Trust Based Relational Intervention
(TBRI)
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.
Children From Hard Places
Trust Based Relational Intervention
(TBRI)
Felt Safety
Predictability
Transitions
Physiology
Ecology
TBRI emphasizes the following principles:
Empowering Principles
Safe Touch
Sensory Input
/Physical Activity
Hydration/Nutrition
Trust Based Relational Intervention
(TBRI)
Observing
Recognizing
Behavior
Eye Contact
Body Position
Voice and Inflection
Encourage Process
Engagement
Awareness
TBRI emphasizes the following principles:
Connecting Principles
Matching
Active Listening
Nurturing
Interaction
Playful
Engagement
Trust Based Relational Intervention
(TBRI)
Emotional
Regulation
Encourage the
Positive
Life Value Terms
Choice for
Growth
Re-directive Strategies
Proactive Strategies
TBRI emphasizes the following principles:
Correcting Principles
Choices for
Discipline
Redos
Consequences
Voice/Stance
Ideal Response
(TBRI) – Empowering Principles
Felt Safety
This is an environment where
the child recognizes that they
are safe, not just safe from
the parents standpoint.
(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.
Senses
(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
(TBRI) – Empowering Principles
Felt Safety = A Sensory Sensitive Environment
Sensory Processing Disorder Continuum
Regulatory
Disorder
Mild
ADHD
PDD
Aspergers
Syndrome
Autism
Severe
Research suggests that “children who had
the greatest number of sensory deficits also
had the greatest number of attachment and
behavioral problems”.
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
(TBRI) – Empowering Principles
Felt Safety = A Sensory Sensitive Environment
(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.
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.
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.
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
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”
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.
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”.
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?”
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