The TCI SAFE Project: Strategies, Challenges, and Implications in Measuring Training and Program Fidelity Lisa A. McCabe, Ph.D. Jack C. Holden, Ph.D. Residential Child Care Project Family Life Development Center Cornell University National Human Services Training Evaluation Symposium Cornell University, Ithaca, NY June, 2011

TCI: Study About Fidelity & Effectiveness 30 years of The Therapeutic Crisis Intervention (TCI) System Early research* suggests its effectiveness, but need to better understand how TCI training and implementation relate to programmatic practices *(Nunno, Holden, & Leidy, 2003)

TCI: Study About Fidelity & Effectiveness Process/fidelity of TCI training and implementation in residential child care agencies Organizational culture and climate around issues of restraint use How organizational climate and TCI implementation relate to programmatic practices (e.g. number of restraints used)

TCI: SAFE Case Studies TCI Agencies in the US Document review (e.g. program handbooks, incident records) Agency profile survey Staff interviews Training observation Anonymous staff surveys TCI Implementation Reducing Seclusion and Restraint Organizational Questionnaire (Colton & Xiong, 2010) TCI fidelity checklist

What is the TCI System? Crisis prevention and intervention model Prevent crises De-escalate potential crises Reduce injury and risk of injury to young people and staff Reduce use of physical interventions Teach young people new coping skills Develop a learning circle with in the organization

Skills Building Pyramid Skills Building for Co-regulation Strategies in TCI LSI Crisis Co-regulation Emotional First Aid Active Listening Crisis Communication Self Awareness Co-regulation skills and strategies

TCI Training of Trainers Program (5 days) Associate and Professional Certification Levels TCI Core Training (20-28 hours) TCI Updates (1-2 days) Adapting the LSI for Proactive Aggression Conflict Resolution Post Crisis Response TCI Trainer Support Developing Professional Level TCI Training Skills

Effective TCI Implementation Includes Leadership and program support Clinical participation Supervision and post crisis response Training and competency standards Documentation and incident monitoring and feedback

Today’s TCI: SAFE Workshop When measuring fidelity to a program, should the goal be certification/assessment, program improvement, or both? Is it possible to have one instrument that accomplishes both goals? Can you conduct an authentic evaluation of a program in the absence of in-depth observations of program implementation? How are TCI training, implementation and organizational climate related and how do they relate to training goals (e.g. critical incident rates)?