Another article in the trauma-informed series by Dr. Teresa Camille Kolu, Ph.D., BCBA-D
In relationships we do rituals.
“BLECH!” Startled, I looked down at my sweet, expressive daughter with a true disgust face. Everybody laughed. I was kinda mortified but I laughed too. The woman at MeOhMyCoffeeAndPie (you HAVE to go) had just answered her question with “it’s sauteed onion” when my kid asked “what’s the scone flavor today?”
Ok, I guess she wasn’t expecting that.
I was too caught up noticing this awesome tiny, framed quote by the display case. As a young reader I LOVED Larry McMurtry, see, who wrote Lonesome Dove and a whole lot more. He and I both went to UNT (decades apart, of course) where he gave us a wonderful author meet and greet (early 90s for me, when this kid was not even a twinkle). The coffee and pie shop had quite appropriately chosen to frame this gem of a quote: “She made great biscuits, but her behavior was TERRIBLE”.
My daughter and I were out doing a ritual Saturday thing. My mom used to sing “Come Saturday Morning” with me (we had the sheet music, so it was right up there with “Country Roads” and “The City of New Orleans” in my book). And sometimes we would spend time just us, and I would look at her hands and sing this song in my head. Saturday mornings, for a couple precious hours, are time when my daughter doesn’t have to share me with her little brother, and she pays me back by asking me questions I can’t answer. It’s at this time I learn that even 5 year olds wonder things about God and the universe, have nightmares, they can have crushes, they have fears, they might still want to hold my hand.
I LOVE biscuits but I love her even more. I love her more than her behavior, even that sort of behavior that makes you want to fire the babysitter just so you’ll never have to greet that face that saw the terrible behavior you thought your kid would never do in public and after all, you are a behavior analyst! (Do I think it’s easier because I’m a behavior analyst, my new friend asked recently? Heck no. I personally think it’s harder. But I do think being a parent has made me a better behavior analyst.)
So in relationships we do rituals, like setting up meaningful goodbyes when we leave the room, or when rhythms change and we won’t be spending as much time together anymore. If not, we leave devastation.
When I watch animals grieving each other’s deaths… especially horses and dogs… I notice how fully present they are for the goodbye.
And I am always grieved to consider the implication: such a meaningless slog of goodbyes without reason, or participation, we inflect this on clients when caseloads shift; when a therapist moves; when a client with certain behaviors moves into Hall B, so we just HAVE to abruptly move Client A into Hall D, so they won’t antagonize each other and never mind Client A will never again see her best friend client, or even the janitor—who was like a mother to her and had been there for 12 of the client’s 15 years in this mental facility again.
We often have to make hard decisions, but we should ask questions (“what really hurt your feelings this past week? Today?”) because in relationships we apologize when we’re wrong.
When we realize we hurt others, we shift so that we won’t keep doing the hurtful thing.
My mom remembered the pain of being hurried as a child. I knew that, and I forgot it. I remembered it again this month when I was going through an exercise I was making for a new workshop we will offer at cuspemergenceuniversity.com. The exercise has us grownups go through questions that reveal the triggers for us – the things in our everyday situations that make us more likely to react swiftly (often in a hurtful way) to the others around us. And I realized two things: being hurried doesn’t feel good to children, and hurrying children doesn’t feel good to adults. So what do we do? This week, maybe you will notice a ritual that is always done with urgency, and think, how does this feel? What would this feel like if I slowed down? Now, the harder part: What would it take for me to build in space around this… ten extra minutes before it, so that we don’t have to experience this, every single time, in hurried mode? I tried this, and my children really love it, although I won’t hear about it from them. Their lingering hugs (mama, don’t let go first!) and their wonder as we have time to look around the yard for a new flower before we buckle our seatbelts… the absence of urgent reminders and exasperated sighs… perhaps even a reduction in tense moments when I’m about to lose it and yell. These changes are rewarding enough for me to keep doing this. Because I love them more than biscuits.
Yes, rapport is often transactional. Although it was by design at first, it doesn’t always have to be that way. I talk about this just a little bit in my buffers article, in the relationship section. And in the trauma sensitivity course we talk a little about how to be more sensitive to what folks go through (including your staff) so that YOU can be a little less harsh, a little more supportive, around things you didn’t even realize were hurting the other person.
In relationships, we apologize; we give freely; we do things uncontingently (yes, I know you won’t be able to look that up, and there’s a reason- we talk about it more on instagram and it bears more attention); and we are generous with things the person really needs, like time, kind words, and those little rituals that they consider special. Have you ever worked with a therapist the client really adored? Or a professor beloved by their students? I remember two. The professor is loved and really loves. She gives generously of her wisdom, time, and appreciation for students. (You wanted to ace her class and reflect what you admired in her, even as she whispered the things that made you more of yourself, more creative and passionate and able to grow confidently in the direction of your dreams.) The other person I remember is a therapist who had kids riding on her shoulder at recess in our mixed school for kids with developmental differences and peers. And those folks taught me that you can have instructional control when it’s time, and still have fun with the people who look up to you. Rapport IS often transactional. But the relationship doesn’t have to be.
Thanks for reading.
