1. Trust Based Relational Intervention (TBRI)

2. Trust Based Relational Intervention (TBRI)
Developed by Dr. Karyn Purvis and Dr. David Cross from TCU institute of Child Development
Family-based intervention designed for children who have experienced relationship-based traumas.
Considered an emerging intervention.
Based on neuropsychological theory and research, and tempered by humanitarian principles.

3. Children From Hard Places
Video Children from Hard Places

4. Trust Based Relational Intervention (TBRI)
TBRI emphasizes the following principles:
Empowering Principles
Ecology
Transitions
Predictability
Felt Safety
Physiology
Hydration/Nutrition
Sensory Input /Physical Activity
Safe Touch

5. Trust Based Relational Intervention (TBRI)
TBRI emphasizes the following principles:
Connecting Principles
Awareness
Voice and Inflection
Body Position
Eye Contact
Observing
Recognizing Behavior
Encourage Process
Engagement
Playful Engagement
Nurturing Interaction
Active Listening
Matching

6. Trust Based Relational Intervention (TBRI)
TBRI emphasizes the following principles:
Correcting Principles
Proactive Strategies
Choice for Growth
Life Value Terms
Encourage the Positive
Emotional Regulation
Re-directive Strategies
Ideal Response
Voice/Stance
Consequences
Redos
Choices for Discipline

7. (TBRI) – Empowering Principles
Felt Safety
This is an environment where the child recognizes that they are safe, not just safe from the parents standpoint.

8. (TBRI) – Empowering Principles Felt Safety
An environment of felt safety is attachment rich and sensory rich.
Nurturing touch causes a physiological response.
Decreased heart rate & blood pressure
Release of Serotonin
Use of Theraplay materials to provide appropriate opportunities for Nurturing touch.
Because many foster children have been traumatized by touch, care givers need to be extremely sensitive and aware in the use of touch.
Unfortunately in many ways the State has thrown the baby out with the bathwater around touch.

9. Senses
Video – A Child’s view of Sensory Processing

10. (TBRI) – Empowering Principles Felt Safety = A Sensory Sensitive Environment
1 in 20 children have Sensory Processing Disorder (SPD)…our population is likely much higher given the risk factors for SPD.
SPD is the inability to use information received through the senses in order to function smoothly in daily life.
Over/Under responsive or Sensory Seeking
Touch
Movement Balance
Sights, Sounds, Smell or Taste
Risk factors for SPD:
Prenatal exposure to chemicals, medications, toxins, smoke, drugs, alcohol, great emotional stress, virus, chronic illness or problem with the placenta • Prematurity or low birth weight • Postnatal exposure to environmental pollutants, child abuse, insufficient stimulation (limited play and interaction), lengthy hospitalization, and placement in an orphanage.
For example Over responsive with touch an child may avoid touch, extremely overreact to getting dirty, certain texture of clothing and food, and to light unexpected touch
Under responsive to touch is unaware of messy face, hands or clothes. May not know whether she is being touched, does not notice how things feel, and may drop items easily.
Sensory Seeking – Wallows in mud, dumps out bins of toys and rummages through them mindlessly, constantly chews on inedible objects, rubs against walls and furniture, or bumps into people.

11. (TBRI) – Empowering Principles Felt Safety = A Sensory Sensitive Environment
Sensory Processing Disorder Continuum
Regulatory Disorder
ADHD
PDD
Aspergers Syndrome
Autism
Severe
Mild
Research suggests that “children who had the greatest number of sensory deficits also had the greatest number of attachment and behavioral problems”.

12. Prevent Sensory Overload The Connected Child, by Dr. Karyn Purvis & Dr
Prevent Sensory Overload The Connected Child, by Dr. Karyn Purvis & Dr. David Cross
1. Reduce Visual Clutter
2. Choose simple and subdued decorations for your home.
3. Keep a few toys available
4. Minimize brightly colored and loud videos or games.
5. Speak quietly and lower the music or television volume a few notches
6. Be mindful to remove extra odors
7. Be Cautious about places like, restaurants, activity centers, and amusement parks

13. (TBRI) – Empowering Principles Felt Safety = A Sensory Sensitive Environment
For example: A child who is Over responsive to touch may avoid touch, extremely overreact to getting dirty, certain texture of clothing and food, and to light of unexpected touch
Under responsive to touch is unaware of messy face, hands or clothes. May not know whether she is being touched, does not notice how things feel, and may drop items easily.
Sensory Seeking – Wallows in mud, dumps out bins of toys and rummages through them mindlessly, constantly chews on inedible objects, rubs against walls and furniture, or bumps into people.

