An Introduction to Trust-Based Relational Intervention (TBRI)

Posted by Rene Thomsen

Trust-Based Relation Intervention (TBRI) centers on building a connection between a caregiver and child, creating an optimal physical environment, and handling discipline in an attachment-focused way.  TBRI is an attachment-based, trauma-informed intervention that is designed to meet the complex needs of vulnerable children, including those in foster care, adoption, and those who have experienced various forms of trauma (physical abuse, emotional abuse, sexual abuse).  There are six different risk factors that make children vulnerable:

1. Difficult pregnancy
   1. Can be for reasons including medical, drugs/alcohol, crisis or other trauma.
   2. Can be due to persistent, high level of stress throughout pregnancy (domestic violence, adoption process, natural disasters, etc.)
2. Difficult birth
3. Early hospitalization
   1. Children who experience early hospitalization often experience painful touch rather than nurturing, comforting touch in the first few days of life.
4. Abuse
   1. Children from abusive backgrounds know to always be on guard and have been trained to be on alert at all times to the environment around them – the message sent is  “adults aren’t safe, and I can’t trust them.”
5. Neglect
   1. The message sent to a child from a neglectful background is “I don’t exist.”
   2. Children from neglectful backgrounds often suffer from the most severe behavioral problems and brain deficits.
6. Trauma
   1. Any number of traumas in the child’s life (witnessing a car crash, murder, natural disaster) can cause the child’s developmental trajectory to change.

Vulnerable children from “hard places” need parents and caregivers, who are insightful, prepared, equipped, and committed for the long term.  TBRI has a set of principles and strategies that give caregivers, parents and professionals the tools to bring healing and well-being to children and adolescents who come from “hard places.”  It consists of three principles: Correcting, Connecting, and Empowering.

Connecting Principles help children build trust and meaningful relationships. These include:

• Engagement Strategies: connecting with children non-verbally, such as with eye contact, behavior matching, and playful engagement.
• Mindfulness Strategies: caregivers being aware of what they bring to interactions with children, such as being conscious of their own relationship histories.

Empowering Principles help children learn important skills like self-regulation. There are two types of Empowering strategies:

• Physiological Strategies: focusing on the internal physical needs of the child. These include things like hydration, blood sugar, and sensory needs. Think of a time your mood or behavior was affected by being hungry (low blood sugar) or thirsty (dehydration).
• Ecological Strategies: focusing on the child’s external environment and guiding children toward learning self-regulation skills. Ecological Strategies include things like transitions, scaffolding, and daily rituals.

Some items to make transitions easier could include:

• Give reminders (“five  more minutes until_____,” “three more minutes until_____”)
• Allow child to set a timer
• Allow child to choose between two amounts of time  (e.g. five or seven minutes)
• Be a detective, taking notice of the child’s behavior throughout the day can do wonders for understanding their needs  – Try keeping a behavior diary for a week and record each time a behavioral episode occurs – this type of attunement will help you become more proactive instead of reactive.

Correcting Principles help children learn behavioral and social competence so that they can better navigate the social world they live in. Correcting Principles include:

• Proactive Strategies: teach social skills to children during calm times.
• Responsive Strategies: provide caregivers with tools for responding to challenging behavior from children.  The IDEAL response:
  • Immediate: Respond within 3 seconds; learning occurs best when behavior is addressed immediately
  • Direct: use engagement strategies; get on the child’s level and use soft eye contact
  • Efficient: Use only the amount of intervention necessary to get behavior back on track
  • Action-based: guide children through a re-do or compromise.  Leveled at behavior not child: for children from hard places, self-esteem is very fragile. Be clear that children are not defined by their behavior.  For example “it is not ok to hit,” vs. “mean people hit, don’t let me see you hit again”

“All children need to know that they’re precious and unique and special.  But, a child who comes from a hard place needs to know it more desperately.”  Dr. Karyn Purvis
Find out more information on TBRI by following this link
TBRI Part-Two will discuss Levels of Response and outline what caregivers can do in different challenging situations with children.

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