Category Archives: adults

Part 12 in Trauma-Informed Behavior Analysis: What’s behavioral about treating reactive attachment disorder?

26 Monday Feb 2018

Posted by in adults, Behavior Analysis, behavior cusp, Behavioral Cusp, children, collaboration, Community, Education, ethics, RAD, reactive attachment disorder, risk assessment, supervision, trauma, trauma-informed behavior analysis, Uncategorized

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(Part 12 of a series of posts about Trauma-informed behavior analysis by Dr. Teresa Camille Kolu, Ph.D., BCBA-D)

If you’re a behavior analyst, perhaps you read that title as “Is it behavioral to treat reactive attachment?” or “is it appropriate to use behavior analysis with a person who has been diagnosed with reactive attachment?” Perhaps you are really wondering, “is there anything I can do as a behavior analyst to help someone who has been affected by reactive attachment disorder?”

These are all good questions. First, to pose the problem another way, and to see the depth of the controversy, let’s go over some other observations I’ve heard, from mental health therapists to educators to families to BCBA’s: “Behavior analysts shouldn’t mess with reactive attachment.” “Kids with reactive attachment disorder don’t respond to behavior analysis.” “Families (or educators) whose children (or students) are suffering after reactive attachment related diagnoses can be harmed by or mistreated if people use reactive attachment.” “Reactive attachment is not a behavioral term and shouldn’t be treated with ABA.”

Now if you’re a longtime blog reader, you’ll find other ways of addressing these questions elsewhere on this blog. (I especially like talking to educators, family members and staff about what to do when praise doesn’t work, reminding us all that behavior is INDIVIDUAL, trauma-informed behavior analysis might look VERY different than that old discrete trial program you saw in college, and behavior analysis is not one cookie-cutter bag of tricks.) But I continue to hear questions about it, especially from educators, family members, and hospital and day program professionals faced with supporting the “toughest” cases. Continue reading →

Part 11 in Trauma-Informed Behavior Analysis: Very early learning relates to behavior much later (see end of post for several references)

02 Monday Oct 2017

Posted by in acquisition, adults, Behavior Analysis, behavior cusp, Behavioral Cusp, children, Education, ethics, extinction, learning, teaching behavior analysis, teaching ethics, trauma, Uncategorized, variability

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Trigger warning: This topic is disturbing and sensitive, yet I wish more behavior analysts applied their science to this ugly real world problem.  Let’s face the hard thing together, by discussing some effects of initial learning on later behavior and learning. Several references are below for this topic: How acquisition predicts extinction; variability during acquisition and extinction. This article is Part 11 in a series on how behavior analysts can grow towards supporting children and adults affected by trauma, by Dr. Camille Kolu, Ph.D., BCBA-D.

Severely aversive experiences affect us for a long time. And acquisition can predict what someone’s behavior will look like during extinction (or how behavior will depend on original learning even long after those variables are “gone”). A BCBA recently asked me for references on this topic during SAFET logo letters onlya training I provided to an autism agency on how to provide safer and more appropriate supports for individuals affected by events we characterize as “traumatic”. Thank you to the BCBA for the excellent question!

At first try, we might have a hard time finding references and resources showing how a young child’s traumatic history leads to bizarre and challenging behavior much later in life. If this seems strange, consider how absurd it would be to suggest that caregivers are carefully documenting and reporting how they deprived a child of the food, comfort, diaper changes and other kinds of care the child needed as an infant or growing young person. These tragic events are usually documented after, not while, they occur (if ever). But at least scientists can get familiar with how early learning affects later learning, and behavior later in life. This helps us to make sense of otherwise bizarre behaviors, provide important contextual information to caregivers and decision makers, and even to inform our preventative treatment of behaviors that don’t seem related to the ongoing situation.

Behavior analysts or psychologists might relate this to how early learning conditions affect subsequent learning, or how the variables present during early learning exerts effects on behavior, after that situation is no longer present. This discussion is to provide some examples of literature that might be useful for behavior analysts interesting in exploring this topic.