Oh… and I personally think, in the Longmont area, that Lucille’s has the best biscuits.
And OhMeOhMyCoffeeAndPie has the best lemon bars, if you’re wondering.
I love you more than biscuits, daughter of mine. And I love you even when your behavior is terrible.
Another article in the TIBA series by Dr. Teresa Camille Kolu BCBA-D
In Chapter 8 of our course on Trauma Sensitivity, we cover the concept of “triggers” and what we can do about them. We cover this mostly from a responsive perspective in the course and use the following operational definition: “Triggers are historically meaningful stimulus complexes or relations between them. In their presence, behaviors or response patterns may be temporarily more likely to occur.” We continue with the big idea from Chapter 8 of that course, “One of the most supportive actions we can take is to stay mindful and do what needs doing in the moment”.
However, another huge thing we can do in helping someone through those triggering events or moments is to plan ahead. Below are some questions we ask our clients and their family members to answer, if they are interested in exploring this. Read on if you’re interested in some examples (we share a brief example of a dyad’s answers, where one member is the 5 year old kid, and the other is a parent). (Oh, and it may be helpful to check out the IPASS (find it in our RESOURCES tab)- this is a little tool we use for folks to go through their sensory environment for clues about triggers, if they need somewhere to start.)
Questions:
1.Name a person you love or a primary relationship you care deeply about.
2.Name an action that you do that shows compassion with them.
3.Name some things the person also does… that REALLY get under your skin.
4.Name an environmental situation or trigger that happens right before it is HARDEST to keep your cool.
5.List some things you start to notice when you’re feeling about to blow up/ lose your cool/ start doing actions that are inconsistent with your values to that #1 person.
6.State things you do to calm down in those moments that REALLY work or are most likely to work.
7.If you DIDN’T act to calm down and things kept getting worse, state the action(s) you would be likely to use next in the presence of that person.
Growth statement: Write your plan to prevent the triggers (3 and 4 above) from leading to actions that are inconsistent with your values (e.g., 7), by doing (6) as soon as you begin to notice things about your insides or the outside environment (5).
Ready to see this in action? Below are some parent answers. Keep in mind that neurodivergent parents often have neurodivergent children (or, looking backward, that neurodivergent children often have neurodivergent parents, whose qualities might not be appreciated until later, in the context of exploring diagnoses with their own children). Have you ever seen a mom struggling with her own misophonia exactly at the same time her child uses loud repetitive noises? Talk about triggering (for and to each other)! But stay hopeful and in the moment, because as hard as it is to be the thing in your loved one’s environment that sets them off, it’s lovely to be the person in their environment who can really understand where they’re coming from.
Parent Example: Answers to 7 questions, above
1.I love my kids.
2.I love it when I am able to use kind words and a calm voice with them.
3.Sometimes my kid makes repetitive noises, does not listen or interrupts me, or doesn’t follow instructions.
4.It is most difficult to keep my cool with my kids when I’m running late somewhere and my kid is not following instructions or is not doing something the “right” way.
5.I start to notice my face getting hot, my neck and face muscles are strained, and my breathing is shallow and fast.
6.If I splash water on my face, relax my muscles, stop and hug my kid, and breathe deeply, it helps to calm me down in the moment.
7.If I skip that step above, I usually proceed to raise my voice and may even shout or say things I don’t mean (things that are not kind and compassionate).
Parent Growth plan: “When I’m late somewhere and it’s really noisy, it’s especially important that I start to notice when I’m using shallow breath, the noise around me is increasing, or I’m noticing everything “wrong” my kids do and nothing right they’re doing. Right then, before I talk to my kid, I need to immediately try some of my calming strategies I listed above.”
OK, now for the kid’s answers.
1.I love my mom and baby brother.
2.I love it when I am able to keep playing, share, have fun.
3.Sometimes my mom tells me to stop doing something I love or tells me how to do something better or my brother takes my stuff.
4.When mom yells or my brother takes my stuff or we have to leave my game or book, it is most difficult to keep my cool.
5.I start to notice my face getting hot, my movements are jerky, my chest hurts, and my breathing is fast.
6.If I hug my mom, splash water on my face, stop and do some jumping jacks and then sit and breathe, it helps to calm me down in the moment.
7.If I skip that step above, I usually yell, hit my brother, or shout “NO! I WON’T!”.
Growth plan my parents can help with: When I’m being asked to stop playing or to do something that interrupts my flow, notice when I’m breathing faster and having a hard time talking. You can help by giving me a hug, doing some jumping jacks with me, and sitting with me and helping me to breathe.
At this point, we ask the parent some meaningful questions to help them make sense of what we’re noticing. And often this is uncomfortable (but becomes exciting and doable) as they first think, “oh, but won’t we be reinforcing escalation?” No, we’re turning it off.
Parents or caregivers, did you notice…
-Whether your having a hard time makes it harder for you to help your other person with THEIR hard time?
-Whether your hard time perhaps CONTRIBUTES to their hard time?
-Whether your triggers are echoed by the ones that seem to affect your kid or client? (e.g., are you teaching your other person to struggle with the same thing you struggle with, without your meaning for this to happen)?
