Trust-Based Relational Intervention®
What is it?
TBRI® is an attachment-based, trauma-informed intervention that is designed to meet the complex needs of vulnerable children. TBRI® uses Empowering Principles to address physical needs, Connecting Principles for attachment needs, and Correcting Principles to disarm fear-based behaviors. While the intervention is based on years of attachment, sensory processing, and neuroscience research, the heartbeat of TBRI® is connection. TBRI® Caregiver Training offers many concrete effective tools alongside the theory.
Who is it for and who should use it?
TBRI® is designed for children from “hard places” such as abuse, neglect, and/or trauma. Because of their histories, it is often difficult for these children to trust the loving adults in their lives, which often results in perplexing behaviors. TBRI® offers practical tools for parents, caregivers, teachers, or anyone who works with children, to see the “whole child” in their care and help that child reach his highest potential.
TBRI® is a great tool, however, for all children. It is a model for interacting with children in ways that offer a healthy balance of nurture and structure.
Why use it?
Because of their histories, children from hard places have changes in their bodies, brains, behaviors, and belief systems. While a variety of parenting strategies may be successful in typical circumstances, children from hard places need caregiving that meets their unique needs and addresses the whole child.
Where is it used?
TBRI® is used in homes, residential treatment facilities, group homes, schools, camps, and international orphanages.
How do you do it?
If you’d like to get started right away, we encourage you to look around our site for more information and resources. Reading our book, The Connected Child, or viewing any of our DVDs are both great places to start. TBRI® 101: A Self-Guided Course in Trust-Based Relationships also provides nearly eight hours of instruction on TBRI®. Parents can learn to implement Trust-based parenting in a variety of ways and we offer a few ideas on where to start on our parent resource page. Professionals can apply to attend our TBRI® Professional training. Please check out local training opportunities by clicking the link below.
Where can I read about it?
Purvis, K. B., Cross, D. R., & Sunshine, W. L. (2007). The Connected
Child: Bringing hope and healing to your adoptive family. New York, NY:
McGraw-Hill.
Purvis, K. B., Cross, D. R., Dansereau, D. F., & Parris, S. R. (2013).
Trust-based relational intervention (TBRI®): A systematic approach to
complex developmental trauma. Child & Youth Services, 34(4), 1-28.
Purvis, K. B., Cross, D. R., & Pennings, J. S. (2009). Trust-based
relational intervention: Interactive principles for adopted children with
special social-emotional needs. Journal of Humanistic Counseling,
Education, and Development, 48, 3-22.
Purvis, K. B., Parris, S. R., & Cross, D. R. (2011). Trust-based
relational intervention: Principles and practices. In Rosman, E. A.,
Johnson, C. E., & Callahan, N. M. (Eds.), Adoption factbook V (pp.
485-489). Alexandria, VA: National Council for Adoption.
Evidence-Based Practice
The Karyn Purvis Institute of Child Development has published many peer reviewed journal articles which provide evidence for the success of the intervention. Trust-Based Relational Intervention® is currently listed on the California Evidence-Based Clearinghouse for Child Welfare (CEBC) registry, and is rated as being “Highly” relevant in the child welfare system based upon the program being designed to meet the needs of children, youth, and families receiving child welfare services. Trust-Based Relational Intervention® is listed as a promising intervention in two categories: TBRI® Online Caregiver Training & TBRI® Caregiver Training in the area of Parent Training Programs that Address Behavior Problems in Children & Adolescents.
TBRI® Research Articles:
Howard, A.R., Nielsen, L., Parris, S.R., Lusk, R., Bush, K., Purvis, K.B., & Cross, D. R. (in press, 2015). Keeping adoptive families together: Predicting changes in parenting stress and child psychiatric behaviors from parental investment in a trauma-informed intervention. Child Welfare.
Key Findings: This study is a secondary analysis, using pre- and post-data from a clinical adoption preservation program. TBRI® training was provided to adoptive parents as a complementary intervention added to the normative treatment prescribed for the family. Based on post-data collected six months after treatment began, the adoptive children (n = 82) of these parents demonstrated significantly improved global functioning based on the Brief Psychiatric Rating Scale for Children (BPRS-C), and a significant decrease in psychiatric symptom levels based on the Child’s Global Assessment Scale (CGAS). In addition, post-data showed that caregiver’s stress levels as reported on the Parental Stress Scale (PSS) significantly decreased.
Purvis, K.B., Razuri, E. B., Howard, A.R., Call, C., DeLuna, J., Hall, J.S., & Cross, D. R. (2015). Decrease in behavioral problems and trauma symptoms among at-risk adopted children following trauma-informed parent training intervention. Journal of Child & Adolescent Trauma.