In my work with children and adults after traumatic experiences before and during foster care (or other traumatic events including long duration life threatening illnesses or aversive experiences), I have been collecting data on the types of behaviors that “show up in the behavior stream and repertoire” of children who were exposed earlier – and in some cases much earlier- to situations of neglect and abuse. Continue reading →

Part 10 in Trauma-Informed Behavior Analysis: A behavior analyst walks into a hospital

29 Friday Sep 2017

Posted by in adults, Behavior Analysis, behavior cusp, Behavioral Cusp, collaboration, Community, data, hospital, trauma, Uncategorized

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This article is Part 10 in an ongoing series about ways that behavior analysts can practice in a “trauma-informed” way. Considering that behavior analysts need to be ready to participate with medical and other providers, this article shares some lessons learned about becoming involved with the medical team. Whether your client is going through trauma or not, it should be helpful. But it’s particularly important for my clients who are being treated in intensive settings for their mental and medical health (often resulting from years of trauma). Be well, Dr. Camille Kolu Ph.D., BCBA-D

One of the ways I like to learn from others is hearing their “lessons learned”. By listening to them share what they have learned and what did or didn’t work, I can hone my own role and be more prepared the next time I enter a similar setting. For many of us, the mental or medical hospital is a new frontier. What can we behavior analysts can do to help in this type of setting?

I think about my role this way: As a behavior analyst, I am not the person’s medical doctor. But we often need to collaborate- and yet most medical professionals are not extremely familiar with collaborating with us. What can I do to support our mutual clients, making their healers’ work more effective?

Here are some ideas that have helped me to integrate into these settings more effectively. In some cases they are lessons I learned when I failed to do something up front that could have made a marked difference later on. In all cases, we have an ethical imperative as behavior analysts to get a medical perspective (or to rule out medical concerns) when there might be a medical component to behaviors that are challenging… but most home and clinic based behavior analysts don’t typically work in the hospital settings.

Continue reading →

Part 9 in Trauma-Informed Behavior Analysis: On intervention for fetal alcohol exposure

18 Monday Sep 2017

Posted by in adults, Behavior Analysis, children, Early Intervention, Education, enriched environment, FAS, FASD, Fetal Alcohol Spectrum Disorders, risk assessment, self injurious behavior, Social Interaction, teaching ethics, trauma, Uncategorized

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Early intervention after an unfair start in life: Fetal exposure to alcohol

Those of us who work with people who have lived through adverse childhood experiences are familiar with the importance of individualizing treatment. We can do a lot of harm if we don’t consider what someone went through in life, or if we assume that one child’s preferences and needs are similar to those of another person.

Of course, this series about trauma has emphasized that it is the responsibility of ANY behavior analyst to individualize treatment, to consider the history of a client before moving forward with treatment, and to treat more than the “local” functions of behavior. Unfortunately, it is easy to miss the importance of this component of assessment and treatment, especially for new behavior analysts who have gained their “hours” working with highly similar clients, working without supervisors experienced in a diverse clientele, of without any supervisor or instructor who appreciates experimental as well as applied behavior analysis. One of the ways we find out more, is to go to the literature. This may be easier said than done, and an example of successfully data mining for this topic is provided toward the end of the article.

Today’s discussion involves clients who have been affected by what’s known as “Fetal alcohol syndrome”, or exposure to alcohol in the womb.

This is more than adverse childhood experience, for it goes back further in development, perhaps even as early as the neural tube (which will give rise to the spinal cord) and other important structures were being formed. This kind of exposure can affect an individual for their entire lifetime.

So we can consider it an adverse experience, although it happened even earlier than what we think of as “childhood”, and it has long lasting consequences, altering the way someone will learn and interact for the rest of their life.

Can we treat behavior after this condition? Continue reading →

Flooded with support when a steady stream is required

08 Friday Sep 2017

Posted by in adults, children, Community, flood, hurricane, resources, safety skills, Uncategorized

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From Oregon to Florida, and Texas to India, people face terrible disasters.