-Whether your triggers might be easier to manage at a period of time when you (or both of you) are well fed, rested, and exercised?
(An article in the TIBA series by Dr. Teresa Camille Kolu BCBA-D)
One day this spring, Dr. Camille of Cusp Emergence sat down to answer a few questions, and learn a LOT, from Enasha Anglade of LaughLoveLive Again. (You can learn more about Enasha and her work on Episode 87 of the Behaviour Speak Podcast!) Enasha and her fellow researcher and BCBA, Stephanie, talked with Camille about how Enasha’s company and work applies behavior analysis to supporting individuals affected by domestic violence. (And did we mention this dynamic duo will be presenting at BABA this weekend?! Go find them if you’re there!) We also discussed some of the barriers people face in this special context. Not all barriers can be solved with behavior analysis, of course, but there are many things we can do to insure we are minimizing the ones we know about, always staying open to learn about the client’s experience and special context. Each of the headers below reflects an important point heard from Enasha and Stephanie and some thoughts from a trauma-sensitive and behavior analytic perspective.
First, be safe.
Interested in getting involved in working with this population? First things first: it’s really important to be safe for someone. This may seem like a no-brainer. In fact, providing a safe starting place for your therapy is where all trauma-informed support begins, even if (and especially when) your therapy is not treating the trauma itself, but solving problems or building skills or meeting needs related to it. However, there are so many ways behavior analysts violate this number one rule. We might do it unintentionally, such as when we go right to changing behavior instead of listening to a person’s experience and what they truly need first. While there are many trauma-informed resources out there on establishing safety and trust, you can also check out a course on building trauma-sensitive environments (starting with safety), or read a behavior analyst’s discussion on safety in Rajaraman et al.’s 2022 paper on trauma-informed applications of behavior analysis. But don’t skip asking the person how they feel safe and whether there are things you are doing or saying that contribute to their safety or their experience of danger. That’s right- behavior analysts can inadverdently present danger signals to our clients in many ways. When someone is in the middle of a dangerous situation, they are in survival mode and not ready to learn. We don’t want to trigger this for a client and we don’t want to make worse a situation that already exists for them. Being safe (and making sure our presence and therapeutic environment are safe) is not about helping clients avoid all aversive, challenging, or difficult circumstances. Our clients (especially in this context of domestic survivors) are already going through one of the difficult things in their lives. Coming for help and walking out of horrible situations may be even harder than what they’ve been through before… it will be unfamiliar, may be incredibly risky, and may occur at great personal cost to them. What they’re doing is brave. They’re already doing the hard thing. This is about taking their hand and really listening to what they’re going through.
2. Don’t be afraid to go there… but secure support for yourself so your client does not have to do the work for you
Speaking of listening to what they’re going through, behavior analysts can be bad at listening. Does that sound strange? Behavior analysts are great at observing, typically by nature and training… but we can learn to be better listeners, too. And it’s CRUCIAL in this work. Enasha notes that we are often afraid to be personal, to “go there” with our clients. For behavior analysts in the trenches of severe challenging behavior, we’ve often gotten our hands dirty, literally. But to understand our clients coming from domestic violence, being a witness to their story can be meaningful. Listen to your client. Listen long enough to hear. Listen enough to learn what they could benefit from, too. She may need a counselor recommendation, a connection to somewhere she can forge a meaningful relationship, or a tool that you can’t provide (but that someone you know, could). Their daughter may need help for something you don’t treat. Most important, listen to help your client, not just to facilitate your client’s progress with your program.
Related to “going there” with your client, make sure you are not a burden on THEM. If their issues trigger you, your session with them is not the time to discuss that. Of course, there’s nuance involved in learning to listen to someone, so it would be helpful to do any or all of these suggestions: secure your own therapist to go to if you are troubled; be prepared by using specific ACT and mindfulness techniques that keep you able to use your flexibility skills; help your staff debrief with pre-planned supportive interactions after difficult client visits; learn more about motivational interviewing (for a constructional approach from a behavioral perspective see Goldiamond’s constructional interview); and provide training for you and your staff from a trauma expert outside behavior analysis to answer questions about how to support someone disclosing difficult material).
3. Value relationship over rapport, but in the right way.
Of course, if we were talking about real rapport, in the way the layperson uses the term rapport, we’d be talking about the same thing as relationship. The word rapport just means “a close and harmonious relationship in which the people or groups concerned understand each other’s feelings or ideas and communicate well”. But in behavior analysis, the word rapport typically connotes a more transactional process, one used as a procedure as a means to an end. Ultimately, many behavior analysts view rapport as a process one includes in the beginning of sessions or relationships with clients so that clients will be more likely to approach the instructor, and so that the instructor can deliver instructions, reinforcers and other environmental stimuli that encourage the client to change their behavior in specific ways the team has defined and prioritized.
