(Continued from Part 1 of Trauma-informed behavior analysis series by Dr. Teresa Camille Kolu, Ph.D., BCBA-D)
Part 2, Engineering Supportive Environments
On arranging the environment
What does it mean to arrange the environment in a preventative way? This means to think about everything someone needs, and how they get it or communicate that they need it. After we consider this piece, we see holes in the behavioral environment.
If these holes go unfilled, the person will likely do whatever they need to do to fill them, often in a way that is ultimately unproductive and painful for themselves or others.
In a way, everyone is doing the best they can, all the time.
So in considering what someone needs in advance, we can find ways to plug in something helpful where it is needed, in a preventative way. This means that before someone needs something, an observant caregiver or friend may recognize the need is coming, and begin to set up the surroundings so that need is being filled. Before someone falls in the well, we fill up the well with concrete and make it so that they cannot fall in — even if they step right on top of it. For example 1 in Part 1, the client who was left alone in the dark is given preventative repertoire building, and taught skills that help her to cope each night with the coming darkness. Her caregivers are taught new repertoires, learning to announce their presence and ask her permission before entering; to problem solve with her instead of forcing the next event on her; and to check in in a preventative way to see if she needs anything, instead of responding with force when something is already going wrong. Eventually, she learns to ask for help before it gets to a crisis, to soothe herself to sleep instead of showing agitation leading to support going to bed, and to problem solve by herself when about to face a known triggering event.
For example 2 referenced in Part 1 of this article, the client who was abused and neglected at age two is provided preventative caregiving interactions (check-ins from a teacher or foster parent). It is important to do this more frequently than he used to “act out”. He is given some tasks to do on a child appropriate schedule, and there is interaction and problem solving after he does his tasks (instead of attention and a principal’s visit after he is discovered off-task, in the corner, using self abuse or hurting another child). When he is in a crisis and is “melting down”, he is not ignored until he is calm, but given cues that help him remember how he practiced “calming himself”. This step may be a little different than the typical way of approaching his “challenging behavior” in considering only its immediate function. Instead of using calming strategies only when he is upset, his team involves him in regular practice throughout the day (even on a “good” day) to practice soothing himself and solving problems.
Fostering better and deeper collaboration
Everyone who plays a key role in the client’s life (the client, their safety officers, social workers, CASA team, child and family advocates, mental health workers, occupational, speech, and family therapists, educators, caregivers, biological and other family members, and behavior analysts) can benefit from a shared approach that is both trauma-informed and behaviorally supportive. Whether the client is a grandparent, parent, child or adult, neither of these approaches (e.g., trauma-informed care and behavioral support) would be as effective, or have a chance of success, without the other. We can use shared language, learn about each other’s values and goals, educate each other on our recommended practices and why we use them, make a collaboration plan, and meet regularly giving feedback to each other. We will all need to use the skills of arranging a preventative environment, together with listing and teaching the skills needed in the repertoires of the client and their surrounding audience (e.g., the people who listen when they share their needs, and who provide input to goals and skills that are needed to meet these needs).
When people have been through a lot, it’s hard to get back on track. We can start by engineering the environment in advance to support the change, and by teaching each party to use appropriate supportive skills. Dr. Kolu helps people to do this through her private practice and trainings, such as the team- or client-individualized SAFE-T training for supervisors to learn how to conduct more supportive supervision in difficult cases. And the skill of engineering a preventative and supportive behavioral environment can be an important cusp for a behavior analyst.
As always, the discussion in this blog is not a substitute for behavior analytic assessment or treatment recommendations and should be used only as a resource to learn more. Ask a BCBA (Board Certified Behavior Analyst) for help, or find one in your area by going to www.bacb.com and clicking on ‘Find/Contact Certificants’.
References and follow up:
If you’re a behavior analyst reading this blog, you might be thinking that this idea of “preventative schedules” sounds similar to the use of NCR, or noncontingent reinforcement, on reducing challenging behavior. Yes, although I use the term “preventative schedule” to connect with the caregivers, hospital staff and psych nurses, the literature term is NCR (effective for reduction of challenging behavior; see this meta-analysis recently published in the Journal of Behavior Analysis).
Finally, behavior analyst working with differential reinforcement of alternative behaviors, you may enjoy this article on using differential reinforcement without extinction. Pay attention to the sections on other variables that can make reinforcement of alternative behavior more effective.
By the way, I used the term “behavioral environment” in this article: I think of the “behavioral environment” as anything in the environment that can affect my behavior, including the people and things around me that I can see, hear and touch.
Thanks for reading! Let us know if you’d like to chat about these studies, ideas, or your own experiences.