What does a horse story have to do with ethical practice of behavior analysis in trauma prevention? Find out at Stone Soup 2022

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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!

New 4h course: Autism, TIBA and Ethics

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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!

Get ready to learn about ASD and trauma

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By Dr. Camille Kolu, Ph.D., BCBA-D

Behavior analysts who treat people with autism probably know that ASD often co-occurs with trauma. But did you know that up to 50 percent or more of people with autism may have experienced trauma, that ASD itself is a risk factor for experiencing trauma, or that children with autism may be around 2.5 times more likely to experience foster care, itself another risk factor for trauma?

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.

Just can’t wait for the CEU course on autism and trauma to be posted in the coming months? Tune in to The Autism Helper’s podcast. Dr. Kolu’s interview with Sasha Long, BCBA is live and we’re excited to share it with you!

25 Things I Want You to Know: Ways I use trauma to inform my practice of behavior analysis

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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 that now, 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
  • have medical problems that are going unaddressed because my providers have never asked me about my trauma history, despite it being a fact that it confers serious medical risks. (See the incomparable Nadine Burke Harris talk about her work on this, and the amazing takeaways, in her classic TED Talk– or see some of her research and outcomes on using screening tools)
  • be more likely to use certain “challenging behaviors”
  • and find it more reinforcing, even important, to use behaviors you would describe as challenging
  • use behaviors that are more resistant to change than you are used to as an instructor, therapist, parent, supervisor or friend
  • find certain interventions painful, difficult, or harmful
  • 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?

Self-paced SAFE-T Assessment Training is here!

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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.

Several of 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).
  • Table of potentially contraindicated procedures (cross referenced with items and risk clusters assessed in the Risks and Needs form)
  • 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.

Price (includes 4.5 CEU course and SAFE-T Assessment booklet download): $189.99

For $20 off through the end of February, use the coupon code “SAFET20”.

To register: cusp.university

Contraindicated behavioral procedures after trauma

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This is the 20th article in a series on Trauma-Informed Behavior Analysis by Dr. Camille Kolu, BCBA-D

In medicine, contraindicated procedures are those that are withheld due to the potential harm they might cause to a patient. More and more, behavior analysts are interested in learning about someone’s history, in part to lessen the risk they will do a client harm.

We are tasked, ethically, to do no harm (and see the BACB Ethical and Professional Code item 4.02); to evaluate potential risks and side effects of interventions and to weigh the possible benefits of each (see 2.09 and 4.05); and to avoid using harmful reinforcers or those that require excessive motivating operations to be effective (4.10).  For RBTs as well as those certified at higher levels, ethics obligates us to protect our clients from harm (see RBT Ethics Code section 2.02).

In our live webinars (please see CuspEmergenceUniversity.com where we list topics we train frequently on– any course you see there is available as a live webinar training or, in some cases, available as an on-demand training), we receive frequent questions like this:

What kind of procedures should be avoided when working with a new client after certain types of trauma? Are there certain procedures we should give more thought to after a client has been through challenges we know about? What do we do if so?

Given these wonderful questions, today’s post shares a few basic procedures that may be contraindicated – at least at first—given a specific combination of historical factors involving trauma.

Of course, it’s not black and white. Often this should just be the first step for the team, a conversation in which people consider potential for risk conferred by historical variables. The team can then make a more careful decision in order to mitigate possible risks and maximize the benefit of any procedures selected, along the lines of what our code suggests in item 4.05. Though each procedure below is potentially contraindicated at first, it could be appropriate later in treatment, or perhaps from the beginning- the point is that this should depend on an individualized risk versus benefit analysis of the other options available to the team, the client’s history and needs, the severity of the past abuse or neglect or trauma, etc.

  1. For a client who has experienced previous food insecurity, food related abuse or neglect, and/or severe food deprivation:

One potentially contraindicated procedure is using edible reinforcers.

