The TCI Effect: Since the institution of the teaching and application of TCI in residential settings, the need for physical interventions has dropped precipitously. Also, young people are being consistently coached to learn and use new and improved coping skills.
Therapeutic Crisis Intervention: According to the literature, [1]The Therapeutic Crisis Intervention System Residential Child Care Project development began in the 1980’s at the Family Life Development Center at Cornell University. Most commonly referred to as TCI, it was designed to assist [2]organizations in preventing crises from occurring, de-escalating potential crises, managing acute physical behavior, reducing potential and actual injury to young people and staff, teaching young people adaptive coping skills, and developing a learning organization.
Below is a summary drawn from my own study notes of how TCI works. For the real nitty-gritty, however, I suggest you go to the internet or download here a free copy of Crisis Intervention Handbook TCI Manual.
An Invitation: Please peruse my extremely simplified outline and if interested, as suggested above, take the time to read more about Therapeutic Crisis Intervention as I believe that within it there are nuggets of information possibly of value to anyone just going about the business of living and being human.
Roy’s Quick Notes on TCI
During the Crisis
The key concepts as I found them to be during the crisis as described inTCI are five:
- Self-Awareness
o The Four Questions
1. What am I feeling now?
2. What does the young person feel, need, or want?
3. How is the environment affecting the young person?
4. How do I best respond?
- Crisis Communication/Active Listening
o KEY CONCEPT: Meaning to the young person is communicated mostly by Facial Expression (55%) and Tone of Voice (38%) with Words (7%) carrying the least meaningful part of the message
o Care providers meantime:
1. Use Encouraging and Eliciting Techniques
2. Understanding Responses
3. Active Listening
- Behavior Support Techniques relate to the
o Environment
1. Decrease availability of possible causative factors
2. Remove potential targets or weapons from the environment
3. Consider need to ontrol heat and loudness levelso Expressions of Care
1. Caring gesture – hand to shoulder, smile if appropriate
2. Proximity – move closer or sit down near if appropriateo Verbal Guidance
1. Prompting
2. Hurtle Help
3. Directive Statements
4. Redirection and Distractionso Time Away in which young person agrees to a need for quiet and a place where such quiet would be available and goes there for a length of time to be determined as the young person begins to calm and can agree he/she is all right to return (Used only if young person has good self-regulating skills)
- Emotional First Aid
o Goals
1. Co-regulation = Immediate help and support to reduce emotional intensity
2. Resolve the immediate crisis
3. Keep the young person in the program or activityo Challenges the Caregiver to
1. See the incident from the young person’s perspective
2. Help the child connect his or her feelings and behaviors
3. Encourage the young person to be responsible for his/her actions
- Crisis Co-Regulation
o Purpose: To support both the Caregiver and the Young Person through the response of
the Caregivero What the Caregiver can do:
1. Use four questions (See Self-Awareness above) and positive self-talk (e.g. I can do
this. The day is almost over. We got through this before.)
2. Take a deep breath – Step back/ use protective stance (arms down, finger tips raised),
Give the situation Time – Sit down if appropriate
3. Remember the non-verbal message (facial expression, tone of voice, gestures and
postures)
4. SAY: Very little
5. GIVE: Understanding Responses until such time as young person returns to baselineFollowing the Crisis
- The Life Space Interview or LSI
o Goals of the LSI:
1. Clarify events with/for the young person
2. Repair and restore the relationship with the young person
3. Teach the young person new coping skills
4. Return the young person to normal functioning
5. Reintegrate the young person into the programo LSI Steps – I ESCAPE
I– Isolate the conversation with the young person so no one other may comment in it
E – Explore the young person’s point of view
S – Summarize verbally the young person’s story of the event and feelings expressed
C – Connect the young person’s feelings to his/her behaviors
A – Alternative behaviors must be discussed to suggest other, more acceptable ways for
the young person to respond in the future
P – Plan or develop one or more new behaviors to be used in similar situations in the
future/Practice (role play) that new behavior
E– Enter the young person back into the routine
robertamroy 
Thank you, your article was very helpful to me.
Awesome! As a new clinician on the field and working in a psychiatric in-patient setting, your article is just the right fit for me. Thanks.
Most happy to have been of service.
i WORKED WITH CHILDREN ON THE AUTISTIC SPECTRUM FOR 9 YEARS USING TCI GAVE A GREATER UNDERSTADING OF THE EMOTIONAL WELL BEING OF THE CHILDREN AND AIDED A POSITIVE DEVELOPMENT, THROUGHOUT WHICH THE CHILDREN HAD LEARNED GREATER UNDERSTANDING OF THEMSELVES AND THERE INTERACTION WITH OTHERS HELPING THEM TOWARDS REACHING THEIR FULL POTENTIAL, IT WORKS PLEASE TRY IT.
Can i ask, does the training still suggest that it takes in excess of 200 crisis’ before you achieve a change in behaviour for children in out of home care?
In my experience the application of the method to de-escalate and prevent crises is the most effective way to change a child’s behavior and using this approach in working with numerous emotionally troubled children over the years, typically the improvement was noted without the need to de-escalate a major crisis.
I have been working for 15 mths as an ohc direct care worker although I have heard these comments all missmash they have never been put into such a good contect I can understand now. I will be doing the whole TCI training soon this has definatly helped me understand
Happy to help!
TCI ? That’s only one letter away from SCI – which stands for “Sensitive Compartmented Information” in the USAF’s (DOD’s) intelligence community. But my point is that you should not be following the Military’s penchant for acronyms. They are CI (Counter Informative).
I am so with you in your observation however the TCI chicken was long out of the egg before I came along but I too would prefer it be refereed to as Therapeutic Crisis Intervention.
THIS ARTICLE INDEED SIMPLIFY THE TCI MODEL. VERY GOOD WORK.
Appreciate your appreciation!
Remember
thank you.
the link isn’t working for “however, I suggest you go to the internet or download here a free copy of Crisis Intervention Handbook TCI Manual.”