Relationship viewed as an end is different. It has benefits beyond the program. It validates the person and prioritizes their needs. You might think of the way that with a relationship between two people who care about each other, we say goodbye when we’re done. We don’t just transfer off the case without letting the family know because we got a new job, or our hours were cut. However, we’re also not suggesting behavior analysts engage in dual relationships with our clients (an unethical and unhelpful practice to be sure!) What we’re really saying is to value the person over momentary instructional control, and treat them… well, like a person.We still need to be careful, and cautious, to preserve the integrity of precious boundaries. In other words, you are still not going to show up as your client’s “friend”, and you need to teach them, lovingly, how this will work in the beginning of your therapeutic relationship with them. You care about them, and you care enough to support them with their goals. That may include finding friends, or engineering environments that facilitate their making friends, but that’s not you; you’re the therapist. You can still be a good listener, care about your person, and support them without being their friend.
We can program toward the end the entire time, so that there is no disruptive surprise for the client at the ending of the relationship. I like to think about this as fading out interactions to a very low rate that is tolerable, and with programming additional sources of reinforcement for the client. Being the only person your client can trust wouldn’t be helpful; what if you were to have a car accident, move away, or have to reduce your hours? All those things happen, but if you plan from the beginning, you can insure they happen in more therapeutic ways. Be really careful to use ethics code guidelines on transferring cases, especially when you are working with someone in a sensitive and vulnerable situation like those surviving domestic violence.
4. Accept this: any behavior can be influenced both by its consequences in the moment, AND the relevant context and history.
When loud voices in the room ask “what does history have to do with behavior? Shouldn’t we just treat the function that’s controlling it now?”, it can be tempting for vulnerable behavior analysts to question themselves. Should I even be taking a trauma-sensitive approach? Should I take this person’s history into account at all? If it’s just paying off for them in the attention it produces, and we technically know about methods to turn behavior on and off using procedures based on consequences and arranging stimulus control conditions, what does it really matter?
Actually—in terms of bringing up trauma, or changing goals based on it—the answer may vary depending on what the client needs! CuspEmergence doesn’t recommend taking a trauma-informed approach when clients don’t need it. But those going through domestic violence all have been through trauma, by definition. As Rajaraman et al. (2022) states, “Responses to trauma may indeed vary from person to person; however, ACEs are well documented, and a preventative TIC approach would acknowledge their potential impact”.
We recommend behavior analysts working with survivors of trauma be intimately acquainted with the ways trauma relates to behavior, to medical needs, to subsequent challenges and needs, and to the barriers people face in moving on to healing circumstances. (See the sections nearer the end of this article for educating your team if that’s not your forte). And yes, behavior can be influenced by BOTH history (such as the trauma-related factors that were present when someone began to use behaviors that are now difficult for them and they want to change, even if those behaviors are NOW maintained by other environmental factors).
Because behavior is at any moment a function of the dynamic interaction between the local and historical context, it is possible that the intervention strategies identified during the functional assessment phase as “likely to be effective’ will need some modification when it is actually time to intervene. As Stephanie notes, clients affected by domestic violence may face unpredictable and changing needs. The needs of the client demand that the analyst be flexible and sensitive to the contingencies and challenges our client faces. We should be especially focused on tracking the ways we might be contributing (perhaps unintentionally) to coercive cycles of interaction for our client, perhaps hindering their growth by playing in to a power differential or offering choices using an architecture that WE don’t perceive as, but the CLIENT experiences, as coercive.
5. Identify the basic training your team will need. What are the most essential and meaningful training components your staff will need? Who provides that training, and how can you value it at the levels of culture, group, and individual?
What happens when most of the team cannot relate to the particular difficulties with which a client is struggling? They might recommend changes that are not feasible to the client; they might miss danger signals the client is sending based on what is happening around the client (and miss an opportunity to prevent harm); they might take personally or misunderstand the challenges a client is having and miss crucial chances to intervene appropriately; they might cause harm by actions intended to help; and so much more.
One team we know used to have a person on staff who provided this training because she had been through it, but her caseload is now too big for her to spend time with each new staff person. As the team grew, the personalized approach they were known for was eroded and eventually, the services they provided looked like most other agencies, and they were no longer meeting the individual needs of client families. However, they didn’t know it until they received feedback, because nothing had been intentionally changed; it was simply a product of drift that happened with the welcomed growth going on.
So one solution for teams with similar paths is to prioritize providing training from a reputable and experienced source, and doing that both routinely and in a way that continues to answer questions the new team members will have as they gain their own experiences and put their previous knowledge into their new context. In a subfield like domestic violence, this training needs to come from someone either outside of behavior analysis, or from someone whose training, expertise, experience and culture strongly intersects with that of the clients and their needs. If this person is not on staff, it is essential to secure regular training, as well as embedding this as a priority into the agency’s mission, core processes, values at work, and interacting with clients. Staff should not have to ask for designated and regular times they will be paid to access and discuss and apply the training (and receive appropriate feedback from someone equally experienced and trained).
6. Identify the most important kinds of support your clients will need that you cannot or do not provide. What kind of support is needed, who else provides it, and what would you like to be doing in 5 years if you removed barriers related to this support?
The first part (who else provides this?) is a logistics question. Prioritize finding those answers right NOW. If most of your clients receive behavioral support from you, but also need to be able to access certain other resources to survive, find out all about those resources and who provides them.
The idea is that you can position your agency in the middle of a network to which you can connect your clients. You do not want them struggling, alone, with something that could make or break their ability to come back to access your services or to implement them. We can start small, beginning with very simple connections you provide your client, such as a list of websites, phone numbers and connection names for partner agencies in your area that meet big needs (and funding options for those needs).