14. (TBRI) – Empowering Principles Felt Safety = Hydration & Nutrition
Hydration and Nutrition are directly tied to healthy brain chemistry.
Dehydration can affect a child’s neurotransmitters.
Ensure stable blood sugar by giving small regular snacks (preferably every two hours) with a balance of complex carbs and protein
Avoid power struggles with food.
Too much glutamate in the brain can result challenging behaviors.
Hydration helps to stabilize levels of glutamate in a child’s brain in which enables him/her to learn higher order tasks (Purvis, Cross, & Pennings, Spring 2009).
Ensuring proper nutrition, “by giving a child small and regular snacks (preferably every two hours) that contains a balance of protein and complex carbohydrates helps keep blood sugar levels stable” (Purvis, Cross, & Pennings, Spring 2009).
Many foster children deal with food issues related to early life trauma associated with neglect and abuse, as such it is not uncommon for foster parents to see maladaptive behaviors from foster children associated with food.

15. TBRI Connecting Principles
Connecting principles address the relational needs of the child through awareness & engagement.
The connecting principles address the tendency of a child to withdraw or dissociate as a means of self protection, by engaging the child while attending to his/her feelings of threat or fear.

16. TBRI Connecting Principles - Observing
Many foster children continue to engage in maladaptive strategies that are fear and anxiety based, even though they are in a safe environment.
These behaviors are masked as anger, willfulness, stubbornness, manipulation or defiance.
The goal of observing is twofold
One is to help caregivers recognize the physiological signs of fear and anxiety such as dilated pupils, stiff limbs, or clenched fists;
Second to recognize their own anxiety level. A caregiver who is able to recognize stress and/or anxiety, their own, or their child’s, is more able to respond effectively to the child’s underlying need.

17. TBRI Connecting Principles – Recognizing Behavior
Many of the maladaptive behaviors that traumatized children engage in are need driven.
Unfortunately rather than addressing the need caregivers often respond with “an assault of adult force”.
Is the behavior due to:
Pain
Fear
Hunger /Thirst
Tiredness
Grief and Loss

18. TBRI Connecting Principles Eye Contact ~ Body Position ~ Voice & Inflection
Valuing safe eye contact is an intervention goal as a means for caregivers to connect with children.
“Giving eye contact conveys how much you value your child, and requesting eye contact is a way to gain a child’s attention should you need to communicate important messages”
Playfully moving the parents head into the child’s field of vision, by getting eye level with the child.
Saying the child’s name in the context of the sentence the parent is speaking, and then pausing.
Or specifically asking for eye contact, through phases like “let me see those beautiful eyes”.

19. TBRI Connecting Principles Eye Contact ~ Body Position ~ Voice & Inflection
Mirroring a child body position can facilitate connection with the child.
For example when a child is sitting on the floor reading a book, the parent may sit beside the child, and also participate in looking at the book.
For children who are resistant to connection, a parent could use this technique to engage the child in a non-threatening manner.

20. TBRI Connecting Principles Eye Contact ~ Body Position ~ Voice & Inflection
Caregivers can look for opportunities to connect with their child through encouraging mirrored playful verbal interaction.
For example utilizing phrases such as “Good enough?”, “Okie Dokie?” and lead the child to respond with the same words.
Not unlike a mother mimicking her infants coos, “this small “dance” between adult and child can set the stage for deeper attunement in communication”.

21. TBRI Connecting Principles Encourage Process
Foster families must be sensitive to a child’s emotional needs and recognize that behaviors that look like anger, aggression or lethargy may be rooted in sadness.
Children need to be given permission to process their feelings, for example a caregiver may state “sometimes I feel sad too, or it is okay to feel angry, what are some good ways to deal with anger?”

22. TBRI Correcting Principles
Proactive and Responsive
Balance structure and nurture to build trust
Overly structured or firm response can stimulate the fight, flight or freeze adrenaline response
Sharing power, choices, compromises
Goals of Correcting
1. Parents maintain connection with the child
2. Children end the episode feeling content
3. Episode ends with behavioral change