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Category Archives: adults

Trauma-informed behavior analysis, Part 2: Arranging a supportive behavioral environment

03 Thursday Aug 2017

Posted by kolubcbad in adults, Behavior Analysis, Behavioral Cusp, enriched environment, ethics, supervision, teaching behavior analysis, teaching ethics, trauma, Uncategorized

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(Continued from Part 1 of Trauma-informed behavior analysis series by Dr. Teresa Camille Kolu, Ph.D., BCBA-D)

pencil_three years old (2)

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. Continue reading →

Resource Wednesday: How do you document risks?

02 Wednesday Aug 2017

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

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Many behavior analysis supervisees, students, and even young Board Certified Behavior Analysts (BCBA’s) have not yet obtained proficiency communicating with their clients and agencies about risk assessments, and may even lack the experience or training to use or document them in their own practice. Yet, a risk assessment is required by our Compliance Code (for example, see related items 2.09 c and d, or items 4.06-4.07), and the need for this skill is evident in the Task List (see C-01, C-02, and C-03).

As a consultant and an instructor for a university’s course sequence toward certification in Behavior Analysis, I use the Bailey and Burch text on ethics as a resource both for my students and for my practice. Several editions of this text mention and describe a Risk Assessment Tool which is not only necessary and required, but can also be a powerful decision making tool for teams, supervisors, agencies, and even families. When services are discontinued after barriers to service have been repeatedly encountered, supervisors and the court systems value evidence that the behavior analyst documented and discussed the risks and barriers with a family or team. Also, lives might be saved by considering the short and long-term risks before moving forward with an intervention that is at best, inappropriate, and at worst, dangerous. Risk assessments can facilitate otherwise difficult conversations about risks (or benefits) to a client, family, team, agency, system, or even a consultant’s reputation and credentials.

So what tools do YOU use, and what are those used by your team? Kolu and Winn (2017) presented tools for our work, based on something developed in our consulting practices. First a Risk versus benefit flowchart helps walk a supervisor, team, agency or family through a sequence of questions. Then the Risk Assessment Tool helps keep track of the answers, and can be used to facilitate a discussion with families and teams. When making a tough decision, it helps to ask about the short- and long-term risks of doing “the current option” or doing “something else”, and weigh these against the potential benefits. Should my family pull our child out of a school where he is not really benefiting from education but has immense social interaction opportunities? Should I stay with this employer billing in a confusing and possibly unethical way, or start my own practice? What should I consider when approached by a long-distance supervision client whose client caseload doesn’t really match my skillset?

And as the Compliance Code makes clear, we should be continuously asking, what is the best treatment recommendation, given the possible options, the current environment, resources, and the risks and benefits?

With these questions and more, a risk versus benefit assessment can be extremely informative, helpful, and may even be required. Know the requirements, and then assess, document and communicate about the risks. It might just save your credibility one day when you are called to testify. (We all think it won’t happen to us, until it happens to us.)

Need a tool to document your risk versus benefit results? Download this Risk Assessment Tool and let us know your suggestions or what kinds of decisions you use it for.

Email us if you’d like a word version of the form that you can use to fill in with your team or agency. And if you’d like to share, let us know what YOU use to document risks.

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Self Injury in the General Population: Will I hurt myself today?

01 Tuesday Aug 2017

Posted by kolubcbad in adults, Behavior Analysis, Community, enriched environment, functional alternative behavior, self injurious behavior, trauma, Uncategorized

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Will I hurt myself today… Or do something (F.A.B.) instead?

Time for a Trauma Tuesday post. But this one is not what you think.

By this time, most people have heard the notion that those who have been hurt may be more at risk to hurt others.

In my work with clients who have been through childhood abuse, mistreatment and neglect, I often see the tragic pattern they try to stop, often failing because of a lack of resources, or knowledge about what to do differently.

And on our caseloads with clients with autism or developmental disabilities, we frequently treat another kind of pain, the kind that a person produces for themselves and often related to the challenging environments in which our clients live, or a lack of skill in expressing one’s needs. In our field, hurting oneself is known as “self-injury” or SIB (self-injurious behavior).

However, this post is not about treating SIB in our clients, although there are many resources for doing this, and your friendly local behavior analyst can do a functional behavior assessment to determine where to start, before making an individualized plan.

This post is about something else that is common, yet hidden.

Recently in a women’s empowerment group for supposedly “neurotypical” people, a behavior analyst was stunned when 75 percent of hands went up as the question was asked, “how many of us have actually hurt ourselves, or do this on a regular basis?”

Today, my question for us is, what about the pain all around us? What about self injury in the general population? Continue reading →

Trauma-informed behavior analysis

31 Monday Jul 2017

Posted by kolubcbad in adults, Behavior Analysis, trauma, Uncategorized

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Part 1: Trauma-informed Behavior Analysis: Beyond the immediate “function”chalk_child playing (2)

(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? Continue reading →

New blog series: Treating trauma from a behavior analytic perspective

28 Friday Jul 2017

Posted by kolubcbad in adults, Education, ethics, trauma, Uncategorized

≈ 1 Comment

A new series on trauma and behavior analysis  

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

chalk_teddy (2)Behavior analysts are tasked with doing no harm. Like other professionals who adhere to a rigorous code of ethics, they are responsible for working only in their defined areas of competence, while seeking supervision and training in other areas as appropriate if needed to grow their expertise.

A new training is available from Dr. Kolu on the ethical and behavioral treatment of cases related to “trauma” (e.g., adverse childhood experiences or variables related to early disrupted caregiving). See some of the learning objectives below, check out our related blog series, and contact us today if we can support your team.

SAFE-T model Continue reading →

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