Notes: Here there are risks to the client, and also potential risks to the client’s relationship with their caregivers and team members. The conditions necessary to establish the motivating operation for reinforcement may be similar to previously neglectful or abusive conditions, or may act as conditioned motivating operations that make harmful behaviors temporarily more likely. In our history treating clients after these circumstances, we have also experienced something related to behavioral contrast in this situation. For example, a client who was provided edible reinforcement in their new applied behavior analysis setting then went home and used dangerous and surprising behaviors related to their neglectful history. The client’s foster family was caught off-guard by these new behaviors, but they could have been predicted during team education on how edible reinforcers might need to be avoided at first when conditioning new team members as reinforcing (and as instruction-related discriminative stimuli).  

2. For a client who has been involved in previous sexual abuse (including when the client also makes allegations):

One contraindicated procedure is assigning a 1:1 without additional oversight.

Notes: Here there are risks to both the client and additional team members. When the team receives this case, it would be contraindicated to immediately assign 1:1 support without preventative measures such as training for the 1:1 and supplemental recording, additional oversight or whatever is deemed necessary.

3. For a client who has experienced medical complications from sexual or physical trauma (e.g., this could include incontinence, fecal smearing or related concerns, etc):

One contraindicated procedure is conducting toilet training without oversight from a medical professional, additional training or consultation by someone with expertise in this circumstance, etc.

Notes: In this situation, respondent and operant interactions can occur that are dangerous to treat without expertise; the client can risk serious complications and worsening medical problems; there is a risk of further conditioning the experiences of voiding (and related rituals) as aversive; there is a risk of occasioning behaviors related to the past abuse, or pairing aversive events with team members involved in the procedures; and more.

4. For a client who has experienced previous neglect or adverse circumstances (such as deaths of parents, removal from unsafe conditions, or experiencing war, dangerous immigration or poverty related issues), resulting in deprivation of basic needs and social interaction:   

Some potentially contraindicated procedures involve attention related extinction, differential reinforcement of appropriate versus inappropriate requests, or time out from attention reinforcement.

Notes: In this situation, there are safer procedures to begin using that could avoid some of the harmful side effects of removing attention contingent on unsafe behavior. A child with a serious history of neglect may have used behaviors that can seem bizarre or out of context for typical child development, but that were critical to the child’s survival. At the same time, it may not be appropriate to pair new team members with procedures that were used in the child’s neglect, even if the “intent” is different. There are many procedures that can be used more safely, such as using enriched environments and fixed time schedules, to provide monitoring, insure high levels of safe attention, and begin to condition adults as neutral stimuli again, if needed, after harmful interactions with adults in the person’s past.

5. For a client who has been affected by physical and/or sexual abuse, behaviors and circumstances consistent with reactive attachment disorder, or multiple and changing caregivers in childhood:

One potentially contraindicated procedure might be contingent praise statements to establish compliance related behaviors.

Notes: In this situation, a client may have had a history in which adults could not be trusted, behaved inconsistently or inappropriately, or paired unsafe and harmful actions with typical caregiving behaviors. Clients who experienced this may initially present as lacking “a compliance repertoire”, but it may be contraindicated to attempt to establish and praise compliance, for several reasons. Some may be overly compliant, and lack self-help and self-advocacy repertoires that are critical to autonomy; if they are still going home at night after the school day to an unstable situation or multiple foster homes, to praise rigid compliance may increase the risk of further victimization or contribute to future abuse. At the same time, initial praise for compliance may damage relationships between the client and new caregivers who have not “earned” the right to praise the client’s behavior by establishing a history of consistency and helpful interactions. Furthermore, praise might already be conditioned as aversive for the client and could sabotage the caregiver’s attempts to establish a relationship or instruct appropriate behavior. (CuspEmergence.com has written elsewhere about praise here).

6. For a client who has been affected by neglect, and involved with law enforcement, suspensions and challenging behavior:

A potentially contraindicated procedure is least to most punishment.