The second part (what would you be doing in 5 years if you removed obstacles?) takes more planning, but might make sense strategically depending on your clientele and their challenges. Some of the solutions could include creating a part- or full-time position of Resource Coordinator, hiring a social worker, or forging a strategic partnership with someone who fills this role for other companies and who knows your area well and can devote time to your own clients on a weekly or regular basis that makes sense for your client volume.
Do you do this work yourself? Contact us and add your essential strategies. Want to learn more? Find Enasha and Stephanie at BABA, listen to the podcast (Ben is in Detroit right now documenting BABA 2023!), follow ACES and ABA groups on social media, send us a comment and leave us your email below, or take a course on trauma sensitivity. We hope to hear from you soon!
Specific buffers (see Purewal et al., 2016) can actually protect against the harmful impacts of ACES on medical health. The particular buffers found to reduce harm include getting enough sleep, eating nutritious food, having access to mental health care, experiencing a safe relationship with someone, exercising regularly, and practicing stress relief techniques that allow someone to experience calming down (such as a simple mindfulness technique). Adding buffers may be a set of seemingly small actions, but they contribute to preventing problems from becoming larger, and may help solve challenges related to why a behavior plan is just not working. (Solving basic problems in the behavioral environment regarding access to needs can be an area consistent with the ethical imperative behavior analysts have to address conditions interfering with service delivery; see BACB, 2020, 2.19).
Although the buffers make a big difference in preventing from harms and protecting against future ones related to ACES, many individuals and families face major barriers related to access, information, resources, or behavioral needs. These barriers can reflect resource inequalities, individual differences, and cultural challenges that prevent many from experiencing the benefits. How could we leverage “buffers and barriers” policies to protect against harms (and truly embody the preventative arm of behavior analysis)?
One of the difficulties with beginning to implement buffers for individual clients is that behavior analysts may be hesitant to devote precious resources to this new and potential preventive area. To assist teams in understanding further how policies might affect our clients, their caregivers, and our staff, Cusp Emergence is engaged in developing resources and collecting feedback about their use. Some of the resources provide examples for conversations we could have with others, while others are visuals to help others easily understand the buffers and barriers (such as the “Be a buffer. Solve a barrier” downloadable pdfs in this article). We also have lists of policy ideas for interested agencies, risk benefit assessments to aid in their implementation, and examples of how we define buffers for individual clients, families and staff. Use our contact us form below to let us know which resources are your favorites or what else would help you more actively approach this area. Oh, and stay tuned for more on this incredible topic. Soon we’ll be be exploring buffers in more detail, including sharing some ways we integrate it for our clients, how it can be meaningful for caregivers and staff, and some of the research on each one.
For me, an on-demand workshop does several things: It can be taken any time; one can take it with a group and apply exercises with other people if desired; but since it’s on-demand, an individual will benefit even if taking it solo. It should be expandable if one wants to be able to sit with a chapter for a few extra hours because we simply love the content; there will be resources to grow with and come back to if one can’t do all the exercises right NOW. I’ve been on sabbatical a while; as I return to doing interviews, conferences, talks, and podcasts (including a new one we taped recently for the Atypical Behavior Analyst, with my friend Dr. Eddie Fernandez airing later), it is nice to be able to take something on my own time, when tiny folks are asleep, and I know many parents – and folks going through school and work at the same time – are in the same boat.
30+ exercises with the videos: Because this is an on-demand workshop, we present a TON of exercises packaged with the videos. Teams or individuals can easily do a chapter a week along with exercises for a truly transformative experience in your office or supervision setting. But if they choose to take it all at once in an afternoon, that’s possible too. So it’s customizable.
Scalable applications for team members, supervisors and supervisees: The new content (on leveling up the trauma sensitivity of our staff and client environments) is “scalable”, meaning we include applications for 3 different levels of staff: those in roles that are basic; intermediate; and advanced. Presenting it as a workshop meant that the team members “leading” the discussions and exercises benefit just as much as (but different from) the less advanced team members they are mentoring through it.
Supervision guides and chapter handouts: These come with every chapter video and walk the student through the material, from the main ideas we presented, to definitions for any new vocabulary, exercises, lists of Ethics Code items that relate, thoughtful discussion questions, exercises, and chapter resources and articles. Every chapter comes with its own handout and supervision guide to help BACB supervisors or team leaders support our coworkers and supervisees.
The two things I personally love most about this workshop are:
it addresses tough topics like moral injury with your team members and considering how this ethics area could apply to our supervisees but our clients too;
and we provide resources to follow up on big ideas like this one: there are some behavioral needs that medical providers consider symptoms of trauma-related concerns. (If folks are new to integrating trauma sensitivity in their supervision and client environments, we might miss this huge opportunity to make sure we do no harm by treating behavior needs that are actually related to new abuse.)
