The TCI System
What are the Goals of TCI?
SUPPORT: environmentally and emotionally to reduce stress and risk.
TEACH: children better ways to cope with stress.
4 conditions needed to be present to use a physical intervention
School policy
Child's ICMP states it
Professional risk assessment
School framework in place to review restraints
Label the 5 stages of the Stress Model of Crisis
Precrisis State (Baseline)
Triggering Event (agitation)
Escalation Phase (aggression)
Outburst Crisis (violence)
Recovery
Non-verbal crisis co-regulation "help me help myself" strategies to help a potentially violent child.
Deep breath
Use a protective stance
Step back
Give time
Sit down if appropriate
Remember the importance of body language and facial expression
What are 3 nonverbal techniques to be aware of when working with an agitated or upset student
Silence
Nods
Facial Expression
Eye Contact
Space
4 questions we ask ourselves when facing a potential crisis.
What am I feeling?
What does the child feel, need, want?
How is the environment impacting the child?
How do I best respond?
3 PREDISPOSING risk factors that put a student at greater risk of serious injury during physical restraint.
Obesity
Under influence of alcohol or drugs
Underlying natural disease (i.e. enlarged heart)High blood pressure/diabetes
Certain medication
Hot/humid environment
Prolonged violent aggression
What is the difference between proactive and reactive aggression?
Proactive Aggression is goal oriented, cognitions are dominant, and is instrumental or operant aggression, appears calm, controlled, menacing, smiling/smirking
Reactive Aggression is a loss of control and emotional flooding, emotions are dominant, and is affective or expressive aggression (wide-eyed, red faced, angry, loud, shrill, highly aroused)
3 aspects of non-verbal crisis communication that staff should consider.
Eye contact
Body language
Personal space
Height differences
Gender differences
Cultural difference
What is an example of an encouraging and eliciting technique to utilize to help encourage the student to talk
Tone of Voice
Minimal encouragements: "uh-huh" "go on" "I see"; Door Openers: "Tell me about that"
Closed Questions: "Do you like your teacher?"
Open Questions: "How did you respond?"
The 4 elements of a violent situation.
1. Trigger
2. Target
3. Weapon
4. Level of Stress or Motivation
3 examples of when NOT TO USE physical interventions
Can't control safely
Risk of re-traumatization
We are not in control/too angry
Medical condition prohibits it
Sexual stimulation is the motive
Certain medicationsPublic places
Student has a weapon
Identify 4 ways to avoid the conflict cycle
Using positive self talk
Listening and validating feelings
Managing the environment (e.g. removing others)
Giving choices and the time to decide
Redirecting the young person to a positive activity
Appealing to the young person's self-interest Dropping or changing the expectation
Describe the TCI iceberg.
The part of the iceberg that is seen represents ____?
The part of the iceberg that is under water/not seen is ________?
Behaviors are seen
Feelings and needs are not seen (biggest part of the iceberg)3 examples of pain-based behavior.
Impulsive outbursts
Aggression
Running away
Self-injury
Defiance
Inability to regulate emotions
Trauma re-enactment
Anything that makes a challenging behavior more or less likely to occur.
Setting Condition: Organizational Culture
Environment
Program related
Personal
Relationship-based
3 errors to avoid when using a TCI physical restraint that could lead to injury or death
Never:
Place weight on a person's chest or back
Put pressure on the neck
Place the head in a position which compresses the neck
Allow the person to stay in the supine position once they are no longer a safety risk
Bend the child forward in a small childPlace anything on or near the child's face
Ignore the warning signs of asphyxia
Restrain a child under the age of 5
What are the steps in the LSI
Isolate the conversation
Explore young person's point of view
Summarize the feelings and content
Connect feelings to behavior
Alternative behaviors discussed
Plan developed/Practice new behavior
Enter young person back into the routine
Identify 4 of the 8 behavior support techniques you can utilize
Managing the Environment Prompting
Caring Gesture Hurdle Help
Redirection/distraction Proximity
Directive statement Time away***
*only when able to self-regulate
What are the strategies for Emotional First Aid?
Drain off emotions
Clarify Events
Maintain the relationship and lines of communication
Remind the child of expectations and mediate the situation if necessary
Goes limp and ceases to breathe
States he/she can't breathe
Respiration is labored
Makes grunting noises
Vomit
Turns a dusky purple color
4 stages of the power struggle
1. Stressful incident
2. Child's feelings
3. Child's behavior
4. Adult's response
I can see...(validate)
When you...(encouraging positive behaviors)
I am sorry that...(apology)
I know we...(emphasize desirable outcomes)
What are the goals of emotional first aid?
1. Provide immediate help and support to reduce emotional intensity.
2. Resolve the immediate crisis.
3. Keep the child in the program/activity.