Part 1: Trauma-informed Behavior Analysis: Beyond the immediate “function”
(Also see Part 2 coming later this week, on Engineering Supportive Environments)
What is trauma-informed care? Should we provide it as behavior analysts?
For any given behavior analyst, perhaps we already think of a good functional behavior assessment as “trauma-informed”. This is because a comprehensive assessment would necessarily take into account the kinds of information that makes an assessment or treatment trauma-informed.
For example, an assessment is required to take into account someone’s history before treatment recommendations are made. But how much history do we review? What are the guidelines for what to consider? When, and how consistently, are these guidelines followed?
How much history is enough?
Some assessors (or agencies) write only a few lines or a paragraph about “previous history” or “previous treatments” without fully understanding their impact, or learning more about what happened and how it contributed to current functioning. This may happen because there is not funding or hours available to look into these variables. In some cases it occurs because the records are not available to the agency conducting the assessment. This is frequent in a case in which much of the client’s family history is unknown, or when a school psychologist or behavior specialist is doing a behavioral assessment for educational purposes but doesn’t have access to (or time to find) the information.
What happens when we don’t consider history?
Shallow assessments lead to shallow treatments. Ill-informed assessments give rise to environments that are ill-prepared to support a client’s growth or improvement, and educators and caregivers who are not expecting the massive behavior challenges that can erupt seemingly out of “nowhere” when a client faces a trigger that would have been predictable.
Example 1: a client who was left alone and experienced childhood trauma in dark environments, is now being punished when she acts out during the night-time. She is being given routine encounters with safety control officers who hold her down physically and force her to take medications when she becomes agitated, then self-abusive, then aggressive, overnight. She lives in an institution where she has little control over her world, but it’s not the appropriate environment. Her “inappropriate behaviors” often lead to repeated exposure to the things that make it harder for her to practice the skills needed in order to get better.
Example 2: a client who was abused and neglected at age two is now being recommended “planned ignoring” by well-meaning caregivers and teachers who asked for help from a behavior specialist at preschool who identified “attention” as the “function of behavior”.
Beyond immediate function
The two clients above are 30 years apart in age, but both are experiencing trauma on a daily basis by the caregivers who have begged for help. A better way is engineering a behavioral environment rich with preventative interactions; we could call this trauma-informed behavior analysis, if we wanted to use the T-word. We could also simply call it behavior analysis, making sure our approach includes arranging the behavioral environment in a preventative way, and constructing preventative repertoires for both caregivers and clients. When we have preventative and responsive interactions ready to go, based on what was needed in the past, we can engineer a path toward a brighter future. But we cannot do that if we look only at immediate function of behavior without considering the context in which it occurs.
For behavior analysts, see Journal of Applied Behavior Analysis results for functional behavior assessment, or find the JABA archive here.
Or check out our previous post on trainings available to supervisors who conduct support of these vulnerable populations!
Coming later this week, see Part 2: Engineering Supportive Behavioral Environments. Future posts also review some operational definitions of what others think of as “trauma”, breaking down “preventative schedules”, and more. Stay tuned!