Wondering about the content of the new workshop? Here are the chapters (each has its own video, ethics intersections, resources, thought questions, and exercises):
Chapter 1: Principles of Trauma-Sensitive Care
Chapter 2: Interactions that could help or do harm
Chapter 3: Features of trauma-related responding
Chapter 4: Defining trauma
Chapter 5: Risks related to trauma
Chapter 6: Elements of a potentially trauma-related response
Chapter 10: Want to mitigate risk? Document it first
Chapter 11: Skills and Stress
Chapter 12: Healthy Collaboration
Above: Table of chapters from Trauma Sensitivity in the Behavioral Workplace, new on-demand workshop from Cusp Emergence
Did you enjoy this article? Come back soon when we’ll cover a few more related topics including: mentorship groups for those applying trauma sensitivity principles in their supervision sessions; how to get the most out of your workshop experience by doing exercises as a group or dyad; more info on a brand new all-trauma conference coming in April hosted by the formidable Dr. Gabi Morgan; meetups in Denver May 2023; and more!
Read below for final thoughts and some links if you’re in the market for values related CEUs: Recently, when my own CEU cycle was about to turn over, I knew it was time to take a course or workshop in something I could use NOW and am passionate about… so I went searching for three things: supervision CEUs; offerings from people I admire and from folks who literally wrote the books on leveling up mentorship and supervision and working with families; and opportunities to learn about values in a deeper way that would help me level up my own practice. That led me to a couple of great courses and podcasts; one of these opportunities was a workshop with built in exercises that could be taken quickly or over the course of a few weeks and included opportunities to network with other folks. It was a really lovely experience. Included are links to a couple trainings and podcasts from respected folks who continue to inspire, below.
Have you heard of the Stone Soup Conference? I’m so proud to join a group of amazing presenters to share lessons and ideas with folks in the behavior analysis community. All proceeds go to Lake Ridge Community Support Services, and (in their words) “build capacity to provide applied behaviour analysis services to children, youth and their families who are in financial need and waiting on service through the ABA for All Fund”. That’s a pretty great mission and I’ve worked with them before… this organization was one of the “early adopters” of anything trauma-related! Years before anyone wanted a keynote about trauma, these folks were simply interested in helping their practitioners get mentorship and consultation for “tough clients” struggling with their returns to communities. I think this type of consultation helps newer practitioners, and ones whose existing clients grapple with new challenges, to fulfill this piece of our Ethics code: “Being aware of, working within, and continually evaluating the boundaries of their competence” (Ethics Code for Behavior Analysts, p. 4).
That’s why I was so eager to say “yes!” to this invitation (and thanks so much for our connection, Matt! Your podcast continues to bring exciting topics to forge new paths for behavior analysts interested in growing our repertoires… like exposing us to Rajamaran’s article (finally!) putting trauma in the pages of JABA where it belongs. I loved hearing the stories behind it).
So next week, join me as I talk about horses and love and most of all, why I believe it’s so important to honor the SPIRIT in addition to the LETTER of the Ethics Code: You will find “Treat Others with Compassion, Dignity, and Respect” on page 4, but you will not be able to find a specific code number about it. That might make it seem like it’s not as worthy of an ethical goal. However, it’s actually such an important idea that it pervades and breathes life into every single other component of the Code.
More on this during my talk next Friday. If you can, join us. Check out my teaser video here, then check out other folks’. Come for the CEUs and stay for the stories. I can’t wait to see you in the virtual space!
Last time I wrote, I shared some ideas about this intersection. Today, the new course is up! Before you go check it out (and claim your February 2022 coupon for 20% off by typing ASD2022)– during the introductory month of the course)- learn why I’m so passionate about screening for trauma in a population so many behavior analysts have been working with (for some, virtually their entire professional lives).
Have you ever worked with someone in pain? How do we know if they’re currently hurting, whether it’s because they are sick, it’s related to interventions we chose, or from experiences we reminded them of? How would we know if that was the case? Did that person cower, freeze, or grimace? Did they flinch, close their eyes, seem to “zone out”? Perhaps someone has run away, played repetitively with the toys they had, or fallen asleep at school? Sometimes, respondent behaviors may be giveaways that people are experiencing fear or in pain, but successful avoidance behavior can hide that pain. Other times people have been through experiences making them more likely to use aggression or property destruction. In the least, we should consider whether our interventions cause harm. This harm could include causing our clients distress or pain, exposing someone to additional risks, detracting from their quality of life, failing to program in sustainable ways that transfer to the maintaining environment, and so much more.
A new training is up on Cusp.University on the intersection of autism, trauma informed behavior analysis, and ethics. By the time we near the end, we have discussed and revisited the idea of contra-indicated procedures. Given that lists exist for diagnoses of autism alone, why isn’t there a list of best practices appropriate for clientele meeting diagnostic criteria for autism who also come to therapy with trauma histories? Why is it so difficult to find articles suggesting best treatment paths for individuals with both autism and trauma related experiences in the literature? In behavior analysis, answers to these questions may be related to our field, its historical publishing practices, and the ethical and pragmatic need to individualize procedures for each client.
In terms of publishing practices, a panelist in ABAI’s “Exploring Publication Bias in Behavior Analytic Research” (which included Galizio, Travers, and Ringdahl, 2021) stated,
“No intervention is guaranteed to work for every individual, every time, in every context.”