There is trauma born of unpredictable and uncontrollable loss, and unwanted dependency on others for homes or meals after floods or tornadoes or fires devastate their neighborhoods. These events force capable people to rely on others, living out of hospitals or shelters.

And more people, including friends, families and people you don’t know, will suffer medical tragedies and unexpected losses.

There are similarities between these experiences and those of a foster kid moving into her 5th home in as many months. There are similarities between the needs of her foster parent, and those of the natural disaster victims who received initial support and are forgotten, alone, and still in a shelter.

While we were still thinking about Harvey and cleaning up homes, another round of disasters struck all around the world. Today Mexico’s most powerful earthquake in a century was devastating. And it will keep happening, although in between there will be periods of silence.

At the end of this article you can download some resources including visuals for caregivers of people with special needs facing disasters. But first, thoughts about the strange, sustained, nonlinear nature of recovery after tragedy or life after disruption.

A few months ago I attended a series of permanency roundtables. (Permanency… this is something those in flood zones or fire-ripe mountains – or foster homes – might never have.)

These roundtables were events to listen to hundreds of family members attempting permanent adoptions with children who had tragic stories of abuse, neglect, and repeated failed placements.

At these meetings, I heard a repeated chorus:

“We need long-lasting, repeated support.”

“We are grateful for what we’ve been given and still we work hard every day and night with no rest.”

“Our adoption workers mean well and yet are often quick to remove the supports that were so helpful for the 6 weeks of “honeymoon” after the paperwork was finalized.”

“It’s been months (or years) and the struggles are still there.”

“The kids seem to be really impacted by what they went through, and it’s showing up in difficult educational challenges which are hard to address.”

“The behavior challenges are still just as dire.”

“The wounds to our adult family members who tried to restrain the child in the middle of a furious display of emotion and behavior (whether these “come out of the blue” or after he spotted his biological aunt in Wal-Mart) are still healing and there are more coming.”

“The police are getting tired of the calls and the hospital we reached out to for help has started to blame us.”

“We look more normal now. But we actually have less support than ever before- and we still need help.”

Today, as we watch another storm about to hit, I think of a story I read last week, in which former flood victims shared their thoughts on how to help others.

When we want to help someone who will need help long-term, it suggested, we embrace the regular pace of helping a little at a time.

We say what we are doing and ask if there’s anything else. We mention when we’ll be back and we put it on our calendars, or set a reminder on our phone. We come back soon.

This approach reminds us a little of the preventative schedule… of using repeated orienting statements and offers of help and kindness… on a regular schedule, even when someone looks like they don’t need it. We have written about how it can be helpful for adult and child survivors of sexual abuse and dementia, Alzheimers, and those in mental health facilities. It’s helpful in schools. But it’s also important, useful, and do-able—to provide small, regular doses of whatever is helpful, to victims of disasters, and to keep doing this for a while after the visible evidence goes away.

Maybe the hard part is not what to give. Sure, we can give money. And at first, cash is more helpful than supplies because transportation is expensive and slow. But people rebuilding their lives need someone to show up after the show is over.

It might be as simple as dropping off fast food, working a shift piling up ruined household items, bringing hot coffee, or washing clothes and bringing them back clean. The hard part is to keep doing it regularly as long as it is needed.

What if I ask and they don’t tell me how to help?

If you leave near someone affected, but you were not, maybe you are thinking of asking them if they need something.

When someone has been through something very hard, they don’t respond well to questions.

“What do you need?” may produce a blank stare (from new moms with colicky babies after long hospital stays, or foster children or parents who clearly need support but can’t request it, to disaster victims who could really benefit from someone dropping by.

So should we shrug when we get that blank stare? After all, we asked and they said no, right?

Again, sometimes the most supportive thing to do is say how you’re addressing a need and when you’ll be back. “Hello. I’m here with food and next week I’ll be back with diapers. Let me know if there’s anything else you need.”

