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.

Guided Creative Therapy

Adventure Care has an in house highly qualified psychotherapist with 14 years of extensive experience working with looked after young people. Peter Russell, specialises in art therapy and psychotherapy for children and young adults in care homes. During Peter’s experience as a psychotherapist he has significantly reduced placement breakdowns in the homes and helps with the emotional development of a child or young adult. He also offers clinical supervision to the key workers and carers to help them work and have a better understanding of the functioning and their approach.

Peter uses Guided creative therapy sessions using art, music or drama which can externalize and release traumas that have been deeply buried as a result of childhood trauma, abuse or neglect where traditional psychotherapy methods can or have failed. Unresolved or unacknowledged traumas can severely affect the normal development of a child or young adult which can eventually lead to psychological or emotional difficulties in adulthood that can last a lifetime. Perter has specialized in working with Trauma in young people who have difficulty trusting and engaging with health professionals. He has helped many a young person to work through their difficulties helping them to create a new healthy pathway that is more emotionally secure.

Peter is a specialist in the area of insecure attachment styles, attachment disorders and working with ‘Looked After Children’ he has a sound understanding of the theory and practice. In Art Psychotherapy he has studied at Masters level, has an MA, a Postgraduate Diploma and also a BA (Hon’s).

Equine Assisted Therapy (Horse Therapy)

At Adventure Care we introduce horses into our therapy sessions. We use Equine therapy to address many of the issues that a young person that may come to us with; these include:

  • Abuse issues (sexual, verbal and physical)
  • Violence and neglect issues
  • Substance abuse issues
  • Lack of self-esteem, confidence and respect
  • Poor listening skills
  • Attention deficit problems
  • Lack of trust
  • Poor relationship skills
  • Attachment problems
  • Depression
  • Anxiety
  • Poor communication skills
  • Lack of response to traditional therapies

Horses are masters at relationships; they naturally find the healthy balance between independence, and cohesion with others. Horses are very neutral upon first encounter. This allows the relationship built to be based on present behaviours and responses rather than past expectations or experiences. Below are some examples of the benefits of Equine Therapy:

  • Developing communication
  • Assertiveness
  • Creative thinking
  • Teamwork and group effort
  • Confidence
  • Leadership
  • Empathy
  • Responsibility
  • Adaptability
  • Patience
  • Sense of belonging
  • Sense of accomplishment
  • Soothing and calming

The skills that the children discover during the sessions will be both long lasting and transferable to other situations in life.

Below are some examples of the types of activities that take place during Horse therapy. Some activities can be skills based where service users can work through set tasks and achieve certificates. We have devised a 'Practical Horse Care Task' booklet, where children do not need any academic skills, and reading and writing is not required. It is experiential achievement. Other activities can be less directive and more about experiment and play. It is person led, tailored to suit the individual.

 

The Horse Experience

Activities can vary in ability. For service users who are either unable, or choose not to be directly and physically involved, simply being in the environment will provide a therapeutic and enriching experience. A simple though powerful example is, a service user is restricted to a wheel chair, and having a horse approach them. Watching horses interact and play, and being in the company of such creatures stimulates all the senses. The lulling rhythm of the horse, combined with the sights, scents and sounds of the natural surroundings elevate the spirit, and alleviates tension.

Meeting and Greeting

This involves firstly observing the horses body language. Learning to interpret the horse's body language is the first step. Service users will then be shown how to approach a horse and stay in a safe proximity of the horse during the session.

Grooming

This is therapeutic in its own right and also helps develop relationships, it is relaxing and soothing, it develops motor skills, and stimulates all the senses.

Leading

This is for the more able and confident. Major benefits are leadership, assertiveness, and confidence among others.

Horse Care

This develops care and responsibility and can involve feeding, and a wide range of stable management.