TCI (7th Edition) Exam Questions with completed Answers 2024, Study Guides, Projects, Research of Nursing

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TCI (7th Edition) Exam Questions with

completed Answers 2024

Day One Information

pg. 108

A Therapeutic Milieu has...

SPICE

(A Therapeutic Milieu: The combination of people, emotions, attitudes, and objects that

creates a sense of safety, respect, belonging, care, and accountability.) Read More

Spaces within The Therapeutic Milieu

S.P.I.C.E. (social, physical, ideological, cultural, emotional)

Spaces within The Therapeutic Milieu: S

Social Space

Spaces within The Therapeutic Milieu: P

Physical Space

Spaces within The Therapeutic Milieu: I

Ideological

Spaces within The Therapeutic Milieu: C

Cultural Space

Cultural Space:

(know 2/4)

• Develops culturally competent staff
• Accepts and celebrates cultural differences

• Supports family connections and involvement
• Allows for culturally diverse staff-child interactions

List 2 of the 4 ways to develop cultural space:

• Develops culturally competent staff
• Accepts and celebrates cultural differences

Spaces within The Therapeutic Milieu: E

Emotional Space

Setting Conditions:

Anything that makes challenging behavior or traumatic stress responses more or less

likely to occur.

What is the definition of "Setting Conditions?"

Anything that makes challenging behaviors or traumatic stress responses more or less

likely to occur.

Foundations For Intentional Use of Self

(know 2/4)

~ Self-awareness

~ Self-regulation

~ Relationships Skills & Attunement

~ Self-care

List 2 of the 4 skills needed for successful "intentional use of self"

self-awareness

self-regulation

The Triune Brain

• Thinking Brain
• Emotional Brain
• Survival Brain

What are the 3 basic brain processing regions?

• thinking brain
• emotional brain
• survival brain

Survival Brain

Active most in trauma

Pain-Based Behavior

(know 3 for test)

• Inability to regulate emotions
• Overreaction to situations
• Impulsive outbursts
• Trauma re-enactment
• Defiance
• Inflexibility
• Running away through anger or fear
• Self-injury
• Withdrawal

What are 3 examples of pain-based behavior?

• self-injury
• withdrawal
• Impulsive outbursts

Assessing Behavior:

All behavior has meaning

Goals of Crisis Intervention

SUPPORT: provide immediate emotional and environmental support to reduce stress

and risk and increase child's sense of safety.

TEACH: help children learn and practice ways to regulate their emotions and behaviors.

What are the 2 goals of crisis intervention?

• Support
• Teach

Stress Model of Crisis

• Baseline
• Triggering event (agitation)
• Escalation (aggressive)
• Outburst (violence)
• Recovery (can only teach here)

Stress Model of Crisis Trigger Example

• bad phone call

Stress Model of Crisis Escalation Example

• yelling, cursing, throwing things

Stress Model of Crisis Outburst Example

• self-harm
• harming others

Recovery Phase Outcomes

• Higher: learned something
• No Change: back to "baseline"
• Lower: something negative happened

What outcome do we want in the recovery phase?

Higher (want them to learn something)

4 Questions We Ask Ourselves In A Crisis Situation:

1.) What am I feeling?

2.) What does this child feel, need, expect, or want?

3.) How is the environment affecting the situation?

4.) How do I best respond?

Reflective Response

Connect with the child's FEELINGS

• "You look upset."

Empathetic Response

Connect with the child's EXPERIENCE

• "This is really hard for you."

Day Two Information

pg. 128

Behavior Support Techniques

(know 5/8)

• Managing the environment
• Prompting
• Caring gesture
• Hurdle help
• Redirection & distractions
• Proximity
• Directive statements
• Time away

My - >

Pet - >

Cat - >

Has - >

Rabies - >

Please - >

Don't - >

Touch - >

• Managing the environment
• Prompting
• Caring gesture
• Hurdle help

• Redirection & distractions
• Proximity
• Directive statements
• Time away

List 5 of the 8 Behavior Support Techniques:

1.) Prompting

2.) Proximity

3.) Time away

4.) Hurdle help

5.) Managing the Environment

Goals of Emotional First Aid:

• Provide Immediate support to reduce emotional intensity
• Identify and resolve the underlying concerns causing distress
• Keep the child in the activity

What are the 3 Goals of Emotional First Aid?

• Provide Immediate support to reduce emotional intensity
• Identify and resolve the underlying concerns causing distress
• Keep the child in the activity

Strategies for Emotional First Aid:

Co-regulate emotions & be a calm presence

What is the 1st strategy of emotional first aid?

Co-regulate emotions & be a calm presence

Effects of Anger on a Stressful Situation:

• Anger is a physical & emotional state
• Anger undermines objectivity
• Anger reduces cognitive abilities

What are 2 of the 3 effects of Anger in a Stressful Situation?

• anger undermines objectivity
• anger reduces cognitive abilities

We Can Avoid or End the Power Struggle by...