After the storm is gone but evidence is still there underneath brave faces, people won’t need a flood of support. Instead, try contributing in a steady stream… or even a slow trickle.

Resources and links

Boardmaker downloads for hurricanes and emergencies, including core words

http://boardmakeronline.com/hurricaneharvey

Social stories about hurricanes and tragedies

http://fhautism.com/hurricane-harvey-helpful-social-stories-for-children-and-people-with-autism-and-special-needs-by-carol-gray.html

Emergency preparedness for special needs, and Florida resources:

http://www.coj.net/departments/parks-and-recreation/disabled-services/resources/emergency-preparedness-for-special-needs

Oregon fire victims

https://www.bizjournals.com/portland/news/2017/09/07/how-oregons-businesses-are-helping-fire-and.html

Examples of special needs groups helping each other after Harvey

https://www.facebook.com/HarveySNH/?ref=br_rs

http://www.littlelobbyists.org/harvey/

https://www.facebook.com/Hurricane-Harvey-Autism-Relief-Group-832143870293854/

Do trials always make us stronger?

18 Friday Aug 2017

Posted by in adults, Behavior Analysis, Community, dementia, resources, teaching behavior analysis, teaching ethics, trauma, Uncategorized

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Sometimes I write of success; of hope; of happy endings.

These are notable in part because so much of the time, the families with whom I collaborate are those whose children probably won’t learn to talk or bathe themselves, or whose middle aged children might die in the mental hospital, or whose children might never overcome their meth addiction—or women who, like me, wonder if their infertility might be lifelong.

And by itself, merely “facing a challenge” doesn’t do anything.

In a cruel twist, those facing stressful and often life-long battles also encounter the most unhelpful and banal clichés that range from “not comforting” to insulting or humiliating. They often come from well-meaning people who haven’t walked a mile in the moccasins of those they are trying to help. I’m sure I’ve been guilty of this and that we all will be again.

But who cares about words. The interaction between a speaker and listener, and the actions of people, matter much more. It’s not what I say in a challenge that matters, compared to what I do. I’m reminded of Ogden Lindsley’s quip that “if a dead man can do it, it ain’t behavior”: I guess a dead person can face a problem. But can he solve it?

Maybe I don’t get stronger merely by facing challenges.

In fact, perhaps I become softer, more tender.

I cry more easily.

I empathize more, and longer, with the parents who struggled for 15 years to have a child often to learn that their expensive and long-prayed-for baby has life-threatening and life-long diagnoses.

If I’m not stronger, at least I’m listening more.

And I notice something else a dead person can’t do:

Whatever skills I practice become more fluent.

I listen and get better at listening.

I empathize and gain fluency at showing empathy.

I help, and gain skills in doing helpful things.

I care, and continue to care.

And I share and feel uncomfortable, and become more comfortable at being uncomfortable.

(Sorry, behavior analysts, I’m not sure if that last one was an actual “behavior”. Similarly, I’m sure a dead man could do this one too, but it took me lots of practice to finally become quite skilled at staying calm while having my blood drawn. I would like to stop practicing now, I’m fluent, thank you very much.)

Many parents of my clients with low functioning autism, or the grandparent clients who are raising their great-grandchildren while multiple generations in between are in jail or recovery, tell me that they are tired of being called heroes. That they are simply doing the best they can, all the time, like you or me.

That often they still wish they could do more or do it better.

As I help clients – such as those whose loved ones have dementia – I discover more and more that our trials are universal, although many of them seem so foreign to young people (and to inexperienced behavior analysts in the helping profession).  Lately I have been developing tools that seem so simple, yet also seem helpful to so many different clients, like this Resource_Orienting statement tool for a loved one who is distressed and disoriented.

Whatever tools we use, what matters seems to be to keep going—and to keep holding someone’s hand when it matters.  Granny and PaPa walking.jpg

Trauma-informed behavior analysis, Part 4: On terms (Is “trauma” behavioral?)

