Behaviour Support Through the Use of Therapeutic Crisis Intervention (TCI)

 What is TCI all about…?

TCI is a behaviour support programme explicitly designed to reduce the use of reactive strategies when supporting people in crisis.

The aim of the programme is to reduce or eliminate the need for physical intervention. It aims to provide staff that work with people who challenge with the skills and knowledge to become the catalyst through which people change old habits, destructive responses and behaviour patterns.

Its goals are to provide immediate emotional and environmental support in order to reduce stress and risk and to develop coping strategies.

The key focus of the whole programme is on prevention and de-escalation, but moves on to the provision of support for people in crisis. The programme is orientated toward giving staff the tools they need to help people learn appropriate and constructive ways to deal with feelings of frustration, failure, anger and pain. This is achieved by helping people learn from an experience and working with them to develop improved ways of coping and dealing with such situations in the future.

The programme was designed by the Residential Child Care Project, Cornell University New York, and is also accredited by BILD (British Institute for Learning Disabilities)

In order to successfully implement the programme five key areas need to be addressed and working together

  • Leadership, involving key managers at strategic and operational levels
  • Clinical support from specialists in behaviour
  • Supervision, in order to ensure all are working together using the TCI principles and models in practice
  • Training and competency standards, to ensure staff are able to apply the learning they have received
  • Monitoring and Evaluation ongoing throughout the programme

The programme itself is a five day workshop and focuses on the following key areas:

  • Knowing ourselves and what we as staff bring to the situation
  • The need to manage ourselves and then the environment around us for the person in difficulty
  • Crisis communication and the development of active listening skills
  • Behaviour support techniques and emotional ‘first aid’
  • Elements of the conflict cycle and how to disengage from this
  • Helping the person in crisis to help themselves
  • Choosing and using safety interventions
  • Working and supporting those with developmental disabilities

The programme outlines the theory and skills required for each of the above areas, which the trainers then demonstrate and then ask participants to practice. The workshop is very practical.

 How did you do this…?

In order to get a pilot programme we began with an assessment and planning meeting to identify what needed to be done and how this would be achieved. We identified what we currently had in place to support our young people and what we wanted to improve. From this we created an establishment action plan for a pilot project. This was then presented to senior managers to seek approval for a pilot project to go ahead. This was given, and the TCI programme was launched in April 2008 in key residential areas of our school.

We started by training key managers in the programme’s philosophy, approach and expectations. To date we have trained 163 staff, which has involved participants from all sectors, managers, supervisors, clinical support, behavioural services, care staff, teaching staff and the Quality and Compliance Manager. We have also managed to train ten key staff as TCI trainers. We kept costs to a minimum by having a good formula for operational staffing support and cover to enable staff to access the training.

The training programme is a real ‘hands on’ experience. It involves explaining the key principles and models to be used. These are then demonstrated by the trainers and discussed and evaluated, leading to participants practising the techniques.

We also use accelerated learning approaches to help participants to recall and remember all the theories, models and skills used. In this we encourage:

  • ‘twiddling and doodling’ as research has shown this can help to aid concentration and learning
  • the use of ditties to remember and recall complex information
  • repeating and visualising key themes and models
  • visual reminders placed around the room
  • refocus sessions where participants can work in groups at the beginning of each session to recall the inputs from the previous sessions
  • role-play with feedback about how we got on
  • videos to help us see them practise key skills

TCI is competency-based, and you need to successfully pass a written test and two skills based tests. This helps to cement the learning process.

We have held in-house refreshers throughout the year with additional updates from supervisors to help maintain the core competency of the TCI model. The latest update for TCI trainers has been Post Crisis Response, where we have focussed on developing the skills of providing supervision and debriefing for staff using the TCI framework.

We also needed to amend the incident reporting to reflect the TCI principles.  This has had a two-fold affect on the staff, first improving the quality of the reporting and secondly helping staff by reinforcing the learning.



How has TCI helped staff when working with the young people …?

