TCI training PowerPoint Presentation


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  • This does not take the place of training, only serving as a summary and refresher. Be sure to keep your certification updated. While we make an effort to monitor this and notify you, it is your responsibility to stay current. You may contact Karen Corum or myself. There will be a schedule of training opportunities available throughout the year. Know where your certificate is, and be sure to follow the guidelines and interventions approved by TCI. Avoid physical intervention whenever possible and appropriate, and when it is necessary due to imminent risk, only use techniques approved by TCI. It is only to be used for safety.
  • Remember, the goals are to support and to teach.
  • Be sure to begin with checking your own state of mind, considering the child’s motives, the environment, and then making a choice.
  • We want them to learn to use words rather than physical action.
  • The time is well spent on the front end, saving valuable time later.
  • Do not neglect the use of these, as they can often defuse situations if used appropriately and in a timely manner.
  • The adult’s response, based on your professional judgment, is critical in either escalating or deescalating the situation.
  • You need to consider all four.
  • Watch your body language and demeanor.
  • Do not get caught in a struggle for power, the goal is safety.
  • Plan carefully from the beginning, be careful what is available.
  • Use this early and sincerely.
  • Remember, you always use the first three, and then choose from the remaining four.
  • Do not ignore the interview following the crisis situation.
  • Each part is important, and works as part of a whole. Do not skip parts.
  • Be patient and persistent.
  • Remember, the Functional Behavior Assessment (FBA) and the Behavior Intervention Plan (BIP) serve these purposes.
  • Always consider these first, and use whenever possible and appropriate.
  • This is our only goal, the only goal.
  • Restraint is only used when there is imminent risk, for no other reason.
  • These are not valid or appropriate reasons. Be sure a restraint never occurs due to one of these.
  • Use your judgment, and work with your team to have appropriate plans in place.
  • Proper position is critical. Be sure to practice with your team, review, and contact a trainer if you have any questions or need clarification.
  • Consider these in developing your plans, and making your decision as to how to best respond.
  • Keep constant watch for these, and any other warning signs.
  • Monitor and adjust throughout any crisis situation.
  • Continue to monitor and adjust.
  • Be sure to submit the county restraint form to the appropriate contact person for your building, and to Dr. Enloe’s office.
  • TCI training PowerPoint Presentation

    1. 1. Summary of Main Points August 15, 2007 <ul><li>Therapeutic </li></ul><ul><li>Crisis Intervention </li></ul>
    2. 2. Goals Of Crisis Intervention <ul><li>To provide immediate emotional and environmental support in a way that reduces the stress and risk </li></ul><ul><li>To teach better, more constructive and effective ways to deal with stress or painful feelings </li></ul>TCI TRAINING [4]
    3. 3. 4 Questions We Ask Ourselves In A Crisis <ul><li>What am I feeling now? </li></ul><ul><li>What does this young person feel, need, or want? </li></ul><ul><li>How is the environment affecting the young person? </li></ul><ul><li>How do I best respond? </li></ul>TCI TRAINING [7]
    4. 4. Active Listening <ul><li>Identifies and expresses emotions </li></ul><ul><li>Is respectful of a young person </li></ul><ul><li>Responds to feelings, rather than just behavior </li></ul><ul><li>Communicates that we care and understand </li></ul><ul><li>Helps young people “talk out rather than act out” </li></ul>TCI TRAINING [26]
    5. 5. Active Listening Is Not <ul><li>Throwing up roadblocks </li></ul><ul><li>Premature problem-solving </li></ul><ul><li>Arguing or establishing facts </li></ul><ul><li>Permission giving </li></ul><ul><li>Necessarily time consuming </li></ul>TCI TRAINING [27]
