The TCI SAFE Project: Strategies, Challenges, and Implications in Measuring Training and Program FidelityLisa A. McCabe, Ph.D.Jack C. Holden, Ph.D.Residential Child Care ProjectFamily Life Development CenterCornell University

National Human Services Training Evaluation Symposium

Cornell University, Ithaca, NYJune, 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

1) Process/fidelity of TCI training and implementation in residential child care agencies

2) Organizational culture and climate around issues of restraint use

3) 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

LSI

Crisis Co-regulation

Emotional First Aid

Active Listening Crisis Communication

Self Awareness

Skills Building for Co-regulation Strategies in TCI Co-

regu

lation

skills

and s

trate

gies

TCI Training

• 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

1. 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?

2. Can you conduct an authentic evaluation of a program in the absence of in-depth observations of program implementation?

3. How are TCI training, implementation and organizational climate related and how do they relate to training goals (e.g. critical incident rates)?