(know 3/4)

• Listening & validating feelings
• Managing the environment
• Give choices & the time to decide what to do next
• Dropping or changing the expectation

What are 3 strategies to avoid or end the power struggle?

• drop or change expectations
• manage environment
• listen & validate feelings

Elements of A Potentially Violent Situation

• The Spark
• The Target (easiest to remove)
• The Weapon
• The Level of stress or motivation

Taylor - >

Swift - >

Wants - >

Love - >

Target

Spark

Weapon

Level of stress/motivation

What are the 4 elements of a potentially violent situation?

Target

Spark

Weapon

Level of stress/motivation

Decrease the Level of Stress or Motivation by...

using co-regulation strategies (reactive aggression)

How can we reduce stress or motivation in a potentially violent situation?

co-regulation

What To Do (Nonverbal Strategies)

(know 3/5)

• Take a deep breath and slowly exhale
• Give the child space and time
• Use silence
• If safe, step away from Child's sight
• Assume a neutral stance and concerned facial expression

List 3 of the 5 nonverbal crisis co-regulation strategies

• deep breath, exhale slow
• give space & time
• silence

Goals of LSI (Life Space Interview)

(know all 5)

• Provide a sense of emotional safety (secure)
• Help clarify events for the child and adult (clarify)
• Repair and restore the relationship between the adult and child (repair & restore)
• Help the child learn to regulate emotions (teach)
• Re-enter the child back into the routine (re-enter)

Steps to the LSI (must be in order)

1.) I- Identify a place and a time to talk

2.) E- Explore child's point of view

3.) S- Summarize feelings and content

4.) C- Connect trigger to feelings to behavior

5.) A- Alternative responses to feelings discussed

6.) P- Plan developed/Practice

7.) E- Enter child back into the routine

LSI: Step One (I)

Identify a place and time to talk

LSI: Step Two (E)

Explore the child's point of view

LSI: Step Three (S)

Summarize feelings and content

LSI: Step Four (C)

Connect trigger to feelings to behavior

Connecting Statement

When (trigger), you become (feeling), and you (behavior)

("When someone makes fun of you, you become angry and you hit them.")

LSI: Step Five (A)

Alternative responses to feelings discussed

LSI: Step Six (P)

Plan developed/Practice

LSI: Step Seven (E)

Enter child back into the routine

What stage of the stress model do we complete the LSI?

Recovery phase

Day 3 information

Pg. 159

Options to Handle Physical Violence

• Eliminate one of the elements of a violent situation
• Use releases and maintain a safe distance with a protective stance
• Employ physical restraint techniques (if indicated in the ICMP)
• Leave the situation and get assistance

Give the 3 options to handle physical violence that don't include physical restraint.

• Eliminate one of the Elements of violence
• Releases/Protective stance
• Leave and get assistance

Physical Restraint Should Only Be Used When:

• Agency policies & state regulations regarding restraint allow it
• The child's individual crisis support plan prescribes it
• Our professional dynamic risk assessment indicates it (red rule)

What 3 conditions have to be present to use a physical restraint?

• Agency policies and state regulations allow it
• The child's ICSP prescribes it
• Our professional dynamic risk assessment indicates it

Restraint Should be Avoided or Discontinued When:

(know 3)

• Adults cannot control the child safely
• Adult is not in control (too angry)
• Child is threatening and is capable of harming self
• Sexual stimulation is the motivation
• In a public place
• Child has a weapon
• Child's medical condition prohibits it
• Child has emotional problems risking traumatization
• Child is on medications that affects their system

List 3 situations a restraint would be indicated, but should be avoided.

• child has a weapon
• medical condition
• public place

The Letting Go Process

• States what is expected of the young person
• Is directed by the leader
• Is supportive of the young person
• Sets the tone for the recovery phase

List 2 principles of the "Letting Go Process"

• States what is Expected of the child
• Is Directed by the team leader
• Is Supportive of the child
• Sets the Tone for recovery process

Definition of Asphyxia

Deprivation of oxygen to living cells

Improper Restraint Techniques

(know 2)

• pressure on the neck or chest
• obstructing the mouth or nose
• Incorrect positioning of arms
• Abnormal positioning of the body

What are 2 improper restraint techniques?

• pressure on the neck or chest
• obstructing the mouth or nose

Predisposing Risk Factors Include

(know 3)

• Obesity
• Underlying natural disease
• Hot humid environments
• Influence of alcohol or drugs
• Prolonged violent physical agitation
• Younger person taking certain types of medication
• Effects of severe trauma history

List 3 predisposing risk factors that will put a child at greater risk of serious injury during

restraint

• Obesity
• Certain medications
• Hot/humid environments

Monitor During Restraints

(know 2)

Make sure the restraint position is correct

Assure there are no breathing problems

Observe & Assess:

• Skin color
• Respiration

- LOC

• Level of agitation
• Rang of motion in extremities

Recommendations to Reduce Risk of Injury or Death

• NEVER allow the child to continue lying/sleeping on the floor after a restraint. Once

the child is no longer a safety risk, get the child up and seated.

• NEVER use these restraint techniques on children under five years of age