08 Tuesday Aug 2017

Posted by in adults, Behavior Analysis, children, Early Intervention, ethics, supervision, teaching behavior analysis, teaching ethics, trauma, Uncategorized

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This article is the fourth installment in a series on trauma-informed behavior analysis, by Dr. Teresa Camille Kolu, Ph.D., BCBA-D.

Is “trauma” a behavioral term?

“Trauma” is a buzzword lately. As several people recently noted on behavior analytic forums, it seems as though schools and other entities are requiring “trauma-informed care” from people tasked with providing behavioral interventions, yet it isn’t clear whether trauma actually presents as anything different than the reinforcement history, or a client’s past, that would be explored routinely in any old behavior assessment.

On a recent facebook post in a behavior analytic group, one person posted, “Trauma”, “trauma-informed”, etc, is [just] the new buzzword to get grant funding and sell product”. Another poster chimed in, “Trauma? What’s the behaviors [sic] of concern? What’s the function?” This seems to imply that if we know the current function of behavior, what more do we need to know? It suggests that the resulting treatment path is likely to be no different than that for a “typically developing child” of the same age and an apparently similar behavioral repertoire.

The implication in the social media posts above seems to be, “what’s the big deal?” In other words, trauma is thought of as some in the behavior analysis community as simply another sexy concept that is meant to sell and sound good, rather than being something critical to appreciate (and to suggest differential treatment based on its presence or absence).

As a behavior analyst who has treated children and adults exposed to serious and adverse childhood experiences, I have come to appreciate that the current function is NOT the only important thing to know before treating someone’s challenging behavior patterns, or helping an adoptive parent cope with challenges a mental health therapist might call “reactive attachment”.

So what’s a BCBA to do? Continue reading →

What does hope sound like?

07 Monday Aug 2017

Posted by in adults, Autism, Behavior Analysis, Early Intervention, Uncategorized

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What does hope look like?

The behavioral doctor sat between house calls in her car with amazed tears streaming down her face.

Was this viral story true?bird.jpg

Intuitively, she knew that it must be, for she instantly recognized the chubby little face she saw on the screen. She suddenly recalled the clear little voice asking for “music!”, and a couple of weeks later, “music, please!”. She remembered when his list of words included about five. She recalled singing songs (“Way up in the sky, the little birds fly….”) to a toddler who had needed early intervention desperately.

But the story she read on facebook was also hard to believe, because this young man wrote so confidently and was about to graduate. He also sang so beautifully, as links posted by his mother—and his scholarships to prestigious programs—confirmed. It had been at least 15 years since she saw the toddler’s face, or said “do this” and prompted him to carefully stack one block on top of the other, painstakingly teaching play skills that other children seemed to learn so naturally. At the time she had worked for an early intervention program, providing or supervising up to 7 hours per day of behavior therapy to children whose tantrums often overwhelmed and injured their parents, teachers and skilled therapists—but communicated their wants and needs before they had words. And at the time, she did not know that behavior analysis would become her fulfilling career and that she would go on to study neuroscience and learn how the brain really does change with the hundreds and in some cases, thousands of hours of careful social input that certified behavior analysts are trained to provide.

But this was definitely the same little guy, except he was all grown up. Continue reading →

Trauma-Informed Behavior Analysis, Part 3: Is It Ethical For Behavior Analysts to Treat “Trauma”?

05 Saturday Aug 2017

Posted by in adults, Behavior Analysis, behavior cusp, Behavioral Cusp, Community, Education, ethics, risk assessment, supervision, teaching behavior analysis, teaching ethics, trauma, Uncategorized

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This is Part 3 in a series of how behavior analysts approach “trauma”, by Teresa Camille Kolu, Ph.D., BCBA-D.

Is It Ethical For Behavior Analysts to Treat “Trauma”?

Meaningful answers often depend on asking an appropriate question.

Since this “yes-or-no” question is not the least bit appropriate for many of us to answer “yes” to without more information, let’s start by refining our question.

