FAMILY & PLACEMENT
SUPPORT SERVICES
THERAPEUTIC CRISIS
INTERVENTION POLICY
NEIL PENNY
PLANNING & POLICY GROUP
JUNE 1999
FPSS AMENDMENTS - ALAN BARTON
FAMILY & PLACEMENT SUPPORT SERVICES MANAGER
APRIL 2004
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FAMILY & PLACEMENT SUPPORT SERVICES (FPSS)
THERAPEUTIC CRISIS INTERVENTION
CONTENTS
1. Policy Statement
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2. Purpose
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3. Scope
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4. Definitions
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5. Context of Policy
3
6. Mandatory Procedures
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7. Practice Guidance
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8. Monitoring
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Appendix 1
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FAMILY & PLACEMENT SUPPORT SERVICES (FPSS)
THERAPEUTIC CRISIS INTERVENTION
1.
Policy Statement
The Family and Placement Support Service use Therapeutic Crisis
Intervention (TCI see Appendix 1) in its emergency overnight
accommodation and in the Activities Team. It is essential for the
department to establish consistency in its techniques for dealing with
potential and actual crises within its teams.
2.
Purpose
All aspects of TCI will be given to staff through formal training with
emphasis placed on preventing the use of restraint by managing a
given situation. There is also a need to formalise the recording of the
circumstances in which a situation occurs and the actions taken to deal
with it. This will enable the department to analyse cases where crisis
intervention was necessary and support staff more fully where trends
are identified. Untrained staff do not use the physical elements of TCI.
3.
Scope
The policy will apply to all staff who are involved in looking after
children at Social Services residential units and within the Activities
Team. There are direct links to the existing policy on Restraint and will
also be links to the policy on Recording Significant Events.
4.
Definitions
Therapeutic Crisis Intervention - This process was developed by
Cornell University in the USA " To provide positive, therapeutic,
practical and proven methods for managing children in crisis." A more
detailed description of the key elements of TCI is given in Appendix 1.
5.
Context of the policy
5.1
The policy is framed under the Children Act 1989.
5.2
The Children Act 1989 Guidance and Regulations - Volume 4:
Residential Care deals with issues around disciplinary measures.
6.
Mandatory Procedures
6.1
TCI is the method that the Family and Placement Support Service
use to deal with crisis situations. To this end the methods of restraint
taught as part of the TCI training course are the ones that should be
used within residential units or the Activities Team.
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7.
Practice guidance
There are a number of different approaches that can be adopted to
resolve a particular crisis situation and these can be adapted to what
suits the personalities of the worker and young person involved. These
will be explored through the training.
7.1
Early Intervention
7.1.1 The emphasis in TCI is placed on early identification of potential
for crisis and acting to defuse the situation. By identifying that a
situation is developing in a way that could lead to violence, techniques
can be used to reduce the tension and avoid the need for restraint.
7.2
Restraint
7.2.1 Physical restraint is not an easy option and places a
considerable strain, both mental and physical, on all those involved. It
is however, at times unavoidable and necessary to prevent a young
person harming themselves, others or property. Full details of the
restraint techniques are given in the training programme.
Key points to remember are:
7.2.2 Before deciding to restrain a person singly, a member of staff
should gauge their own level of control and also the comparison in size
between them and the young person to be restrained.
7.2.3 The restraint techniques dealt with during the training course are
the only ones which should be used with young people within a unit
setting or in a public place.
7.2.4 It is essential in the initial stages of restraint that staff do not talk
to the young person. This has been shown to be an effective way to
defuse a situation and helps those involved to regain emotional control.
7.2.5 All incidents of restraint must be recorded with reports being
acknowledged and signed by the team manager. Copy of the report
must by placed on the young person’s file.
7.3
Recovery
7.3.1 An important element of TCI is the recovery period following a
restraint taking place.
The key guidelines are:
7.3.2 The opportunity should be taken to discuss with the young
person what led to the crisis situation and what other ways could be
used to deal with a similar situation in a way which would not lead to
confrontation.
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7.3.3 The life space interview which takes place, either singly or in a
group situation, should ideally be conducted by the member of staff
principally involved in restraining the young person.
7.3.4 Following the life space interview it is important to establish a
plan which will address the circumstances which led to the restraint
occurring. Involvement of the young person restrained is essential at
all stages of the recovery period in order that future plans can be
agreed by all sides.
7.3.5 As soon as possible after a restraint, discussion should take
place between the staff involved and a senior practitioner or team
manager not directly involved in the restraint. This should include the
situation leading to the restraint, the restraint itself and the measures
that have been put in place to try and avoid any repetition.
8.
Monitoring
Incidents involving restraint will be monitored through the supervision
process. Linked to this will be specific feedback about the use of TCI
from all those involved, to enable the Family and Placement Support
Service to evaluate the impact of this approach at its various stages,
not just with regard to the use of restraint.
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Appendix 1
Therapeutic Crisis Intervention
Background
TCI is concerned with managing situations using positive actions and
procedures to avoid a situation being reached where restraint is necessary.
Where it does become necessary to restrain there are techniques suggested,
as presented in training sessions to staff by the Family and Placement
Support Service authorised trainers, Alan Barton, Alayne O'Connor and John
Cotton.
Key elements of Therapeutic Crisis Intervention
TCI aims to provide child care workers with the skills and knowledge through
which the child changes old habits, destructive responses and maladaptive
behaviours patterns. The goal of the training programme is to train child care
workers to develop new responses to their environment that will enable them
to achieve a higher level of social and emotional maturity.
TCI will help staff to develop skills, knowledge and attitudes that enable them
to deal with children when they are at their most destructive.
TCI will provide staff with an appreciation of the influence adults have as
those responsible for the care and treatment of damaged children in crisis
situations.
TCI will emphasise the need for staff to respond to the feelings behind the
displays of aggression and violence by young people as well as the behaviour
itself.
TCI training consists of five modules:
1. Crisis as Opportunity
2. Awareness
3. Early Interventions
4. Therapeutic Physical Interventions
5. Recovery
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