Notes: Implementing punitive procedures (or procedures that educators assume to be aversive and are using to control behavior) in a “least-to-most” order is dangerous, especially after the interactions mentioned here. Any time punishment is implemented in a LTM order, we risk these outcomes: conditioning the aversive stimuli becoming more reinforcing, and more familiar; worsening the client’s behavior as they need to contact more and more of the supposedly aversive stimulus; pairing the people administering the punishment with aversive control, making it more likely the client will (to speak loosely) act out more and more for their high-quality attention; etc. (CuspEmergence.com has written about the potential pipeline from special education to prison here, in an article referencing some of these concerns and containing behavior analytic references.)

7. For a client with symptoms or diagnosis of trauma-related disorders or needs:

A potentially contraindicated thing to do is recommending or implementing applied behavior analysis without any mental health or trauma-focused treatment or input.

Notes: Behavior analysis (at least the kind I provide and teach about) is not a trauma treatment. We are also not a source of diagnosis for trauma. Instead, I work in a complementary way with a team and/or family that is interested in learning about risks related to trauma history, and how these risks affect the person’s behavior, needs, and supports. There are therapies that can provide trauma-focused treatment and aid a person to heal after experiencing difficult circumstances; a person may need these in addition to, or before, receiving behavior analysis to aid them in developing a safe, expanded behavioral repertoire. If someone trusts you with their trauma history, please be careful and supportive.

In closing, for a client with a specific conditioning history, the contraindicated procedure would likely involve aversive conditions and potentially medical or biological variables. Always consider items 3.02 and 4.08 from our Professional and Ethical Code, and discuss whether they apply to your case:

3.02 Medical Consultation. Behavior analysts recommend seeking a medical consultation if there is any reasonable possibility that a referred behavior is influenced by medical or biological variables.

4.08 (d): Behavior analysts ensure that aversive procedures are accompanied by an increased level of training, supervision, and oversight. Behavior analysts must evaluate the effectiveness of aversive procedures in a timely manner and modify the behavior-change program if it is ineffective. Behavior analysts always include a plan to discontinue the use of aversive procedures when no longer needed.”

Upcoming: Brief webinar series on TIBA in partnership with Connections-Behavior.com

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Now that the annual conference for ABAInternational is past (whew!), Cusp Emergence is excited about upcoming webinars and online conferences (New Hampshire and FABA, I’m looking at you!). First up is a partnership with Connections-Behavior.com: We will look at trauma-informed behavior analysis in two parts, on June 1 and 15. Register here for this CEU opportunity!

3 Simple Ideas: Teachers Check In on Families Staying Home

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Today as I online and supervised a special education teacher via a Zoom chat, we talked about her ideas and mine for teachers supporting special needs students and their families from behind our computer screens right now.

Note that she is doing a LOT. Families are doing a lot. And many teachers have families too and we’re all a bit swamped. Most of us are trying to practice grace- both giving it and operating from a place of grace ourselves, being easy on ourselves when we don’t finish everything… but it’s still hard. So here are 3 easy ideas that might make a difference. If you’ve done them, GREAT. Just move on. 😊 If you haven’t, it can’t hurt. If you have young children at home you can ask your kid’s teacher for a little guidance on the first 2 and they’ll probably be happy to help you out.