They suggested that authors writing about their research should include more detailed descriptions of the conditions under which successful implementation of the intervention occurred.
When we screen for trauma related or aversive historical situations and stimuli, we often learn things that
help us prioritize treatment,
document risks for certain procedures,
avoid or prioritize certain stimuli,
detect environmental conditions that are acting as motivational operations and conditioned MOs,
and ultimately, perhaps minimize harm to our client.
Screening for trauma can help to identify individuals with prior risk factors who are at risk for experiencing additional adverse events and aversive conditioning. Attendees learn in chapter 1 some facts about how being autistic is to be at increased risk for trauma, bullying, abuse, increased likelihood of experiencing foster care—and in chapter 3, learn about the higher rates of experiencing restraint, seclusion and being excluded from school.
But another effect of screening – one that should affect all behavior analysts—could be an increased awareness of the fact that behavior analytic procedures are being used all the time for this population at the intersection of autism and trauma. Perhaps the least we can do is to begin doing behavior analysis with people instead of to people, and to be transparent, inviting, and open in looking at options—and their likelihood of causing harm either now in the future.
Let’s look at this juxtaposition: we have a great ethical responsibility to do no harm, but also an ability to cause great harm. With using any behavioral procedure there comes a risk that we may do just that. This is especially true when we don’t have literature evidence that a given intervention is appropriate and effective for the person’s needs given their history and current situation. Perhaps they don’t actually need behavior analysis seeking to change their behavior as much as they need a roof, a meal, a bus pass, a blender, a respite provider, a ride to the doctor, a coat, a medication, a trip to the dentist… the list could go on and on. So clearly the first step is to see what the person needs.
When designing an individualized behavior support plan, two things are important to consider:
(1) the risks and benefits for the client themselves, given their needs, values, environment, etc., (e.g., the long- and short-term outcomes of procedures and decisions, and
(2) evidence the procedure is appropriate for our client.
In terms of evidence, when considering decisions in context of the literature, few studies provide sufficient detail in characteristics of the participants. So it is difficult to tell, reminds the panel, which characteristics were present for study participants received successful or unsuccessful interventions. Thus we can’t really tell how many of the massive number of papers on treating behaviors in autism, also apply and were conducted with individuals with autism who also had a trauma background. But statistics suggest many of them must have. In the science of behavior analysis, each subject’s behavior is its own control, so if we control our conditions and try to measure well, we may reveal additional elements of historical and current behavioral environments that exert contextual and stimulus control on the client’s behavior- and that change their needs. At times, historical aversive conditioning experiences may have contributed changes making it painful or inappropriate for clients to experience certain interventions. As we discuss in the new training, some of those conditioning experiences may even have occurred during and as part of behavioral treatment.
We can’t know for sure what our clients have been through. But when owe it to them to honor those experiences if they are comfortable sharing them.
Here are some of the things you’ll learn.
Course Objectives:
1. List connections between autism and trauma in the research
2. State different kinds or examples of trauma that may affect individuals with autism
3. State supportive ways to ask about trauma histories
4. Select examples of how medical history can be related to trauma
5. State examples of repertoires beneficial for practitioners who serve clients affected by both autism and trauma
Ready to learn more? The new training offers hints from Dr. Kolu on how we begin the conversation about informed consent and screening for trauma, why assent is so important, how trauma and autism might intersect with medical needs affecting our clients, and more. And all the resources are available as free content in the preview section, so go grab that now! See you at a conference soon or find us online. And thank you for listening!
These findings are some of the reasons researchers (as well as research-practitioners, including those of us at Cusp Emergence) urge practitioners to adopt screening in order to support the huge group of people affected by both trauma and ASD (see Brenner, Pan and Mazefsky et al. on the need for screening, and special behavioral differences that occur in this population).
ASD and TIBA: Our newest upcoming course on CuspEmergenceUniversity.com
They are also just a few of the things you’ll learn when you take the upcoming course on CuspEmergenceUniversity on trauma and autism (coming Fall 2021). Other topics we cover include:
-client examples from both child and adult populations whose experiences include autism and trauma
-literature references helping practitioners discover more about what trauma related experiences people with autism may face
-how behaviors themselves can be risk factors for additional trauma
-behavior programming examples that may be counterindicated procedures depending on the individual needs of autistic people who faced trauma
-examples of ASD communication needs that have been particularly helpful to target when supporting this population after trauma
-behavioral cusps that can make a huge difference after trauma
-examples of worst case scenarios people face when trauma history is not taken into account for individuals with autism after trauma….
…and much more. We also cover how Cusp Emergence uses the SAFE-T model and Assessment (including our risk versus benefit tools) to be more supportive, mitigate risks unique to autism and trauma, and learn more about the whole person and their needs.
