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TCI Seventh Edition Study Guide Review
1. The TCI System helps Organizations: Prevent Crises. De-escalate potential crises, Manage acute Physical behavior, Reduce potential
and actual injury to children and staff, Teach children adaptive coping skills, Develop a learning organization.
2. Developmental Relationships: are characterized by attachment, reciprocity, progressive complexity,
and balance of power.
3. Theory of Change: Identifies roles and tasks as well as desired practice at all levels of the organization that, when implemented create a
consistent approach to crisis prevention and management in a nurturing, safe, and predictable environment.
4. What are the six domains in TCI?: 1. Leadership and program support
2. Child and family inclusions
3. Clinical participation
4. Supervision and post-crisis response,
5. Training and competency standards, and
6. Documentation, incident monitoring, and feedback
5. What are the six modules of TCI?: 1. Crisis Prevention: Creating a Safe Place for Learning
2. Crisis as Opportunity
3. De-Escalating the Crisis
4. Managing the Crisis
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5. Recovery
6. Safety Interventions
6. A Trauma-informed organization: Supports trauma-informed care through: Policies
Procedures Practices
7. A Trauma -Informed Organization Ensures that Staff: Understand- Understand what
trauma is and how it impacts everyone in the system. Recognize- Recognize behaviors and patterns that reflect past and present trauma. Respond- Respond in ways that avoid re-traumatization
8. Developmental Relationships are characterized by: Attachment Reciprocity
Progressive Complexity Balance of Power
9. What is the definition of Crisis?: Is an upset in a steady or normal state.
10. Reactive Aggression: When there is a loss of ability to regulate emotions and emotions instead of reason
drive the child's actions.
11. Proactive Aggression: Is planned and is used to obtain something; reason and the thinking brain dominate not
emotions.
12. What is the fight, flight, or Freeze response: It is the stress response
13. What can trigger a stress response?: A smell, thought, or perceived danger
14. What is the Therapeutic Milieu?: The combinations of people, emotions, attitude, and objects that
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20. Social Space: 1. Values attachments and developmental relationships.
2. Balances structure and flexibility to meet individual and group needs.
3. Creates opportunities to participate and contribute.
4. Has goals, structure, and is designed to help children develop skills.
5. Allows for practice of important life skills.
21. Emotional Space: 1. Taken into consideration specific effects of trauma
2. Facilitates an atmosphere of safety and acceptance
3. Encourages warm and response relationships
4. Requires emotionally competent staff
5. Allows for development of co regulation and self regulations skills.
22. 4 Foundations for intentional Use of Self: 1. Self awareness
- Self Regulation
- Relationship skills and attunement
- Self Care
23. Self Awareness: 1. Knowing our own attitudes, values, and beliefs about children and how they influence our behaviors
2. Understanding our own cultural values, fears, and beliefs.
3. Understanding how our previous life experiences can influence current behaviors
4. Knowing our beliefs about trauma and pain-based behavior
24. Self Regulations: -Ability to consciously focus attention
5 / 24 -Awareness of our own physical and emotional state -Skills to marriage our own emotions and behaviors. -Ability to draw on memory and experience to adapt effectively in the present situation.
25. Relationship Skills and Attunement: To build developmental relationships, adults need to:
-Listen and engage the child -"Tune in" to what the child is saying and feeling -Be aware of their own feelings -Respond to the child -Be attuned to how the child is experiencing adults.
26. Self-Care: -Monitor personal levels of stress
-Maintain a healthy lifestyle -Use reflective supervision
27. Knowing The Child: to help them therapeutically to a child , you need to have a understanding of what is driving the child's
emotions and behaviors.
28. The Truine Brain Model: Pail McLean described three basic brain processing regions. The Survival Brain, The Emotional Brain,
The Thinking Brain.
29. The Survival Brain: Also known as the reptilian brain. It is responsible for survival functions like breathing, heart rate,
circulations and most bodily functions that don't require conscious thought.
30. The Emotional Brain: Also called the limbic system and is for center emotions, emotional behavior, and motivation. This is also
amygdala is and is also known as the sentry. Amygdala plays the role to help determine whether or not something is a threat.
31. The Thinking Brain: This is the neocortex and is responsible for higher functions like reasoning, language,
creativity and abstract thought. Children with trauma often perceive things differently or sense danger even when there is not. They struggle with
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39. Triggering Event: Children who are already struggling and have experience high levels of stress as they attempt to cope with
everyday challenges are more likely to react negatively or emotionally to frustration or to a challenging situation than those who are not already stressed. The aroused state or increased stress can be caused by ditterent types of setting conditions.
