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Between 1990 and 2018, countries spent between 2.67% (Europe) and 3.6% (USA) of their GDP to treat harmful behavioral, medical and other effects of trauma (Bellis et al., 2019). Evidence shows that several medical areas are impacted by ACES (adverse childhood experiences; see Nadine Burke Harris’ incredible TED Talk on ACES). These harms increase in a dose-dependent way, with higher number of ACES related to greater risk of medical harms (Anda et al., 2008). Some of the medical harms that are increased after trauma include an increased likelihood of disease in adulthood (particularly obstructive pulmonary disease; ischemic heart disease; and autoimmune disease); greater number of infections; dental problems; asthma; sleep disturbances; and pain and gynocological disorders (Koita et al. 2018; Anda et al., 2008; Dong et al., 2004; Dube et al., 2009; Wyman et al., 2007; Lanier et al. 2010; Bright et al. 2015; Paras et al., 2009; Reissing et al., 2003).  

A small solution that goes a long way

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).

Image shows 6 buffer areas with an icon for each, including a lungs icon for mindfulness, an apple icon for nutrition, a bed icon for getting enough sleep, a heart for mental health care, two adults for having a safe relationship, and a picture of a person exercising. The text says "Be a buffer. Solve a barrier".

Install buffers, solve barriers

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.