When students are involved in situations and behaviors that are disruptive or dangerous, we have a set of steps we take to ensure safety and to help students learn skills to manage these situations more effectively in the future. Depending on the seriousness of the situation, staff will assign processing tasks that focus on making repairs for any harm to others or to the program. Here is a list of these steps and a description of when and how they are used.

Taking Space

Students can request to take a brief break from the current task when feeling overwhelmed or triggered. Students can simply ask staff if they can take space. Staff will talk with students to understand their needs and work with students to support them, including taking space if appropriate. Most of the time, staff will be able to take students for space. Sometimes a staff may ask students to wait while he/she makes a plan for the supervision of the rest of the students on the team. If a plan cannot be worked out for taking space, the staff will work with students to figure out an alternate plan. Sometimes a staff may encourage students to try a skill right in the area, if they have been working together on skills that can help the student stay in program. The goal of taking space is for the student to use a skill to manage their emotions and behaviors and to have them rejoin program as quickly as possible.

 Skill Coaching Exercises

• Skill Coaching Exercises will be assigned when students exhibit repetitive, disruptive behavior that signals the need for skill development.
• Examples: swearing, refusing to complete tasks, provoking, horseplay, non-dangerous contraband, excessive yelling
• Steps:

1) Identify what skill is lacking

2) Identify a way for the student to practice this skill

3) Coach and/or rehearse the skill with the student

If skill coaching exercises are not successful and the student continues to use the inappropriate behavior, student can be placed on the next level, Support Level.

Support Level

• Behavior that is disruptive to programming or is concerning for the students’ safety and well-being.
• Minimal potential or intent to cause harm to self or others
• The student is not considered to need increased supervision and/or counseling as a result.
• May prevent program from occurring as scheduled.
• These behaviors indicate the need for increased staff support to complete skills and tasks.

Because of this need for increased staff support, processing will be assigned and the student’s privileges will be suspended. When all processing is complete and behavior is stable, the student may participate in regular programming (regaining use of privileges). Processing is considered complete when it is approved by staff and supervisor.

Safety Level

• Behavior that caused, or was intended to cause potential significant harm to self or others.
• Student is considered to need increased supervision and counseling as a result.
• Safety Level behaviors indicate the need for increased staff support to complete skills and tasks.

Because of the significant safety concern and need for increased supervision, privileges will be suspended. When all processing is complete and safety is restored, indicating that the student no longer needs increased support and supervision, the student may participate in regular programming (regaining use of privileges). This occurs at start of next circle up period if processing is approved by staff and supervisor.

Individualized Programming

In very serious situations, where a student’s behavior has put themselves or others in very serious risk of harm, and where remaining in regular programming will not reduce this risk, Individualize Programming may be used. Individualized programming means that the treatment team makes a plan for the student to receive programming in a way that is different than the other students. This may mean having extra staff supervision, participating in some part or all parts of program from a different location, having separate transitions from the rest of the team, or other interventions that are designed to keep everyone safe and ensure that the student continues to receive programming. Individualized programming always includes skill practice, processing, and intensive support for the issues that resulted in the dangerous behaviors.

Community Board Review

Community Board Review involves a group of staff who meet weekly to discuss any serious incidents from the week that had a significant and serious impact on the community. When such an incident happens, the Board places the student on Board Review Status and meets with the student to discuss the incident. Students who are on Board Review Status will not have access to their privileges. The focus of Board Review is around safety and accountability.

The following incidents would require Board Review:

• Assault
• AWOL or Major Off-Location
• Serious Sexual Behavior
• Fire Setting Behavior (including pulling fire alarm)
• Interfering with a restraint
• Continual Disruption to the HEC Community Values

The Board will assign tasks to the student that focus on restoring safety, taking responsibility for her actions, and making plans for eliminating this behavior in the future. Each week, a student’s board work will be reviewed with the student at Board Review. Once all Board Work is complete, the student will no longer be on Board Review Status.

Individualized Crisis Management Plan 

The Individualized Crisis Management Plan is a very detailed plan for ensuring the safety of the child and managing high risk behaviors is completed upon admission. This plan, entitled the Individualized Crisis Management Plan or ICMP, is rooted in utilizing a trauma informed approach to treatment. The ICMP is a component of Therapeutic Crisis Intervention (TCI). Hillcrest’s ICMP is a 2 page document that incorporates input from the student, the student’s family, guardian, funding agencies, and the HEC treatment team. The first page is completed with the student and clinician within 24 hours of admission. The second page will be completed by a program administrator with 24 hours of admission, with a review of the full document by the campus management team and/or the treatment team within 7 days of the student’s admission. All parts of this process will utilize the input of the family, guardian, and funding agencies as well as student records as current interactions with the student.