This is the 21st article in a series on Trauma-Informed Behavior Analysis by Dr. Camille Kolu, BCBA-D
I often hear from educators and behavior analysts, “What do you actually do differently if your client has faced trauma, given your role as a behavior analyst?” In this bulleted series we’ll get there, but we’ll start with what I would want you to understand about myself as your client (or teammate!) who has experienced adverse experiences. Here we list 25 different things I want you to know. (As a hint, each thing we can understand about a person could be a bridge, if you choose to walk through this difficult thing to a shared place of understanding on the other side. We’ll explain in more detail in future posts, or you can check out our course library over at CuspEmergenceUniversity if you’re interested in expanding your boundary of competence). But first,if I were your client or team member – if my past involved trauma – I would want you to understand thatnow, with the presence of historical trauma,
I MAY:
have difficulties calming down when under pressure
have difficulties using “appropriate” behaviors even after years of programmed reinforcement for using them
have mental health concerns that have never been appropriately addressed because my behavior masks my needs
find some kinds of social interactions difficult or painful
have trouble controlling some of my bodily functions, but may not be able to describe to you why
experience “triggers” in the environment that you can’t see (but that an experienced provider could locate, document, and learn to help me explore or move with, as appropriate)
experience some times of the day, week, month, or year that are marked by aversive events for me that you won’t know about
may not be able to explain WHY this time is difficult or why I am using an “old pattern of behavior”
find it more difficult to perform, or to learn and remember new things than others of my age, skill level, or occupation – even if “on a good day” I can do this just fine. (By the way, have you read The Four Agreements? Do you know how important it is to take nothing personally and know that others are doing their best (and how critical it is for you to do the same)? If not go check it out.
use occasional behavior that is mistaken as “ADHD” or “ODD”, or more, but that is actually related to how I was mistreated
have been given misdiagnoses, treatments that didn’t work, or medications that made my problems worse or that interacted with each other in harmful ways that hurt my body and cognitive function
attempt to advocate but get ignored when I try to communicate pain, mistreatment, or a medical concern
be more likely to experience FUTURE trauma because of what I faced before
lack a reinforcing and useful repertoire (e.g., full complement of skills and things to enjoy), especially if I faced treatments that just tried to “teach me a replacement behavior” for a few challenging things I did, instead of understand and grow me as a person in the context of my own community, needs and desires for my future
be part of a long line of marginalized people or one of multiple generations exposed to trauma
have a chance to change our lineage… if you help
After all, I AM:
a human being with interests, feelings, and great potential for growth and joy
more likely to experience certain risks (I may be at greater risk of losing my educational or therapeutic setting, go through harmful discipline practices, be exposed to law enforcement interaction, for example)
in need of understanding, an informed supervisor and system of support, and someone who will document my challenges so we can work on them, but not emphasize them so much they ignore my strengths, needs and skills
capable of much more on my best day than I show on a hard day… but I am always doing “my best” at the time, given what I have been through and what I AM going through, and despite what it looks like
Taking these points as a starting place, future posts in this series explore what I NEED as a person who may have faced these things, and what I DO as a behavior analyst who cares. We’ll also share some of what I need from my supervisors or systems administrators! What would you add to this list? What are some of your action items?
It’s finally here! We have learned so much from workshop attendees, trainees and supervisees in this area over the past several years, and appreciate the attendance, feedback and support of everyone who has taken the training or used a version of the SAFE-T Assessment. Coming on Monday, the booklet and training for assessing trauma-related factors affecting our clients of behavioral services, are available ONLINE as a self-paced course. This course provides a download of the new and expanded SAFE-T Checklist booklet, which contains several tools enabling the screening and documentation of over 200 trauma-related factors, and a Risks and Needs form to help teams understand (and document) how these factors confer risks (and converge in risk factors that must be solved or mitigated to protect our clients, teams, and ourselves). The booklet contains an extensive reference section and team supportive tools as you use your new knowledge to better align your team’s skillset with the Ethics Code, and the individualized needs of behavior services clients after trauma.
Severalof our behavior analytic and collaborator clients across institutions, educational facilities and private companies clients have shared that learning to assess risk factors related to trauma, and to apply this information to their teams’ FBAs and risk mitigation plans, took their skillset to the next level – essentially affording them an opportunity to acquire an important behavioral cusp for their teams.
Some new components of the booklet include:
An optional buffer/ resilience score to assess whether protective environmental and therapeutic components of a client’s plan are in place (to understand some ways that trauma gives rise to medical and behavioral challenges and some buffering factors that can help, please see the book or scholarly articles by Dr. Nadine Burke Harris (e.g., Oh D.L. et al. 2018), who is the Presidential Scholar for 2021’s upcoming Association for Behavior Analysis International’s conference. She will address the critical topic of breaking the intergenerational cycle of adversity, and screening for ACES (adverse childhood experiences).
Information about over 50 risk clusters (groups of related risks in the 6 assessed sections of the SAFE-T Assessment)
Cross-reference tables showing, for each item we screen for, the location(s) in the SAFE-T Checklist
Infographic on components of a trauma-informed FBA
Brief templates for Risk Versus Benefit Analysis and Risk Mitigation Planning
The IPASS (Inventory of Potential Aversive Stimuli and Setting Events) tool and instructions
References (organized by topics) covering over 40 areas or topics of literature related to trauma (including relationships of ACES to medical problems, ACT and intellectual disability, ACT and anxiety, foster care and adoption, the relationship of abuse to pain, drug use and trauma, and much more).
Time required: The course includes about 4.5 hours of video content in 12 lessons, each followed by a brief quiz.
Cusp Emergence 
