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.
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