The goal of the first page of the ICMP is to ensure the student’s input is immediately utilized in his/her treatment. It utilizes questions posed to the student to identify the student’s goals, strengths, and interests. It includes questions posed to the student that help identify the student’s triggers, sore spots, and situations that overwhelm their coping skills. Page 1 also identifies skills, resources, and interventions that the student finds helpful or not helpful.

The second page of the ICMP provides important information about the student’s current and historical high risk behaviors and high risk situations. Important safety information such as medical concerns, trauma triggers, current diagnoses, and current medications is included. This page then identifies individualized interventions to utilize when the child presents at different stages in the stress model of crisis. Page 2 also identifies very specific parameters for the use of physical intervention and what types of physical intervention are permitted.

Collaborative Problem-Solving (CPS) 

At the core of the HEC treatment model is the belief that problematic behaviors are displayed as adaptations to situations where coping skills and resources are overwhelmed. In order to intervene effectively, we must help individuals understand and recognize the impact of their own behavior, identify the related skill/support deficits, and assist the individual to develop needed skills and resources to manage the situation more effectively in the future.

The primary intervention approaches guided by the CPS philosophy are skills assessment, skills development, and a collaborative problem solving process that leads to a mutually acceptable plan for working things out. HEC community members must practice the steps of collaborative problem solving in their interactions with others. This process involves three steps: 1) empathize, 2) define the problem, 3) invite the other person to problem-solve. Potential solutions that are complex, affect others in the community, or are long standing, must be brought to interdisciplinary team meeting for discussion and approval prior to implementation.

In order for the collaborative treatment approach to work, the student, and as approved, the family or community members connected to the well-being of a student, as well as HEC staff, must understand behavior from a skills perspective, provide formal and informal opportunities to develop lagging skills, and have collaborative input into all aspects of the treatment and problem-solving process. Students should attend, or if unwilling/unable, have input into the CTP, special and emergency team meetings, as well as other venues when important decisions/problems are being considered.

Trauma Informed Care (TIC) 

When the environment is very overwhelming, as is often the case when a person experiences trauma, attachment disruption, loss, domestic violence or abuse, the result can be significant impact on the development of the person’s skills and resources. Exposure to those who have experienced these events has impact on others in the community. A trauma informed environment requires an understanding of trauma and considers its effects, at the personal, individual, and societal levels.

As trauma and loss are, at their core, violations of interpersonal connection, the HEC community focuses on developing healthy relationships with others. Within these healthy relationships, motivation, healthy sense of self and connections to others and the community are developed. Other primary intervention approaches from the TIC philosophy include psycho-education about trauma/vicarious trauma and its effects, understanding the influence of individual trauma histories, making meaning from these difficult experiences, developing self-awareness, developing skills and resources to manage more effectively, and proactively planning for safety.

THE TCI SYSTEM

Therapeutic Crisis Intervention (TCI) is the crisis prevention and intervention model currently in use in all Hillcrest Educational Centers programs. It teaches care workers about the impact supportive adults can have on students’ lives and how to interact with sensitivity to help de-escalate situations where young people may be experiencing difficult feelings or displaying troubling behavior. TCI includes many of the concepts of Collaborative Problem Solving and Trauma Informed Care.

Even though the TCI system is focused on verbal interventions and de-escalation, the use of physical intervention with our students is still sometimes necessary. Use of physical intervention is only used as a last resort and only in emergency situations to keep everyone safe. The use of prone, or face-down, restraint is prohibited in our state unless it is the only restraint that may keep a young person safe and we have gotten permission from the parent. Supine, or face-up, standing, and seated restraints are included in the TCI system and used by Hillcrest Educational Centers.

Every student that we work with has an Individual Crisis Management Plan (ICMP) that is made with their input when they first arrive and is updated frequently. It includes information like goals the student has for the future, things that may make the student upset, medical issues the student may have, and types of things staff can do to help the student when they are upset. The ICMP also includes which types of restraint are appropriate for use with each student if restraint must be used in an emergency situation.

TCI also makes sure that students and staff alike learn from difficult situations when they occur. After any incident staff will use a TCI tool called the Life Space Interview (LSI) to talk to the student and try to understand what the student was going through, what may have contributed to the difficult situation, and how similar situations could be handled differently in the future to prevent troublesome behaviors. Furthermore, behavioral incidents, including physical interventions, are often debriefed by staff and supervisors afterword to ensure that we are handling them as safely and effectively as possible.

We are always trying to reduce our use of restraint as an emergency intervention, and each of our programs has a Student Treatment and Intervention Committee and an Improving Organizational Performance committee that meet frequently to review restraint data and discuss ways to reduce its use and make sure it is being used carefully and properly. As vital members of the treatment team parent/guardian input on ways to reduce the use of restraint with their child/client is always welcome.

For more information visit the website: http://rccp.cornell.edu/tcimainpage.html or http://rccp.cornell.edu/assets/TCI SYSTBULLETIN.pdf