  1. Arrange the environment to help students understand what’s going on. Number 1 is to give parents guidance on “arranging the environment”. Something teachers do before school starts is to arrange the classroom. Ever notice that when you walk in your student’s room, that there are usually separate little areas? There’s an area for work, and it’s where your child learns to sit down and do learning activities. Maybe there’s a little table and chair there, and some baskets for papers or materials. Then there’s an area for breaks, which you can usually notice by its comfortable chair or bean bag or rug, and perhaps some books or games that are just for fun times. If you’re a teacher working with kids at home, ask families if there is a designated area for work, and one for play. Give families some suggestions that are easy and similar to what you do in your classroom. It’s easy but it can go a long way toward normalcy, helping students get ready to do their work, and helping caregivers and parents help their kids get in to the new routine.
  2. Send home important visuals, or give a really quick tutorial on how to create one.  I’ve been surprised by how sometimes therapists and teachers forget that they always have a certain thing on the table that reminds students how to sit, listen, or be a part of the classroom. Maybe you feel it’s not that important at home, or that it’s just more work. But students really thrive when you help their learning behaviors to “generalize”… by putting things in the environment at HOME that they are used to seeing at school. If your school has a simple visual schedule or job aid that reminds students what to do with their eyes, hands, body and mouth while it’s “time to work”, send it home. Parents can even draw one with markers or crayons if they don’t have a printer. Now’s not the time to get too fancy or require too much. In behavior analysis we might call this “programming common stimuli”, when we use a helpful reminder across environments. But it’s just a super simple tool you have that you can give parents during your check-in or start-up session.
  3. Do a check-in with parents/caregivers every time you see the family. Some teachers are having groups with students, which is amazing. You may also be doing quick individual check-ins. A few days ago I wrote about how child abuse and neglect are escalating right now, as families are facing increasing pressures and hardships from all sides, and the typical “reporters” are not seeing the kids in person to make social services calls. (It’s a great time to learn more about what your school can do to help teachers develop a process for this). One simple idea is to have a quick script you go through every time you make contact with a caregiver, especially one of a family you know is always at risk. Put THREE THINGS by your computer: First, put the script by your computer. Second, put a simple datasheet there beside it. (A simple datasheet might include the list of families you contact, dates you ran through the script, and star any families you need to follow up on based on the outcomes of the script. Then when a family answers a question that needs follow up, you can share referrals or make a call to connect them to a resource). Third, put a list of resources and phone numbers related to the script questions. These might need individualization based on your area, but here are some ideas.

Example of using the check-in idea:

Margot is a teacher of special needs kids in elementary school. She writes a script with questions like this: “How are you doing? … What is most concerning to you right now? … Do you have at least one way that you can get a break when you need it? … Are you worried about where you might get food? … Are you feeling ok emotionally or do you need someone to talk to? …  Is there anything your child is doing that you think needs a follow up phone call? …. Is everyone in your family safe right now?”  

Then Margot shared the script with her team and each teacher and paraeducator was assigned one family per day to check in on. The team brainstormed and wrote a list of important phone numbers and websites in the event that a family indicates they need basic assistance like food; they are feeling extra stressed and need a mental health support check-in with a teletherapist; or someone in the household is hurting them and they need to make a phone call to a domestic abuse hotline.

Finally, the team distributed a quick reference sheet with the script on top, a log in the middle, and resources (phone numbers and websites) on the bottom. Each team member recorded the results of their check-ins in case follow up was necessary to help a family they checked on.

That’s it. You can see an example Check-In and Follow Up Log sheet below. Let me know your own ideas and thank you for all your hard work! And just email me if you’d like to obtain an editable version of the sheet.

Homebound and Vulnerable: What will you do to prevent abuse and neglect?

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This is the 19th article in a series on Trauma-Informed Behavior Analysis by Dr. Camille Kolu, BCBA-D. Start by becoming informed; then please read to the end if you’re interested in taking steps with your organization to support therapists and teachers to continue to fulfill their roles as mandatory reporters.

Child abuse, elder abuse, domestic violence, and abuse of people with intellectual disabilities is going on all around you. It may have just become simultaneously more prevalent, invisible, and insidious.

For example, in some areas, there has been a marked decrease in calls to the hotlines that typically lead to welfare checks for vulnerable people in their homes to insure that families have resources they need, children are not being abused or neglected, and appropriate actions can be taken if they are. (See this story from Colorado reporting a drop in calls the 9th and 10th of March as schools began to close).

