Task Analysis

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

• The stress model of crisis
• The power struggle model and techniques to decrease power struggles

The first unit will focus on how setting conditions may effect children's feelings and thus creating specific behaviors. Each of these behaviors changes depending upon the level of stress, the particular child and the overall situation. As students enter these levels of emotion, a behavior is displayed. The adult is responsible for collecting information on each child that has higher levels of aggression and lack the necessary coping skills for stressful situations. This documentation should be analyzed to support the adult. The adult reacting to these children will have a greater chance of de-escalating the child before a crisis occurs or a greater chance of reacting to a crisis situation appropriately so the 2 goals of TCI are achieved. Participants must also learn what a power struggle is and how it can negatively impact the stress model of crisis. These are the pre-requisite skills necessary for completing the entire mini-course because the units have been broken down based upon each section of the stress model of crisis. Also, power struggles can occur during any situation or stress level, with any student, at any time; thus making it important for adults to recognize when there is a power struggle and how to eliminate them to ensure the best results for the child and adult.

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 second unit will focus the triggering and escalation phases of the stress model of crisis. Crisis communication and active listening are the overall tools necessary for successfully de-escalating a crisis which are a combination of multiple skills that an adult must acquire while working with children identified with having an emotional disturbance, traumatic brain injury and/or learning impairment (i.e.; identified with having ADHD, scores poorly on English tests, cannot communicate verbally). While the child is agitated or _________, alongside using crisis communication and active listening skills, the adult must also de-escalate the potential crisis by using appropriate behavior support techniques. It's important that the adult uses the analyzed data collection of behaviors to select the correct technique that will diffuse stressful situations.

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

• The 2 types of aggression found typically during a crisis situation
• The non-restrained certified protective techniques that can be used during a crisis

The third unit will focus on the outburst phase of the stress model of crisis.

During the fourth unit: Learning From a Crisis, participants will learn:

• The 3 types of recovery
• The way to execute a Life-Space Interview after a crisis

The fourth unit will focus on both the recovery and baseline phase found on the stress model of crisis.

References & Resources

Holden, M. & Holden, J. (2013). Therapeutic crisis intervention for schools workbook: Residential child care project. New York, NY: Cornell University.

Holden M. & Holden, J. (2013). TCI activity guide. Therapeutic crisis intervention for schools: Residential child care project. (pp. 1-8). New York, NY: Cornell University.