Under what conditions would it be appropriate for a behavior analyst to treat someone whose behaviors relate to their adverse childhood experiences?

The question above is one way of asking the question, and your team might think of others. It also may help to check out Tuesday’s upcoming article on Behavioral Terminology Related to “Trauma”.

I’ve certainly seen some inappropriate, well-meaning, and harmful treatment of behavior when the children and people involved have been through adverse childhood (or other) experiences.

Part of my concern is that young behavior analysts may have come from a program that did not cover adequately the experimental basis of our field, including schedule effects or concepts like the molecular or molar view of behavior.

I think young behavior analysts who are smart and curious can get these things; they need to have better exposure in their classes (and online course sequences toward certification paths aren’t likely to bring this exposure) or groups (so ask your friendly local or skype article CEU club if you’d like to read an article like this one on the paradigm shift from the molecular to molar view in behavior analysis). This is why a supportive verbal community of reinforcement is so critical for developing behavior analysts (more on that later elsewhere on this site).

(Not sure how to look up pdf’s of articles? An easy way is to first look at the online journal list (for example, for JABA or JEAB) and first enter your search terms, then when you find the article, go to the journal’s archive and click on the issue where the article was published, and download the pdf. This works for all archived JABA and archived JEAB issues through 2012.)

That was fun; let’s get back to the scary stuff: inappropriate, well-meaning, and harmful treatment of behavior.

Sometimes an inexperienced behavior analyst treats only the “local function”, such as treating a behavior in your classroom that seems like it’s related to attention with pure extinction (e.g., without conducting a complete and appropriate functional assessment). This might seem appropriate without more information, but in clients with “trauma backgrounds” or exposure to serious past (or hidden and ongoing) childhood adverse experiences (such as disruptions in primary caregiving and exposure to abuse and neglect), this course of treatment may lead to further harmful escalation, or serious risks and side effects. There are other possibly more appropriate options such as differential reinforcement without extinction, or the preventative schedule approach I mentioned in a previous article. At the least we need to base decisions on better information.

In a classroom where I observed a child who had been through a series of terrible and neglectful situations, when his behavior was placed on attention extinction, he virtually lost all advocacy skills (e.g., stopped manding for help or showing his distress), was being abused by others and never reported it, and started hiding his self-injury which became more and more severe. These were some of the risks involved of using a procedure without evaluating the possible side effects given the child’s repertoire and the reinforcement available for his appropriate skills, and without collaborating with others who had access to the child’s history and current home situation (Compliance Code 2.03b).

The teacher was using the procedure recommended by a behavior analyst, but the BCBA did not know about the child’s history or home life (and did not ask). As I’ve said before, I am NOT asking anyone to stop a function-based approach!- but to demand the information you need to understand the larger context for behavior.

So what’s a behavior analyst to do?

I typically try to think first of ethics (asking, “should I be doing this?”) before diving into strategies (“what should I be doing?”). Here are some ethical considerations:

  1. Is this in my boundary of competence and based on my education, training, and supervised experience?

See Compliance Code 1.02a). If not, it’s a good idea to first seek continuing study, training, supervision and consultation (see Compliance Code 1.02b). I think the skill of reaching out to obtain supervision and mentorship when appropriate (e.g., accepting clients appropriately) may be an important behavior cusp critical to the future repertoires of behavior analysts trying to practice ethically.

  1. I think of ethical behavior analysis as practicing within my boundaries, yet at the same time as growing my boundaries of competence so that next year I will have expanded them and will be able to take a client I said no to this year.

Dr. LeBlanc and colleagues have an article on expanding the consumer base for behavior analytic services that is available for a CEU.

  1. Consider ethics and your own experience and resources carefully, before you begin treating trauma or accepting any kind of trauma-related client.

See 1 and 2 above, and remember not to give advice that stands in for services (e.g., 1.05a). Our responsibility is always to do no harm, and at times the side effects of inappropriate treatment may be riskier than doing nothing (2.09c). It is important to develop a relationship with a mentor who has been there and can assist you to apply new information to an exquisitely sensitive set of problems and clients. If not, arrange for appropriate consultation and referrals (2.03).