40. Escalation phase: During this phase the child becomes more and more upset or agitated and less able to manage their emotions
as the amygdala sends the danger message to the survival brain and this takes over.
41. Outburst Phase: During the outburst phase, the child is in survival mode and may explode in a manner that could be
dangerous to themselves and others.
42. Setting Conditions: Anything that makes challenging behavior more or less likely to occur
43. Setting Conditions that make pain based behavior to occur:: -Physiological Stress
-Psychological Stress
- Use of drugs or alcohol -Biological or neurological conditions -External pressures such as having a paper due, being unable to understand instructions, or not being able to spend more time at home.
44. Recovery Phase Outcome: Higher
No Change Lower
45. Higher: In this outcome the child is damage by the crisis by the way it was handled or ignored.
46. No Change: In this outcome, the crisis is handled, no one was injured, and every thing went back to "normal".
The immediate goal of crisis intervention was achieved by reducing the stress and risk of the situation. There was nothing learned by the statt or child.
47. Higher Outcome: In this outcome, an intervention occurred in a therapeutic manner. The child is supported
by the adult and the adult and child have an opportunity to reflect on the incident. There is growth and repair.
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48. Assessing a Crisis Situation: Accurately assessing a potential crisis situation and choosing strategies that will provide the
emotional and environmental support the child needs to navigate through the event.
49. 4 Questions We ask Ourselves in a Crisis Situation: 1. What am I feeling now?
2. What does this child feel, need, expect, or want?
3. How is the environment affecting the situation?
4. How do I best respond?
10 / 24 Facial Expression Eye contact Tone of Voice
56. Encouraging and Eliciting techniques: Minimal Encouragement Door Openers
Closed Questions Open Questions
57. Reflective and Emphatic Response are ways?: Connect with the child's Feelings.
Connect with the Child Experience
58. Summarization: Sum up feelings and content
59. Behavior Support Techniques: Redirection and Distractions Managing
the Environment Prompting Proximity Direct Statements Caring Gesture Time Away Hurdle Help
60. Redirection and Distractions: this helps the child or group by changing the activity, location, or
request and this in turn comes or reduces the stress.
61. Proximity: nearness, closeness Sometimes the presence of the adult gives the needed support to stay focused.
62. Criteria For Using Direct Statements: -The Child has a trusting relationships with the adults
-The expectation is important enough to risk escalating the situation. -The Child has the ability to meet the expectations and has demonstrated this ability in the past when they were at the same level of arousal.
11 / 24 -The child is still in control enough to hear and understand the statement and respond positively to the request -The request is made respectfully and calmly.
63. Criteria for Using Time Away: -The child has demonstrated an ability to self-regulate
-The child is not too highly escalated -The child can go somewhere to relax, be quiet and think -The purpose is to help the child quiet their emotions, not to punish
64. Adults can be a source of strength for children by:: -Seeing the situations from the child's point of view
(empathetic response) -Lending enough support (emotional and environmental) to help bring the situation within the child's ability to manage. -Celebrating the child's efforts and success
65. 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
66. Strategies for Emotional First Aid: - Co-regulate emotions-Be a Calm presence
- Maintain the relationship and lines of communication
- Plan and anticipate-be a coach
67. Pain Based Behaviors: Is an expression of the emotional and psychological pain children experience.
68. Pain-based behavior takes many self-destructive forms.: -When a child has a loss of
control -Reminded of a traumatic event(Consciously or Unconsciously)
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- Am I able to provide a feeling of safety and trust? -Am I communicating concern and acceptance or irritation and frustration?
- How is my worldview influencing me?
- How is the young person experiencing my though their worldview?
75. What does this child feel, expect, or want? How is the child experiencing me?: - What does the child
expect from me based on their past experience?
- How is the child's worldview affecting their reactions to the situation?
- What feelings are driving the child's behavior, fear, anger, frustration? What are they expressing?
- What is the child's ability to regulate their emotions?
- How is the child experiencing me? Am I am source of strength, and support or stress?
- How might the child's trauma background and memories be influencing their perceptions?
76. How is the environment Affecting the situation?: Emotional and Cultural Space Social Space
Physical Space Ideological Space
- What combination of setting conditions are making a potential trigger to pain-based behavior more likely? -How is the organizational culture and climate impacting the child's behavior and my thinking?
