Therapeutic Crisis Intervention - Good Practice Guidance

It is mandatory that any Trainer must have completed the initial full five days Certification Training. Thereafter, the Trainers must attend the two day annual Refresher Training for Trainers Course for two years, subsequently one day annually.

It is a requirement that at least one out of the two Trainers delivering a course to staff hold a current First Aid Qualification.

Following the training, it is the Trainers responsibility to feedback a participant’s progress to their Manager. In any situation where concerns about a participant arise, this must be done immediately in writing (e.g. TCI refresher delegate attendance).

To ensure standards of good practice, it is the responsibility of all employees who have undertaken the full TCI Training to successfully complete a skills/knowledge review on a six monthly basis. This review must be documented in the staff member’s Personal Development Profile to enable progress to be reviewed in supervision.

A record of all training completed will be held in the Training Section.

Safety intervention techniques must only be undertaken by staff that have successfully completed the 28 hour TCI Training and have successfully completed a TCI Refresher within the last six months.

It is essential that all care staff are physically able to perform and participate in safety intervention techniques. It is acknowledged that there may be occasions when short to long term health problems may arise which may impact on an individual’s ability to perform safety interventions. This will require monitoring and review of the situation via the Registered Manger and TCI co-ordinator in the Home, in consultation with the Occupational Health Service.

The only safety intervention techniques that may be used are those taught on the TCI Training Programme. Staff are not permitted to use any other methods.

The approved physical safety intervention techniques are:

1. Releases;
2. Protective Stance;
3. Breaking Away Techniques;
4. Standing Hold;
5. Team/Third Person Restraint;
6. Three Person Restraint and transferring control;
7. Small Child Restraint.

During safety intervention techniques, principles of good practice must ensure that the technique does not intentionally inflict pain, injury or harm on the young person. The adult must not hold on bodily joints therefore it may be necessary to hold onto items of clothing. At all times, the young person’s breathing must not be restricted.

Consideration must be given to what safety intervention might mean to the young person in the light of their history and risk assessment. This also needs to link in with the Individualised Crisis Management Plan. Consideration must be given to alternatives to safety interventions, e.g. Early intervention techniques.

Staff must believe the immediate action is necessary to prevent harm to the young person or others and to prevent serious damage to property. This is in accordance with the Home and individual Risk Assessments.

Staff must judge that the proposed safety intervention is carried out safely and successfully taking into account the number of staff available, the location and the young person’s gender, size and age and professional judgement.

The overriding principal must be that a safety intervention is an act of care and control and not punishment. Safety intervention must never be used as;

1. Punishment;
2. Consequence;
3. For demonstrating "who is in charge"; or
4. Used to gain compliance.

Safety intervention techniques must only use the minimum force necessary and for the minimum duration and they must cease when the young person is judged to be safe and no longer at risk of self- injury or harming others. Therefore, as soon as it is safe, the intervention must be gradually released to allow the young person to regain self-control and self-respect. Every effort must be made to re-establish normal relations without the young person feeling demeaned.

Other young people are not permitted to use or assist with any of the safety intervention techniques.

After the incident is over, both the young person and staff concerned should make an opportunity to discuss and reflect upon the incident, its causes and outcomes.

The Life Space Interview provides a structure for this discussion. This helps the young person learn that there are better ways of dealing with difficult situations than losing control. Staff have a responsibility to follow this process through at the most appropriate time.

Young people must have access to the Complaints Procedure if they remain unhappy with the way the incident was handled.

Medical Attention – Young people must be asked if they require medical attention.

An important element of TCI is the recovery period following a safety intervention.

The key guidelines are:

1. The opportunity must 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;
2. The LSI, which takes place with the young person, should be conducted by the member of staff principally involved in the incident;
3. As part of the LSI, 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;
4. If a young person wishes to make a complaint about the handling of the incident they must be provided with the relevant information and supported in this process;
5. Following any incident, the staff involved and witnesses must be afforded the opportunity to reflect on their own feelings about the handling of events. Supervision will give people this opportunity; the LSI format is suitable for this process too.

It is the responsibility of a Young Person’s Key worker/Co Worker to develop an Individual Crisis Management Plan (ICMP) for each young person accommodated. This ICMP must be updated as and when required and reviewed on a regular basis alongside the Care Plan and Risk Assessment to ensure that appropriate safety interventions, which meet the young person’s needs, are recorded accurately.

It is the responsibility of the Registered Manager/Management Team to monitor the plans in supervision. It is the responsibility of all staff to inform of any changes and the Key Worker to share the information with the staff team in a recorded Team Meeting and amend the ICMP.

All significant incidents must be recorded on the TCI Proforma (Appendix B) by the member of staff on duty. The Registered Manager must countersign.

It is the responsibility of the duty staff and Registered Manager/ Management Team to ensure that:

1. All significant incidents, including safety interventions are reported to Ofsted, using the TCI Proforma and Notifications Proforma;
2. The Young Person’s Social Worker/Personal Advisor and parents are informed of the incident;
3. The Health & Safety Officer for Children’s Services is informed via the TCI Proforma and V3 accident form;
4. If the Police are involved then the Residential Manager is informed via the TCI Proforma and copy of the OFSTED Notifications Proforma;
5. The incident is recorded in the Homes Record of Restraint (in accordance with the Children’s Homes Regulations 2001).

Where an injury is sustained to either a young person or member of staff, it is the responsibility of the other staff on duty to record in the Homes Accident Books. This must be countersigned by the Registered Manager.

Following any significant incident, it is the responsibility of the Key Worker to update the young person’s ICMP and care Plan as soon as possible.

The Registered Manager must review the situation and decide whether or not to implement a Dynamic Risk Assessment. (Cross refers to Risk Management Procedure).

Records will be available to be reviewed by Managers, IRO’s, Ofsted Inspectors. Regulation 44 visitors. Information gained from monitoring and evaluation incidents will be used to inform management, planning and training decisions.

As well as delivering training to staff the role of the trainer will also include the following:

• Attend TCI Implementation Meetings;
• Ensure staff have read and signed that they have read the Policy;
• Cascade information via the use of the Team Meetings;
• Be a point of contact within the Home and to other Coordinators.

All staff are responsible for developing their own TCI practice, using the supervision process to reflect and enhance their own practice. Equally Supervisors are also responsible for monitoring and reviewing individual TCI skills which are reviewed as part of the yearly appraisal process.

Key Workers are responsible for drawing up the Care Plan and the Individual Crisis Management Plan, ensuring that they link to risk assessments. These pieces of work must be reviewed as and when required and at regular intervals.

It is the responsibility of each staff member to record the incident on the appropriate documentation following each and every incident and ensuring that a Life Space Interview occurs at the first appropriate opportunity.

All staff are responsible in ensuring that all young people are provided with information regarding the complaints procedure and to support them in this process.

Staff must regularly monitor and review the young person’s progress and review each Individualised Crisis Management Plan. Young people must be involved at all levels of decision making to promote a positive care environment and to receive support to where necessary i.e. Advocate

All staff in Residential Services will be expected to comply with the principles of the TCI Good Practice Guidance. Managers are responsible for making sure this document has been distributed in line with Care Standards Act Jan 2014.