  1. All this goes for supervisors too:

Just like we should be careful before we accept a client for treatment, we accept a supervisee who is treating in a sensitive area only after considering our own defined area of competence (5.01). How will we communicate about and report risks (7.02) if we are not experienced enough to recognize and communicate about the risks of our own treatment (2.09)? Agencies may be under particular pressure to accept clients when there is funding, but there are serious risks of doing this too early or without appropriate in-house supervision.

  1. Be prepared for extensive collaboration:

I’ve talked to supervisors who have taken on trauma cases without completing assessments of risks and side effects (2.09c) or collaborating with other therapists the child is concurrently seeing, and this means they are already in danger of not being able to review and appraise effects of other treatments that might impact the goals of the program (2.09d).

Why do you need mentorship, education and experience under supervision first?

This is partly because after you accept a client (e.g., 2.01) whose service needs are consistent with your education and training, experience, resources and policies, your responsibilities are to everyone effected by your behavior analytic services. For example, once I started treating clients affected by trauma, I also found myself treating foster families’ other children to deal with the abuse the affected child talked about, the primary caregiver who used to be on drugs and was trying to demonstrate she could follow a plan and get her children back, and the social workers and other team members who didn’t understand schedule effects and were making placement decisions without data on behavior.

In an upcoming article we discuss some treatment approaches and how we can improve our supervision of BCBA’s treating these serious concerns. But first, next Tuesday covers some behavioral ways of talking about “trauma”. Stay tuned!

And as ever, this information is not a substitute for mentorship or supervision. This is intended for use in supporting behavior analysts to reach out to their own networks and supervisors and mentors, growing their boundaries of competence in an ethical and responsible way.

May we all keep expanding our repertoires.

 

Ethical Friday presents: The power of a Worst Case Scenario

04 Friday Aug 2017

Posted by in adults, Behavior Analysis, Community, ethics, job aids, risk assessment, safety skills, supervision, teaching behavior analysis, teaching ethics, Uncategorized

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Picture the worst that could happen.

Can you even imagine it?

And if you’re a seasoned therapist or behavior analyst, how do you communicate about this with your students and supervisees, who almost certainly can’t really go there?

If you’re like many of us, you don’t know what you don’t know. Suppose a client wants to gift your staff a gourmet coffee gift card, or a mother wants to step out quickly to get her dry cleaning. “It’s a five minute drive, I’ll just be a second”, she calls, as you work with her child in an upstairs therapy room. “No problem”, you start to call… but your ethics bone starts to tingle. Surely you’re over-reacting. What, if  anything, could go wrong?

When the worst case scenario relates to our vulnerable clients affected by trauma, the consequences may be even more dire– and yet, those who haven’t faced the possibilities may not recognize the dangers.

Should I accept this client in foster care with severe challenging behavior and a history of abuse although I have never treated similar cases? Should my agency supervise our new BCBA to take on a new trauma case (we have funding, after all) when we haven’t experienced this situation?Danger sign

For those of us tasked with supervising and teaching others, or working with families, we can help students, supervisors or parents picture the worst case scenarios so they can better prepare for, predict, and prevent dangerous outcomes. The Compliance code helps give guidance and rules that we follow, but for those of us who have NOT encountered situations that make us keenly aware of the reasons for these, some of the code items may seem “nit-picky” or unreasonable, and may be disregarded in a dangerous way.

To support our own cases and our supervisees where it counts, we must have a wealth of experience, stellar training that exposed us to a variety of worst case outcomes and possibilities and some solutions, or a great imagination- and a few good teaching and documentation tools.

I get a new wake up call every semester I teach ethics students about the origins of Behavior Analysis’ Ethics Code, which was spurred in part by atrocious, life changing and widespread abuses by those doing “behavior modification” in recent decades.

When I ask “what do you think? Could those things ever happen here?”, Continue reading →