Staff Comments …

  • It’s given us the tools and techniques to help the young people in a way we can understand. (Support Worker)
  • It’s helped us move away from fire-fighting to supporting the young people to learn from their experiences and get their needs met in a more acceptable way. (Assistant Team Manager)
  • It’s helped the team to communicate better with each other, and given us a framework to do this. (Team Manager)
  • It’s given us a common language. (Trainee Applied Behaviour Analyst)
  • Asking and thinking ‘what does this person feel, need or want’ helps us to adjust our approach and think about things from where they are at rather than on the presenting behaviour. (Senior Support Worker)
  • It gives young people the opportunity to say how they were feeling and why they did things without forcing the issue … or making judgements … This is a real change for me. (Senior Support Worker)
  • We are moving away from problems (seeing behaviour as a problem) to support and understanding. (Assistant Team Manager)
  • We are being more successful at intervening when the young people show signs of agitation and understand the need to pick up on signs of agitation as soon as possible. (Teacher)
  • The behaviour support techniques make so much sense. (Support Worker)
  • The intervention approaches make so much sense. It has helped me work out when I am using the right or wrong approach depending on the circumstances. (Senior Support Worker)
  • We have learned to be more patient and wait, to give the young people time and space. (Assistant Team Manager)
  • We listen more and involve the young people in working things through. (Senior Support Worker)
  • There’s more participation between all of us and between ourselves and the young people. (Senior Support Worker)
  • We are developing better and stronger relationships as a result. (Senior Support Worker)
  • We realise we have been relying too much on ‘relating’, not that this is a bad thing, but some of the young people need structuring and directing because of their needs and this helps them to learn. (Senior Support Worker)
  • It stays in your mind … It’s simpler to remember than other approaches we been asked to use. (Assistant Team Manager)
  • There is less arguing with the young people and more listening. (Team Manager)
  • We are helping them to develop coping skills rather than them having to get angry and upset or cause problem in order to get their needs met. (Care Manager)
  • It has helped me to develop my input with the young people more clearly. (Teacher)

 Comments from Team Discussions:

  • We’ve now got permission to help young people think and work things through instead of pretending nothing ever happened.
  • It works brilliantly with M****.
  • It’s opened my eyes to what can be done and to help me understand the young people and where they are at.
  • I hadn’t realised we could use the LSI approach at any time. .. That’s a really helpful idea as this would help when young people start showing signs of agitation.
  • Staff see things being done differently, and want to know what it is all about because it works!
  • The students are happier.
  • When I get caught in the win-lose situation, I think “I am better or bigger than this”. I find myself wanting to stop the win-lose.
  • I’ve got better at keeping calm. I want to stop myself from reacting to the situation and try to understand what the young person feels, needs, or wants.
  • M***** will tell us everything if we ask and show we are listening.
  • I find myself getting less involve in conflict with the young people.
  • It’s helped me to avoid the ‘challenge’ that young people use to draw us into conflict.
  • It’s helped us to find ways to resolve things before it gets to crisis.
  • Everybody needs to know about this.
  • It makes so much sense.

Things Young People Have Said …

  • I like the way you work with me now.
  • Me and you get on better now you listen.
  • People are smiling more.
  • I like it when you listen; it helps me with my problems.
  • I can get my feelings across without getting frustrated.

Have there been any other benefits …?

The most significant change has been the difference in culture where staff have been trained compared with those who have not.  Managers are reporting a shift in the staff’s approach from behaviour management to behaviour support.  This is evidenced by the improved interactions and developing relationships between staff and young people.  Managers report that staff are now focussing far more clearly on the feelings, needs and wants of the young people as opposed to just focussing on and dealing with the presenting behaviour.

The staff and young people clearly feel it has been really worthwhile and is evidenced in the comments made above.  It is also clear that the TCI system complements the role of our colleagues in therapy, clinical and behavioural services in that it provides a common language and approach and also empowers individual staff to view themselves as active contributors in the support and care of the young people.

The TCI approach is also clearly reflected in the new National Minimum Care Standards for children’s homes that are currently out for consultation (i.e. Standard 2, Helping children understand their behaviour and responding to children appropriately).

The success of the pilot was further evidenced in our review of the implementation of the TCI pilot programme in October 2009 when the Programme Director from Cornell University in New York came over to visit us. Staff and young people were so positive about the programme in direct feedback to her and the group. This reinforced how it has helped them to develop their practice and support the young people in helping to meet their needs.

The TCI pilot has been a huge success, such that it has not only met the initial aims as agreed when we started – but it has surpassed our expectations in terms of the impact on culture and climate, language and philosophy of care.

Staff have felt compelled to feedback directly to the trainers and their own managers about their experiences of undertaking TCI training and how they have applied it in practice.  The common theme has been how it has changed their thinking and practice in working with young people. The TCI programme has been heavily endorsed by all sectors and disciplines.

Based upon the success of this pilot, the improved outcomes for young people and the developing agenda for standards of care for children and young people in a residential setting, the teams involved in the pilot project have no hesitation in recommending the TCI system and approach to working with young people.


Cornell University; Residential Child Care Project; College of Human Ecology; Family Life Development Center


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