    6. 6. Behavior Management Techniques <ul><li>Managing the environment </li></ul><ul><li>Prompting </li></ul><ul><li>Caring gesture (hypodermic affection) </li></ul><ul><li>Hurdle help </li></ul><ul><li>Redirection </li></ul><ul><li>Proximity </li></ul><ul><li>Planned ignoring and Positive attention </li></ul><ul><li>Directive statements </li></ul><ul><li>Time away </li></ul>TCI TRAINING [28]
    7. 7. Crisis Cycle TCI TRAINING [30]
    8. 8. Elements of a Potentially Violent Situation <ul><li>A potential trigger to violence </li></ul><ul><li>A target </li></ul><ul><li>A weapon </li></ul><ul><li>Level of stress </li></ul>TCI TRAINING [37]
    9. 9. To De-escalate the Crisis Remove: <ul><li>The potential trigger to violence by: </li></ul><ul><li>Never touching an angry and potentially violent person </li></ul><ul><li>Avoiding any aggressive moves and provocative statements </li></ul><ul><li>Avoiding the crisis cycle and counter aggression </li></ul><ul><li>Removing others that might trigger the violence </li></ul><ul><li>— Body language is critical— </li></ul>TCI TRAINING [38]
    10. 10. To De-escalate the Crisis Remove: <ul><li>The target by: </li></ul><ul><li>Asking the targeted person to leave </li></ul><ul><li>If it’s you, reminding young person of your relationship or </li></ul><ul><li>Leaving the situation and asking a “neutral” staff to manage the incident </li></ul><ul><li>— The target may shift during the episode — </li></ul>TCI TRAINING [39]
    11. 11. To De-escalate the Crisis Avoid: <ul><li>The weapon by: </li></ul><ul><li>Discretely removing objects </li></ul><ul><li>Maneuvering away from weapons </li></ul><ul><li>Staying a safe distance away </li></ul>TCI TRAINING [40]
    12. 12. To De-escalate the Crisis Remove: <ul><li>The level of stress by: </li></ul><ul><li>Using your relationship </li></ul><ul><li>Actively listening to identify feelings </li></ul><ul><li>Using non-confrontational limit-setting (I ASSIST) </li></ul>TCI TRAINING [41]
    13. 13. I ASSIST <ul><li>I - Isolate the young person </li></ul><ul><li>A - Actively listen </li></ul><ul><li>S – Speak calmly, assertively, respectfully </li></ul><ul><li>S – Statements of understanding precede requests </li></ul><ul><li>I – Invite the young people to consider positive outcomes and behaviors </li></ul><ul><li>S – Space reduces pressure </li></ul><ul><li>T – Time helps young people respond to requests </li></ul>TCI TRAINING [43]
    14. 14. Goals of the LSI <ul><li>1. Return young person to normal functioning </li></ul><ul><li>2. Clarify events </li></ul><ul><li>3. Repair and restore the relationship </li></ul><ul><li>4. Teach new coping skills </li></ul><ul><li>5. Reintegrate young person back into routine </li></ul>TCI TRAINING [45]
    15. 15. Steps to the LSI <ul><li>I – Isolate the conversation </li></ul><ul><li>E – Explore young person’s point of view </li></ul><ul><li>S – Summarize the feelings and content </li></ul><ul><li>C – Connect behavior to feelings </li></ul><ul><li>A – Alternative behaviors discussed </li></ul><ul><li>P – Plan developed/Practice new behavior </li></ul><ul><li>E – Enter young person back into the routine </li></ul><ul><li>Conducted by the direct care worker </li></ul>TCI TRAINING [46]
    16. 16. Potential Pitfalls of an LSI <ul><li>Young person refuses to talk </li></ul><ul><ul><li>Convey calm support, sanction silence </li></ul></ul><ul><ul><li>Ask a focused question </li></ul></ul><ul><ul><li>Reschedule LSI </li></ul></ul><ul><li>Young person gets off subject </li></ul><ul><ul><li>Allow exploration, relate to incident </li></ul></ul><ul><ul><li>Focus on issue at hand </li></ul></ul><ul><li>Premature plan </li></ul><ul><ul><li>Don’t interrupt young person’s thought process </li></ul></ul><ul><ul><li>Don’t develop plan for young person </li></ul></ul>TCI TRAINING [57]
    17. 17. Individualized Crisis Management Plan <ul><li>Functional analysis of crisis behavior </li></ul><ul><li>Strategy for intervening tailored for the young person </li></ul><ul><li>Periodic review and update </li></ul>TCI TRAINING [50]
    18. 18. Options To Handle Physical Violence <ul><li>Eliminate one of the elements of a violent situation </li></ul><ul><li>Make a directive statement that clearly communicates that the violence must stop </li></ul><ul><li>Use releases and maintain a safe distance with a protective stance </li></ul><ul><li>Leave the situation and get assistance </li></ul><ul><li>Employ physical restraint techniques (if indicated on the Individual Crisis Management Plan) </li></ul>TCI TRAINING [47]