- What is the atmosphere and is it contributing to the stress of the child, the group or myself?
- How is the physical environment affecting the children and staff? -How are the expectations and activities influencing the child's anxiety level?
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77. How Do I Best Respond? How Can I use My Relationship to Comfort the Child?: - What do I
want to Happen?
- How do I want the child to experience me and respond to me? If the child is not experiencing me the way I would like, what do I need to change? -What response will most likely reduce the child's stress and arousal?
- How can I support this child through this crisis? -How can I co-regulate with this child?
78. How To Best Respond?: - Is my response increasing the stress or decreasing the stress?
-Am I in control of my own emotions and behavior?
- Am I able to co-regulate with the child? -Can I recognize and reinforce the child attempt to cope?
79. We Can Avoid or End the Power Struggle By?: -Listening and validating feelings
- Giving choices and the time to decide what to do next. -Managers the environment (removing overs) -Dropping or changing the expectation
80. Nonverbal Messaging: -Eye Contact
-Body Language -Personal Space -Height and Gender -Sensitivity to Cultural Issues
81. Non- Verbal Crisis co-regulation "help me help myself" strategies: take a deep breath and exhale slowly
16 / 24 -Using co-regulation strategies (reactive aggression) -Removing the audience -Using co-regulations strategies (reactive aggression) -Offering alternative, non aggressive ways to achieve goals (if motivation)
87. Objective of Crisis Co-Regulation: - To provide support in a way the reduces stress and risk and increase the child's
sense of safety.
88. What to think (Self-Talk): -Ask yourself the four questions
-Use positive self-talk
89. What to Say (verbal strategies): -Say very little
-Speak calmly, assertively, respectfully
- Understanding responses
- Remember the importance of tone of voice.
90. What to Do (When it is over): -It's over when
-Prepare to discuss the situation in a LSI
91. Effective TCI Implementation Includes: 1. Immediate Response (Is everything ok?)
2. LSI with the Child (how can the young person recover at a higher level?
3. Documentation (What happened?)
4. Incident Review with Statt (What have I learned from this?)
5. Incident Review with Team (how can we all learn from this?)
92. The Life Space Interview: A verbal process that helps turn crisis events into learning experiences.
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93. Goals of Life Space Interview: -Provide a sense of emotional safety
-Help clarify events for the events for the child and adult -Repair and restore the relationship between the adult and child -Help the child learn to regulate emotions -Re-enter the child back into the routine
94. Steps to The LSI: I- Identify a place and time to talk E-
Explore child's point of view S- Summarize feelings and content C- Connect trigger to feelings to behavior A- Alternative responses to feelings discussed P- Plan developed/Practice E-Enter child back into routine
95. Potential Pain-Based Responses During the LSI: Child does not respond
-Convey calm support and aflrm silence -Ask a focused question -Reschedule LSI Child gets off subject
- Allow exploration and relate it to incident -Focus on issues at hand Adult or Child want to just "fix it" -Don't interrupt child's thought process
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102. Basic Principles of Physical Intervention: A maximum amount of care with a minimum amount
of force and the goal of de-escalating the situation by reducing stimulation.
103. Caveat: *Participate only if physical and medically able
*Otter no resistance in the role of the child(unless the trainers instruct you otherwise)
- Remove objects that might cause injury *Be appropriately dressed *Practice only the techniques demonstrated
104. Personal Consideration and Decision Making: What do you think and feel about the possibility of making the
decision to use a high-risk intervention? What are the possible emotional impacts of the restraint?
105. Duty of care: *Always act in the best intentions of individuals and others.
*Not act or fail to act in a way that results in harm.
*Act within one's own competence.
*Not take on anything one does not believe they can do safely.
106. Duty of Candor: *Tell the child and family when something has gone wrong.
*Apologize to the child and family. *Otter an appropriate remedy or support to put matters right if possible.
- Explain fully to the child and family the short and long term effects of what has happened.
107. Making High-Consequence Decisions: What skills will you need to make the high-consequence decision to apply a
restraint?
20 / 24 What organizational support and structures need to be in a place for you to make that decisions?
108. High- Consequence Decisions Require: - Training and competence
-Dynamic risk assessment skills -Knowledge of child's medical condition and trauma history -Informed consent -Safety plans and ICSP's -Statt and team debriefing -LSI's between child and staff *Organizational monitoring
109. The Letting Go Process: States what is expected of the young person Is directed by
the team leader
