TCI 7th Edition |49 questions and answers

Discussion Questions 1. What is the child experiencing? 2. What thoughts and perceptions might this child have about adults? About the world in general? 3. What behaviors might we expect from this child? 4. What will this child need to feel safe? Trauma-Informed organization Supports and facilitates trauma-informed care through: Policies Procedures Practices Trauma-Informed Organization Ensures that staff Understand- what trauma is and how it impacts everyone in the system Recognize- behaviors and patterns that reflect past or present trauma Respond- in ways that avoid re-traumatization Developmental relationships are characterized by: attachment, reciprocity, progressive complexity, balance of power TCI system assists organizations to: Prevent- crises from occurring De-escalate- potential crises Manage- acute physical behavior Reduce- potential and actual injury to children and staff Teach- children emotional regulation skills and coping strategies Develop- a learning organization Effective TCI implementation Includes Leadership & program support, child & family inclusion, clinical participation, supervision and post crisis response, training & competency standards, documentation & incident monitoring & feedback Goal of TCI To create safe, developmentally appropriate, non-confrontational, trauma-sensitive environments that are supported at all levels of the organization Therapeutic Milieu The combination of people, emotions, attitudes, and objects that create a sense of safety, respect, belonging, care and accountability Spaces within the therapeutic milieu ideological, physical, cultural, social, emotional Setting Conditions Any thing that makes challenging behavior more or less likely to occur Ideological Space -communicates a philosophy of care -supports developmentally appropriate practice -provides opportunities for children to participate successfully in activities -involves children, families, and staff members in decision making -encourages relationship building activities -creates a learning environment physical space -makes good use of space for personal and public use -Is clean, orderly, inviting -Feels safe and nurturing -Has soft lighting and reasonable calming noise level -Is furnished and decorated appropriately for the age group living there Cultural Space -Develops culturally competent staff - Accepts and celebrates cultural differences supports family connections and involvement -allows for culturally diverse staff-child interactions social space -values attachments and developmental relationships -Balances structure and flexibility to meet individual and group needs -creates opportunities to participate and contribute -Has goals, structure, and is designed to help children develop skills -Allows for practice of important life skills emotional space -takes into consideration specific effects of trauma -facilitates an atmosphere of safety and acceptance -encourages warm and responsive relationships -requires emotionally competent staff -allows for development of co-regulation and self-regulation skills Foundations for Intentional Use of Self Self-awareness, self-regulation, relationship skills and attunement, self-care Self-regulation -ability to consciously focus attention -awareness of our own physical and emotional state -skills to manage our own emotions and behavior -ability to draw on memory and experience to adapt effectively in the present situation The triune brain the thinking brain- neocortex the emotional brain- limbic system the survival brain- brain stem Pain Based Behaviors -Inability to regulate emotions -overreaction to situations -impulsive outburst -trauma re-enactment -defiance -inflexibility -running away through anger or fear -self injury -withdrawal A crisis occurs when a child's fight, flight or freeze response is activated and they are unable to regulate their emotions and behaviors Goals of Crisis Intervention Support & Teach goals of the stress model of crisis -create a healing environment -develop trusting relationships -provide a sense of safety -practice new skills Stress Model of Crisis Baseline, Triggering event (agitation), Escalation phase (aggression), Outburst crisis (violence), Recovery recovery phase outcomes Higher- supported and taught no change- firefighter response lower- not taught non-verbal techniques silence, facial expression, eye contact, and tone of voice active listening -helps children express their thoughts and feelings -reduces defensiveness and opposition -promotes change -communicates we understand and have a desire to help -helps children learn to self-soothe as we model ways to respond (co-regulation) -helps children "talk out rather than act out" Behavior support techniques Manage environment, prompting, caring gesture, hurdle help, redirection & distractions, proximity, directive statements, time away Criteria for using directive statements -the child has a trusting relationship with the adult -the expectation is important enough to risk escalating the situation -the child has the ability to meet the expectation and has demonstrated the ability in the past when they were at the same level of arousal -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 criteria for using time away -the child 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 Goals of emotional first aid 1. Provide immediate help and support to reduce emotional intensity (co-regulation) 2. Identify and resolve the underlying concerns causing distress 3. Keep the child in the activity strategies for emotional first aid 1. co-regulate emotions--be a calm presence 2. Maintain the relationship and lines of communication 3. Plan and anticipate--be a coach nonverbal messaging -eye contact -body language -personal space -height and gender -sensitivity to cultural issues Elements of a potentially violent situation 1. the spark 2. the target 3. the weapon 4. level of stress or motivation remove the spark -never touching an angry and potentially violent child -avoiding any aggressive moves and provocative statements -avoiding the power struggle and counter-aggression -removing others who might spark the violence --body language is critical-- remove the target by -asking the targeted person to leave -if it's you, reminding the child of your relationship or leaving the situation and asking a "neutral" staff to manage the incident --the target may shift during the episode-- Avoid the weapon by -discreetly removing objects -maneuvering away from weapons -staying a safe distance away decrease the level of stress or motivation by -Using your relationship (intentional use of self) -Actively listening to identify feelings (reflective responses) and communicate understanding (empathetic responses) -Removing the audience -Using co-regulation strategies (reactive aggression) -Offering alternative, non aggressive ways to achieve goals (if motivation) Objective of crisis co-regulation To provide support in a way that reduces stress and risk and increases child's sense of safety post-crisis multi-level response timeline immediate response (is everyone okay?) ----> LSI with the child (how can the child recover at a higher level?) ---> Documentation (what happened?) ----> Incident review with staff (What have I learned from this?) ---> Incident review with team (how can we all learn from this?)