    19. 19. Goal of Physical Intervention <ul><li>To ensure safety </li></ul>TCI TRAINING [51]
    20. 20. Definitions of Physical Restraint <ul><li>Physical Restraint: use of staff members to hold a young person in order to contain acute physical behavior </li></ul><ul><li>Acute physical behavior: behavior likely to result in physical injury </li></ul><ul><li>The young person, other clients, staff members or others are at imminent risk of physical harm </li></ul>TCI TRAINING [52]
    21. 21. Physical Restraint Is Not Used To: <ul><li>Demonstrate authority </li></ul><ul><li>Enforce compliance </li></ul><ul><li>Inflict pain or harm </li></ul><ul><li>Punish or discipline </li></ul>TCI TRAINING [54]
    22. 22. Do Not Use Physical Restraint When: <ul><li>We cannot control the young person safely </li></ul><ul><li>We are not in control </li></ul><ul><li>Sexual stimulation is the motivation </li></ul><ul><li>We are in a public place </li></ul><ul><li>Young person has a weapon </li></ul><ul><li>Young person’s medical condition prohibits it </li></ul><ul><li>Young person has emotional problems (trauma) </li></ul><ul><li>Young person is on medication(s) that affects his or her system </li></ul>TCI TRAINING [58]
    23. 23. Definition of Asphyxia <ul><li>Asphyxia: the deprivation of oxygen to living cells </li></ul><ul><li>Positional asphyxia: fatal respiratory arrest in which the ability to breath is compromised by the positioning of the body in relationship to its immediate surroundings </li></ul>TCI TRAINING [59]
    24. 24. Predisposing Risk Factors <ul><li>Obesity </li></ul><ul><li>Individual under the influence of alcohol or drugs </li></ul><ul><li>Prolonged violent physical agitation </li></ul><ul><li>Underlying natural disease (i.e. enlarged heart, asthma, high blood pressure, diabetes) </li></ul><ul><li>Hot humid environment </li></ul><ul><li>Individual taking certain types of medication </li></ul>TCI TRAINING [60]
    25. 25. Warning Signs <ul><li>Asphyxia due to neck compression: </li></ul><ul><li>Goes limp and ceases to breathe </li></ul><ul><li>Asphyxia due to respiratory interference: </li></ul><ul><li>States he/she can’t breathe </li></ul><ul><li>Respiration is labored, rapid, or abnormal </li></ul><ul><li>May make grunting noises </li></ul><ul><li>Vomiting or turning a dusky purple color, especially the face </li></ul><ul><li>Goes limp and ceases to breathe </li></ul>TCI TRAINING [61]
    26. 26. Recommendations For Reducing Risk <ul><li>Never place weight on a young person’s chest or back </li></ul><ul><li>Never put pressure on the young person’s neck </li></ul><ul><li>Never place the head in a position that causes the neck to be compressed </li></ul><ul><li>Never allow a young person to stay in the prone position once he or she is no longer a safety risk—get the person up and in a seated position </li></ul><ul><li>Never place a young person’s arms behind his or her back when that person is in a prone position </li></ul><ul><li>Never bend a child forward in a small child restraint </li></ul>TCI TRAINING [62]
    27. 27. Recommendations For Reducing Risk, cont. <ul><li>Never place anything over or near the young person’s face, mouth, or nose that can be inhaled or conform to the contours of the face </li></ul><ul><li>Never conduct a restraint on a soft surface such as a mattress </li></ul><ul><li>Never ignore any of the warning signs of pending asphyxia </li></ul><ul><li>Never fail to take immediate action if there is a need for emergency medical treatment </li></ul>TCI TRAINING [62]
    28. 28. Documentation <ul><li>Who, what, when, where? </li></ul><ul><li>What were the antecedents? </li></ul><ul><li>What did staff do to de-escalate the situation? </li></ul><ul><li>If physical contact, who did what (be specific)? </li></ul><ul><li>How long did the restraint last? </li></ul><ul><li>Staff/young person injuries? Medical attention? </li></ul><ul><li>What plan was developed in the Life Space Interview? </li></ul><ul><li>Debriefing of staff? </li></ul><ul><li>Follow up needed? Was family notified? </li></ul>TCI TRAINING [63]