Across the nation, different states are reporting similar decreases in calls but also a spike in the number of serious child abuse hospitalizations and even deaths.

Reasons for this disturbing increase are numerous. Little annoyances become big ones when there is no possibility of a break and both mental health (e.g., patience) and physical (e.g., food and sleep) resources are running thin. Even a normal battle on whether your kid will eat the peanut butter sandwich becomes a crisis when you’re trying to feed several people a balanced diet with whatever dwindling foodstuff you still have in the cabinet, while money (and outside trips) become scarce.

For many families, the struggle is not only real but getting uglier by the day, by each hour the kids are home from school.

There is conflicting advice, some of it really unhelpful, yet most of it well-intentioned. (I read a recent article about how we should just give in and let kids watch endless videos during this unprecedented time; but for many children, a huge increase in access to media may be accompanied by major behavior challenges (and even injurious and aggressive behavior) when parents try to have them turn it off for meals or bed. Research shows increased screen time can cause impulsivity, hyperactivity, and inattentiveness,

all of which are even more difficult to deal with when you’re cooped up. Of course, you need solutions, and the quick fix is even more appealing right now.

And there are major barriers to resources. Some have said this crisis is leveling the playing field, but really, it’s revealing discrepancies.  

Being quarantined at home doesn’t hurt that much when there’s plenty of food, you already know how to navigate technology to work from a home office, and there is room and time to get away from housemates or family members for a little while.

Being at home with other people who normally require 7 to 9 hours of behavior support and school-provided structure, let alone meals, while you work to make ends meet—that is another story altogether.

So there are the struggles to which we can all relate, and then there is the reality of jumping into these struggles with no help, no end in sight: There is the reality of suddenly not being able to be by oneself for even a minute, and not knowing when it will end; there are children whining or crying (or hurting themselves while other things need their caregiver’s attention; there is behavior, so much behavior, that a parent doesn’t know how to handle and is made worse by a lack of structure, suddenly upended routines, and for some, the complete loss of safety figures.  At the same time, there are abusive people who are now alone with their victims for the next few weeks.

Maintaining a safe environment for a child depends on several behavioral and environmental factors. Right now, those factors are not all present. Instead, we have

-Caregiver behaviors that are really important to keep people safe, but may not be FLUENT (such as giving effective instructions to a child, creating a schedule for several people, or responding to unsafe behavior that you usually don’t have to respond to)

-Caregivers that may physically present, but not AVAILABLE (e.g., an adult who can provide continuous, adequate supervision to every single member of the household who needs it)

-The presence of new circumstances creating unsafe environments (such as having 3 children with special needs home at the same time, for hours and days on end, and without the things (therapies, bus drivers, respite workers, social outings and educational time) that typically provide structure and relief)

-The additional presence of huge stressors (the unending flow of news about the virus; the dwindling of food and resources; the loss of jobs)

-Competing, sometimes incompatible, needs (like people home from work who need quiet to make money but who also have to provide constant caregiving and supervision; or people who have intellectual and other disabilities and are without their scheduled programs, events, therapies, social opportunities)  

-Therapists and teachers who are working from home or not at all, but who normally document and relay evidence that a child or adult may be being abused, mistreated or neglected

These factors and more combine to produce

-The occasion for more abuse or neglect to occur

-Decreased opportunities for abuse to be reported

-Emotional and physical needs that may make the outcomes of a child being quiet or following directions suddenly much more important or reinforcing, whatever the cost

So, my therapist, day program provider, and educational staff friends- how will you add and document safety checks for all your clients on a reliable schedule to take the place of “having eyes on” the client in your clinic, their home, or your school or program?

