Using a Systems of Care Approach to Trauma Informed Care and Therapeutic Crisis Intervention (TCI)

The Systems of Care approach is rooted in the idea that coordinated services and supports to meet the needs of most vulnerable children and families is the most effective way to employ intervention efforts. This is built on the premise that multi-system sharing of resources, responsibility and collaboration provides the highest chance for promoting wellness for children across their lifespan. Programs that are designed specifically to provide these services, both residential and school based, aim to do so through the use of Trauma Informed Care and evidenced based models such as Therapeutic Crisis Intervention (TCI). A multi-system structure is key to the success of Trauma Informed Care and TCI, highlighting and promoting the interdependence between the child and family, program staff, leadership support, and clinical participation. The degree to which we can evaluate success can be done so by asking ourselves imperative questions around the goals of training and what is the day to day practice within these program settings. This presentation will focus on the importance of assessing and ensuring TCI model fidelity as foundational in providing the highest standard of services. Programmatically, we have experienced both the challenges and successes of sustaining Cornell’s Therapeutic Crisis Intervention, specifically as it relates directly to treatment for children. We have to continue to evaluate our current TCI practice and compare to the authentic model standard. Additionally, programs that use this and similar models must consistently monitor fidelity and how that translates into outcomes for children.
Assessing fidelity at the direct staff and service provider level is imperative to interpreting behavioral challenges and outcomes. If we don’t assess fidelity, then we cannot:
A. be sure the intervention (TCI) was actually used
B. attribute outcomes to the use of the intervention (TCI)
C. know what to focus on for improvement
If outcomes are not what we’d hoped for, and on a programmatic level we continue to see the same patterns of behavior, but we have no fidelity data, it’s difficult to develop an improvement plan and make adjustments to treatment planning and crisis intervention strategies. We must be able to ask ourselves if results are poor because we chose the wrong intervention or because the intervention is not being used as intended? We need to know the answers to these questions in order to create a functional plan to work towards ensuring that all staff, at all times are utilizing all components of the model to fidelity. This presentation will focus on the challenges that impact utilizing TCI to fidelity programmatically and how best to build an infrastructure within these programs enhance the use of the model.


Miranda Himes, LCSW-R

Associate Executive Director , St. Catherine's Center for Children