Key Findings: Using a two-group, pre-post intervention design, the study evaluated the effectiveness of parent training utilizing Trust-Based Relational Intervention (n=96). Children of parents in the treatment group demonstrated significant decreases in behavioral problems on the Strengths and Difficulties Questionnaire and significant decreases in trauma symptoms on the Trauma Symptom Checklist for Children after intervention.
Parris, S.R., Dozier, M., Purvis, K.B., Whitney, C., Grisham, A., & Cross, D.R. (2015). Implementing Trust-Based Relational Intervention in a charter school at a residential facility for at-risk youth. Contemporary School Psychology, 19(3), 157-164. doi: 10.1007/s40688-014-0033-7
Key Findings: Number of incident reports for aggressive and disruptive behavior over a 2-year implementation of TBRI:
a) After the first year of implementation, school data showed a 33% decrease in referrals for physical aggression or fighting with peers over a one-year period (35 in 2010-2011; 23 in 2011-2012).
b) After a two-year period of implementation, school data showed a 68% decrease in office referrals for physical aggression (35 in 2010-2011; 11 in 2012-2013); an 88% decrease in referrals for verbal aggression (116 in 2010-2011; 14 in 2012-2013); and a 95% decrease in referrals for disruptive behavior (751 in 2010-2011; 34 in 2012-2013). Overall there were 902 of these types of referrals combined in 2010-2011, and only 59 in 2012-2013, resulting in a 93.5% decrease in these types of incidents after the first two years of the implementation process.
Razuri, E. B., Howard, A.R., Call, C., DeLuna, J., Hall, J.S., Purvis, K.B., & Cross, D. R. (2015). Decrease in behavioral problems and trauma symptoms among at-risk adopted children following trauma-informed web-based trauma-informed parent training intervention. Journal of Evidence-Informed Social Work, 1-14.
Key Findings: Using a two-group, pre-post intervention design, the study evaluated the effectiveness of parent training utilizing Trust-Based Relational Intervention in an on-line format (n=256). Children of parents in the treatment group demonstrated significant decreases in behavioral problems on the Strengths and Difficulties Questionnaire and significant decreases in trauma symptoms on the Trauma Symptom Checklist for Children after intervention.
Purvis, K.B., Milton, H.S., Harlow, J.G., Parris, S.R., & Cross, D.R. (2015). The importance of addressing complex trauma in schools: Implementing Trust-Based Relational Intervention in an elementary school. ENGAGE: An International Journal on Research and Practices in School Engagement 1(2).
Key Findings: 18% decrease in incident reports and 23% decrease in the number of office referrals for the top ten most frequently referred students following TBRI implementation in an elementary school with an at-risk student population (p. 9).
Purvis, K.B., Cross, D.R., Jones, D., & Buff, G. (2012). Transforming cultures of care: A case study in organizational change. Reclaiming Children and Youth, Special Edition on Practice-Based Evidence, 21(2), 12-20.
Key Findings: Decreases in serious incident reports by 39% and containments by 60% after TBRI implementation in a group home setting providing transitional services for children ages 4 to 12 who can no longer live with their families (p. 14-15).
Purvis, K.B., Cross, D. R., Federici, R., Johnson, D., & McKenzie, L.B. (2007). The Hope Connection: A therapeutic summer day camp for adopted and at-risk children with special socio-emotional needs. Adoption & Fostering, 31(4), 38-48.
Key Findings: Significant decreases in thought problems, attention problems, aggressive behavior, and other problems for adopted children from pre-intervention to post-intervention (p. 44-45). Significant increase in positive attachment behaviors and a significant decrease in negative attachment behaviors on the Beechbrook Attachment Disorder Checklist for adopted children from pre-intervention to post-intervention (p. 44-45). A significant decrease in attachment disturbance on the Randolph Attachment Disorder Questionnaire for adopted children from pre-intervention to post-intervention (p. 45). Significant increase in positive scores and a significant decrease in negative scores on Family Drawings for adopted children from pre-intervention to post-intervention (p. 45).
Purvis, K.B. & Cross, D.R. (2006). Improvements in salivary cortisol, depression, and representations of family relationships in at-risk adopted children utilizing a short-term therapeutic intervention. Adoption Quarterly, 10(1), 25-43.
Key Findings: Significant decreases in salivary cortisol levels during the intervention for adopted children (p. 34-35). Significant decreases on the Child Depression Inventory total score, negative mood score, and interpersonal relationships score for adopted children from pre-intervention to post-intervention (p.35). Significant decreases in proximity from child to mother and from child to father on Family Drawing scores for adopted children from pre-intervention to post-intervention (p. 35-36).