Use of self in responding to pain-based behavior: identifying and explicating threshold concepts in Therapeutic Crisis Intervention

Responding helpfully to distressed children and youth is fundamental to good practice in therapeutic care and education settings, and vital to reducing physical restraint and preventing harm. It is also one of the most difficult areas of practitioner development, yet evidence for informing said development is scant. This paper presents findings of mixed-methods research that applied the Threshold Concepts Framework, a prominent pedagogic theory, to identify areas of learning that positively transformed practice in responding to children’s distress, but that were also troublesome to master. Research methods included Group Concept Mapping and, for purposes of triangulation and experiential data, individual and focus group interviews. Participants included instructors, trainers and learners of the Therapeutic Crisis Intervention curriculum, a trauma-informed training and organizational development system addressed to the prevention, de-escalation and management of children’s distress and challenging behavior in therapeutic care and education settings. Both methods yielded the same two threshold concepts as most prominent: use of self and pain-based behavior. These two threshold concepts have illuminative power to inform education, training and organizational support to improve practice responses to distress and challenging behavior, reduce physical restraints and related harms, and enhance the therapeutic care and education of children and youth.