Therapeutic Crisis Intervention
"In our work in residential child care, the most important tool we possess in helping young people change, grow, and develop into well-adjusted members of society is ourselves. Our ability to relate to the young people we care for in an open, sensitive, consistent, and caring way is perhaps the single most important contribution we make. It is a fundamental assumption of residential treatment that the adults who spend the most time with a young person, regardless of who they are, can directly affect their behaviour and learning, and hence, growth." (Source: Therapeutic Crisis Intervention Manual 2001)
At Adventure Care we see crisis as an opportunity for growth. Crisis is not an obstacle - it is an opportunity for learning. Our aim is to help the child to develop better, more constructive, effective ways of dealing with stress or painful feelings.
We therefore follow the follow the University of Cornell Therapeutic Crisis Intervention (version 5). This is a Crisis Prevention and Management System first developed in 1980, subsequently revised, and in widespread use in the UK, Ireland, USA, Canada and Australia.
Therapeutic Crisis Intervention embodies a therapeutic approach to crisis prevention and management designed to reduce the need to rely on high-risk interventions. The programme provides a structure to help make sense of a child's difficult behaviour.
Staff are taught specific techniques to prevent and manage crisis situations. This includes understanding the distinction between situational and maturational crisis; the stress model of crisis and at what stages certain techniques can be employed; proactive and reactive aggression; the use of a variety of intervention approaches and specific behaviour management techniques (e.g. caring gesture, prompting, planned ignoring and positive attention, hurdle help, time away).
Staff are given specific direction on active listening skills, managing non-compliant behaviour, and averting a crisis. Staff also employ the Life Space Interview, a therapeutic, verbal strategy for intervening with young people that was developed by Redl and Wineman in the 1950s. This is an intervention that occurs in the child's own life space, it uses their own reactions to difficult situations as a vehicle to change their behaviour and expand their understanding and insight into their own, and others, behaviour and feelings. The Life Space Interview can be used after any crisis event. It does not solve the problem; it is an ongoing strategy to help teach the child better coping skills.
Therapeutic Crisis Intervention also teaches a range of safety interventions, including releases and physical restraint. Physical interventions rest on the principles of a maximum amount of caring with a minimum amount of force and the goal of de-escalating the situation by reducing stimulation.
Written records are made of all Life Space Interviews and physical interventions. The Manager countersigns restraint forms. As stated all the staff are trained in these techniques by Robin Barker who is an accredited Trainer with the University of Cornell. Management provide debriefings following an incident. External supervision and support is also available from Robin Barker, who visits Adventure Care and provides advice if required.
Adventure Care frequently utilize circle work, as a method of increasing self esteem and confidence, while helping the young person gain a better knowledge of self and enabling them to develop. It may also be deemed necessary to provide Anger Management to the young people, to teach them alternative coping mechanisms. Adventure Care has utilized different methods of therapy in the past, including CAMHS and a psychiatrist. Other types of therapy would be welcomed if it was felt this would benefit the young person.