There are no hard and fast answers. For instance, some behavior analysts are out of work; could they be repurposed to providing online support of families with children at home? Having eyes on the family is good, but it’s also introducing a risk that we will give advice that we don’t have an assessment to back up, or that is not fully safe to implement. And while I’d like to share ideas for behavior analysts to incorporate safety checks of your clients virtually, it’s most important for me to encourage you to reach out, right now, to your organization—and ask for your TEAM’S plan to do that. This is because different states and areas have different guidelines and requirements for you to follow depending on your local recommendations for HOW you monitor and report unsafe situations. You need to do it, but you should follow your local guidelines and state laws.

  1. Recommit to your role as a mandatory reporter for individuals with disabilities, the elderly, or children, if you are a therapist, teacher, etc.
  2. ACT as an employee: If you work for an organization, act by asking your company what their contingency plan is for all employees to fulfill this role given our emergency situation, and how you can help.
  3. ACT as an employer: If you own or lead an organization, stop right now and generate a brief plan for how you’ll support your team to fulfill their roles as mandatory reporters. Here are some ideas:
    • Write up a plan and email it out. Bonus points if you schedule an online meeting right away to disseminate it and give examples and encouragement.
    • Assign everyone a recommended frequency to make check-ins that specifically deal with the client’s physical well-being and mental health.
    • Give the team an example for what questions they can ask, and what they should avoid (if needed) to maintain everyone’s safety in the home they are looking at.
    • Tell employees to document the outcome of their checks (e.g., if they notice things that typically would indicate possible abuse or neglect; or if they notice something might be wrong that warrants another check-in from a supervisor on your team; if calls are made to CPS or APS)
    • Reinforce and encourage the behavior of employees who follow the plan, including having social support carved out for them so they don’t have to go it alone.

Telehealth provision is already a new skillset for some employees, including teachers, and if they are suddenly without any social support when they used to be able to walk down the hall to the counselor, administrator or psychologist on site, they may freeze and wait when action is important. It’s your job to make the unfamiliar but correct action as easy and supported as possible.

And here’s a notice: Social services haven’t closed down. In Colorado, not only are they still making visits, they are hiring. Hotlines are available and staffed with trained professionals to take your call.

Resources: Read guidance from the Behavior Analysis Certification Board on ethics, safety and more related to Covid-19.

Here’s more on how a few states are monitoring this issue.

Colorado:

Call 1-844-CO-4-KIDS if you suspect abuse or neglect

https://www.coloradocac.org/

For birth to 3 receiving services: http://coloradoofficeofearlychildhood.force.com/eicolorado/EI_QuickLinks?p=Home&s=EI-CO-Response-to-COVID-19&lang=en

Ohio: https://www.cleveland.com/court-justice/2020/03/staying-at-home-amid-the-global-coronavirus-pandemic-creates-new-dangers-for-victims-of-domestic-violence-and-abuse-experts-say.html

And in Texas, use this info:

https://www.allianceforchildren.org/

If you suspect a child is being abused or neglected, please contact the Texas Department of Family and Protective Services toll free at 1-800-252-5400, 24 hours a day, 7 days a week.

You may also file a report using the secure TDFPS website. Reports made through this website take up to 24 hours to process.

The Texas Abuse Hotline is 1-800-252-5400.

Connecting Behavior Analysis, Aging, Trauma, and Supervision

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Behavior Analysis, Aging, Trauma, and Supervision (or BATS, in honor of Dr. Janet Ellis).

This is the 18th article in a series on Trauma-Informed Behavior Analysis by Dr. Camille Kolu, BCBA-D. It includes something new that we have been asked about: Companion notes for students and supervisees working through this information with the support of their supervisor.

I heard Jon Baker give a great talk on advances in behavioral treatment of gerontology the other day at COABA. It made me think of my students at the University of Colorado Denver and our supervisees. (There was also a fantastic talk on supervision and feedback by the incomparable Ellie Kazemi, whose book on supervision is out now). When they ask about clients other than autism who have benefited from applied behavior analysis, my supervisees are usually excited to read stories in which ABA changed the lives of people with dementia, brain injury, medical needs, and more. For example, an article from Baker (2006) Continue reading